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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 cause of restrictive cardiomyopathy in children?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Kawasaki disease
Endocardial fibroelastosis (rare)
Harmartoma

2. What heart sound manifest with an ASD?
Elevated ASO anti - DNase B titers
Split S2 on auscultation
Valve replacement
Decrease preload -->lowers myocardial stress

3. What is typically the mechanims of sudden cardiac death?
Congenital rubella
Ventricular arrhythmia
IV drug users
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

4. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
4-7 days
Erythematous nontender lesions on palms and soles.
Ostium secundum (90%)
Myxoma - benign

5. What congenital heart defect is associated with fetal alcohol syndrome?
Small - nondestructive vegetations (subacute endocarditis)
1%
VSD
>70%

6. What is a water - hammer pulse?
Concentric LV hypertophy
Osler nodes (ouch - ouch Osler)
Bounding pulse
Dark discoloration coagulative necrosis

7. With what condition are rhabdomyomas associated?
Tuberous sclerosis
Libman - Sacks endocarditis
ASD - R-->L
Limits thrombosis

8. What is the most common congenital heart defect?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
LAD
VSD
AD mutation in sarcomere proteins

9. What are the causes of restrictive cardiomyopathy in adults?
Coronary artery vasospasm - emboli - vasculitis
When a bacterial protein resembles a protein in human tissue
Prophylactic abx during dental procedures
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

10. EKG for stable angina?
ST- segment depression
Chronic ischemic heart disease
Mitral stenosis
Increased blood in right heart delays closure of P valve

11. What generally causes ischemic heart disease?
Ehlers - Danlow and Marfan syndrome
Janeway lesions
Increased blood in right heart delays closure of P valve
Atherosclerosis of coronary arteries

12. How do you prevent S viridans endocarditis?
Coexisting mitral stenosis and fusion of commisures exist
Months out fibrosis
Prophylactic abx during dental procedures
Indomethacin - decreases PGE

13. What gross and microscopic changes occur 4-7 days after an MI?
Infectious
Janeway lesions
Yellow pallor macrophages
S viridans

14. What does rupture of a papillary muscle cause?
Mitral insufficiency
VSD
Autoimmune pericarditis 6-8 wks post MI
Decreases LV dilation by decreasing volume

15. L- to - R shunt switching to R- to - L shunt.
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Low voltage EKG w/diminished QRS amplitude
Eisenmenger syndrome
Fetal alcohol syndrome

16. With what disease is transposition of the great vessels associated?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Maternal diabetes
Squat in response to cyanotic spell
Heart transplant

17. What is the murmur of mitral regurg?
Congestive heart failure
Coxsackie A or B
Holosystolic blowing murmur
Small - nondestructive vegetations (subacute endocarditis)

18. Why would cardiac enzymes continue to increase after the initial MI?
PDA
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Fibrosis and dystrophic calcification
Reperfusion injury

19. What complications occur within 4 hrs post MI?
Cardiogenic shock - CHF - arrhythmia
Preductal - post aortic arch
Gelatinous - abundant ground substance
Reactive histiocyte with caterpillar nucleus

20. What increases the volume of mitral regurg murmur?
Squatting - expiration
Myocarditis in acute rheumatic heart fever
Ventricles cannot pump
Autoimmune pericarditis 6-8 wks post MI

21. What artery is the 2nd most often occluded in an MI?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
NG or Ca channel blocker
Right to left
RCA

22. What are the complications of aortic stenosis?
Tetralogy of fallot
Prophylactic abx during dental procedures
Blood vessels coming in from normal tissue
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

23. What are the Jones criteria?
Loeffler syndrome
Small vegetations along the line of closure
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Left -->right

24. What is the rate of mitral valve prolapse in the US?
Tuberous sclerosis
Prinzmetal stable and unstable
Fetal alcohol syndrome
2-3%

25. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
Autoimmune pericarditis 6-8 wks post MI
Circumflex
Hypercoagulable state or underlying adenocarcinoma

26. What are the clinical features of RHF due to?
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Congenital rubella
Systemic venous congestion
Mitral insufficiency

27. What causes acute endocarditis?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Large vegetations of S aureus
Rhabdomyoma
Heart can't fill

28. Which angina is relieved by Ca channel blockers?
Elevated ASO anti - DNase B titers
Hypertophy of RV atrophy of LV
Prinzmetal
Small vegetations along the line of closure

29. When do CK- MB levels rise - peak - and return to normal?
Blood vessels coming in from normal tissue
Within the first day
Infectious
4-6 hours - 24 hours - 72 hours

30. What is the tx for aortic stenosis?
Mitral mitral+aortic
Valve replacement AFTER the onset of complications
White scar fibrosis
Open blocked vessels

31. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Infantile coarctation of the aorta PDA
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Myocardium
Mitral valve prolapse

32. What are the sx of PDA at birth?
Osler nodes (ouch - ouch Osler)
Coexisting mitral stenosis and fusion of commisures exist
Wear and tear
Asymptomatic

33. What valves are most commonly involved in chronic rheumatic heart disease?
ST- segment depression
Mitral mitral+aortic
Small - nondestructive vegetations (subacute endocarditis)
Transposition of the great vessels

34. Why are cardiac enzymes elevated after an MI?
Infantile coarctation of the aorta PDA
Membrane damage
Systolic dysfx leading to biventricular CHF
Rhabdomyoma

35. What cardiac disease is associated with tuberous sclerosis?
Anitschow cell
Inability to maintain systemic pressure w/lack of O2 to vital organs
LHF
Rhabdomyoma

36. What bug causes acute rheumatic fever?
R-->L
Group A beta - hemolytic streptococci
Granulation tissue
Months out fibrosis

37. With what developmental disorder is VSD associated?
Contraction band necrosis
Turner syndrome
Fetal alcohol syndrome
Right to left

38. Sudden death in a young athlete.
Membrane damage
Myocarditis
Migratory polyarthritis
Hypertrophic cardiomyopathy

39. What is the 1day-1wk -1mo mneumonic for MI?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Slow HR - decreasing O2 demand and risk for arrhythmia
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

40. What are Janeway lesions?
Myofiber hypertrophy with disarray
Erythematous nontender lesions on palms and soles.
Asymptomatic
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

41. What are the major criteria of the Jones criteria?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
MI
Coronary artery vasospasm - emboli - vasculitis
Large - destructive vegetations

42. 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
Bacterial endocarditis
Prinzmetal
When a bacterial protein resembles a protein in human tissue

43. How do you tx prinzmetal angina?
PGE
NG or Ca channel blocker
Thickening of chrodae tendinae and cusps - mitral stenosis
Coronary artery vasospasm

44. What is the characteristic murmur of aortic stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
Squat in response to cyanotic spell
Reactive histiocyte with caterpillar nucleus
Mitral regurgitation due to vegetations

45. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
3-8 wks
PDA
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

46. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Within the first day
Ischemic heart disease
Aortic regurg
Open blocked vessels

47. What effect does transposition of the great vessels have on the ventricles?
Colon cancer
Concentric LV hypertophy
Hypertophy of RV atrophy of LV
Myofiber hypertrophy with disarray

48. What does rupture of the IV septum cause?
Shunt
Loss of LV fx
Spontaneous
Blood vessels coming in from normal tissue

49. What type of vegetations form in nonbacterial thrombotic endocarditis?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
ST- segment depression
Sterile vegetations on mitral valve along lines of closure
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

50. What imaging test is useful for detecting lesions on valves?
Dilation of all four chambers of the heart
Rupture of free wall - IV septum - or papillary muscle
Mitral regurg
Transesophageal echo