ALL THINGS CARDIO- FINAL

Question 1

What’s the first sign of atherosclerosis that’s visible without magnification?

Answer 1

fatty streaks

A fatty streak consists of lipid-containing foam cells in the arterial wall just beneath the endothelium

Question 2

what develops on the second third or fourth day following a transmural myocardial infarction?

Answer 2

A fibrinous or fibrino-hemorrhagic pericarditis

Pericarditis following myocardial infarction usually resolves over time with no serious consequence or sequelae

Question 3

what is the form of pericarditis that occurs weeks to months after injury to the heart or the pericardium?

Answer 3

Dressler’s syndrome

Question 4

what is the predominant cause of renal artery stenosis, usu in those with acute onset of hypertension 50 years or older?

Answer 4

Atherosclerosis

Question 5

what is the predominant cause of renal artery stenosis, usu in those with acute onset of hypertension 40 years old and female?

Answer 5

Fibromuscular dysplasia

Question 6

__________ and ________are vessels in which aneurysm development has the greatest potential for increased morbidity and mortality

Answer 6

aorta

the circle of Willis

Question 7

someone with a Berry Aneurysm might say?

Answer 7

“this is the worse h/a ever”

Question 8

dissection usually occurs through which layers?

Answer 8

medial tissue layer of the aorta

blood penetrates the intima and enters the media

Question 9

aneurysm usually refers to?

Answer 9

the “ballooning out” of a vessel wall due to underlying weakness of the wall and/ or the force of increased blood pressure.

Question 10

Marfan’s syndrome is a genetic connective tissue disorder that results from abnormal production of what?

Answer 10

fibrillin-1 protein

Question 11

histologically, Marfan’s syndrome demonstrates_________

Answer 11

cystic medial necrosis, where pink elastic fibers, instead of running in parallel arrays, are disrupted by pools of blue mucinous ground substance.

Question 12

Another cause of cystic medial necrosis (besides Marfan’s syndrome) is_________

Answer 12

copper deficiency

Question 13

what is the name of the pathology that originates in the lungs and leads to CHF?

Answer 13

cor pulmonale

Question 14

3 major categories of cardiomyopathy are?

Answer 14

dilated (most common)
hypertrophic
restrictive

Question 15

dilated cardiomyopathy is characterized by

Answer 15

enlargement and dilatation of all four chambers of the heart

most common non-ischemic cause is alcoholism

Question 16

Histology of dilated cardiomyopathy reveals

Answer 16

nonspecific abnormalities, including variations in myocyte size, myocyte vacuolation, loss of myofibrillar material, and fibrosis

Question 17

hypertrophic cardiomyopathy (HCM) is characterized by

Answer 17

myocardial hypertrophy, abnormal diastolic filling (due to reduce chamber size) and in about one third of cases, intermittent ventricular outflow obstruction (due to bulging septum)
its genetic

Question 18

Histology of hypertrophic cardiomyopathy reveals

Answer 18

hypertrophy of myocardial fibers (which also have prominent dark nuclei) along with interstitial
fibrosis.

Question 19

restrictive cardiomyopathy is characterized by

Answer 19

cardiomyopathy infiltrated by abnormal tissue that results in impaired contractility

Question 20

The most common causes of restrictive cardiomyopathy are

Answer 20

amyloidosis and hemochromatosis

Question 21

histology of restrictive cardiomyopathy demonstrates

Answer 21

amorphous deposits of pale pink material between myocardial fibers. This is characteristic for amyloid.

Question 22

Endocarditis generally refers to inflammation on the

Answer 22

valves

Question 23

The vegetations of infectious endocarditis are

Answer 23

collections of infected thrombotic debris deposited on and around the affected valve

Question 24

Microscopic view of valve in patient with infectious

endocarditis demonstrates

Answer 24

friable vegetations of fibrin and platelets mixed with inflammatory cells and bacterial colonies

Question 25

Organisms commonly associated with community-acquired endocarditis include

Answer 25

Staphylococcus aureus (30-50%, minority MRSA)
Alpha-hemolytic Strep (S. viridans) (10-35%)
Enterococci (5-10%)
Culture negative (5-30%)
Staphylococcus epidermidis
Misc. organisms including Escherichia coli, Klebsiella sp., Corynebacterium (<5%)

