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Step 1 > Cardiology- Pathology > Flashcards

Cardiology- Pathology Flashcards

1
Q

Describe persistent truncus arteriosus

A

Failure of truncus arteriosus to divide into pulm trunk and aorta; R to L shunt

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2
Q

Describe transposition of great vessels

A

Aorta leaves RV, pulm trunk leaves LV; separation of pulm and systemic circulation

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3
Q

What is the cause of transposition of great vessels

A

Failure of aorticopulmonary septum to spiral

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4
Q

Describe tricuspid atresia

A

abscence of tricuspid valve and hypoplastic RV

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5
Q

What two defects are required for viability of tricuspid atresia

A

ASD and VSD

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6
Q

What is the underlying defect of tetralogy of fallot

A

Displacement of infundibular septum

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7
Q

What are 4 defects associated with tetralogy of fallot

A
  1. pulmonary infundibular stenosis
  2. RVH (boot-shaped heart)
  3. overriding aorta
  4. VSD
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8
Q

A boot-shaped heart on CXR is assoc with what congenital heart defect

A

RVH, tetraology of fallot

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9
Q

Describe Total anomalous pulmonary venous return (TAPVR)

A

Pulmonary veins drain into R heart circulation; R to L shunt

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10
Q

What is the most common congenital heart defect

A

VSD

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11
Q

What congenital heart defect is associated with maternal diabetes?

A

Transposition of great vessels

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12
Q

What congenital heart defect is associated with fetal alcohol syndrome?

A

VSD

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13
Q

What septum is usually defective in an ASD?

A

Septum secundum

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14
Q

What cardiac defect is associated with congenital rubella?

A

PDA, septal defects, pulm artery stenosis

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15
Q

If uncorrected, can result in late cyanosis of the lower extremities

A

PDA

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16
Q

What causes Eisenmenger syndrome

A

Uncorrected L to R shunt
Pulm HTN
RVH
R to L shunt

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17
Q

Presents as late cyanosis, clubbing, polycythemia

A

eisenmenger syndrome

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18
Q

What aspect of the defect distinguishes infantile from adult type coarctation of the aorta

A

Infantile: proximal to ductus arteriosus
Adult: distal to ligamentum arteriosus

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19
Q

Infantile coarctation is associated with what chromosomal abnormality?

A

Turner syndrome

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20
Q

Presents with notching of the ribs, hypertension of the upper extremities, weak, delayed pulses of lower extremities

A

Coarctation of the aorta

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21
Q

Cardiac defects associated with 22q11 syndromes

A

truncus arteriosus, ToF

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22
Q

Cardiac defects associated with Down syndrome

A

ASD, VSD, AV septal defect (every kind of septal defect!)

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23
Q

What is corneal arcus

A

lipid deposits in the cornea

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24
Q

What are xanthomas

A

plaques of lipd-laden histiocytes

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25
Q

What is fibromuscular dysplasia? What is systemic consequence?

A

Dysplasia of renal arteries; common cause of hypotension in young adults

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26
Q

What is severe hypertension

A

> 180/120

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27
Q

What is Monckeberg arteriosclerosis

A

calcification of the media of arteries; usually radial or ulnar

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28
Q

What are the 2 causes of hyaline arteriosclerosis? Describe finding

A

essential hypertension and DM

thickening of small arteries

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29
Q

What is the cause of hyperplastic arteriosclerosis? What is the histologic finding?

A

Severe hypertension

“onion skinning”

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30
Q

Atherosclerosis vs arteriosclerosis

A

Arteriosclerosis: small blood vessels, hardening of arteriolar wall; thickening of wall
atherosclerosis: elastic arteries, large and medium-sized muscular arteries; deposits

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31
Q

What are the four most common arteries involved in atherosclerosis

A

Abdominal aorta
coronary artery
popliteal artery
carotid artery

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32
Q

What is the most common cause of abdominal aortic aneurysm?

A

Atherosclerosis (hypertensive male smoker)

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33
Q

What are the common causes of thoracic aortic aneurysms (3)?

A

Cystic medial degeneration due to hypertension
Marfan syndrome
Tertiary syphilis (obliterative endarteritis of vasa vasorum)

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34
Q

Presents with tearing chest pain of sudden onset, radiating to the back; may have unequal BP in arms

A

Aortic dissection

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35
Q

What are the worst complications of Aortic dissection

A

pericardial tamponade, aortic rupture

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36
Q

What ECG findings are indicative of stable angina

A

ST depression

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37
Q

How much occlusion is necessary for symptoms?

A

70%

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38
Q

What is Prinzmetal angina?

A

Episodes of chest pain associated with coronary artery spasm; assoc with tobacco, cocaine, triptans

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39
Q

What are ECG findings with Prinzmetal angina

A

transient ST elevation

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40
Q

What is Unstable/crescendo angina?

