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SN Pathology final > B. X > Flashcards

B. X Flashcards

1
Q

Congenital heart defects arise when

A

Week 3-8

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2
Q

Most Congenital heart defects are _____

A

Sporadic

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3
Q

Congenital heart defects often result in

A

Shunting btw. left and right

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4
Q

What is the most common Congenital heart defects?

A

VSD Ventricular Septal Defect

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5
Q

VSD Ventricular Septal Defect results in

A

Left-to-right shunt

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6
Q

Large VSD can lead to

A

Eisenmenger syndrome

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7
Q

Eisenmenger syndrome=

A

Pulmonary HTN
Reverse of flow
Cynaosis

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8
Q

Congenital heart defects (8)

A 
VSD
ASD
PDA
Tetralogy of fallot
Transposition of the great vessels
Truncus arteriosus
Tricuspid atresia
Coarctation of the aorta
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9
Q

ASD most common type

A

Ostium secundum

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10
Q

ASD ostium primum is associated with

A

Down syndrome

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11
Q

ASD result in

A

Left-to-right shunt
Split of S2 on auscultation
Paradoxial emboli

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12
Q

PDA=

A

Failure of ductus arteriosus to close

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13
Q

PDA is associated with

A

Congenital rubella

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14
Q

PDA results in

A

Left-to-right shunt btw. aorta and pulmonary artery

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15
Q

What maintains patency of ductus arteriosus?

A

PGE

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16
Q

What can lower PGE

A

Indomethacin

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17
Q

Tetralogy of fallot=

A
  1. Stenosis of right vent. outflow tract
  2. RVH
  3. VSD
  4. Aorta that overrides the VSD
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18
Q

Tetralogy of fallot results in

A

Right-to-left shunt

Early cyanosis

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19
Q

Tetralogy of fallot treatment

A

Patient squat in order to increase arterial resistance

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20
Q

Transposition of the great vessels characterized by

A

Pulmonary artery arising from left vent. and aorta arising from right vent.

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21
Q

Transposition of the great vessels is associated with

A

Maternal diabetes

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22
Q

Transposition of the great vessels present with

A

Early cyanosis

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23
Q

Transposition of the great vessels treatment

A

Creating of a shunt in order for the blood to mix and surgery

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24
Q

Transposition of the great vessels results in

A

RVH

Left vent. atrophy

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25
Q

Truncus arteriosus=

A

Single large vessel arising from both vent.

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26
Q

Tricuspid atresia=

A

Tricuspid valve orifice fails to develop

Right vent. is hypoplastic

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27
Q

Coarctation of the aorta=

A

Narrowing of the aorta

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28
Q

Coarctation of the aorta is devided to

A

Infantile

Adult

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29
Q

Infantile Coarctation of the aorta is associated with

A

PDA

Turner syndrome

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30
Q

Adult Coarctation of the aorta, coarctaition lies

A

After to aortic arch

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31
Q

Adult Coarctation of the aorta present with

A

HTN in upper extermitis

Hypotension in lower extermitis

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32
Q

How can we discover clacified aortic valve?

A

Chest radiograph/autopsy

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33
Q

Calcium deposits usually affect the

A

Leaflets of the aortic valve

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34
Q

Mitral valve prolapse may be seen in what syndrome?

A

Marfan

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35
Q

Mitral valve prolapse AKA

A

Click-murmur syndrome

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36
Q

Valvular lesions generally result in (2)

A

Stenosis

Regurigation

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37
Q

Valvular disorders (7)

A 
Acute rheumatioc fever
Chronic rheumatioc fever
Aortic stenosis
Aortic regurgitation
Mitral valve prolapse
Mitral regurgitation
Mitral stenosis
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38
Q

Rheumatioc fever order of valve affecting

A

Mitral
Aortic
Tricuspid

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39
Q

What is the consequence of Chronic rheumatioc fever

A

Valve scarring
Stenosis
“Fish mouth”

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40
Q

Chronic rheumatioc fever leads to thickening of the

A

Chordae tendineae

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41
Q

Complication of Chronic rheumatioc fever

A

Infectious endocarditis

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42
Q

Atherosclerosis=

A

Intimal plaque that obstructs blood flow

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43
Q

Atherosclerosis consist of

A

Necrotic lipid core (cholesterol)

Fibromuscular cap

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44
Q

FIbrous cap contains

A

Smooth muscle cell
MPH
Lymphocytes
Collagen

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45
Q

Necrotic center contains

A 
Smooth muscle cell
MPH
Foam cells
Lymphocytes
Cholesterol crystals
Calcium
Cell debris
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46
Q

