Cardiology

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jaz_walker
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Cardiology
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2014-04-29 15:38:55
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  1. 1. True or false regarding congenital heart disease. A foramen ovale is patent in up to 20% of the population.
    T
  2. 2. A 79 year old male presents with atypical chest pain. A pericardial rub is heard. A serous pericardial fluid is aspirated. What are the 2 causes of serous pericardial effusion?
    T - Congestive heart failure, hypoalbuminaemia of any cause
  3. 3. True or false regarding infective endocarditis. acute endocarditis can affect previously normal valves.
    T
  4. 4. True or false regarding cardiomyopathies. Alcohol ingestion can lead to DCM.
    T
  5. 5. True or false regarding cardiomyopathies. amyloidosis leads to dilated CM.
    F - Restrictive is the least common form.
  6. 6. True or false regarding congenital heart disease. An ASD opens temporarily when right sided atrial pressures increase (e.g. during sneezing).
    F - this is a patent foramen ovale
  7. 7. True or false regarding non infective endocarditis. Antiphospholipid syndrome can predispose to Libman-Sacks endocarditis.
    T - but SLE is the most common association
  8. 8. True or false regarding congenital heart disease. ASDs are often without any other cardiac abnormalities.
    T
  9. 9. A 79 year old woman has mitral regurgitation. At autopsy her heart is hypertrophic. Where have new sarcomeres been added?
    In series with old sarcomeres (i.e. dilatatory hypertrophy)
  10. 10. A 78 year old man has longstanding hypertension, and aortic stenosis. At autopsy his heart is hypertrophic. Where have new sarcomeres been added?
    In parallel with old sarcomeres (i.e. concentric hypertrophy)
  11. 11. Atherosclerotic plaques with a paucity of smooth muscle cells are more likely to rupture.
    T
  12. 12. A 34 year old woman dies suddenly. Autopsy shows a thick-walled, heavy, hypercontractile heart. There is asymmetrical septal hypertrophy of the left ventricle free wall. Histology is abnormal. What may have caused her death?
    Hypertrophic cardiomyopathy
  13. 13. A 79 year old woman presents with shortness of breath. She dies shortly afterwards. Autopsy shows centrilobular necrosis. what is the likely cause?
    Left sided heart failure.
  14. 14. A 54 year old man presents with flushing, diarrhea and dermatitis which occurs episodically. During these episodes he also has hypertension. He dies suddenly. Autopsy shows glistening white intimal plaquelike thickeings on the endocardial surfaces of the cardiac chambers. These contain smooth muscle cells and sparse collagen fibres. Underlying structures are intact. What has caused these findings?
    Carcinoid heart disease - from carcinoid tumours
  15. 15. A 58 year old man experiences chest pain and is rapidly thrombolysed, as ECG changes show STeMI. He dies soon afterwards. Autopsy shows haemorrhage within the infarction. What may be the cause of this?
    Reperfusion injury
  16. 16. A 58 year old man experiences chest pain and dies 6 hours afterwards. Autopsy shows necrosis of the anterior wall of the left ventricle, the anterior two thirds of the ventricular septum and most of the heart apex. Which artery has been occluded?
    Left anterior descending
  17. 17. A 58 year old man experiences chest pain and dies 6 hours afterwards. Autopsy shows necrosis of the lateral left ventricle. Which artery has been occluded?
    Left circumflex
  18. 18. A 79 year old woman presents with hepatomegaly. She dies shortly afterwards. Autopsy shows nutmeg liver and hepato.megaly. what is the likely cause?
    Right sided heart failure
  19. 19. A 58 year old man experiences chest pain and dies 6 hours afterwards. Autopsy shows right ventricle necrosis. Which artery has been occluded?
    right coronary artery
  20. 20. A 53 year old man dies suddenly. autopsy shows severe atherosclerotic disease. What is the most common cause of sudden cardiac death?
    Ventricular arrhythmia
  21. 21. A 54 year old man presents with flushing, diarrhea and dermatitis which occurs episodically. During these episodes he also has hypertension. He dies suddenly. Autopsy shows tricuspid insufficiency and pulmonic stenosis. What has caused these findings?
