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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 dilated cardiomyopathy?
RBC damaged while crossing the calcified valve causing schistocytes
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Heart transplant
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

2. Which coronary artery supplies the anterior wall and anterior septum?
LAD
Louder - increased systemic resistence decreases LV emptying
Rhabdomyoma
Myocardium

3. What is the tx for mitral valve prolapse?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Backward LHF pulm htn and RHF - afib and associated mural thombis
Valve replacement
Tender lesions on fingers or toes.

4. How do you prevent S viridans endocarditis?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Prophylactic abx during dental procedures
Ostium secundum (90%)
Ehlers - Danlow and Marfan syndrome

5. Tx for PDA?
Migratory polyarthritis
Indomethacin - decreases PGE
Pulsating nail bed
Hemosiderin laden macrophages

6. What is the murmur of mitral regurg?
Decrease preload -->lowers myocardial stress
Holosystolic blowing murmur
Sudden cardiac death
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

7. What are the clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
ST- segment depression
Aortic stenosis

8. What always follows necrosis?
Acute inflammation
Mitral stenosis
Squatting - increased systemic resistence decreases LV emptying
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

9. What is an Anitschow cell?
Cardiac tamponade
Mitral valve prolapse
Reactive histiocyte with caterpillar nucleus
Reversible

10. Turner syndrome is associated with which congenital heart defect?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
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
Infantile coarctation of the aorta
Mitral and tricuspid regurg - arrhythmia

11. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
2-4 hours - 24 hours - 7-10 days
Aschoff bodies
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Gelatinous - abundant ground substance

12. What is the characteristic finding on CXR in tetralogy of fallot?
Bounding pulse
Reperfusion injury
Boot shaped heart
Decreased forward perfusion pulmonary congestion

13. What are the major criteria of the Jones criteria?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Infectious endocarditis
Slow HR - decreasing O2 demand and risk for arrhythmia
Holosystolic machine like murmur

14. How does fibrinolysis/angioplasty tx MI?
Cardiac tamponade
Anitschow cell
2-3%
Open blocked vessels

15. Pericarditis 6-8 wks post MI.
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Aortic regurg
Dressler syndrome
Ventricular arrhythmia

16. What causes unstable angina?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Congenital rubella
Yellow pallor macrophages
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

17. What type of shunt does transposition of the great vessels cause?
Mitral regurg
Large vegetations of S aureus
Coxsackie A or B
R-->L

18. What does chronic ischemic heart disease progress to?
CHF
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Colon cancer
Prophylactic abx during dental procedures

19. What does rupture of the LV free wall cause?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Cardiac tamponade
First 4 hours
Left -->right

20. When is an MI patent at highest risk for fibrionous pericarditis?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Degree of pulmonary artery stenosis
Loeffler syndrome
1-3 days out

21. How does adult coarctation of the aorta present?
Ventricles cannot pump
Myocarditis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
NG or Ca channel blocker

22. How does stable angina present?
Squatting - increased systemic resistence decreases LV emptying
Months out fibrosis
Fibrinous pericarditis
Chest pain <20 min brought on by exertion or emotional stress

23. What is the effect of mitral regurg on the heart?
Volume overload and LHF
Infectious endocarditis - arrythmias - severe mitral regurg no
Chronic rheumatic heart disease
Increased blood in right heart delays closure of P valve

24. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
Mitral regurgitation due to vegetations
Myocarditis
Troponin I

25. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
1-3 days
Hypertophy of RV atrophy of LV
Stable angina
Adult coarctation of the aorta

26. How does subendocardial MI/ischemia present on EKG?
ST- segment depression
S viridans
Rupture of free wall - IV septum - or papillary muscle
Small vegetations along the line of closure

27. What is the major cause of MI?
Nonspecific - eg fever and elevated ESR
L->R
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Volume overload and LHF

28. What is the most common form of cardiomyopathy?
Increased hydrostatic pressure
Dilated
Congested central veins
Libman - Sacks endocarditis

29. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Type I
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

30. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Ehlers - Danlow and Marfan syndrome
Tender lesions on fingers or toes.
Anitschow cell
LHF

31. What does a biopsy of hypertrophic cardiomyopathy look like?
Ventricles cannot pump
Myofiber hypertrophy with disarray
Aortic regurg
Autoimmune pericarditis 6-8 wks post MI

32. What are the sx of PDA at birth?
Asymptomatic
Inability to fill ventricles
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
PDA

33. What type of tumor is a rhabdomyoma?
Harmartoma
Minimizes ischemia
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Dressler syndrome

34. When is an MI pt at greatest risk for cardiogenic shock?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Colon cancer
First 4 hours
Paradoxical emboli

35. What heart sound manifest with an ASD?
Myocarditis in acute rheumatic heart fever
Friction rub and chest pain
Split S2 on auscultation
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

36. What is the JOneS mneumonic?
Slow HR - decreasing O2 demand and risk for arrhythmia
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
Small vegetations along the line of closure
Myocardium

37. What cardiac enzyme is useful for detecting reinfarction?
CK- MB
Bicuspid aortic valve
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Troponin I

38. What is the most common cause of mitral stenosis?
NG or Ca channel blocker
Membrane damage
Chronic rheumatic heart disease
Myocarditis in acute rheumatic heart fever

39. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
SLE
Elevated ASO anti - DNase B titers
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

40. What are the sx of cardiac myxoma?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
3-8 wks
Breast and lung carcinoma - melanoma - lymphoma

41. What are the sx of hypertrophic cardiomyopathy?
>70%
Cardiac tamponade
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Mitral and tricuspid regurg - arrhythmia

42. With what condition are rhabdomyomas associated?
3-8 wks
Tuberous sclerosis
ACE inhibitor
Red border granulation tissue

43. What are the clinical features of endocarditis? What causes each feature?
4-7 days
Coexisting mitral stenosis and fusion of commisures exist
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
Contraction band necrosis

44. With what virus is PDA associated?
Congenital rubella
Colon cancer
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Wear and tear

45. What is the most common cause of infectious endocarditis?
Streptococcus viridans
Squat in response to cyanotic spell
Blood vessels coming in from normal tissue
PDA

46. What are the laboratory findings of bacterial endocarditis?
Positive blood cultures anemia of chronic disease
S aureus
Prinzmetal stable and unstable
Contraction band necrosis - reperfusion injury

47. With what disease is infantile coarctation of the aorta associated?
Mitral stenosis
Paradoxical emboli
Turner syndrome
ST- segment depression

48. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Pts w/previously damaged valves
Aortic regurg
Months out fibrosis
Reperfusion injury

49. What is the most common congenital heart defect?
VSD
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
S aureus
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

50. Infects predamaged valves after transient bacteremia?
S viridans
Migratory polyarthritis
Valve replacement AFTER the onset of complications
Months out fibrosis