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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 clinical features of RHF?
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Myocarditis
4-6 hours - 24 hours - 72 hours
Heart transplant

2. What is a Quincke pulse?
Pulsating nail bed
1-3 days out
Prinzmetal angina - cocaine
Increased blood in right heart delays closure of P valve

3. What is the basic principle of CHF?
Pump failure
Cardiac tamponade
4-6 hours - 24 hours - 72 hours
4-24 hours

4. What causes acute endocarditis?
Granulation tissue
Breast and lung carcinoma - melanoma - lymphoma
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Large vegetations of S aureus

5. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
2-3%
Congenital rubella
Decreased forward perfusion pulmonary congestion

6. What type of endocarditis is associated w/metastatic cancer and wasting conditions?
R-->L
Reperfusion injury
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Nonbacterial thrombotic endocarditis (marantic endocarditis)

7. With what endocarditis is S epidermidis associated?
Mitral and tricuspid regurg - arrhythmia
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Endocarditis of prosthetic valves
Preductal - post aortic arch

8. How does aortic regurg affect the heart chambers?
LA
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
LV dilation and eccentric hypertrophy
Dilation of all four chambers of the heart

9. What causes the split S2 in ASD?
Increased blood in right heart delays closure of P valve
Streptococcus viridans
When a bacterial protein resembles a protein in human tissue
Migratory polyarthritis

10. What causes wear and tear aortic stenosis?
Infantile coarctation of the aorta PDA
Fibrosis and dystrophic calcification
Ventricles cannot pump
Holosystolic machine like murmur

11. When is an MI pt at greatest risk for cardiogenic shock?
PDA
First 4 hours
Transesophageal echo
Infectious

12. What is the cause of restrictive cardiomyopathy in children?
Coxsackie A or B
Endocardial fibroelastosis (rare)
Split S2 on auscultation
Heart transplant

13. What complications occur 4-7 days post MI?
Rupture of free wall - IV septum - or papillary muscle
Nonspecific - eg fever and elevated ESR
Turner syndrome
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

14. What are the sx of cardiac myxoma?
Pedunculated mass in the LA that causes syncope due to obstruction of MV
Degree of pulmonary artery stenosis
S aureus
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

15. 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
Valve scarring that arises as a consequence of rheumatic fever
Anitschow cell
Osler nodes (ouch - ouch Osler)

16. How do nitrates tx MI?
Infantile coarctation of the aorta PDA
Mitral mitral+aortic
Decrease preload -->lowers myocardial stress
Annular - non pruritic rash w/erythematous borders trunks and limbs

17. What type of valvular vegetations does S aureus cause?
Hypertophy of RV atrophy of LV
Large - destructive vegetations
Osler nodes (ouch - ouch Osler)
Stable angina

18. What artery is the 2nd most often occluded in an MI?
Mid - systolic click followed by regurgitation murmur
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
RCA
Myxoma - benign

19. Which coronary artery supplies the anterior wall and anterior septum?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
4-6 hours - 24 hours - 72 hours
Group A beta - hemolytic streptococci
LAD

20. With what disease is infantile coarctation of the aorta associated?
Thickening of chrodae tendinae and cusps - mitral stenosis
Turner syndrome
Pancarditis
Granulation tissue

21. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Colon cancer
Rhadbomyoma - benign

22. What is cardiogenic shock?
Mitral regurg
Inability to maintain systemic pressure w/lack of O2 to vital organs
Pericardial effusion due to pericardial involvement
4-24 hours

23. What effect does aortic stenosis have on the chambers of the heart?
Dense layer of elastic and fibrotic tissue in the endocardium - children
Holosystolic blowing murmur
R-->L
Concentric LV hypertophy

24. When do neutrophils infiltrate the myocardium post MI?
1-3 days
Pericarditits
Surgical closure small defects may close spontaneously
Yellow pallor macrophages

