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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. When do neutrophils infiltrate the myocardium post MI?
Myocardium
Cardiac tamponade
Friction rub and chest pain
1-3 days

2. What causes the dependent pitting edema in RHF?
Boot shaped heart
Mitral stenosis
Erythematous nontender lesions on palms and soles.
Increased hydrostatic pressure

3. What vavular defect results from acute rheumatic fever?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Mitral regurgitation due to vegetations
RCA
Right -->left

4. What coronary arterysupplies the lateral wall of the LV?
LAD
Circumflex
Stretched muscle loses contractility
Right to left

5. What is the only Jones criteria that doesn't resolve with time?
White scar fibrosis
Yellow pallor neutrophils
Pancarditis
Posterior wall of LV - posterior septum - papillary muscles

6. Drug that vasodilates both arteries and veins but mostly veins. Used to decrease preload to heart.
Valve replacement
Breast and lung carcinoma - melanoma - lymphoma
Libman - Sacks endocarditis
Nitroglycerin

7. EKG for stable angina?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Decrease preload -->lowers myocardial stress
ST- segment depression
Reversible

8. What always follows necrosis?
Limits thrombosis
Streptococcus viridans
Acute inflammation
Bacterial endocarditis

9. How does fibrinolysis/angioplasty tx MI?
Infantile coarctation of the aorta
Open blocked vessels
Contraction band necrosis - reperfusion injury
Subendocardial

10. What is the most common form of cardiomyopathy?
Systemic venous congestion
Dilated
Surgical closure small defects may close spontaneously
Backward LHF pulm htn and RHF - afib and associated mural thombis

11. Which angina(s) cause subendocardial ischemia? Transmural ischemia?
Intercostal arteries enlarged due to collateral circulation
Stable and unstable prinzmetal
Reversible
Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material

12. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
2-3%
Mitral regurg
20 min
Pedunculated mass in the LA that causes syncope due to obstruction of MV

13. Which vasculitis can cause MI?
Acute inflammation
Kawasaki disease
Restrictive cardiomyopathy
Mitral regurg

14. What areas of the heart does the LAD supply?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Anterior wall of LV and anterior septum
Pulsating nail bed
Atherosclerosis of coronary arteries

15. What makes the MV prolapse murmur louder? Why?
Squatting - increased systemic resistence decreases LV emptying
Infantile coarctation of the aorta PDA
Right -->left
Infectious endocarditis - arrythmias - severe mitral regurg no

16. Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils.
S epidermidis
Libman - Sacks endocarditis
Myxoma - benign
Contraction band necrosis

17. What is Loeffler syndrome?
ST- segment depression
Mitral valve prolapse
Hypertophy of RV atrophy of LV
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

18. What is migratory polyarthritis?
Regurg vs stenosis
4-6 hours - 24 hours - 72 hours
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Trisomy 21

19. What causes acute endocarditis?
Large vegetations of S aureus
Prophylactic abx during dental procedures
Loss of fx
Group A beta - hemolytic streptococci

20. What congenital heart defect is associated with fetal alcohol syndrome?
S aureus
VSD
Stable angina
Right side - serotonin and other secretory products detoxified in the lung

21. What are complications of dilated cardiomyopathy?
Mitral and tricuspid regurg - arrhythmia
Hemosiderin laden macrophages
Months out fibrosis
Intercostal arteries enlarged due to collateral circulation

22. What imaging test is useful for detecting lesions on valves?
Libman - Sacks endocarditis
Transesophageal echo
20 min
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

23. What is the most common primary cardiac tumor in children? Is it malignant or benign?
LA dilation
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Infectious
Rhadbomyoma - benign

24. What causes wear and tear aortic stenosis?
Ventricle
Mitral stenosis
Elevated ASO anti - DNase B titers
Fibrosis and dystrophic calcification

25. What is the tx for aortic stenosis?
Red border granulation tissue
Valve replacement AFTER the onset of complications
Myocarditis
Inability to fill ventricles

26. What are the causes of restrictive cardiomyopathy in adults?
Chronic rheumatic heart disease
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Myocarditis in acute rheumatic heart fever

27. Erythematous nontender lesions on palms and soles.
Janeway lesions
Infantile coarctation of the aorta
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
VSD

28. What is the rate of congenital heart defects?
1%
Mitral mitral+aortic
Restrictive cardiomyopathy
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia

29. What cardiac disease is associated with tuberous sclerosis?
Metastasis
Chronic ischemic heart disease
Rhabdomyoma
Ventricles cannot pump

30. What is the most common cause of aortic stenosis?
Louder - increased systemic resistence decreases LV emptying
Prinzmetal angina - cocaine
Wear and tear
Colon cancer

31. What is an Anitschow cell?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Nonspecific - eg fever and elevated ESR
Reactive histiocyte with caterpillar nucleus
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

32. What are the complications of aortic stenosis?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Mitral regurg
Annular - non pruritic rash w/erythematous borders trunks and limbs
Chronic ischemic heart disease

33. Dilated cardiomyopathy is a late complication of what illness?
Myocarditis
Inability to maintain systemic pressure w/lack of O2 to vital organs
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Papillary muscle - free wall - IV septum

34. What effect does aortic stenosis have on the chambers of the heart?
Concentric LV hypertophy
Bounding pulse
Papillary muscle - free wall - IV septum
Infectious

35. What is the effect of mitral regurg on the heart?
Adult coarctation of the aorta
Trisomy 21
Volume overload and LHF
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

36. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
LHF
VSD
PDA
Myxoma - benign

37. What type of shunt results in cyanosis at birth?
Valve replacement AFTER the onset of complications
Right to left
1-3 days
Increased hydrostatic pressure

38. What is a water - hammer pulse?
Increased hydrostatic pressure
Inability to fill ventricles
Bounding pulse
Loss of LV fx

39. With what virus is PDA associated?
Mitral regurg
Congenital rubella
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

40. How does O2 tx MI?
Spontaneous
MI
Minimizes ischemia
ST- segment depression

41. What is the main cause of MV regurg? What are other causes?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
When a bacterial protein resembles a protein in human tissue
Systemic venous congestion
Myocardium

42. What are the cancers that most commonly metastasize to the heart?
PDA
Troponin I
Prinzmetal angina
Breast and lung carcinoma - melanoma - lymphoma

43. What is typically the mechanims of sudden cardiac death?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Right -->left
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Ventricular arrhythmia

44. How does aortic regurg affect the heart chambers?
Nitroglycerin
Tetralogy of fallot
LV dilation and eccentric hypertrophy
Fetal alcohol syndrome

45. Opening snap followed by diastolic rumble.
Granulation tissue
Sudden cardiac death
2-4 hours - 24 hours - 7-10 days
Mitral stenosis

46. What is the major cause of MI?
4-7 days macrophage infiltration
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
PDA
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture

47. What typically causes hypertrophic cardiomyopathy?
AD mutation in sarcomere proteins
Osler nodes (ouch - ouch Osler)
Coronary artery vasospasm - emboli - vasculitis
Nonbacterial thrombotic endocarditis (marantic endocarditis)

48. What is the foundation of a scar?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Granulation tissue
Nitroglycerin
Mitral mitral+aortic

49. What congenital heart defect presents later in life with lower extremity cyanosis?
Pericarditits
PDA
Regurg vs stenosis
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

50. What determines the extent of shunting and cyanosis in tetralogy of fallot?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Holosystolic machine like murmur
Degree of pulmonary artery stenosis
Valve replacement AFTER the onset of complications