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System Path I > Cardio > Flashcards

Cardio Flashcards

1
Q

ST segment depression

A

Stable and unstable angina (subendocardial ischemia)

Initial phase of MI

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2
Q

ST segment elevation

A

Prinzmetal angina

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3
Q

Coronary vasospasm

A

Prinzmetal angina
Cocaine
Emboli
Kawasaki disease

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4
Q

Perfusion of papillary muscles

A

RCA

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5
Q

Contraction band necrosis

A

Reperfusion injury after cardiac necrosis 4-12 hours due to calcium influx and hypercontraction

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6
Q

Abs against pericardium

A

Dressler syndrome

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7
Q

Stage of MI with pericarditis with friction rub

A

1-3 days - neutrophil invasion

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8
Q

Stage of MI with rupture of wall leading to cardiac tamponade

A

4-7 days with macrophage infusion

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9
Q

Nutmeg liver

A

Right sided heart failure

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10
Q

Boot-shaped heart and assoc. signs

A 
Tetralogy of Fallot - PROVeS
Pulmonary valve stenosis
Right ventricular hypertrophy
Overriding aorta
VSD
Squat during cyanotic spell
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11
Q

Shunt reversal

A

Eisenmenger syndrome - Congenital defects

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12
Q

fetal alcohol syndrome and Eisenmenger or trisomy 13, 18, 21

A

Ventricular septal defect (VSD)

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13
Q

Down syndrome and paradoxical emboli (assoc and then most common)

A

Atrial septal defect (ASD) - ostium primum

Ostium secundum most common

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14
Q

congenital rubella, holosystolic “machine-like” murmur, Eisenmenger, lower extremity cyanosis

A

Patent ductus arteriosus

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15
Q

Maternal diabetes, administration of PGE

A

transposition of great vessels

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16
Q

Turner syndrome, lower extremity cyanosis

A

Infantile coarctation of the aorta - assoc with PDA

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17
Q

Bicuspid aortic valve, upper extremity hypertension, lower extremity hypotension

A

Adult coarctation of the aorta - NOT assoc with PDA

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18
Q

notching of ribs on x-ray

A

adult coarctation of aorta - NOT assoc with PDA

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19
Q

molecular mimicry, M protein, group A Beta-hemolytic strep

A

rheumatic fever

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20
Q

migratory joint pain, pancarditis, rash on trunk and limbs, chorea

A

acute rheumatic fever

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21
Q

Aschoff bodies (disease and location)

A

Acute rheumatic fever - myocardium

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22
Q

Anitschkow cells (morphology and disease)

A

Caterpillar - Acute rheumatic fever

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23
Q

“Fish mouth” valve - which one and disease

A

mitral valve most common - Chronic Rheumatic fever

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24
Q

Fusion of commissures of aortic valve

A

Chronic Rheumatic fever

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25
Q

Systolic ejection click and crescendo-decrescendo murmur

A

aortic stenosis

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26
Q

LV hypertrophy, syncope with exercise, hemolytic anemia - disease and most common cause

A

aortic stenosis - “wear and tear”

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27
Q

water-hammer pulse, Quincke pulse, increased pulse pressure, eccentric hypertrophy, LV dilation

A

Aortic regurgitation (pulse pressure: difference between systolic and diastolic - diastolic dec due to regurg and systolic inc due to inc. stroke vol)

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28
Q

Marfan syndrome, Ehlers Danlos, myxoid degeneration, mid-systolic click

A

mitral valve prolapse

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29
Q

c-ANCA, granulomas with giant cells, sinusitis, hematuria

A

Wegener’s granulomatosis

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30
Q

Left flank pain, pulsatile mass in abdomen (disease, where, complication)

A

Triple A - below renal a’s, above bifurcation - hemiparesis

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31
Q

“tree bark” (disease, location, common finding)

A

Syphilitic aortic aneurysm (treponema pallidum) - ascending aorta - cor bovinum (LV hypertrophy)

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32
Q

“tearing” anterior chest pain, radiates down back (disease, common pts, associations, complication)

A

Aortic dissection - Marfan’s, males with hypertension, pregnancy, berry aneurysm - NOT atherosclerosis - rupture into body cavity, if rupture back through intima -> double barreled

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33
Q

Smoker with polycystic kidney disease, terrible headache with diplopia (disease, common location, late sequelae)

A

Berry aneurysm - circle of willis (ICA or anterior communicating) - noncommunicating hydrocephalus

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34
Q

wavy fibers

A

6-24 hours post MI

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35
Q

granulation tissue and fibrosis post MI (time frame and type of tissue)

A

Granulation: 7-10 days (red border) type III collagen
Fibrosis: months - type I collagen

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36
Q

small friable masses, what lab tests?

