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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 sx/complications of myocarditis?
Infectious endocarditis - arrythmias - severe mitral regurg no
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

2. What are the sx of PDA at birth?
Ostium primum
Asymptomatic
Positive blood cultures anemia of chronic disease
Coronary artery vasospasm - emboli - vasculitis

3. What characterizes acute rheumatic fever endocarditiis?
Months out fibrosis
Atherosclerosis of coronary arteries
ST- segment elevation
Small vegetations along the line of closure

4. What type of vegetations does Strep viridans cause?
Right -->left
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Small - nondestructive vegetations (subacute endocarditis)
L->R

5. Crushing chest pain lasting >20 minutes that radiates to left arm or jaw - diaphoresis - and dyspnea. Sx not relieved by NG.
ACE inhibitor
S viridans
White scar fibrosis
MI

6. Why are cardiac enzymes elevated after an MI?
Ventricle
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Slow HR - decreasing O2 demand and risk for arrhythmia
Membrane damage

7. What are the sx of hypertrophic cardiomyopathy?
Stretched muscle loses contractility
Pancarditis
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
LA

8. Vegetations on surface and undersurface of mitral valve.
Libman - Sacks endocarditis
Valve scarring that arises as a consequence of rheumatic fever
Mitral mitral+aortic
Backward LHF pulm htn and RHF - afib and associated mural thombis

9. What artery is the 2nd most often occluded in an MI?
Reactive histiocyte with caterpillar nucleus
Rupture of free wall - IV septum - or papillary muscle
RCA
Systolic dysfx leading to biventricular CHF

10. How does fibrinolysis/angioplasty tx MI?
Ostium primum
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Months out fibrosis
Open blocked vessels

11. What causes an early - blowing diastolic murmur?
ACE inhibitor
Infectious
Aortic regurg
Nonbacterial thrombotic endocarditis (marantic endocarditis)

12. What causes heart failure cells?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Decrease preload -->lowers myocardial stress
Red border granulation tissue
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

13. What are the causes of restrictive cardiomyopathy in adults?
LA
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Dilation of all four chambers of the heart
Backward LHF pulm htn and RHF - afib and associated mural thombis

14. What is the murmur of mitral regurg?
Contraction band necrosis - reperfusion injury
Dressler syndrome
Acute inflammation
Holosystolic blowing murmur

15. What are the sx of cardiac myxoma?
Yellow pallor neutrophils
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Mitral stenosis
Contraction band necrosis - reperfusion injury

16. What congenital heart defect is associated with fetal alcohol syndrome?
Prophylactic abx during dental procedures
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Chronic rheumatic heart disease
VSD

17. What always follows necrosis?
Acute inflammation
Bacterial endocarditis
Slow HR - decreasing O2 demand and risk for arrhythmia
Decreased forward perfusion pulmonary congestion

18. What gross and microscopic changes occur 1-3 days after an MI?
Annular - non pruritic rash w/erythematous borders trunks and limbs
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Prinzmetal angina - cocaine
Yellow pallor neutrophils

19. When would arrhythmia occur after MI?
Pts w/previously damaged valves
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Nonspecific - eg fever and elevated ESR
Within the first day

20. What type of shunt does ASD cause?
Contraction band necrosis
Left -->right
Chest pain <20 min brought on by exertion or emotional stress
Volume overload and LHF

21. What are Osler nodes?
Membrane damage
Tender lesions on fingers or toes.
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Endocardial fibroelastosis

22. What type of tumor is a rhabdomyoma?
Harmartoma
Dilation of all four chambers of the heart
Aortic stenosis
Dressler syndrome

23. Systolic ejection click followed by crescendo - decrescendo murmur.
Troponin I
Aortic stenosis
Streptococcus viridans
Colon cancer

24. Why would cardiac enzymes continue to increase after the initial MI?
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
Myxoid degeneration
Reperfusion injury
Months out fibrosis

25. What does Libman - Sacks endocarditis cause?
Thickening of chrodae tendinae and cusps - mitral stenosis
Holosystolic blowing murmur
Nonspecific - eg fever and elevated ESR
Mitral regurg

