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 % of MIs involve the LAD?
NG or Ca channel blocker
45%
Day 1-7
Volume overload and LHF

2. How does fibrinolysis/angioplasty tx MI?
>70%
Heart can't fill
Open blocked vessels
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

3. What type of collagen is involved in fibrosis?
Type I
Fibrosis and dystrophic calcification
Aortic regurg
Valve replacement AFTER the onset of complications

4. What effect does aortic regurg have on the pulse pressure? Why?
Valve replacement
Paradoxical emboli
Decreased forward perfusion pulmonary congestion
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume

5. What does rupture of a papillary muscle cause?
Congested central veins
Mitral insufficiency
Systemic venous congestion
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

6. What causes microangiopathic hemolytic anemia in aortic stenosis?
RBC damaged while crossing the calcified valve causing schistocytes
Circumflex
Hemosiderin laden macrophages
Yellow pallor macrophages

7. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
L->R
Chronic rheumatic heart disease
Positive blood cultures anemia of chronic disease

8. What endocarditis is commonly found in patients with colon cancer?
First 4 hours
Streptococcus bovis/
Mitral mitral+aortic
Annular - non pruritic rash w/erythematous borders trunks and limbs

9. What gross and microscopic changes occur 4-7 days after an MI?
4-7 days
Regurg vs stenosis
Yellow pallor macrophages
Nonbacterial thrombotic endocarditis (marantic endocarditis)

10. What are the Jones criteria?
Sterile vegetations on surface and undersurface on mitral valve
Reactive histiocyte with caterpillar nucleus
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
R-->L

11. Why are cardiac enzymes elevated after an MI?
Gelatinous - abundant ground substance
Streptococcus bovis/
Membrane damage
Transesophageal echo

12. What areas of the heart does the RCA supply?
Increased hydrostatic pressure
Posterior wall of LV - posterior septum - papillary muscles
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Degree of pulmonary artery stenosis

13. What are the complications of mitral valve prolapse? Are they common?
Mitral mitral+aortic
ACE inhibitor
Mitral regurg
Infectious endocarditis - arrythmias - severe mitral regurg no

14. In transposition of the great vessels - What is required for survival? How is this achieved?
Aortic regurg
NG or Ca channel blocker
Shunt - PGE to maintain PDA until surgical repair can be performed
Systemic venous congestion

15. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Fibrosis and dystrophic calcification
LHF
Months out fibrosis
Prinzmetal angina

16. What causes the dependent pitting edema in RHF?
Dark discoloration coagulative necrosis
Increased hydrostatic pressure
Cardiac tamponade
Open blocked vessels

17. When does the heart have dark discoloration post MI?
VSD
Pts w/previously damaged valves
4-24 hours
Endocardial fibroelastosis

18. What are the sx of right - to - left shunt?
Shunt - PGE to maintain PDA until surgical repair can be performed
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Cyanosis - RV hypertrophy - polycythemia - clubbing
Shunt

19. What are the two effects of ATII?
Chronic rheumatic heart disease
Ischemic heart disease
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Gelatinous - abundant ground substance

20. Chest pain the arises with exertion or emotional stress and is relieved by NG or rest. The pain lasts <20 min and radiates to the left arm or jaw. There is also diaphoresis and SOB - EKG shows ST- segment depression.
Open blocked vessels
LA dilation
Libman - Sacks endocarditis
Stable angina

21. What is chronic rheumatic heart disease?
Type I
Valve scarring that arises as a consequence of rheumatic fever
Reperfusion injury
Inability to fill ventricles

22. How does asprin/heparin tx MI?
Hemosiderin laden macrophages
Myxoma - benign
Prinzmetal stable and unstable
Limits thrombosis

23. In which pts does S viridans cause endocarditits?
Pts w/previously damaged valves
Autoimmune pericarditis 6-8 wks post MI
Aortic regurg
Red border granulation tissue

24. What effect does aortic stenosis have on the chambers of the heart?
ASD - R-->L
Prophylactic abx during dental procedures
Squat in response to cyanotic spell
Concentric LV hypertophy

