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Path Exam 2 > CVS > Flashcards

CVS Flashcards

1
Q

describe the presentation of the condition seen in the image

A
  • presentation = classic sudden death from arrhythmias (athlete that collapses and dies)
    • exertional dyspnea
    • diastolic dysfunction
    • decreased LVEDV and decreased stroke volume → normal EF
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2
Q

describe symptoms of the acute vs. subacute form of the condition seen in the image

A
  • acute:
    • high fever
    • splinter hemorrhages
    • no splenomegaly
    • no finger clubbing
    • no anemia
  • subacute
    • low-grade fever
    • splenomegaly
    • finger clubbing
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3
Q

describe what is seen in the image

A
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4
Q

describe the presentation of the condition seen in the image

A
  • presentation:
    • becomes apparent 6 months after birth (once fetal Hb decreases, since fetal Hb binds O2 with higher affinity)
    • tet spells (squatting)
      • afterload increases to reverse the shunt (L → R) → cyanosis transiently improves
      • single S2 → no sound from pulmonic valve
      • large VSD → no murmur
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5
Q

describe the image

A

Wegener/GPA

lung from a patient with granulomatosis with polyangiitis, demonstrating large nodular cavitating lesions

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6
Q

describe what would be seen on x-ray in the condition seen in the image

A

x-ray: widening of mediastinum since the blood collects in the media

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7
Q

describe the complications of the condition seen in the image

A
  • complications:
    • arrhythmias → HF
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8
Q

describe the treatment for the condition seen in the image

A

treatment = large aneurysms → surgically replaced by prosthetic grafts

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9
Q

describe what is seen in the image

A
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10
Q

describe the condition in the image and how & when it occurs

A

occurs 3-14 days post-MI

  • papillary muscle rupture: severe mitral regurg. → pulm. veins → pulm. edema
    • pan-systolic murmur loudest at apex (at the mitral valve)
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11
Q

describe the 2 types of the condition seen in the image

A
  • 2 types:
    • transmural: full thickness of ventricular wall; associated with plaque disruption & superimposed completely occlusive thrombosis
      • STEMI
    • subendocardial: inner 1/3 to 1/2 of ventricular wall;
      • commonly caused by hypovolemic shock due to a gunshot wound
      • subendocardium is a watershed area and receives blood last → infarction alone tends to be due to ischemia rather than complete occlusion of an artery
      • NSTEMI
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12
Q

describe the presentation of the condition seen in the image

A
  • presentation: most commonly asymptomatic
    • incidental finding of a pulsatile and expansile abdominal mass or on ultrasound/CT
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13
Q

describe the organisms involved in the acute vs. subacute form of the condition seen in the image

A
  • acute
    • S. aureus in normal valves
      • most common among IVDU → tricuspid valve
    • Pseudomonas aeruginosa 2nd most common in IVDU
    • candida in IVDU
  • subacute
    • S. viridans in abnormal valves → good prognosis w/ antibiotics
    • S. bovis → tricuspid involvement + colon cancer
    • HACEK group
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14
Q
A
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15
Q

describe investigations for the condition seen in the image

A
  • investigation: ECG → will see unfused valve leaflets and LVH
    • systolic ejection click followed by crescendo-decrescendo murmur → radiates to carotids
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16
Q

describe what is seen in the image

A
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17
Q

describe the condition in the image and how & when it occurs

A

occurs after scar is fulled formed

  • left ventricular aneurysm after full formed scar
    • stasis → mural thrombus → arrhythmia + embolism → most common place is legs, brain
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18
Q

describe the pathogenesis of the condition seen in the image

A
  • pathogenesis:
    • antero-superior displacement of the infundibular septum moves towards the RV → drags the aorta with it → overriding RV → creates large VSD
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19
Q

describe what is seen in the image

A
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20
Q

describe the type of hypertrophy seen in the image

A
  • HCM = concentric hypertrophy → impaired diastolic filling → LV-outflow obstruction → anterior leaflet of MV
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21
Q

list other risk factors for the condition seen in the image

A
  • other risk factors:
    • homocystinuria, lipoprotein a, increased PA-1 inhibitor, CRP, decreased estrogen
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22
Q

describe investigations for the condition seen in the image

A
  • investigations:
    • markedly elevated ESR (>100) → nonspecific marker of inflammation
    • temporal artery biopsy: the disease is focal and skips so need to take a segmental biopsy
      • elastic trichrome stain
      • negative biopsy does NOT rule out the disease
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23
Q

describe the most common form of the condition seen in the image and what it is associated with