    Carcinoid heart disease - from carcinoid tumours
  22. 22. True or false regarding replacement heart valves. Bioprosthetic valves require lifelong anticoagulation.
    F - Only mechanical valves require lifelong anticoagulation
  23. 23. A 71 year old female presents with bilateral pedal oedema and a cough. Blood cultures are positive for strep. Viridans. Which valvular lesion might you consider?
    Aortic regurgitation
  24. 24. True or false regarding infective endocarditis. Can cause glomerulonephritis.
    T - due to immune complexes.
  25. 25. True or false regarding myocarditis. Chagas disease is a cause of this.
    T
  26. 26. True or false regarding cor pulmonale. Chronic cor pulmonale can cause atheromatous pulmonary arterial plaques.
    T
  27. 27. True or false regarding myocardial infarctions. CK begins to rise within an hour of a MI.
    F - begins to rise within 2-4 hours
  28. 28. True or false regarding myocardial infarctions. Ck peaks at 24-48 hours.
    T - returns to normal within 72 hours
  29. 29. True or false regarding myocarditis. CMV and HIV can cause this.
    T
  30. 30. True or false regarding ischaemic heart disease. Critical stenosis occurs at 40% stenosis.
    F - Around 70% stenosis
  31. 31. A 12 year old male presents with a fever and migratory polyarthritis of large joints. Two weeks earlier he had a pharyngitis. Cultures are negative for streptococci, a pericardial rub can be heard. Aschoff bodies can be seen in a cardiac biopsy.
    - Streptolysin O
  32. 32. True or false regarding cardiomyopathies. Dilated cardiomyopathy is the most common form.
    T
  33. 33. True or false regarding cardiomyopathies. Dilated cardiomyopathy leads to diastolic dysfunction.
    F - Leads to systolic dysfunction
  34. 34. True or false regarding cardiomyopathies. Dilatory cardiomyopathy usually presents between ages 20 and 50.
    T
  35. 35. True or false regarding cardiomyopathies. Dilatory CM is the most common manifestation of iron overload.
    T - due to haemachromatosis or multiple transfusions
  36. 36. True or false regarding congenital heart disease. Ductal closure is often delayed or absent in children with hypoxia.
    T - e.g. related to respiratory distress or heart disease.
  37. 37. A 58 year old male presents with atrial fibrillation. ECG shows left ventricular hypertrophy. What is the most common cause of this?
    Longstanding hypertension
  38. 38. A 58 year old man experiences chest pain. ECG shows no ST elevation, troponin is positive. what pattern of infarct is likely to have occurred?
    Subendothelial
  39. 39. A 58 year old man experiences chest pain. ECG shows ST elevation. what pattern of infarct is likely to have occurred?
    Transmural
  40. 40. A 51 year old male presents with a fever, malaise and syncope. Echo shows a neoplasm on the valve causing a 'ball valve' obstruction. What are the 2 most common metastases in the heart?
    Lung cancer, lymphoma
  41. 41. True or false regarding congenital heart disease. Females are more commonly affected than males with aortic coarctation.
    F - Males are twice as commonly affected
  42. 42. True or false regarding congenital heart disease. females with Turner syndrome frequently have aortic coarctation.
    T
  43. 43. True or false regarding cardiomyopathies. Friedreich ataxia leads to hypertrophic CM.
    T
  44. 44. True or false regarding cardiomyopathies. Haemochromatosis leads to restrictive CM.
    F - dilated
  45. 45. True or false regarding infective endocarditis. Haemophilus, actinobacillus, cardiobacterium, eikenella and kingella are commensals of the skin which commonly cause IE.
    F - They are oral cavity commensals
  46. 46. A 40 year old male presents with a new heart murmur. He mentions he has ankylosing spondylitis. Which valvular lesion might you consider?
    Aortic regurgitation
  47. 47. A 40 year old male presents with a new heart murmur. He mentions he has Marfan syndrome. Which 2 valvular lesions might you consider?
