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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. When does the heart have a yellow pallor post MI?
Valve replacement AFTER the onset of complications
Systemic venous congestion
Day 1-7
Fibrinous pericarditis

2. What gross and microscopic changes occur 4-24 hours after an MI?
Dark discoloration coagulative necrosis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Reperfusion injury

3. What gross and microscopic changes occur 1-3 days after an MI?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
S epidermidis
Aschoff bodies
Yellow pallor neutrophils

4. What does rupture of the LV free wall cause?
Infantile coarctation of the aorta PDA
Cardiac tamponade
Mitral insufficiency
CHF

5. When is an MI patent at highest risk for fibrionous pericarditis?
1-3 days out
Fetal alcohol syndrome
2-3 weeks
Group A beta - hemolytic streptococci

6. What is cardiogenic shock?
Hypertrophic cardiomyopathy
Inability to maintain systemic pressure w/lack of O2 to vital organs
Yellow pallor macrophages
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

7. What is the main cause of MV regurg? What are other causes?
Mitral regurg
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Transposition of the great vessels
RCA

8. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
First 4 hours
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Yellow pallor macrophages

9. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Tender lesions on fingers or toes.
Valve scarring that arises as a consequence of rheumatic fever
Infantile coarctation of the aorta

10. When does the heart have dark discoloration post MI?
4-24 hours
Ventricle
Pts w/previously damaged valves
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

11. What is chronic rheumatic heart disease?
Dilation of all four chambers of the heart
Squatting - increased systemic resistence decreases LV emptying
Valve scarring that arises as a consequence of rheumatic fever
Annular - non pruritic rash w/erythematous borders trunks and limbs

12. What are complications of dilated cardiomyopathy?
RCA
Mitral and tricuspid regurg - arrhythmia
4-6 hours - 24 hours - 72 hours
Myocarditis

13. What is the most common cause of mitral stenosis?
S aureus
Rhabdomyoma
Infectious endocarditis
Chronic rheumatic heart disease

14. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Myxoma - benign
Atherosclerosis of coronary arteries
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Migratory polyarthritis

15. How does transmural MI/ischemia present on EKG?
ST- segment elevation
Mitral stenosis
Heart transplant
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

16. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Loeffler syndrome
Pericarditits
Hypertrophic cardiomyopathy
Circumflex

17. How do beta blockers tx MI?
Shunt - PGE to maintain PDA until surgical repair can be performed
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Slow HR - decreasing O2 demand and risk for arrhythmia

18. Large vegetations on tricuspid valve?
Reversible
Metastasis
Streptococcus viridans
S aureus

19. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Pts w/previously damaged valves
Adult coarctation of the aorta
Doxorubicin - cocaine
PDA

20. Friction rub and chest pain.
Pericarditits
Contraction band necrosis - reperfusion injury
Tetralogy of fallot
IV drug users

21. EKG for stable angina?
Rhabdomyoma
Myocarditis in acute rheumatic heart fever
SLE
ST- segment depression

22. With what condition are rhabdomyomas associated?
Tuberous sclerosis
CK- MB
Libman - Sacks endocarditis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

23. Turner syndrome is associated with which congenital heart defect?
4-6 hours - 24 hours - 72 hours
Mid - systolic click followed by regurgitation murmur
Transesophageal echo
Infantile coarctation of the aorta

24. What is the major cause of MI?
Aortic stenosis
Plump fibroblasts - collagen - blood vessels
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

25. What imaging test is useful for detecting lesions on valves?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Tricuspid
Transesophageal echo
Stretched muscle loses contractility

26. Sudden death in a young athlete.
Heart can't fill
Decrease in blood flow to an organ
Hypertrophic cardiomyopathy
45%

27. What is migratory polyarthritis?
Sterile vegetations on surface and undersurface on mitral valve
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
PGE
LAD

28. What effect does transposition of the great vessels have on the ventricles?
Acute inflammation
Hypertophy of RV atrophy of LV
Large - destructive vegetations
Rhadbomyoma - benign

29. What type of shunt results in cyanosis at birth?
PDA
Hypertrophic cardiomyopathy
Right to left
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

30. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Aschoff bodies
PDA
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

31. What is the most common cause of dilated cardiomyopathy? What are other causes?
Contraction band necrosis
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Reperfusion injury
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

32. What type of shunt does ASD cause?
Left -->right
Holosystolic blowing murmur
Red border granulation tissue
Troponin I

33. What does chronic ischemic heart disease progress to?
Tender lesions on fingers or toes.
Colon cancer
Asymptomatic
CHF

34. What conditions can cause nonbacterial thrombotic endocarditis?
Hypercoagulable state or underlying adenocarcinoma
Myocarditis
Dark discoloration coagulative necrosis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

35. What is the most common type of ASD? What %?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Ostium secundum (90%)
Coxsackie A or B
Fibrosis and dystrophic calcification

36. What does Libman - Sacks endocarditis cause?
Hypertophy of RV atrophy of LV
Squatting - increased systemic resistence decreases LV emptying
4-7 days
Mitral regurg

37. Ostium primum ASD is associated with what congenital disorder?
Right to left
Trisomy 21
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
First 4 hours

38. What are the complications of mitral stenosis?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Transposition of the great vessels
CHF
Ehlers - Danlow and Marfan syndrome

39. What does a biopsy of hypertrophic cardiomyopathy look like?
Minimizes ischemia
Myofiber hypertrophy with disarray
Mitral mitral+aortic
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

40. What effect does aortic stenosis have on the chambers of the heart?
Concentric LV hypertophy
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
RCA
Annular - non pruritic rash w/erythematous borders trunks and limbs

41. What cardiac disease is associated with tuberous sclerosis?
PDA
Rhabdomyoma
Acute inflammation
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

42. When is an MI pt at greatest risk for cardiogenic shock?
Aortic stenosis
First 4 hours
Valve replacement AFTER the onset of complications
Mitral regurg

43. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
4-24 hours
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Fibrinous pericarditis
Fibrosis and dystrophic calcification

44. What makes the MV prolapse murmur louder? Why?
Nitroglycerin
Squatting - increased systemic resistence decreases LV emptying
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Maternal diabetes

45. Erythematous nontender lesions on palms and soles.
Tetralogy of fallot
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Anitschow cell
Janeway lesions

46. What are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Atherosclerosis of coronary arteries
Osler nodes (ouch - ouch Osler)
Bicuspid aortic valve

47. What causes a mid - systolic click followed by a regurgitation murmur?
Months out fibrosis
Group A beta - hemolytic streptococci
Concentric LV hypertophy
Mitral valve prolapse

48. Which chambers of the heart are generally spared in an MI?
Atria and RV
Transesophageal echo
Streptococcus bovis/
Valve replacement

49. How long after pharyngitis does acute rheumatic fever occur?
Mitral regurg
Shunt
2-3 weeks
Mid - systolic click followed by regurgitation murmur

50. What always follows necrosis?
Surgical closure small defects may close spontaneously
Tricuspid
Acute inflammation
Myxoid degeneration