A

Angina increasing in frequency or at rest; thrombosis with incomplete occlusion

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41
Q

ECG findings for unstable angina

A

ST depression

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42
Q

Coronary steal syndrome

A

vessels are maximally dilated at baseline distally to the coronary stenosis
Vasodilators dilates only normal vessels and shunts blood to wellperfused areas

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43
Q

Most common cause of sudden cardiac death

A

lethal arrythmia

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44
Q

ECG findings after MI

A

Transmural: ST elevation
Subendocardial: ST depression

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45
Q

3 most commonly occluded coronary arteries

A

LAD>RCA>circumflex

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46
Q

Dressler syndrome

A

autoimmune phenomenon; fibrinous pericarditis several weeks post-MI

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47
Q

What time point post MI do you see gross findings of dark mottling, pale with tetrazolium staining?

A

4-12h

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48
Q

What time point post MI do you see gross findings of hyperemia?

A

1-3d

49
Q

What time point post MI do you see gross findings of a hyperemic border with central yellow-brown softening?

A

3-14d

50
Q

What time point post MI do you see gross findings of gray-white tisseu with recanalized artery?

A

> 2 weeks

51
Q

What causes contraction bands and what time are they seen?

A

12-24h post MI

from reperfusion injury (Ca2+ back)

52
Q 
Describe the immune cell/ Healing process for an MI
Hours
Days
Weeks
A month
A

Hours- Coagulative necrosis
Days- Neutrophils then macrophages
Weeks- granulation tissue
A month- scar tissue

53
Q

At what time point post MI is the heart susceptible to wall rupture and aneurysm?

A

3-14 d (macrophages eat up dieing tissue)

54
Q

What markers are used to diagnose MI and what timepoints are the elevated?

A

Troponin I: 4hr to 7-10 days
CK-MB: returns to normal in 48h
good for diagnosing reinfarct

55
Q

What leads are changed for an MI of the anterior wall?

A

V1-V4 (LAD)

56
Q

What leads are changed for an MI of the lateral wall?

A

I, aVL (LCX)

57
Q

What leads are changed for an MI of the inferior wall?

A

II, III, aVF (RCA)

58
Q

Which types of cardiomyopathy (3) cause systolic vs diastolic dysfunction?

A

Cystolic: Dilated
Diastolic: Hypertrophic, restrictive

59
Q

What are the auscultatory findings for dilated vs hypertrophic cardiomyopathy

A

Dilated: S3
Hypertrophic: S4, systolic murmur

60
Q

What type of cardiac defect is a common cause of sudden death in young althletes?

A

Hypertrophic Cardiomyopathy

61
Q

What is the defect and inheritance of hypertrophic cardiomyopathy?

A

b-myosin heavy chain

autosomal dominant

62
Q

What is Loffler syndrome?

A

at type of restrictive/infiltrative cardiomyopathy

endomyocrdial fibrosis with prominent eosinophilic infiltrate

63
Q

What is the presentation/ECG finding of restrictive cardiomyopathy?

A

CHF, low-voltage ECG

64
Q

Describe the gross and molecular findings of hypertrophic cardiomyopathy?

A

Gross: concentric hypertrophy of ventricles
Microscopic: myofibrillar disarray and fibrosis

65
Q

What type of hypertrophy is seen in dilated cardiomyopathy?

A

Eccentric hypertrophy (sarcomeres added in series)`

66
Q

What infectious etiologies are causes of dilated cardiomyopathy?

A

Coxsackie B virus myocarditis

Chagas disease

67
Q

Compare EF, contractility and compliance in systolic vs diastolic dysfunction

A

Systolic: Low EF and contractility
Diastolic: normal EF and contractility; decr compliance

68
Q

What are hemosiderin-laden macrophages a sign of?

A

Pulmonary edema, LH failure

69
Q

What are signs of Left heart failure (3)

A

Pulmonary edema
orthopnea
paroxysmal nocturnal dyspnea

70
Q

What are signs of right heart failure (3)

A

Hepatomegaly (nutmeg liver)
Peripheral edema
JVD

71
Q

What 4 treatments decrease mortality in CHF?

A

ACE inh, bblock, ang II R block, spironolactone

72
Q

What do Roth spots, Osler nodes, and Janeway lesions indicate and describe each?

A

Bacterial endocarditis
Roth spots: round white spots on retina, surrounded by hemorrhage
Osler nodes: tender raised lesions on finger or toe pads
Janeway: small, painless, erythematous lesions on palm or sole

73
Q

What is the main causative organism of acute endocarditis

A

S. aureus

74
Q

What is the main causative organism of subacute endocarditis

A

viridans streptococci

75
Q

What is the most common causative organism seen with prosthetic valves?

A

S. epidermidis

76
Q

What type of endocarditis indicates colon cancer

A

S. bovis

77
Q

What type of hypersensitivity is associated with rheumatic fever and what is causative antigen?

A

Type II hypersensitivity

M protein

78
Q

What organisms are associated with culture negative endocarditis?

