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Cardiac
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Subject
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health-sciences
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 cardiac enzyme is useful for detecting reinfarction?
Streptococcus viridans
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
CK- MB
2. How does transmural MI/ischemia present on EKG?
Mitral and tricuspid regurg - arrhythmia
Large - destructive vegetations
Bacterial endocarditis
ST- segment elevation
3. What vavular defect results from acute rheumatic fever?
Large - destructive vegetations
Prinzmetal angina - cocaine
Atherosclerosis of coronary arteries
Mitral regurgitation due to vegetations
4. Hypertension in upper extremities - hypotension in lower extremities - notching of ribs on CXR.
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Low voltage EKG w/diminished QRS amplitude
45%
Adult coarctation of the aorta
5. Myofiber hypertrophy with disarray.
Tuberous sclerosis
Bounding pulse
Hypertrophic cardiomyopathy
Cardiogenic shock - CHF - arrhythmia
6. What complication occurs 1-3 days post MI?
Fibrinous pericarditis
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
Holosystolic blowing murmur
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
7. What murmur ccan be heard in PDA?
Holosystolic machine like murmur
Stretched muscle loses contractility
Yellow pallor neutrophils
PDA
8. What is the major cause of MI?
Pulsating nail bed
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery
Rhabdomyoma
Systolic ejection click followed by crescendo - decrescendo murmur
9. How does MI cause LHF?
Loss of LV fx
Mitral mitral+aortic
RCA
Decrease preload -->lowers myocardial stress
10. What distinguishes stenosis caused by chronic rheumatic heart disease from wear and tear aortic stenosis?
Coexisting mitral stenosis and fusion of commisures exist
Shunt - PGE to maintain PDA until surgical repair can be performed
Inability to fill ventricles
Mitral regurgitation due to vegetations
11. What does rupture of the IV septum cause?
PDA
Shunt
Infectious
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
12. When is an MI pt at greatest risk for cardiogenic shock?
First 4 hours
Thickening of chrodae tendinae and cusps - mitral stenosis
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Prinzmetal stable and unstable
13. With what virus is PDA associated?
Months out fibrosis
Acute inflammation
2-4 hours - 24 hours - 7-10 days
Congenital rubella
14. Opening snap followed by diastolic rumble.
Mitral stenosis
Hemosiderin laden macrophages
Reversible
Transesophageal echo
15. What is the leading cause of death in the US?
Bounding pulse
Nonspecific - eg fever and elevated ESR
Fibrosis and dystrophic calcification
Ischemic heart disease
16. How does aortic regurg affect the heart chambers?
LV dilation and eccentric hypertrophy
Wear and tear
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
Granulation tissue
17. Dilated cardiomyopathy is a late complication of what illness?
Right -->left
Anterior wall of LV and anterior septum
Myocarditis
Mitral valve prolapse
18. What tests show prior group A beta - hemolytic strep infection?
Elevated ASO anti - DNase B titers
Concentric LV hypertophy
Ostium secundum (90%)
ST- segment elevation
19. What coronary artery supplies the mitral valve papillary muscles?
Paradoxical emboli
RCA
Bacterial endocarditis
Janeway lesions
20. Boot - shaped heart on x- ray?
Loeffler syndrome
Autoimmune pericarditis 6-8 wks post MI
Aschoff bodies
Tetralogy of fallot
21. What is the murmur of mitral valve prolapse?
Mid - systolic click followed by regurgitation murmur
Reactive histiocyte with caterpillar nucleus
Adult coarctation of the aorta
Chronic ischemic heart disease
22. What type of collagen is involved in fibrosis?
Chronic rheumatic heart disease
Libman - Sacks endocarditis
Type I
Myocarditis
23. In which chamber of the heart are cardiac myxomas found?
Backward LHF pulm htn and RHF - afib and associated mural thombis
Mid - systolic click followed by regurgitation murmur
LA
Pedunculated mass in the LA that causes syncope due to obstruction of MV
24. What conditions can cause nonbacterial thrombotic endocarditis?
PDA
Rhabdomyoma
Squatting - expiration
Hypercoagulable state or underlying adenocarcinoma
25. Which vasculitis can cause MI?
Ventricles cannot pump
Plump fibroblasts - collagen - blood vessels
Kawasaki disease
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
26. What are Osler nodes?
RCA
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Tender lesions on fingers or toes.
