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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. Friction rub and chest pain.
Decreases LV dilation by decreasing volume
Cyanosis - RV hypertrophy - polycythemia - clubbing
Pericarditits
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

2. What causes heart failure cells?
Squatting - increased systemic resistence decreases LV emptying
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
RHF
Reversible

3. What causes microangiopathic hemolytic anemia in aortic stenosis?
4-24 hours
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Rupture of free wall - IV septum - or papillary muscle
RBC damaged while crossing the calcified valve causing schistocytes

4. In what pt population does S aureus commonly cause valvular disease?
Wear and tear
Elevated ASO anti - DNase B titers
Streptococcus bovis/
IV drug users

5. Which congenital heart defect is associated with maternal diabetes?
Contraction band necrosis - reperfusion injury
Wear and tear
Transposition of the great vessels
Nonbacterial thrombotic endocarditis (marantic endocarditis)

6. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Nitroglycerin
Aschoff bodies
Dilated
Valve replacement once LV dysfx develops

7. What are the four defects in tetralogy of fallot?
Chest pain <20 min brought on by exertion or emotional stress
Squatting - expiration
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Nitroglycerin

8. How does MI cause LHF?
Elevated ASO anti - DNase B titers
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
Loss of LV fx
2-3 weeks

9. L- to - R shunt switching to R- to - L shunt.
Eisenmenger syndrome
Prophylactic abx during dental procedures
Low voltage EKG w/diminished QRS amplitude
Left -->right

10. Low voltage EKG w/diminished QRS amplitude.
ASD - R-->L
Holosystolic blowing murmur
Restrictive cardiomyopathy
PDA

11. When do neutrophils infiltrate the myocardium post MI?
1-3 days
Aortic stenosis
PGE
LAD

12. What causes the dependent pitting edema in RHF?
Louder - increased systemic resistence decreases LV emptying
Mitral regurg
Increased hydrostatic pressure
45%

13. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
Tender lesions on fingers or toes.
Atherosclerosis of coronary arteries
Contraction band necrosis - reperfusion injury

14. What causes a mid - systolic click followed by a regurgitation murmur?
Shunt - PGE to maintain PDA until surgical repair can be performed
R-->L
Mitral valve prolapse
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

15. What is the most common cause of aortic stenosis?
First 4 hours
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Libman - Sacks endocarditis
Wear and tear

16. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Yellow pallor macrophages
Contraction band necrosis
Maternal diabetes
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

17. What is the most common cause of myocarditis?
Tuberous sclerosis
Coxsackie A or B
Slow HR - decreasing O2 demand and risk for arrhythmia
Wear and tear

18. What murmur ccan be heard in PDA?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Fetal alcohol syndrome
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Holosystolic machine like murmur

19. What is the tx for LHF?
Squatting - expiration
ACE inhibitor
Dilation of all four chambers of the heart
Endocardial fibroelastosis

20. What type of endocarditis is associated with SLE?
LAD
PDA
Libman - Sacks endocarditis
Aneurysm - mural thrombus - Dressler syndrome

21. What are the minor critera of the Jones criteria?
Posterior wall of LV - posterior septum - papillary muscles
Nonspecific - eg fever and elevated ESR
Trisomy 21
Ischemic heart disease

22. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
RCA
Cardiogenic shock - CHF - arrhythmia
Shunt - PGE to maintain PDA until surgical repair can be performed

23. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Yellow pallor neutrophils
Systemic venous congestion
Ostium secundum (90%)
Aschoff bodies

24. Vegetations on surface and undersurface of mitral valve.
IV drug users
Libman - Sacks endocarditis
Anterior wall of LV and anterior septum
Ostium primum

25. With what disease is Libman - Sacks endocarditis associated?
SLE
Myocarditis
Cyanosis - RV hypertrophy - polycythemia - clubbing
Hypertophy of RV atrophy of LV

26. What is the only Jones criteria that doesn't resolve with time?
Pericarditits
VSD
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Pancarditis

27. What causes angina and syncope in aortic stenosis?

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28. Which artery is most often occluded in an MI?
LAD
Mitral mitral+aortic
ASD - R-->L
RHF

29. Is scar tissue or myocardium stronger?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
MI
Myocardium
Ostium primum

30. What type of vegetations are associated with Libman - Sacks endocarditis?
Hypertrophic cardiomyopathy
Sterile vegetations on surface and undersurface on mitral valve
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Positive blood cultures anemia of chronic disease

31. How does adult coarctation of the aorta present?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Eisenmenger syndrome
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Coxsackie A or B

32. How does fibrinolysis/angioplasty tx MI?
Ehlers - Danlow and Marfan syndrome
Hypercoagulable state or underlying adenocarcinoma
Congestive heart failure
Open blocked vessels

33. What type of collagen is involved in fibrosis?
Type I
R-->L
Rupture of free wall - IV septum - or papillary muscle
Pericardial effusion due to pericardial involvement

34. What is chronic rheumatic heart disease?
Endocardial fibroelastosis (rare)
Mitral insufficiency
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Valve scarring that arises as a consequence of rheumatic fever

35. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
4-7 days macrophage infiltration
Cardiogenic shock - CHF - arrhythmia
Mitral regurg
Posterior wall of LV - posterior septum - papillary muscles

36. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Concentric LV hypertophy
RHF
Within the first day

37. What is the most common valve infected by S aureus?
Tricuspid
Mitral regurgitation due to vegetations
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Ostium primum

38. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Myxoma - benign
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
ST- segment elevation
R-->L

39. How does dilated cardiomyopathy cause LHF?
Small vegetations along the line of closure
Systolic dysfx leading to biventricular CHF
Stretched muscle loses contractility
VSD

40. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Rhadbomyoma - benign
Within the first day
Prophylactic abx during dental procedures
Right -->left

41. When would arrhythmia occur after MI?
Cardiac tamponade
Within the first day
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

42. How long after pharyngitis does acute rheumatic fever occur?
Within the first day
2-3 weeks
MI
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

43. What causes the split S2 in ASD?
Ischemic heart disease
Atherosclerosis of coronary arteries
Increased blood in right heart delays closure of P valve
Decrease in blood flow to an organ

44. What is the most common cause of death during the acute phase of rheumatic fever?
PDA
>70%
Doxorubicin - cocaine
Myocarditis

45. What is the JOneS mneumonic?
Bacterial endocarditis
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
Gelatinous - abundant ground substance
4-7 days macrophage infiltration

46. What congenital heart defect is associated with fetal alcohol syndrome?
Hypercoagulable state or underlying adenocarcinoma
Asymptomatic
LA
VSD

47. What are the complications of mitral stenosis?
Ventricular arrhythmia
Reactive histiocyte with caterpillar nucleus
Backward LHF pulm htn and RHF - afib and associated mural thombis
Coexisting mitral stenosis and fusion of commisures exist

48. Poor myocardial fx due to chronic ischemic damage?
Dilation of all four chambers of the heart
Chronic ischemic heart disease
Dark discoloration coagulative necrosis
Loss of fx

49. What typically causes hypertrophic cardiomyopathy?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
AD mutation in sarcomere proteins
Decrease preload -->lowers myocardial stress
Harmartoma

50. What type of shunt does a VSD cause?
Eisenmenger syndrome
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Right side - serotonin and other secretory products detoxified in the lung
L->R