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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 is the most common cause of endocarditis in IV drug users?
Myofiber hypertrophy with disarray
ST- segment depression
Low voltage EKG w/diminished QRS amplitude
S aureus

2. What type of shunt does transposition of the great vessels cause?
Idiopathic genetic mutation (AD) - myocarditis - alcohol - drugs - pregnancy
Granulation tissue
R-->L
When a bacterial protein resembles a protein in human tissue

3. What is the characteristic finding on CXR in tetralogy of fallot?
Yellow pallor neutrophils
Boot shaped heart
Congenital rubella
VSD

4. What murmur ccan be heard in PDA?
Tetralogy of fallot
Holosystolic machine like murmur
AD mutation in sarcomere proteins
>70%

5. Large vegetations on tricuspid valve?
S aureus
Rupture of free wall - IV septum - or papillary muscle
Libman - Sacks endocarditis
Tricuspid

6. What is Dressler syndrome? When does it occur?
Mitral valve prolapse
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Hypercoagulable state or underlying adenocarcinoma
Autoimmune pericarditis 6-8 wks post MI

7. Foci of chronic inflammation - reactive histiocytes with slender - wavy nuclei - giant cells - and fibrinoid material.
Acute ischemia - mitral valve prolapse - cardiomyopathy - cocaine abuse
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Aschoff bodies
Myocardium

8. What congenital heart defect often is present with infantile coarctation of the aorta?
Hypertophy of RV atrophy of LV
Mitral valve prolapse
Dressler syndrome
PDA

9. With what disease is infantile coarctation of the aorta associated?
Turner syndrome
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume

10. What % of MIs involve the LAD?
Mitral mitral+aortic
S aureus
45%
Streptococcus bovis/

11. What imaging test is useful for detecting lesions on valves?
Transesophageal echo
Systolic dysfx leading to biventricular CHF
Cyanosis - RV hypertrophy - polycythemia - clubbing
Harmartoma

12. What are the clinical features of RHF?
Gelatinous - abundant ground substance
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema
Myocardium
Prinzmetal angina - cocaine

13. With what disease is Libman - Sacks endocarditis associated?
Trisomy 21
Repeat exposure to group A beta - hemolytic strep that results in relapse of the acute phase
L->R
SLE

14. What is diastolic dysfx?
Regurg vs stenosis
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Squatting - increased systemic resistence decreases LV emptying
Inability to fill ventricles

15. What is migratory polyarthritis?
Small vegetations along the line of closure
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Reperfusion of irreversibly damaged cells results in Ca influx - leading to hypercontraction of myofibrils
Pericarditits

16. What is molecular mimicry?
When a bacterial protein resembles a protein in human tissue
Heart can't fill
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Rupture of atherosclerotic plaque and complete occlusion of the coronary artery

17. How do beta blockers tx MI?
PDA
Subendocardial
Slow HR - decreasing O2 demand and risk for arrhythmia
Nonbacterial thrombotic endocarditis (marantic endocarditis)

18. What tests show prior group A beta - hemolytic strep infection?
Prinzmetal angina - cocaine
Coronary artery vasospasm - emboli - vasculitis
Trisomy 21
Elevated ASO anti - DNase B titers

19. What effect does transposition of the great vessels have on the ventricles?
Fusion of the commissures with 'fish mouth' appearence - aortic stenosis
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Subendocardial
Hypertophy of RV atrophy of LV

20. How long can cardiac myocytes be deprived of oxygen before they become irreversibly injured?
20 min
RCA
Hypercoagulable state or underlying adenocarcinoma
Infantile coarctation of the aorta

21. What are the sx of PDA at birth?
Posterior wall of LV - posterior septum - papillary muscles
White scar fibrosis
Backward LHF pulm htn and RHF - afib and associated mural thombis
Asymptomatic

22. What is the most common form of cardiomyopathy?
Chronic rheumatic heart disease
Ischemia - htn - dilated cardiomyopathy - MI - restrictive cardiomyopathy
Slow HR - decreasing O2 demand and risk for arrhythmia
Dilated

23. What cardiac disease is associated with tuberous sclerosis?
Hypercoagulable state or underlying adenocarcinoma
Increased hydrostatic pressure
Contraction band necrosis - reperfusion injury
Rhabdomyoma

24. What is the tx for aortic stenosis?
NG or Ca channel blocker
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
stenosis of RV outflow tract - RV hypertrophy - VSD - aorta that overrides the VSD
Valve replacement AFTER the onset of complications

