CV1 Flashcards
1
Q
A berry aneurysm ruptures. What kind of cranial bleed is there?
A
SAH
2
Q
What are the complications of HTN?
A
- Cornoary Artery Disease
- LVH
- HF
- Atrial fib
- Aortic disssectino
- AA
- STroke
- CKD
- retinopathy
3
Q
Proteins are leaking into the vessel wall.
A
HTN hyaline arteriosclerosis
4
Q
Vaso vasorum sclerosis
A
Aortic dissection from hyaline arteriosclerosis
Tertiary syphilis
5
Q
Pt has incresaed C Reactive protein in the presence of vascular disease. What does this mean?
A
If you have atherosclerosis and increased C Reactive protein, it means you’ll get cardiovascular failure.
6
Q
Bx shows cholesterol crystals,/clefts, needle like spaces
A
Atherosclerosis
7
Q
You see calcificatino fo aortic arch that looks like tree bark.
A
Syphilitic heart disease
Tree bark - calcifications that happen to the entire aorta
8
Q
You see cystic medial degeneration.
This is cysts and necrosis in the media layer of a large artery
What is increased?
A
= aneurysm from loss of connective tissu
Things that cause aneurysms:
- HTN –> Hyaline arteriosclerosis –> Aneurysm
- Marfan’s can also cause CMD;
- Syphils
- Atherosclerosis
Proteoglycans in aorta
9
Q
Which vascular pathology is located between the renal arteries and the bifurcation?
10 cm from aortic arch?
A
AAA
aortic dissection - 10 cm
10
Q
Which large artery disease can result in aortic valve insufficiency?
A
Takayasu arteritis
11
Q
Polyarteritis nodosa, explain
A
Necrotizing infalmmation at renal arteries, when it heals, makes a string of pearls on imaging
12
Q
Mucocutaneous lymph node syndrome affects what artery? What unique cliniical presentation does it come with
A
AKA Kawasaki disease
coronary artery
Conjunctivitis, rash on palms and soles
13
Q
What is leukocytoclastic vasculitis
and what is it’s morph
A
Microscopic polyangiitis
fibrinoid necrosis
14
Q
Aphthous ulcers, genital ulcers, uveitis. What is diagnostic?
A
Behcet disease - neutrophilic inflammation
HLAB51
15
Q
A female patient has fingers that turn blue when she gets stressed out, what’s she got?
A
primary Raynaud
16
Q
What things cause 2 Raynaud phenomenon?
A
SLE, Scleroderma, thromboangiitis obliterans
17
Q
Pt presents with needle tracks in their arm and cardiac arrest., what happened?
A
Epi, cocaine OD; myocardial vasospasm (cardiac Raynaud)
18
Q
Milky chylous accumulations in body cavities from rupture of what
A
Lymphedema
19
Q
Describe Sturge Weber
A
Port wine stains
trigeminal nerve
- Mental retarded, seizure, hemiplegia
20
Q
CD31; where does this arise?
A
Angiosarcoma
Skin breast liver
21
Q
What causes high output cardiac failure?
A
Arterioveno shunt
22
Q
A baby has a nevus flammeus, what are you worried about? What areas of the body should you look at?
A
Sturge Weber Syndrome; port wine stains.
brain for skull radiopacities, leptomeningieal angiomatosis masses
23
Q
A pregnant patient presents with spider telangiectasisas. What caused these?
A
Hyperestrogen
24
Q
A pt with angiosarcoma may work around the following chemicals
A
PVC, Arsenic, thorotrast
25
An alcoholic mother has her child and the child is messed up. What heart defect?
VSD
| fetal alcohol syndrome
26
Baby born with rubella. what heart defect he got?
Patent ductus arteriosus
Pulm a steno
septal
27
A pt has transposition of great vessels, what did the mother likely have?
Maternal diabetes
28
Turner Syndrome associations
Coarctation fo the aorta
29
Pts have prinzmetal variant angina is caused by what toxins?
Cocaine alcohol triptans
30
When do MI deaths occur?
within 1 hour due to arrhythmia
or
2-4 days when macrophages come weaken the wall and rupture the myocardium
31
Hypertensive patients die from what?
- Stroke
| - Renal failure
32
What's the path from HTN to aortic dissection?
HTN --> hyaline arteriosclorosis --> Vaso vasorum sclerosis --> aortic dissection
33
Homeless pt has swallowing/breathing problems with a persistent cough. PMH sig for HTN. Auscultation reveals a systolic whooshing sound.
Systolic whooshing - aortic valve insufficiency
| Impingement of thoracic AA on esophagus and laryngeal nerves.
34
```
alcohol?
Rubella?
Down?
Diabetic
Marfan
Turner
```
```
OH2: VSD
Rubella: PDA
21: VSD & endocardial cushion cells
DM: Transposition
Marfan: MVP
Turner: Coarctation
```
35
Pt has a fever but grams are negative. What is the main source of vasculitis without infection?
Drugs
SLE
immune complexes
36
What do ANCAs do?