A

ASO titres for acute rheumatic fever

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37
Q

thickening of chordae tendenae

A

Chronic Rheumatic fever

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38
Q

female in 20s, mid systolic click and murmur, polycystic kidney disease, asymptomatic (disease and outcome)

A

Myxomatous degen of mitral valve - sudden cardiac death

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39
Q

large friable masses on mitral valve, high grade fever (disease and other signs)

A

acute bacterial endocarditis with strep veridans - Roth spots in retina, osler nodes, janeway lesions, splinter hemorrhages

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40
Q

patchy necrosis, inc CK-MB, arrythmia, diarrhea, friction rub, myocytes retain nuclei (disease, histo findings, and bugs (3) )

A

viral myocarditis, basophilic infiltrates (lymphocytes NOT PMNs), Coxsakie B, enterovirus, trypanosoma cruzi

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41
Q

mutations in sarcomere proteins (name and part of cardiac cycle affected)

A

Hypertrophic cardiomyopathy - diastolic

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42
Q

Assoc with Chaga’s, eclampsia, alcohol, cocaine (name, part of cardiac cycle affected, complication)

A

Dilated cardiomyopathy - systolic - decreased ejection fraction and beri beri

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43
Q

amyloid, hemochromatosis, Loeffler’s (disease and part of cardiac cycle affected)

A

restrictive cardiomyopathy - diastolic

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44
Q

anterosuperior displacement of the infundibular septum

A

Tetrology of fallot

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45
Q

tet spell, squatting

A

tetrology of fallot

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46
Q

patent foramen ovale

A

Atrial septal defect (ASD)

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47
Q

triple bypass - arteries bypassed

A

LAD, R. coronary, left circumflex

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48
Q

scalloped internal elastic lamina

A

muscular artery

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49
Q

muscular arteries esp. renal and ulnar Dystrophic calcification of tunica media
Does not occlude the lumen

A

Medial calcific sclerosis a.k.a. Mockenberg sclerosis

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50
Q

atheromas in intima - name of pathology, vessels affected

A

atherosclerosis - major vessels

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51
Q

fatty streaks - age first seen, leads to what, in what vessels?

A

10
atherosclerosis
large vessels

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52
Q

thickening of arterioles: what compound, name of disease, primary cause, and major complication?

A

hyaline
hyaline arteriosclerosis
diabetes mellitus
chronic renal failure, glomerular scarring

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53
Q

onion skinning: disease and major cause

A 
Hyperplastic Arteriosclerosis
malignant hypertension (210/120)
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54
Q

granulomatous inflammation, female over 50, jaw claudication, facial pain, polymyalgia rheumatica. What size vessel, risk of what without treatment, describe lesions.

A

large vessels: carotid
risk of blindness (ophthalmic a. involvement)
segmental lesions, must take long segment
(Temporal (giant cell) arteritis

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55
Q

young asian female, granulomatous inflammation, visual symptoms, retinal hemorrhage, hemiparesis. Give most common finding.

A

Weak/absent pulse in upper extremity
“pulseless disease”
Takayasu Arteritis

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56
Q

young adults, hypertension, abdominal pain with melena, neurologic problems, skin lesions, “string of pearls” appearance on imagine. What is found in serum? what sized vessel and where? what system is spared?

A

HBsAg (Hep B)
medium sized vessel - branch points
LUNG
Polyarteritis Nodosa (PAN)

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57
Q

Asian child < 4, fever, conjunctivitis, rash on palms and soles, enlarged cervical lymph nodes, kid has MI. How to treat, why is this strange?

A

IVIG and ASPIRIN (opposite of treatment for viral infection which it mimics. Treating viral infeciton with aspirin in kids leads to Reye’s)

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58
Q

raynaud phenomenon, fingers and toes of ulceration and gangrene, instep claudication. What is the leading cause of this disease? What size vessel?

A

heavy smoking
medium
(Buerger)

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59
Q

middle aged male with sinusitis, hemoptysis, and hematuria. What is found in serum and on histo?

A

c-ANCA
nectrotizing granulomas
Wegener granulomatosis (we-C-ener)

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60
Q

necrotizing inflammation in lung and kidney. What is found in serum? What is absent?

A

p-ANCA
granulomas
Microscopic Polyangiitis

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61
Q

eosinophils, lungs and heart affected, asthma, granulomas. What is in serum?

A

p-ANCA

Churg-Strauss

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62
Q

child presents with palpable purpura on butt and legs, GI pain and bleeding. What is the cause and the initial trigger?

A

IgA immune complex deposition

occus after upper respiratory tract infection

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63
Q

What is considered HTN?

A

140/90

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64
Q

how does ATII act and what does it do?

A

raises BP
contracts arteriole s. muscle (inc vasc peripheral resistance)
promotes adrenal release of aldosterone (salt resorption)

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65
Q

young female presents with HTN and unilateral renal atrophy, most common cause?

A

Fibromuscular dysplasia: irregular thickening of large/med arteries, esp renal

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66
Q

what is malignant HTN?

A

210/120

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67
Q

Common risk factors for atherosclerosis. modifiable and nonmodifiable

A

Modifiable: HTN, hypercholesterolemia, smoking, diabetes

Nonmodifiable: older age, males and postmenopausal females, genetics

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68
Q

pink hyaline deposition in arterioles. 2 causes and what it can lead to

A

benign HTN and diabetes

chronic renal failure

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69
Q

woman comes in for mammography you find lots of thin, wirey opacities, should you be concerned?