Sterile vegetations on surface and undersurface on mitral valve
27. What type of ischemia does stable angina cause?
LA
First 4 hours
Louder - increased systemic resistence decreases LV emptying
Subendocardial
28. EKG for stable angina?
Limits thrombosis
Metastasis
Granulation tissue
ST- segment depression
29. What is Dressler syndrome? When does it occur?
Autoimmune pericarditis 6-8 wks post MI
Loss of fx
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Anterior wall of LV and anterior septum
30. At What age does wear and tear aortic stenosis present? What congenital disease hastens the onset?
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
>60 years - bicuspid aortic valve
Hemosiderin laden macrophages
L->R
31. When would arrhythmia occur after MI?
Bacterial endocarditis
Ischemic heart disease
Within the first day
Dense layer of elastic and fibrotic tissue in the endocardium - children
32. In which pts does S viridans cause endocarditits?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Valve replacement AFTER the onset of complications
ACE inhibitor
Pts w/previously damaged valves
33. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
Concentric LV hypertophy
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Myxoma - benign
Anitschow cell
34. What is an important complication of ASD?
Asymptomatic
Paradoxical emboli
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Congested central veins
35. With what other congenital heart defect is tricuspid atresia associated? What type of shunt is present?
Troponin I
Sterile vegetations on mitral valve along lines of closure
ASD - R-->L
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
36. What are the sx of pericardiits?
Tuberous sclerosis
Friction rub and chest pain
Slow HR - decreasing O2 demand and risk for arrhythmia
Decreased CO due to diastolic dysfx - syncope w/exercise - sudden death due to vfib
37. What is the etiology of S viridans endocarditis?
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Fibrosis and dystrophic calcification
Regurg vs stenosis
Membrane damage
38. How do you tx prinzmetal angina?
Decrease in blood flow to an organ
Myxoid degeneration
Hypertophy of RV atrophy of LV
NG or Ca channel blocker
39. What effect does mitral stenosis have on the heart chambers?
LA dilation
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Sterile vegetations on mitral valve along lines of closure
Sterile vegetations on surface and undersurface on mitral valve
40. What are the complications of mitral valve prolapse? Are they common?
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Infectious endocarditis - arrythmias - severe mitral regurg no
Hypertophy of RV atrophy of LV
2-3 weeks
41. What are the causes of restrictive cardiomyopathy in adults?
Coronary artery vasospasm
RHF
Group A beta - hemolytic streptococci
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
42. How does stable angina present?
LV dilation and eccentric hypertrophy
Chest pain <20 min brought on by exertion or emotional stress
ST- segment depression
Dilation of all four chambers of the heart
43. Infects predamaged valves after transient bacteremia?
S viridans
Squatting - increased systemic resistence decreases LV emptying
Positive blood cultures anemia of chronic disease
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
44. Vegetations on surface and undersurface of mitral valve.
Chronic rheumatic heart disease
Sterile vegetations on surface and undersurface on mitral valve
Libman - Sacks endocarditis
PDA
45. What type of shunt dose PDA cause?
R-->L
Left -->right
Eisenmenger syndrome
PDA
46. How does squating decrease hypoxemia in tetralogy of fallot?
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
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
LV dilation and eccentric hypertrophy
47. How do beta blockers tx MI?
Subendocardial
Endocarditis of prosthetic valves
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Slow HR - decreasing O2 demand and risk for arrhythmia
48. What gross and microscopic changes occur 4-24 hours after an MI?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Tetralogy of fallot
Dark discoloration coagulative necrosis
Pulsating nail bed
49. What is the basic principle of CHF?
Pump failure
Prinzmetal stable and unstable
RCA
Heart can't fill
50. What type of vegetations does Strep viridans cause?
Rhabdomyoma
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Small - nondestructive vegetations (subacute endocarditis)
20 min
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