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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 genetic conditions predispose a pt to mitral valve prolapse?
Sterile vegetations on surface and undersurface on mitral valve
Indomethacin - decreases PGE
Aneurysm - mural thrombus - Dressler syndrome
Ehlers - Danlow and Marfan syndrome

2. What causes heart failure cells?
Minimizes ischemia
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Myocarditis
Tender lesions on fingers or toes.

3. With what disease is infantile coarctation of the aorta associated?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Trisomy 21
Dressler syndrome
Turner syndrome

4. What characterizes acute rheumatic fever endocarditiis?
Small vegetations along the line of closure
PDA
Maternal diabetes
Streptococcus viridans

5. What type of vegetations are associated with Libman - Sacks endocarditis?
Sterile vegetations on surface and undersurface on mitral valve
Prinzmetal
45%
Preductal - post aortic arch

6. What are the causes of restrictive cardiomyopathy in adults?
IV drug users
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
ST- segment elevation
Infectious endocarditis

7. When is an MI patent at highest risk for fibrionous pericarditis?
Aschoff bodies
1-3 days out
PDA
S epidermidis

8. In transposition of the great vessels - What is required for survival? How is this achieved?
Myocardium
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Shunt - PGE to maintain PDA until surgical repair can be performed
Granulation tissue

9. Which angina(s) show ST elevation on EKG? ST depression?
Prinzmetal stable and unstable
IV drug users
S viridans
Low voltage EKG w/diminished QRS amplitude

10. What is the most common cause of infectious endocarditis?
Transesophageal echo
Adult coarctation of the aorta
Streptococcus viridans
Elevated ASO anti - DNase B titers

11. Erythematous nontender lesions on palms and soles.
Endocardial fibroelastosis
Decrease in blood flow to an organ
Plump fibroblasts - collagen - blood vessels
Janeway lesions

12. What coronary arterysupplies the lateral wall of the LV?
Split S2 on auscultation
3-8 wks
Circumflex
Mitral mitral+aortic

13. What effect does aortic stenosis have on the chambers of the heart?
Loeffler syndrome
Concentric LV hypertophy
Cardiogenic shock - CHF - arrhythmia
Coxsackie A or B

14. Dilated cardiomyopathy is a late complication of what illness?
20 min
Myocarditis
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
Anitschow cell

15. Ostium primum ASD is associated with what congenital disorder?
Valve replacement AFTER the onset of complications
Bacterial endocarditis
Congenital rubella
Trisomy 21

16. Myofiber hypertrophy with disarray.
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Hypertrophic cardiomyopathy
PGE
Hypercoagulable state or underlying adenocarcinoma

17. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
RHF
PGE
Slow HR - decreasing O2 demand and risk for arrhythmia

18. What is the effect of mitral regurg on the heart?
Right -->left
Volume overload and LHF
Decrease in blood flow to an organ
Shunt

19. Turner syndrome is associated with which congenital heart defect?
Infantile coarctation of the aorta
Infectious endocarditis - arrythmias - severe mitral regurg no
Maternal diabetes
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

20. What are Osler nodes?
Restrictive cardiomyopathy
Hypercoagulable state or underlying adenocarcinoma
MI
Tender lesions on fingers or toes.

21. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Positive blood cultures anemia of chronic disease
Aschoff bodies
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

22. What congenital heart defect is associated with fetal alcohol syndrome?
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Myocarditis
Sterile vegetations on mitral valve along lines of closure
VSD

23. What is the characteristic murmurr of mitral stenosis?
Aneurysm - mural thrombus - Dressler syndrome
Tetralogy of fallot
Prinzmetal angina
Opening snap followed by diastolic rumble

24. Infects predamaged valves after transient bacteremia?
Mitral regurg
S viridans
Prophylactic abx during dental procedures
Rupture of free wall - IV septum - or papillary muscle

25. What is the gold standard blood marker for MI?
Myxoma - benign
Endocardial fibroelastosis (rare)
Infectious endocarditis
Troponin I

26. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
PDA
Ventricle
Prinzmetal angina

27. What side of the heart do carcinoid tumors affect? Why?
Right side - serotonin and other secretory products detoxified in the lung
Pericarditits
Hemosiderin laden macrophages
Right -->left

28. What does rupture of the LV free wall cause?
Dilation of all four chambers of the heart
Fibrosis and dystrophic calcification
Cardiac tamponade
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

29. What causes wear and tear aortic stenosis?
Fibrosis and dystrophic calcification
Coronary artery vasospasm
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

30. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Stable and unstable prinzmetal
Nitroglycerin

31. What is eythema marginatum? What parts of the body does it commonly involve?
20 min
Tuberous sclerosis
Atherosclerosis of coronary arteries
Annular - non pruritic rash w/erythematous borders trunks and limbs

32. When does the heart have a yellow pallor post MI?
Day 1-7
Mitral and tricuspid regurg - arrhythmia
Volume overload and LHF
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

33. How does contraction band necrosis occur?
Contraction band necrosis - reperfusion injury
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Transesophageal echo
Janeway lesions

34. How does hypertension cause LHF?

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35. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Hypertrophic cardiomyopathy
Myocarditis in acute rheumatic heart fever
Louder - increased systemic resistence decreases LV emptying
ACE inhibitor

36. Lower extremity cyanosis later in life - holostystolic machine like murmur.
Congestive heart failure
SLE
PDA
3-8 wks

37. What effect does mitral stenosis have on the heart chambers?
Systolic dysfx leading to biventricular CHF
LAD
LA dilation
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

38. In which chamber of the heart are rhabdomyomas found?
Prinzmetal
Indomethacin - decreases PGE
Stable angina
Ventricle

39. When would arrhythmia occur after MI?
Red border granulation tissue
Myocarditis
Within the first day
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

40. What gross and microscopic changes occur months after an MI?
Anterior wall of LV and anterior septum
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Tuberous sclerosis
White scar fibrosis

41. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
Libman - Sacks endocarditis
Stretched muscle loses contractility
MI
Endocarditis of prosthetic valves

42. What does Libman - Sacks endocarditis cause?
Janeway lesions
Doxorubicin - cocaine
Mitral regurg
Backward LHF pulm htn and RHF - afib and associated mural thombis

43. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
ASD - R-->L
Hypertrophic cardiomyopathy
Decreased forward perfusion pulmonary congestion
1-3 days out

44. What compensatory mechanism do tetralogy of fallot pts learn?
Squat in response to cyanotic spell
Prophylactic abx during dental procedures
RCA
Ventricular arrhythmia

45. What generally causes ischemic heart disease?
Thickening of chrodae tendinae and cusps - mitral stenosis
Months out fibrosis
Congestive heart failure
Atherosclerosis of coronary arteries

46. How long after pharyngitis does acute rheumatic fever occur?
RCA
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
2-3 weeks
Backward LHF pulm htn and RHF - afib and associated mural thombis

47. What is migratory polyarthritis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Circumflex
Intercostal arteries enlarged due to collateral circulation
PDA

48. Holosystolic blowing murmur that increases w/expiration?
Libman - Sacks endocarditis
Months out fibrosis
Mitral regurg
20 min

49. How does O2 tx MI?
SLE
Minimizes ischemia
RCA
Systolic ejection click followed by crescendo - decrescendo murmur

50. What structures are susceptible to rupture post MI?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
When a bacterial protein resembles a protein in human tissue
Myofiber hypertrophy with disarray
Papillary muscle - free wall - IV septum