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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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1. What does Libman - Sacks endocarditis cause?
Mitral regurg
Reperfusion injury
Within the first day
Intercostal arteries enlarged due to collateral circulation

2. Vegetations on surface and undersurface of mitral valve.
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
Aschoff bodies
Harmartoma
Libman - Sacks endocarditis

3. What causes an early - blowing diastolic murmur?
PDA
Aortic regurg
Infectious
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

4. With what virus is PDA associated?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Congenital rubella
Infectious endocarditis
Day 1-7

5. Boot - shaped heart on x- ray?
Transposition of the great vessels
Heart transplant
Papillary muscle - free wall - IV septum
Tetralogy of fallot

6. What type of vegetations form in nonbacterial thrombotic endocarditis?
L->R
Sterile vegetations on mitral valve along lines of closure
Hypertrophic cardiomyopathy
4-24 hours

7. With what disease is infantile coarctation of the aorta associated?
Aortic regurg
3-8 wks
Turner syndrome
Ehlers - Danlow and Marfan syndrome

8. With what congenital heart defect is ADULT coarctation of the aorta associated?
Posterior wall of LV - posterior septum - papillary muscles
Bicuspid aortic valve
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

9. What causes endocarditis of prosthetic valves?
Systolic dysfx leading to biventricular CHF
Congestive heart failure
Bounding pulse
S epidermidis

10. What are complications of dilated cardiomyopathy?
Stable angina
Intercostal arteries enlarged due to collateral circulation
Mitral and tricuspid regurg - arrhythmia
Fetal alcohol syndrome

11. How long after pharyngitis does acute rheumatic fever occur?
Shunt
45%
Reperfusion injury
2-3 weeks

12. Ostium primum ASD is associated with what congenital disorder?
Decrease preload -->lowers myocardial stress
Trisomy 21
4-7 days macrophage infiltration
Preductal - post aortic arch

13. What endocarditis is commonly found in patients with colon cancer?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Libman - Sacks endocarditis
Tuberous sclerosis
Streptococcus bovis/

14. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Small - nondestructive vegetations (subacute endocarditis)
Myocarditis
Mitral regurg

15. Pericarditis 6-8 wks post MI.
Circumflex
Anterior wall of LV and anterior septum
Dressler syndrome
Rupture of free wall - IV septum - or papillary muscle

16. In which pts does S viridans cause endocarditits?
Ischemic heart disease
LA
Inability to maintain systemic pressure w/lack of O2 to vital organs
Pts w/previously damaged valves

17. What is cardiogenic shock?
RCA
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Inability to maintain systemic pressure w/lack of O2 to vital organs
VSD

18. What type of ischemia does stable angina cause?
4-6 hours - 24 hours - 72 hours
Subendocardial
Breast and lung carcinoma - melanoma - lymphoma
RBC damaged while crossing the calcified valve causing schistocytes

19. What type of shunt dose PDA cause?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
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
Left -->right
Ventricle

20. What are the Jones criteria?
ASD - R-->L
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Migratory polyarthritis

21. What are the sx of cardiac myxoma?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Backward LHF pulm htn and RHF - afib and associated mural thombis
Cardiac tamponade
Decreased forward perfusion pulmonary congestion

22. How does aortic regurg affect the heart chambers?
Prinzmetal angina - cocaine
Paradoxical emboli
Nonbacterial thrombotic endocarditis (marantic endocarditis)
LV dilation and eccentric hypertrophy

23. How does restrictive cardiomyopathy cause LHF?

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24. Tender lesions on fingers or toes.
Osler nodes (ouch - ouch Osler)
Infectious endocarditis - arrythmias - severe mitral regurg no
RHF
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

25. Is injury due angina reversible or irreversible?
Contraction band necrosis
Reversible
Stable and unstable prinzmetal
Ehlers - Danlow and Marfan syndrome

26. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Nitroglycerin
>60 years - bicuspid aortic valve
Inability to maintain systemic pressure w/lack of O2 to vital organs
Endocardial fibroelastosis (rare)

27. What is the most common form of cardiomyopathy?
Dilated
Paradoxical emboli
PDA
Yellow pallor neutrophils

28. What are the clinical features of LHF due to?
Metastasis
Decreased forward perfusion pulmonary congestion
NG or Ca channel blocker
White scar fibrosis

29. What effect does chronic rheumatic heart disease have the mitral valve?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Thickening of chrodae tendinae and cusps - mitral stenosis
ACE inhibitor
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

30. What is the most common cause of infectious endocarditis?
Turner syndrome
Streptococcus viridans
NG or Ca channel blocker
Months out fibrosis

31. What is the murmur of mitral regurg?
2-4 hours - 24 hours - 7-10 days
Loeffler syndrome
Holosystolic blowing murmur
3-8 wks

32. What congenital heart defect does indomethacin tx?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Open blocked vessels
PDA
Papillary muscle - free wall - IV septum

33. What two things happen when a blocked vessel is opened after an MI?
2-3%
Restrictive cardiomyopathy
Tuberous sclerosis
Contraction band necrosis - reperfusion injury

34. How do you prevent S viridans endocarditis?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Colon cancer
Reactive histiocyte with caterpillar nucleus
Prophylactic abx during dental procedures

35. What is the tx for dilated cardiomyopathy?
Annular - non pruritic rash w/erythematous borders trunks and limbs
ACE inhibitor
Dilation of all four chambers of the heart
Heart transplant

36. How does MI cause LHF?
Infectious
>70%
Loss of LV fx
Congested central veins

37. What is the most common cause of myocarditis?
PGE
Fibrinous pericarditis
Ostium primum
Coxsackie A or B

38. Which coronary artery supplies the anterior wall and anterior septum?
LAD
Infectious
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Type I

39. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Left -->right
Anitschow cell
LV dilation and eccentric hypertrophy

40. With what endocarditis is S epidermidis associated?
Myocarditis
Systolic ejection click followed by crescendo - decrescendo murmur
4-24 hours
Endocarditis of prosthetic valves

41. What are the complications of mitral stenosis?
Hypertrophic cardiomyopathy
Backward LHF pulm htn and RHF - afib and associated mural thombis
VSD
Cyanosis - RV hypertrophy - polycythemia - clubbing

42. What is Loeffler syndrome?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
>60 years - bicuspid aortic valve
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Prinzmetal angina

43. Infects predamaged valves after transient bacteremia?
Sterile vegetations on surface and undersurface on mitral valve
S viridans
Chronic ischemic heart disease
LA

44. What type of ASD is associated w/Down syndrome?
Ostium primum
Granulation tissue
Dressler syndrome
Loss of fx

45. What is the rate of congenital heart defects?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Reperfusion injury
1%
Acute inflammation

46. How does stable angina present?
Congenital rubella
Chest pain <20 min brought on by exertion or emotional stress
Cardiac tamponade
Bounding pulse

47. Which angina is relieved by Ca channel blockers?
Migratory polyarthritis
Prinzmetal
Coronary artery vasospasm
Ventricles cannot pump

48. What is the effect of mitral regurg on the heart?
1%
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Preductal - post aortic arch
Volume overload and LHF

49. When does the heart have a yellow pallor post MI?
Day 1-7
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Libman - Sacks endocarditis
Tricuspid

50. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
3-8 wks
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Eisenmenger syndrome