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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 etiology of S viridans endocarditis?
Sudden cardiac death
Membrane damage
Valve replacement once LV dysfx develops
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

2. What makes the MV prolapse murmur louder? Why?
Ostium secundum (90%)
Infantile coarctation of the aorta
Loeffler syndrome
Squatting - increased systemic resistence decreases LV emptying

3. What type of valvular vegetations does S aureus cause?
Large - destructive vegetations
Ventricle
Right to left
Myxoma - benign

4. What is the cause of restrictive cardiomyopathy in children?
Dressler syndrome
Myocarditis
Mitral stenosis
Endocardial fibroelastosis (rare)

5. What are heart failure cells?
Chronic rheumatic heart disease
Shunt - PGE to maintain PDA until surgical repair can be performed
Hemosiderin laden macrophages
Aortic regurg

6. What is the rate of mitral valve prolapse in the US?
2-4 hours - 24 hours - 7-10 days
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
PDA
2-3%

7. What is the most common congenital heart defect?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Heart can't fill
VSD
LV dilation and eccentric hypertrophy

8. What genetic conditions predispose a pt to mitral valve prolapse?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Breast and lung carcinoma - melanoma - lymphoma
PGE
Ehlers - Danlow and Marfan syndrome

9. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
3-8 wks
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Circumflex

10. What congenital heart defect presents later in life with lower extremity cyanosis?
Decrease preload -->lowers myocardial stress
PDA
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
Indomethacin - decreases PGE

11. What is the 1day-1wk -1mo mneumonic for MI?
S aureus
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Ehlers - Danlow and Marfan syndrome
Nitroglycerin

12. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Libman - Sacks endocarditis
Myxoid degeneration
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Tender lesions on fingers or toes.

13. How do ACE inhibitors tx MI?
Ostium secundum (90%)
Day 1-7
Thickening of chrodae tendinae and cusps - mitral stenosis
Decreases LV dilation by decreasing volume

14. Vegetations on surface and undersurface of mitral valve.
Granulation tissue
Libman - Sacks endocarditis
Dilation of all four chambers of the heart
Pancarditis

15. Which angina is relieved by Ca channel blockers?
Prinzmetal
>60 years - bicuspid aortic valve
Coxsackie A or B
Holosystolic machine like murmur

16. What causes mitral valve prolapse?
Spontaneous
Stable and unstable prinzmetal
Myxoid degeneration
Myxoma - benign

17. Which angina(s) show ST elevation on EKG? ST depression?
Aschoff bodies
Asymptomatic
Pts w/previously damaged valves
Prinzmetal stable and unstable

18. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Small - nondestructive vegetations (subacute endocarditis)
Valve replacement once LV dysfx develops
Aortic regurg
Eisenmenger syndrome

19. What type of shunt does transposition of the great vessels cause?
Holosystolic machine like murmur
R-->L
Degree of pulmonary artery stenosis
Mitral valve prolapse

20. What is the most common cause of aortic stenosis?
Heart can't fill
Mitral regurgitation due to vegetations
Prinzmetal angina
Wear and tear

21. What generally causes ischemic heart disease?
Atherosclerosis of coronary arteries
Sterile vegetations on surface and undersurface on mitral valve
Membrane damage
Slow HR - decreasing O2 demand and risk for arrhythmia

22. What is the characteristic murmur of aortic stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
Backward LHF pulm htn and RHF - afib and associated mural thombis
Reperfusion injury
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

23. Which congenital heart defect is associated with congenital rubella?
LHF
PDA
Yellow pallor macrophages
Mitral regurg

24. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Increased blood in right heart delays closure of P valve
Maternal diabetes
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Migratory polyarthritis

25. What does rupture of the LV free wall cause?
Left -->right
RCA
3-8 wks
Cardiac tamponade

26. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Hemosiderin laden macrophages
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Shunt
4-7 days macrophage infiltration

27. When do neutrophils infiltrate the myocardium post MI?
2-4 hours - 24 hours - 7-10 days
Cyanosis - RV hypertrophy - polycythemia - clubbing
Decreases LV dilation by decreasing volume
1-3 days

28. What does granulation tissue contain?
Chronic rheumatic heart disease
Plump fibroblasts - collagen - blood vessels
PGE
Stable angina

29. What does Libman - Sacks endocarditis cause?
Mitral regurgitation due to vegetations
Fibrosis and dystrophic calcification
Mitral regurg
Valve replacement AFTER the onset of complications

30. What type of tumor is a rhabdomyoma?
Bounding pulse
Harmartoma
Left -->right
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

31. What maintains patency of the PDA?
Atherosclerosis of coronary arteries
Friction rub and chest pain
Prinzmetal angina - cocaine
PGE

32. What type of shunt results in cyanosis at birth?
Right to left
Aortic regurg
Atria and RV
Nitroglycerin

33. What is the most common cause of RHF? What are others?
Ventricular arrhythmia
Pump failure
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Stable angina

34. What are the forward and backward sx of LHF?
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
VSD
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

35. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
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
Minimizes ischemia
Anitschow cell

36. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
S viridans
>70%
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Elevated ASO anti - DNase B titers

37. What always follows necrosis?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Acute inflammation
Prinzmetal
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

38. What are the sx of PDA at birth?
Infectious endocarditis - arrythmias - severe mitral regurg no
Increased blood in right heart delays closure of P valve
>70%
Asymptomatic

39. What is the most common cause of infectious endocarditis?
Loss of fx
Reversible
Adult coarctation of the aorta
Streptococcus viridans

40. What are the clinical features of endocarditis? What causes each feature?
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
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
CHF
Ischemic heart disease

41. What gross and microscopic changes occur 1-3 weeks after an MI?
Atherosclerosis of coronary arteries
Yellow pallor neutrophils
Myocarditis
Red border granulation tissue

42. What type of ASD is associated w/Down syndrome?
RCA
Hypertrophic cardiomyopathy
Ostium primum
Mitral insufficiency

43. What is the gross and microscopic appearance of cardiac myxomas?
Aschoff bodies
LAD
Gelatinous - abundant ground substance
Loss of fx

44. What is the most common cause of mitral stenosis?
Decrease in blood flow to an organ
Mitral and tricuspid regurg - arrhythmia
ST- segment depression
Chronic rheumatic heart disease

45. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
3-8 wks
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Increased hydrostatic pressure

46. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
VSD
4-6 hours - 24 hours - 72 hours
Squatting - expiration

47. What is the only Jones criteria that doesn't resolve with time?
Pancarditis
Elevated ASO anti - DNase B titers
Heart can't fill
Congenital rubella

48. How does subendocardial MI/ischemia present on EKG?
ST- segment depression
Yellow pallor macrophages
Ostium primum
AD mutation in sarcomere proteins

49. How long after pharyngitis does acute rheumatic fever occur?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
2-3 weeks
Streptococcus viridans
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

50. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Minimizes ischemia
>60 years - bicuspid aortic valve
Sterile vegetations on surface and undersurface on mitral valve
R-->L