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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. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
Metastasis
Reperfusion injury
ST- segment depression

2. Pericarditis 6-8 wks post MI.
Acute inflammation
ASD - R-->L
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Dressler syndrome

3. What effect does chronic rheumatic heart disease have on the aortic valve?

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4. What % of MIs involve the LAD?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
45%
4-24 hours
2-4 hours - 24 hours - 7-10 days

5. What does rupture of the IV septum cause?
S aureus
Shunt
CK- MB
Heart can't fill

6. What type of shunt dose PDA cause?
Subendocardial
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Left -->right
Minimizes ischemia

7. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
RBC damaged while crossing the calcified valve causing schistocytes
Colon cancer
Mitral regurg
Mitral regurg

8. What complications occur 4-7 days post MI?
Thickening of chrodae tendinae and cusps - mitral stenosis
Backward LHF pulm htn and RHF - afib and associated mural thombis
Mitral regurg
Rupture of free wall - IV septum - or papillary muscle

9. What are the sx of cardiac myxoma?
Mid - systolic click followed by regurgitation murmur
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Nonspecific - eg fever and elevated ESR
Aneurysm - mural thrombus - Dressler syndrome

10. What type of shunt does transposition of the great vessels cause?
Loss of fx
R-->L
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Inability to maintain systemic pressure w/lack of O2 to vital organs

11. What is the most common cause of myocarditis?
Coxsackie A or B
Valve replacement
Infectious endocarditis - arrythmias - severe mitral regurg no
Circumflex

12. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Stable angina
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Loeffler syndrome

13. What two things cause coronary artery vasospasm?
S aureus
Tender lesions on fingers or toes.
Prinzmetal angina - cocaine
Type I

14. What is an Aschoff body?
Pancarditis
Regurg vs stenosis
Thickening of chrodae tendinae and cusps - mitral stenosis
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

15. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Mitral regurg
Loss of LV fx
4-7 days

16. What are the complications of mitral valve prolapse? Are they common?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Bicuspid aortic valve
Infectious endocarditis - arrythmias - severe mitral regurg no
Ventricle

17. What is an Anitschow cell?
Backward: dyspnea - PND - orthopnea - crackles (pulmonary congestion and edema) - heart failure cells forward: fluid retention due to decreased flow to kidneys leading to activation of RAA
Reactive histiocyte with caterpillar nucleus
Friction rub and chest pain
Systolic dysfx leading to biventricular CHF

18. What always follows necrosis?
Mitral regurg
Acute inflammation
Degree of pulmonary artery stenosis
Hypertrophic cardiomyopathy

19. What causes heart failure cells?
Mitral insufficiency
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
20 min
PDA

20. What gross and microscopic changes occur 1-3 weeks after an MI?
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
Yellow pallor macrophages
Red border granulation tissue
Months out fibrosis

21. Holosystolic blowing murmur that increases w/expiration?
4-24 hours
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Stretched muscle loses contractility
Mitral regurg

22. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Nitroglycerin
Harmartoma
Myocardium
LA

23. How does asprin/heparin tx MI?
LAD
Limits thrombosis
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

24. What is the major cause of MI?
LA
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Tetralogy of fallot
Infectious

25. What are Osler nodes?
When a bacterial protein resembles a protein in human tissue
Congestive heart failure
Degree of pulmonary artery stenosis
Tender lesions on fingers or toes.

26. What congenital heart defect often is present with infantile coarctation of the aorta?
PDA
White scar fibrosis
VSD
Endocarditis of prosthetic valves

27. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
2-4 hours - 24 hours - 7-10 days
Pulsating nail bed
Migratory polyarthritis
Pancarditis

28. When do troponin levels rise - peak - and return to normal?
Trisomy 21
2-4 hours - 24 hours - 7-10 days
Valve replacement
Aschoff bodies

29. What causes the split S2 in ASD?
1%
Small - nondestructive vegetations (subacute endocarditis)
Right side - serotonin and other secretory products detoxified in the lung
Increased blood in right heart delays closure of P valve

30. What effect does dilated cardiomyopathy have on the heart?
Large - destructive vegetations
Systolic dysfx leading to biventricular CHF
Infectious endocarditis
Concentric LV hypertophy

31. What is a common complication of cardiac metastasis?
Pericardial effusion due to pericardial involvement
Volume overload and LHF
First 4 hours
Small vegetations along the line of closure

32. What heart sound manifest with an ASD?
SLE
Infectious endocarditis
VSD
Split S2 on auscultation

33. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
Reactive histiocyte with caterpillar nucleus
S aureus
Systemic venous congestion

34. What areas of the heart does the LAD supply?
Anterior wall of LV and anterior septum
Granulation tissue
Yellow pallor neutrophils
Heart can't fill

35. What is the cause of the red border around granulation tissue?
Mitral and tricuspid regurg - arrhythmia
Bicuspid aortic valve
Congenital rubella
Blood vessels coming in from normal tissue

36. What does rupture of the LV free wall cause?
4-7 days
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Surgical closure small defects may close spontaneously
Cardiac tamponade

37. What maintains patency of the PDA?
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
Anitschow cell
Infantile coarctation of the aorta
PGE

38. What coronary artery supplies the mitral valve papillary muscles?
Migratory polyarthritis
Right side - serotonin and other secretory products detoxified in the lung
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
RCA

39. What genetic conditions predispose a pt to mitral valve prolapse?
Fibrosis and dystrophic calcification
PDA
Subendocardial
Ehlers - Danlow and Marfan syndrome

40. What is a water - hammer pulse?
20 min
Chronic rheumatic heart disease
Bounding pulse
Turner syndrome

41. What congenital heart defect is associated with fetal alcohol syndrome?
Mid - systolic click followed by regurgitation murmur
VSD
>70%
Squat in response to cyanotic spell

42. What complications occur within 4 hrs post MI?
Congenital rubella
Cardiogenic shock - CHF - arrhythmia
Nitroglycerin
Ventricular arrhythmia

43. What is the gross and microscopic appearance of cardiac myxomas?
Gelatinous - abundant ground substance
Stable and unstable prinzmetal
Rhabdomyoma
Libman - Sacks endocarditis

44. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
Myocarditis in acute rheumatic heart fever
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Metastasis

45. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Bacterial endocarditis
Breast and lung carcinoma - melanoma - lymphoma

46. Erythematous nontender lesions on palms and soles.
Reactive histiocyte with caterpillar nucleus
Rhadbomyoma - benign
Janeway lesions
Annular - non pruritic rash w/erythematous borders trunks and limbs

47. What is the most common cause of mitral stenosis?
Thickening of chrodae tendinae and cusps - mitral stenosis
Chronic rheumatic heart disease
Tetralogy of fallot
Cyanosis - RV hypertrophy - polycythemia - clubbing

48. What are heart failure cells?
White scar fibrosis
Hemosiderin laden macrophages
Coxsackie A or B
Concentric LV hypertophy

49. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Myocarditis
PDA
4-6 hours - 24 hours - 72 hours
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

50. What disesase has Aschoff bodies?
Maternal diabetes
Nitroglycerin
Myocarditis in acute rheumatic heart fever
PDA