Atherosclerosis involves

A

Large and medium vessels

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47
Q

Atherosclerosis-

Which vessels are commonly affected

A

Abdominal aorta
Coronary a
Popliteal a
Internal carotis a

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48
Q

Atherosclerosis modifiable risk factors

A

HTN
Hypercholesterolemia
Smoking
Diabetes

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49
Q

Atherosclerosis non-modifiable risk factors

A

Age
Gender (Estrogen is protective)
Genetics

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50
Q

Atherosclerosis pathogenesis

A
  1. Endot. damage
  2. Lipids leak into intima
  3. Lipids are oxidize
  4. Consumed by MPH
  5. Result in foam cells
  6. Inflammation and healing- SMC prolif. and EC matrix deposition
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51
Q

Atherosclerosis morphologic stages

A
  1. Fatty streaks

2. Atheroma

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52
Q

Fatty streaks=

A

Flat yellow lesion of the intima consist of Lipid-laden MPH

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53
Q

Atherosclerosis complication (4)

A
  1. Meidum vessels stenosis
  2. Plaque rupture and thrombosis
  3. Plaque rupture with embolization
  4. Aneurysm
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54
Q

Acute rheumatic fever myocardial inflammatory lesions are called

A

Aschoff bodies

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55
Q

Aschoff bodies=

A 
Collection of lymphocytes, plasma cells, 
Anitschkow cells (pulp activated MPH)
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56
Q

In rheumatic fever, the Ab which the immune system generates against the M proteins may cross react with

A

Heart muscle cell protein myosin

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57
Q

Most common cause of endocarditis

A

Strep. viridans

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58
Q

Strep. viridans infects previously

A

Damaged valves

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59
Q

Endocarditis results in

A

Small vegetations that do not destroy the valve

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60
Q

What is the most common cause in IVDU?

A

Staph. aureus

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61
Q

Staph. aureus Endocarditis results in

A

Large vegetationsthat destroy the valve

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62
Q

Staph. epidermidis is associated with

A

Endocarditis of prosthetic valves

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63
Q

Negative culture Endocarditis is associated with what organisms

A

HACEK

Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella
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64
Q

How can we detect bacterial Endocarditis in imaging?

A

Transesophageal echocardiogram

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65
Q

Nonnacterial thrombotic endocarditis is due to

A

Sterile vegetations that arise in association with hypercoagulable state / adenocarcinpma

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66
Q

SLE associated Endocarditis

A

Libman-Sack Endocarditis

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67
Q

In what case can we see vegetations in both sides of the heart valve?

A

Libman-Sack Endocarditis

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68
Q

Define cardiomyopathy

A

Myocardial disease that result in cardiac dysfunction

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69
Q

Dilated cardiomyopathy=

A

Dilation of all 4 chambers of the heart

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70
Q

What is the most commn form of cardiomyopathy

A

Dilated cardiomyopathy

71
Q

Dilated cardiomyopathy results in

A

Systolic disfunction (vent. cant pump)

72
Q

Most common origin of Dilated cardiomyopathy

A 
Idiopathic
Genetics
Myocarditis (Coxsackie A/B)
Alcohol
Drugs
Pregnancy
73
Q

Hypertrophic cardiomyopathy=

A

Massive hypertrophy of the left ventricle

74
Q

Hypertrophic cardiomyopathy is usually due to

A

AD Genetic mutation in sarcomere proteins

75
Q

Hypertrophic cardiomyopathy clinical features

A

Decreased CO
Sudden death dur to arrhythmia
Syncope with exercise

76
Q

Hypertrophic cardiomyopathy- why do we see Decreased CO?

A

Ventricles cannot fill

77
Q

Restrictive cardiomyopathy=

A

Decreased compliance of the vent. endomyocardium that restricts filling during diastole

78
Q

Restrictive cardiomyopathy causes (5)

A 
Amyloidosis
Sarcoidosis
Hemochromatosis
Endocardial fibroelastosis
Loeffler syndrome
79
Q

Restrictive cardiomyopathy presents as

A

Congestive heart failure

80
Q

Most common cause of Myocarditis

A

Coxsackieviruses A/B
CMV
HIV
Influenza virus

81
Q

Non-viral myocarditis causes

A

Trypanosoma cruzi
Toxoplasma gondii
Trichomonas spirallis
Borrelia burgdorferi

82
Q

Non-infectious causes of Myocarditis

A

SLE

Drugs HSN

83
Q

Myocarditis microscpically appearance

A

Edema
Inflammatory infiltrates
Myocyte injury
Lymphocytic infiltrate

84
Q

Vasculitis=

A

Vessel wall inflammation

85
Q

Most common pathogenic mechanisms of vasculitis are (2)

A

Immune mediated inflammation

Direct vascular invasion by infectious pathogens

86
Q

Large vessel vasculitis 2

A

Temporal Giant cell arteritis
Takayasu arteritis

TG!! Like Tia and Guy

87
Q

Medium vessel vasculitis 3

A

Polyarthritis nodosa
Kawasaki disease
Burger disease

PiKaBu!!!