A

no, Monckeberg medial calcific sclerosis, nonobstructive calcification of medium arteries

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70
Q

pt. with chronic hypertension presents with tearing chest pain that radiates to the back, name the pathological appearance of the affected vessel and most common cause of death

A

hyaline atherosclerosis of vasa vasorum

cardiac tamponade

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71
Q

man dies from aneurysm, autopsy shows “tree-bark” appearance of aorta. Major complication and major association

A

dilation of aortic valve root -> aortic regurg

tertiary syphilis

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72
Q

male smoker over 60 presents with flank pain, hypotension, and pulsatile mass in abdomen. Rupture is common at what size and name common complication

A

> 5cm

compression of local structures like ureter

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73
Q

someone who has worked with polyvinyl chloride for many years shows proliferation of endothelial cells. name 3 common sites. should you be concerned?

A

skin, breast, liver

yes, highly aggressive malignancy

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74
Q

older eastern european male presents with purple patches and nodules on his skin. they are non-blanching. This condition is associated with what disease?

A

HHV-8

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75
Q

endothelial stimulation vs. endothelial activation

A

stimulation: rapid, reversible
activation: altered gene expression, protein synthesis, no NO production, loss of anti-coag properties

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76
Q

lipoprotein (a) what is it, what does it do?

A

altered LDL -> atherogenic

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77
Q

statins 2 fold mechanism

A

inhibits cholesterol syn

reduces CRP

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78
Q

toll like receptors TLRs: what do they do generally?

A

increase inflammation

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79
Q

4 features of vulnerable plaque

A

Large core
thin cap
inflammation/foam cells in cap
matrix metalloproteases

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80
Q

extravascular hematoma that communicates with intravascular space

A

false/pseudoaneurysm

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81
Q

2 genetic diseases leading to medial weakening of blood vessels

A

marfan’s

polycystic kidney disease

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82
Q

fibrillin-1 gene, disease and chromosome

A

marfans

15

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83
Q

unhappy asian kid, rash palms and soles of feet, pathogenesis?

A

autoantibodies against endothelium

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84
Q

instep claudication, microabcesses

A

Buerger’s

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85
Q

normal heart weights:

A

male: 300g
female: 250g

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86
Q

most blood flow to myocardium through coronaries is during what phase of heart cycle?

A

diastole

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87
Q

elevation of what biomarker indicates higher risk of death from heart failure?

A

BNP - brain natriuretic protein

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88
Q

male, <65, alcoholic, Q waves, cardiomegaly indicate heart failure of what cycle?

A

systolic

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89
Q

> 70, female, HTN, LVH indicate heart failure of what cycle?

A

diastolic

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90
Q

q waves indicate what?

A

prior MI

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91
Q

alveolar hemosiderosis indicates what?

A

left heart failure “heart failure cells”

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92
Q

what % is considered critical stenosis in coronaries

A

75%

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93
Q

is sudden cardiac death due to complete or incomplete obstruction of coronaries?

A

incomplete due to arrhythmias

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94
Q

what do endothelins do?

A

vasoconstriction

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95
Q

angina that occurs at rest with ST segement elevation is caused by what?

A

Prinzmetal

coronary artery spasm

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96
Q

angina that occurs with physical activity is due to?

A

stable agina

fixed stenosis

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97
Q

angina that progressively increases in frequency is caused by what?

A

unstable angina

disruption of plaque, superimposed thrombosis

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98
Q

major cause of MI?

A

rupture of plaque with thrombosis

NOT STENOSIS!! 85% of pts have less than 70% stenosis

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99
Q

is the prognosis of MI patient better for a healthy athlete who has an MI after exercising, or an obese man who has an MI watching a football game on his couch?

A

better for obese man, less metabolic demand for O2 if MI occurs at rest, longer time for ischemia to develop

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100
Q

wavefront phenomenon, what is it and significance

A

progression of myocardial necrosis from subendocardial to transmural seems to occur in waves spreading to larger area

sig: to mature to transmural infarct takes 3-6 hours, can save lots of heart wall if dealt with soon enough

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101
Q

which direction does heart scarring occur?

A

outside to inside

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102
Q

what kind of necrosis in MI?

A

coagultion - all blood vessels

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103
Q

time frame of troponin release following MI. Detectable, peak, lasts how long?

A

seen at 2-4 hours
peak at 48 hours
lasts 7-10 days

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104
Q

time frame of CK-MB release following MI. Detectable, peak, lasts how long?

A

seen at 2-4 hours
peaks at 24 hours
gone by 72 hours (3 days)

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105
Q

is heparin sufficient treatment post MI?

A

no, it is not thrombolytic, need to give something to break down clot (streptokinase)

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106
Q

which plaque responds best to balloon angioplasty and why? eccentric or concentric?

