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Cardiac

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What is the most common type of ASD? What %?
Mitral valve prolapse
Ostium secundum (90%)
Friction rub and chest pain
Decreased forward perfusion pulmonary congestion

2. What are the clinical features of RHF due to?
Pancarditis
Systemic venous congestion
Myocarditis
Volume overload and LHF

3. What structures are susceptible to rupture post MI?
Inability to fill ventricles
Papillary muscle - free wall - IV septum
PDA
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

4. What type of shunt results in cyanosis at birth?
RCA
Right to left
Ostium secundum (90%)
S viridans

5. What heart sound manifest with an ASD?
Right to left
Dressler syndrome
Migratory polyarthritis
Split S2 on auscultation

6. What iis the tx for aortic regurg?
Mitral regurg
Metastasis
LAD
Valve replacement once LV dysfx develops

7. When does the heart have a yellow pallor post MI?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Increased blood in right heart delays closure of P valve
Day 1-7
Reversible

8. Which congenital heart defect is associated with congenital rubella?
Rhabdomyoma
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
PDA

9. What are the sx of PDA at birth?
Right to left
Asymptomatic
Reactive histiocyte with caterpillar nucleus
Heart transplant

10. When is an MI pt at greatest risk for cardiogenic shock?
Myofiber hypertrophy with disarray
First 4 hours
LA
Membrane damage

11. What does granulation tissue contain?
Myxoid degeneration
Plump fibroblasts - collagen - blood vessels
Circumflex
Coronary artery vasospasm

12. How do you prevent S viridans endocarditis?
Mitral mitral+aortic
Months out fibrosis
Migratory polyarthritis
Prophylactic abx during dental procedures

13. What always follows necrosis?
Dressler syndrome
Acute inflammation
Ventricles cannot pump
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

14. Is scar tissue or myocardium stronger?
Stable and unstable prinzmetal
Papillary muscle - free wall - IV septum
Infantile coarctation of the aorta PDA
Myocardium

15. What is the tx for LHF?
Opening snap followed by diastolic rumble
AD mutation in sarcomere proteins
ACE inhibitor
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

16. What maintains patency of the PDA?
PGE
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Opening snap followed by diastolic rumble
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

17. What is the rate of congenital heart defects?
Valve replacement AFTER the onset of complications
Months out fibrosis
1%
LAD

18. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Indomethacin - decreases PGE
PDA
Coexisting mitral stenosis and fusion of commisures exist
Valve scarring that arises as a consequence of rheumatic fever

19. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Adult coarctation of the aorta
Membrane damage
4-6 hours - 24 hours - 72 hours

20. What causes an early - blowing diastolic murmur?
Aortic regurg
Degree of pulmonary artery stenosis
S aureus
Gelatinous - abundant ground substance

21. What gross and microscopic changes occur months after an MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
White scar fibrosis
Granulation tissue
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

22. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Bounding pulse
Nitroglycerin
Tetralogy of fallot
Reversible

23. What increases the risk for chronic rheumatic heart disease?
4-24 hours
Thickening of chrodae tendinae and cusps - mitral stenosis
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Sterile vegetations on mitral valve along lines of closure

24. What causes acute endocarditis?
Large vegetations of S aureus
Systolic ejection click followed by crescendo - decrescendo murmur
Loeffler syndrome
Pancarditis

25. What is the tx for aortic stenosis?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Plump fibroblasts - collagen - blood vessels
Valve replacement AFTER the onset of complications
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

26. Erythematous nontender lesions on palms and soles.
Janeway lesions
Transposition of the great vessels
Inability to maintain systemic pressure w/lack of O2 to vital organs
Asymptomatic

27. What causes the split S2 in ASD?
Shunt - PGE to maintain PDA until surgical repair can be performed
Hypercoagulable state or underlying adenocarcinoma
Increased blood in right heart delays closure of P valve
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

28. Pericarditis 6-8 wks post MI.
Left -->right
Endocardial fibroelastosis (rare)
Group A beta - hemolytic streptococci
Dressler syndrome

29. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Endocardial fibroelastosis

30. What is the characteristic murmur of aortic stenosis?
ST- segment elevation
Infectious endocarditis
Systolic ejection click followed by crescendo - decrescendo murmur
Type I

31. What imaging test is useful for detecting lesions on valves?
Chest pain <20 min brought on by exertion or emotional stress
Small - nondestructive vegetations (subacute endocarditis)
Transesophageal echo
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

32. What congenital heart defect often is present with infantile coarctation of the aorta?
S epidermidis
Large vegetations of S aureus
PDA
LA dilation

33. What tests show prior group A beta - hemolytic strep infection?
Colon cancer
Blood vessels coming in from normal tissue
Elevated ASO anti - DNase B titers
Nitroglycerin

34. What causes unstable angina?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Months out fibrosis
PDA
Rhabdomyoma

35. Is injury due angina reversible or irreversible?
Mitral regurg
Cardiac tamponade
Opening snap followed by diastolic rumble
Reversible

36. What effect does mitral stenosis have on the heart chambers?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Hemosiderin laden macrophages
Tuberous sclerosis
LA dilation

37. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
Shunt
ST- segment depression
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

38. Why would cardiac enzymes continue to increase after the initial MI?
Reperfusion injury
First 4 hours
PDA
Atherosclerosis of coronary arteries

39. What coronary arterysupplies the lateral wall of the LV?
Circumflex
Nitroglycerin
Sterile vegetations on surface and undersurface on mitral valve
>60 years - bicuspid aortic valve

40. What are the complications of mitral valve prolapse? Are they common?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Friction rub and chest pain
Infectious endocarditis - arrythmias - severe mitral regurg no
Myocarditis

41. When do neutrophils infiltrate the myocardium post MI?
Wear and tear
Dilation of all four chambers of the heart
1-3 days
Ischemic heart disease

42. When do CK- MB levels rise - peak - and return to normal?
Streptococcus bovis/
4-6 hours - 24 hours - 72 hours
Left to right shunt causes increased flow thru pulm circulation which results in hypertrophy of pulm vessels and pulm htn - increased pulm resistance results in reveral of shunt
IV drug users

43. EKG for stable angina?
Yellow pallor neutrophils
ST- segment depression
Small vegetations along the line of closure
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

44. What is the JOneS mneumonic?
Major criteria of Jones criteria for acute rheumatic fever J: joint (migratory polyarthritis) O: heart (pancarditis) N: nodules (subcutaneous nodules) E: erythema marginatum S: Sydenham chorea
Mid - systolic click followed by regurgitation murmur
Ventricular arrhythmia
Stretched muscle loses contractility

45. What causes endocarditis of prosthetic valves?
Dark discoloration coagulative necrosis
S epidermidis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Membrane damage

46. What does rupture of the LV free wall cause?
Valve replacement once LV dysfx develops
Thickening of chrodae tendinae and cusps - mitral stenosis
Backward LHF pulm htn and RHF - afib and associated mural thombis
Cardiac tamponade

47. What is systolic dysfx?
Months out fibrosis
Ventricles cannot pump
Hypercoagulable state or underlying adenocarcinoma
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

48. What bug causes acute rheumatic fever?
Group A beta - hemolytic streptococci
Endocardial fibroelastosis
Asymptomatic
Bicuspid aortic valve

49. What is the definition of ischemia?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Decrease in blood flow to an organ
Squat in response to cyanotic spell
Eisenmenger syndrome

50. What generally causes ischemic heart disease?
Rupture of free wall - IV septum - or papillary muscle
Atherosclerosis of coronary arteries
Preductal - post aortic arch
Restrictive cardiomyopathy