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Cardiac
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Subject
:
health-sciences
Instructions:
Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
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 endocarditis is commonly found in patients with colon cancer?
Hemosiderin laden macrophages
Streptococcus bovis/
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Sterile vegetations on mitral valve along lines of closure
2. What causes unstable angina?
ST- segment depression
Anitschow cell
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
3. With what disease is Libman - Sacks endocarditis associated?
Large - destructive vegetations
Dark discoloration coagulative necrosis
SLE
LAD
4. What is the gold standard blood marker for MI?
LA dilation
Right -->left
Holosystolic machine like murmur
Troponin I
5. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Decreased forward perfusion pulmonary congestion
Bicuspid aortic valve
Hemosiderin laden macrophages
6. What is the most common cause of death during the acute phase of rheumatic fever?
Mitral mitral+aortic
Louder - increased systemic resistence decreases LV emptying
Myocarditis
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
7. What is systolic dysfx?
MI
Valve scarring that arises as a consequence of rheumatic fever
Increased blood in right heart delays closure of P valve
Ventricles cannot pump
8. What does rupture of a papillary muscle cause?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Mitral mitral+aortic
Mitral insufficiency
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
9. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Stable angina
Within the first day
Dilation of all four chambers of the heart
Contraction band necrosis - reperfusion injury
10. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Endocarditis of prosthetic valves
Decreased forward perfusion pulmonary congestion
Louder - increased systemic resistence decreases LV emptying
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
11. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Erythematous nontender lesions on palms and soles.
Harmartoma
Anitschow cell
12. How does subendocardial MI/ischemia present on EKG?
Pulsating nail bed
Valve replacement AFTER the onset of complications
Bounding pulse
ST- segment depression
13. What genetic conditions predispose a pt to mitral valve prolapse?
First 4 hours
Decreased forward perfusion pulmonary congestion
ST- segment depression
Ehlers - Danlow and Marfan syndrome
14. What is Dressler syndrome? When does it occur?
Myocardium
20 min
Dark discoloration coagulative necrosis
Autoimmune pericarditis 6-8 wks post MI
15. What is the etiology of S viridans endocarditis?
Pancarditis
Small - nondestructive vegetations (subacute endocarditis)
Bacterial endocarditis
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
16. What cardiac enzyme is useful for detecting reinfarction?
CK- MB
Right side - serotonin and other secretory products detoxified in the lung
Cardiac tamponade
Valve replacement
17. What causes mitral valve prolapse?
Granulation tissue
Endocardial fibroelastosis (rare)
Holosystolic machine like murmur
Myxoid degeneration
18. What type of valvular vegetations does S aureus cause?
1%
Large - destructive vegetations
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
19. What drug relieves stable angina?
4-7 days macrophage infiltration
Systemic venous congestion
Surgical closure small defects may close spontaneously
Nitroglycerin
20. What cardiac disease is associated with tuberous sclerosis?
SLE
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Rhabdomyoma
1%
21. What type of ASD is associated w/Down syndrome?
Congestive heart failure
Preductal - post aortic arch
Osler nodes (ouch - ouch Osler)
Ostium primum
22. Ostium primum ASD is associated with what congenital disorder?
Acute inflammation
Trisomy 21
VSD
Reactive histiocyte with caterpillar nucleus
23. How does O2 tx MI?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
PGE
Posterior wall of LV - posterior septum - papillary muscles
Minimizes ischemia
24. What causes acute endocarditis?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
LA dilation
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Large vegetations of S aureus
25. What is the most common cause of endocarditis in IV drug users?
Myocarditis
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
S aureus
26. When is an MI pt at greatest risk for cardiogenic shock?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Coexisting mitral stenosis and fusion of commisures exist
First 4 hours
Asymptomatic
27. How does fibrinolysis/angioplasty tx MI?
Mitral regurg
Open blocked vessels
Limits thrombosis
PDA
28. What type of endocarditis is associated with SLE?
Libman - Sacks endocarditis
Sudden cardiac death
Inability to maintain systemic pressure w/lack of O2 to vital organs
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
29. What causes an early - blowing diastolic murmur?
Aortic regurg
R-->L
Split S2 on auscultation
ST- segment depression
30. What imaging test is useful for detecting lesions on valves?
Contraction band necrosis
AD mutation in sarcomere proteins
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Transesophageal echo
31. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Thickening of chrodae tendinae and cusps - mitral stenosis
32. How does aortic regurg affect the heart chambers?
RCA
Shunt - PGE to maintain PDA until surgical repair can be performed
LV dilation and eccentric hypertrophy
Kawasaki disease
33. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Colon cancer
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
ST- segment depression
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
34. Which angina is relieved by Ca channel blockers?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Mitral regurg
Prinzmetal
Prinzmetal angina - cocaine
35. How does Eisenmeger syndrome occur?
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
Ostium primum
Pericarditits
Shunt - PGE to maintain PDA until surgical repair can be performed
36. What is an important complication of ASD?
LA
Dark discoloration coagulative necrosis
Prinzmetal angina - cocaine
Paradoxical emboli
37. What is the foundation of a scar?
Autoimmune pericarditis 6-8 wks post MI
Granulation tissue
Mitral and tricuspid regurg - arrhythmia
Mitral regurg
38. When does the heart have a yellow pallor post MI?
Day 1-7
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
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
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
39. What are the complications of mitral stenosis?
Ostium secundum (90%)
Shunt
Backward LHF pulm htn and RHF - afib and associated mural thombis
Pancarditis
40. What effect does dilated cardiomyopathy have on the heart?
Restrictive cardiomyopathy
Systolic dysfx leading to biventricular CHF
L->R
Myofiber hypertrophy with disarray
41. What murmur ccan be heard in PDA?
Coexisting mitral stenosis and fusion of commisures exist
Ventricles cannot pump
Papillary muscle - free wall - IV septum
Holosystolic machine like murmur
42. What is the cause of restrictive cardiomyopathy in children?
Ventricle
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Infectious
Endocardial fibroelastosis (rare)
43. Dense layer of elastic and fibrotic tissue in the endocardium.
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Endocardial fibroelastosis
Turner syndrome
Limits thrombosis
44. What causes endocarditis of prosthetic valves?
Mitral mitral+aortic
Systemic venous congestion
2-3%
S epidermidis
45. What are the cancers that most commonly metastasize to the heart?
Louder - increased systemic resistence decreases LV emptying
Breast and lung carcinoma - melanoma - lymphoma
Hypertrophic cardiomyopathy
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
46. What % stenosis causes stable angina?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Indomethacin - decreases PGE
Myocarditis in acute rheumatic heart fever
>70%
47. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Migratory polyarthritis
Pump failure
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Prinzmetal angina
48. What are the forward and backward sx of LHF?
Wear and tear
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
Paradoxical emboli
Contraction band necrosis - reperfusion injury
49. What areas of the heart does the RCA supply?
Posterior wall of LV - posterior septum - papillary muscles
Regurg vs stenosis
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
RCA
50. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Wear and tear
Months out fibrosis
R-->L
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
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