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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 eythema marginatum? What parts of the body does it commonly involve?
AD mutation in sarcomere proteins
Prinzmetal
ASD - R-->L
Annular - non pruritic rash w/erythematous borders trunks and limbs

2. What are Janeway lesions?
Erythematous nontender lesions on palms and soles.
Coronary artery vasospasm - emboli - vasculitis
ST- segment depression
Papillary muscle - free wall - IV septum

3. What does rupture of the IV septum cause?
Prinzmetal
Shunt
Valve replacement AFTER the onset of complications
Tender lesions on fingers or toes.

4. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
VSD
Fetal alcohol syndrome
Mitral and tricuspid regurg - arrhythmia
Anitschow cell

5. What complications occur 4-7 days post MI?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Rupture of free wall - IV septum - or papillary muscle
Infantile coarctation of the aorta
1-3 days

6. What is the most common form of cardiomyopathy?
Reversible
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Transesophageal echo
Dilated

7. What is the basic principle of CHF?
Pump failure
Eisenmenger syndrome
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
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

8. What makes the MV prolapse murmur louder? Why?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Transesophageal echo
Streptococcus viridans
Squatting - increased systemic resistence decreases LV emptying

9. What is the tx for LHF?
Mid - systolic click followed by regurgitation murmur
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
ACE inhibitor
Spontaneous

10. Which congenital heart defect is associated with maternal diabetes?
Anterior wall of LV and anterior septum
Bounding pulse
Circumflex
Transposition of the great vessels

11. What creates the immune reaction in acute rhuematic fever?

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12. What are the HACEK organisms? With what condition are they associated?
Mitral mitral+aortic
Migratory polyarthritis
Fibrosis and dystrophic calcification
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

13. With what endocarditis is S epidermidis associated?
NG or Ca channel blocker
Hypertrophic cardiomyopathy
Paradoxical emboli
Endocarditis of prosthetic valves

14. What is the tx for dilated cardiomyopathy?
>70%
Tricuspid
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Heart transplant

15. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
Myocarditis
Asymptomatic
Hemosiderin laden macrophages

16. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Regurg vs stenosis
Heart can't fill
Group A beta - hemolytic streptococci

17. Lower extremity cyanosis in infants? In adults?
Troponin I
Infantile coarctation of the aorta PDA
Metastasis
Limits thrombosis

18. What two things cause coronary artery vasospasm?
Prinzmetal angina - cocaine
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
LA dilation
Decrease preload -->lowers myocardial stress

19. How do ACE inhibitors tx MI?
Decreases LV dilation by decreasing volume
Anitschow cell
Type I
Right -->left

20. What is the most common type of endocarditis?
Infectious
Small vegetations along the line of closure
Nitroglycerin
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

21. What cardiac disease is associated with tuberous sclerosis?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Contraction band necrosis - reperfusion injury
Rhabdomyoma
Myocarditis

22. What type of shunt dose PDA cause?
Stretched muscle loses contractility
Troponin I
Left -->right
Subendocardial

23. When do CK- MB levels rise - peak - and return to normal?
4-6 hours - 24 hours - 72 hours
ST- segment depression
Pump failure
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

24. Erythematous nontender lesions on palms and soles.
Right to left
Janeway lesions
Backward LHF pulm htn and RHF - afib and associated mural thombis
Chronic ischemic heart disease

25. What is the rate of congenital heart defects?
Mitral regurgitation due to vegetations
Pump failure
Mitral stenosis
1%

26. What is the rate of mitral valve prolapse in the US?
Red border granulation tissue
2-3%
ACE inhibitor
Osler nodes (ouch - ouch Osler)

27. What is a Quincke pulse?
Yellow pallor macrophages
Endocarditis of prosthetic valves
Prinzmetal angina - cocaine
Pulsating nail bed

28. What is cardiogenic shock?
Atria and RV
Aneurysm - mural thrombus - Dressler syndrome
Congested central veins
Inability to maintain systemic pressure w/lack of O2 to vital organs

29. What characterizes acute rheumatic fever endocarditiis?
Mitral regurg
Within the first day
Aortic regurg
Small vegetations along the line of closure

30. How does stable angina present?
Restrictive cardiomyopathy
Autoimmune pericarditis 6-8 wks post MI
Chest pain <20 min brought on by exertion or emotional stress
Mitral insufficiency

31. What causes the nutmeg color in nutmeg liver?
Contraction band necrosis
Systemic venous congestion
Bicuspid aortic valve
Congested central veins

32. With what congenital heart defect is ADULT coarctation of the aorta associated?
Systemic venous congestion
Bicuspid aortic valve
Janeway lesions
MI

33. What causes angina and syncope in aortic stenosis?

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

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35. How does hypertension cause LHF?

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36. What increases the risk for chronic rheumatic heart disease?
4-7 days
Mitral insufficiency
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Friction rub and chest pain

37. What is dilated cardiomyopathy?
ACE inhibitor
Infectious endocarditis
Heart can't fill
Dilation of all four chambers of the heart

38. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
PDA
Right -->left
Migratory polyarthritis

39. What is the most common cause of myocarditis?
Coxsackie A or B
Mitral regurg
White scar fibrosis
Myxoma - benign

40. With what developmental disorder is VSD associated?
Fetal alcohol syndrome
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Prinzmetal
Wear and tear

41. How does reperfusion injury occur?
RCA
RCA
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

42. What iis the tx for aortic regurg?
Mitral regurgitation due to vegetations
Fibrinous pericarditis
Valve replacement once LV dysfx develops
Nonspecific - eg fever and elevated ESR

43. Myofiber hypertrophy with disarray.
Congenital rubella
Hypertrophic cardiomyopathy
3-8 wks
Transposition of the great vessels

44. What are the two effects of ATII?
Infectious
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Hemosiderin laden macrophages
Louder - increased systemic resistence decreases LV emptying

45. What causes an early - blowing diastolic murmur?
Aortic regurg
S viridans
L->R
Valve replacement AFTER the onset of complications

46. When is an MI patent at highest risk for fibrionous pericarditis?
1-3 days out
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
PDA
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

47. Are most congenital heart defects spontaneous or inherited?
Streptococcus bovis/
Spontaneous
LAD
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

48. What genetic conditions predispose a pt to mitral valve prolapse?
Reactive histiocyte with caterpillar nucleus
Reperfusion injury
Subendocardial
Ehlers - Danlow and Marfan syndrome

49. Is injury due angina reversible or irreversible?
Reversible
Tuberous sclerosis
Tender lesions on fingers or toes.
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

50. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
Colon cancer
PDA
Mitral regurg