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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. Friction rub and chest pain.
Sterile vegetations on surface and undersurface on mitral valve
Pericarditits
Asymptomatic
Valve replacement AFTER the onset of complications

2. What compensatory mechanism do tetralogy of fallot pts learn?
Blood vessels coming in from normal tissue
Prophylactic abx during dental procedures
Yellow pallor neutrophils
Squat in response to cyanotic spell

3. What gross and microscopic changes occur months after an MI?
Atria and RV
Posterior wall of LV - posterior septum - papillary muscles
White scar fibrosis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

4. What is the rate of mitral valve prolapse in the US?
Opening snap followed by diastolic rumble
2-3%
Aneurysm - mural thrombus - Dressler syndrome
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy

5. How does ischemia cause LHF?
Loss of fx
Ventricular arrhythmia
1%
Subendocardial

6. Ostium primum ASD is associated with what congenital disorder?
Trisomy 21
Valve replacement
Congestive heart failure
Concentric LV hypertophy

7. What causes notching of the ribs in adult coarctation of the aorta?
Pump failure
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
>70%
Intercostal arteries enlarged due to collateral circulation

8. Myofiber hypertrophy with disarray.
Hypertrophic cardiomyopathy
Degree of pulmonary artery stenosis
Tender lesions on fingers or toes.
Acute inflammation

9. Which vasculitis can cause MI?
Reperfusion injury
IV drug users
Kawasaki disease
Backward LHF pulm htn and RHF - afib and associated mural thombis

10. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Chronic rheumatic heart disease
Hemosiderin laden macrophages
LV dilation and eccentric hypertrophy

11. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Anitschow cell
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Migratory polyarthritis
Ventricle

12. What is diastolic dysfx?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
RCA
Inability to fill ventricles
LHF

13. What type of collagen is involved in fibrosis?
Hemosiderin laden macrophages
Intercostal arteries enlarged due to collateral circulation
Boot shaped heart
Type I

14. What is the basic principle of CHF?
Months out fibrosis
Pump failure
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Doxorubicin - cocaine

15. With what condition are rhabdomyomas associated?
Hemosiderin laden macrophages
Tuberous sclerosis
Granulation tissue
R-->L

16. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Paradoxical emboli
Eisenmenger syndrome
Anitschow cell
Preductal - post aortic arch

17. What are the laboratory findings of bacterial endocarditis?
Systemic venous congestion
Tender lesions on fingers or toes.
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Positive blood cultures anemia of chronic disease

18. What causes acute endocarditis?
Mitral stenosis
Myofiber hypertrophy with disarray
S epidermidis
Large vegetations of S aureus

19. What is typically the mechanims of sudden cardiac death?
Ventricular arrhythmia
Increased hydrostatic pressure
ST- segment depression
Congenital rubella

20. What artery is the 2nd most often occluded in an MI?
Aschoff bodies
RCA
Adult coarctation of the aorta
Valve replacement AFTER the onset of complications

21. What are the tx for MI?
Endocardial fibroelastosis
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Positive blood cultures anemia of chronic disease
NG or Ca channel blocker

22. What are the four defects in tetralogy of fallot?
Coexisting mitral stenosis and fusion of commisures exist
Ostium primum
Libman - Sacks endocarditis
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

23. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Fetal alcohol syndrome
Loeffler syndrome
CK- MB
Nitroglycerin

24. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Bacterial endocarditis
2-3%
Decreases LV dilation by decreasing volume
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

25. Sudden death in a young athlete.
Inability to maintain systemic pressure w/lack of O2 to vital organs
Bicuspid aortic valve
Hypertrophic cardiomyopathy
Evidence of prior group A beta - hemolytic strep plus major and minor criteria

26. What drugs can cause dilated cardiomyopathy?
Transesophageal echo
Tuberous sclerosis
Doxorubicin - cocaine
Ostium secundum (90%)

27. What valves are most commonly involved in chronic rheumatic heart disease?
Indomethacin - decreases PGE
Mitral mitral+aortic
Pulsating nail bed
Sterile vegetations on surface and undersurface on mitral valve

28. When would arrhythmia occur after MI?
Within the first day
Slow HR - decreasing O2 demand and risk for arrhythmia
Large - destructive vegetations
Turner syndrome

29. What is the effect of mitral regurg on the heart?
Paradoxical emboli
Myocarditis
Subendocardial
Volume overload and LHF

30. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
PDA
Reperfusion injury
S epidermidis
Bacterial endocarditis

31. How does reperfusion injury occur?
Holosystolic machine like murmur
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Large vegetations of S aureus
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

32. Lower extremity cyanosis in infants? In adults?
Infantile coarctation of the aorta
Heart transplant
Infantile coarctation of the aorta PDA
Mitral insufficiency

33. How does hypertension cause LHF?

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34. What creates the immune reaction in acute rhuematic fever?

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35. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Loss of fx
Months out fibrosis
Endocarditis of prosthetic valves
Tricuspid

36. What two things cause coronary artery vasospasm?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Infectious endocarditis
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Prinzmetal angina - cocaine

37. What tests show prior group A beta - hemolytic strep infection?
Prophylactic abx during dental procedures
ST- segment depression
Elevated ASO anti - DNase B titers
Valve replacement

38. What causes angina and syncope in aortic stenosis?

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39. What causes endocarditis of prosthetic valves?
2-3%
S epidermidis
Inability to maintain systemic pressure w/lack of O2 to vital organs
Sudden cardiac death

40. What causes microangiopathic hemolytic anemia in aortic stenosis?
SLE
4-24 hours
RBC damaged while crossing the calcified valve causing schistocytes
Endocarditis of prosthetic valves

41. What type of vegetations does Strep viridans cause?
Erythematous nontender lesions on palms and soles.
Small - nondestructive vegetations (subacute endocarditis)
3-8 wks
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

42. What is the most common form of cardiomyopathy?
RBC damaged while crossing the calcified valve causing schistocytes
Hypercoagulable state or underlying adenocarcinoma
Dilated
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

43. What increases the risk for chronic rheumatic heart disease?
Decrease in blood flow to an organ
Right side - serotonin and other secretory products detoxified in the lung
RBC damaged while crossing the calcified valve causing schistocytes
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

44. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Reperfusion injury
ACE inhibitor
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

45. What is systolic dysfx?
Ventricles cannot pump
ACE inhibitor
LAD
4-24 hours

46. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
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
Stable and unstable prinzmetal
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Ventricles cannot pump

47. When do CK- MB levels rise - peak - and return to normal?
4-6 hours - 24 hours - 72 hours
Valve replacement once LV dysfx develops
Endocarditis of prosthetic valves
Blood vessels coming in from normal tissue

48. What are Janeway lesions?
Erythematous nontender lesions on palms and soles.
Months out fibrosis
R-->L
Boot shaped heart

49. What are the sx/complications of myocarditis?
Reperfusion injury
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
IV drug users
Decrease preload -->lowers myocardial stress

50. What is a common complication of cardiac metastasis?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Months out fibrosis
Subendocardial
Pericardial effusion due to pericardial involvement