    Aortic regurgitation, myxomatous degeneration of the mitral valve
  48. 48. A 81 year old female has shortness of breath and dies. Heart is hypertrophic and massively dilated. Microscopy shows myocyte hypertrophy and mild interstitial fibrosis. What may be the cause of this?
    Left sided congestive heart failure.
  49. 49. True or false regarding infective endocarditis. Hepatomegaly is common in subacute cases.
    F - Splenomegaly is common
  50. 50. True or false regarding non infective endocarditis. Hypercoagulability is the main risk factor for NBTE.
    T - e.g. DIC, hyperoestrogenic states, malignancy
  51. 51. True or false regarding cardiomyopathies. Hypertrophic cardiomyopathy is always genetic.
    T
  52. 52. True or false regarding cardiomyopathies. Hypertrophic cardiomyopathy is the least common form.
    F - Restrictive is the least common form.
  53. 53. in acute bacterial pericarditis the exudate is fibrinous.
    F - the exudate is typically fibrinopurulent
  54. 54. True or false regarding cor pulmonale. In acute cor pulmonale, there is right ventricle dilation.
    T
  55. 55. In acute viral pericarditis, exudate is typically serous.
    F - exudate is typically fibrinous
  56. 56. True or false regarding cor pulmonale. In ventricular failure, the right atrium and ventricle are dilated.
    T
  57. 57. True or false regarding congenital heart disease. Infantile aortic coarctation is usually postductal.
    F - It is usually preductal, and circumferential
  58. 58. True or false regarding congenital heart disease. Infantile aortic coarctation is usually postductal.
    T - It is usually ridged, and opposite the ligamentum arteriosum
  59. 59. Presentation. Investigations. Question
    Disease - Further Information
  60. 60. True or false regarding right sided heart failure. It is associated with centrilobular necrosis of the liver.
    f - it is associated with nutmeg liver
  61. 61. True or false regarding right sided heart failure. it is associated with nutmeg liver.
    t - and also hepatomegaly
  62. 62. True or false regarding right sided heart failure. It is associated with pleural effusions which are serous, with a low protein content.
    t
  63. 63. True or false regarding right sided heart failure. It is associated with pulmonary oedema.
    f - this is left sided heart failure
  64. 64. True or false regarding right sided heart failure. It is associated with shortness of breath.
    f - this is left sided heart failure
  65. 65. True or false regarding infective endocarditis. IV antibiotics are required for up to 2 weeks.
    F - usually up to 6 weeks
  66. 66. True or false regarding myocardial infarctions. Left ventricular hypertrophy is a risk factor for myocardial rupture post-MI.
    F - it is protective
  67. 67. True or false regarding non infective endocarditis. Libman-Sacks endocarditis involves coagulative necrosis of the valve substance.
    F - Involves fibrinoid necrosis of valve substance.
  68. 68. true or false regarding cardiac tumours. lung cancer is a common metastasis to the heart.
    T
  69. 69. A 81 year old female has shortness of breath and dies. Lungs are heavy and boggy, and microscopically show perivascular and interstitial transudate, alveolar septal oedema. There are haemosiderin laden alveolar macrophages. What may be the cause of this?
    Left sided congestive heart failure.
  70. 70. true or false regarding pericardial disease. malignancy results in a serosanguineous pericardial effusion.
    T
  71. 71. MI involves necrosis.
    T - due to ischaemia
  72. 72. True or false regarding congenital heart disease. Most ASDs are a patent ostium primum.
    F
  73. 73. True or false regarding congenital heart disease. Most ASDs are a patent ostium secundum.
    t
  74. 74. True or false regarding congenital heart disease. Most ASDs present with neonatal cyanosis.
    F - Usually only present later in life with Eisenmenger's syndrome, or not at all
  75. 75. True or false regarding myocarditis. Most commonly caused by strep. Viridans.
    F - Most commonly caused by coxsackieviruses a and B
  76. 76. True or false regarding congenital heart failure. most congenital heart disease arises from faulty embryogenesis during gestational weeks 10-13.
    f - mostly weeks 3-8
  77. 77. True or false regarding congenital heart disease. Most VSDs close spontaneously.
