Challenge Bowl Cardio

Front 1

A 25 year old IV drug abuser presents with fever, chills, weakness, weight loss, and diaphoresis. On PE, splinter hemorrhages and petechiae are seen. A cardiac murmur is audible on auscultation of the heart. What is the most likely diagnosis and causative organism?

Back 1

Infective endocarditis; Staph aureus

Front 2

What is the most likely valvular cause of embolic stroke in patients under 45?

Back 2

Mitral valve prolapse

Front 3

Name the components of Virchow's triad.

Back 3

Endothelial injury, hypercoagulable state, venous stasis

Front 4

In what vascular disease would immune complexes, antineutrophil autoantibodies, fibrinoid necrosis, and thrombosis be present?

Back 4

Polyarteritis nodosa

Front 5

Native valve infective endocarditis is most commonly associated with what pathogen?

Back 5

Streptococcus viridans

Front 6

Prosthetic mitral valve infective endocarditis is most commonly associated with what pathogen?

Back 6

Staph aureus

Front 7

A patient with an aneurysm of the middle cerebral artery has a defect in what area of the artery?

Back 7

Tunica media

Front 8

What is the primary event that occurs in the vessel leading to atherosclerosis?

Back 8

Endothelial injury (leads to attraction of monocytes & platelets)

Front 9

What is the immune cell found within the early stages of atherosclerotic plaques?

Back 9

Monocytes or macrophages

Front 10

Thrombophlebitis of the anterior chest wall that can present as a tender or nontender cord is known as what?

Back 10

Mondor's disease

Front 11

In mammals, what amino acid is not essential because it can be synthesized from phenylalanine?

Back 11

Tyrosine

Front 12

What is the classic triad of Horner's syndrome?

Back 12

Ptosis, meiosis, anhidrosis

Front 13

Atherosclerotic lesions of arteries start in what area of the artery?

Back 13

Tunica intima

Front 14

What are the two most common microscopic findings in myocarditis?

Back 14

Aschoff bodies & Anitschkow cells

Front 15

What genetic disorder is most commonly associated with coarctation of the aorta?

Back 15

Turner syndrome

Front 16

What is the most common congenital heart condition in children?

Back 16

VSD

Front 17

What is the most common congenital heart condition in adults?

Back 17

ASD

Front 18

What viral infection is associated with patent ductus arteriosus?

Back 18

Rubella

Front 19

What valve is most commonly associated with infective endocarditis?

Back 19

Mitral

Front 20

What heart defect causes an opening snap during diastole?

Back 20

Mitral stenosis

Front 21

What valve defect is associated with a pansystolic murmur?

Back 21

Mitral regurgitation

Front 22

What valve defect has a mid-systolic click?

Back 22

Mitral valve prolapse

Front 23

What murmur makes a diamond shape (crescendo, decrescendo) sound in systole?

Back 23

Stenosis (either aortic or pulmonic)

Front 24

Rheumatic fever is caused by what pathogen?

Back 24

Group A strep pyogenes

Front 25

What is the formula for ejection fraction?

Back 25

Stroke volume divided by end-diastolic volume

Front 26

What hormone inhibits renin release, stimulates salt and water excertion and causes vascular smooth muscle relaxation?

Back 26

Atrial natriuretic peptide

Front 27

Osborn waves are generally seen with what condition?

Back 27

Hypothermia

Front 28

What is the junctional intrinsic rate at the AV node?

Back 28

40-60 BPM

Front 29

What valves open in systole?

Back 29

Aortic & pulmonic

Front 30

What EKG change can be seen in hyperkalemia?

Back 30

Peaked T waves

Front 31

What form of angina shows ST elevation on EKG?

Back 31

Prinzmetal's

Front 32

Stimulation of what nerve is responsible for a decrease in heart rate?

Back 32

Vagus nerve (Cranial nerve X)

Front 33

The tension produced by a chamber of the heart in order to contract is known as what?

Back 33

Afterload

Front 34

Right sided heart failure is also known as what?

Back 34

Cor pulmonale

Front 35

Fatigue, aching, numbness, or pain in the lower calf may be caused by arterial ischemia in what artery?

Back 35

Popliteal

Front 36

What condition is characterized by brownish discoloration or ulcers just above the malleolus?

Back 36

Chronic venous insufficiency

Front 37

On an EKG, ST elevations in leads II, III, aVF indicate damage to what wall?

Back 37

Inferior

Front 38

What is the MOA of clopidogrel bisulfate (Plavix)?

Back 38

Platelet ADP inhibitor

Front 39

What are the features of Beck's triad?

Back 39

Hypotension, distant heart sounds, JVD

Front 40

What 3 tests make up the Cincinnati Stroke Scale?

Back 40

Facial droop, arm drift, speech

Front 41

What is the preferred graft used in a coronary artery bypass graft (CABG) procedure?

Back 41

Internal thoracic artery

Front 42

What is an Osborn wave?