A

membranous VSD is the most common VSD

  • L → R shunt but most close with age
  • associated with trisomy 21, 13, 18
  • incidental finding on ECG
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24
Q

describe the unstable form of the condition seen in the image

A
  • unstable = usually rupture → lefts off the cap and exposes core to lumen
    • moderately stenotic (50-75%)
    • thinner fibrous cap
    • core rich in lipids, T cells and macrophages
    • less smooth muscle prolif.
      • smooth muscle makes the collagen for the fibrous cap
    • eccentric
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25
Q

describe the genetic etiology of the condition seen in the image

A
  • genetics:
    • most common → AD mutations affecting cytoskeletal proteins
    • less common = X-linked mutations → dystrophin gene
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26
Q

describe the condition seen in the image

A
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27
Q

describe the complications of the condition seen in the image

A
  • complications:
    • arrhythmias
    • IE of mitral valve
    • LHF
    • RHF
    • mural thrombus due to stasis that can embolize and give stroke
    • infarcts of the septum → ischemia → angina or MI
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28
Q

describe the image seen

A

mitral valve prolapse

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29
Q

describe the heart sound associated with the condition in the image

A

harsh pansystolic murmur : loudest at left sternal border incidentally found on physic

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30
Q

describe the presentation of the condition seen in the image

A
  • presentation:
    • usually in patients over 60 yrs
    • congenital bicuspid valve (Turner’s) - occurs in earlier in life (40 yrs)
    • SAD (syncope, angina, dyspnea) due to CHF/arrhythmia
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31
Q

describe the form of hypertrophy seen in the condition in the image

A
  • dilated = most common cardiomyopathy; eccentric hypertrophy
    • eccentric = sarcomeres added in series
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32
Q

describe the complications in the acute form of the condition seen in the image

A
  • acute IE complications:
    • sepsis → septic emboli → lungs → multiple lung abscesses
    • ring abscess in myocardium → arrhythmia
    • abscesses form → liquefactive necrosis
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33
Q

describe the etiology and pathogenesis of the condition seen in the image

A
  • hyaline arteriosclerosis:
    • etiology: chronic benign hypertension → affects only afferent arteriole
    • pathogenesis: endothelial damage → leakage of plasma proteins v exudate
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34
Q

describe the presentation of the condition seen in the image

A
  • presentation:
    • more common in males about 40 y/o
    • URT sx:naso-mucosal ulcerations, sinusitis
    • LRT: necrotizing pneumonia, granulomatous vasculitis that does NOT spare the lung → lung abscess
      • pneumonia does NOT get better with antibiotics (similar to adenocarcinoma in-situ)
    • affects kidneys → renal infarcts and affects glomeruli capillaries
      • crescent shape → hematuria
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35
Q

describe investigations for the condition seen in the image

A
  • investigation:
    • c-ANCA in blood (PR3 antibodies)
    • don’t see anything with immunofluorescence → pauci-immune
      • this is common among all ANCA-associated vasculitides
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36
Q

describe what a rupture into the lumen would be called in the condition seen in the image

