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CV-Step 1 > CV > Flashcards

CV Flashcards

1
Q

What acute cardiac condition?

ST Elevation

A

Acute MI

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2
Q

What acute cardiac condition?

Q waves

A

old MI

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3
Q

Localize the infarction: heart location? vessel?

Leads I and aVL

A

Lateral MI

Left circumflex a.

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4
Q

Localize the infarction: heart location? vessel?

Leads V5-6:

A

Lateral MI

L circumflex a.

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5
Q

Localize the infarction: heart location? vessel?

Leads V1-4:

A

Lateral MI

Proximal L anterior descending a. (LAD)

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6
Q

Localize the infarction: heart location? vessel?

Leads V3-4

A

Lateral MI

distal LAD

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7
Q

Localize the infarction: heart location? vessel?

Leads V1-6, I, aVL

A

Anterolateral MI

L main coronary a

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8
Q

Localize the infarction: heart location? vessel?

Leads II, III, aVF

A

Inferior MI

R coronary a

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9
Q

Transplant rejection of which organ?

systolic dysfunction; dyspnea on exertion

A

cardiac

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10
Q

Transplant rejection of which organ?

interstitial lymphocytic infiltrate and damaged myocytes

A

cardiac

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11
Q

what type of transplant rejection rxn?

gross mottling & cyanosis
Arterial fibrinoid necrosis & capillary thrombotic occlusion

A

hyperacute

onset: min-hr
etio: preform recipient Abs against graft Ag

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12
Q

what type of transplant rejection rxn?

cellular: lymphocytic interstitial infiltrate & endothelitis

Humoral: C4d deposition, neutrophilic infiltrate, necrotizing vasculitis

A

acute

onset: <6mo
etio: mainly cell-mediated; also exposure to donor Ag induce activation of naive immune cells

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13
Q

what type of transplant rejection rxn?

Vascular wall thickening & luminal narrowing
Interstitial fibrosis & parenchymal atrophy

A

chronic

onset: mo-yrs
etio: low-grade immune response refractory to immunosuppression – mixed cell-mediated and humoral

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14
Q

what type of collagen subtypes?

Skin, bone, tendon, ligaments, dentin, cornea, blood vessels, scar tissue

A

type I

Assoc dz: osteogenesis imperfecta

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15
Q

what type of collagen subtypes?

cartilage, vitreous humor, nucleus pulposis

A

Type II

Assoc dz: skeletal dysplasias

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16
Q

what type of collagen subtypes?

Skin, lungs, intestines, blood vessels, bone marrow, lymphatics, granulation tissue

A

Type III

Assoc dz: vascular Ehlers-Danlos syndrome (Type IV)

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17
Q

what type of collagen subtypes?

Basement membrane

A

Type IV

Assoc dz: alport syndrome

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18
Q

Time after MI?

Morph: no visible change

A

0-4 hrs

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19
Q

Time after MI?

morph: wavy fibers w/ narrow, elongated myocytes

A

4-12 hrs

Etio: Digestion of cyto organelles, denaturation of protein, loss of RNA

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20
Q

Time after MI?

Morph: Myocyte hypereosinophilia w/ pyknotic (shrunken) nuclei

A

12-24 hrs

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21
Q

Time after MI?

Morph: Coagulation necrosis (loss of nuc/striation), prominent neutrophilic* infiltrate.

A

1-3 days

etio: Tissue response to proinflammatory cytokines (IL6/8) = neutrophils infiltrate the border&raquo_space; migrate to central portion of infarct&raquo_space; neutrophils phagocytize death myocytes release lysosomal enz, ROS, cytokines (IL1, TNF-a) = prevent pathogen/ facilitate wound healing.

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22
Q

Time after MI?

Morph: Disintegration of dead neutrophils/ myofibers, macrophage* infiltration at border areas

A

3-7 days

etio: Macrophage* infiltrate, phagocytize dead myocytes/ neutrophils&raquo_space; formation of granulation tissue by producing IL-1, TGF-B

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23
Q

Time after MI?

Morph: Robust phagocytosis of dead cells by macrophages; beginning formation of granulation* tissue at margins

A

7-10 days

Etio: Macrophage infiltrate, phagocytize dead myocytes/ neutrophils&raquo_space; formation of granulation tissue by producing IL-1, TGF-B

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24
Q

Time after MI?

Morph: Well dev granulation tissue with neovascularization*

A

10-14 days

Etio: Fibroblast proliferation, collagen deposition, neovascularization of granulation tissue

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25
Q

Time after MI?

