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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. What is the effect of acute vs chronic rheumatic disease off the mitral valve?
Regurg vs stenosis
Prinzmetal
Yellow pallor neutrophils
Mitral regurgitation due to vegetations

2. What is chronic rheumatic heart disease?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Valve scarring that arises as a consequence of rheumatic fever
Transposition of the great vessels
Small - nondestructive vegetations (subacute endocarditis)

3. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Bacterial endocarditis
Restrictive cardiomyopathy
Decreases LV dilation by decreasing volume
Membrane damage

4. What drug relieves stable angina?
Maternal diabetes
Nitroglycerin
Infectious endocarditis
Ventricular arrhythmia

5. Lower extremity cyanosis in infants? In adults?
Degree of pulmonary artery stenosis
Preductal - post aortic arch
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Infantile coarctation of the aorta PDA

6. What is the most common cause of infectious endocarditis?
VSD
Small vegetations along the line of closure
Streptococcus viridans
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

7. Myofiber hypertrophy with disarray.
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Hypertrophic cardiomyopathy
LAD
Heart can't fill

8. Which artery is most often occluded in an MI?
SLE
LAD
Fibrosis and dystrophic calcification
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

9. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
CHF
Mitral regurg
Prinzmetal angina
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

10. What effect does dilated cardiomyopathy have on the heart?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Systolic dysfx leading to biventricular CHF
Prinzmetal
Limits thrombosis

11. What conditions can cause nonbacterial thrombotic endocarditis?
Hypercoagulable state or underlying adenocarcinoma
Contraction band necrosis
Coronary artery vasospasm
Atherosclerosis of coronary arteries

12. What are the clinical features of RHF due to?
4-6 hours - 24 hours - 72 hours
Prinzmetal angina
1%
Systemic venous congestion

13. What is a water - hammer pulse?
Aortic regurg
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Pulsating nail bed
Bounding pulse

14. Which chambers of the heart are generally spared in an MI?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Atria and RV
Left -->right
Coxsackie A or B

15. EKG for stable angina?
ST- segment depression
Troponin I
Decrease in blood flow to an organ
Concentric LV hypertophy

16. What causes wear and tear aortic stenosis?
Hypercoagulable state or underlying adenocarcinoma
Fibrosis and dystrophic calcification
Loss of LV fx
Louder - increased systemic resistence decreases LV emptying

17. What gross and microscopic changes occur 1-3 weeks after an MI?
Coexisting mitral stenosis and fusion of commisures exist
Posterior wall of LV - posterior septum - papillary muscles
Indomethacin - decreases PGE
Red border granulation tissue

18. What are the complications that occur months after an MI?
Pump failure
Asymptomatic
Aneurysm - mural thrombus - Dressler syndrome
PDA

19. What is an Anitschow cell?
Papillary muscle - free wall - IV septum
Reactive histiocyte with caterpillar nucleus
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
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

20. What % stenosis causes stable angina?
Right -->left
Dressler syndrome
>70%
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

21. When is an MI patent at highest risk for fibrionous pericarditis?
1-3 days out
Ventricles cannot pump
Nitroglycerin
Myocarditis in acute rheumatic heart fever

22. What complications occur 4-7 days post MI?
Nitroglycerin
Infantile coarctation of the aorta PDA
Shunt - PGE to maintain PDA until surgical repair can be performed
Rupture of free wall - IV septum - or papillary muscle

23. What is the effect of mitral regurg on the heart?
R-->L
Volume overload and 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
Slow HR - decreasing O2 demand and risk for arrhythmia

24. What is a common complication of cardiac metastasis?
Pericardial effusion due to pericardial involvement
Posterior wall of LV - posterior septum - papillary muscles
Decrease preload -->lowers myocardial stress
Streptococcus viridans

25. At what point in development do congenital heart defects arise?
Preductal - post aortic arch
4-6 hours - 24 hours - 72 hours
Hypertrophic cardiomyopathy
3-8 wks

