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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. Turner syndrome is associated with which congenital heart defect?
Inability to fill ventricles
Trisomy 21
Infantile coarctation of the aorta
Myxoid degeneration

2. What causes the nutmeg color in nutmeg liver?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Subendocardial
ACE inhibitor
Congested central veins

3. What does Libman - Sacks endocarditis cause?
Coronary artery vasospasm - emboli - vasculitis
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Valve replacement
Mitral regurg

4. When do troponin levels rise - peak - and return to normal?
Shunt - PGE to maintain PDA until surgical repair can be performed
Breast and lung carcinoma - melanoma - lymphoma
2-4 hours - 24 hours - 7-10 days
Mitral regurg

5. What is diastolic dysfx?
CK- MB
Inability to fill ventricles
Ostium secundum (90%)
Contraction band necrosis

6. When does the heart have a yellow pallor post MI?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Elevated ASO anti - DNase B titers
Streptococcus viridans
Day 1-7

7. What side of the heart do carcinoid tumors affect? Why?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
RCA
Right side - serotonin and other secretory products detoxified in the lung
4-24 hours

8. What are the clinical features of RHF due to?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Systemic venous congestion
Coronary artery vasospasm - emboli - vasculitis
Myocarditis in acute rheumatic heart fever

9. What causes unstable angina?
Harmartoma
Congenital rubella
Mitral valve prolapse
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

10. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Squatting - expiration
Months out fibrosis
4-7 days
Libman - Sacks endocarditis

11. What type of endocarditis is associated with SLE?
RCA
Libman - Sacks endocarditis
Trisomy 21
Adult coarctation of the aorta

12. What are the minor critera of the Jones criteria?
Fibrinous pericarditis
Kawasaki disease
Nonspecific - eg fever and elevated ESR
Aschoff bodies

13. What type of collagen is involved in fibrosis?
Type I
Degree of pulmonary artery stenosis
Aortic regurg
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

14. In which chamber of the heart are cardiac myxomas found?
Bicuspid aortic valve
4-24 hours
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
LA

15. What is the leading cause of death in the US?
Endocardial fibroelastosis (rare)
Stable and unstable prinzmetal
Ischemic heart disease
Streptococcus viridans

16. What drugs can cause dilated cardiomyopathy?
Doxorubicin - cocaine
Within the first day
Nonbacterial thrombotic endocarditis (marantic endocarditis)
1-3 days

17. What does chronic ischemic heart disease progress to?
Decreases LV dilation by decreasing volume
Transposition of the great vessels
Infectious endocarditis
CHF

18. What causes microangiopathic hemolytic anemia in aortic stenosis?
Positive blood cultures anemia of chronic disease
Tricuspid
Tender lesions on fingers or toes.
RBC damaged while crossing the calcified valve causing schistocytes

19. What % stenosis causes stable angina?
Gelatinous - abundant ground substance
CK- MB
>70%
Squat in response to cyanotic spell

20. What is the murmur of mitral regurg?
Myxoma - benign
Libman - Sacks endocarditis
2-3 weeks
Holosystolic blowing murmur

21. What is the most common cause of death during the acute phase of rheumatic fever?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
ASD - R-->L
Myocarditis
Congenital rubella

22. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
PDA
Infectious endocarditis - arrythmias - severe mitral regurg no
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Aortic regurg

23. What type of shunt does transposition of the great vessels cause?
Prophylactic abx during dental procedures
Congenital rubella
Coexisting mitral stenosis and fusion of commisures exist
R-->L

24. What type of shunt does a VSD cause?
Reactive histiocyte with caterpillar nucleus
>60 years - bicuspid aortic valve
L->R
Prinzmetal angina

25. What increases the volume of mitral regurg murmur?
ACE inhibitor
S viridans
Myofiber hypertrophy with disarray
Squatting - expiration

26. What always follows necrosis?
4-6 hours - 24 hours - 72 hours
Acute inflammation
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Libman - Sacks endocarditis

27. What is the tx for mitral valve prolapse?
Squatting - expiration
Decreased forward perfusion pulmonary congestion
Increased hydrostatic pressure
Valve replacement

28. What is a common complication of cardiac metastasis?
Reperfusion injury
Louder - increased systemic resistence decreases LV emptying
2-4 hours - 24 hours - 7-10 days
Pericardial effusion due to pericardial involvement

29. What typically causes hypertrophic cardiomyopathy?
AD mutation in sarcomere proteins
Adult coarctation of the aorta
Bicuspid aortic valve
Infectious endocarditis

30. What are Osler nodes?
S aureus
Small vegetations along the line of closure
Infantile coarctation of the aorta PDA
Tender lesions on fingers or toes.

31. Opening snap followed by diastolic rumble.
Infantile coarctation of the aorta PDA
Rupture of free wall - IV septum - or papillary muscle
Mitral stenosis
Asymptomatic

32. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
Papillary muscle - free wall - IV septum
Left -->right
2-4 hours - 24 hours - 7-10 days

33. What type of ischemia does stable angina cause?
PDA
Subendocardial
Aschoff bodies
Hemosiderin laden macrophages

34. How does asprin/heparin tx MI?
Metastasis
Nonspecific - eg fever and elevated ESR
S epidermidis
Limits thrombosis

35. What causes an early - blowing diastolic murmur?
Aortic regurg
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Volume overload and LHF
Ventricle

36. Holosystolic blowing murmur that increases w/expiration?
Pulsating nail bed
Atherosclerosis of coronary arteries
Ehlers - Danlow and Marfan syndrome
Mitral regurg

37. What vavular defect results from acute rheumatic fever?
Mitral regurgitation due to vegetations
Turner syndrome
Mitral insufficiency
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

38. What gross and microscopic changes occur 4-24 hours after an MI?
Dark discoloration coagulative necrosis
LA dilation
Trisomy 21
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve

39. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
Loss of LV fx
RHF
Hypertophy of RV atrophy of LV
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

40. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Aschoff bodies
Mitral and tricuspid regurg - arrhythmia
Loss of fx
Erythematous nontender lesions on palms and soles.

41. In which chamber of the heart are rhabdomyomas found?
Ventricle
Pericardial effusion due to pericardial involvement
Ostium primum
Pedunculated mass in the LA that causes syncope due to obstruction of MV

42. What is eythema marginatum? What parts of the body does it commonly involve?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Tuberous sclerosis
Libman - Sacks endocarditis

43. What is the 1day-1wk -1mo mneumonic for MI?
Infectious endocarditis - arrythmias - severe mitral regurg no
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Mitral insufficiency
>70%

44. What is the most common cause of dilated cardiomyopathy? What are other causes?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Thickening of chrodae tendinae and cusps - mitral stenosis
Maternal diabetes
Hemosiderin laden macrophages

45. What is the JOneS mneumonic?
Hypertrophic cardiomyopathy
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
Troponin I

46. What compensatory mechanism do tetralogy of fallot pts learn?
Squat in response to cyanotic spell
Tender lesions on fingers or toes.
When a bacterial protein resembles a protein in human tissue
Pts w/previously damaged valves

47. What is the characteristic murmur of aortic stenosis?
Systolic ejection click followed by crescendo - decrescendo murmur
Mitral valve prolapse
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

48. Tx for PDA?
Indomethacin - decreases PGE
Type I
ST- segment elevation
Erythematous nontender lesions on palms and soles.

49. Is scar tissue or myocardium stronger?
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Concentric LV hypertophy
Right to left
Myocardium

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

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