Morph: Progressive collagen deposition & scar formation

A

2-8 weeks

etio: Collagen remodeling, fibroblast diff into myofibroblasts drive the formation of scar tissue

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26
Q

endurance or strength training athlete’s heart?

incr LV cavity size (eccentric hypertrophy)
incr RV cav size
incr diastolic filling and stroke vol
unchanged LV ejection fraction

A

endurance

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27
Q

endurance or strength training athlete’s heart?

Incr LV wall thickening (concentric hypertrophy)
no RV change
unchanged diastolic filling
LV ejection fraction unchanged or slightly incr

A

strength training

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28
Q

What antiarrhythmic drug?

Stimulates A1 Rs on surface of cardiac cells&raquo_space; activate K channel&raquo_space; incr K conductance&raquo_space; membrane AP remain negative for longer period

A

adenosine

*Transient slowing of sinus rate and incr AV nodal conduction delay

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29
Q

What antiarrhythmic drug?

Inhibit Na/K ATPase pump in myocardial cells&raquo_space; incr IC Na&raquo_space; incr IC Ca++ conc
*AV node inh

A

Digoxin

*Antiarrhythmic
Incr cardiac contractility&raquo_space; subsequent decr in ventr filling P

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30
Q

What antiarrhythmic drug?

Class III anti-arrhythmic drugs
*Block K channels = inhibit outward K current during phase 3 of AP

A

Amiodarone, sotalol, dofetilide

*Prolonged repol and total AP duration

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31
Q

What antiarrhythmic drug?

Class II antiarrhythmic
Rapid-acting, short-duration B-blocker

A

Esmolol

Slow rate of discharge of sinus or ectopic pacemakers, incr refractory period of AV node

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32
Q

What antiarrhythmic drug?

Class IA
Inh Na-dependent (phase 0) depol/slow conduction

A

Procainamide, quinidine

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33
Q

What antiarrhythmic drug?

Class IB
Inh Na-dependent (phase 0) depol/slow conduction

A

Lidocaine

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34
Q

What antiarrhythmic drug?

Class IC
Inh Na-dependent (phase 0) depol/slow conduction

A

Flecainide

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35
Q

What antiarrhythmic drug?

L-type Ca channels blocker

  • affect phase 2 of cardiac nonpace maker AP
  • affect phase 0 of pacemake
A

Verapamil
Diltiazem

*Reduce cardiac contractility
Slow sinus rate, prolong conduction thru AV node

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36
Q

which aortic arch?

part of maxillary a.

A

first

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37
Q

which aortic arch?
hyoid a.
stapedial a.

A

second

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38
Q

which aortic arch?

common carotid a.
proximal internal carotid a.

A

third

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39
Q

which aortic arch?

L: aortic arch (*Aortic coartation)
R: prox R subclavian a.

A

fourth

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40
Q

which aortic arch?

prox pulm a
L: ductus arteriosus

A

Sixth

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41
Q

Which conduction system of the heart?

3rd degree AV block
ECG with wide* QRS complex

A

bundle branches
Purkinje system

*widen QRS compare to AV node and His bundle (narrowed QRS)

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42
Q

Which conduction system of the heart?

3rd degree AV block
ECG with narrow* QRS complex

A

AV node
bundle of HIS

*SA nodes doesn’t work appropriately = AV block

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43
Q

This embryo structure gives rise to what?

cardinal veins

A

SVC - superior vena cava

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44
Q

This embryo structure gives rise to what?

truncus arteriosus

A

pulm trunk

ascending aorta

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45
Q

This embryo structure gives rise to what?

endodermal foregut

A

esophagus

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46
Q

This embryo structure gives rise to what?

fusion of embryonic R and L dorsal aortas

A

descending aorta

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47
Q

Murmur describe what heart condition?

holosytolic @ LLSB

A

VSD

*murmur intensify with hand grip

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48
Q

Murmur describe what heart condition?

decrescendo early diastolic murmur
@ LSB

A

Aortic regurgitation

*intensify with hand grip

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49
Q

Murmur describe what heart condition?

crescendo-decrescendo systolic murmur

A

Aortic stenosis

*decreases with handgrip

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50
Q

Murmur describe what heart condition?

faint systolic murmur @ LUSB
wide and fixed splitting S2

A

atrial septal defect

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51
Q

Murmur describe what heart condition?

systolic ejection murmur @ LMSB

A

hypertrophic cardiomyopathy

*handgrip decreases murmur

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52
Q

Murmur describe what heart condition?

continuous flow murmur @ LUSB or posterior interscapular region

A

patent ductus arteriosus

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53
Q

aneurysm or dissection?

intact intima

A

aneurysm

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54
Q

aneurysm or dissection?

intimal tear

A

dissection

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55
Q

This morph describe which cardiac condition?

myxomatous degeneration

A

cystic medial degeneration
*Aortic aneurysm

*Assoc with marfan syndrome - CT disruption

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56
Q

This morph describe which cardiac condition?

