Test your basic knowledge |

Cardiac

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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 definition of ischemia?
ST- segment depression
Decrease in blood flow to an organ
Libman - Sacks endocarditis
Hypertrophic cardiomyopathy

2. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Squatting - increased systemic resistence decreases LV emptying
Months out fibrosis
Intercostal arteries enlarged due to collateral circulation
Erythematous nontender lesions on palms and soles.

3. What are the sx of cardiac myxoma?
Myxoid degeneration
Infectious
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Group A beta - hemolytic streptococci

4. What is a Quincke pulse?
Louder - increased systemic resistence decreases LV emptying
Pulsating nail bed
Aschoff bodies
Friction rub and chest pain

5. What causes an early - blowing diastolic murmur?
Split S2 on auscultation
Aortic regurg
Anterior wall of LV and anterior septum
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea

6. What valves are most commonly involved in chronic rheumatic heart disease?
Mitral mitral+aortic
Chest pain <20 min brought on by exertion or emotional stress
Infantile coarctation of the aorta PDA
Spontaneous

7. When do troponin levels rise - peak - and return to normal?
2-4 hours - 24 hours - 7-10 days
LV dilation and eccentric hypertrophy
Atherosclerosis of coronary arteries
Prinzmetal

8. What effect does chronic rheumatic heart disease have the mitral valve?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Thickening of chrodae tendinae and cusps - mitral stenosis
Atria and RV
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

9. What typically causes hypertrophic cardiomyopathy?
Tricuspid
AD mutation in sarcomere proteins
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
Inability to maintain systemic pressure w/lack of O2 to vital organs

10. How does ischemia cause LHF?
Loss of fx
Type I
Bicuspid aortic valve
Valve replacement

11. What does rupture of the LV free wall cause?
Infectious endocarditis
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Cardiac tamponade
Pericarditits

12. What is an Anitschow cell?
Turner syndrome
Reactive histiocyte with caterpillar nucleus
Bounding pulse
ACE inhibitor

13. What congenital heart defect is associated with fetal alcohol syndrome?
Infantile coarctation of the aorta PDA
Chronic ischemic heart disease
VSD
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

14. Infects predamaged valves after transient bacteremia?
Mitral regurgitation due to vegetations
S viridans
Left -->right
Prophylactic abx during dental procedures

15. What % of MIs involve the LAD?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Bounding pulse
45%
Ventricles cannot pump

16. What does nonbacterial thrombotic endocarditis cause?
Valve replacement AFTER the onset of complications
Open blocked vessels
NG or Ca channel blocker
Mitral regurg

17. How does restrictive cardiomyopathy present?
Congestive heart failure
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Coexisting mitral stenosis and fusion of commisures exist
CHF

18. What causes mitral valve prolapse?
SLE
Ostium secundum (90%)
Myxoid degeneration
Chronic rheumatic heart disease

19. What two things happen when a blocked vessel is opened after an MI?
Tetralogy of fallot
Small vegetations along the line of closure
Reactive histiocyte with caterpillar nucleus
Contraction band necrosis - reperfusion injury

20. In which pts does S viridans cause endocarditits?
Pts w/previously damaged valves
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
RCA
Open blocked vessels

21. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
LV dilation and eccentric hypertrophy
Papillary muscle - free wall - IV septum
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
ASD - R-->L

22. What are the complications of mitral valve prolapse? Are they common?
Decreased forward perfusion pulmonary congestion
4-7 days macrophage infiltration
Infectious endocarditis - arrythmias - severe mitral regurg no
Endocarditis of prosthetic valves

23. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
Prinzmetal angina - cocaine
Cardiogenic shock - CHF - arrhythmia
Stable angina

24. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
CHF
Positive blood cultures anemia of chronic disease
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Anitschow cell

25. What effect does aortic regurg have on the pulse pressure? Why?
R-->L
Valve replacement AFTER the onset of complications
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