A
  • rupture into lumen = double-barreled aorta
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37
Q

describe how the condition in the image affects all layers of the heart

A
  • myocarditis: arrhythmia; Aschoff bodies around arteries (perivascular) and granuloma-like (combination of CD4+ lymphocytes & activated macrophages/Antischkow cells)
    • most common cause of death in the acute stage
  • pericarditis: fibrinous pericarditis (bread and butter) → friction rub
  • endocarditis: regurgitation of mitral valve → could cause pulm. edema
    • pansystolic murmur loudest at apex
    • sterile vegetations with fibrin b/c organism is no longer there
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38
Q

describe the treatment for the condition seen in the image

A
  • treat with IV steroids to prevent blindness/reduce inflammation on ophthalmic artery
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39
Q

describe the pathogenesis of the condition seen in the image

A
  • pathogenesis:
    • inflammatory response starts in vaso vasorum which supplies the t. media → obliterative end arteritis (narrowing) → occlusion of vaso vasorum due to endothelial damage → necrosis of media → ischemia causes loss of elastic fibers → chronic inflammation → fibrosis → vessel becomes weakened → aneurysm
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40
Q

describe what is seen in the image

A
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41
Q

describe the pathogenesis of the condition in the image

A
  • pathogenesis:
    • immune complex-mediated disease of medium vessels
      • type III HS
    • transmural and affects small to medium arteries but the LUNG IS SPARED
      • fibrinoid necrosis → heals with fibrosa → feels like nodes → nodosa
      • capillaries, venules and arterioles UNAFFECTED
      • string of pearls appearance on angiogram → rosary sign
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42
Q

describe what is seen in the image

A
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43
Q

describe the ascending form of the condition seen in the image

A
  • ascending = worse prognosis
    • rupture backward into the pericardial space → pericardial tamponade
    • rupture forward & compromise:
      • common carotid a. → stroke
      • coronary a. → MI
      • subclavian a. → unequal BP and pulse in upper ex.
      • anterior spinal a. → myelitis
      • renal a. → renal failure
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44
Q

describe the image

A

HCM

histo demonstrating disarray, extreme hypertrophy, characteristic branching of myocytes as well as interstitial fibrosis

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45
Q

describe the pathogenesis of the condition in the image

A
  • pathogenesis: unknown
    • medium to large arteries affected
      • temporal, ophthalmic (blindness) and vertebral a.
    • giant cells and mononuclear cells
    • focal nodular, intimal thickening, fragmentation of IEL
    • NOT transmural (only affects intima and inner media)
    • granulomatous vasculitis = CD4 mediated
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46
Q

describe the 4 cardinal features seen in the condition in the image

A
  • 4 cardinal features = PROVe
    • Pulmonary stenosis (most important; determines severity of condition)
    • RVH
    • Overriding aorta
    • VSD
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47
Q

describe the image

A

DCM

the histologic picture shows myocyte hypertrophy and interstitial fibrosis (collagen is blue bc Masson-trichrome stained)

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48
Q

describe microscopic polyangiitis

A
  • necrotizing vasculitis (similar to PAN) but:
    • smaller vessels (capillaries, small arterioles)
    • no granulomas
    • lung affected (pulm. capillaries → hemoptysis)
    • lesions are the same stage/age
      • unlike in PAN
    • MPO-ANCA/p-ANCA
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49
Q

describe Churg-Strauss syndrome

A
50
Q

what other disease is the condition in the image associated with?

A

associated with Hep B

51
Q

describe investigations for the condition seen in the image

A
  • investigations:
    • EKG: ST elevation for transmural due to occlusive infarct
      • ST depression (NSTEMI) for subendocardial infarct
    • troponin I/T = rise in 3-12 hours, peak at 48, persists 5-14 days
    • CK-MB = rise in 3-12 hours, peak at 24 hours, disappears in 3 days; use to check for reinfarction
    • LDH: rises in 24 hours, peaks at 3-6 days, returns to baseline in 8-12 days
    • myoglobin = first marker to rise (not specific, rarely used)
52
Q

differentiate from rheumatic heart disease and calcified aortic stenosis

A
  • RHD affects mitral first, then aortic
  • in calcific aortic stenosis, valve is unfused, unlike RHD where there is commissural fusion
53
Q

describe the pathogenesis of the condition seen in the image

A
  • pathogenesis:
    • direct damage by virus + CD8 mediated damage against infected myocytes → cytokine release → aggravation of myocardial dysfunction
    • inflammation (infiltration of lymphocytes) → necrosis (patchy) of myocytes
54
Q

describe the image

A
55
Q

describe the complications in the subacute form of the condition seen in the image