intimal atheromas

A

atherosclerosis

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57
Q

This morph describe which cardiac condition?

granulomatous inflammation of the media and fragmentation of internal elastic lamina

A

Giant cell arteritis

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58
Q

This morph describe which cardiac condition?

concentric lamellar reduplication of the intimal smooth m cells (onion skinning)

A

hyperplastic arteriosclerosis of renal arterioles

*assoc with malignant HTN

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59
Q

Give rise to what ECG rhythm?

abn conduction in areas of ischemic ventricular scarring

A

monomorphic ventricular tach
reg rhythm
wide QRS complexes (rhythm originate below AV node)

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60
Q

Give rise to what ECG rhythm?

atrial remodeling ectopic foci in pulm vein ostia

A

afib
irreg rhythm, no P wave
narrow QRS complexes

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61
Q

Give rise to what ECG rhythm?

degen of SA node
sick sinus syndrome (>65yo)

A

sinus bradycardia w/ sinus pauses and sinus arrest

*sometimes sinus tach

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62
Q

Give rise to what ECG rhythm?

delayed repol of ventricular cardiomyocytes

A

torsade de pointes
~polymorphic ventricular tachycardia
oscillate wide QRS complexes

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63
Q

Give rise to what ECG rhythm?

abn conduction thru AV nodes

A

narrow QRS complex tachyC w/ reg rhythm, nonvisible P wave

paroxysmal supraventricular tachycardia
*AV nodal reentrant tachycardia (AVNRT)

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64
Q

Murmur assoc with what cardiac condition?

S3 gallop

A

MR, HF

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65
Q

Murmur assoc with what cardiac condition?

S4, low freq diastolic sound
during atrial kick of ventricular diastole

A

hypertrophic cardiomyopathy or concentric L ven hypertrophy

*reflect stiff ventricular wall, HTN, aortic stenosis

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66
Q

Murmur assoc with what cardiac condition?

mid-systolic click

A

mitral valve prolapse

*d/t sudden tensing of chordae tendineae

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67
Q

Murmur assoc with what cardiac condition?

Opening snap, early diastolic after S2

A

mitral/tricuspid stenosis

*shorter S2 opening snap interval = more severe mitral stenosis

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68
Q

Murmur assoc with what cardiac condition?

widened splitting of S2
Accentuated by inspiration = incr venous return to the R side of heart

A

pulmonic valve stenosis = delays pulmonic valve closure

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69
Q

Anatomical location of saphenous vein?

A

just inferolateral to the pubic tubercle

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70
Q

What is the preferred vessel for bypass grafting of LAD a. of the heart?

A
  1. L internal mammary (thoracic) a.

2. great saphenous vein (when mult a./vessels other than LAD require revascularization)

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71
Q

Common location of surgeons access to the great saphenous vein

A
  1. medial leg
  2. femoral triangle of upper thigh (less common) - near point of saphenous v. termination.

*Femoral triangle border: inguinal L (superior), sartorius m (lat), adductor longus m (medially).

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72
Q

MC location of peripheral a. aneurysm?

A

popliteal a. aneurysm

*Anatomy: in popliteal fossa ( popliteal a./v., tibial n.)

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73
Q

Which vitamin deficiency?

beriberi (peripheral neuropathy, HF
Wernicke-Korsakoff syndrome

A

Thiamine (B1)

primary fx: decarboxylation of a-keto acid (carbohydrate metabolism)

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74
Q

Which vitamin deficiency?

Cheilosis, stomatitis, glossitis
Normocytic anemia

A

Riboflavin (B2)

Primary fx: mito redox rxn (FMN, FAD)

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75
Q

Which vitamin deficiency?

Pellagra (dermatitis, dementia, diarrhea)

A

Niacin (B3)

Primary fx: redox rxn (NAD/NADP)

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76
Q

Which vitamin deficiency?

Distal paresthesia (rare)

A

Pantothenic acid (B5)

Primary fx: acetylation rxn (CoA)

77
Q

Which vitamin deficiency?

peripheral neuropathy
Cheilosis, stomatitis, glossitis

A

pyridoxine (B6)

Primary fx: transamination of AA (AA syn)

78
Q

Which vitamin deficiency?

Dermatitis, conjunctivitis, alopecia, neurologic changes

A

Biotin (B7)

Primary fx: Carboxylase rxn (CO2 carrier)

79
Q

Which vitamin deficiency?

Megaloblastic anemia
Neural tube defects (fetus)

A

Folate (B9)

Primary fx: hydroxymethyl/formyl carrier (purine and thymine syn)

80
Q

Which vitamin deficiency?