A

eccentric: more prone to break and rupture at 1 place, less likely to hemorrhage

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107
Q

explain negative remodeling

A

after angioplasty, media and adventitia get stretched -> fibrosis, scar contracts, narrows lumen

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108
Q

why is internal mammary (thoracic) artery good for bypass?

A

atherosclerosis is rare

own vasovasorum and lymph drainage

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109
Q

most common cause of sudden cardiac death and how soon does death occur after onset of symptoms?

A

1 hr

ischemic heart disease (obstructive disease leading to diffuse myocardial dysfunction)

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110
Q

what causes death in sudden cardiac death? SCD

A

cause: lethal arrhythmia from 80-90% critical stenosis of one or more coronaries

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111
Q

does stress /sex increase risk of SCD?

A

no, even coupled with coronary artery disease

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112
Q

state 1A of arrhythmia, timing and what happens

A

2-10 min post occlusion

altered extracellular K+ -> cells re-exciting prematurely

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113
Q

state 1B of arrhythmia, timing and what happens

A

18-30 min
depression of excitability of epicardial cells, electrical signals at border of ischemic zone leads to unequal stretching

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114
Q

“box-car” shaped nuclei (rectangular) are found in what pathology?

A

ventricular hypertrophy in cardiomyocytes

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115
Q

most common cause of cor pulmonale?

A

COPD

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116
Q

what causes acute cor pulmonale? findings of RV?

A

pulmonary embolism

RV is dilated but not hypertrophic

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117
Q

marathon runner drops dead suddenly, what does his hear look like? what part of cycle involved?

A

hypertrophic cardiomyopathy

diastolic

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118
Q

myofiber disarray, abnormally branching myocytes, interstitial fibrosis, small vessel disease myocyte diameter is 45

A

hypertrophic cardiomyopathy

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119
Q

alcohol and viral myocarditis can lead to what cardiomyopathy?

A

dilated

120
Q

find apple green birefringence in cardiomyocytes, this can lead to what cardiomyopathy? what heart cycle is affected?

A

restrictive (amyloid)

Diastolic

121
Q

hyperkeratosis of palms and soles, triangle of dysplasia, young adults, fibrofatty replacement of cardiac tissue with thinning. defect in what? What part of heart is affected? Name of condition?

A

desmosomal adhesion proteins
affects RV
arrhythmogenic right ventricular cardiomyopathy ARVC

122
Q

karate kid drops dead after being hit in chest, name of disease, and what part of heart cycle was affected

A

commotio cordis

T wave upstroke

123
Q

right sided, plaque like fibrosis

A

carcinoid disease

124
Q

which type of valve requires anticoagulation therapy?

A

mechanical

125
Q

subacute endocarditis has what kind of prognosis? what organism? what kind of valve does it affect?

A

good
strep viridans
native valve

126
Q

HACEK organisms causing endocarditis are common in what age group?

A

infants and immunocompromised children

127
Q

bulky friable vegetations and ring abcesses in perivalvular myocardium common on what valve from what cause?

A

tricuspid, IV drug abuse

128
Q

splinter hemorrhages, roth spots indicate what?

A

peripheral emboli from infective endocarditis

129
Q

growths of fibrin and delicate layers of aggregated platelets on ventricular side of mitral valve. what type of endocarditis, what disease, and what are they made of?

A

Libman-Sacks endocarditis (noninfective)
SLE - lupus
LSE -> SLE
immune complexes

130
Q

viral myocarditis can lead to what kind of acquired response?

A

cytotoxic T cell autoimmune

131
Q

epicardial rosary lesions from what organism? disease? heart consequence?

A

trypanosoma cruzi
chagas
dilation

132
Q

young healthy woman been hiking for 2 weeks, presents with bundle branch block. bug? disease?

A 
borrelia burgdorferi (rickettsia)
lyme carditis
133
Q

asteroid bodies, thymoma

A

giant cell myocarditis

134
Q

most common congenital heart disease in kids?

A

VSDs (42%)

135
Q

coarctation of aorta has higher risk in patients with that genetic abnormality?

A

turner syndrome

136
Q

most common congenital abnormality in adults

A

ASD

137
Q

down’s is assoc most commonly with what congenital heart abnormality?

A

VSD

138
Q

explain eisenmenger complex

A

left to right shunt eventually causes pulmonary HTN from pulmonary vessel hypertrophy, increased pressure in RV reverses shunt to R to L -> cyanosis

139
Q

swiss cheese muscular heart

A

VSD

140
Q

what keeps PDA open?

A

prostaglandin E

141
Q

what closes PDA?

A

indomethacin

142
Q

aorta receives blood from both ventricles

A

truncus arteriosus

143
Q

baby is born pink, but turns blue in 15 hours when ductus closes, why?

A

pulmonary valve atresia, no connection between RV and lungs

144
Q

hypoplasia of left ventricle and aorta

A

aortic valve atresia, no outflow from LV

145
Q

hypoplasia of aortic arch and LV hypertrophy

A

congenital aortic stenosis

146
Q

baby born blue, most common cause?

