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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?
Aortic regurg
Myxoid degeneration
NG or Ca channel blocker
Decrease in blood flow to an organ

2. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Sudden cardiac death
Red border granulation tissue
3-8 wks
Bicuspid aortic valve

3. With what condition are rhabdomyomas associated?
Tuberous sclerosis
Erythematous nontender lesions on palms and soles.
Reperfusion injury
Low voltage EKG w/diminished QRS amplitude

4. What gross and microscopic changes occur 4-24 hours after an MI?
Dark discoloration coagulative necrosis
Endocardial fibroelastosis (rare)
Janeway lesions
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

5. Holosystolic blowing murmur that increases w/expiration?
Streptococcus viridans
Low voltage EKG w/diminished QRS amplitude
Mitral regurg
Chronic rheumatic heart disease

6. What is a Quincke pulse?
Infectious endocarditis
Valve scarring that arises as a consequence of rheumatic fever
PDA
Pulsating nail bed

7. What is the murmur of mitral valve prolapse?
Infectious
Positive blood cultures anemia of chronic disease
Mitral insufficiency
Mid - systolic click followed by regurgitation murmur

8. What does rupture of a papillary muscle cause?
S aureus
Yellow pallor macrophages
Mitral insufficiency
Loss of fx

9. What is the most common congenital heart defect?
Tricuspid
Sterile vegetations on mitral valve along lines of closure
VSD
LV dilation and eccentric hypertrophy

10. What % of MIs involve the LAD?
Valve replacement once LV dysfx develops
45%
Congested central veins
Tender lesions on fingers or toes.

11. What is the tx for dilated cardiomyopathy?
LAD
Heart transplant
Granulation tissue
Pericarditits

12. What are the laboratory findings of bacterial endocarditis?
Positive blood cultures anemia of chronic disease
LAD
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Dressler syndrome

13. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
Elevated ASO anti - DNase B titers
Ventricle
4-7 days macrophage infiltration
Bacterial endocarditis

14. What is migratory polyarthritis?
Large - destructive vegetations
Reversible
IV drug users
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

15. What drug relieves stable angina?
Coexisting mitral stenosis and fusion of commisures exist
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Nitroglycerin
Troponin I

16. What is the only Jones criteria that doesn't resolve with time?
Pancarditis
Degree of pulmonary artery stenosis
Membrane damage
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

17. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Yellow pallor macrophages
Nonbacterial thrombotic endocarditis (marantic endocarditis)
PDA
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

18. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
Cardiogenic shock - CHF - arrhythmia
Decreases LV dilation by decreasing volume
LA

19. What are the sx/complications of myocarditis?
Mitral regurg
Backward LHF pulm htn and RHF - afib and associated mural thombis
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Coexisting mitral stenosis and fusion of commisures exist

20. What type of shunt does ASD cause?
Left -->right
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Ostium primum
Opening snap followed by diastolic rumble

21. Systolic ejection click followed by crescendo - decrescendo murmur.
Doxorubicin - cocaine
Aortic stenosis
Mitral regurgitation due to vegetations
Nonbacterial thrombotic endocarditis (marantic endocarditis)

22. What complication occurs 1-3 days post MI?
Fibrinous pericarditis
Osler nodes (ouch - ouch Osler)
Reperfusion injury
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

23. In what pt population does S aureus commonly cause valvular disease?
IV drug users
Rhadbomyoma - benign
Ostium secundum (90%)
Minimizes ischemia

24. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Contraction band necrosis
Mitral regurg
Loeffler syndrome

25. What imaging test is useful for detecting lesions on valves?
Decrease preload -->lowers myocardial stress
Transesophageal echo
ST- segment elevation
Blood vessels coming in from normal tissue

26. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
Coronary artery vasospasm - emboli - vasculitis
Systolic dysfx leading to biventricular CHF
Dark discoloration coagulative necrosis

27. What is the rate of mitral valve prolapse in the US?
Aschoff bodies
2-3%
Hypertrophic cardiomyopathy
Open blocked vessels

28. What congenital heart defect presents later in life with lower extremity cyanosis?
PDA
Dark discoloration coagulative necrosis
Plump fibroblasts - collagen - blood vessels
Loss of LV fx

29. What are the sx of right - to - left shunt?
S viridans
Cyanosis - RV hypertrophy - polycythemia - clubbing
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Endocarditis of prosthetic valves

30. What coronary artery supplies the mitral valve papillary muscles?
RCA
ST- segment elevation
Months out fibrosis
Erythematous nontender lesions on palms and soles.

31. What are the clinical features of RHF?
Limits thrombosis
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Reperfusion injury
Louder - increased systemic resistence decreases LV emptying

32. How does hypertension cause LHF?

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33. How does fibrinolysis/angioplasty tx MI?
Troponin I
Infectious endocarditis
Open blocked vessels
Myxoid degeneration

34. What type of collagen is involved in fibrosis?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Months out fibrosis
Type I
S epidermidis

35. How does restrictive cardiomyopathy present?
Hypertrophic cardiomyopathy
Congestive heart failure
Plump fibroblasts - collagen - blood vessels
Sudden cardiac death

36. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Months out fibrosis
Intercostal arteries enlarged due to collateral circulation
>60 years - bicuspid aortic valve
Tetralogy of fallot

37. Lower extremity cyanosis in infants? In adults?
Ventricular arrhythmia
Transposition of the great vessels
2-4 hours - 24 hours - 7-10 days
Infantile coarctation of the aorta PDA

38. When is an MI pt at greatest risk for cardiogenic shock?
First 4 hours
IV drug users
Anitschow cell
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

39. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Ventricular arrhythmia
Papillary muscle - free wall - IV septum

40. What are the complications that occur months after an MI?
Aneurysm - mural thrombus - Dressler syndrome
Myocarditis in acute rheumatic heart fever
Myofiber hypertrophy with disarray
Pulsating nail bed

41. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
>60 years - bicuspid aortic valve
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
1-3 days
Membrane damage

42. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Yellow pallor neutrophils
Pts w/previously damaged valves
VSD

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

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44. What does chronic ischemic heart disease progress to?
CHF
2-4 hours - 24 hours - 7-10 days
Mitral regurg
Stable angina

45. With what congenital heart defect is ADULT coarctation of the aorta associated?
Aortic regurg
LAD
Colon cancer
Bicuspid aortic valve

46. Which congenital heart defect is associated with congenital rubella?
Autoimmune pericarditis 6-8 wks post MI
PDA
Myofiber hypertrophy with disarray
Coxsackie A or B

47. What causes angina and syncope in aortic stenosis?

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48. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Heart can't fill
Asymptomatic
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
Adult coarctation of the aorta

49. What are the four defects in tetralogy of fallot?
Red border granulation tissue
Increased blood in right heart delays closure of P valve
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
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

50. What is the murmur of mitral regurg?
Hypertrophic cardiomyopathy
Holosystolic blowing murmur
Subendocardial
Rhadbomyoma - benign