Megaloblastic anemia
Neurologic deficit

A

Cobalamin (B12)

Primary fx: isomerase & methyltransferase cofactor (DNA & methionine syn)

81
Q

Which vitamin deficiency?

Scurvy (perifollicular hemorrhage, gingivitis, muscle pain)

A

Ascorbic acid (C)

Primary fx: hydroxylation of proline & lysine (collagen syn)

82
Q

Common occlusion site of thigh claudication? (4)

A

ipsi external iliac a.

common femoral
superficial femoral
profunda femoris a.

83
Q

Common occlusion site of impotence/ gluteal claudication?

A

Aortoiliac occlusion
*Leriche syndrome
Also diminishes blood flow to the internal pudendal and gluteal branches of the internal iliac a.

84
Q

This morphology describe the hallmark of which vascular disease?

Granulomatous inflammation of the arterial media

A

Temporal (giant cell) arteritis

  • MC form of systemic vasculitis in adults
  • > 50yo
  • sx: headache, facial pain, jaw claudication, visual loss.
85
Q

This morphology describe the hallmark of which vascular disease?

Hyaline arteriolosclerosis - homogenous deposition of hyaline material in the intima and media of small arteries and arterioles

A

typical in HTN, DM

  • underlying structure intact
  • thickened intima = narrowed blood vessel lumen
86
Q

This morphology describe the hallmark of which vascular disease?

Medial band-like calcifications

A

Medial calcific sclerosis (Monckeberg arteriosclerosis)

  • Calcified deposits in muscular a.
  • common in >50yo
  • Palpable in PE, visible in radio
  • Asx, do not narrow vessel lumen.
87
Q

CV defects are associated with what genetic dz?

endocardial cushion defects (ostium primum atrial septal defects, regurgitant AV valves

A

Down syndrome

88
Q

CV defects are associated with what genetic dz?

Tetralogy of Fallot
Interrupted aortic arch (more severe than aortic coarctation)

A

DiGeorge syndrome

89
Q

CV defects are associated with what genetic dz?

Hypertrophic cardiomyopathy

A

Friedreich ataxia

90
Q

CV defects are associated with what genetic dz?

Situs Inversus

A

Kartagener syndrome

*rare, autosomal recessive genetic ciliary disorder comprising the triad of situs inversus, chronic sinusitis, and bronchiectasis

91
Q

CV defects are associated with what genetic dz?

Cystic medial necrosis (aortic dissection & aneurysm)
Mitral valve prolapse

A

Marfan syndrome

92
Q

CV defects are associated with what genetic dz?

Valvulvar obstruction d/t cardiac rhabdomyomas

A

Tuberous sclerosis

93
Q

CV defects are associated with what genetic dz?

Aortic coartation
Bicuspid aortic valve

A

turner syndrome (45 X,O)

94
Q

L atrial enlargement (d/t MS, MR) can cause what GI condition?

A

dysphagia through external compression of esophagus

*Anatomy of heart

95
Q

Epinephrine MOA (3)

A

B1 sti = incr HR, contractility&raquo_space; incr SBP
B2 sti = skm. - vasodilation, decr DBP
A1 sti = sm m. in skin/viscera - incr PVR = incr DBP

96
Q

Atropine MOA

A

Competitive antagonist of cholinergic M2 in heart&raquo_space; block PNS vagal influence
= incr HR

97
Q

Isoproterenol MOA

A

Nonselective B-adrenergic agonist&raquo_space; sti both sm m. B2 Rs & cardiac B1 R&raquo_space; vasodilation & incr HR, contractility

*Decr DBP, inr HR

98
Q

Phentolamine MOA

A

nonspec a-1 & a-2 blocker

*Profound fall in DBP, reflex tachC

99
Q

Phenylephrine MOA

A

Selective a-adrenergic agonist

Incr SBP and DBP, ~reflex bradyC

100
Q

ECG:

Holiday heart syndrome

A

afib

*absence P waves, irregularly irregular rhythm with varying R-R intervals

101
Q

Histology describe which vascular disease?

necrotizing arteritis and focal collections of epithelioid histiocytes

A

granulomatosis with polyangiitis (GPA)

(+) ANCA, cavitary lung lesion

  • dx by bx
    sx:
  • upper resp (sinusitis/otitis), saddle-nose deformity, crusting/ulcers, rhinorrhea
  • lower resp (lung nodules/cavitation), hoarseness, cough, stridor, hemoptysis, pulm infiltrates
  • renal (rapidly progressive glomerulonephritis);
  • skin (livedo reticularis, nonhealing ulcers)

*Contrast with PAN (polyarteritis nodosa) = (-) ANCA, spared lung, affect kidney

102
Q

Histology describe which vascular disease?

