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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. How does squating decrease hypoxemia in tetralogy of fallot?
Valve replacement
Positive blood cultures anemia of chronic disease
Open blocked vessels
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

2. What imaging test is useful for detecting lesions on valves?
Restrictive cardiomyopathy
Increased blood in right heart delays closure of P valve
NG or Ca channel blocker
Transesophageal echo

3. What % of MIs involve the LAD?
Reactive histiocyte with caterpillar nucleus
45%
Acute inflammation
Libman - Sacks endocarditis

4. What side of the heart do carcinoid tumors affect? Why?
Spontaneous
Nonspecific - eg fever and elevated ESR
Right side - serotonin and other secretory products detoxified in the lung
Valve replacement AFTER the onset of complications

5. Erythematous nontender lesions on palms and soles.
Janeway lesions
Boot shaped heart
Pts w/previously damaged valves
1-3 days out

6. What causes unstable angina?
Tetralogy of fallot
Hypercoagulable state or underlying adenocarcinoma
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

7. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Circumflex
Bacterial endocarditis
Congestive heart failure
ASD - R-->L

8. What iis the tx for aortic regurg?
Kawasaki disease
Valve replacement once LV dysfx develops
Autoimmune pericarditis 6-8 wks post MI
Concentric LV hypertophy

9. What causes acute endocarditis?
Ischemic heart disease
Nitroglycerin
Large vegetations of S aureus
Rhadbomyoma - benign

10. What causes mitral valve prolapse?
Hypercoagulable state or underlying adenocarcinoma
Mitral valve prolapse
Myxoid degeneration
Janeway lesions

11. What causes a mid - systolic click followed by a regurgitation murmur?
Tender lesions on fingers or toes.
Contraction band necrosis - reperfusion injury
Nitroglycerin
Mitral valve prolapse

12. What characterizes acute rheumatic fever endocarditiis?
Nonspecific - eg fever and elevated ESR
4-24 hours
Small vegetations along the line of closure
Shunt - PGE to maintain PDA until surgical repair can be performed

13. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Pulsating nail bed
Nonspecific - eg fever and elevated ESR
Chest pain <20 min brought on by exertion or emotional stress
RHF

14. Opening snap followed by diastolic rumble.
Endocarditis of prosthetic valves
Mitral stenosis
Louder - increased systemic resistence decreases LV emptying
Bounding pulse

15. Where is the coarctation in infantile coarctation of the aorta?
Ventricular arrhythmia
Preductal - post aortic arch
Sudden cardiac death
Infectious endocarditis

16. What is the most common cause of aortic stenosis?
First 4 hours
Wear and tear
Cardiac tamponade
Valve scarring that arises as a consequence of rheumatic fever

17. What are Osler nodes?
Slow HR - decreasing O2 demand and risk for arrhythmia
Tender lesions on fingers or toes.
1-3 days out
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

18. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Streptococcus viridans
Acute inflammation
PDA

19. Which congenital heart defect is associated with congenital rubella?
Sterile vegetations on surface and undersurface on mitral valve
Prinzmetal
Maternal diabetes
PDA

20. What are the complications of aortic stenosis?
Holosystolic blowing murmur
Pulsating nail bed
ST- segment depression
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

21. What drug relieves stable angina?
Nitroglycerin
Acute inflammation
2-3%
Reversible

22. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Decreased forward perfusion pulmonary congestion
Anitschow cell
Streptococcus bovis/
Libman - Sacks endocarditis

23. What compensatory mechanism do tetralogy of fallot pts learn?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Squat in response to cyanotic spell
Degree of pulmonary artery stenosis
Congestive heart failure

24. What is the most common type of ASD? What %?
Trisomy 21
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
VSD
Ostium secundum (90%)

25. What is endocardial fibroelastosis? In what population is it found?
Shunt
First 4 hours
Dense layer of elastic and fibrotic tissue in the endocardium - children
Opening snap followed by diastolic rumble

26. What is the effect of mitral regurg on the heart?
Anterior wall of LV and anterior septum
Volume overload and LHF
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Slow HR - decreasing O2 demand and risk for arrhythmia

27. Which vasculitis can cause MI?
Kawasaki disease
LAD
Prinzmetal stable and unstable
Fibrinous pericarditis

28. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Aortic regurg
Tuberous sclerosis
Loss of LV fx
Subendocardial

29. What is systolic dysfx?
Systemic venous congestion
Small vegetations along the line of closure
Pancarditis
Ventricles cannot pump

30. Friction rub and chest pain.
Pericarditits
Decrease preload -->lowers myocardial stress
Turner syndrome
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

31. What always follows necrosis?
Positive blood cultures anemia of chronic disease
Rhadbomyoma - benign
Decrease preload -->lowers myocardial stress
Acute inflammation

32. How do you prevent S viridans endocarditis?
Ventricles cannot pump
Ventricle
Prophylactic abx during dental procedures
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

33. What does granulation tissue contain?
Squatting - increased systemic resistence decreases LV emptying
ST- segment depression
Anterior wall of LV and anterior septum
Plump fibroblasts - collagen - blood vessels

34. What determines the extent of shunting and cyanosis in tetralogy of fallot?
ST- segment depression
Degree of pulmonary artery stenosis
Fetal alcohol syndrome
Bacterial endocarditis

35. What conditions can cause nonbacterial thrombotic endocarditis?
Tricuspid
PGE
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Hypercoagulable state or underlying adenocarcinoma

36. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Bicuspid aortic valve
Asymptomatic
Aschoff bodies
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

37. What type of ASD is associated w/Down syndrome?
ACE inhibitor
Spontaneous
Ostium primum
RCA

38. What type of shunt does ASD cause?
Anitschow cell
Granulation tissue
Left -->right
Congenital rubella

39. What does Libman - Sacks endocarditis cause?
Migratory polyarthritis
Right side - serotonin and other secretory products detoxified in the lung
Congenital rubella
Mitral regurg

40. What type of shunt does transposition of the great vessels cause?
Metastasis
Subendocardial
Ischemic heart disease
R-->L

41. What are the sx of hypertrophic cardiomyopathy?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
VSD

42. What causes wear and tear aortic stenosis?
Tricuspid
Streptococcus viridans
Fibrosis and dystrophic calcification
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

43. What endocarditis is commonly found in patients with colon cancer?
Rupture of free wall - IV septum - or papillary muscle
Contraction band necrosis
4-24 hours
Streptococcus bovis/

44. Systolic ejection click followed by crescendo - decrescendo murmur.
Aortic stenosis
RHF
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Colon cancer

45. What is Loeffler syndrome?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Metastasis
Circumflex
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

46. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Yellow pallor macrophages
Metastasis
ASD - R-->L
Plump fibroblasts - collagen - blood vessels

47. How do ACE inhibitors tx MI?
Prinzmetal angina
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Decreases LV dilation by decreasing volume
Ostium secundum (90%)

48. Poor myocardial fx due to chronic ischemic damage?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Aortic stenosis
Chronic ischemic heart disease
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

49. Lower extremity cyanosis in infants? In adults?
ST- segment elevation
Pericarditits
Infantile coarctation of the aorta PDA
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

50. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Pts w/previously damaged valves
Contraction band necrosis
2-4 hours - 24 hours - 7-10 days
Prophylactic abx during dental procedures