    T
  78. 78. True or false regarding myocardial infarctions. Myocardial rupture post-MI is most common 3-7 days after the MI.
    T
  79. 79. True or false regarding non infective endocarditis. NTBE involves a mostly inflammatory reaction in the valve cusp.
    F - mostly thrombus.
  80. 80. A 34 year old woman dies suddenly. On autopsy, her heart was flabby, with dilation of all chambers. Ventricular walls are thin, and mural thrombi are present. Histology is non-specific. What may have caused her death?
    Dilatory cardiomyopathy
  81. 81. A 34 year old woman dies suddenly. One myocardium is firm. There is biatrial dilation. Microscopy shows mild interstitial fibrosis. What is this?
    restrictive cardiomyopathy
  82. 82. Patients with chronic IHD exhibit left ventricular dilation and hypertrophy.
    T
  83. 83. Patients with chronic IHD often have a history of a previous MI.
    T
  84. 84. True or false regarding myocardial infarctions. Pericarditis is common around a month after Mis.
    F - Most commonly occurs 2-3 days afterwards and resolves within days.
  85. 85. True or false regarding cor pulmonale. Pneumoconiosis causes cor pulmonale through affecting pulmonary arterial constriction.
    F - through affecting pulmonary parenchyma
  86. 86. True or false regarding congenital heart disease. Postductal aortic coarctation often has upper extremity weak pulses and relative hypotension of lower extremities.
    T
  87. 87. true or false regarding pericardial disease. primary pericarditis is more common than secondary pericarditis.
    F - Pericarditis is usually secondary to acute MI
  88. 88. True or false regarding myocardial infarctions. Prior MIs are a risk factor for myocardial rupture post-MI.
    F - Scarring from previous MIs limits the risk of myocardial tearing
  89. 89. True or false regarding non infective endocarditis. Prior valvular damage is a risk for NBTE.
    F - usually normal valves
  90. 90. True or false regarding congenital heart disease. Prostaglandin E2 helps to shut the ductus arteriosus.
    F - It helps to keep it open.
  91. 91. True or false regarding congenital heart disease. Pulmonary hypertension is common in tetralogy of fallow.
    F - The pulmonary stenosis protects the pulmonary vasculature
  92. 92. True or false regarding cardiomyopathies. radiation induced fibrosis leads to restrictive CM.
    T
  93. 93. True or false regarding myocardial infarctions. reperfusion may cause CK to peak later.
    F - may cause it to peak earlier due to washout of protein
  94. 94. True or false regarding cardiomyopathies. restrictive and hypertrophic myopathies lead to diastolic dysfunction.
    t
  95. 95. True or false regarding infective endocarditis. S. viridans is the major infective agent of previously healthy valves.
    F - S. aureus is more common in cases of previously healthy valves.
  96. 96. True or false regarding cardiomyopathies. Sarcoidosis can be associated with cardiomyopathy.
    T
  97. 97. True or false regarding myocarditis. Sarcoidosis is the most common non-infectious cause.
    F - SLE is the most common non-infectious cause
  98. 98. True or false regarding cardiomyopathies. Sarcoidosis leads to hypertrophic CM.
    F - dilated
  99. 99. A 71 year old female presents with bilateral pedal oedema and a cough. She mentions she has had rheumatic fever when younger. Which 3 valvular lesions might you consider and what was the original causative organism?
    Mitral stenosis primarily, also aortic stenosis, mitral regurgitation - Group A b-haemolytic streptococci
  100. 100. A 71 year old female presents with bilateral pedal oedema and a cough. She mentions she has rheumatoid arthritis. Which valvular lesion might you consider?
    Aortic regurgitation
  101. 101. A 71 year old female presents with bilateral pedal oedema and a cough. She mentions she has syphillis. Which valvular lesion might you consider?
    Aortic regurgitation
  102. 102. True or false regarding infective endocarditis. Splenomegaly is common in subacute cases.
    T
  103. 103. True or false regarding myocardial infarctions. STEMIs have a higher risk of arrhythmia than non-STEMIs.