Back 42

A positive deflection at the J point indicating hypothermia

Front 43

What signalling molecule does nitric oxide trigger to initiate vasodilation?

Back 43

cGMP (cyclic guanosine monophosphate)

Front 44

What are the 4 components of Tetralogy of Fallot?

Back 44

Pulmonic stenosis, right ventricular hypertrophy, overriding aorta, VSD

Front 45

A "boot shaped heart" on chest xray indicates what?

Back 45

Tetralogy of Fallot

Front 46

Cotton wool spots are a classic finding of?

Back 46

Chronic hypertension

Front 47

What condition is present with Corrigan's pulse?

Back 47

Aortic regurgitation "water-hammer pulse"

Front 48

A patient presents with carotid pulses that abruptly rise and quickly collapse. They are exaggerated by raising the patient's arm. What condition does the patient likely have?

Back 48

Aortic regurgitation - "water-hammer pulse," Corrigan's pulse

Front 49

The widowmaker is what coronary artery?

Back 49

Left anterior descending

Front 50

What is the procedure performed for treatment for acute cardiac tamponade with hemodynamic compromise?

Back 50

Pericardiocentesis

Front 51

An abnormally large decrease in systolic blood pressure during inspiration of over 10 mmHg is known as what?

Back 51

Pulsus paradoxus, or paradoxical pulse

Front 52

A positive Homan's sign is indicative of what condition?

Back 52

DVT

Front 53

The most sensitive cardiac marker for MI is what?

Back 53

Troponin I

Front 54

The cardiac marker that rises the most quickly in an MI is what?

Back 54

Myoglobin

Front 55

Which valve disorder produces a murmur that is holosystolic and radiates to the left axilla?

Back 55

Mitral insufficiency (regurgitation)

Front 56

An inferior MI is most often caused by an occlusion of what artery?

Back 56

Right coronary artery

Front 57

A lateral MI will likely be evident with ST elevation in which leads on EKG?

Back 57

I, aVL, V5, V6

Front 58

Name 4 conditions associated with pulsus paradoxicus.

Back 58

Pericardial tamponade, pneumothorax, emphysema, severe asthma

Front 59

An EKG reading described as "irregularly irregular" indicates what?

Back 59

Atrial fibrillation

Front 60

This congenital heart defect enables blood flow between the left and right atria via the interatrial septum.

Back 60

ASD

Front 61

Intermittent claudication of the low back, buttocks, hip or thigh; impotency, and global atrophy of distal extremities indicates what condition?

Back 61

Leriche syndrome (aortoiliac occlusive disease)

Front 62

Large blue babies are associated with what defect?

Back 62

Transposition of the great arteries

Front 63

Egg on a string finding on xray is associated with what defect?

Back 63

Transposition of the great arteries

Front 64

A VSD causing a left to right blood flow shunt that becomes a right to left shunt due to increased pressures in the right side of the heart is known as what syndrome?

Back 64

Eisenmenger's syndrome

Front 65

This congenital heart disorder found primarily in neonates is indicated by a vascular opening between the pulmonary artery and aortic arch.

Back 65

Patent ductus arteriosus

Front 66

A patient presents with a loud systolic murmur that is heard best at the base of the heart with radiation to the neck. What is the most likely diagnosis?

Back 66

Aortic stenosis

Front 67

A 68-year-old patient presents with syncope. EKG reveals no relationship between P waves and QRS complexes. QRS complexes are wide. What is the most appropriate long-term intervention?

Back 67

Permanent pacemaker - this is 3rd degree AV block

Front 68

What is the most common cause of dilated cardiomyopathy?

Back 68

Alcohol abuse

Front 69

A patient complains of palpitations and lightheadedness. On physical exam, the pulse is occasionally irregular with an ectopic beat and a compensatory pause following each ectopic beat. What is the most likely diagnosis?

Back 69

Premature ventricular complexes

Front 70

An 18 year old soccer player has a syncopal episode while playing. On PE a systolic murmur is heard at the left sternal border. What is the most likely diagnosis?

Back 70

Hypertrophic cardiomyopathy

Front 71

A downward displacement of the triscuspid valve into the right ventricle due to adherence of leaflets to the ventricle wall is known as what?

Back 71

Ebstein's anomaly

Front 72

Decreased femoral pulses with normal radial pulses would indicate what disorder?

Back 72

Coarctation of the aorta

Front 73

A patient presents with yellow green visual disturbances, EKG changes; what is the most likely diagnosis?

Back 73

Digoxin toxicity

Front 74

Fixed split S2 on expiration is indicative of what?

Back 74

ASD with left to right shunt

Front 75

How do you know if a possible solution is feasible?

Back 75

If resources such as time, money, and material are available, a solution may be feasible. You must also ensure that you have the authority to implement a solution in order for it to be a feasible proposal.

Front 76

Which of the 4 heart sounds is normal in pregnancy?

Back 76

S3, S4