A
  • subacute IE complications:
    • sepsis → septic emboli → legs, brain
    • glomerulonephritis (type III HS with immune complex deposition)
56
Q

describe what is seen in the image

A

view of the junction of the fibrous cap and core, showing scattered inflammatory cells, calcification (arrowheads) and neovascularization (arrows)

57
Q

describe the pathogenesis of the condition seen in the image

A
  • pathogenesis:
    • disruption of atheromatous plaque → subendothelial collagen and thrombogenic necrotic material are exposed → platelets adhere to the exposed material and eventually form an occlusive platelet thrombus with help of TxA2 and serotonin → complete occlusion of coronary artery
58
Q

describe how the reversal of the condition in the image leads to complications

A
  • Eisenmenger’s syndrome
    • pulm. HTN → reversal of shunt (R→L) → cyanosis
      • clubbing of fingers
      • polycythemia
        • low O2 stimulates EPO from kidney
59
Q

the condition seen in the image is the only vasculitis that eventually extends to ______

A

the condition seen in the image is the only vasculitis that eventually extends to veins and nerves (involves the entire neurovascular bundle)

60
Q

describe the pathogenesis of the condition seen in the image

A
  • pathogenesis:
    • repeated S. pyogenes pharyngitis = type II hypersensitivity
      • cross-reacting antibodies to M protein of S. pyogenes cross-reacting with antigens of valves and joins = molecular mimicry
61
Q

describe the condition seen in the image

A
  • restrictive: least common type
    • stiff walls → loss of ventricular compliance → impaired ventricular filling during diastole → diastolic dysfunction → systolic dysfunction
62
Q

list the modifiable vs. non-modifiable predisposing factors of the condition seen in the image

A
  • modifiable:
    • hypercholesterolemia
    • hypertension
    • smoking
    • diabetes
  • non-modifiable
    • age
    • gender
    • genetic predisposition
63
Q

describe the presentation of the condition seen in the image

A
  • presentation:
    • tree bark appearance due to intimal wrinkling
    • compresses central structures:
      • esophagus → dysphagia
      • left recurrent → hoarseness
      • trachea → dyspnea
    • inflammation can spread to aortic roots where coronary a. originate → ischemia of myocardium → MI
    • can lead to aortic regurg./insuff./incompetency → getting blood from both LA AND aorta → volume overload → cor bovinum → LHF → pulm. edema → RHF
      • most common cause of death
    • stasis in heart causes mural thrombus
    • IE from dental work (superimposed infxn on damaged valves)
64
Q

describe complications of the condition seen in the image

A
  • complications:
    • DVT (paradoxical embolism → bypasses pulm. circulation and goes to systemic circulation)
    • jet lesions (R → L ventricle → lands on endocardial surface and damages it → dental work → IE)
65
Q

describe the morphology of the subacute form of the condition seen in the image

A
  • subacute IE morphology:
    • small vegetations, granulation tissue, fibrosis, plasma cells, macrophages, fibroblasts
    • dystrophic calcification
66
Q

describe the etiology, pathogenesis, and signs/symptoms of the condition seen in the image

A
  • hyperplastic = chronic malignant HTN
    • concentric, laminated thickening of the walls → “onion-skin” → hyperplasia
  • signs:
    • hematuria, oliguria
    • malignant nephrosclerosis → flea-bitten appearance
  • fibrinoid necrosis: due to sudden malignant HTN → necrotizing arteriolitis
    • seen in pheochromocytoma, pre-eclampsia
    • complications:
      • aortic dissection, hemorrhagic stroke, papilledema
67
Q

describe the condition in the image and how it can be non-immune related as well as immune-related