    T
  104. 104. True or false regarding infective endocarditis. Streptococcus viridans is the most common cause of infective endocarditis.
    T
  105. 105. True or false regarding infective endocarditis. Subacute endocarditis cannot affect normal valves.
    T
  106. 106. A 58 year old man experiences chest pain and dies 6 hours afterwards. t troponin is positive. What microscopic changes would you expect?
    coagulation necrosis, oedema, haemorrhage - no macroscopic changes up to 12 hours
  107. 107. A 58 year old man experiences chest pain and dies 12-24 hours afterwards. t troponin is positive. What macroscopic changes would you expect?
    Dark mottling of red/blue
  108. 108. A 58 year old man experiences chest pain and dies 1-3 days afterwards. t troponin is positive. What macroscopic changes would you expect?
    Dark mottling with a yellow-tan infarct centre - microscopically expect 'wavy' fibres
  109. 109. A 58 year old man experiences chest pain and dies 3-7 days afterwards. t troponin is positive. What macroscopic changes would you expect?
    Central yellow-tan infarct centre, with a hyperaemic border. Macrophages start to migrate in
  110. 110. A 58 year old man experiences chest pain and dies 7-10 days afterwards. t troponin is positive. What macroscopic changes would you expect?
    red-gray depressed infarct borders. Well established granulation tissue
  111. 111. True or false regarding valvular heart disease. The aortic valve is the most commonly affected.
    F - the mitral valve is most commonly affected
  112. 112. True or false regarding congenital heart disease. The ductus arteriosus joins the aorta just proximal to the origin of the left subclavian artery.
    F - It joins just distally to the left subclavian.
  113. 113. True or false regarding infective endocarditis. The Duke criteriae can be used to diagnose IE.
    t
  114. 114. A neonate has cyanosis which does not respond to oxygen therapy. The heart is large and 'boot-shaped'. The pulmonary trunk is hypoplastic. There is an overriding aorta. What is this?
    Tetralogy of Fallot
  115. 115. True or false regarding infective endocarditis. The mitral valve is more likely to be affected in IVDUs.
    F - the tricuspid valve is particularly vulnerable
  116. 116. True or false regarding congenital heart failure. the most common defect is an atrial septal defect.
    f - this is second most common, ventricular septal defects being most common
  117. 117. true or false regarding pericardial disease. The pericardial sac usually contains no fluid.
    F - 30 - 50mL of clear serous fluid
  118. 118. True or false regarding infective endocarditis. the right side of the heart is more likely to be affected.
    F - The left valves are more commonly affected.
  119. 119. True or false regarding congenital heart disease. ToGA is associated with right ventricular hypertrophy.
    T - as it is acting as the systemic ventricle
  120. 120. True or false regarding congenital heart disease. Transposition of the great arteries are commonly associated with VSDs.
    t - a shunt is required for ToGA to be viable
  121. 121. True or false regarding congenital heart disease. Transposition of the great vessels is a type of cyanotic heart disease.
    T
  122. 122. Transposition of the great vessels is associated with clubbing and polycythaemia.
    T - these are consequences of severe, systemic cyanosis
  123. 123. A 55 year old man presents with chest pain. Troponin T is raised. Which 2 arteries are the most likely to have been affected?
    Left anterior descending, left circumflex
  124. 124. A 58 year old man experiences chest pain. Troponin T is raised. What kind of necrosis might you expect to see in the heart?
    Coagulation necrosis
  125. 125. A 58 year old man experiences chest pain. Troponin T is raised. What in this context is his highest risk of sudden cardiac death 24 hours on?
    Ventricular fibrillation
  126. 126. A 58 year old man experiences chest pain. Troponin T is raised. Which part of the heart is first to become irreversibly ischaemic and how long does this take?
    Subendocardial zone - 20-40 minutes
  127. 127. True or false regarding myocardial infarctions. troponin T is raised up to a month after an MI.
    F - raised for up to 10 days
  128. 128. Unstable angina is associated with plaque disruption.