88
Q

Small vessel vasculitis 4

A

Wegener granulomatosis
Microscopic polyangitis
Churg-strauss syndrome
Henoch-Schonlein purpura

89
Q

Temporal Giant cell arteritis involves which arteries?

A

Carotid s branches

90
Q

What is the most common cause of vasculitis in older adults >50

A

Temporal Giant cell arteritis

91
Q

Temporal Giant cell arteritis presets as

A

Headach (temporal a involvment)
Vision symp,
Jaw claudicayion

92
Q

Temporal Giant cell arteritis is a _______ vasculitis

A

Granulomatous

93
Q

Temporal Giant cell arteritis lesion are segmental/non-segmental

A

Segmental

94
Q

Temporal Giant cell arteritis biopsy reveals

A

Inflamed vessel wall with giant cells and intimal fibrosis

95
Q

Temporal Giant cell arteritis treatment

A

Corticosteroids

96
Q

Takayasu arteritis is a _____ arthritis

A

Granulomatous

97
Q

Takayasu arteritis clasically involves

A

Aortic arch at branch points

98
Q

Takayasu arteritis is present in what population

A

Adult < 50

Young asian female

99
Q

Takayasu arteritis presents as

A

Visual and neurological symp. with weak or absent pulse in the upper extremities

100
Q

Takayasu arteritis is also called

A

Pulseless disease

101
Q

Which arthritis causes weak or absent pulse in the upper extremities?

A

Takayasu arteritis

102
Q

Takayasu arteritis treatment

A

Corticosteroids

103
Q

Polyarthritis nodosa=

A

Necrotizing vasulitis

104
Q

Which organ is spared in Polyarthritis nodosa

A

Lungs

105
Q

Polyarthritis nodosa common in what population

A

Young adults

106
Q

Polyarthritis nodosa symp.

A

HTN (renal artery)
Melena (mesenteric a)
Skin lesion
Neurologic disturbance

107
Q

Polyarthritis nodosa is associated with what Ag

A

HBsAg

108
Q

What kind of lesions are present in Polyarthritis nodosa

A

Varying stages

109
Q

Imaging appearance of Polyarthritis nodosa

A

String of pearls

110
Q

Why do we see String of pearls in Polyarthritis nodosa

A

Necrosis that heals with fibeosis

111
Q

Which vasculitis classicaly affects asian children < 4 years old

A

Kawasaki disease

112
Q

Kawasaki disease symp.

A

Fever
Conjunctvitis
Rash on palms and soles
Enlarged cervical lymph nodes

113
Q

Kawasaki disease commonly involves which artery?

A

Carotid

114
Q

Kawasaki disease treatment

A

Aspirin

IVIG

115
Q

Which medium vessels vasculitis is self limited

A

Kawasaki disease

116
Q

Buerger disease=

A

Necrotizing vasculitis involving digits

117
Q

Buerger disease involves the

A

Digits

118
Q

Buerger disease presents as

A

Ulceration, gangrene and autoamputation of fingers and toes

119
Q

Which phenomenon is often present with Buerger disease

A

Raynaud

120
Q

Raynaud phenomeno=

A

Spasm of arteries cause episodes of reduced blood flow.

Typically, the fingers

121
Q

Buerger disease is highly associated with

A

Smoking

אתה מחזיק את הסיגריות באצבעות

122
Q

Wegener granulomatosis involves which vessels

A

Nasopharynx
Lungs
Kidneys

123
Q

lassic presentation of Wegener granulomatosis

A

Middle aged male with sinusitis, hemoptysis and hematuria

124
Q

Serum levels of ____ correlate with Wegener granulomatosis

A

c-ANCA

125
Q

Wegener granulomatosis treatment

A

Cyclophosphamide steroids

126
Q

Microscopic polyangitis involves

A

Multiple organs

127
Q

Microscopic polyangitis involves especially

A

Lung

Kidney

128
Q

What is the difference btw Microscopic polyangitis and Wegener granulomatosis?