A

Tetralogy of fallot

147
Q

most common primary cardiac tumor, how do you find it?

A

cardiac myxoma

calcify and see on x-ray

148
Q

pedunculated mass in left atrium

A

cardiac myxoma

149
Q

most common systemic disorder associated with pericarditis

A

uremia

150
Q

blood between layers of tunica media, no dilation

A

aortic dissection

151
Q

mediastinal widening

A

aortic dissection

152
Q

african woman, worst head ache of life, diplopia, common place and late sequelae

A

circle of willis

noncommunicating hydrocephalus from scarring of meninges

153
Q

Nutmeg liver

A

Right sided heart failure

154
Q

Boot-shaped heart and assoc. signs

A 
Tetralogy of Fallot - PROVeS
Pulmonary valve stenosis
Right ventricular hypertrophy
Overriding aorta
VSD
Squat during cyanotic spell
155
Q

Shunt reversal

A

Eisenmenger syndrome - Congenital defects

156
Q

fetal alcohol syndrome and Eisenmenger or trisomy 13, 18, 21

A

Ventricular septal defect (VSD)

157
Q

Down syndrome and paradoxical emboli (assoc and then most common)

A

Atrial septal defect (ASD) - ostium primum

Ostium secundum most common

158
Q

congenital rubella, holosystolic “machine-like” murmur, Eisenmenger, lower extremity cyanosis

A

Patent ductus arteriosus

159
Q

Maternal diabetes, administration of PGE

A

transposition of great vessels

160
Q

Turner syndrome, lower extremity cyanosis

A

Infantile coarctation of the aorta - assoc with PDA

161
Q

Bicuspid aortic valve, upper extremity hypertension, lower extremity hypotension

A

Adult coarctation of the aorta - NOT assoc with PDA

162
Q

notching of ribs on x-ray

A

adult coarctation of aorta - NOT assoc with PDA

163
Q

molecular mimicry, M protein, group A Beta-hemolytic strep

A

rheumatic fever

164
Q

migratory joint pain, pancarditis, rash on trunk and limbs, chorea

A

acute rheumatic fever

165
Q

Aschoff bodies (disease and location)

A

Acute rheumatic fever - myocardium

166
Q

Anitschkow cells (morphology and disease)

A

Caterpillar - Acute rheumatic fever

167
Q

“Fish mouth” valve - which one and disease

A

mitral valve most common - Chronic Rheumatic fever

168
Q

Fusion of commissures of aortic valve

A

Chronic Rheumatic fever

169
Q

Systolic ejection click and crescendo-decrescendo murmur

A

aortic stenosis

170
Q

LV hypertrophy, syncope with exercise, hemolytic anemia - disease and most common cause

A

aortic stenosis - “wear and tear”

171
Q

water-hammer pulse, Quincke pulse, increased pulse pressure, eccentric hypertrophy, LV dilation

A

Aortic regurgitation (pulse pressure: difference between systolic and diastolic - diastolic dec due to regurg and systolic inc due to inc. stroke vol)

172
Q

Marfan syndrome, Ehlers Danlos, myxoid degeneration, mid-systolic click

A

mitral valve prolapse

173
Q

c-ANCA, granulomas with giant cells, sinusitis, hematuria

A

Wegener’s granulomatosis

174
Q

Left flank pain, pulsatile mass in abdomen (disease, where, complication)

A

Triple A - below renal a’s, above bifurcation - hemiparesis

175
Q

“tree bark” (disease, location, common finding)

A

Syphilitic aortic aneurysm (treponema pallidum) - ascending aorta - cor bovinum (LV hypertrophy)

176
Q

“tearing” anterior chest pain, radiates down back (disease, common pts, associations, complication)

A

Aortic dissection - Marfan’s, males with hypertension, pregnancy, berry aneurysm - NOT atherosclerosis - rupture into body cavity, if rupture back through intima -> double barreled

177
Q

Smoker with polycystic kidney disease, terrible headache with diplopia (disease, common location, late sequelae)

A

Berry aneurysm - circle of willis (ICA or anterior communicating) - noncommunicating hydrocephalus

178
Q

wavy fibers

A

6-24 hours post MI

179
Q

granulation tissue and fibrosis post MI (time frame and type of tissue)

A

Granulation: 7-10 days (red border) type III collagen
Fibrosis: months - type I collagen

180
Q

small friable masses, what lab tests?