Question 26

Organisms commonly associated with nosocomial endocarditis include

Answer 26

Staph. aureus (60-80%; majority MRSA)
Alpha hemolytic streptococci (<5%)
Misc. others including: E coli, Klebsiella, Corynebacterium; 5-10%)

Question 27

Portals of entry for organisms that may cause endocarditis include but are not limited to:

Answer 27

Poor dental health, dental procedures or pharyngeal infection
Genitourinary infections and instrumentation of the GU tract
Skin infections such as impetigo
Pulmonary infections
IV drug use

Question 28

acute endocarditis vs subacute endocartiditis

Answer 28

acute - virulent bug

subacute- not that virulent, already damaged valve

Question 29

subacute endocarditis has systemic sx such as

Answer 29

petechiae in such areas as the mouth or under the tongue, the finger nail beds (called splinter hemorrhages) or Microemboli in to the retina (known as Roth’s spots)

Question 30

risk factors for endocarditis are

Answer 30

RF - used to be leading cause
Patients with artificial valves
Immunocompromised patients   
IV drug abusers
Alcoholics 
Patients with indwelling catheters 
Patients with vascular grafts

Question 31

Risk factors and associated endocarditis organisms

Answer 31

Prosthetic valves - Staph epidermitis
IV drug abusers – Staph aureus
Alcoholics – anaerobes and oral cavity bugs
After procedures such as cystoscopy or prostatectomy or with indwelling catheters with Gram negative organisms such as E. coli are more common.

Question 32

The gram negative organism, ___________, is more commonly seen in patients with carcinoma of the colon

Answer 32

Strep bovis

Question 33

The endocarditis of S.L.E. is sometimes referred to as_________
(it’s a non-infectious inflammatory endocarditis)

Answer 33

Libman-Sacks endocarditis

Question 34

endocarditis when the vegetations are due to a hypercoagulable state is called __________________

Answer 34

Marantic endocarditis

Question 35

The small pink vegetation on the rightmost cusp

margin represents the typical finding with non-bacterial endocarditis in a patient with__________

Answer 35

Marantic endocarditis

Question 36

infective endocarditis can lead to serious damage of the valves that looks like___________

Answer 36

Irregular reddish tan vegetations overlie valve cusps that are being destroyed

Question 37

virus associated with myocarditis is

Answer 37

Coxsackie virus

Question 38

histologic characteristic appearance in viral myocarditis

Answer 38

interstitial lymphocytic infiltrates

Question 39

What is a possible sequelae to group A Streptococcal pharyngitis (strep throat)?

Answer 39

Rheumatic fever, can progress to rheumatic heart disease

Question 40

Rheumatic fever develops following pharyngitis with

Answer 40

group A beta-hemolytic Streptococcus

Question 41

Strep throat is usu diagnosed by

Answer 41

antistrepotolysin O or ASO titer

Question 42

post-streptococcal acute rheumatic fever is likely due to an autoimmune response caused by

Answer 42

anti-streptococcal M protein antibodies which cross-react with cardiac myosin

Question 43

________ nodules are found in the hearts of individuals with RF

Answer 43

Aschoff bodies (granulomatous structures)
pathognomonic for RF

Question 44

the most important cardiac related consequence of rheumatic heart disease is

Answer 44

mitral stenosis (“fish mouth”)

Question 45

common systemic consequences of rheumatic heart disease are

Answer 45

polyarthritis (the most common sign and symptom), chorea, erythema marginatum, and subcutaneous nodules

Question 46

pericarditis is characterized as being

Answer 46

Serous
Fibrinous- Post-MI or Dressler’s syndrome
Hemorrhagic
Purulent
Caseous - TB

Question 47

the most common tumor of the heart is______

Answer 47

atrial myxoma (a benign tumor)
occur within the chambers of the heart, usually the left atrium

Question 48

histologic findings of atrial myxoma

Answer 48

cells that are polygonal or have an elongated cell shape. These cells may be mononuclear or multinucleated and usually have finely vacuolated eosinophilic cytoplasms.

Question 49

whats the most common pediatric tumor the heart?

Answer 49

Cardiac rhabdomyoma (benign tumor)

Question 50

histologic findings of cardiac rhabdomyoma

Answer 50

Cells are clear, compared with normal myocardium. The cells are round or polygonal in shape and are enlarged, with clear cytoplasm

Question 51

the neoplasm with the greatest propensity to METS to the heart is

Answer 51

melanoma