    T - it often is the harbinger of MI
  129. 129. True or false regarding carcinoid heart disease. Usually affects the right side of the heart.
    T - This is the first area receiving it
  130. 130. True or false regarding carcinoid heart disease. Usually occurs in the presence of lung metastases.
    F - usually in the presence of hepatic metastases
  131. 131. variant angina is caused by atherosclerosis of coronary arteries.
    F - It is caused by coronary artery spasm, often associated with atherosclerotic plaques
  132. 132. True or false regarding myocardial infarctions. Ventricular aneurysms are an early complication of MI.
    F - They are a late complication
  133. 133. True or false regarding congenital heart disease. VSDs are often without any other cardiac abnormalities.
    F - They are often associated with other cardiac malformations.
  134. 134. What are the 3 types of left to right shunt?.
    ASDs, VSDs, patent ductus arteriosus
  135. 135. What are the 4 most common known causes of congenital heart disease?.
    Congenital rubella, teratogens, maternal diabetes, genetic factors
  136. 136. a baby is born cyanotic, and does not improve with oxygen therapy. What classification of heart defect might you suspect?.
    Cyanotic right to left shunt.
  137. 137. What is the most common cause of congenital heart disease?.
    Tetralogy of Fallot
  138. 138. A male baby is born with an absent radial bone, and an atrial septal defect. Which gene is mutated in holt-Oram syndrome?.
    TBX5
  139. 139. A male baby is born with a webbed neck and pulmonary valve stenosis, with an ASD. Which syndrome might you consider?.
    Noonan syndrome
  140. 140. True or false regarding cardiomyopathies. X linked dilatory CM is most frequently associated with a collagen mutation.
    F - it is most commonly associated with dystrophin gene mutation.
  141. 141. A 76 year old male presents with shortness of breath and chest pain. You hear a pericardial rub. You aspire an exuberant shaggy fibrinous exudate pericardially which has bloody effusion. What are you concerned about?
    Malignancy, particularly leukaemia.
  142. 142. What are the 2 most common causes of systolic heart failure?
    Ischaemic heart disease or hypertension
  143. 143. What are the 3 most common causes of diastolic heart failure?
    Left ventricular hypertrophy, myocardial fibrosis, amyloid deposition, constrictive pericarditis.
  144. 144. What 3 groups of people are predisposed to diastolic heart failure?
    Elderly, diabetic and female.
  145. 145. A 83 year old man is noticed on autopsy to have concentric hypertrophy of the heart. He was noted in life to have left sided cardiac failure. What is the most common cause for left sided cardiac failure?
    Ischaemic heart disease.
  146. 146. What is the most common cause for right sided cardiac failure?
    Left sided heart failure.
  147. 147. A 58 year old man is told he has ischaemic heart disease. What is the major cause of this?
    90% are caused by obstructive atherosclerotic vascular disease.
  148. 148. What 3 presentations are encompassed by Acute Coronary Syndrome?
    Angina, Acute MI, sudden cardiac death
  149. 149. A 58 year old man is told he has ischaemic heart disease. How is this defined?
    Inadequate coronary perfusion relative to myocardial demand.
  150. 150. A 58 year old man experiences chest pain and dies 2-8 weeks afterwards.
    grey-white scar.
  151. 151. A 68 year old man with a longstanding history of hypertension dies of an unrelated cause. What heart finding might you expect on autopsy
    Left ventricular hypertrophy.
  152. 152. What 4 classes of problem can cause cor pulmonale?
    pulmonary parenchyma, pulmonary vessels, chest movement, pulmonary arterial constriction
  153. 153. What is the most common congenital valvular lesion?
    Bicuspid aortic valve
  154. 155. A 67 year old woman with a known mucinous adenocarcinoma presents with a stroke. What might you look for?
    NBTE (non bacterial thrombotic endocarditis)
  155. 156. What are the 3 categories of cardiomyopathy?
    Dilated, hypertrophic and restrictive
  156. 157. A 51 year old female presents in shock. You note paradoxical pulse. What are you concerned about?
    Cardiac tamponade

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