A

ASO titres for acute rheumatic fever

181
Q

thickening of chordae tendenae

A

Chronic Rheumatic fever

182
Q

female in 20s, mid systolic click and murmur, polycystic kidney disease, asymptomatic (disease and outcome)

A

Myxomatous degen of mitral valve - sudden cardiac death

183
Q

large friable masses on mitral valve, high grade fever (disease and other signs)

A

acute bacterial endocarditis with strep veridans - Roth spots in retina, osler nodes, janeway lesions, splinter hemorrhages

184
Q

patchy necrosis, inc CK-MB, arrythmia, diarrhea, friction rub, myocytes retain nuclei (disease, histo findings, and bugs (3) )

A

viral myocarditis, basophilic infiltrates (lymphocytes NOT PMNs), Coxsakie B, enterovirus, trypanosoma cruzi

185
Q

mutations in sarcomere proteins (name and part of cardiac cycle affected)

A

Hypertrophic cardiomyopathy - diastolic

186
Q

Assoc with Chaga’s, eclampsia, alcohol, cocaine (name, part of cardiac cycle affected, complication)

A

Dilated cardiomyopathy - systolic - decreased ejection fraction and beri beri

187
Q

amyloid, hemochromatosis, Loeffler’s (disease and part of cardiac cycle affected)

A

restrictive cardiomyopathy - diastolic

188
Q

anterosuperior displacement of the infundibular septum

A

Tetrology of fallot

189
Q

tet spell, squatting

A

tetrology of fallot

190
Q

patent foramen ovale

A

Atrial septal defect (ASD)

191
Q

triple bypass - arteries bypassed

A

LAD, R. coronary, left circumflex

192
Q

scalloped internal elastic lamina

A

muscular artery

193
Q

muscular arteries esp. renal and ulnar Dystrophic calcification of tunica media
Does not occlude the lumen

A

Medial calcific sclerosis a.k.a. Mockenberg sclerosis

194
Q

atheromas in intima - name of pathology, vessels affected

A

atherosclerosis - major vessels

195
Q

fatty streaks - age first seen, leads to what, in what vessels?

A

10
atherosclerosis
large vessels

196
Q

thickening of arterioles: what compound, name of disease, primary cause, and major complication?

A

hyaline
hyaline arteriosclerosis
diabetes mellitus
chronic renal failure, glomerular scarring

197
Q

onion skinning: disease and major cause

A 
Hyperplastic Arteriosclerosis
malignant hypertension (210/120)
198
Q

granulomatous inflammation, female over 50, jaw claudication, facial pain, polymyalgia rheumatica. What size vessel, risk of what without treatment, describe lesions.

A

large vessels: carotid
risk of blindness (ophthalmic a. involvement)
segmental lesions, must take long segment
(Temporal (giant cell) arteritis

199
Q

young asian female, granulomatous inflammation, visual symptoms, retinal hemorrhage, hemiparesis. Give most common finding.

A

Weak/absent pulse in upper extremity
“pulseless disease”
Takayasu Arteritis

200
Q

young adults, hypertension, abdominal pain with melena, neurologic problems, skin lesions, “string of pearls” appearance on imagine. What is found in serum? what sized vessel and where? what system is spared?

A

HBsAg (Hep B)
medium sized vessel - branch points
LUNG
Polyarteritis Nodosa (PAN)

201
Q

Asian child < 4, fever, conjunctivitis, rash on palms and soles, enlarged cervical lymph nodes, kid has MI. How to treat, why is this strange?

A

IVIG and ASPIRIN (opposite of treatment for viral infection which it mimics. Treating viral infeciton with aspirin in kids leads to Reye’s)

202
Q

raynaud phenomenon, fingers and toes of ulceration and gangrene, instep claudication. What is the leading cause of this disease? What size vessel?

A

heavy smoking
medium
(Buerger)

203
Q

middle aged male with sinusitis, hemoptysis, and hematuria. What is found in serum and on histo?

A

c-ANCA
nectrotizing granulomas
Wegener granulomatosis (we-C-ener)

204
Q

necrotizing inflammation in lung and kidney. What is found in serum? What is absent?

A

p-ANCA
granulomas
Microscopic Polyangiitis

205
Q

eosinophils, lungs and heart affected, asthma, granulomas. What is in serum?

A

p-ANCA

Churg-Strauss

206
Q

child presents with palpable purpura on butt and legs, GI pain and bleeding. What is the cause and the initial trigger?

A

IgA immune complex deposition

occus after upper respiratory tract infection

207
Q

What is considered HTN?

A

140/90

208
Q

how does ATII act and what does it do?

A

raises BP
contracts arteriole s. muscle (inc vasc peripheral resistance)
promotes adrenal release of aldosterone (salt resorption)

209
Q

young female presents with HTN and unilateral renal atrophy, most common cause?

A

Fibromuscular dysplasia: irregular thickening of large/med arteries, esp renal

210
Q

what is malignant HTN?

A

210/120

211
Q

Common risk factors for atherosclerosis. modifiable and nonmodifiable

A

Modifiable: HTN, hypercholesterolemia, smoking, diabetes

Nonmodifiable: older age, males and postmenopausal females, genetics

212
Q

pink hyaline deposition in arterioles. 2 causes and what it can lead to

A

benign HTN and diabetes

chronic renal failure

213
Q

woman comes in for mammography you find lots of thin, wirey opacities, should you be concerned?

