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Cardiac

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. Is injury due angina reversible or irreversible?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Reversible
Friction rub and chest pain
Congestive heart failure

2. Myofiber hypertrophy with disarray.
Tricuspid
Hypertrophic cardiomyopathy
2-3%
Slow HR - decreasing O2 demand and risk for arrhythmia

3. What is the most common cause of infectious endocarditis?
Holosystolic machine like murmur
Infectious endocarditis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Streptococcus viridans

4. What are the sx of cardiac myxoma?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Decrease preload -->lowers myocardial stress
Mitral regurg
Pedunculated mass in the LA that causes syncope due to obstruction of MV

5. What is an Anitschow cell?
Transesophageal echo
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Kawasaki disease
Reactive histiocyte with caterpillar nucleus

6. With what condition are rhabdomyomas associated?
Yellow pallor neutrophils
Prinzmetal angina - cocaine
Tuberous sclerosis
RHF

7. At what point in development do congenital heart defects arise?
RCA
S aureus
Bounding pulse
3-8 wks

8. When do macrophagess infiltrate the myocardium post MI?
4-7 days
Increased hydrostatic pressure
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Libman - Sacks endocarditis

9. Lower extremity cyanosis in infants? In adults?
4-24 hours
Infantile coarctation of the aorta PDA
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Low voltage EKG w/diminished QRS amplitude

10. What causes heart failure cells?
Right side - serotonin and other secretory products detoxified in the lung
PDA
Preductal - post aortic arch
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

11. When would arrhythmia occur after MI?
Myocarditis
ST- segment elevation
Transposition of the great vessels
Within the first day

12. What causes wear and tear aortic stenosis?
Fibrosis and dystrophic calcification
Doxorubicin - cocaine
Reversible
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

13. How do you tx prinzmetal angina?
Sudden cardiac death
Bacterial endocarditis
NG or Ca channel blocker
S aureus

14. What cardiac disease is associated with tuberous sclerosis?
IV drug users
Rhabdomyoma
Mitral mitral+aortic
MI

15. What are the complications of mitral valve prolapse? Are they common?
L->R
Blood vessels coming in from normal tissue
Infectious endocarditis - arrythmias - severe mitral regurg no
Papillary muscle - free wall - IV septum

16. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Prinzmetal angina
Infectious endocarditis - arrythmias - severe mitral regurg no
Right side - serotonin and other secretory products detoxified in the lung

17. What are other (not atherosclerotic) causes of MI?
Mitral mitral+aortic
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Coronary artery vasospasm - emboli - vasculitis
LAD

18. What is the 1day-1wk -1mo mneumonic for MI?
Systolic dysfx leading to biventricular CHF
Inability to fill ventricles
Mitral regurg
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

19. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Coexisting mitral stenosis and fusion of commisures exist
2-3%
Blood vessels coming in from normal tissue
Valve replacement

20. What are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Chronic ischemic heart disease
Infantile coarctation of the aorta
Mitral stenosis

21. What complication occurs 1-3 days post MI?
First 4 hours
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Type I
Fibrinous pericarditis

22. With what developmental disorder is VSD associated?
4-7 days
Fetal alcohol syndrome
Infectious endocarditis
Heart can't fill

23. What are the major criteria of the Jones criteria?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Prinzmetal angina
Prinzmetal stable and unstable
Adult coarctation of the aorta

24. What does chronic ischemic heart disease progress to?
Cardiogenic shock - CHF - arrhythmia
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
CHF
Systemic venous congestion

25. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
RHF
Doxorubicin - cocaine
Ischemic heart disease
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

26. What drug relieves stable angina?
Squatting - expiration
Nitroglycerin
Membrane damage
Large vegetations of S aureus

27. Which chambers of the heart are generally spared in an MI?
Atria and RV
Sudden cardiac death
Nitroglycerin
Thickening of chrodae tendinae and cusps - mitral stenosis

28. What does Libman - Sacks endocarditis cause?
Mitral regurg
Circumflex
Squatting - expiration
Coronary artery vasospasm

29. How do nitrates tx MI?
Loeffler syndrome
Dilated
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Decrease preload -->lowers myocardial stress

30. What are the causes of restrictive cardiomyopathy in adults?
ST- segment depression
Aortic regurg
Friction rub and chest pain
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

31. With what endocarditis is S epidermidis associated?
L->R
Holosystolic blowing murmur
Dark discoloration coagulative necrosis
Endocarditis of prosthetic valves

32. What is the main cause of MV regurg? What are other causes?
Adult coarctation of the aorta
Libman - Sacks endocarditis
Stretched muscle loses contractility
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

33. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
>60 years - bicuspid aortic valve
Aortic regurg
Hypercoagulable state or underlying adenocarcinoma
Metastasis

34. What congenital heart defect presents later in life with lower extremity cyanosis?
Coxsackie A or B
Aortic regurg
PDA
Indomethacin - decreases PGE

35. What vavular defect results from acute rheumatic fever?
Reperfusion injury
Breast and lung carcinoma - melanoma - lymphoma
Low voltage EKG w/diminished QRS amplitude
Mitral regurgitation due to vegetations

36. What disesase has Aschoff bodies?
Right side - serotonin and other secretory products detoxified in the lung
Boot shaped heart
Contraction band necrosis - reperfusion injury
Myocarditis in acute rheumatic heart fever

37. What are the sx of aortic regurg?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Aortic regurg
Valve replacement once LV dysfx develops

38. What genetic conditions predispose a pt to mitral valve prolapse?
2-4 hours - 24 hours - 7-10 days
Hypertrophic cardiomyopathy
PGE
Ehlers - Danlow and Marfan syndrome

39. What is a common complication of cardiac metastasis?
Mid - systolic click followed by regurgitation murmur
Adult coarctation of the aorta
Pericardial effusion due to pericardial involvement
Ventricular arrhythmia

40. What maintains patency of the PDA?
Decrease preload -->lowers myocardial stress
PGE
Cardiogenic shock - CHF - arrhythmia
Congenital rubella

41. What is a complication of chronic rheumatic heart disease?
Congestive heart failure
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Infectious endocarditis
1-3 days out

42. Tender lesions on fingers or toes.
Stretched muscle loses contractility
Osler nodes (ouch - ouch Osler)
Open blocked vessels
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

43. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Friction rub and chest pain
Degree of pulmonary artery stenosis

44. What is the gross and microscopic appearance of cardiac myxomas?
Decrease in blood flow to an organ
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
CK- MB
Gelatinous - abundant ground substance

45. What effect does aortic regurg have on the pulse pressure? Why?
Regurg vs stenosis
Breast and lung carcinoma - melanoma - lymphoma
Sterile vegetations on mitral valve along lines of closure
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

46. When is an MI pt at greatest risk for cardiogenic shock?
Systolic dysfx leading to biventricular CHF
Fetal alcohol syndrome
First 4 hours
RCA

47. What is the most common type of ASD? What %?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Opening snap followed by diastolic rumble
Ostium secundum (90%)
Infectious endocarditis - arrythmias - severe mitral regurg no

48. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Myocarditis
Stretched muscle loses contractility
Mid - systolic click followed by regurgitation murmur

49. What causes endocarditis of prosthetic valves?
Indomethacin - decreases PGE
Coronary artery vasospasm - emboli - vasculitis
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
S epidermidis

50. What is the most common congenital heart defect?
>70%
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
VSD
Myocarditis in acute rheumatic heart fever