Test your basic knowledge |

Cardiac

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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. What is the most common cause of mitral stenosis?
Loss of LV fx
Aortic regurg
Acute inflammation
Chronic rheumatic heart disease

2. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Atherosclerosis of coronary arteries
Bounding pulse
MI

3. What causes a mid - systolic click followed by a regurgitation murmur?
Atherosclerosis of coronary arteries
Regurg vs stenosis
Volume overload and LHF
Mitral valve prolapse

4. What causes the split S2 in ASD?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Increased blood in right heart delays closure of P valve
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Shunt

5. What causes the nutmeg color in nutmeg liver?
Mitral and tricuspid regurg - arrhythmia
Positive blood cultures anemia of chronic disease
Reactive histiocyte with caterpillar nucleus
Congested central veins

6. Myofiber hypertrophy with disarray.
Hypertrophic cardiomyopathy
Blood vessels coming in from normal tissue
S aureus
Ventricle

7. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Aortic regurg
Decrease in blood flow to an organ
Gelatinous - abundant ground substance

8. What heart sound manifest with an ASD?
Split S2 on auscultation
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Janeway lesions
Blood vessels coming in from normal tissue

9. Is injury due angina reversible or irreversible?
Rhabdomyoma
>70%
Small vegetations along the line of closure
Reversible

10. What are the sx of PDA at birth?
Asymptomatic
20 min
Large vegetations of S aureus
LA

11. What increases the risk for chronic rheumatic heart disease?
Breast and lung carcinoma - melanoma - lymphoma
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Hypertrophic cardiomyopathy
Months out fibrosis

12. What cardiac enzyme is useful for detecting reinfarction?
RCA
CK- MB
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Large - destructive vegetations

13. What are the clinical features of RHF due to?
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
Systemic venous congestion
Pts w/previously damaged valves
Coxsackie A or B

14. What is the definition of ischemia?
Contraction band necrosis
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
Decrease in blood flow to an organ
Congestive heart failure

15. What makes the MV prolapse murmur louder? Why?
Valve replacement AFTER the onset of complications
RCA
Squatting - increased systemic resistence decreases LV emptying
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

16. What is the tx for LHF?
Mid - systolic click followed by regurgitation murmur
ACE inhibitor
Prinzmetal
Valve replacement once LV dysfx develops

17. What coronary artery supplies the mitral valve papillary muscles?
Reperfusion injury
RCA
Holosystolic machine like murmur
Doxorubicin - cocaine

18. Dense layer of elastic and fibrotic tissue in the endocardium.
Pulsating nail bed
Tetralogy of fallot
Endocardial fibroelastosis
Papillary muscle - free wall - IV septum

19. What are the complications of aortic stenosis?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
LAD
NG or Ca channel blocker
Dense layer of elastic and fibrotic tissue in the endocardium - children

20. How does adult coarctation of the aorta present?
Infantile coarctation of the aorta
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
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
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

21. What is migratory polyarthritis?
S epidermidis
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Holosystolic blowing murmur
Hypertophy of RV atrophy of LV

22. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Loeffler syndrome
Tender lesions on fingers or toes.
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
ST- segment depression

23. How does fibrinolysis/angioplasty tx MI?
1-3 days
Tetralogy of fallot
Regurg vs stenosis
Open blocked vessels

24. What congenital heart defect presents later in life with lower extremity cyanosis?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
PDA
Papillary muscle - free wall - IV septum
Concentric LV hypertophy

25. What is the most common congenital heart defect?
Coxsackie A or B
4-7 days macrophage infiltration
VSD
Yellow pallor macrophages

26. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Libman - Sacks endocarditis
Valve replacement
Louder - increased systemic resistence decreases LV emptying
Aortic regurg

27. What is dilated cardiomyopathy?
Dilation of all four chambers of the heart
Heart can't fill
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Systolic ejection click followed by crescendo - decrescendo murmur

28. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Reperfusion injury
Ostium secundum (90%)
Prinzmetal angina
Cyanosis - RV hypertrophy - polycythemia - clubbing

29. How does ischemia cause LHF?
Loss of fx
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Troponin I
Mitral valve prolapse

30. What type of endocarditis is associated with SLE?
CK- MB
ST- segment depression
Libman - Sacks endocarditis
Prinzmetal stable and unstable

31. What are complications of dilated cardiomyopathy?
Tetralogy of fallot
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
Endocarditis of prosthetic valves
Mitral and tricuspid regurg - arrhythmia

32. What conditions can cause nonbacterial thrombotic endocarditis?
Boot shaped heart
Hypercoagulable state or underlying adenocarcinoma
Mitral regurg
Positive blood cultures anemia of chronic disease

33. With what developmental disorder is VSD associated?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Fetal alcohol syndrome
Sudden cardiac death
Nonbacterial thrombotic endocarditis (marantic endocarditis)

34. What is the 1day-1wk -1mo mneumonic for MI?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Day 1-7
PGE
Shunt - PGE to maintain PDA until surgical repair can be performed

35. What are the sx of hypertrophic cardiomyopathy?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Hemosiderin laden macrophages
PDA
Mitral regurg

36. What generally causes ischemic heart disease?
Months out fibrosis
Systolic ejection click followed by crescendo - decrescendo murmur
Atherosclerosis of coronary arteries
Myocarditis

37. How long after pharyngitis does acute rheumatic fever occur?
Plump fibroblasts - collagen - blood vessels
PDA
Blood vessels coming in from normal tissue
2-3 weeks

38. What is the basic principle of CHF?
Pump failure
Reversible
Rupture of free wall - IV septum - or papillary muscle
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

39. What is the gold standard blood marker for MI?
Months out fibrosis
Autoimmune pericarditis 6-8 wks post MI
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Troponin I

40. What are the laboratory findings of bacterial endocarditis?
Yellow pallor neutrophils
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Positive blood cultures anemia of chronic disease
Ostium secundum (90%)

41. Infects predamaged valves after transient bacteremia?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
S viridans
Infectious endocarditis - arrythmias - severe mitral regurg no
Holosystolic blowing murmur

42. What are the HACEK organisms? With what condition are they associated?
Myxoid degeneration
Systemic venous congestion
Backward LHF pulm htn and RHF - afib and associated mural thombis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

43. What is the tx for mitral valve prolapse?
Yellow pallor neutrophils
Valve replacement
Reperfusion injury
4-24 hours

44. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Valve replacement AFTER the onset of complications
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
>60 years - bicuspid aortic valve

45. Is scar tissue or myocardium stronger?
Tetralogy of fallot
Type I
S epidermidis
Myocardium

46. Systolic ejection click followed by crescendo - decrescendo murmur.
Reperfusion injury
>70%
Myocarditis
Aortic stenosis

47. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
RHF
Decrease preload -->lowers myocardial stress
S viridans
Months out fibrosis

48. Where is the coarctation in infantile coarctation of the aorta?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Preductal - post aortic arch
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Loss of LV fx

49. How do ACE inhibitors tx MI?
Adult coarctation of the aorta
Decreases LV dilation by decreasing volume
Transposition of the great vessels
ACE inhibitor

50. What type of vegetations does Strep viridans cause?
Small - nondestructive vegetations (subacute endocarditis)
PDA
CHF
Ventricles cannot pump