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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. With what endocarditis is S epidermidis associated?
Endocarditis of prosthetic valves
Myofiber hypertrophy with disarray
LHF
Osler nodes (ouch - ouch Osler)

2. What is the gross and microscopic appearance of cardiac myxomas?
Yellow pallor macrophages
Gelatinous - abundant ground substance
Systemic venous congestion
Hemosiderin laden macrophages

3. What are Osler nodes?
S epidermidis
LAD
Large - destructive vegetations
Tender lesions on fingers or toes.

4. What congenital heart defect presents later in life with lower extremity cyanosis?
Fetal alcohol syndrome
Spontaneous
PDA
Ischemic heart disease

5. When is a post - MI pt at highest risk for Dressler syndrome? With what microscopic change is this complication associated?
Transposition of the great vessels
White scar fibrosis
Months out fibrosis
1%

6. How does reperfusion injury occur?
3-8 wks
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Granulation tissue
Pericarditits

7. What is the cause of the red border around granulation tissue?
Blood vessels coming in from normal tissue
Bicuspid aortic valve
Chest pain <20 min brought on by exertion or emotional stress
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

8. With what congenital heart defect is ADULT coarctation of the aorta associated?
PDA
Nitroglycerin
Bicuspid aortic valve
Prinzmetal

9. What effect does dilated cardiomyopathy have on the heart?
PDA
Systolic dysfx leading to biventricular CHF
Loss of fx
Fibrosis and dystrophic calcification

10. Myofiber hypertrophy with disarray.
Hypertrophic cardiomyopathy
Elevated ASO anti - DNase B titers
Small vegetations along the line of closure
Myocarditis

11. What type of shunt does transposition of the great vessels cause?
Fetal alcohol syndrome
SLE
Tender lesions on fingers or toes.
R-->L

12. What is the rate of congenital heart defects?
Mid - systolic click followed by regurgitation murmur
Infectious
Coxsackie A or B
1%

13. What does granulation tissue contain?
Acute inflammation
Mitral mitral+aortic
Plump fibroblasts - collagen - blood vessels
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib

14. What are the causes of restrictive cardiomyopathy in adults?
1-3 days out
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Systolic dysfx leading to biventricular CHF
Mitral valve prolapse

15. What are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
NG or Ca channel blocker
4-24 hours
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

16. Erythematous nontender lesions on palms and soles.
Valve replacement once LV dysfx develops
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
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
Janeway lesions

17. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
ACE inhibitor
Stable angina
Atherosclerosis of coronary arteries
Months out fibrosis

18. What are the cancers that most commonly metastasize to the heart?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Ventricle
Breast and lung carcinoma - melanoma - lymphoma
Myxoma - benign

19. Large vegetations on tricuspid valve?
Tetralogy of fallot
S epidermidis
S aureus
Pancarditis

20. What is the characteristic murmur of aortic stenosis?
Low voltage EKG w/diminished QRS amplitude
Systolic ejection click followed by crescendo - decrescendo murmur
Pump failure
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint

21. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina
Surgical closure small defects may close spontaneously
Congested central veins
Paradoxical emboli

22. What is chronic rheumatic heart disease?
Mitral regurg
Valve scarring that arises as a consequence of rheumatic fever
Volume overload and LHF
Streptococcus viridans

23. With what condition are rhabdomyomas associated?
Tuberous sclerosis
Right side - serotonin and other secretory products detoxified in the lung
Myxoma - benign
Cardiac tamponade

24. What is the most common cause of myocarditis?
Congested central veins
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
PDA
Coxsackie A or B

25. In which chamber of the heart are cardiac myxomas found?
Colon cancer
LA
Preductal - post aortic arch
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

26. Which congenital heart defect is associated with maternal diabetes?
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Transposition of the great vessels
Cyanosis - RV hypertrophy - polycythemia - clubbing
Prinzmetal angina - cocaine

27. What is the 1day-1wk -1mo mneumonic for MI?
VSD
Coxsackie A or B
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
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

28. What is an important complication of ASD?
Open blocked vessels
2-3%
Paradoxical emboli
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets

29. What are the minor critera of the Jones criteria?
Mitral insufficiency
Nonspecific - eg fever and elevated ESR
Systemic venous congestion
Congenital rubella

30. What type of collagen is involved in fibrosis?
Type I
Right to left
Adult coarctation of the aorta
Myocarditis

31. What gross and microscopic changes occur 4-24 hours after an MI?
Dark discoloration coagulative necrosis
Right side - serotonin and other secretory products detoxified in the lung
>60 years - bicuspid aortic valve
Preductal - post aortic arch

32. How long after pharyngitis does acute rheumatic fever occur?
2-3 weeks
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Infantile coarctation of the aorta PDA
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

33. How does dilated cardiomyopathy cause LHF?
Opening snap followed by diastolic rumble
CHF
Myocarditis in acute rheumatic heart fever
Stretched muscle loses contractility

34. How does stable angina present?
RCA
Chest pain <20 min brought on by exertion or emotional stress
Prophylactic abx during dental procedures
Small - nondestructive vegetations (subacute endocarditis)

35. What type of shunt does ASD cause?
Left -->right
Transposition of the great vessels
Paradoxical emboli
Day 1-7

36. When do macrophagess infiltrate the myocardium post MI?
Libman - Sacks endocarditis
4-7 days
Spontaneous
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

37. How does asprin/heparin tx MI?
Aneurysm - mural thrombus - Dressler syndrome
Limits thrombosis
Doxorubicin - cocaine
Months out fibrosis

38. How do you tx prinzmetal angina?
Fibrinous pericarditis
Surgical closure small defects may close spontaneously
NG or Ca channel blocker
Congested central veins

39. What is the most common cause of sudden cardiac death? What are less common causes of sudden cardiac death?
Red border granulation tissue
Loeffler syndrome
Aortic regurg
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

40. What is the characteristic murmurr of mitral stenosis?
Opening snap followed by diastolic rumble
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Months out fibrosis

41. What artery is the 2nd most often occluded in an MI?
VSD
Slow HR - decreasing O2 demand and risk for arrhythmia
Prinzmetal stable and unstable
RCA

42. Reactive histiocyte with slender - wavy 'caterpillar' nucleus.
CK- MB
MI
Anitschow cell
Within the first day

43. What typically causes hypertrophic cardiomyopathy?
Infectious endocarditis - arrythmias - severe mitral regurg no
AD mutation in sarcomere proteins
Nitroglycerin
Maternal diabetes

44. What characterizes acute rheumatic fever endocarditiis?
RCA
White scar fibrosis
4-7 days
Small vegetations along the line of closure

45. What is dilated cardiomyopathy?
RCA
Dilation of all four chambers of the heart
PDA
Sterile vegetations on surface and undersurface on mitral valve

46. What imaging test is useful for detecting lesions on 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
Volume overload and LHF
Transesophageal echo
R-->L

47. What causes the dependent pitting edema in RHF?
Reversible
Transesophageal echo
45%
Increased hydrostatic pressure

48. What is the most common form of cardiomyopathy?
PDA
Mitral mitral+aortic
Dilated
Fetal alcohol syndrome

49. What iis the tx for aortic regurg?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Valve replacement once LV dysfx develops
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

50. What gross and microscopic changes occur 4-7 days after an MI?
Indomethacin - decreases PGE
Adult coarctation of the aorta
Yellow pallor macrophages
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase