Test your basic knowledge |

Cardiac

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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. Dense layer of elastic and fibrotic tissue in the endocardium.
Constrict peripheral arterioles - increasing TPR - release aldosterone - increasing blood volume
Mitral and tricuspid regurg - arrhythmia
Preductal - post aortic arch
Endocardial fibroelastosis

2. What is the most common cause of death during the acute phase of rheumatic fever?
Myocarditis
Shunt - PGE to maintain PDA until surgical repair can be performed
Small vegetations along the line of closure
Rupture of free wall - IV septum - or papillary muscle

3. What is the most common cause of infectious endocarditis?
Streptococcus viridans
Cardiogenic shock - CHF - arrhythmia
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Breast and lung carcinoma - melanoma - lymphoma

4. What shunt does tetralogy of fallot produce?
Right -->left
Dilation of all four chambers of the heart
1 day: coag necr 1 wk: inflammation (neutrophils and macrophages) 1 mo: scar
PDA

5. What is the most common primary cardiac tumor in adults? Is it malignant or benign?
1) migratory polyarthritis 2) pancarditis 3) subcutaneous nodules 4) erythema marginatum 5) Syndenham chorea
Valve scarring that arises as a consequence of rheumatic fever
Myxoma - benign
Infectious endocarditis

6. What cardiac disease is associated with tuberous sclerosis?
Valve replacement AFTER the onset of complications
Rhabdomyoma
Ostium primum
RCA

7. In which pts does S viridans cause endocarditits?
Endocardial fibroelastosis
Concentric LV hypertophy
Pts w/previously damaged valves
VSD

8. What are the minor critera of the Jones criteria?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
Migratory polyarthritis
AD mutation in sarcomere proteins
Nonspecific - eg fever and elevated ESR

9. What is the most common congenital heart defect?
Type I
PDA
VSD
LV dilation and eccentric hypertrophy

10. What causes microangiopathic hemolytic anemia in aortic stenosis?
Infectious endocarditis
CK- MB
RBC damaged while crossing the calcified valve causing schistocytes
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

11. What congenital heart defect often is present with infantile coarctation of the aorta?
RCA
Dark discoloration coagulative necrosis
Backward LHF pulm htn and RHF - afib and associated mural thombis
PDA

12. Are most congenital heart defects spontaneous or inherited?
Reactive histiocyte with caterpillar nucleus
Mitral valve prolapse
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Spontaneous

13. Which artery is most often occluded in an MI?
Reversible
LAD
Annular - non pruritic rash w/erythematous borders trunks and limbs
Stable and unstable prinzmetal

14. Which angina(s) show ST elevation on EKG? ST depression?
Nonbacterial thrombotic endocarditis (marantic endocarditis)
When a bacterial protein resembles a protein in human tissue
Prinzmetal stable and unstable
Libman - Sacks endocarditis

15. What is typically the mechanims of sudden cardiac death?
Right -->left
Ventricular arrhythmia
Dilation of all four chambers of the heart
LHF

16. What type of tumor is a rhabdomyoma?
Stable angina
Concentric hypertrophy - can't oxygenate full wall - ischemic damage
Shunt - PGE to maintain PDA until surgical repair can be performed
Harmartoma

17. What is the characteristic murmur of aortic stenosis?
Turner syndrome
Systolic ejection click followed by crescendo - decrescendo murmur
Systemic venous congestion
RCA

18. When does the heart have dark discoloration post MI?
Systolic ejection click followed by crescendo - decrescendo murmur
Mitral and tricuspid regurg - arrhythmia
4-24 hours
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

19. What murmur ccan be heard in PDA?
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Holosystolic machine like murmur
S viridans
Spontaneous

20. What causes unstable angina?
4-7 days
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery
Dark discoloration coagulative necrosis
Mitral regurg

21. What drug relieves stable angina?
4-24 hours
Nitroglycerin
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
Louder - increased systemic resistence decreases LV emptying

22. What are the cancers that most commonly metastasize to the heart?
Intercostal arteries enlarged due to collateral circulation
Atherosclerosis of coronary arteries
Breast and lung carcinoma - melanoma - lymphoma
Mitral stenosis

23. What does rupture of the IV septum cause?
RBC damaged while crossing the calcified valve causing schistocytes
>70%
Shunt
RCA

24. What effect does chronic rheumatic heart disease have the mitral valve?
Thickening of chrodae tendinae and cusps - mitral stenosis
4-6 hours - 24 hours - 72 hours
2-3 weeks
Myocarditis

25. What is the most comon cause of aortic regurg? What are the other causes?
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
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
Trisomy 21

26. What drugs can cause dilated cardiomyopathy?
Maternal diabetes
Fibrinous pericarditis
Doxorubicin - cocaine
Pericarditits