Activate neutrophil --> granule release and ROS
37
Which vasculitis is associated with immune T cells?
Giant cell temporal arteritis
Granulomastosis with polyangiitis
Takayasu as well
38
A pt presents and yous ee intimal thickening, fragmentation of the lamina and granulomatous inflammation on bx of a large artery. What clinical symptoms will yousee?
Giant cell arteritis
Vision loss, headache
39
Aortic valve insufficiency can be caused by
AOrtic dissection
Thoracic aortic aneurysm
takayasu arteritis
40
Pulseless disease is whatguy
Takayasu
41
A pt presents with a systemic vasculitis. PMH Hep B. Which vessels are affected?
LUngs SPARED
| mostly renal
42
A pt with suspected vasculitis has a cavitation in the lung
Granulomatosis with polyangiitis wegener
43
What tumors can cuse SVC and IVC syndromes?
SVC - Bronchogenic cacinoma, mediastinal alymphoma,
IVC - RCC HCC
44
What venous dilation can cause hemoptysis, GI bleeds, ematuria, epistaxis
Hereditary hemorrhagic telangiectasia
45
NOTCH 1
| NOTCH 2
NOTCH 1 - bicuspid aortic valve
| NOTCH 2 = tetraology
46
What type of angina has ST depression? ST elevation?
ST depression = unstable
| St elevation = prinzmetal
47
What is contraction band necrosis
reperfusion injury of Ca coming in and hypercontracting muscle
48
What can cause sudden cardiac death?
- CAD ischemia --> fatal arrhythmia
- Cardiomyopathy
- Congenital channelopathies
- Myocarditis
- myocardial hypertrophy
49
Mitral annular calcifications, what is it?
| What does it do the valve?
Females with MVP, get thrombus or bacterial endocarditis;
calcifican in a fibrous annulus
Does no thing sto the valve.
50
Mitral stenosis is usually caused by what
Chronic rheumatic heart disease
51
how do you tell the difference between rheumatic fever aortic stenosis and regualr?
mitral valve issues and fusion of aortic valve commissures
52
You see fusion of commissures of the aortic valve
chronic rheumatic disease
53
A pt's tricuspid valve is messed up. Cultures are negative. Sxs include flushing, diarrhea, dermatitis, bronchoconstriction
5HIAA carcinoid syndrome =
| ONLY right sided valvular fibrosis bc lungs get rid of 5 HIAA
54
A pt has onion skin fibrosis with necrotizing arteriolitis
Malignant hypertension = hyperplastic arteriosclerosis
55
What protects patients from atherosclerosis
ESTROGEN;
| so post menopausal women get shafted
56
What 3 things can cause Thoracic aortic aneurysm?
Syphilis
Marfan
HTN
57
Who's at risk for Aortic dissection
HTN
| Marfan
58
transmulra necrotizing inflammatino at artery branch points
PAN
59
Microabscess are located in the thrombi of what vasculitis?
Thromboangiitis obliterans (buerger disease)
60
Geographic patterns of central necrosis
Wegener, granulomatosis with polyangiitis
61
Palpable Purpura
Churg-Strauss Syndrome
Also? Microscopic polyangiitis
MOST USUALLY
Henoch Schenloin IgA
62
pt has dilation of vessels in head, neck, arms, and cyanosis due to respiratory distress. What could they have?
SVC syndrome due to Bronchogenic carcinoma, mediastinal lymphoma or an AA
63
mucin producing adenocacrinomas cause what? Where are they located?
Hypercoagulability --> Migratory thrombophlebitis
pancreas lung ovary
64
Most common cause of arrythmia
ischemia
65
A pt has RV dilation, but there is no hypertrophy. What is the cause?
What if there's hypertrophy?
Acute, cor pulmonale; caused by a PE
Hypertrophy = chronic, which is caused by parenchymal disease, pulmonary isorders really.
66
What puts a pt at risk for calcific valvular degeneration? Whats the pathophys
Old people wear and tear from
HTN inflammation hyperlipidemia
Osteoblast like cells deposit and stenose the valve.
67
Pt has myxomatous degeneration from proteglycan deposits. Whatcha looking at?
Mitral valve prolapse
68
Causes of mitral valve regurg?
```
Progression from MVP
LV dilation
Infective endocarditis
Acute strep heart disease
Papillary muscle rupture
```
69
Pt presents with microangiopathic hemolytic anemia as a complication of what heart defect?
Aortic Stenosis
70
Describe Rheumatic
When you get strep, make abs against it, but molecular mimicry of your body's own M cells.
2-3 weeks later you have created enough antibodies that the antibodies attacking your body do some damage and you get the Jones Criteria. (Pancarditis)
Say you keep getting strep over and over, your body finally makes so many antibodies against M protein that it really takes out the mitral valve with fibrosis (so much fibrosis you get sticky commissures; fish mouth stenosis)
This fibrosis is sticky to infections, too so you can get infective endocarditis
So when do you get Aschoff and stuff? During the fever stage when you have pancarditis
71
Patient is an IV drug user, gets infective endocarditis.