25. Return of O2 and inflammatory cells cause FR generation - further damaging myocytes.
CHF
Libman - Sacks endocarditis
Reperfusion injury
Tricuspid

26. What are the causes of LHF?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Valve scarring that arises as a consequence of rheumatic fever
Months out fibrosis
Pump failure

27. What are the complications of mitral stenosis?
Mitral valve prolapse
45%
Backward LHF pulm htn and RHF - afib and associated mural thombis
Papillary muscle - free wall - IV septum

28. When does the heart have a yellow pallor post MI?
LHF
Day 1-7
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Mitral and tricuspid regurg - arrhythmia

29. What heart sound manifest with an ASD?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Split S2 on auscultation
Increased hydrostatic pressure
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

30. Opening snap followed by diastolic rumble.
VSD
Decreases LV dilation by decreasing volume
Mitral stenosis
Hemosiderin laden macrophages

31. What makes the MV prolapse murmur louder? Why?
Indomethacin - decreases PGE
Right -->left
White scar fibrosis
Squatting - increased systemic resistence decreases LV emptying

32. Is scar tissue or myocardium stronger?
Myocardium
Nonspecific - eg fever and elevated ESR
Membrane damage
When a bacterial protein resembles a protein in human tissue

33. What is the murmur of mitral regurg?
Infectious
Systolic dysfx leading to biventricular CHF
Holosystolic blowing murmur
Stable angina

34. Boot - shaped heart on x- ray?
Tetralogy of fallot
Membrane damage
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Asymptomatic

35. What type of vegetations does nonbacterial thrombotic endocarditis (marantic endocarditis) cause?
Endocarditis of prosthetic valves
LA dilation
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Annular - non pruritic rash w/erythematous borders trunks and limbs

36. How do ACE inhibitors tx MI?
Decreases LV dilation by decreasing volume
Louder - increased systemic resistence decreases LV emptying
Yellow pallor macrophages
>70%

37. What compensatory mechanism do tetralogy of fallot pts learn?
Squat in response to cyanotic spell
Friction rub and chest pain
Valve replacement once LV dysfx develops
Wear and tear

38. What cardiac enzyme is useful for detecting reinfarction?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Transesophageal echo
CK- MB
Colon cancer

39. What tests show prior group A beta - hemolytic strep infection?
Erythematous nontender lesions on palms and soles.
Tricuspid
Subendocardial
Elevated ASO anti - DNase B titers

40. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Months out fibrosis
Doxorubicin - cocaine
Colon cancer
R-->L

41. What shunt does tetralogy of fallot produce?
Split S2 on auscultation
Rhabdomyoma
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Right -->left

42. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Aortic regurg
S viridans
Colon cancer

43. What effect does mitral stenosis have on the heart chambers?
Group A beta - hemolytic streptococci
Systolic ejection click followed by crescendo - decrescendo murmur
LA dilation
Regurg vs stenosis

44. How do beta blockers tx MI?
Large - destructive vegetations
Breast and lung carcinoma - melanoma - lymphoma
Tender lesions on fingers or toes.
Slow HR - decreasing O2 demand and risk for arrhythmia

45. Which congenital heart defect is associated with maternal diabetes?
Transposition of the great vessels
Degree of pulmonary artery stenosis
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Janeway lesions

46. What is systolic dysfx?
Prinzmetal angina
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Cardiogenic shock - CHF - arrhythmia
Ventricles cannot pump

47. Large vegetations on tricuspid valve?
Endocardial fibroelastosis
S aureus
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Autoimmune pericarditis 6-8 wks post MI

48. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Trisomy 21
Reactive histiocyte with caterpillar nucleus
PDA
LHF

49. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
LAD
Myxoma - benign
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Streptococcus viridans

50. What is a common complication of cardiac metastasis?
Valve replacement
Squatting - increased systemic resistence decreases LV emptying
Pericardial effusion due to pericardial involvement
Regurg vs stenosis