A

Microscopic polyangitis doesnt involve the nasopharynx

129
Q

Serum levels of ____ correlate with Microscopic polyangitis

A

p-ANCA

130
Q

p-ANCA + vasculitis

A

Microscopic polyangitis

Churg-Strauss syndrome

131
Q

Churg-strauss syndrome=

A

Necrotizing granulomatous inflammation with eosinophils

132
Q

Churg-strauss syndrome involves mostly

A

Lung

Heart

133
Q

What is often present in Churg-strauss syndrome

A

Asthma

Peripheral eosinphilia

134
Q

Serum levels of ____ correlate with Churg-strauss syndrome

A

p-ANCA

135
Q

What is the most common vasculitis in children?

A

Henoch-Schonlein purpura

136
Q

Henoch-Schonlein purpura=

A

Vasculitis due to IgA immune complex deposition

137
Q

Henoch-Schonlein purpura treatment

A

Mostly self limited

138
Q

Henoch-Schonlein purpura symptoms

A

Palpable purpura on buttocks and legs
GI pain and bleeding
Hematuria (IgA nephropathy)

139
Q

Leading cause of death in US

A

Ischemic Heart Disease

140
Q

MI=

A

Necrosis of cardiac myocytes

141
Q

MI happens usually due to

A

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

142
Q

MI symp.

A

Crushing chest pain
Sweating
Dyspnea

143
Q

Infarction usually involves ___

A

Left vent.

144
Q

What is the most common involved artery in MI

A

LAD

145
Q

LAD-> where is the MI?

A

Ant wall and septum of LV

146
Q

Initial phase of infarction leads to ______ necrosis

A

Subendocardial

147
Q

Continued ischemia leads to _____ necrosis

A

Transmural

148
Q

MI cardiac enzymes

A

Troponin I peak at 24 hours post MI

CK-MB

149
Q

MI treatment

A 
Aspirin
O2
Nitrates (vasodilation)
B-blockers (lowering HR)
ACE inhibitors (decreases LV dilation)
150
Q

Gross change in MI + Which cells are present?

<4 h

A 
None
None
Cardiogenic shock
CHF
Arrhythmia
151
Q

Gross change in MI + Which cells are present + complication

4-24 h

A

Dark discolaration
Coagulative necrosis
Arrhythmia

152
Q

Gross change in MI + Which cells are present + complication

1-3 d

A

Yellow pallor
Neut.
Fubrinous pericarditis

153
Q

Gross change in MI + Which cells are present + complication

4-7 d

A

Yellow pallor
MPH
Rupture of wall

154
Q

Gross change in MI + Which cells are present + complication

1-3 w

A

Red border

Granulation tissue, collage, blood vessels

155
Q

Gross change in MI + Which cells are present + complication

1 month

A

White scar
Fibrosis
Aneurysm

156
Q

Types of angina

A

Stable
Unstable
Prinzmetal

157
Q

Angina is due to

A

Atherosclerosis of coronary a > 70%

158
Q

Stable angina arises when

A

Exortion or emotional stress

159
Q

ECG of stable angina

A

STD due to subendothelial ischemia

160
Q

Stable angina is relived with

A

Rest

Nitroglycerin

161
Q

Unstable angina is usually due to

A

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

162
Q

Prinzmetal angina=

A

Episodic chest pain due to coronary artery vasospasm

163
Q

Prinzmetal angina ECG shows

A

STE due to transmural ischemia

164
Q

Most common etiology of sudden cardiac death

A

Acute ischemia

Fetal ventricular arrhythmia

165
Q

CHF occurs when

A

The heart cannot generate sufficient output to meet metabolic demands of the tissues

166
Q

Left CHF is due to

A 
Ischemia
Hypertension
Dilated cardiomyopathy
MI
Restrictive cardiomyopathy
167
Q

Clinical features in LCHF are due to

A

Decreased forward perfusion

Pulmonary congestion

168
Q

Pulmonary congestion leads to

A

Pulmonary edema

169
Q

Pulmonary edema leads to

A

Dyspnea

Small alveolar capiilaries may burst ->Intraalveolar hemorrhage -> Laden MPH

170
Q

In Left sided heart failur, decreased flow to kidneys cause

A

Activation of renin-angiotensin mechanism

171
Q

Right sided heart failure is most commonly due to

A

Left sided heart failure

But also
Left to right shunt
Chronic lung disease

172
Q

What chronic disease causes Right sided heart failure

A

Chronic lung disease (cor-pulmonale)

173
Q

Right sided heart failure symp.

A

Jugular venous distension
Hepatosplenomegaly (nutmag liver)
Pitting edema

SN Pathology final (13 decks)

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