26. What causes wear and tear aortic stenosis?
Boot shaped heart
Chronic ischemic heart disease
Fibrosis and dystrophic calcification
Endocarditis of prosthetic valves

27. Holosystolic blowing murmur that increases w/expiration?
Dilated
Janeway lesions
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Mitral regurg

28. What causes acute endocarditis?
Posterior wall of LV - posterior septum - papillary muscles
Large vegetations of S aureus
4-7 days macrophage infiltration
Friction rub and chest pain

29. What areas of the heart does the LAD supply?
Ventricles cannot pump
45%
Anterior wall of LV and anterior septum
Hypercoagulable state or underlying adenocarcinoma

30. What causes the dependent pitting edema in RHF?
Holosystolic machine like murmur
Prinzmetal
Increased hydrostatic pressure
Doxorubicin - cocaine

31. Myofiber hypertrophy with disarray.
Hypertrophic cardiomyopathy
Increased blood in right heart delays closure of P valve
Chest pain <20 min brought on by exertion or emotional stress
Increased hydrostatic pressure

32. What type of shunt does truncus arteriosus cause?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
R-->L
Myofiber hypertrophy with disarray
Dilated

33. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Turner syndrome
Eisenmenger syndrome
Thickening of chrodae tendinae and cusps - mitral stenosis

34. How do beta blockers tx MI?
Aortic regurg
Harmartoma
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Slow HR - decreasing O2 demand and risk for arrhythmia

35. What gross and microscopic changes occur 1-3 days after an MI?
Subendocardial
Increased hydrostatic pressure
Yellow pallor neutrophils
Plump fibroblasts - collagen - blood vessels

36. What determines the extent of shunting and cyanosis in tetralogy of fallot?
Degree of pulmonary artery stenosis
Cyanosis - RV hypertrophy - polycythemia - clubbing
Open blocked vessels
White scar fibrosis

37. What increases the risk for chronic rheumatic heart disease?
Rhabdomyoma
Subendocardial
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

38. Opening snap followed by diastolic rumble.
Paradoxical emboli
Mitral stenosis
Fibrinous pericarditis
Large - destructive vegetations

39. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Months out fibrosis
S aureus
Congestive heart failure
Mitral regurgitation due to vegetations

40. What is the characteristic murmur of aortic stenosis?
RCA
Louder - increased systemic resistence decreases LV emptying
4-7 days
Systolic ejection click followed by crescendo - decrescendo murmur

41. What is the effect of mitral regurg on the heart?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Degree of pulmonary artery stenosis
Volume overload and LHF
MI

42. Dilated cardiomyopathy is a late complication of what illness?
Tetralogy of fallot
Red border granulation tissue
Rhadbomyoma - benign
Myocarditis

43. What is the tx for aortic stenosis?
Aortic stenosis
LA
Valve replacement AFTER the onset of complications
VSD

44. What are heart failure cells?
Dressler syndrome
Mitral mitral+aortic
Ischemic heart disease
Hemosiderin laden macrophages

45. How does adult coarctation of the aorta present?
Reactive histiocyte with caterpillar nucleus
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
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

46. What structures are susceptible to rupture post MI?
Group A beta - hemolytic streptococci
Infectious endocarditis
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Papillary muscle - free wall - IV septum

47. What are the sx of pericardiits?
Myocarditis
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Pts w/previously damaged valves
Friction rub and chest pain

48. What is the 1day-1wk -1mo mneumonic for MI?
PDA
Preductal - post aortic arch
Mitral insufficiency
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

49. How does Eisenmeger syndrome occur?
Fetal alcohol syndrome
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
Bicuspid aortic valve
Nonbacterial thrombotic endocarditis (marantic endocarditis)

50. What are the sx of hypertrophic cardiomyopathy?
Pericardial effusion due to pericardial involvement
Fibrinous pericarditis
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Nonspecific - eg fever and elevated ESR