cardio

Question 1

5 Ts of congenital heart disease?

Answer 1

Truncus
Transposition
Tricuspid
Tetralogy
TAPVR

Question 2

cause of truncus?

Answer 2

failure of aorticopulmonary septum formation

usually accompanying VSD

Question 3

cause of TGA?

Answer 3

failure of aorticopulmonary septum spiralling

Question 4

what do you need for viability in tricuspid atresia?

Answer 4

ASD and VSD

Question 5

ASD vs PFO?

Answer 5

ASD: missing tissue in ostium secundum > ostium primum
PFO: failure of fusion

Question 6

congenital heart defect in infants of diabetic mothers?

Answer 6

TGA

Question 7

cardiac defect in Williams syndrome?

Answer 7

supravalvular aortic stenosis

Question 8

types of arteriolosclerosis?

Answer 8

hyaline: thickening of vessel walls
hyperplastic: onion skinning and proliferation of smooth mm cells - severe HTN

Question 9

calcification of arterial elastic lamina?

Answer 9

Monckeberg medial calcific sclerosis
vascular stiffening without obstruction
“pipestem” on XR

Question 10

pathogenesis of atherosclerosis?

Answer 10

endothelial cell dysfn –> macrophage and LDL accumulation –> foam cell formation –> fatty streaks –> PDGF, FGF, smooth mm cell migration –> proliferation, ECM deposition –> fibrous plaque –> complex atheromas

Question 11

MC locations of atherosclerotic plaque?

Answer 11

abdominal aorta > coronary a > popliteal a > carotid a

Question 12

risk factors for thoracic aortic aneurysm?

Answer 12

cystic medial degeneration

HTN, bicuspid aortic valve, CT disease, tertiary syphilis

Question 13

how to treat types of aortic dissection?

Answer 13

A: surgery
B: BBs then vasodilators

Question 14

tx of prinzmetal angina?

Answer 14

CCBs, nitrates, smoking cessation

Question 15

changes 4-24 hr post-MI?

Answer 15

early coag necrosis, edema, hemorrhage, wavy fibers, neutrophils
dark mottling; pale with tetrazolium stain

** reperfusion injury may cause contraction bands (free radical damage)

Question 16

complications 2-24 hr post-MI?

Answer 16

arrhythmia, HF, cardiogenic shock

Question 17

changes 1-3 days post-MI?

Answer 17

coagulative necrosis, acute inflammation with neutrophils

hyperemia

Question 18

complications 1-3 days post-MI?

Answer 18

postinfarction fibrinous pericarditis

Question 19

changes 3-14 days post-MI?

Answer 19

macrophages –> granulation tissue at margins

hyperemic border with central yellow-brown softening

Question 20

complications 3-14 days post MI?

Answer 20

free wall rupture
papillary mm rupture
IV septum rupture (from macrophage-mediated structural degradation)
LV pseudoaneurysm

Question 21

changes 2 wks - months post-MI?

Answer 21

completed contracted scar

gray-white tissue

Question 22

complications 2 wks - months post-MI?

Answer 22

Dressler syndrome
HF
arrhythmias
true ventricular aneurysm

Question 23

Dressler syndrome?

Answer 23

autoimmune rxn post-MI –> fibrinous pericarditis several weeks after

Question 24

causes of dilated cardiomyopathy?

Answer 24

alcohol
beriberi
cocaine
chagas
doxorubicin
hemochromatosis
sarcoid
peripartum

Question 25

beta-myosin heavy chain mutation?

Answer 25

familial hypertrophic cardiomyopathy

Question 26

Friedrich ataxia cardiac issues?

Answer 26

hypertrophic cardiomyopathy

Question 27

tx of hypertrophic cardiomyopathy?

Answer 27

stop high-intensity athletics BBs or CCBs ICD if high risk

Question 28

causes of restrictive infiltrative cardiomyopathy?