26. When do neutrophils infiltrate the myocardium post MI?
Endocarditis of prosthetic valves
1-3 days
Migratory polyarthritis
Decrease in blood flow to an organ

27. What is an Aschoff body?
Transposition of the great vessels
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material
S viridans
Pericardial effusion due to pericardial involvement

28. With what virus is PDA associated?
Increased blood in right heart delays closure of P valve
SLE
Congenital rubella
Libman - Sacks endocarditis

29. When do CK- MB levels rise - peak - and return to normal?
Atherosclerosis of coronary arteries
Reperfusion injury
Congested central veins
4-6 hours - 24 hours - 72 hours

30. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy
Aschoff bodies
Myofiber hypertrophy with disarray

31. What areas of the heart does the LAD supply?
Eisenmenger syndrome
ASD - R-->L
First 4 hours
Anterior wall of LV and anterior septum

32. What causes a mid - systolic click followed by a regurgitation murmur?
Friction rub and chest pain
White scar fibrosis
4-7 days
Mitral valve prolapse

33. What causes the nutmeg color in nutmeg liver?
Mitral mitral+aortic
Trisomy 21
Metastasis
Congested central veins

34. What does nonbacterial thrombotic endocarditis cause?
R-->L
Increased blood in right heart delays closure of P valve
Mitral regurg
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing

35. What gross and microscopic changes occur 1-3 weeks after an MI?
Libman - Sacks endocarditis
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Red border granulation tissue

36. What type of shunt dose PDA cause?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Mitral and tricuspid regurg - arrhythmia
S epidermidis
Left -->right

37. What does rupture of the LV free wall cause?
1%
4-24 hours
Cardiac tamponade
Infectious

38. In which pts does S viridans cause endocarditits?
Pts w/previously damaged valves
Ehlers - Danlow and Marfan syndrome
ST- segment elevation
Large - destructive vegetations

39. What murmur ccan be heard in PDA?
Bacterial endocarditis
RBC damaged while crossing the calcified valve causing schistocytes
Elevated ASO anti - DNase B titers
Holosystolic machine like murmur

40. What causes endocarditis of prosthetic valves?
S epidermidis
Sterile vegetations on surface and undersurface on mitral valve
Large vegetations of S aureus
Ehlers - Danlow and Marfan syndrome

41. What is the leading cause of death in the US?
Ischemic heart disease
Group A beta - hemolytic streptococci
Nitroglycerin
Fetal alcohol syndrome

42. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
Hypertophy of RV atrophy of LV
Adult coarctation of the aorta
Dark discoloration coagulative necrosis
Ehlers - Danlow and Marfan syndrome

43. Which angina is relieved by Ca channel blockers?
Prinzmetal
Gelatinous - abundant ground substance
Preductal - post aortic arch
4-6 hours - 24 hours - 72 hours

44. Is scar tissue or myocardium stronger?
Myocardium
2-4 hours - 24 hours - 7-10 days
Reperfusion injury
Degree of pulmonary artery stenosis

45. Which artery is most often occluded in an MI?
Indomethacin - decreases PGE
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
LA
LAD

46. With what disease is Libman - Sacks endocarditis associated?
1-3 days
Decrease in blood flow to an organ
Fetal alcohol syndrome
SLE

47. What are the complications of mitral stenosis?
Libman - Sacks endocarditis
First 4 hours
Backward LHF pulm htn and RHF - afib and associated mural thombis
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

48. What tests show prior group A beta - hemolytic strep infection?
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Degree of pulmonary artery stenosis
Pulsating nail bed
Elevated ASO anti - DNase B titers

49. How do you prevent S viridans endocarditis?
Prophylactic abx during dental procedures
Inability to fill ventricles
Ventricles cannot pump
Ventricular arrhythmia

50. What effect does dilated cardiomyopathy have on the heart?
Systolic dysfx leading to biventricular CHF
2-3 weeks
Infantile coarctation of the aorta PDA
Myxoid degeneration