Fibrinoid degeneration of the medium sized vessel wall with luminal narrowing

A

PAN (polyarteritis nodosa)

*affect kidney, spared lungs

103
Q

Histology describe which vascular disease?

necrotizing granuloma with a predominance of eosinophils

A

Churg-strauss (eosinophilic granulomatosis with polyangiitis)

*Chronic asthmas, assoc renal insuf

104
Q

Histology describe which vascular disease?

Proliferation of irreg shaped glands and pleomorphic cells

A

Adenocarcinoma of lung

  • Older patient
  • Normocytic anemia, cough, SOB, WL
105
Q

Rx for Paroxysmal supraventricular tachycardia

A

Adenosine

(Stimulates A1 Rs on surface of cardiac cells&raquo_space; activate K channel&raquo_space; incr K conductance&raquo_space; membrane AP remain negative for longer period)
*Transient slowing of sinus rate and incr AV nodal conduction delay

106
Q

Rx for Supraventricular Tachyarrhythmia

A

Digoxin

Inhibit Na/K ATPase pump in myocardial cells&raquo_space; incr IC Na&raquo_space; incr IC Ca++ conc
*AV node inh
*Enhance vagal tone
= Antiarrhythmic
Incr cardiac contractility&raquo_space; subsequent decr in ventr filling P

107
Q

Rx?

Manage ST-elevation MI when PCI not avail in time

A

Alteplase

*Fibrinolytic agent

108
Q

Assoc PE condition/aus/ECG/maneuver?

  1. Cardiac tamponade
  2. Asthma/ chronic obstructive pulm dz (less common)
    Constrictive pericarditis
A

Pulsus paradoxus
Inspiration cause drop in sys pulse P

*Pericardial fluid accum w/ late diastolic collapse of R atrium

109
Q

Assoc PE condition/aus/ECG/maneuver?

~Cardiac tamponade

A

Electrical alternans

Beat to beat variation in QRS complex amp on ECG (variation in electrical signal)- d/t swinging motion of the heart in pericardial fluid

*contrast with pulsus alternan in severe LV sys dysfx (aus- beat to beat variation in pulse)

110
Q

Assoc PE condition/aus/ECG/maneuver?

Severe LV sys dysfx

A

Pulsus alternans
aus: Beat-beat variation in pulse amp

*contrast with electrical alternans in cardiac tamponade (beat to beat variation in ECG - electrical signal)

111
Q

Assoc PE condition/aus/ECG/maneuver?

Severe sys dysfx & high SVR&raquo_space; accentuated diastolic dicrotic wave after dicrotic noth

A

Dicrotic pulse

2 distinct peak pulse - 1 during sys and 1 during diastole

112
Q

Assoc PE condition/aus/ECG/maneuver?

Aortic regurgitation
High output HF (thyrotoxicosis, arteriovenous fistula)

A

Hyperkinetic pulse

Rapidly rising amp (d/t rapid ejection of large stroke vol against decr afterload)

113
Q

Assoc PE condition/aus/ECG/maneuver?

Fixed LV outflow tract obstruction
Valvular aortic stenosis

A

Pulsus parvus et tardus

- Slow rising, low amp pulse (d/t diminished stroke vol - pulsus parvus; and prolonged LV ejection time - pulsus tardus)

114
Q

Important ECG SE in these drugs?

quinidine, sotalol
macrolides, fluoroquinolones
methadone, haloperidol

A

torsade de pointes: polymorphic ventricular tach - QRS complexes of varying amp and cycle length - appearance that the tip of QRS complex is twisting around the ECG baseline

115
Q

Embryological defect associate with what condition/syndrome?

deviation of infundibular septum (ant and cephalad deviation of infundibular septum)

A

VSD with overriding aorta
R ventricular outflow obstruction&raquo_space; sys murmur

  • squats to incr peripheral SVR & decr R to L shunt
  • tetralogy of Fallot
116
Q

Embryological defect associate with what condition/syndrome?

anomalous pulmonary venous return

A

R atrial/ventrical dilation
R to L atrial shunt

oxy/deoxy blood from pulm/venous sys flow into R atrium

117
Q

Embryological defect associate with what condition/syndrome?

failed fusion of superior and inferior endocardial cushions

A

endocardial cushion defect of AV septum/valves (mitral/tricuspid)

  • initial as atrial defect and/or VSD with L to R shunt
  • overtime, incr R sided blood flow&raquo_space; pulm HTN = EISENMENGER SYNDROME
118
Q

Embryological defect associate with what condition/syndrome?

linear dev of aorticopulmonary septum in utero

A

transposition of the great arteries

119
Q

Associated Heart condition:

TTR (transthyretin) gene mutation

A

TTR misfold = produce amyloid protein = infiltrates the myocardium (infiltrative cardiomyopathy) = decompensated CHF

120
Q

what murmur assoc with head bobbing (de Musset sign)?

