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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. How does MI cause LHF?
Cardiogenic shock - CHF - arrhythmia
Loss of LV fx
IV drug users
MI

2. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
ASD - R-->L
Nonbacterial thrombotic endocarditis (marantic endocarditis)
S aureus
LA dilation

3. What type of collagen is involved in fibrosis?
Valve scarring that arises as a consequence of rheumatic fever
>70%
Type I
Backward LHF pulm htn and RHF - afib and associated mural thombis

4. Which angina(s) show ST elevation on EKG? ST depression?
Prinzmetal stable and unstable
Atherosclerosis of coronary arteries
Troponin I
Heart can't fill

5. What characterizes acute rheumatic fever endocarditiis?
Tricuspid
ST- segment elevation
Small vegetations along the line of closure
ASD - R-->L

6. What does rupture of the IV septum cause?
Migratory polyarthritis
Prinzmetal angina - cocaine
Shunt
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'

7. What are the laboratory findings of bacterial endocarditis?
Hypertrophic cardiomyopathy
Tetralogy of fallot
4-7 days
Positive blood cultures anemia of chronic disease

8. How does dilated cardiomyopathy cause LHF?
Dilated
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Stretched muscle loses contractility
Dilation of all four chambers of the heart

9. What are the four defects in tetralogy of fallot?
Preductal - post aortic arch
Ehlers - Danlow and Marfan syndrome
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Hypertrophic cardiomyopathy

10. What is the most common type of ASD? What %?
Months out fibrosis
Ostium secundum (90%)
Dressler syndrome
Right to left

11. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
Contraction band necrosis
Trisomy 21
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Pts w/previously damaged valves

12. What is the most common cause of infectious endocarditis?
Kawasaki disease
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Streptococcus viridans

13. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Red border granulation tissue
Aortic stenosis
Aortic regurg
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase

14. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Ventricular arrhythmia
Stable and unstable prinzmetal
Prinzmetal
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

15. What type of shunt dose PDA cause?
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
4-7 days
PDA
Left -->right

16. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
IV drug users
Preductal - post aortic arch
RHF
Right -->left

17. In which chamber of the heart are rhabdomyomas found?
Infectious endocarditis
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Ventricle
Nonbacterial thrombotic endocarditis (marantic endocarditis)

18. Vegetations on surface and undersurface of mitral valve.
Streptococcus bovis/
Libman - Sacks endocarditis
Streptococcus viridans
Boot shaped heart

19. Small - sterile fibrin deposits randomly arranged on closure of valve leaflets in a pt w/metastatic colon cancer?
Metastasis
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Infectious
Volume overload and LHF

20. What is eythema marginatum? What parts of the body does it commonly involve?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Inability to maintain systemic pressure w/lack of O2 to vital organs
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Small - nondestructive vegetations (subacute endocarditis)

21. What does rupture of the LV free wall cause?
Opening snap followed by diastolic rumble
Cardiac tamponade
Turner syndrome
Months out fibrosis

22. How do you tx prinzmetal angina?
Tetralogy of fallot
Boot shaped heart
NG or Ca channel blocker
Osler nodes (ouch - ouch Osler)

23. What congenital heart defect presents later in life with lower extremity cyanosis?
PDA
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
PGE
Contraction band necrosis - reperfusion injury

24. How does asprin/heparin tx MI?
Contraction band necrosis - reperfusion injury
Limits thrombosis
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Myocarditis

25. What are the complications of mitral valve prolapse? Are they common?
Infectious endocarditis - arrythmias - severe mitral regurg no
Ehlers - Danlow and Marfan syndrome
Type I
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

26. What is an Aschoff body?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Pericarditits
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
Chronic rheumatic heart disease

27. What areas of the heart does the RCA supply?
Myocardium
Paradoxical emboli
Posterior wall of LV - posterior septum - papillary muscles
RCA

28. When do CK- MB levels rise - peak - and return to normal?
Granulation tissue
Transesophageal echo
LHF
4-6 hours - 24 hours - 72 hours

29. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
When a bacterial protein resembles a protein in human tissue
Mitral mitral+aortic
Tender lesions on fingers or toes.
MI

30. What complications occur 4-7 days post MI?
ACE inhibitor
Left -->right
Rupture of free wall - IV septum - or papillary muscle
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

31. Friction rub and chest pain.
Pericarditits
S epidermidis
Inability to maintain systemic pressure w/lack of O2 to vital organs
Ostium primum

32. What effect does mitral stenosis have on the heart chambers?
Myocarditis
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Sterile vegetations on surface and undersurface on mitral valve
LA dilation

33. What causes an early - blowing diastolic murmur?
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Pump failure
Aortic regurg
Stable and unstable prinzmetal

34. What bug causes acute rheumatic fever?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
ACE inhibitor
Small - nondestructive vegetations (subacute endocarditis)
Group A beta - hemolytic streptococci

35. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Months out fibrosis
Reperfusion injury
Fetal alcohol syndrome
LHF

36. What are the forward and backward sx of LHF?
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
Pulsating nail bed
Chest pain <20 min brought on by exertion or emotional stress
Infectious endocarditis

37. How does hypertension cause LHF?

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38. Which chambers of the heart are generally spared in an MI?
RBC damaged while crossing the calcified valve causing schistocytes
LA
Hypercoagulable state or underlying adenocarcinoma
Atria and RV

39. What is dilated cardiomyopathy?
Indomethacin - decreases PGE
Dilation of all four chambers of the heart
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Limits thrombosis

40. What causes heart failure cells?
Contraction band necrosis
Aortic regurg
CK- MB
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

41. What is the tx for mitral valve prolapse?
Squat in response to cyanotic spell
Valve replacement
1%
Valve replacement AFTER the onset of complications

42. With what virus is PDA associated?
Congenital rubella
Opening snap followed by diastolic rumble
VSD
IV drug users

43. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Anitschow cell
Loeffler syndrome
4-7 days macrophage infiltration
Nonspecific - eg fever and elevated ESR

44. What is cardiogenic shock?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Yellow pallor macrophages
Heart transplant
Surgical closure small defects may close spontaneously

45. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Chronic rheumatic heart disease
PDA
Stretched muscle loses contractility
>60 years - bicuspid aortic valve

46. Sudden death in a young athlete.
Hypertrophic cardiomyopathy
Harmartoma
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Mitral regurg

47. What is the tx for VSD?
Yellow pallor macrophages
Surgical closure small defects may close spontaneously
Rhadbomyoma - benign
Shunt

48. Ostium primum ASD is associated with what congenital disorder?
Aneurysm - mural thrombus - Dressler syndrome
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Heart can't fill
Trisomy 21

49. Episodic chest pain unrelated to exertion due to coronary vasospasm. ST- segment elevation. Relieved by NG or Ca channel blockers.
Prinzmetal angina - cocaine
Within the first day
RHF
Prinzmetal angina

50. What valves are involved in rhuematic endocarditis?
Mitral mitral+aortic
Fibrinous pericarditis
Ischemic heart disease
Heart can't fill