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Cardiac

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. How do ACE inhibitors tx MI?
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Decreases LV dilation by decreasing volume
Right -->left
Prinzmetal angina

2. What characterizes acute rheumatic fever endocarditiis?
Aneurysm - mural thrombus - Dressler syndrome
Intercostal arteries enlarged due to collateral circulation
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Small vegetations along the line of closure

3. What gross and microscopic changes occur 4-24 hours after an MI?
Decreases LV dilation by decreasing volume
Dark discoloration coagulative necrosis
Shunt
Slow HR - decreasing O2 demand and risk for arrhythmia

4. Are most congenital heart defects spontaneous or inherited?
Aortic stenosis
MV prolapse LV dilation - infective endocarditis - acute rheumatic heart disease - papillary muscle rupture
Spontaneous
White scar fibrosis

5. When is an MI patent at highest risk for fibrionous pericarditis?
Myocarditis
1-3 days out
Wear and tear
Ventricular arrhythmia

6. What makes the MV prolapse murmur louder? Why?
Squatting - increased systemic resistence decreases LV emptying
Group A beta - hemolytic streptococci
Endocarditis of prosthetic valves
Valve replacement once LV dysfx develops

7. Which angina(s) show ST elevation on EKG? ST depression?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Large - destructive vegetations
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
Prinzmetal stable and unstable

8. What valves are most commonly involved in chronic rheumatic heart disease?
Mitral mitral+aortic
Congenital rubella
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

9. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
2-4 hours - 24 hours - 7-10 days
Months out fibrosis
Harmartoma
20 min

10. What does a biopsy of hypertrophic cardiomyopathy look like?
Tricuspid
Myofiber hypertrophy with disarray
Myocardium
PDA

11. What does rupture of the LV free wall cause?
ASD - R-->L
Cardiac tamponade
Infantile coarctation of the aorta
Tuberous sclerosis

12. What complications occur 4-7 days post MI?
20 min
Rupture of free wall - IV septum - or papillary muscle
4-7 days macrophage infiltration
Bacterial endocarditis

13. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
L->R
Colon cancer
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Mitral and tricuspid regurg - arrhythmia

14. What is the most common cause of mitral stenosis?
Chronic rheumatic heart disease
Tender lesions on fingers or toes.
Spontaneous
Streptococcus viridans

15. What is the most common type of ASD? What %?
Kawasaki disease
Within the first day
Ostium secundum (90%)
RCA

16. What effect does dilated cardiomyopathy have on the heart?
Systolic dysfx leading to biventricular CHF
Backward LHF pulm htn and RHF - afib and associated mural thombis
Mitral mitral+aortic
Sterile vegetations on surface and undersurface on mitral valve

17. Early - blowing diastolic murmur - bounding pulse - pulsating nail bed - and head bobbing.
Aortic regurg
Slow HR - decreasing O2 demand and risk for arrhythmia
Stable angina
Indomethacin - decreases PGE

18. Sudden death in a young athlete.
RBC damaged while crossing the calcified valve causing schistocytes
Systolic ejection click followed by crescendo - decrescendo murmur
Hypertrophic cardiomyopathy
Ventricle

19. Lower extremity cyanosis later in life - holostystolic machine like murmur.
LV dilation and eccentric hypertrophy
Inability to maintain systemic pressure w/lack of O2 to vital organs
PDA
Stable angina

20. What gross and microscopic changes occur 4-7 days after an MI?
Yellow pallor macrophages
Mitral mitral+aortic
Mitral insufficiency
Loss of LV fx

21. Vegetations on surface and undersurface of mitral valve.
Fibrosis and dystrophic calcification
Libman - Sacks endocarditis
Inability to fill ventricles
2-4 hours - 24 hours - 7-10 days

22. What is the gross and microscopic appearance of cardiac myxomas?
Gelatinous - abundant ground substance
Ventricle
Squat in response to cyanotic spell
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

23. What is a water - hammer pulse?
VSD
Bounding pulse
Streptococcus bovis/
Autoimmune pericarditis 6-8 wks post MI

24. How does stable angina present?
Chest pain <20 min brought on by exertion or emotional stress
Friction rub and chest pain
Dense layer of elastic and fibrotic tissue in the endocardium - children
Stable angina