A

Coxiella burnetti, Bartonella sp

79
Q

What are the causes of fibrinous pericarditis? (3)

A

Dressler syndrome (post MI)
uremia
radiation

80
Q

What causes serous pericarditis?

A

viral pericarditis

81
Q

What causes suppurative pericaraditis?

A

bacterial infxn

82
Q

What is associated with ECG changes of widespread ST-segment elevation and/or PR depression?

A

pericarditis

83
Q

What is pulsus paradoxus?

A

Decr amplitude of systolic BP by >10mmHg during inspiration

84
Q

What is Kussmaul sign?

A

Incr JVP on inspiration; indicative of limited RV filling

85
Q

What valves are affected by Rheumatic fever?

A

mitral>aortic»tricuspid

86
Q

What are Aschoff bodies and Anitschkow cells associated with?

A

Rheumatic fever

87
Q

What is Beck’s triad? What disease does it indicate?

A

Hypotension
Distended neck veins
Distant heart sounds

88
Q

What is associated with ECG findings of low-voltage QRS and electrical alterans

A

Cardiac tamponade

89
Q

Where do myxomas commonly occur?

A

atria

90
Q

What cardiac defect is associated with tuberous sclerosis?

A

Rhabdomyomas

91
Q

Compare Raynaud disease vs Raynaud syndrome

A

Disease: primary, idiopathic
Syndrome: secondary to a disease process, eg SLE, CREST

92
Q

What ages are strawberry vs cherry hemangiomas seen?

A

Strawberry: children, regress by 5-8y
Cherry: elderly, does not regress

93
Q

What chromosomal abnormality is cystic hygroma associated with?

A

Turner syndrome (cavernous lymphangioma of the skin)

94
Q

What populatio are bacillary angiomatoses seen in and what is the causative organism?

A

AIDS

Bartonella henselae

95
Q

What cells do glomus tumors arise from?

Where are they located?

A

smooth muscle cells of the glomus body

underneath fingernails

96
Q

What malignancy is associated with persistent lymphedema (eg post-radical mastectomy)?

A

Lymphangiosarcoma

97
Q

What organ other than the skin can one find hemangiomas and angiosarcomas?

A

Liver

98
Q

How does one distinguish a purpura from a hemangioma?

A

Hemangioma blanches on compression

99
Q

What systems other than the skin are Kaposi sarcoma associated with?

A

GI tract, respiratory tract

100
Q

What blood vessels does temporal arteritis most commonly effect?

A

Branches of he carotid artery (temporal, ophthalmic)

101
Q

What disease presents with unilateral headache and jaw claudication?

A

Temporal arteritis

102
Q

What population is most commonly affected by Takayasu arteritis

A

Asian females, <40

103
Q

What disease presents with weak upper extremity pulses, fever, night sweats, arthritis, myalgias, skin nodues, and ocular disturbances?

A

Takayasu arteritis

104
Q

What are the histologic/ gross findings of Takayasu arteritis?

A

Granulomatous thinckening and narrowing of the aortic arch

105
Q

What population typically gets polyarteritis nodosa (age and exposure)

A

Young adults, Hep B+

106
Q

What vessels are most commonly involved in polyarteritis nodosa? What is usually spared?

A

Involved: renal (HTN), visceral
Spared: lung
muscular arteries

107
Q

What is the immune mechanims of polyartertitis nodosa?

A

Immune complex mediated

108
Q

What population is Kawasaki disease seen in?

A

Asian children < 4 years old

109
Q

What vascular disease is associated with fever, cervical lymphadenitis, conjuctival injectin, strawberry tongue, and hand-foot erythema

A

Kawasaki disease

110
Q

What is the most dangerous complication of Kawaski disease?

A

coronary artery aneurysm and thrombosis (MI, rupture)

111
Q

What population is Buerger disease associated with?

A

Heavy smoker males <40y

112
Q

Describe buerger disease

A

necrotizing vasculitis of the digits

113
Q

What organs are typically involved in Graunlomatosis with polyangitis?

A

nasopharynx (perforation septum, sinusitis)
Lung (hemoptysis, dyspnea)
kidney (hematuria, RBC casts)

114
Q

What presents with the triad of:

  • focal necrotizing vasculitis
  • necrotizing granuloma of the lung and upper airway
  • necrotizing glomerulonephritis
A

Graunlomatosis with polyangitis

115
Q

How is microscopic polyangitis distinguished from Graunlomatosis with polyangitis?

A

No nasopharyngeal involvement

No granulomas

116
Q

What presents with asthma, sinusitis, palpable purpura, peripheral neuropathy?

A

Churg-Strauss syndrome

117
Q

What is the underlying immune cause of Henoch-schonlein purpura?

A

IgA complex deposition

118
Q

What is usually the inciting event for Henoch-schonlein purpura?

A

URI

119
Q

What presents with
Palpable purpura of bottocks/legs
arthralgias
adominal pain and melena

A

Henoch-schonlein purpura

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