A

AR

*d/t forceful pulsations in Intracranial a.

121
Q

Chronic transmural inflammation of the aorta is assoc with vascular condition?

A

AAA
» inflammation&raquo_space; release MMP/ elastase > degrade ECM/ elastin/collagen&raquo_space; weakening and progressive expansion of aortic wall

122
Q

Cystic medial necrosis is assoc with what vascular dz?

A

Marfan syndrome (*predispose to ascending aortic aneurysm/ dissection)

*Loss of smooth m/collagen/elastic tissue with formation of cystic mucoid spaces in the aortic media.

123
Q

Assoc condition?

intimal tear in the aortic wall

A

Aortic dissection

*Diastolic decrescendo murmur at the RSB

124
Q

Assoc condition?

Vasa vasorum endarteritis (endarteritis obliterans) in the thoracic aorta

A

thoracic aortic aneurysm cause by syphilis

125
Q

cor pulmonale

A

RV failure d/t incr pulm vascular resistance

126
Q

Kussmaul sign

A

paradoxical increase in jugular venous P on inspiration (cardiac tamponade/restriction)

*normal inspiration would cause decrease in jugular venous P

127
Q

Histology describe what CV disease/condition?

Amorphous ECM with scattered stellate of globular myxoma cells w/in abundant mucopolysaccharide (myxoid) ground substance containing chondroitin sulfate and hyaluronic acid
+ hemosiderin laden macrophage (d/t tumor high vascularity-hemorrhage)

*can embolize

A

Cardiac myxoma in L atrium

*lipomas = second MC primary cardiac neo, rarely embolize

128
Q

Histology describe what CV disease/condition?

malignant vascular spindle cells

A

primary cardiac angiosarcoma

*usually R atrium (rare)

129
Q

Histology describe what CV disease/condition?

malignant epithelial cells with necrotic debris

A

secondary involvement of the heart from metastatic malignancy (melanoma, lung cancer, breast cancer)

*usually locate at pericardium

130
Q

Cromolyn sodium Inhibit what process in chronic asthma?

A

inhibits mast cell degranuation and release histamine/leukotrienes
*chronic asthma management

131
Q

corticosteroid role in ___ degranuation in asthma/COPD control

A

eosinophils

132
Q

B-adrenergic agonists effect on bronchial?

A

bronchial smooth m. dilation

*Gs&raquo_space; AC&raquo_space; IC cAMP conc incr

133
Q

TTN gene mutation = assoc with what CV disease?

A

DCM (dilated cardiomyopathy)

TTN gene encodes for sarcomere protein titin == mutation results absence of complete titin proteins = myocardial dysfx
*AD, incomplete penetrance

134
Q

NOTCH1 gene = assoc what CV dz?

A

familial bicuspid aortic valve dz

135
Q

hemosiderin-laden macrophage (siderophages) = MC assoc with what CV dz?

*golden-brown cytoplasmic granules

A

heart failure

136
Q

what CV disease?

carbon-laden macrophage

A

coal’s worker’s pneumoconiosis

137
Q

Red man syndrome

Which med induce? MOA?

A

vancomycin induced

mediated by histamine release non-IgE mediated mast cell degranulation.

138
Q

Ablation procedure for which CV condition?

interatrial septum near opening of coronary sinus

A

AV node - persistent Afib

139
Q

Radiofrequency Ablation procedure for which CV condition?

between tricuspid valve and IVC opening

A

Atrial flutter

140
Q

Radiofrequency Ablation procedure for which CV condition?

L atrium near the opening of pulm v.

A

ectopic afib

*prevent recurrent afib

141
Q

Radiofrequency Ablation procedure for which CV condition?

upper part of crista terminalis near SVC opening

A

SA node - Afib

142
Q

Exudate or Transudate? Cause?

Low LDH
Low protein

A

transudate

HF

143
Q

Exudate or Transudate? Cause?

High protein lvs
high LDH

A

exudate

d/t inflam, infection, malignancy

144
Q

Exudate or Transudate? Cause?

high amylase

A

exudate

d/t pancreatitis, pancreatic pseudocyst, esophageal rupture

145
Q

Exudate or Transudate? Cause?

high leukocyte count

A

exudate

d/t complicated parapneumonic effusion, some type of malig pleural effusion

146
Q

Exudate or Transudate? Cause?

low glucose

A

exudate

d/t malig or infection (bac/neutrophils/malig cells consum glu),

147
Q

SE of which ABx?

ototoxicity, nephrotoxicity

A

gentamicin (aminoglycoside ABx)

148
Q

SE of which ABx?

red man syndrome (RMS)

A

rapid infusion of vancomycin (non Ig-E mediated)

  • inhibit cell wall syn (bind D-ala-D-ala terminus)
  • resolve if infuse at slower rate.
149
Q

SE of which ABx?

megaloblastic anemia, thrombocytopenia, leukopenia, toxic epidermal necrosis

A

trimethoprim-sulfamethoxazole

150
Q

CV dx?