25. What causes mitral valve prolapse?
Myxoid degeneration
Squatting - expiration
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF
Janeway lesions

26. What drug relieves stable angina?
Nitroglycerin
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
Left -->right
LHF

27. What is the definition of ischemia?
Decrease in blood flow to an organ
SLE
Sudden cardiac death
Endocarditis of prosthetic valves

28. What are Janeway lesions?
Subendocardial
Atria and RV
Libman - Sacks endocarditis
Erythematous nontender lesions on palms and soles.

29. What causes the dependent pitting edema in RHF?
Dressler syndrome
Increased hydrostatic pressure
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Stretched muscle loses contractility

30. What is the only Jones criteria that doesn't resolve with time?
Pancarditis
Sudden cardiac death
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Limits thrombosis

31. What gross and microscopic changes occur 1-3 weeks after an MI?
Red border granulation tissue
Contraction band necrosis - reperfusion injury
Circumflex
Aneurysm - mural thrombus - Dressler syndrome

32. With what disease is transposition of the great vessels associated?
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
CHF
Maternal diabetes
Bicuspid aortic valve

33. Erythematous nontender lesions on palms and soles.
Group A beta - hemolytic streptococci
Harmartoma
Janeway lesions
Mitral regurg

34. What are the clinical features of RHF due to?
Sudden cardiac death
MI
Systemic venous congestion
Reactive histiocyte with caterpillar nucleus

35. What causes endocarditis of prosthetic valves?
Loss of LV fx
S epidermidis
Chest pain <20 min brought on by exertion or emotional stress
Membrane damage

36. What type of shunt does truncus arteriosus cause?
Rhadbomyoma - benign
R-->L
Congestive heart failure
Months out fibrosis

37. What cardiac enzyme is useful for detecting reinfarction?
Congestive heart failure
CK- MB
IV drug users
Transesophageal echo

38. What effect does transposition of the great vessels have on the ventricles?
Hypertophy of RV atrophy of LV
Sterile vegetations on surface and undersurface on mitral valve
Acute inflammation
Coexisting mitral stenosis and fusion of commisures exist

39. With what endocarditis is S epidermidis associated?
Friction rub and chest pain
S aureus
Endocarditis of prosthetic valves
Metastasis

40. What always follows necrosis?
Decreased forward perfusion pulmonary congestion
Anterior wall of LV and anterior septum
Acute inflammation
Reactive histiocyte with caterpillar nucleus

41. What is the most comon cause of aortic regurg? What are the other causes?
Decrease in blood flow to an organ
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Congested central veins
Myocardium

42. What causes a mid - systolic click followed by a regurgitation murmur?
Mitral valve prolapse
Nonspecific - eg fever and elevated ESR
Intercostal arteries enlarged due to collateral circulation
Restrictive cardiomyopathy

43. What is the tx for aortic stenosis?
IV drug users
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
PDA
Valve replacement AFTER the onset of complications

44. What is the murmur of mitral regurg?
Months out fibrosis
Open blocked vessels
Infantile coarctation of the aorta PDA
Holosystolic blowing murmur

45. What bug causes acute rheumatic fever?
Mitral and tricuspid regurg - arrhythmia
Endocardial fibroelastosis
Group A beta - hemolytic streptococci
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

46. Holosystolic blowing murmur that increases w/expiration?
Yellow pallor macrophages
Mitral regurg
Streptococcus bovis/
Red border granulation tissue

47. What is the most common valve infected by S aureus?
Infectious endocarditis
Reversible
Tricuspid
Preductal - post aortic arch

48. What is cardiogenic shock?
Slow HR - decreasing O2 demand and risk for arrhythmia
Systemic venous congestion
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy
Inability to maintain systemic pressure w/lack of O2 to vital organs

49. What are the clinical features of RHF?
Open blocked vessels
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
PDA
Positive blood cultures anemia of chronic disease

50. Which coronary artery supplies the anterior wall and anterior septum?
Squatting - expiration
LAD
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
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve