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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. Which angina is relieved by Ca channel blockers?
Prinzmetal
Kawasaki disease
Pericardial effusion due to pericardial involvement
AD mutation in sarcomere proteins

2. In transposition of the great vessels - What is required for survival? How is this achieved?
Shunt - PGE to maintain PDA until surgical repair can be performed
Fetal alcohol syndrome
Small vegetations along the line of closure
Large - destructive vegetations

3. What is the most common primary cardiac tumor in children? Is it malignant or benign?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Split S2 on auscultation
Rhadbomyoma - benign
Infantile coarctation of the aorta PDA

4. What is cardiogenic shock?
Subendocardial
Maternal diabetes
Pulsating nail bed
Inability to maintain systemic pressure w/lack of O2 to vital organs

5. What is typically the mechanims of sudden cardiac death?
Infectious
Loeffler syndrome
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Ventricular arrhythmia

6. What is the tx for mitral valve prolapse?
Valve replacement
Right to left
Acute inflammation
Decreased forward perfusion pulmonary congestion

7. How long after pharyngitis does acute rheumatic fever occur?
Osler nodes (ouch - ouch Osler)
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
2-3 weeks
S aureus

8. Erythematous nontender lesions on palms and soles.
Sudden cardiac death
Anterior wall of LV and anterior septum
Janeway lesions
Metastasis

9. What disesase has Aschoff bodies?
Decrease preload -->lowers myocardial stress
S aureus
Myocarditis in acute rheumatic heart fever
Large vegetations of S aureus

10. What are the causes of restrictive cardiomyopathy in adults?
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Eisenmenger syndrome
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
2-4 hours - 24 hours - 7-10 days

11. What bug causes acute rheumatic fever?
Trisomy 21
Large - destructive vegetations
Group A beta - hemolytic streptococci
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

12. What are the sx/complications of myocarditis?
Endocarditis of prosthetic valves
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Paradoxical emboli

13. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Osler nodes (ouch - ouch Osler)
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Stable and unstable prinzmetal

14. Large vegetations on tricuspid valve?
Group A beta - hemolytic streptococci
Degree of pulmonary artery stenosis
S aureus
Yellow pallor neutrophils

15. Which congenital heart defect is associated with maternal diabetes?
Transposition of the great vessels
RCA
Ventricular arrhythmia
Bounding pulse

16. What causes notching of the ribs in adult coarctation of the aorta?
Maternal diabetes
>70%
Intercostal arteries enlarged due to collateral circulation
Chronic ischemic heart disease

17. What does rupture of a papillary muscle cause?
Myocardium
Mitral insufficiency
S aureus
Autoimmune pericarditis 6-8 wks post MI

18. Dense layer of elastic and fibrotic tissue in the endocardium.
Turner syndrome
L->R
Endocardial fibroelastosis
MI

19. Which artery is most often occluded in an MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Dilated
Mitral and tricuspid regurg - arrhythmia
LAD

20. What is molecular mimicry?
Sudden cardiac death
Large vegetations of S aureus
When a bacterial protein resembles a protein in human tissue
Dressler syndrome

21. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Aortic regurg
ST- segment depression
Open blocked vessels
Turner syndrome

22. How does ischemia cause LHF?
Coxsackie A or B
1-3 days
Loss of fx
VSD

23. What does nonbacterial thrombotic endocarditis cause?
Anterior wall of LV and anterior septum
Dark discoloration coagulative necrosis
Subendocardial
Mitral regurg

24. What coronary arterysupplies the lateral wall of the LV?
Within the first day
Circumflex
Cyanosis - RV hypertrophy - polycythemia - clubbing
Aortic regurg

25. Are most congenital heart defects spontaneous or inherited?
PDA
Spontaneous
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

26. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
Streptococcus viridans
Endocardial fibroelastosis
LHF

27. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Dark discoloration coagulative necrosis
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Louder - increased systemic resistence decreases LV emptying

28. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
RHF
ST- segment elevation
S aureus
Mitral regurgitation due to vegetations

29. What type of shunt does a VSD cause?
LHF
PDA
L->R
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

30. What is an important complication of ASD?
Ischemic heart disease
Paradoxical emboli
Heart transplant
4-24 hours

31. What is the rate of congenital heart defects?
PDA
1%
AD mutation in sarcomere proteins
Months out fibrosis

32. With what virus is PDA associated?
Congenital rubella
Ostium secundum (90%)
Kawasaki disease
Decrease in blood flow to an organ

33. What type of endocarditis is associated with SLE?
White scar fibrosis
Libman - Sacks endocarditis
Hypertrophic cardiomyopathy
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

34. What drugs can cause dilated cardiomyopathy?
Spontaneous
Doxorubicin - cocaine
Mitral regurg
Mitral stenosis

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

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36. What is the JOneS mneumonic?
White scar fibrosis
Prophylactic abx during dental procedures
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
VSD

37. When does the heart have dark discoloration post MI?
4-24 hours
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
RCA
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

38. What % stenosis causes stable angina?
>70%
Tetralogy of fallot
Small vegetations along the line of closure
Circumflex

39. What type of shunt results in cyanosis at birth?
Myxoid degeneration
Paradoxical emboli
Libman - Sacks endocarditis
Right to left

40. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
LA dilation
Nitroglycerin

41. At what point in development do congenital heart defects arise?
3-8 wks
Left -->right
Harmartoma
Circumflex

42. What cardiac disease is associated with tuberous sclerosis?
Mitral regurg
Rhabdomyoma
Restrictive cardiomyopathy
Hypertophy of RV atrophy of LV

43. What is the murmur of mitral valve prolapse?
Restrictive cardiomyopathy
Systolic dysfx leading to biventricular CHF
Mid - systolic click followed by regurgitation murmur
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

44. What endocarditis is commonly found in patients with colon cancer?
Streptococcus bovis/
Contraction band necrosis
Low voltage EKG w/diminished QRS amplitude
Sudden cardiac death

45. What is an Anitschow cell?
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Reactive histiocyte with caterpillar nucleus
Increased hydrostatic pressure
Spontaneous

46. What is the etiology of S viridans endocarditis?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Myocarditis in acute rheumatic heart fever
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Inability to maintain systemic pressure w/lack of O2 to vital organs

47. Opening snap followed by diastolic rumble.
SLE
Congenital rubella
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Mitral stenosis

48. How do you prevent S viridans endocarditis?
Prophylactic abx during dental procedures
Coronary artery vasospasm - emboli - vasculitis
Transesophageal echo
RCA

49. What imaging test is useful for detecting lesions on valves?
Trisomy 21
Mitral mitral+aortic
Transesophageal echo
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

50. What drug relieves stable angina?
Streptococcus bovis/
Preductal - post aortic arch
Nitroglycerin
Tricuspid