Chapter 8 ( Cardiac )

Question 1

Subendocardial ischemia is represented on EKG by ?

Answer 1

ST segment depression

Question 2

Mechanism of stable angina ?

Answer 2

Atherosclerosis of coronary artery with >70% stenosis

Question 3

Mechanism of unstable angina ?

Answer 3

Rupture of an atherosclerotic plaque with thrombosis and incomplete occlusion of a coronary artery

Question 4

Transmural ischemia is represented on EKG by ?

Answer 4

ST segment elevation

Question 5

Papillary muscle of the LV is supplied by ?

Answer 5

Right coronary artery

Question 6

The most sensitive and specific marker for MI ?

Answer 6

Troponin I

Question 7

Mechanism of contraction band necrosis ?

Answer 7

Reperfusion of irreversibly damaged cells results in Ca influx , leading to hypercontraction of myofibrils

Question 8

Reperfusion injury mechanism ?

Answer 8

Return of oxygen and inflammatory cells may lead to free radicle generation , further damaging myocytes

Question 9

Complications of MI that can occur in the first 4 hours ?

Answer 9

Cariogenic shock
Congestive heart failure
Arrhythmia

Question 10

Gross changes , microscopic changes and complications of 4-24 hours after MI ?

Answer 10

Gross : dark discoloration
Micro : Coagulative necrosis
Complications : arrhythmia

Question 11

Gross changes , microscopic changes and complications of 1-3 days after MI ?

Answer 11

Gross : yellow pallor
Micro : Neutrophils
Complications : Fibrinous pericarditis ( with transmural infarction )

Question 12

Gross changes , microscopic changes and complications of 4-7 days after MI ?

Answer 12

Gross : yellow pallor 
Micro : Macrophages 
Complications : rupture of 
Ventricular free wall
Interventricular septum 
Papillary muscle ( in right coronary artery occlusion )

Question 13

Gross changes , microscopic changes and complications of 1-3 weeks after MI ?

Answer 13

Gross : red border emerges as granulation tissue enters from edge of infarct
Micro : Granulation tissue with plump fibroblasts , collagen , blood vessels

Question 14

Gross changes , microscopic changes and complications of months after MI ?

Answer 14

Gross : white scar 
Micro : Fibrosis 
Complications : 
Aneurysm 
Mural thrombus 
Dressler syndrome

Question 15

Causes of sudden cardiac death ?

Answer 15

Most common : Acute ischemia 
Less common :
Mitral valve prolapse 
Cardiomyopathy 
Cocaine abuse

Question 16

Heart failure cells ?

Answer 16

Hemosidren-laden macrophages founded in alveoli when the small congested capillaries due to left sided heart failure burst

Question 17

Nutmeg liver ?

Answer 17

Cardiac hepatomegaly

Congestion of the hepatic veins gives the liver it nutmeg ( red ) color

Question 18

Most common congenital heart defect ?

Answer 18

VSD

Question 19

VSD associated with what ?

Answer 19

Fetal alcohol syndrome

Question 20

Most common type of ASD ?

Answer 20

Ostium secundum ( 90% of cases )

Question 21

Ostium primum is associated with ?

Answer 21

Down syndrome

Question 22

Important complication of ASD ?

Answer 22

Paradoxical emboli

Question 23

PDA is associated with ?

Answer 23

Congenital rubella

Question 24

PDA complicated by Eisenmenger syndrome results in ?

Answer 24

LOWER EXTREMITY cyanosis

Question 25

Ttt of PDA ? Its mechanism ?

Answer 25

Indomethacin | Decreases PGE resulting in PDA closure ( as PGE maintains the patency of the ductus arteriosus )

Question 26

Fallot tetralogy components ?

Answer 26

1- PS 2- right ventricular hypertrophy 3- VSD 4- aorta that overrides the VSD

Question 27

TGA is associated with ?

Answer 27

Maternal diabetes

Question 28

Ttt of TGA ?

Answer 28

Surgical correction | PGE can be administered to maintain a PDA until definitive surgical repair is performed

Question 29

Tricuspid atresia is associated with ?

Answer 29

ASD

Question 30

Infantile form of coarctation of aorta ( before PDA ) is presented by ?

Answer 30

LOWER EXTREMITY cyanosis

Question 31

Infantile form of coarctation of aorta is associated with ?

Answer 31

Turner syndrome

Question 32

Adult form of coarctation of aorta is associated with ?

Answer 32

Bicuspid aortic valve

Question 33

Adult form of coarctation of aorta is characterized by what on x ray ?

Answer 33

Notching of ribs

Question 34

Mechanism of acute rheumatic fever ?

Answer 34

Molecular mimicry | Bacterial M protein resembles proteins in human tissues

Question 35

Components of Aschoff bodies ?

Answer 35

1- Foci of chronic inflammation 2- Antischkow cells : reactive histiocytes with slender wavy nuclei 3- Giant cells 4- Fibrinoid material

Question 36

How to differentiate AS caused by Rheumatic valve disease from AS caused by wear and tear ?

Answer 36

1- coexisting mitral stenosis 2- fusion of the aortic valve commissures Both of which aren’t found with AS caused by wear and tear

Question 37

Mechanism of MAHA with AS ?

Answer 37

RBCs are damaged producing schistocytes while crossing the calcific valve

Question 38

Mechanism of mitral valve prolapse ?

Answer 38

Myxoid degeneration ( accumulation of ground substance ) of the valve making it floppy

Question 39

The most common overall endocarditis ?

Answer 39

Streptococcus viridans

Question 40

Staphylococcus epidermidis associated with which cause of endocarditis ?

Answer 40

Endocarditis of prosthetic valves

Question 41

Streptococcus bovis is associated with which cause of endocarditis ?

Answer 41

In patients with underlying colorectal carcinoma

Question 42

Non bacterial thrombotic endocarditis is associated with ? Mechanism ?

Answer 42

Hypercoagulable state Adenocarcinoma Sterile vegetations arise on the mitral valve along lines of closure causing MR

Question 43

Most common form of cardiomyopathy ?

Answer 43

Dilated cardiomyopathy

Question 44

Causes of dilated cardio myopathy ?

Answer 44

``` PH GAMD 1- Pregnancy 2- Hemochromatosis 3- Genetic mutation (AD) 4- Alcohol abuse 5- Myocarditis ( due to Coxackie A or B ) 6- Drugs ( Doxorubicin ) ```

Question 45

Mechanism of Hypertrophic cardiomyopathy ?

Answer 45

Genetic mutations in sarcomere proteins , most common form is autosomal dominant

Question 46

Characteristic finding in biopsy of hypertrophic cardiomyopathy ?

Answer 46

Myofiberhypertrophy with disarray

Question 47

Loeffler syndrome ?

Answer 47

Endomyocardial fibrosis with eosinophilic infiltrate and eosinophilia

Question 48

EKG classic findings of restrictive cardiomyopathy ?

Answer 48

Low voltage EKG | Diminished QRS amplitude

Question 49

Most common primary cardiac tumor in adults ?

Answer 49

Myxoma ( benign mesenchymal tumor )

Question 50

Most common primary cardiac tumor in children ?

Answer 50

Rhabdomyoma ( benign hamartoma of cardiac muscle )

Question 51

Rhabdomyoma is associated with ?

Answer 51

Tuberous sclerosis