27. What is a common complication of cardiac metastasis?
Pericardial effusion due to pericardial involvement
Transposition of the great vessels
ASD - R-->L
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture

28. What causes heart failure cells?
Small - sterile fibrin deposits randomly arranged on closure of valve leaflets
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)
Increased arterial resistence decreases shunting - allowing more blood to reach lungs
Rupture of capillaries leading to intraalveolar hemorrhage - sx of LHF

29. How do beta blockers tx MI?
Slow HR - decreasing O2 demand and risk for arrhythmia
CK- MB
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Endocardial fibroelastosis

30. What is the most common tumor of the heart?
Aortic regurg
Metastasis
First 4 hours
4-6 hours - 24 hours - 72 hours

31. How does adult coarctation of the aorta present?
PGE
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
S viridans
Htn in upper extremities - hypotn in lower extremities - notching of ribs on CXR

32. When does the heart have a yellow pallor post MI?
Pericardial effusion due to pericardial involvement
Congenital rubella
Day 1-7
S aureus

33. What areas of the heart does the LAD supply?
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Anterior wall of LV and anterior septum
PDA
Ventricle

34. What causes mitral valve prolapse?
Myxoid degeneration
Indomethacin - decreases PGE
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
Maternal diabetes

35. What are Osler nodes?
S viridans
Prinzmetal
Tender lesions on fingers or toes.
Rupture of plaque with w/thrombus and incomplete occlusion of coronary artery

36. What type of shunt does transposition of the great vessels cause?
R-->L
PDA
Infectious endocarditis
Infectious

37. What gross and microscopic changes occur months after an MI?
Aortic regurg
White scar fibrosis
Small vegetations along the line of closure
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome

38. Dilated cardiomyopathy is a late complication of what illness?
Myocarditis
Infantile coarctation of the aorta
Reversible
Jugular venous distension - painful hepatosplenomegaly w/nutmeg liver - cardica cirrhosis - dependent pitting edema

39. What tests show prior group A beta - hemolytic strep infection?
Elevated ASO anti - DNase B titers
Myocarditis in acute rheumatic heart fever
PDA
Nonbacterial thrombotic endocarditis (marantic endocarditis)

40. What are the HACEK organisms? With what condition are they associated?
Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella endocarditis w/negative blood culture
Amyloidosis - sarcoidosis - hemochromatosis - and Loeffler syndrome
Systemic venous congestion
Coexisting mitral stenosis and fusion of commisures exist

41. Dyspnea - PND - orthopnea - crackles - fluid rentention - heart failure cells.
Bacterial M protein resembles proteins in human tissue - 'molecular mimicry'
Months out fibrosis
Myofiber hypertrophy with disarray
LHF

42. What is the most common cause of endocarditis in IV drug users?
Valve replacement AFTER the onset of complications
Congenital rubella
Early - blowing diastolic murmur bounding pulse - pulsating nail bed - and head bobbing
S aureus

43. When do troponin levels rise - peak - and return to normal?
Type I
Arthritis in a large joint (wrist - knees - ankles) that resolves within days and migrates to another large joint
Gelatinous - abundant ground substance
2-4 hours - 24 hours - 7-10 days

44. What does nonbacterial thrombotic endocarditis cause?
Regurg vs stenosis
Inability to fill ventricles
Mitral regurg
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

45. What is the tx for VSD?
Surgical closure small defects may close spontaneously
Migratory polyarthritis
1-3 days out
Pedunculated mass in the LA that causes syncope due to obstruction of MV

46. Is scar tissue or myocardium stronger?
Myocardium
Squatting - increased systemic resistence decreases LV emptying
Large vegetations of S aureus
Isolated root dilation - valve damage (infective endocarditis) - aortic root dilation (syphilitic aneurysm or aortic dissection)

47. What always follows necrosis?
LV dilation and eccentric hypertrophy
Acute inflammation
Systolic dysfx leading to biventricular CHF
LA dilation

48. What are the Jones criteria?
Heart transplant
Endomyocardial fibrosis w/eosinophilic infiltrate and eosinophilia
Evidence of prior group A beta - hemolytic strep plus major and minor criteria
When a bacterial protein resembles a protein in human tissue

49. What is the most common cause of RHF? What are others?
Low voltage EKG w/diminished QRS amplitude
Endocardial fibroelastosis (rare)
Metastasis
LHF - left - to - right shunt - chronic lung disease (cor pulmonale)

50. Ostium primum ASD is associated with what congenital disorder?
Increased O2 demand during exercise but can't increase CO b/c of narrowed valve
Bicuspid aortic valve
Rupture of free wall - IV septum - or papillary muscle
Trisomy 21