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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 gross and microscopic changes occur 4-7 days after an MI?
When a bacterial protein resembles a protein in human tissue
Squatting - expiration
Yellow pallor macrophages
Congestive heart failure

2. What does rupture of the IV septum cause?
Small - nondestructive vegetations (subacute endocarditis)
Loss of LV fx
Shunt
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

3. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
>70%
Prinzmetal angina
ST- segment elevation
Decreased forward perfusion pulmonary congestion

4. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Coexisting mitral stenosis and fusion of commisures exist
3-8 wks
Reactive histiocyte with caterpillar nucleus
MI

5. Which chambers of the heart are generally spared in an MI?
Atria and RV
Contraction band necrosis
Aneurysm - mural thrombus - Dressler syndrome
Troponin I

6. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
RHF
Myocarditis in acute rheumatic heart fever
Prinzmetal

7. Which vasculitis can cause MI?
Louder - increased systemic resistence decreases LV emptying
MI
Kawasaki disease
Breast and lung carcinoma - melanoma - lymphoma

8. What is migratory polyarthritis?
RCA
Prinzmetal angina - cocaine
VSD
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

9. What endocarditis is commonly found in patients with colon cancer?
Infectious
Tender lesions on fingers or toes.
Opening snap followed by diastolic rumble
Streptococcus bovis/

10. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Red border granulation tissue
Aschoff bodies
Tetralogy of fallot
Pericardial effusion due to pericardial involvement

11. What is the 1day-1wk -1mo mneumonic for MI?
Mitral and tricuspid regurg - arrhythmia
Fibrinous pericarditis
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

12. What valves are involved in rhuematic endocarditis?
Dilated
Atherosclerosis of coronary arteries
Mitral mitral+aortic
Ostium primum

13. Is injury due angina reversible or irreversible?
Harmartoma
Reversible
Migratory polyarthritis
>60 years - bicuspid aortic valve

14. What is the characteristic murmurr of mitral stenosis?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Wear and tear
Opening snap followed by diastolic rumble
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

15. Which coronary artery supplies the posterior wall of the LV and posterior septum?
Volume overload and LHF
Heart can't fill
RCA
Right to left

16. Which artery is most often occluded in an MI?
Nitroglycerin
Hypercoagulable state or underlying adenocarcinoma
Prophylactic abx during dental procedures
LAD

17. What type of collagen is involved in fibrosis?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Type I
Aschoff bodies
Contraction band necrosis

18. What is the cause of the red border around granulation tissue?
Posterior wall of LV - posterior septum - papillary muscles
Adult coarctation of the aorta
Blood vessels coming in from normal tissue
PDA

19. How does fibrinolysis/angioplasty tx MI?
Ischemic heart disease
Streptococcus viridans
Systemic venous congestion
Open blocked vessels

20. What type of tumor is a rhabdomyoma?
Holosystolic blowing murmur
Harmartoma
Valve replacement AFTER the onset of complications
Streptococcus viridans

21. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
Mitral regurg
Within the first day
RCA

22. What are the sx of aortic regurg?
Systolic ejection click followed by crescendo - decrescendo murmur
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Tricuspid
Day 1-7

23. What is the murmur of mitral valve prolapse?
Endocarditis of prosthetic valves
Mid - systolic click followed by regurgitation murmur
Hemosiderin laden macrophages
Cardiac tamponade

24. Lower extremity cyanosis in infants? In adults?
Infantile coarctation of the aorta PDA
Right side - serotonin and other secretory products detoxified in the lung
Systemic venous congestion
Asymptomatic

25. What coronary arterysupplies the lateral wall of the LV?
Anitschow cell
Small vegetations along the line of closure
Circumflex
Papillary muscle - free wall - IV septum

26. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Colon cancer
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Streptococcus viridans
Type I

27. What congenital heart defect often is present with infantile coarctation of the aorta?
Granulation tissue
PDA
Anitschow cell
Ischemic heart disease

28. What cardiac disease is associated with tuberous sclerosis?
Ventricles cannot pump
Rhabdomyoma
Reperfusion injury
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

29. In which chamber of the heart are cardiac myxomas found?
Dilated
LA
Coxsackie A or B
RCA

30. How does hypertension cause LHF?

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31. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Months out fibrosis
S aureus
20 min

32. Tx for PDA?
Endocardial fibroelastosis (rare)
Prophylactic abx during dental procedures
Pump failure
Indomethacin - decreases PGE

33. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Aortic regurg
Pts w/previously damaged valves
Sudden cardiac death

34. 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.
45%
Stable angina
Maternal diabetes
PDA

35. Holosystolic blowing murmur that increases w/expiration?
2-3%
Mitral regurg
Tender lesions on fingers or toes.
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

36. What is the foundation of a scar?
LV dilation and eccentric hypertrophy
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Reactive histiocyte with caterpillar nucleus
Granulation tissue

37. What causes mitral valve prolapse?
Squat in response to cyanotic spell
Myxoid degeneration
Systemic venous congestion
RHF

38. What type of shunt does truncus arteriosus cause?
Ischemic heart disease
Reperfusion injury
Gelatinous - abundant ground substance
R-->L

39. What compensatory mechanism do tetralogy of fallot pts learn?
Endocarditis of prosthetic valves
Mitral and tricuspid regurg - arrhythmia
Squat in response to cyanotic spell
Paradoxical emboli

40. What characterizes acute rheumatic fever endocarditiis?
Months out fibrosis
2-3%
Small vegetations along the line of closure
PDA

41. Pericarditis 6-8 wks post MI.
Stable angina
Restrictive cardiomyopathy
Limits thrombosis
Dressler syndrome

42. How does stable angina present?
Nonspecific - eg fever and elevated ESR
Regurg vs stenosis
IV drug users
Chest pain <20 min brought on by exertion or emotional stress

43. What is the most common cause of dilated cardiomyopathy? What are other causes?
RBC damaged while crossing the calcified valve causing schistocytes
Infantile coarctation of the aorta PDA
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations

44. What are the laboratory findings of bacterial endocarditis?
Holosystolic machine like murmur
LAD
PDA
Positive blood cultures anemia of chronic disease

45. What is the cause of restrictive cardiomyopathy in children?
Endocardial fibroelastosis (rare)
Mitral regurg
R-->L
Nitroglycerin

46. What is the major cause of MI?
PDA
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
Inability to fill ventricles
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

47. What causes the dependent pitting edema in RHF?
Myofiber hypertrophy with disarray
Annular - non pruritic rash w/erythematous borders trunks and limbs
Increased hydrostatic pressure
Bicuspid aortic valve

48. What gross and microscopic changes occur 1-3 days after an MI?
Yellow pallor neutrophils
Sudden cardiac death
Wear and tear
Blood vessels coming in from normal tissue

49. Which congenital heart defect is associated with maternal diabetes?
Infectious endocarditis
Transposition of the great vessels
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Dilation of all four chambers of the heart

50. What are the sx of hypertrophic cardiomyopathy?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
R-->L