Marfanoid body habitus
+AD, normal intellect, aortic root dilation, upward lens dislocation

A

Marfan syndrome

151
Q

CV dx?

Marfanoid body habitus
+AR, intellectual disability, thrombosis, downward lens dislocation, megaloblastic anemia, fair complexion

A

Homocystinuria

152
Q

What cause unopposed a-adrenergic stimulation?

A

pre-tx of B antagonist before a-adrenergic antagonist

153
Q

Dx?

inflammatory intraluminal thrombi w/ vessel wall sparing, extension into contigious v. and n.

*highly cellular, containing neutrophils, multinucleated giant cells)

A

thromboangiitis obliterans (buerger dz)

  • <45yo, M
  • digital ischemic ulcerations, limb claudication, Raynaud phenomenon, superficial thrombophlebitis

Etio: segmental small & medium sized vessel vasculitis, likely trigger by tobacco smoke

154
Q

Dx?

Granulomatous inflammation of media

> 50yo, UL headache, jaw claudication, transient vision loss

A

Giant cell arteritis (temporal arteritis)

155
Q

Dx?

Granulomatous inflammation of media

  • younger women, Asian descent
  • diminished pulses accom angina and/or carotid artery pain
A

Takayasu arteritis

156
Q

Dx?

transmural inflammation of arterial wall with fibrinoid necrosis

  • affect small/medium sized arteries
  • fever, HTN, abd pain, cutaneous lesions (nodules, livedo reticularis)
A

systemic vasculitis

PAN (polyarteritis nodosa)

157
Q

watershed areas

A

GI: splenic flexure; rectosigmoid junction
Brain: area between ACA, MCA, PCA

158
Q

Dressler syndrome

postcardiac injury syndrome

A

autoimmune-mediated pericarditis

*likely provoked by Ag exposed or created by infarction/necrosis of the cardiac m.

159
Q

Diagnosis:

granulomatous inflammation of arterial media
transmural fibrous thickening, narrowing of lumen
predominantly affects the aorta/branches

A

Takayasu arteritis

  • F, Asian, <40yo
  • Fever, WL, fatigue
  • arterio-occlusive: claudiation, BP discrepancies, bruits, pulse deficits
  • visual/neurologic deficits, arthralgias, myalgias)
  • elevate CRP, ESR
160
Q

Preventive med for dilated cardiomyopathy in anthracyclines

A

Dexrazoxane
(chelating agent = block formation o iron-assoc free radicals + inh formation of anthracycline-topoisomerase II complexes in healthy cardiomyocytes

161
Q

vascular or immunologic phenomena?

Janeway lesions (macular, erythematous, nontender* lesions on pals and soles)

A

vascular

162
Q

vascular or immunologic phenomena?

Osler nodes: painful*, violaceous nodules seen on the fingertips/toes

A

immunology

163
Q

vascular or immunologic phenomena?

Roth spots: edematous/ hemorrhagic lesions of the retina

A

immunologic

164
Q

vascular or immunologic phenomena?

mycotic aneurysm: dilation of an arterial wall due to infection

A

vacular

165
Q

Dx:

brown grannular deposits in myocytes (prussian blue stain)
skin appears darkly tanned
sinus node dysfx, a/ven arrhythmias, sudden cardiac death.
abn diastolic relaxation of LV

A

Cardiac hemochromatosis

  • HFE protein
  • excess intestinal Fe absn&raquo_space; deposiion of ferritin, hemosiderin, free iron in myocardium&raquo_space; oxidative inj to myocytes
  • cardiomyopathy: early diastolic LV dysfx (restrictive pattern)&raquo_space; later cardiac remodeling/dilated cardiomyopathy
166
Q

Dx:

profound BL sensorineural hearing loss + congenital long QT syndrome
*predispose to syncope, sudden cardiac death

A

Jarwell and Lange-Nielsen syndrome

AR, mutation of KCNQ1, KCNE1&raquo_space; alpha and beta subunits of voltage gated K channels

167
Q

ECG changes:

Brugada syndrome, AD
mutation in cardiac Na or L type Ca channel

A

pseudo R bundle branch block
ST segment elevation V1-3
*incr risk of ventricular tachyarrhythmias and sudden cardiac death

168
Q

Hydroxyurea function in fetal Hgb

A

incr Hgb production&raquo_space; improve O2 carrying capacity of blood in sickle cell anemia

169
Q

Dx:

Fibrinoid necrosis - cell death and excessive fibrin deposition w/in arteriolar walls - visible as circumferential, amorphous, pink material with smudged, necrotic endothelial cells that lack cytologic detail

A

hypertensive emergency

170
Q

Dx
hyperplastic arteriosclerosis
onion skin

A

hypertensive nephrosclerosis (long term essential HTN)

  • interstitial fibrosis, tubular atrophy, varying degrees of glomerulosclerosis (focal/global)
  • hyaline arteriosclerosis
171
Q

Result of which dz process?