A
  • fibrinous pericarditis (bread and butter pericarditis)
    • occurs 1-3 days post-MI
    • extension of myocardial inflammation into the pericardium
  • Dresslers autoimmune pericarditis at least 2 weeks to several months after MI
    • immune-mediated
    • fever, leukocytosis, high ESR
68
Q

describe the presentation of the condition seen in the image

A
  • presentation:
    • young (<35), male smokers of Japanese, Indian or Jewish descent
    • initially intermittent claudication
    • Reynaud’s phenomenon
      • vasospasm → white → blue (cyanotic) → blood returns → red
    • superficial nodule phlebitis
      • tender nodules over course of vein
    • auto-amputation of digits
    • chronic ulceration of the skin → gangrene
69
Q

describe the condition in the image and how & why it occurs

A

​​occurs 3-14 days post-MI

  • IV septum rupture (L to R shunt) = VSD, pulm. edema
    • pan-systolic murmur loudest in left lower sternal border
    • only time that right ventricle has O2 blood
      • can differentiate from mitral regurgitation by measuring O2 sat.
70
Q

describe the morphology of the acute form of the condition seen in the image

A
  • acute IE morphology:
    • large vegetations w/ minimal neutrophils (because valves are avascular)
71
Q

describe the image

A

viral myocarditis

lymphocytic myocarditis with edema and associated myocyte injury

72
Q

describe the complications of the condition seen in the image

A
  • LVH → increased protein synthesis or decreased protein degradation
  • LHF = pulm. edmea → pulm. HTN → RHF
    • transudate until 2 weeks in the lungs
    • >2 weeks = fibrosis and hemosiderin-laden macrophages in lungs
  • decreased SV and decreased CO
    • less supply, increased demand
    • ischemia and infarction of myocardium → MI
  • mural thrombus + arrhythmia → embolic stroke
  • aortic valve is damaged → infective subacute endocarditis (S. viridans)
73
Q

describe what is seen in the image

A

aorta with fatty streak

  • fatty streaks begin as minute yellow, flat macules that coalesce into elongated lesions
  • composed of lipid-filled foamy macrophages but are only minimally raised and do not cause any sig. flow disturbances
  • coronary fatty streaks form during adolescence at the same anatomic sites that are prone to plaques later in life
74
Q

describe the presentation of the condition in the image

A
  • renal artery thrombosis (but doesn’t cause glomerular nephritis so no hematuria) → ischemia → hypoxia → acute tubular necrosis → renal failure
    • hypertension because it stimulates JG cells due to hypoxia
  • coronary artery → MI
  • liver infarcts
  • GI → red infarct
  • vaso navorum → common fibular nerve vessel → foot drop
  • skin: nodules, palpable purpura
75
Q

describe the acquired etiology of the condition seen in the image

A

DCM

  • BADD PICCC
  • B = beri beri (thiamine def.)
  • A = alcohol
  • D = dystrophin
  • D = doxorubicin (chemotherapy drug)
  • P = peripartum
  • I = iron overload (hemochromatosis)
  • CCC = Coxsackie, Chagas, cocaine
76
Q

describe the distribution of the lesions in descending order of the condition in the image

A
  • distribution of lesions in descending order:
    • kidney > heart > liver > GI
77
Q

describe the pain associated with the condition in the image

A

pain radiates to the back (felt between the scapulae) and moving down as the dissection progresses

78
Q

name complications for the condition seen in the image

A
  • complications:
    • critical size = > 5cm; has high risk for rupture → hypovolemic shock
    • mural thrombus due to stasis → downstream ischemia
    • compress vertebrae → back pain
    • compress ureter → hydronephrosis
    • if due to mycotic aneurysm → secondary infxn by salmonella possible
79
Q

describe complications of the condition seen in the image

A
  • complications:
    • rupture of chordae tendinae → mitral regurg. → LHF → pulm. edema
      • pansystolic murmur at apex → mid-systolic click followed by decrescendo murmur
    • regurgitation of mitral valve → CHF
    • IE
    • ventricular arrhythmias → SCD
    • thrombo-emboli → stroke → Berry aneurysm
80
Q

