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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 are the Jones criteria?
Yellow pallor macrophages
NG or Ca channel blocker
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Systemic venous congestion

2. What type of tumor is a rhabdomyoma?
Kawasaki disease
Squat in response to cyanotic spell
Shunt - PGE to maintain PDA until surgical repair can be performed
Harmartoma

3. What does rupture of a papillary muscle cause?
Mitral insufficiency
LV dilation and eccentric hypertrophy
Red border granulation tissue
Infectious endocarditis

4. When do neutrophils infiltrate the myocardium post MI?
Streptococcus viridans
Hypertrophic cardiomyopathy
1-3 days
Systolic ejection click followed by crescendo - decrescendo murmur

5. What characterizes acute rheumatic fever endocarditiis?
AD mutation in sarcomere proteins
Squat in response to cyanotic spell
Mitral regurg
Small vegetations along the line of closure

6. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Myxoma - benign
Tender lesions on fingers or toes.
L->R

7. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
Dilation of all four chambers of the heart
20 min
Months out fibrosis
Mitral regurg

8. What is the most common valve infected by S aureus?
RHF
Tricuspid
Fibrinous pericarditis
Intercostal arteries enlarged due to collateral circulation

9. How does adult coarctation of the aorta present?
Months out fibrosis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
4-24 hours
Congenital rubella

10. What does Libman - Sacks endocarditis cause?
Mitral regurg
Thickening of chrodae tendinae and cusps - mitral stenosis
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Loeffler syndrome

11. What congenital heart defect presents later in life with lower extremity cyanosis?
Reperfusion injury
Months out fibrosis
Mitral regurgitation due to vegetations
PDA

12. How does asprin/heparin tx MI?
Tetralogy of fallot
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
Limits thrombosis
PDA

13. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Red border granulation tissue
Anitschow cell
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Aortic regurg

14. What increases the risk for chronic rheumatic heart disease?
Tricuspid
Tuberous sclerosis
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
2-3 weeks

15. What are the forward and backward sx of LHF?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Doxorubicin - cocaine
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
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

16. What causes unstable angina?
Metastasis
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
R-->L
Hypertophy of RV atrophy of LV

17. What are the sx of aortic regurg?
1%
Limits thrombosis
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
Stable and unstable prinzmetal

18. What type of shunt results in cyanosis at birth?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Right to left
Nitroglycerin
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

19. What are the sx/complications of myocarditis?
Posterior wall of LV - posterior septum - papillary muscles
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Pump failure
CK- MB

20. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Posterior wall of LV - posterior septum - papillary muscles
Myocarditis
>60 years - bicuspid aortic valve

21. What is systolic dysfx?
Ventricles cannot pump
Right side - serotonin and other secretory products detoxified in the lung
Bacterial endocarditis
Prinzmetal

22. What effect does squatting have on the murmur of mitral valve prolapse? Why?
Streptococcus viridans
Louder - increased systemic resistence decreases LV emptying
Elevated ASO anti - DNase B titers
Stretched muscle loses contractility

23. L- to - R shunt switching to R- to - L shunt.
Kawasaki disease
Group A beta - hemolytic streptococci
Eisenmenger syndrome
Concentric LV hypertophy

24. Tx for PDA?
Surgical closure small defects may close spontaneously
VSD
Right -->left
Indomethacin - decreases PGE

25. What gross and microscopic changes occur 1-3 weeks after an MI?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
CK- MB
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Red border granulation tissue

26. What causes the dependent pitting edema in RHF?
Ischemic heart disease
Metastasis
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Increased hydrostatic pressure

27. At what point in development do congenital heart defects arise?
Trisomy 21
Low voltage EKG w/diminished QRS amplitude
Dressler syndrome
3-8 wks

28. What is a water - hammer pulse?
Yellow pallor neutrophils
Louder - increased systemic resistence decreases LV emptying
Bounding pulse
RCA

29. What are the clinical features of RHF due to?
Systemic venous congestion
MI
L->R
Reactive histiocyte with caterpillar nucleus

30. When is a post - MI pt at highest risk for a mural thrombus? With what microscopic change is this complication associated?
Rhadbomyoma - benign
Months out fibrosis
Myxoma - benign
Louder - increased systemic resistence decreases LV emptying

31. What imaging test is useful for detecting lesions on valves?
Cardiogenic shock - CHF - arrhythmia
Systolic dysfx leading to biventricular CHF
RCA
Transesophageal echo

32. What % stenosis causes stable angina?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Endocardial fibroelastosis
>70%
Yellow pallor neutrophils

33. What is a complication of chronic rheumatic heart disease?
Infectious endocarditis
LA
L->R
Acute inflammation

34. What causes notching of the ribs in adult coarctation of the aorta?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Intercostal arteries enlarged due to collateral circulation
Hypercoagulable state or underlying adenocarcinoma

35. What is eythema marginatum? What parts of the body does it commonly involve?
VSD
Transesophageal echo
Annular - non pruritic rash w/erythematous borders trunks and limbs
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse

36. What always follows necrosis?
2-3%
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Tricuspid
Acute inflammation

37. What is the tx for aortic stenosis?
Dressler syndrome
Valve replacement AFTER the onset of complications
Squatting - increased systemic resistence decreases LV emptying
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy

38. With what endocarditis is S epidermidis associated?
Transesophageal echo
Mitral valve prolapse
Endocarditis of prosthetic valves
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

39. What are the HACEK organisms? With what condition are they associated?
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Holosystolic machine like murmur
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Within the first day

40. What effect does chronic rheumatic heart disease have the mitral valve?
S aureus
Thickening of chrodae tendinae and cusps - mitral stenosis
2-3%
Loeffler syndrome

41. How does MI cause LHF?
Inability to maintain systemic pressure w/lack of O2 to vital organs
Pancarditis
Loss of LV fx
Transesophageal echo

42. What cardiac disease is associated with tuberous sclerosis?
Holosystolic machine like murmur
Rhabdomyoma
Tetralogy of fallot
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

43. How does restrictive cardiomyopathy present?
Squatting - increased systemic resistence decreases LV emptying
Hemosiderin laden macrophages
Congestive heart failure
Mitral stenosis

44. What is typically the mechanims of sudden cardiac death?
Ventricular arrhythmia
Valve replacement AFTER the onset of complications
Systemic venous congestion
Spontaneous

45. What causes endocarditis of prosthetic valves?
S epidermidis
Aspirin and/or heparin - supplemental O2 - nitrates - beta blocker - ACE inhibitor - fibrinolysis or angioplasty
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Atherosclerosis of coronary arteries

46. Where is the coarctation in infantile coarctation of the aorta?
Preductal - post aortic arch
Spontaneous
MI
Myofiber hypertrophy with disarray

47. What is an Anitschow cell?
Reactive histiocyte with caterpillar nucleus
Day 1-7
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Pericardial effusion due to pericardial involvement

48. What type of ischemia does stable angina cause?
Chronic rheumatic heart disease
Subendocardial
Contraction band necrosis - reperfusion injury
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD

49. With what virus is PDA associated?
Stable and unstable prinzmetal
Congenital rubella
3-8 wks
Migratory polyarthritis

50. How does ischemia cause LHF?
Sterile vegetations on surface and undersurface on mitral valve
Right side - serotonin and other secretory products detoxified in the lung
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Loss of fx