8.4 - Valvular disorders

Question 1

acute rheumatic fever is due to what organism family?

Answer 1

group A beta-hemolytic strep

Question 2

what is the etiology of acute rheumatic fever?

Answer 2

molecular mimicry - bacterial M protein resembles proteins in human tissue

Question 3

how is diagnosis of acute rheumatic fever made?

Answer 3

JONES criteria:

• joints (polyarthritis)
• heart (pancarditis)
• nodules (subcutaneous)
• erythema marginatum
• sydenham chorea

Question 4

endocarditits in acute rheumatic fever leads to what sequalae?

Answer 4

small vegetations lead to regurgitation

Question 5

what is the most common cause of death during acute rheumatic fever?

Answer 5

myocarditis

Question 6

what are aschoff bodies? when / where are they seen?

Answer 6

• foci of chronic inflammation

- myocarditis phase of acute rheumatic fever

Question 7

what are anitschkow cells? when / where are they seen?

Answer 7

• reactive histiocytes with slender, wavy nuclei

- myocarditis phase of acute rheumatic fever

Question 8

how is erythema marginatum in acute rheumatic fever described?

Answer 8

annular, nonpruritic rash with erythematous borders, commonly involving trunk and limbs

Question 9

what is the main complication of chronic rheumatic disease?

Answer 9

endocarditis

Question 10

aschoff bodies and anitschkow cells are seen in what condition?

Answer 10

acute rheumatic fever

Question 11

what are the complications of aortic stenosis?

Answer 11

• concentric LVH
• angina and syncope with exercise
• microangiopathic hemolytic anemia (production of schistocytes)

Question 12

what RBC variant is produced as a result of aortic stenosis?

Answer 12

schistocyte

Question 13

early, blowing, diastolic murmur

Answer 13

aortic regurgitation

Question 14

is the pulse pressure increased or decreased in aortic regurgitation?

Answer 14

increased

Question 15

water hammer pulse - diagnosis?

Answer 15

aortic regurgitation

Question 16

how does aortic regurgitation present?

Answer 16

• head bobbing
• water hammer pulse
• pulsating nail bed (quincke pulse)

Question 17

aortic regurgitation results in what type of hypertrophy? why?

Answer 17

• eccentric hypertrophy

- volume overload

Question 18

mid-systolic click followed by a regurgitation murmur

Answer 18

mitral valve prolapse

Question 19

the click and murmur of mitral valve prolapse become softer with what movement?

Answer 19

squatting (increased systemic resistance decreases LV emptying

Question 20

holosystolic “blowing” murmur

Answer 20

mitral regurgitation

Question 21

mitral regurgitation (holosystolic “blowing” murmur) gets louder with what movements?

Answer 21

• squatting (increased systemic resistance decreases LV emptying)
• expiration (increased return to LA)

Question 22

opening snap followed by diastolic rumble

Answer 22

mitral stenosis

Question 23

what are the sequalae of mitral stenosis?

Answer 23

volume overload leads to dilation of LA:

• pulmonary congestion
• pulmonary HTN
• atrial fibrillation