name a common cause for the condition seen in the image

A
  • common cause = tertiary syphilis → T. pallidum (G-ve spirochete)
81
Q

describe the heart sounds heard in the condition in the image

A

DCM

  • hear S3 sound (gallop rhythm)
  • displaced apex beat (due to dilation of heart)
82
Q

describe the image

A
83
Q

describe the morphological progression of the condition seen in the image

A
  • progression:
    • fatty dots with macrophage foam cells → fatty streaks with lipid-laden macrophages → cholesterol plaques (asymptomatic) → can embolize during vascular procedure (e.g. angiogram)
84
Q

describe what is seen in the image

A

Chagas myocarditis; a myofiber distended with trypanosomes (arrow) is present along with mononuclear inflammation and myofiber necrosis

85
Q

name predisposing factors for the condition seen in the image

A
  • predisposing factors:
    • atherosclerosis
    • HTN
    • trauma
    • vasculitis
    • congenital defects
    • infections (mycotic aneurysms)
86
Q

the condition in the image is a (true/false) aneurysm because it involves ______

A

the condition in the image is a (true/false) aneurysm because it involves all 3 layers of the vessel wall

87
Q
A

Wegener/GPA

vasculitis of a small artery with adjacent granulomatous inflammation including giant cells (arrows)

88
Q

describe the murmur heard in the condition seen in the image

A

midsystolic click that corresponds with sudden tensing of the involved mitral leaflet or chordae tendinae as the leaflet is forced back towards the LA

89
Q

describe the most common outcome and complications of the condition seen in the image

A
  • outcome: COMPLETE RESOLUTION (most commonly)
  • complications:
    • acute heart failure
    • arrhythmias → ventricular are most dangerous → SCD
    • viral myocarditis → DCM → chronic CHF
90
Q

describe the genetic etiology of the condition seen in the image

A
  • familial AD due to point mutation in any of the following genes coding for sarcomere proteins:
    • Beta-myosin heavy chain = most common
    • myosin binding protein C
    • cardiac troponin T
91
Q

name other causes of the condition seen in the image

A
  • parasitic:
    • Trichinella
      • eosinophils predominant
    • Tryapanosoma cruzi (Chagas disease)
      • South America
      • parasitization of scattered myofibers by trypanosomes
    • Toxoplasmosis
      • household cats most common vector
      • causes myocarditis in immunocompromised
92
Q

describe the image

A
93
Q

___ are the most common cause of the condition seen in the image

A

Viruses (specifically Coxsackie A & B) is the most common cause of the condition seen in the image

94
Q

describe what is seen in the image

A
95
Q

describe the etiology of the condition seen in the image

A
  • etiology:
    • endomyocardial fibrosis
      • hemochromatosis
      • amyloidosis
      • sarcoidosis
      • Loffler’s (eosinophilia)
96
Q

describe the order of likelihood that the condition in the image will occur in certain organ

A

in descending order of severity:

infrarenal abdominal aorta > coronary arteries > popliteal arteries > internal carotid arteries > vessels of the circle of Willis

97
Q

describe investigations of the condition seen in the image

A
  • investigations:
    • cardiac catheterization or ECG
    • boot shaped heart
98
Q

describe the pathogenesis of the condition seen in the image

A
  • pathogenesis:
    • accumulation of GAGs in spongiosa layer (myxoid degeneration of valve)
99
Q

describe what is seen in the image

A
100
Q

describe the pathogenesis of the condition seen in the image

A
  • pathogenesis:
    • intimal tear (from HTN) + defective media (HTN leads to narrowing of vasa vasorum; Marfan’s syndrome = fibrillin gene on chr. 15; Ehler’s Danlos)
101
Q

describe the stable form of the condition seen in the image

A
  • stable: intima has thickened (fibrous cap and lipid core)
    • 3 main factors make it stable:
      • thick fibrous cap
        • pluripotent smooth muscles that travel from media to intima to deposit collagen)
      • less lipid core
      • less inflammatory cells (foam cells)
102
Q

the most common location of the condition in the image is _____

A

the most common location of the condition in the image is the infrarenal abdominal aorta