Answer 28

``` sarcoidosis amyloidosis postradiation fibrosis endocardial fibroelastosis Loffler hemochromatosis ```

Question 29

endomyocardial fibrosis with eosinophilic infiltrate?

Answer 29

Loffler syndrome

Question 30

which mx affect mortality in heart failure?

Answer 30

ACEis, ARBs BBs spironolactone select patients: hydralazine with nitrate

Question 31

MC pathogen in acute endocarditis?

Answer 31

S aureus

Question 32

MC pathogen in subacute endocarditis?

Answer 32

viridans strep

Question 33

pathogens in tricuspid valve endocarditis?

Answer 33

S aureus Pseudomonas Candida

Question 34

pathogens in culture negative endocarditis?

Answer 34

Coxiella Bartonella HACEK

Question 35

Aschoff bodies?

Answer 35

granuloma with giant cells - assoc with rheumatic fever

Question 36

Anitschkow cells?

Answer 36

enlarged macrophages with ovoid wavy rod-like nucleus | assoc with rheumatic fever

Question 37

syphilitic heart disease?

Answer 37

disruption of vasa vasorum of aorta --> atrophy of vessel wall and dilatation of aorta/valve ring calcification of aortic root and ascending aortic arch "tree bark" appearance of aorta

Question 38

myxoma?

Answer 38

MC primary cardiac tumor 90% in atria (usually L) multiple syncopal episodes diastolic "tumor plop" sound

Question 39

rhabdomyoma?

Answer 39

most frequent primary cardiac tumor in children | assoc with tuberous sclerosis

Question 40

blood vessel malignancy, elerly, sun-exposed areas?

Answer 40

angiosarcoma assoc with radiation therapy and chronic postmastectomy lymphedema very aggressive and difficult to resect

Question 41

benign capillary skin papules in AIDS patients?

Answer 41

bacillary angiomatosis caused by Bartonella henselae infx ** neutrophilic infiltrate (vs Kaposi)

Question 42

benign capillary hemangioma of elderly?

Answer 42

cherry hemangioma | does not regress

Question 43

cavernous lymphangioma of neck?

Answer 43

cystic hygroma | assoc with Turner

Question 44

red-blue painful tumor under fingernails?

Answer 44

glomus tumor benign from modified smooth mm cells of thermoregulatory glomus body

Question 45

endothelial malignancy of skin, mouth, GI tract, resp tract?

Answer 45

Kaposi - assoc with HHV8 and HIV ** lymphocytic infiltrate (vs bacillary angiomatosis)

Question 46

polypoid capillary hemangioma, can ulcerate/bleed?

Answer 46

pyogenic granuloma | assoc with trauma and pregnancy

Question 47

benign capillary hemangioma of infancy?

Answer 47

strawberry hemangioma | rapid growth, regresses spontaneously by 5-8 yo

Question 48

tx of Raynaud?

Answer 48

CCBs

Question 49

old lady with unilateral headache and jaw claudication?

Answer 49

temporal arteritis | steroids and temporal artery biopsy

Question 50

younger Asian lady with fever, night sweats, arthritis, myalgias, weak upper extremity pulses?

Answer 50

Takayasu arteritis granulomatous thickening and narrowing of aortic arch and prox great vessels tx: steroids

Question 51

young adults with fever, weight loss, malaise, HTN,neurologic dysfunction, cutaneous eruptions, renal damage?

Answer 51

PAN 30% HBV seropositive renal and visceral vessels - NOT pulmonary aa immune complex mediated tx: steroids, cyclophosphamide

Question 52

tx of Kawasaki?

Answer 52

IVIG and aspirin

Question 53

smoker, young male, intermittent claudication, digit autoamputation, Raynaud?

Answer 53

Buerger disease segmental thrombosing vasculitis tx: smoking cessation

Question 54

upper resp tract and lower respiratory tract sx, hematuria, urine RBC casts?

Answer 54

Wegener's: focal necrotizing vasculitis, necrotizing granulomas in lung/airway, necrotizing glomerulonephritis * * PR3-ANCA/c-ANCA * * tx: cyclophosphamide, steroids

Question 55

lung, kidneys, skin involvement; glomerulonephritis and palpable purpura?

Answer 55

Microscopic polyangiitis presentation like GPA but w/o nasopharyngeal involvement no granulomas MPO-ANCA/p-ANCA tx: cyclophosphamide, steroids

Question 56

asthma, sinusitis, skin nodules, peripheral neuropathy?

Answer 56

Churg Strauss can also involve heart, GI, kidneys MPO-ANCA/p-ANCA increased IgE

Question 57

palpable purpura, arthralgia, abdominal pain?

Answer 57

Henoch Schonlein purpura follows URI IgA immune complex deposition associated with Berger disease (IgA nephropathy)