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Cardiac

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. Erythematous nontender lesions on palms and soles.
Blood vessels coming in from normal tissue
Contraction band necrosis - reperfusion injury
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Janeway lesions

2. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Myocarditis in acute rheumatic heart fever
Nitroglycerin
Ventricular arrhythmia
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

3. What are the forward and backward sx of LHF?
Backward: dyspnea - PND - orthopnea - crackles (pulmonary congestion and edema) - heart failure cells forward: fluid retention due to decreased flow to kidneys leading to activation of RAA
Day 1-7
Valve replacement once LV dysfx develops
Loss of LV fx

4. What determines the extent of shunting and cyanosis in tetralogy of fallot?
VSD
Mitral regurg
Degree of pulmonary artery stenosis
Kawasaki disease

5. What causes notching of the ribs in adult coarctation of the aorta?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Tricuspid
Systolic ejection click followed by crescendo - decrescendo murmur
Intercostal arteries enlarged due to collateral circulation

6. What is the most common tumor of the heart?
Metastasis
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Contraction band necrosis
Limits thrombosis

7. What causes the split S2 in ASD?
Mitral mitral+aortic
IV drug users
Mitral and tricuspid regurg - arrhythmia
Increased blood in right heart delays closure of P valve

8. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Left -->right
Intercostal arteries enlarged due to collateral circulation
Loeffler syndrome
Months out fibrosis

9. EKG for stable angina?
Erythematous nontender lesions on palms and soles.
Ventricular arrhythmia
ST- segment depression
Squatting - expiration

10. What are the tx for MI?
ST- segment elevation
Inability to maintain systemic pressure w/lack of O2 to vital organs
Reperfusion injury
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

11. Which artery is most often occluded in an MI?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
LAD
Infantile coarctation of the aorta
Small vegetations along the line of closure

12. What genetic conditions predispose a pt to mitral valve prolapse?
SLE
Ehlers - Danlow and Marfan syndrome
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Myofiber hypertrophy with disarray

13. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Bacterial endocarditis
Breast and lung carcinoma - melanoma - lymphoma
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Prinzmetal angina

14. What % of MIs involve the LAD?
Decreased forward perfusion pulmonary congestion
Slow HR - decreasing O2 demand and risk for arrhythmia
45%
Regurg vs stenosis

15. With what congenital heart defect is ADULT coarctation of the aorta associated?
Prinzmetal
Left -->right
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Bicuspid aortic valve

16. Lower extremity cyanosis in infants? In adults?
>60 years - bicuspid aortic valve
Elevated ASO anti - DNase B titers
Myxoma - benign
Infantile coarctation of the aorta PDA

17. What causes wear and tear aortic stenosis?
Atherosclerosis of coronary arteries
Fibrosis and dystrophic calcification
Months out fibrosis
4-6 hours - 24 hours - 72 hours

18. When does the heart have dark discoloration post MI?
Osler nodes (ouch - ouch Osler)
4-24 hours
Rhadbomyoma - benign
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

19. Which chambers of the heart are generally spared in an MI?
CK- MB
Atria and RV
LV dilation and eccentric hypertrophy
Nonspecific - eg fever and elevated ESR

20. Systolic ejection click followed by crescendo - decrescendo murmur.
Months out fibrosis
Aortic stenosis
LAD
PDA

21. What effect does aortic regurg have on the pulse pressure? Why?
Reversible
Tuberous sclerosis
Degree of pulmonary artery stenosis
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

22. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Pts w/previously damaged valves
Ostium secundum (90%)
Valve replacement AFTER the onset of complications
Adult coarctation of the aorta

23. What is the most comon cause of aortic regurg? What are the other causes?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Prinzmetal angina - cocaine
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

24. What are the sx of right - to - left shunt?
Chest pain <20 min brought on by exertion or emotional stress
Cyanosis - RV hypertrophy - polycythemia - clubbing
Congested central veins
Coexisting mitral stenosis and fusion of commisures exist

25. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Backward LHF pulm htn and RHF - afib and associated mural thombis
Stable and unstable prinzmetal
Nitroglycerin

26. What typically causes hypertrophic cardiomyopathy?
Circumflex
RCA
AD mutation in sarcomere proteins
Hypertophy of RV atrophy of LV

27. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Dilated
LHF
Squat in response to cyanotic spell
Chronic ischemic heart disease

28. Are most congenital heart defects spontaneous or inherited?
ST- segment depression
2-4 hours - 24 hours - 7-10 days
Doxorubicin - cocaine
Spontaneous

29. What areas of the heart does the LAD supply?
L->R
Tuberous sclerosis
Chronic rheumatic heart disease
Anterior wall of LV and anterior septum

30. How does adult coarctation of the aorta present?
MI
Streptococcus viridans
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Congestive heart failure

31. What murmur ccan be heard in PDA?
AD mutation in sarcomere proteins
Holosystolic machine like murmur
Membrane damage
Tricuspid

32. What are the sx of PDA at birth?
Congenital rubella
Coronary artery vasospasm
Asymptomatic
Ehlers - Danlow and Marfan syndrome

33. What causes acute endocarditis?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Anitschow cell
Streptococcus viridans
Large vegetations of S aureus

34. What type of shunt dose PDA cause?
Mitral and tricuspid regurg - arrhythmia
Coronary artery vasospasm - emboli - vasculitis
AD mutation in sarcomere proteins
Left -->right

35. When do CK- MB levels rise - peak - and return to normal?
Ventricle
Squatting - expiration
Adult coarctation of the aorta
4-6 hours - 24 hours - 72 hours

36. What cardiac disease is associated with tuberous sclerosis?
Split S2 on auscultation
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Wear and tear
Rhabdomyoma

37. What structures are susceptible to rupture post MI?
Granulation tissue
Papillary muscle - free wall - IV septum
Myxoid degeneration
RCA

38. Is scar tissue or myocardium stronger?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Myocardium
Gelatinous - abundant ground substance
R-->L

39. How does dilated cardiomyopathy cause LHF?
Stretched muscle loses contractility
PDA
2-4 hours - 24 hours - 7-10 days
Stable and unstable prinzmetal

40. What causes endocarditis of prosthetic valves?
S epidermidis
First 4 hours
Aortic regurg
Infectious endocarditis

41. What type of shunt does ASD cause?
Systolic dysfx leading to biventricular CHF
2-3 weeks
Left -->right
Osler nodes (ouch - ouch Osler)

42. When would arrhythmia occur after MI?
Within the first day
Tender lesions on fingers or toes.
RCA
L->R

43. How does restrictive cardiomyopathy cause LHF?

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44. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Hypertrophic cardiomyopathy
Cardiogenic shock - CHF - arrhythmia
Opening snap followed by diastolic rumble

45. What is the rate of mitral valve prolapse in the US?
2-3%
IV drug users
Pericardial effusion due to pericardial involvement
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

46. What is the tx for aortic stenosis?
Valve replacement AFTER the onset of complications
Dilated
4-7 days macrophage infiltration
Open blocked vessels

47. What does rupture of the LV free wall cause?
Small vegetations along the line of closure
Papillary muscle - free wall - IV septum
Harmartoma
Cardiac tamponade

48. What is the characteristic finding on CXR in tetralogy of fallot?
Boot shaped heart
Within the first day
Myocarditis in acute rheumatic heart fever
Kawasaki disease

49. What are Osler nodes?
Large vegetations of S aureus
Tender lesions on fingers or toes.
Preductal - post aortic arch
Infantile coarctation of the aorta

50. What does granulation tissue contain?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
ST- segment depression
MI
Plump fibroblasts - collagen - blood vessels