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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 the tx for VSD?
ST- segment elevation
Surgical closure small defects may close spontaneously
Transposition of the great vessels
Day 1-7

2. Friction rub and chest pain.
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Trisomy 21
Pericarditits
Valve replacement once LV dysfx develops

3. Erythematous nontender lesions on palms and soles.
Boot shaped heart
Dilation of all four chambers of the heart
Janeway lesions
Libman - Sacks endocarditis

4. Boot - shaped heart on x- ray?
Small vegetations along the line of closure
4-7 days
Tetralogy of fallot
Kawasaki disease

5. In transposition of the great vessels - What is required for survival? How is this achieved?
RHF
Myxoid degeneration
Osler nodes (ouch - ouch Osler)
Shunt - PGE to maintain PDA until surgical repair can be performed

6. What is a water - hammer pulse?
Bounding pulse
Systemic venous congestion
1-3 days out
Pancarditis

7. What does granulation tissue contain?
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
Plump fibroblasts - collagen - blood vessels
S epidermidis
Fever: due to bacteremia murmur: due to vegetations janeway lesions - osler nodes - and splinter hemorrhages: due to embolization of septic vegetations anemia of chronic disease: due to chronic inflammation

8. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Prinzmetal
Aneurysm - mural thrombus - Dressler syndrome
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

9. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Mitral regurgitation due to vegetations
Red border granulation tissue
Endocarditis of prosthetic valves
Bacterial endocarditis

10. What is the etiology of S viridans endocarditis?
2-3%
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

11. What are the tx for MI?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
1-3 days out
Nitroglycerin
Cyanosis - RV hypertrophy - polycythemia - clubbing

12. What drugs can cause dilated cardiomyopathy?
Doxorubicin - cocaine
Indomethacin - decreases PGE
Anterior wall of LV and anterior septum
LAD

13. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
4-7 days macrophage infiltration
LHF
Squatting - increased systemic resistence decreases LV emptying
Large vegetations of S aureus

14. What coronary arterysupplies the lateral wall of the LV?
S epidermidis
Circumflex
PDA
Pancarditis

15. What is eythema marginatum? What parts of the body does it commonly involve?
Chronic ischemic heart disease
ASD - R-->L
Dark discoloration coagulative necrosis
Annular - non pruritic rash w/erythematous borders trunks and limbs

16. What does a biopsy of hypertrophic cardiomyopathy look like?
Myofiber hypertrophy with disarray
Membrane damage
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Aschoff bodies

17. What is Loeffler syndrome?
White scar fibrosis
Yellow pallor macrophages
Type I
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

18. What type of shunt results in cyanosis at birth?
Ehlers - Danlow and Marfan syndrome
Endocardial fibroelastosis
Right to left
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

19. What is an Anitschow cell?
Ischemic heart disease
Indomethacin - decreases PGE
Reactive histiocyte with caterpillar nucleus
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

20. L- to - R shunt switching to R- to - L shunt.
Prinzmetal stable and unstable
Cardiogenic shock - CHF - arrhythmia
Dark discoloration coagulative necrosis
Eisenmenger syndrome

21. What are the causes of restrictive cardiomyopathy in adults?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Fibrosis and dystrophic calcification
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
First 4 hours

22. What bug causes acute rheumatic fever?
Group A beta - hemolytic streptococci
3-8 wks
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
VSD

23. What areas of the heart does the RCA supply?
Posterior wall of LV - posterior septum - papillary muscles
Thickening of chrodae tendinae and cusps - mitral stenosis
Heart can't fill
Ventricles cannot pump

24. Tender lesions on fingers or toes.
Shunt
Osler nodes (ouch - ouch Osler)
1-3 days
Endocardial fibroelastosis

25. What causes microangiopathic hemolytic anemia in aortic stenosis?
Chronic ischemic heart disease
Fibrosis and dystrophic calcification
Elevated ASO anti - DNase B titers
RBC damaged while crossing the calcified valve causing schistocytes

26. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
VSD
Migratory polyarthritis
Coexisting mitral stenosis and fusion of commisures exist
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

27. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
Mitral stenosis
Anterior wall of LV and anterior septum
Plump fibroblasts - collagen - blood vessels

28. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Paradoxical emboli
Chronic ischemic heart disease
Aschoff bodies
ST- segment elevation

29. With what disease is Libman - Sacks endocarditis associated?
SLE
Myxoid degeneration
PDA
Hypertrophic cardiomyopathy

30. What are heart failure cells?
S aureus
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Ischemic heart disease
Hemosiderin laden macrophages

31. What type of endocarditis is associated with SLE?
Ventricle
L->R
Infantile coarctation of the aorta PDA
Libman - Sacks endocarditis

32. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
4-7 days macrophage infiltration
Bicuspid aortic valve
Hypertrophic cardiomyopathy

33. What iis the tx for aortic regurg?
Chest pain <20 min brought on by exertion or emotional stress
Doxorubicin - cocaine
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Valve replacement once LV dysfx develops

34. EKG for stable angina?
ST- segment depression
Mitral regurg
ASD - R-->L
Rhadbomyoma - benign

35. Infects predamaged valves after transient bacteremia?
Heart can't fill
SLE
S viridans
Janeway lesions

36. What are the sx of cardiac myxoma?
Systolic ejection click followed by crescendo - decrescendo murmur
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Ventricles cannot pump
Day 1-7

37. What causes acute endocarditis?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Large vegetations of S aureus
Myxoid degeneration
Aortic stenosis

38. When would arrhythmia occur after MI?
Libman - Sacks endocarditis
Within the first day
Ventricular arrhythmia
Paradoxical emboli

39. What is dilated cardiomyopathy?
Bounding pulse
Dilation of all four chambers of the heart
Coexisting mitral stenosis and fusion of commisures exist
Shunt

40. What is the most common type of ASD? What %?
Ostium secundum (90%)
Ventricular arrhythmia
Harmartoma
Doxorubicin - cocaine

41. What are the minor critera of the Jones criteria?
Open blocked vessels
Breast and lung carcinoma - melanoma - lymphoma
Nonspecific - eg fever and elevated ESR
Coronary artery vasospasm

42. How does contraction band necrosis occur?
Valve replacement once LV dysfx develops
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Cardiac tamponade
Aschoff bodies

43. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Months out fibrosis
PDA
Sterile vegetations on surface and undersurface on mitral valve
Hemosiderin laden macrophages

44. What is the most common cause of infectious endocarditis?
Streptococcus viridans
R-->L
ST- segment elevation
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

45. What causes endocarditis of prosthetic valves?
S epidermidis
Adult coarctation of the aorta
Elevated ASO anti - DNase B titers
Heart transplant

46. What heart sound manifest with an ASD?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Dressler syndrome
Split S2 on auscultation

47. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Nitroglycerin
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
PDA

48. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
Split S2 on auscultation
Opening snap followed by diastolic rumble
Pericarditits

49. What is the cause of the red border around granulation tissue?
Blood vessels coming in from normal tissue
Acute inflammation
Mitral regurgitation due to vegetations
Transesophageal echo

50. What generally causes ischemic heart disease?
Adult coarctation of the aorta
45%
Valve scarring that arises as a consequence of rheumatic fever
Atherosclerosis of coronary arteries