A

no, Monckeberg medial calcific sclerosis, nonobstructive calcification of medium arteries

214
Q

pt. with chronic hypertension presents with tearing chest pain that radiates to the back, name the pathological appearance of the affected vessel and most common cause of death

A

hyaline atherosclerosis of vasa vasorum

cardiac tamponade

215
Q

man dies from aneurysm, autopsy shows “tree-bark” appearance of aorta. Major complication and major association

A

dilation of aortic valve root -> aortic regurg

tertiary syphilis

216
Q

male smoker over 60 presents with flank pain, hypotension, and pulsatile mass in abdomen. Rupture is common at what size and name common complication

A

> 5cm

compression of local structures like ureter

217
Q

someone who has worked with polyvinyl chloride for many years shows proliferation of endothelial cells. name 3 common sites. should you be concerned?

A

skin, breast, liver

yes, highly aggressive malignancy

218
Q

older eastern european male presents with purple patches and nodules on his skin. they are non-blanching. This condition is associated with what disease?

A

HHV-8

219
Q

endothelial stimulation vs. endothelial activation

A

stimulation: rapid, reversible
activation: altered gene expression, protein synthesis, no NO production, loss of anti-coag properties

220
Q

lipoprotein (a) what is it, what does it do?

A

altered LDL -> atherogenic

221
Q

statins 2 fold mechanism

A

inhibits cholesterol syn

reduces CRP

222
Q

toll like receptors TLRs: what do they do generally?

A

increase inflammation

223
Q

4 features of vulnerable plaque

A

Large core
thin cap
inflammation/foam cells in cap
matrix metalloproteases

224
Q

extravascular hematoma that communicates with intravascular space

A

false/pseudoaneurysm

225
Q

2 genetic diseases leading to medial weakening of blood vessels

A

marfan’s

polycystic kidney disease

226
Q

fibrillin-1 gene, disease and chromosome

A

marfans

15

227
Q

unhappy asian kid, rash palms and soles of feet, pathogenesis?

A

autoantibodies against endothelium

228
Q

instep claudication, microabcesses

A

Buerger’s

229
Q

normal heart weights:

A

male: 300g
female: 250g

230
Q

most blood flow to myocardium through coronaries is during what phase of heart cycle?

A

diastole

231
Q

elevation of what biomarker indicates higher risk of death from heart failure?

A

BNP - brain natriuretic protein

232
Q

male, <65, alcoholic, Q waves, cardiomegaly indicate heart failure of what cycle?

A

systolic

233
Q

> 70, female, HTN, LVH indicate heart failure of what cycle?

A

diastolic

234
Q

q waves indicate what?

A

prior MI

235
Q

alveolar hemosiderosis indicates what?

A

left heart failure “heart failure cells”

236
Q

what % is considered critical stenosis in coronaries

A

75%

237
Q

is sudden cardiac death due to complete or incomplete obstruction of coronaries?

A

incomplete due to arrhythmias

238
Q

what do endothelins do?

A

vasoconstriction

239
Q

angina that occurs at rest with ST segement elevation is caused by what?

A

Prinzmetal

coronary artery spasm

240
Q

angina that occurs with physical activity is due to?

A

stable agina

fixed stenosis

241
Q

angina that progressively increases in frequency is caused by what?

A

unstable angina

disruption of plaque, superimposed thrombosis

242
Q

major cause of MI?

A

rupture of plaque with thrombosis

NOT STENOSIS!! 85% of pts have less than 70% stenosis

243
Q

is the prognosis of MI patient better for a healthy athlete who has an MI after exercising, or an obese man who has an MI watching a football game on his couch?

A

better for obese man, less metabolic demand for O2 if MI occurs at rest, longer time for ischemia to develop

244
Q

wavefront phenomenon, what is it and significance

A

progression of myocardial necrosis from subendocardial to transmural seems to occur in waves spreading to larger area

sig: to mature to transmural infarct takes 3-6 hours, can save lots of heart wall if dealt with soon enough

245
Q

which direction does heart scarring occur?

A

outside to inside

246
Q

what kind of necrosis in MI?

A

coagultion - all blood vessels

247
Q

time frame of troponin release following MI. Detectable, peak, lasts how long?

A

seen at 2-4 hours
peak at 48 hours
lasts 7-10 days

248
Q

time frame of CK-MB release following MI. Detectable, peak, lasts how long?

A

seen at 2-4 hours
peaks at 24 hours
gone by 72 hours (3 days)

249
Q

is heparin sufficient treatment post MI?

A

no, it is not thrombolytic, need to give something to break down clot (streptokinase)

250
Q

which plaque responds best to balloon angioplasty and why? eccentric or concentric?

A

eccentric: more prone to break and rupture at 1 place, less likely to hemorrhage

251
Q

explain negative remodeling

A

after angioplasty, media and adventitia get stretched -> fibrosis, scar contracts, narrows lumen

252
Q

why is internal mammary (thoracic) artery good for bypass?

A

atherosclerosis is rare

own vasovasorum and lymph drainage

253
Q

most common cause of sudden cardiac death and how soon does death occur after onset of symptoms?