Staph aureus
Acute.
Tricuspid valve usually (Don't TRI drugs)
72
Pt has valve vegetations and destruction. Gram stain comes back (+) cocci in chains. What is going on? What is the history of teh pt that gets this? Which valve?
Subacute infective pericarditis
Left valve (usulaly bc of RHD)
Dental work, bad needles, bacteremia from sepsis.
73
Pathology of NBTE?
Caused by:
mucinous adenocarcinoma, sepsis, catheters
Small packs of sterile balls on one side of leaflet, loosely attached, so cause emboli
74
You see glistening white plaque like thickening on endocardial surface and valve leaflets. Which valve is it?
Right valve bc it's carcinoid heart disease.
75
Pt presents with regurg L intercostal space 2, right intercostal space 2. What is the morph? What are the causes?
Dilated cardiomyopathy
Interstittial fibrosis
- Genetic
- Coxsackie
- Alcohol
- Doxorubicin
- hemoch
76
An athlete dies on the floor, what is messed up genetically?
Sarcomere proteins's B myosin heavy chain; causes a ventricular outflow obstruction and arrhythmia
77
Pt has Nutmeg liver, & arrythmias, what isthe mutation?
WHat is Naxos syndrome?
RV HF with arrhythmias = arrhythmogenic RVC
mutation is desmosomes, the muscle myocardium is replaced by adipose and fibrosis
Arrhythmogenic RVC with hyperkeratosis of palmar surfaces., which has an additional mutation in plakoglobin gene
78
Pt has dilated bilateral atria, but normal sized ventricles resulting in diastolic dysfunction. What causes this?
Amyloid
Radiation fibrosis
Endocardia fibroelastosis
Loeffler
79
What can cause myocarditis?
Coxsackie a anb b
| trypansoma cruzi chagas
80
how can you tell the difference between dilated cardiomyopathy and myocarditis?
There's fibrosis in cardiomyopathy,
only enlargement and:
lymphocytes - viral
eosinophils - hypersensitive
81
GNAS1
| PRKAR1A
Myxoma
82
Complciations of crdiac transplant
```
Allograft rejection (Lymphocytes, right away)
Allograft arteriopathy (5 years)
EBC associated B cell lymphoma
```
83
Elevated sedimentation rate
- Temporal giant cell
| - PAN
84
"Discrete foci of fibrinoid degeneration and mononuclear inflammatory cells" descrbies what?
Aschoff cbodies
85
Necrotizing granulomas
Wecner)
| Granulomatosis with polyangiitis
86
Segmental thrombosing vasculitis
Buerger disease
87
Lesions same age in this; lesions different stages in this
Same = microsocpic angiitis
Different:
PAN
88
Polymyalgia rheumatica
temporal arteritis
89
what drug inhibits microsomal transverse protein
Lomitapide
90
which drug inhibits apoB
Mipomersen
91
what drug inhibits Na+ late channels
ranolazine
92
What are 2 main drugs that can cause noninfectious vasculitis?
PCN, streptokinase
93
fibrinoid necrosis
Polyarteritis Necrosis
| & Microscopic polyangiitis
94
Pt has an upper prespiratory tract infection, has palpable purpura
IgA Henoch Schenloin
95
What vasculature does hyaline arteriosclerosis occur in?
Small artery walls
96
What can result in dilation of all 4 chambers?
myocarditis (caused by doxo, Chagas, Cox, Rheumatic fever, autoimmune, URI)
and dilated cardiomyopathy
97
Rheumatic Fever
Lymphocytic infiltrate with focal necrosis of myocardial tissue
CHAGAS AND COXSACKIE
SLE
Rheumatic Fever
```
Kawasaki
URI
Borrelia
Cocaine
Doxorubicin
```
98
Glycosaminoglycans in a gelatinous material is fuond in the heart
myxoma
99
Tricuspid bois.
Carcinoid, IVDU IE, NBTE
100
Machine like murmur
PDA
101
MI or angina?
If there's a thrombus = MI
102
Unexpected side effect of verapamil
Hyperprolactinemia
103
Statins worst side effects
hepatotoxicity and myopathy
104
Which drug has a long half life and is not easily reversible
LMWH
105
Which anticoagulation acts on the liver? Which one is acute, which one is chronic?
Warfarin
```
Heparin = acute
Warfarin = chronic
```
106
What drugs inhibit Gp2b/gp3a?
| What drugs inhibit P2Y2 ADP receptor?
GP2 - abciximab, eptifibatide, tirofiban
P2Y2 ADP = clopidogrels, tigra
107
Mechanism of HIT
IgG abs form complex with heparin and platelet factor 4 to destroy platelets?
108
A pt has strokes and TIAs in past. What can you combine with cilostazol and dipyraidamole to prevent CVA?
ASA
109
how does necrosis with warfarin work
Microthrombi in small vessels
| protein C deficiency
110
Pregantn pt develops an hemangioma. Which
Pyogenic
111
Pt has notched ribs
Coarctation of aorta
