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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 definition of ischemia?
PDA
ASD - R-->L
Transesophageal echo
Decrease in blood flow to an organ

2. What increases the volume of mitral regurg murmur?
PDA
Squatting - expiration
Dilated
Shunt

3. Dilated cardiomyopathy is a late complication of what illness?
Aortic regurg
Myocarditis
Large vegetations of S aureus
ASD - R-->L

4. What causes a mid - systolic click followed by a regurgitation murmur?
Prinzmetal
VSD
Mitral valve prolapse
Increased blood in right heart delays closure of P valve

5. Which artery is most often occluded in an MI?
Chronic ischemic heart disease
Heart transplant
LAD
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

6. In what pt population does S aureus commonly cause valvular disease?
MI
Infectious endocarditis
IV drug users
RHF

7. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
S aureus
Tetralogy of fallot
Backward LHF pulm htn and RHF - afib and associated mural thombis

8. Is scar tissue or myocardium stronger?
CHF
Reversible
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Myocardium

9. What are the complications of mitral stenosis?
Dilation of all four chambers of the heart
Bicuspid aortic valve
Adult coarctation of the aorta
Backward LHF pulm htn and RHF - afib and associated mural thombis

10. What causes heart failure cells?
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Dark discoloration coagulative necrosis
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Myocardium

11. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
Adult coarctation of the aorta
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Coxsackie A or B

12. With what disease is transposition of the great vessels associated?
Yellow pallor macrophages
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Sudden cardiac death
Maternal diabetes

13. What always follows necrosis?
Fibrosis and dystrophic calcification
Acute inflammation
Rhabdomyoma
Hypertophy of RV atrophy of LV

14. What does chronic ischemic heart disease progress to?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Holosystolic blowing murmur
Blood vessels coming in from normal tissue
CHF

15. What is dilated cardiomyopathy?
Aortic regurg
Mitral and tricuspid regurg - arrhythmia
Infectious
Dilation of all four chambers of the heart

16. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Chest pain <20 min brought on by exertion or emotional stress
Rhadbomyoma - benign
Myocardium
Yellow pallor macrophages

17. What does rupture of a papillary muscle cause?
Mitral insufficiency
ASD - R-->L
Myocardium
ACE inhibitor

18. What is the most common cause of RHF? What are others?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
L->R
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Stretched muscle loses contractility

19. What is the tx for VSD?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Surgical closure small defects may close spontaneously
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Mitral stenosis

20. What is an Aschoff body?
PGE
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Osler nodes (ouch - ouch Osler)
Concentric LV hypertophy

21. What are the major criteria of the Jones criteria?
Fibrinous pericarditis
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
LAD
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

22. What is Dressler syndrome? When does it occur?
Transesophageal echo
Cardiogenic shock - CHF - arrhythmia
Coxsackie A or B
Autoimmune pericarditis 6-8 wks post MI

23. What is the gold standard blood marker for MI?
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
MI
Autoimmune pericarditis 6-8 wks post MI
Troponin I

24. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
RCA
Positive blood cultures anemia of chronic disease
Stretched muscle loses contractility

25. Which angina is relieved by Ca channel blockers?
Preductal - post aortic arch
NG or Ca channel blocker
Nonspecific - eg fever and elevated ESR
Prinzmetal

26. What is the most common valve infected by S aureus?
PDA
Tricuspid
Decreases LV dilation by decreasing volume
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

27. What causes notching of the ribs in adult coarctation of the aorta?
Colon cancer
Intercostal arteries enlarged due to collateral circulation
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Valve scarring that arises as a consequence of rheumatic fever

28. What type of vegetations form in nonbacterial thrombotic endocarditis?
Sterile vegetations on mitral valve along lines of closure
Loss of fx
Turner syndrome
Cardiac tamponade

29. What is the murmur of mitral valve prolapse?
Mid - systolic click followed by regurgitation murmur
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
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Pump failure

30. What compensatory mechanism do tetralogy of fallot pts learn?
Squat in response to cyanotic spell
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Months out fibrosis
Congestive heart failure

31. How does ischemia cause LHF?
R-->L
Loss of fx
Rhabdomyoma
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

32. What is an important complication of ASD?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Sterile vegetations on surface and undersurface on mitral valve
Paradoxical emboli
Prinzmetal angina

33. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Months out fibrosis
Indomethacin - decreases PGE
Subendocardial
Bacterial endocarditis

34. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
LHF
IV drug users
VSD

35. What makes the MV prolapse murmur louder? Why?
Squatting - increased systemic resistence decreases LV emptying
White scar fibrosis
Pericarditits
Infantile coarctation of the aorta

36. Opening snap followed by diastolic rumble.
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Mitral stenosis
Volume overload and LHF
Sudden cardiac death

37. What is the most common cause of infectious endocarditis?
Loss of fx
Streptococcus viridans
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Split S2 on auscultation

38. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Dressler syndrome
PDA
Anitschow cell
Aortic stenosis

39. What is the tx for dilated cardiomyopathy?
Heart transplant
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
Coxsackie A or B
2-3%

40. What is the murmur of mitral regurg?
Holosystolic blowing murmur
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
PGE
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

41. What is the most common type of endocarditis?
Infectious
Endocardial fibroelastosis
Slow HR - decreasing O2 demand and risk for arrhythmia
Decrease in blood flow to an organ

42. Which congenital heart defect is associated with congenital rubella?
Aschoff bodies
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
PDA
Hypertrophic cardiomyopathy

43. What side of the heart do carcinoid tumors affect? Why?
R-->L
Right side - serotonin and other secretory products detoxified in the lung
Intercostal arteries enlarged due to collateral circulation
Congestive heart failure

44. What is the classic EKG finding of restrictive cardiomyopathy?
Infectious endocarditis
2-4 hours - 24 hours - 7-10 days
Low voltage EKG w/diminished QRS amplitude
Dense layer of elastic and fibrotic tissue in the endocardium - children

45. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
1-3 days
4-7 days macrophage infiltration
Streptococcus viridans
Gelatinous - abundant ground substance

46. What heart sound manifest with an ASD?
Trisomy 21
S viridans
Split S2 on auscultation
Congenital rubella

47. What are the causes of LHF?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Trisomy 21
RBC damaged while crossing the calcified valve causing schistocytes
SLE

48. Tender lesions on fingers or toes.
Osler nodes (ouch - ouch Osler)
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Reactive histiocyte with caterpillar nucleus
Rhadbomyoma - benign

49. With what disease is Libman - Sacks endocarditis associated?
Mid - systolic click followed by regurgitation murmur
SLE
PDA
Infantile coarctation of the aorta

50. What tests show prior group A beta - hemolytic strep infection?
Open blocked vessels
Elevated ASO anti - DNase B titers
Valve replacement once LV dysfx develops
Loeffler syndrome