25. What are the clinical features of LHF due to?
Decreased forward perfusion pulmonary congestion
Asymptomatic
1) damaged endocardial surface develops thrombotic vegetations 2) transient bacteremia leads to trapping of bacteria in the vegetations
Surgical closure small defects may close spontaneously

26. What are the forward and backward sx of LHF?
Hypertrophic cardiomyopathy
Months out fibrosis
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
Aortic regurg

27. What is typically the mechanims of sudden cardiac death?
Ventricular arrhythmia
Myofiber hypertrophy with disarray
Boot shaped heart
Pedunculated mass in the LA that causes syncope due to obstruction of MV

28. Ostium primum ASD is associated with what congenital disorder?
Myxoid degeneration
Limits thrombosis
Myofiber hypertrophy with disarray
Trisomy 21

29. What compensatory mechanism do tetralogy of fallot pts learn?
NG or Ca channel blocker
Squat in response to cyanotic spell
2-3 weeks
Hypercoagulable state or underlying adenocarcinoma

30. Why would cardiac enzymes continue to increase after the initial MI?
Reperfusion injury
Ventricular arrhythmia
Tetralogy of fallot
Libman - Sacks endocarditis

31. What congenital heart defect is associated with fetal alcohol syndrome?
Colon cancer
PDA
PDA
VSD

32. How does restrictive cardiomyopathy cause LHF?

33. What are the Jones criteria?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Reperfusion injury
Dilation of all four chambers of the heart
Boot shaped heart

34. What causes microangiopathic hemolytic anemia in aortic stenosis?
Red border granulation tissue
Bacterial endocarditis
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
RBC damaged while crossing the calcified valve causing schistocytes

35. What are the clinical features of RHF due to?
Systemic venous congestion
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Aortic regurg
PDA

36. What is Dressler syndrome? When does it occur?
Bacterial endocarditis
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Autoimmune pericarditis 6-8 wks post MI

37. What does a biopsy of hypertrophic cardiomyopathy look like?
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Myofiber hypertrophy with disarray
Coxsackie A or B
Fibrinous pericarditis

38. Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia.
Loeffler syndrome
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Large - destructive vegetations
Reperfusion injury

39. What are the sx of right - to - left shunt?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Tetralogy of fallot
Cyanosis - RV hypertrophy - polycythemia - clubbing
Pts w/previously damaged valves

40. Where is the coarctation in infantile coarctation of the aorta?
Acute inflammation
Preductal - post aortic arch
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

41. What is the most common cause of endocarditis in IV drug users?
Dressler syndrome
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Loss of fx
S aureus

42. What are the two effects of ATII?
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
S aureus
L->R
Minimizes ischemia

43. What bug causes acute rheumatic fever?
Right -->left
Group A beta - hemolytic streptococci
Left -->right
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils

44. What does rupture of a papillary muscle cause?
Mitral insufficiency
Valve scarring that arises as a consequence of rheumatic fever
Months out fibrosis
MI

45. What is the tx for dilated cardiomyopathy?
Heart transplant
Hypercoagulable state or underlying adenocarcinoma
Chronic rheumatic heart disease
Squatting - expiration

46. What are Osler nodes?
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Tender lesions on fingers or toes.
4-7 days macrophage infiltration
4-6 hours - 24 hours - 72 hours

47. When is a post - MI pt at highest risk for an aneurysm? With what microscopic change is this complication associated?
Myocarditis in acute rheumatic heart fever
Minimizes ischemia
Tricuspid
Months out fibrosis

48. Poor myocardial fx due to chronic ischemic damage?
Chronic ischemic heart disease
Myocardium
Colon cancer
Circumflex

49. What is the tx for VSD?
Intercostal arteries enlarged due to collateral circulation
Surgical closure small defects may close spontaneously
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Endocardial fibroelastosis (rare)

50. What is the murmur of mitral regurg?
PDA
Fibrinous pericarditis
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Holosystolic blowing murmur