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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. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Prinzmetal stable and unstable
Mitral insufficiency
Anitschow cell
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

2. How does MI cause LHF?
45%
Ehlers - Danlow and Marfan syndrome
Papillary muscle - free wall - IV septum
Loss of LV fx

3. What is the basic principle of CHF?
ACE inhibitor
Pump failure
Degree of pulmonary artery stenosis
Aneurysm - mural thrombus - Dressler syndrome

4. What type of tumor is a rhabdomyoma?
Trisomy 21
Hypertophy of RV atrophy of LV
Harmartoma
Aneurysm - mural thrombus - Dressler syndrome

5. What is the characteristic murmur of aortic stenosis?
Aortic regurg
Libman - Sacks endocarditis
Systolic ejection click followed by crescendo - decrescendo murmur
Mitral regurg

6. What % of MIs involve the LAD?
45%
Tuberous sclerosis
Concentric LV hypertophy
R-->L

7. What always follows necrosis?
Reactive histiocyte with caterpillar nucleus
Acute inflammation
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

8. When do macrophagess infiltrate the myocardium post MI?
Indomethacin - decreases PGE
Congestive heart failure
4-7 days
Acute inflammation

9. What is an Anitschow cell?
Reactive histiocyte with caterpillar nucleus
Tender lesions on fingers or toes.
Right -->left
Breast and lung carcinoma - melanoma - lymphoma

10. What is diastolic dysfx?
Ehlers - Danlow and Marfan syndrome
Coronary artery vasospasm - emboli - vasculitis
Intercostal arteries enlarged due to collateral circulation
Inability to fill ventricles

11. Dilated cardiomyopathy is a late complication of what illness?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
PDA
Opening snap followed by diastolic rumble
Myocarditis

12. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Tricuspid
Aneurysm - mural thrombus - Dressler syndrome
Months out fibrosis
45%

13. Large vegetations on tricuspid valve?
Concentric LV hypertophy
Annular - non pruritic rash w/erythematous borders trunks and limbs
Infectious
S aureus

14. What valves are most commonly involved in chronic rheumatic heart disease?
Mitral mitral+aortic
Infectious endocarditis - arrythmias - severe mitral regurg no
4-7 days
Myocarditis

15. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Dark discoloration coagulative necrosis
Shunt - PGE to maintain PDA until surgical repair can be performed
Contraction band necrosis
Reperfusion injury

16. What is typically the mechanims of sudden cardiac death?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Ischemic heart disease
Ventricular arrhythmia
Systemic venous congestion

17. What type of shunt does transposition of the great vessels cause?
Pancarditis
Sudden cardiac death
R-->L
LV dilation and eccentric hypertrophy

18. In transposition of the great vessels - What is required for survival? How is this achieved?
Shunt - PGE to maintain PDA until surgical repair can be performed
LAD
ASD - R-->L
Mid - systolic click followed by regurgitation murmur

19. What characterizes acute rheumatic fever endocarditiis?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Small vegetations along the line of closure
Congestive heart failure
Papillary muscle - free wall - IV septum

20. Which artery is most often occluded in an MI?
LAD
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Infectious
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

21. What is the most common congenital heart defect?
Small vegetations along the line of closure
VSD
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
Heart can't fill

22. Ostium primum ASD is associated with what congenital disorder?
Trisomy 21
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
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

23. What are the clinical features of LHF due to?
Bounding pulse
Reperfusion injury
Decreased forward perfusion pulmonary congestion
Mitral mitral+aortic

24. What is the tx for LHF?
ACE inhibitor
Boot shaped heart
LHF
Chest pain <20 min brought on by exertion or emotional stress

25. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
4-7 days macrophage infiltration
Elevated ASO anti - DNase B titers
Prinzmetal angina
LA dilation

26. How does restrictive cardiomyopathy present?
S epidermidis
Congestive heart failure
IV drug users
Sudden cardiac death

27. What effect does aortic stenosis have on the chambers of the heart?
Congestive heart failure
Concentric LV hypertophy
Migratory polyarthritis
Blood vessels coming in from normal tissue

28. When is an MI patent at highest risk for fibrionous pericarditis?
LAD
2-3 weeks
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
1-3 days out

29. What are Janeway lesions?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Hypercoagulable state or underlying adenocarcinoma
Erythematous nontender lesions on palms and soles.
PDA

30. What side of the heart do carcinoid tumors affect? Why?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
3-8 wks
Right side - serotonin and other secretory products detoxified in the lung
Squatting - increased systemic resistence decreases LV emptying

31. Which congenital heart defect is associated with congenital rubella?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
PDA
Myofiber hypertrophy with disarray
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

32. What coronary arterysupplies the lateral wall of the LV?
Paradoxical emboli
S aureus
Bicuspid aortic valve
Circumflex

33. What does rupture of the IV septum cause?
Dressler syndrome
Asymptomatic
4-24 hours
Shunt

34. Which vasculitis can cause MI?
Kawasaki disease
Coronary artery vasospasm - emboli - vasculitis
When a bacterial protein resembles a protein in human tissue
Increased hydrostatic pressure

35. What congenital heart defect does indomethacin tx?
PDA
Mitral regurg
Colon cancer
NG or Ca channel blocker

36. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Within the first day
Coxsackie A or B
Degree of pulmonary artery stenosis

37. When do neutrophils infiltrate the myocardium post MI?
1-3 days
Acute inflammation
CK- MB
Prinzmetal angina - cocaine

38. Which chambers of the heart are generally spared in an MI?
Atria and RV
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Sterile vegetations on mitral valve along lines of closure
Ventricular arrhythmia

39. EKG for stable angina?
Coxsackie A or B
4-6 hours - 24 hours - 72 hours
ST- segment depression
Systolic dysfx leading to biventricular CHF

40. What is the rate of congenital heart defects?
Libman - Sacks endocarditis
1%
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Prinzmetal angina - cocaine

41. What gross and microscopic changes occur 1-3 weeks after an MI?
Volume overload and LHF
Red border granulation tissue
Loss of LV fx
Trisomy 21

42. What causes notching of the ribs in adult coarctation of the aorta?
Intercostal arteries enlarged due to collateral circulation
Restrictive cardiomyopathy
MI
Right -->left

43. How does contraction band necrosis occur?
Mitral insufficiency
Pump failure
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

44. What is the gross and microscopic appearance of cardiac myxomas?
S viridans
Months out fibrosis
Cardiogenic shock - CHF - arrhythmia
Gelatinous - abundant ground substance

45. When do CK- MB levels rise - peak - and return to normal?
Minimizes ischemia
Sterile vegetations on surface and undersurface on mitral valve
NG or Ca channel blocker
4-6 hours - 24 hours - 72 hours

46. What are the cancers that most commonly metastasize to the heart?
Holosystolic blowing murmur
Breast and lung carcinoma - melanoma - lymphoma
ST- segment elevation
Aneurysm - mural thrombus - Dressler syndrome

47. What heart sound manifest with an ASD?
Acute inflammation
Split S2 on auscultation
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

48. What is Loeffler syndrome?
Infectious endocarditis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

49. What valves are involved in rhuematic endocarditis?
4-6 hours - 24 hours - 72 hours
Hypertophy of RV atrophy of LV
Mitral mitral+aortic
Systolic ejection click followed by crescendo - decrescendo murmur

50. Is injury due angina reversible or irreversible?
VSD
Thickening of chrodae tendinae and cusps - mitral stenosis
Reversible
Myofiber hypertrophy with disarray