26. What does granulation tissue contain?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Decreases LV dilation by decreasing volume
Plump fibroblasts - collagen - blood vessels
Hypertrophic cardiomyopathy

27. What are complications of dilated cardiomyopathy?
Autoimmune pericarditis 6-8 wks post MI
Cardiogenic shock - CHF - arrhythmia
Mitral and tricuspid regurg - arrhythmia
Aschoff bodies

28. What increases the volume of mitral regurg murmur?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Squatting - expiration
Anitschow cell
Systemic venous congestion

29. When do troponin levels rise - peak - and return to normal?
Valve replacement AFTER the onset of complications
2-4 hours - 24 hours - 7-10 days
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Myxoid degeneration

30. What is endocardial fibroelastosis? In what population is it found?
Reactive histiocyte with caterpillar nucleus
Increased blood in right heart delays closure of P valve
IV drug users
Dense layer of elastic and fibrotic tissue in the endocardium - children

31. What compensatory mechanism do tetralogy of fallot pts learn?
Contraction band necrosis - reperfusion injury
Decrease preload -->lowers myocardial stress
Squat in response to cyanotic spell
ACE inhibitor

32. What is the foundation of a scar?
Granulation tissue
Coxsackie A or B
Janeway lesions
Hypertrophic cardiomyopathy

33. What typically causes hypertrophic cardiomyopathy?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Backward LHF pulm htn and RHF - afib and associated mural thombis
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
AD mutation in sarcomere proteins

34. What complication occurs 1-3 days post MI?
Fibrinous pericarditis
Within the first day
Prinzmetal angina - cocaine
Mitral stenosis

35. What are Osler nodes?
Yellow pallor neutrophils
Tender lesions on fingers or toes.
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Ventricular arrhythmia

36. Why are cardiac enzymes elevated after an MI?
Aortic regurg
Coronary artery vasospasm
Myxoid degeneration
Membrane damage

37. What effect does chronic rheumatic heart disease have the mitral valve?
Pericarditits
AD mutation in sarcomere proteins
Thickening of chrodae tendinae and cusps - mitral stenosis
>60 years - bicuspid aortic valve

38. Is injury due angina reversible or irreversible?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Reversible
Valve scarring that arises as a consequence of rheumatic fever
When a bacterial protein resembles a protein in human tissue

39. How does fibrinolysis/angioplasty tx MI?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Shunt - PGE to maintain PDA until surgical repair can be performed
First 4 hours
Open blocked vessels

40. What is typically the mechanims of sudden cardiac death?
Decreased forward perfusion pulmonary congestion
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Granulation tissue
Ventricular arrhythmia

41. What is the most common type of endocarditis?
Mitral stenosis
Paradoxical emboli
Infectious
Endocardial fibroelastosis (rare)

42. What causes a mid - systolic click followed by a regurgitation murmur?
Janeway lesions
Eisenmenger syndrome
Left -->right
Mitral valve prolapse

43. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
SLE
Preductal - post aortic arch
Maternal diabetes
4-7 days macrophage infiltration

44. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Libman - Sacks endocarditis
Hemosiderin laden macrophages
Myxoma - benign
Myxoid degeneration

45. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Transesophageal echo
Troponin I
RHF
4-7 days

46. How does reperfusion injury occur?
4-24 hours
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
2-3 weeks
Friction rub and chest pain

47. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
Stable angina
Preductal - post aortic arch
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

48. What type of vegetations are associated with Libman - Sacks endocarditis?
Adult coarctation of the aorta
Bacterial endocarditis
Sterile vegetations on surface and undersurface on mitral valve
Concentric LV hypertophy

49. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Stable and unstable prinzmetal
Friction rub and chest pain
Reversible
>60 years - bicuspid aortic valve

50. With what congenital heart defect is ADULT coarctation of the aorta associated?
Holosystolic machine like murmur
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Bicuspid aortic valve
Cardiac tamponade