Calcific uremic arteriolopathy (calciphylaxis)
» severe skin ischemia & necrosis
*Histo: superficial arteriolar calcification, subintimal fibrosis, thrombosis
*affect only smaller vessels

A

advanced chronic kidney disease

172
Q

Assoc dz:

Monckeberg sclerosis

A

calcified atherosclerotic plaque

  • diffuse medial calcification of small/ medium sized arteries.
  • calcification: blue to violet irregular deposits on hematoxylin-eosin stains
173
Q

Assoc dz process:

Migratory thrombophlebitis
Trousseau syndrome

A

visceral cancer (*pancreas, colon, lung) - ~adenocarcinoma

*hypercoagulability&raquo_space; thromboplastin like substance&raquo_space; chronic intravascular coagulations&raquo_space; disseminate/migrate

174
Q

what type of systemic embolization?

6Ps: pain, pallor, poikilothermia (coolness to touch), paresthesia, paralysis, reduced/absent pulse

A

atrial myoma - mucopolysaccharride rich stroma - myxoma cells

175
Q

chagas dz is assoc with what AD CV dz/condition

A

DCM (dilated cardiomyopathy)

TTN gene mutations = sarcomere titin

(protoxoan parasite = Trypanosoma cruzi)
*South America

176
Q

Dx:

Aschoff body/ giant cell

*new holosystolic murmur

A

Acute rheumatic carditis
*bacterial infection = untx group A streptococcal pharyngeal infection

*MR&raquo_space; MS (fibrous scar)

177
Q

Rx for:

pulm HTN, peripheral vascular dz, Raynaud syndrome.

A

Prostacyclin, epoprostenol

vasodilation and antithromboxane A2

178
Q

Diagnosis:

accumulation of amorphous substance in interstitial space

A

cardiac amyloidosis

  • older pt (>60yo)
  • early: restrictive pattern, stiff/no sign thickened
  • later: diastolic dysfx
  • normal LV cavity size, overall LV mass normal
179
Q

Diagnosis:

distorted myocardial structure and myofibril disarray

A

HCM (hypertrophic cardiomyopathy)

180
Q

Diagnosis:

increase of individual myocardial fiber length more than width

A

athlete’s heart

181
Q

Diagnosis:

myocardial atrophy and replacement with fibrous fatty tissue

A

arrhythmogenic RV cardiomyopathy

  • AD, mutation of cardiac desmosomes (cell junction)
  • affect RV&raquo_space; ven arrythmias/ RV failure
  • if LV involved = eccentric enlargement w/ incr LV cavity size
182
Q

respond to which dz/condition:

subendocardial replacement fibrosis

A

after viral myocarditis&raquo_space; dilated cardiomyopathy

183
Q

Which cancer drug toxicity?

patchy cardiomyocyte necrosis&raquo_space; death w/ diffuse myocardial fibrosis

A

Anthracycline induced cardiotoxicity

*Doxorubicin

184
Q

Which cancer drug toxicity?

reduced cardiomyocyte contractility w/ no fibrosis

A

trastuzumab

(monoclonal Ab = breast cancer meds)
*MOA: blocks downstream signaling&raquo_space; cellular proliferation&raquo_space; encourages malignant cell apoptosis.

185
Q

Diagnosis:

intermittent obstruction of submucosal v. at the muscularis propria of the GI tract - gen GI bleeding

Bx: dilated small vessels lined by thin-walled endothelium;

A

angiodysplasia

186
Q 
Complication of which infectious dz?
syndenham chorea (restlessness, purposeless jerking movement 3mo after sore throat)
A

group A beta-hemolytic streptococcal infection

  • acute rheumatic fever
  • MS
187
Q

which valve is affected:

in verrucous (libman sacks) endocarditis

A

thickened valve leaflets (mitral/aortic) w/ mult small vegetations on both surfaces

*sterile vegetations/ sterile platelet thhrombi interwtwined with strands of fibrin, immune complexes, mononuclear cells.

188
Q

Diagnosis:

Needle shaped cholesterol clefts occluding arterioles with multinucleated giant cells.

A

atheroembolization

*risk of kidney injury

189
Q

Diagnosis:

Egg on string

A

transposition of great arteries

CV-Step 1 (12 decks)

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