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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 maintains patency of the PDA?
Papillary muscle - free wall - IV septum
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Chronic rheumatic heart disease
PGE

2. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Louder - increased systemic resistence decreases LV emptying
Months out fibrosis
Type I
20 min

3. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Circumflex
Sudden cardiac death
4-24 hours
Reversible

4. What is an Aschoff body?
Degree of pulmonary artery stenosis
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Pericarditits
PDA

5. Opening snap followed by diastolic rumble.
Pulsating nail bed
Mitral stenosis
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Contraction band necrosis

6. What type of vegetations does Strep viridans cause?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
S aureus
Small vegetations along the line of closure
Small - nondestructive vegetations (subacute endocarditis)

7. When does the heart have a yellow pallor post MI?
LA
S viridans
Cardiogenic shock - CHF - arrhythmia
Day 1-7

8. Erythematous nontender lesions on palms and soles.
Janeway lesions
Blood vessels coming in from normal tissue
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Large vegetations of S aureus

9. What is an important complication of ASD?
Decreases LV dilation by decreasing volume
Pulsating nail bed
Paradoxical emboli
Nonbacterial thrombotic endocarditis (marantic endocarditis)

10. What are the sx of aortic regurg?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
LA dilation
Maternal diabetes
Low voltage EKG w/diminished QRS amplitude

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

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12. In what pt population does S aureus commonly cause valvular disease?
Doxorubicin - cocaine
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
IV drug users
20 min

13. What is the foundation of a scar?
Granulation tissue
2-3 weeks
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Erythematous nontender lesions on palms and soles.

14. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Yellow pallor neutrophils
Sudden cardiac death
Mitral regurg
Bacterial endocarditis

15. How do you prevent S viridans endocarditis?
PDA
Cardiogenic shock - CHF - arrhythmia
Infectious endocarditis
Prophylactic abx during dental procedures

16. What shunt does tetralogy of fallot produce?
1-3 days out
Right -->left
Mitral regurg
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

17. What complications occur within 4 hrs post MI?
Fibrosis and dystrophic calcification
Cardiogenic shock - CHF - arrhythmia
Bounding pulse
Shunt

18. What type of shunt does a VSD cause?
Atherosclerosis of coronary arteries
Aortic regurg
Endocarditis of prosthetic valves
L->R

19. How does ischemia cause LHF?
Loss of fx
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
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
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis

20. At what point in development do congenital heart defects arise?
4-24 hours
3-8 wks
Trisomy 21
Cyanosis - RV hypertrophy - polycythemia - clubbing

21. What is the murmur of mitral regurg?
Erythematous nontender lesions on palms and soles.
Valve scarring that arises as a consequence of rheumatic fever
Holosystolic blowing murmur
R-->L

22. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Libman - Sacks endocarditis
Streptococcus bovis/
Colon cancer
Atherosclerosis of coronary arteries

23. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Reperfusion injury
Myocarditis
Myxoma - benign
3-8 wks

24. Which chambers of the heart are generally spared in an MI?
Atria and RV
Posterior wall of LV - posterior septum - papillary muscles
MI
VSD

25. What congenital heart defect presents later in life with lower extremity cyanosis?
Nitroglycerin
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
PDA
Transesophageal echo

26. What causes microangiopathic hemolytic anemia in aortic stenosis?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
RBC damaged while crossing the calcified valve causing schistocytes
2-4 hours - 24 hours - 7-10 days

27. What type of shunt dose PDA cause?
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
Left -->right
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
When a bacterial protein resembles a protein in human tissue

28. What is the most common cause of mitral stenosis?
Bicuspid aortic valve
Ventricle
Chronic rheumatic heart disease
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

29. Boot - shaped heart on x- ray?
Indomethacin - decreases PGE
Colon cancer
ST- segment elevation
Tetralogy of fallot

30. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
Adult coarctation of the aorta
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Transesophageal echo
Anitschow cell

31. When do neutrophils infiltrate the myocardium post MI?
1-3 days
Reactive histiocyte with caterpillar nucleus
Pump failure
Myocarditis in acute rheumatic heart fever

32. What gross and microscopic changes occur 1-3 days after an MI?
Myocarditis
Yellow pallor neutrophils
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Mitral insufficiency

33. What is the tx for dilated cardiomyopathy?
Eisenmenger syndrome
Heart transplant
Pts w/previously damaged valves
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

34. What gross and microscopic changes occur 1-3 weeks after an MI?
Myxoma - benign
Mitral regurgitation due to vegetations
Red border granulation tissue
Squatting - increased systemic resistence decreases LV emptying

35. What are Osler nodes?
Tender lesions on fingers or toes.
Inability to maintain systemic pressure w/lack of O2 to vital organs
Pulsating nail bed
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

36. How does adult coarctation of the aorta present?
Thickening of chrodae tendinae and cusps - mitral stenosis
Chronic ischemic heart disease
Infectious endocarditis - arrythmias - severe mitral regurg no
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

37. Is injury due angina reversible or irreversible?
First 4 hours
S epidermidis
Doxorubicin - cocaine
Reversible

38. What are the HACEK organisms? With what condition are they associated?
20 min
Restrictive cardiomyopathy
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
4-24 hours

39. What is dilated cardiomyopathy?
4-7 days
Dilation of all four chambers of the heart
Pancarditis
MI

40. What congenital heart defect is associated with fetal alcohol syndrome?
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Friction rub and chest pain
VSD
Stretched muscle loses contractility

41. Which congenital heart defect is associated with congenital rubella?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Hypertophy of RV atrophy of LV
PDA
LHF

42. What does rupture of a papillary muscle cause?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Mitral insufficiency
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

43. What is the most common valve infected by S aureus?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Tricuspid
Ehlers - Danlow and Marfan syndrome
Ventricles cannot pump

44. What are the clinical features of RHF due to?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Systemic venous congestion
Red border granulation tissue
Stretched muscle loses contractility

45. What type of ischemia does stable angina cause?
Autoimmune pericarditis 6-8 wks post MI
Subendocardial
Janeway lesions
Aschoff bodies

46. Low voltage EKG w/diminished QRS amplitude.
Blood vessels coming in from normal tissue
Mitral and tricuspid regurg - arrhythmia
Restrictive cardiomyopathy
Yellow pallor neutrophils

47. What determines the extent of shunting and cyanosis in tetralogy of fallot?
ST- segment depression
Stable and unstable prinzmetal
Degree of pulmonary artery stenosis
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

48. What complication occurs 1-3 days post MI?
Fibrinous pericarditis
Doxorubicin - cocaine
Sterile vegetations on mitral valve along lines of closure
4-7 days macrophage infiltration

49. What is a complication of chronic rheumatic heart disease?
Squatting - increased systemic resistence decreases LV emptying
Infectious endocarditis
LA
Large vegetations of S aureus

50. What are the sx of PDA at birth?
Restrictive cardiomyopathy
Asymptomatic
Friction rub and chest pain
Nonbacterial thrombotic endocarditis (marantic endocarditis)