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Cardiac

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. Low voltage EKG w/diminished QRS amplitude.
S epidermidis
Pulsating nail bed
Split S2 on auscultation
Restrictive cardiomyopathy

2. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
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
Myocardium
Autoimmune pericarditis 6-8 wks post MI
LHF

3. How does restrictive cardiomyopathy present?
Ventricle
LAD
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation
Congestive heart failure

4. What bug causes acute rheumatic fever?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Transposition of the great vessels
ST- segment elevation
Group A beta - hemolytic streptococci

5. What type of shunt does transposition of the great vessels cause?
Valve replacement
Migratory polyarthritis
Myocarditis
R-->L

6. Infects predamaged valves after transient bacteremia?
Congested central veins
Decrease preload -->lowers myocardial stress
Nitroglycerin
S viridans

7. Which vasculitis can cause MI?
Valve replacement AFTER the onset of complications
Bacterial endocarditis
Kawasaki disease
Open blocked vessels

8. How does squating decrease hypoxemia in tetralogy of fallot?
Systolic dysfx leading to biventricular CHF
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Shunt
Dilated

9. What is the classic EKG finding of restrictive cardiomyopathy?
SLE
Dressler syndrome
Low voltage EKG w/diminished QRS amplitude
Systolic ejection click followed by crescendo - decrescendo murmur

10. Opening snap followed by diastolic rumble.
Mitral stenosis
Cardiogenic shock - CHF - arrhythmia
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Within the first day

11. What drug relieves stable angina?
Loss of fx
PDA
Nitroglycerin
Osler nodes (ouch - ouch Osler)

12. How long after pharyngitis does acute rheumatic fever occur?
Janeway lesions
Coronary artery vasospasm
Shunt
2-3 weeks

13. What is the gross and microscopic appearance of cardiac myxomas?
Gelatinous - abundant ground substance
2-4 hours - 24 hours - 7-10 days
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Kawasaki disease

14. What is the murmur of mitral regurg?
Fibrinous pericarditis
Hemosiderin laden macrophages
Migratory polyarthritis
Holosystolic blowing murmur

15. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
RCA
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Myocarditis

16. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Infectious
Anitschow cell
Heart can't fill
LAD

17. How does Eisenmeger syndrome occur?
Friction rub and chest pain
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
Coxsackie A or B
Ventricle

18. What is the most common cause of aortic stenosis?
Wear and tear
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Spontaneous
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

19. What are the sx/complications of myocarditis?
Stable and unstable prinzmetal
Anitschow cell
Myxoma - benign
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

20. What are complications of dilated cardiomyopathy?
Ischemic heart disease
Minimizes ischemia
Mitral and tricuspid regurg - arrhythmia
Cardiogenic shock - CHF - arrhythmia

21. What makes the MV prolapse murmur louder? Why?
Valve scarring that arises as a consequence of rheumatic fever
Myxoma - benign
Squatting - increased systemic resistence decreases LV emptying
Thickening of chrodae tendinae and cusps - mitral stenosis

22. What causes angina and syncope in aortic stenosis?

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23. What are the forward and backward sx of LHF?
S epidermidis
PDA
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
Months out fibrosis

24. Is scar tissue or myocardium stronger?
Myocardium
Prinzmetal angina
Streptococcus bovis/
Rhabdomyoma

25. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
ST- segment depression
Prinzmetal
Colon cancer

26. What are the tx for MI?
R-->L
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

27. In transposition of the great vessels - What is required for survival? How is this achieved?
Shunt - PGE to maintain PDA until surgical repair can be performed
Pancarditis
ST- segment elevation
Annular - non pruritic rash w/erythematous borders trunks and limbs

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

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29. What causes the nutmeg color in nutmeg liver?
Congested central veins
Heart can't fill
S aureus
Louder - increased systemic resistence decreases LV emptying

30. Sudden death in a young athlete.
Infantile coarctation of the aorta PDA
Hypertrophic cardiomyopathy
Myocarditis
Heart transplant

31. Poor myocardial fx due to chronic ischemic damage?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Boot shaped heart
Chronic ischemic heart disease
Slow HR - decreasing O2 demand and risk for arrhythmia

32. What cardiac enzyme is useful for detecting reinfarction?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
CK- MB
Concentric LV hypertophy
Shunt - PGE to maintain PDA until surgical repair can be performed

33. What is the definition of ischemia?
VSD
Increased hydrostatic pressure
Decrease in blood flow to an organ
Thickening of chrodae tendinae and cusps - mitral stenosis

34. Lower extremity cyanosis later in life - holostystolic machine like murmur.
PDA
S aureus
Streptococcus bovis/
4-7 days macrophage infiltration

35. Which coronary artery supplies the anterior wall and anterior septum?
4-24 hours
LAD
Asymptomatic
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

36. What typically causes hypertrophic cardiomyopathy?
4-6 hours - 24 hours - 72 hours
AD mutation in sarcomere proteins
Pump failure
Hemosiderin laden macrophages

37. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
Endocardial fibroelastosis (rare)
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Loeffler syndrome

38. What is Loeffler syndrome?
Turner syndrome
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Transposition of the great vessels
Open blocked vessels

39. What are the clinical features of LHF due to?
Surgical closure small defects may close spontaneously
Decreased forward perfusion pulmonary congestion
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Mitral regurgitation due to vegetations

40. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Asymptomatic
Regurg vs stenosis
R-->L
CHF

41. What are the sx of right - to - left shunt?
CHF
Cyanosis - RV hypertrophy - polycythemia - clubbing
Infectious
Type I

42. What is the most common tumor of the heart?
Metastasis
Bacterial endocarditis
IV drug users
ASD - R-->L

43. What heart sound manifest with an ASD?
LV dilation and eccentric hypertrophy
ASD - R-->L
Split S2 on auscultation
Hypertophy of RV atrophy of LV

44. What type of vegetations does Strep viridans cause?
Congestive heart failure
Small - nondestructive vegetations (subacute endocarditis)
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Decreased forward perfusion pulmonary congestion

45. What causes microangiopathic hemolytic anemia in aortic stenosis?
RBC damaged while crossing the calcified valve causing schistocytes
Fibrosis and dystrophic calcification
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Nitroglycerin

46. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Holosystolic blowing murmur
Mitral mitral+aortic
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Congenital rubella

47. How does restrictive cardiomyopathy cause LHF?

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48. What are the Jones criteria?
Prinzmetal
Low voltage EKG w/diminished QRS amplitude
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Shunt - PGE to maintain PDA until surgical repair can be performed

49. Boot - shaped heart on x- ray?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Reperfusion injury
1%
Tetralogy of fallot

50. What are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Ostium primum
Group A beta - hemolytic streptococci
Valve scarring that arises as a consequence of rheumatic fever