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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 causes prinzmetal angina?
Ehlers - Danlow and Marfan syndrome
Coronary artery vasospasm
Reversible
Eisenmenger syndrome

2. What are the sx of pericardiits?
Endocarditis of prosthetic valves
Friction rub and chest pain
Ostium secundum (90%)
R-->L

3. What type of ASD is associated w/Down syndrome?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Streptococcus bovis/
Ostium primum
Decrease preload -->lowers myocardial stress

4. When do neutrophils infiltrate the myocardium post MI?
Inability to fill ventricles
1-3 days
Mitral mitral+aortic
Left -->right

5. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Rhabdomyoma
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Myxoma - benign

6. What is a Quincke pulse?
Papillary muscle - free wall - IV septum
Small vegetations along the line of closure
Right -->left
Pulsating nail bed

7. What is the most common primary cardiac tumor in children? Is it malignant or benign?
LHF
Rhadbomyoma - benign
Ehlers - Danlow and Marfan syndrome
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty

8. What are the sx of aortic regurg?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Months out fibrosis
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Colon cancer

9. What type of ischemia does stable angina cause?
Type I
Subendocardial
Mitral regurg
Squatting - expiration

10. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
4-7 days
Pericardial effusion due to pericardial involvement
Turner syndrome
Contraction band necrosis

11. What gross and microscopic changes occur 1-3 weeks after an MI?
Kawasaki disease
Maternal diabetes
LA
Red border granulation tissue

12. What is the murmur of mitral valve prolapse?
Mid - systolic click followed by regurgitation murmur
Ventricular arrhythmia
Hemosiderin laden macrophages
PDA

13. What are the cancers that most commonly metastasize to the heart?
2-3 weeks
Breast and lung carcinoma - melanoma - lymphoma
NG or Ca channel blocker
Valve replacement once LV dysfx develops

14. What complications occur 4-7 days post MI?
Fibrinous pericarditis
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Rupture of free wall - IV septum - or papillary muscle

15. What type of shunt results in cyanosis at birth?
Thickening of chrodae tendinae and cusps - mitral stenosis
Right to left
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Mitral mitral+aortic

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

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17. Lower extremity cyanosis in infants? In adults?
Infantile coarctation of the aorta PDA
Acute inflammation
Mitral insufficiency
Ischemic heart disease

18. What is chronic rheumatic heart disease?
Valve scarring that arises as a consequence of rheumatic fever
Valve replacement
Aneurysm - mural thrombus - Dressler syndrome
Concentric LV hypertophy

19. What heart sound manifest with an ASD?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Volume overload and LHF
Split S2 on auscultation
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia

20. With what disease is transposition of the great vessels associated?
3-8 wks
Maternal diabetes
Adult coarctation of the aorta
4-7 days

21. Poor myocardial fx due to chronic ischemic damage?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Loeffler syndrome
PDA
Chronic ischemic heart disease

22. What is eythema marginatum? What parts of the body does it commonly involve?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Nitroglycerin
Breast and lung carcinoma - melanoma - lymphoma
Elevated ASO anti - DNase B titers

23. At what point in development do congenital heart defects arise?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Ventricle
Decrease preload -->lowers myocardial stress
3-8 wks

24. What congenital heart defect does indomethacin tx?
PDA
CK- MB
Harmartoma
Squat in response to cyanotic spell

25. What is the most common cause of myocarditis?
Coxsackie A or B
Paradoxical emboli
Mitral regurg
Shunt

26. What is the most common cause of infectious endocarditis?
Friction rub and chest pain
Loeffler syndrome
Streptococcus viridans
Kawasaki disease

27. What endocarditis is commonly found in patients with colon cancer?
SLE
Streptococcus bovis/
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
AD mutation in sarcomere proteins

28. What gross and microscopic changes occur 4-24 hours after an MI?
ST- segment elevation
Dark discoloration coagulative necrosis
Months out fibrosis
Coronary artery vasospasm - emboli - vasculitis

29. What type of shunt does transposition of the great vessels cause?
R-->L
S epidermidis
Stable and unstable prinzmetal
3-8 wks

30. What disesase has Aschoff bodies?
Myocarditis in acute rheumatic heart fever
Months out fibrosis
SLE
Aortic stenosis

31. 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.
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Stable angina
Coronary artery vasospasm - emboli - vasculitis

32. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
Prinzmetal
Squat in response to cyanotic spell
LAD

33. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
Coexisting mitral stenosis and fusion of commisures exist
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Cyanosis - RV hypertrophy - polycythemia - clubbing
Ventricles cannot pump

34. Unexpected death due to cardiac disease w/o sx or <1hr after sx arise?
Circumflex
Nitroglycerin
Sudden cardiac death
Blood vessels coming in from normal tissue

35. What does rupture of the LV free wall cause?
Hypertophy of RV atrophy of LV
Myxoma - benign
Cardiac tamponade
Decreases LV dilation by decreasing volume

36. What is migratory polyarthritis?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
LHF
Backward LHF pulm htn and RHF - afib and associated mural thombis
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

37. What does granulation tissue contain?
LA dilation
Loeffler syndrome
Plump fibroblasts - collagen - blood vessels
Bacterial endocarditis

38. What is Dressler syndrome? When does it occur?
Transesophageal echo
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Autoimmune pericarditis 6-8 wks post MI
RCA

39. When do CK- MB levels rise - peak - and return to normal?
Harmartoma
Hypertophy of RV atrophy of LV
3-8 wks
4-6 hours - 24 hours - 72 hours

40. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Chronic rheumatic heart disease
Bacterial endocarditis
Reactive histiocyte with caterpillar nucleus
Nitroglycerin

41. What causes mitral valve prolapse?
Myxoid degeneration
Nonspecific - eg fever and elevated ESR
Chronic rheumatic heart disease
Pericarditits

42. What causes the dependent pitting edema in RHF?
Aortic regurg
Increased hydrostatic pressure
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Increased arterial resistence decreases shunting - allowing more blood to reach lungs

43. What are the sx/complications of myocarditis?
Sterile vegetations on mitral valve along lines of closure
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Rhabdomyoma

44. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
20 min
Aortic stenosis
Inability to fill ventricles

45. What drug relieves stable angina?
Dark discoloration coagulative necrosis
Shunt
Nitroglycerin
Squatting - increased systemic resistence decreases LV emptying

46. With what congenital heart defect is ADULT coarctation of the aorta associated?
Bicuspid aortic valve
1-3 days out
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
L->R

47. With what disease is Libman - Sacks endocarditis associated?
Nitroglycerin
SLE
Stable angina
Hypercoagulable state or underlying adenocarcinoma

48. Myofiber hypertrophy with disarray.
Inability to maintain systemic pressure w/lack of O2 to vital organs
Hypertrophic cardiomyopathy
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes

49. What is the most common type of ASD? What %?
Heart transplant
Endocardial fibroelastosis (rare)
Ostium secundum (90%)
Valve replacement once LV dysfx develops

50. What is the major cause of MI?
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Mitral valve prolapse
Myxoma - benign
MI