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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 chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
Infectious
Hypercoagulable state or underlying adenocarcinoma
Indomethacin - decreases PGE

2. What is the most common form of cardiomyopathy?
Myocardium
Dilated
Streptococcus viridans
Elevated ASO anti - DNase B titers

3. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Ehlers - Danlow and Marfan syndrome
PDA
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Sudden cardiac death

4. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
20 min
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Sterile vegetations on surface and undersurface on mitral valve
Migratory polyarthritis

5. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Louder - increased systemic resistence decreases LV emptying
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Aortic regurg
Ventricular arrhythmia

6. When is an MI pt at greatest risk for cardiogenic shock?
CK- MB
Yellow pallor macrophages
First 4 hours
Holosystolic blowing murmur

7. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Plump fibroblasts - collagen - blood vessels
Tricuspid
Nitroglycerin
Stable and unstable prinzmetal

8. What cardiac enzyme is useful for detecting reinfarction?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
VSD
Infectious
CK- MB

9. What two things happen when a blocked vessel is opened after an MI?
Posterior wall of LV - posterior septum - papillary muscles
Fetal alcohol syndrome
Contraction band necrosis - reperfusion injury
Prinzmetal angina

10. What bug causes acute rheumatic fever?
Heart can't fill
>70%
Group A beta - hemolytic streptococci
Ventricle

11. What type of shunt does transposition of the great vessels cause?
Louder - increased systemic resistence decreases LV emptying
R-->L
Squatting - expiration
Hemosiderin laden macrophages

12. What is Loeffler syndrome?
Coexisting mitral stenosis and fusion of commisures exist
RHF
Group A beta - hemolytic streptococci
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

13. Dilated cardiomyopathy is a late complication of what illness?
Cyanosis - RV hypertrophy - polycythemia - clubbing
Prinzmetal stable and unstable
Myocarditis
Left -->right

14. What always follows necrosis?
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Anitschow cell
Acute inflammation
Osler nodes (ouch - ouch Osler)

15. When is a post - MI pt at highest risk for rupture of a LV structure? With what microscopic change is this complication associated?
4-7 days macrophage infiltration
Circumflex
Ostium primum
Friction rub and chest pain

16. How do nitrates tx MI?
Decrease preload -->lowers myocardial stress
Membrane damage
LA dilation
Colon cancer

17. What type of vegetations does Strep viridans cause?
Hypertrophic cardiomyopathy
Mitral regurgitation due to vegetations
Small - nondestructive vegetations (subacute endocarditis)
Holosystolic machine like murmur

18. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
PDA
Myofiber hypertrophy with disarray
Aortic stenosis

19. What vavular defect results from acute rheumatic fever?
Plump fibroblasts - collagen - blood vessels
Mitral regurgitation due to vegetations
Migratory polyarthritis
Prinzmetal

20. What areas of the heart does the LAD supply?
Anterior wall of LV and anterior septum
Small vegetations along the line of closure
Holosystolic machine like murmur
Atherosclerosis of coronary arteries

21. What is the tx for mitral valve prolapse?
Valve replacement
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Degree of pulmonary artery stenosis
LA

22. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
RCA
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Posterior wall of LV - posterior septum - papillary muscles
ASD - R-->L

23. What is molecular mimicry?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
When a bacterial protein resembles a protein in human tissue
Fetal alcohol syndrome
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

24. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Sterile vegetations on surface and undersurface on mitral valve
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Colon cancer
Ehlers - Danlow and Marfan syndrome

25. What is the most comon cause of aortic regurg? What are the other causes?
PDA
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Spontaneous

26. What murmur ccan be heard in PDA?
Posterior wall of LV - posterior septum - papillary muscles
RCA
Holosystolic machine like murmur
Ischemic heart disease

27. What is typically the mechanims of sudden cardiac death?
Prinzmetal stable and unstable
Mitral mitral+aortic
Ventricular arrhythmia
Pancarditis

28. What are the causes of restrictive cardiomyopathy in adults?
Sudden cardiac death
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
1%
Pancarditis

29. What are the sx/complications of myocarditis?
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Chronic rheumatic heart disease
Infectious endocarditis
Hypertrophic cardiomyopathy

30. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Breast and lung carcinoma - melanoma - lymphoma
LA dilation
Prinzmetal angina - cocaine

31. What causes microangiopathic hemolytic anemia in aortic stenosis?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
RBC damaged while crossing the calcified valve causing schistocytes
White scar fibrosis
Mitral insufficiency

32. EKG for stable angina?
S viridans
Thickening of chrodae tendinae and cusps - mitral stenosis
ST- segment depression
Harmartoma

33. What are the clinical features of RHF due to?
Rhabdomyoma
RHF
Pulsating nail bed
Systemic venous congestion

34. What is the most common primary cardiac tumor in children? Is it malignant or benign?
2-3%
Dense layer of elastic and fibrotic tissue in the endocardium - children
Left -->right
Rhadbomyoma - benign

35. What causes angina and syncope in aortic stenosis?

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36. What are Osler nodes?
Harmartoma
Valve scarring that arises as a consequence of rheumatic fever
Tender lesions on fingers or toes.
Bacterial endocarditis

37. What are the minor critera of the Jones criteria?
Myocardium
RBC damaged while crossing the calcified valve causing schistocytes
Nonspecific - eg fever and elevated ESR
Infectious

38. How does fibrinolysis/angioplasty tx MI?
Open blocked vessels
Congenital rubella
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Preductal - post aortic arch

39. Which coronary artery supplies the anterior wall and anterior septum?
Valve replacement once LV dysfx develops
Blood vessels coming in from normal tissue
Transesophageal echo
LAD

40. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Acute inflammation
20 min
Shunt - PGE to maintain PDA until surgical repair can be performed
Prinzmetal angina

41. What are the four defects in tetralogy of fallot?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Decreases LV dilation by decreasing volume
Aortic regurg

42. What are the sx of right - to - left shunt?
Rhadbomyoma - benign
Myofiber hypertrophy with disarray
Prinzmetal stable and unstable
Cyanosis - RV hypertrophy - polycythemia - clubbing

43. Which angina is relieved by Ca channel blockers?
RCA
Increased hydrostatic pressure
Low voltage EKG w/diminished QRS amplitude
Prinzmetal

44. What artery is the 2nd most often occluded in an MI?
RCA
Osler nodes (ouch - ouch Osler)
Kawasaki disease
Concentric hypertrophy - can't oxygenate full wall - ischemic damage

45. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
L->R
Increased blood in right heart delays closure of P valve
Reperfusion injury
Nonbacterial thrombotic endocarditis (marantic endocarditis)

46. What effect does transposition of the great vessels have on the ventricles?
Osler nodes (ouch - ouch Osler)
MI
Hypertophy of RV atrophy of LV
1-3 days

47. What is a common complication of cardiac metastasis?
Yellow pallor neutrophils
PDA
Wear and tear
Pericardial effusion due to pericardial involvement

48. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
Minimizes ischemia
Coexisting mitral stenosis and fusion of commisures exist
Mid - systolic click followed by regurgitation murmur

49. In what pt population does S aureus commonly cause valvular disease?
Gelatinous - abundant ground substance
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Boot shaped heart
IV drug users

50. What is the most common cause of myocarditis?
Coxsackie A or B
Turner syndrome
Wear and tear
Type I