25. L- to - R shunt switching to R- to - L shunt.
Metastasis
Eisenmenger syndrome
Dense layer of elastic and fibrotic tissue in the endocardium - children
Ehlers - Danlow and Marfan syndrome

26. How does MI cause LHF?
Loss of LV fx
Ventricular arrhythmia
Mid - systolic click followed by regurgitation murmur
Nonbacterial thrombotic endocarditis (marantic endocarditis)

27. If a pt has an endocarditis caused by Streptococcus bovis - what underlying condition should you test for?
Colon cancer
Reperfusion injury
Erythematous nontender lesions on palms and soles.
Transposition of the great vessels

28. What is the only Jones criteria that doesn't resolve with time?
Valve replacement AFTER the onset of complications
Pancarditis
Harmartoma
Dressler syndrome

29. Which angina is relieved by Ca channel blockers?
Rhadbomyoma - benign
Coxsackie A or B
Prinzmetal
Reactive histiocyte with caterpillar nucleus

30. Fever - murmur - Janeway lesions - Osler nodes - splinter hemorrhages - anemia of chronic disease?
Bacterial endocarditis
VSD
Sterile vegetations on surface and undersurface on mitral valve
Nonbacterial thrombotic endocarditis (marantic endocarditis)

31. Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - pitting edema.
RHF
Contraction band necrosis
Chronic rheumatic heart disease
Myxoid degeneration

32. What is the most common cause of RHF? What are others?
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)
Dark discoloration coagulative necrosis
Breast and lung carcinoma - melanoma - lymphoma
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar

33. Is injury due angina reversible or irreversible?
Within the first day
Return of O2 and inflammatory cells cause FR generation - further damaging myocytes
Reversible
Hypertophy of RV atrophy of LV

34. Swelling and pain in a large joint that resolves within days and migrates to involve another large joint.
Migratory polyarthritis
Infectious endocarditis - arrythmias - severe mitral regurg no
First 4 hours
Breast and lung carcinoma - melanoma - lymphoma

35. What makes the MV prolapse murmur louder? Why?
Hemosiderin laden macrophages
Squatting - increased systemic resistence decreases LV emptying
Sterile vegetations on surface and undersurface on mitral valve
Chronic rheumatic heart disease

36. What are the complications of aortic stenosis?
Myocardium
Arrhythmia - CHF - angina - syncope - microangiopathic hemolytic anemia
Preductal - post aortic arch
ST- segment depression

37. What heart sound manifest with an ASD?
Decrease in blood flow to an organ
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Split S2 on auscultation
Breast and lung carcinoma - melanoma - lymphoma

38. What is the most common cause of aortic stenosis?
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
Hemosiderin laden macrophages
Wear and tear
Acute inflammation

39. What type of ischemia does stable angina cause?
Sudden cardiac death
Aortic stenosis
Subendocardial
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

40. What gross and microscopic changes occur 1-3 days after an MI?
Inability to fill ventricles
R-->L
Yellow pallor neutrophils
Metastasis

41. What is a complication of chronic rheumatic heart disease?
NG or Ca channel blocker
Infectious endocarditis
RCA
Months out fibrosis

42. When do neutrophils infiltrate the myocardium post MI?
CHF
Atherosclerosis of coronary arteries
1-3 days
MI

43. What artery is the 2nd most often occluded in an MI?
Troponin I
RCA
Mitral stenosis
Spontaneous

44. Low voltage EKG w/diminished QRS amplitude.
Restrictive cardiomyopathy
Rhadbomyoma - benign
Right side - serotonin and other secretory products detoxified in the lung
Chest pain - arrhythmia - sudden death - heart failure - dilated cardiomyopathy

45. What type of shunt does a VSD cause?
Volume overload and LHF
S epidermidis
LHF
L->R

46. What coronary arterysupplies the lateral wall of the LV?
Loss of LV fx
Holosystolic blowing murmur
First 4 hours
Circumflex

47. What causes wear and tear aortic stenosis?
Split S2 on auscultation
Fibrosis and dystrophic calcification
Widens it diastolic pressure decreases due to regurgitation while systolic pressure increases due to increased stroke volume
Boot shaped heart

48. How does hypertension cause LHF?

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49. What is Loeffler syndrome?
Myxoma - benign
Regurg vs stenosis
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Squat in response to cyanotic spell

50. What causes notching of the ribs in adult coarctation of the aorta?
Migratory polyarthritis
Open blocked vessels
Intercostal arteries enlarged due to collateral circulation
Posterior wall of LV - posterior septum - papillary muscles