A

1 hr

ischemic heart disease (obstructive disease leading to diffuse myocardial dysfunction)

254
Q

what causes death in sudden cardiac death? SCD

A

cause: lethal arrhythmia from 80-90% critical stenosis of one or more coronaries

255
Q

does stress /sex increase risk of SCD?

A

no, even coupled with coronary artery disease

256
Q

state 1A of arrhythmia, timing and what happens

A

2-10 min post occlusion

altered extracellular K+ -> cells re-exciting prematurely

257
Q

state 1B of arrhythmia, timing and what happens

A

18-30 min
depression of excitability of epicardial cells, electrical signals at border of ischemic zone leads to unequal stretching

258
Q

“box-car” shaped nuclei (rectangular) are found in what pathology?

A

ventricular hypertrophy in cardiomyocytes

259
Q

most common cause of cor pulmonale?

A

COPD

260
Q

what causes acute cor pulmonale? findings of RV?

A

pulmonary embolism

RV is dilated but not hypertrophic

261
Q

marathon runner drops dead suddenly, what does his hear look like? what part of cycle involved?

A

hypertrophic cardiomyopathy

diastolic

262
Q

myofiber disarray, abnormally branching myocytes, interstitial fibrosis, small vessel disease myocyte diameter is 45

A

hypertrophic cardiomyopathy

263
Q

alcohol and viral myocarditis can lead to what cardiomyopathy?

A

dilated

264
Q

find apple green birefringence in cardiomyocytes, this can lead to what cardiomyopathy? what heart cycle is affected?

A

restrictive (amyloid)

systolic

265
Q

hyperkeratosis of palms and soles, triangle of dysplasia, young adults, fibrofatty replacement of cardiac tissue with thinning. defect in what?

A

desmosomal adhesion proteins
affects RV
arrhythmogenic right ventrciular cardiomyopathy ARVC

266
Q

karate kid drops dead after being hit in chest, name of disease, and what part of heart cycle was affected

A

commotio cordis

T wave upstroke

267
Q

right sided, plaque like fibrosis

A

carcinoid disease

268
Q

which type of valve requires anticoagulation therapy?

A

mechanical

269
Q

subacute endocarditis has what kind of prognosis? what organism? what kind of valve does it affect?

A

good
strep viridans
native valve

270
Q

HACEK organisms causing endocarditis are common in what age group?

A

infants and immunocompromised children

271
Q

bulky friable vegetations and ring abcesses in perivalvular myocardium common on what valve from what cause?

A

tricuspid, IV drug abuse

272
Q

splinter hemorrhages, roth spots indicate what?

A

peripheral emboli from infective endocarditis

273
Q

growths of fibrin and delicate layers of aggregated platelets on ventricular side of mitral valve. what type of endocarditis, what disease, and what are they made of?

A

Libman-Sacks endocarditis (noninfective)
SLE - lupus
LSE -> SLE
immune complexes

274
Q

viral myocarditis can lead to what kind of acquired response?

A

cytotoxic T cell autoimmune

275
Q

epicardial rosary lesions from what organism? disease? heart consequence?

A

trypanosoma cruzi
chagas
dilation

276
Q

young healthy woman been hiking for 2 weeks, presents with bundle branch block. bug? disease?

A 
borrelia burgdorferi (rickettsia)
lyme carditis
277
Q

asteroid bodies, thymoma

A

giant cell myocarditis

278
Q

most common congenital heart disease in kids?

A

VSDs (42%)

279
Q

coarctation of aorta has higher risk in patients with that genetic abnormality?

A

turner syndrome

280
Q

most common congenital abnormality in adults

A

ASD

281
Q

down’s is assoc most commonly with what congenital heart abnormality?

A

VSD

282
Q

explain eisenmenger complex

A

left to right shunt eventually causes pulmonary HTN from pulmonary vessel hypertrophy, increased pressure in RV reverses shunt to R to L -> cyanosis

283
Q

swiss cheese muscular heart

A

VSD

284
Q

what keeps PDA open?

A

prostaglandin E

285
Q

what closes PDA?

A

indomethacin

286
Q

aorta receives blood from both ventricles

A

truncus arteriosus

287
Q

baby is born pink, but turns blue in 15 hours when ductus closes, why?

A

pulmonary valve atresia, no connection between RV and lungs

288
Q

hypoplasia of left ventricle and aorta

A

aortic valve atresia, no outflow from LV

289
Q

hypoplasia of aortic arch and LV hypertrophy

A

congenital aortic stenosis

290
Q

baby born blue, most common cause?

A

Tetralogy of fallot

291
Q

most common primary cardiac tumor, how do you find it?

A

cardiac myxoma

calcify and see on x-ray

292
Q

pedunculated mass in left atrium

A

cardiac myxoma

293
Q

most common systemic disorder associated with pericarditis

A

uremia

294
Q

blood between layers of tunica media, no dilation

A

aortic dissection

295
Q

mediastinal widening

A

aortic dissection

296
Q

african woman, worst head ache of life, diplopia, common place and late sequelae

A

circle of willis

noncommunicating hydrocephalus from scarring of meninges

System Path I (5 decks)

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