103
Q

describe the image

A
104
Q

describe the presentation of the condition seen in the image

A
  • presentation:
    • varies from asymptomatic to sudden acute HF or arrhythmias
    • but usually nonspecific flu-like symptoms
      • fatigue, dyspnea, palpitations, chest pain, fever
      • may mimic acute MI
105
Q

describe the presentation of the condition seen in the image

A
  • presentation:
    • young women between 20-40
    • fatigue or atypical chest pain
    • Marfan’s syndrome
    • Ehlers Danlos syndrome
    • asymptomatic and incidental finding of mid systolic click → abrupt tension on leaflets and chordae tendinae when valve tries to close
106
Q

describe what is seen in the image

A
107
Q

describe the presentation of the condition seen in the image

A
  • presentation:
    • combination of R and L HF (b/c both ventricles are dilated, like CHF)
    • hear S3 sound (gallop rhythm) → systolic (contractile) dysfunction
    • displaced apex beat (due to dilation at 5th intercostal space mid-clavicular line → pushed to mid-axillary line)
    • EF = <25%
108
Q

describe the presentation of the condition in the image

A
  • presentation:
    • M/F > 50 years old
    • jaw claudication and facial pain
    • polymyalgia rheumatica (fever with muscle and joint pain)
    • ocular symptoms → diplopia, progressive hazy vision
109
Q

describe the image and the components of it

A

Aschoff body in acute rheumatic carditis; there is central necrosis associated with a circumscribed collection of mononuclear inflammatory cells, including some activated macrophages with prominent nucleoli and central wavy (caterpillar) chromatin (Anitschkow cells)

110
Q

describe the investigations for the condition seen in the image

A
  • investigations:
    • echocardiogram: dilated heart chambers with low EF due to systolic dysfunction
    • endomyocardial biopsy: hypertrophy of myocytes with interstitial fibrosis
111
Q

describe the presentation of the condition seen in the image

A
  • presentation:
    • severe, crushing substernal pain >20 min. which can radiate to neck, jaw, epigastrium, shoulder or left arm
      • due to release of adenosine and lactate from necrotic cells on nerve endings
    • sympathetic response: accompanied by diaphoresis and dyspnea with rapid and weak pulse along with cold clammy hands
    • different than angina in that an MI can persist for days and isn’t always relieved by rest and/or vasodilators
112
Q

describe the shape of the LV in the condition seen in the image

A

banana-shaped LV →​ subaortic hypertrophy

113
Q

the condition seen in the image mainly affects the ____ and ___ arteries

A

the condition seen in the image mainly affects the tibial and radial arteries

  • 6Ps
    • paresthesia
    • pain
    • pallor
    • paralysis
    • poikilothermia
    • pulselessness
114
Q

describe the pathogenesis of the condition seen in the image

A
  • pathogenesis:
    • characterized by segmental, thrombosing, acute and chronic inflammation of small to medium arteries
    • granulomatous vasculitis with microabscesses → Type IV HS to tobacco
    • ONLY one that eventually extends to veins and nerves
      • involves entire neurovascular bundle
115
Q

describe the pathogenesis of the condition seen in the image

A
  • pathogenesis:
    • ineffective myocyte contraction → triggers exuberant growth factor release → intense compensatory hypertrophy → myofiber disarray and fibroblast prolif. → myocardial hypertrophy → abnormal diastolic filling
116
Q

describe investigations for the condition seen in the image

A

Antistreptolysin O (ASO) and DNAse B titer in blood

117
Q

describe the phrase “displaced temporal heterogeneity” in relation to the condition in the image

A

displaced temporal heterogeneity = old (fibrosis) and new (neutrophils and fibrinoid necrosis) inflammatory changes

118
Q

describe the most common cause of death by the condition in the image

A
  • can lead to aortic regurg./insufficiency/incompetency → blood to LV from LA AND aorta → volume overload → cor bovinum → LHF → pulm. edema → RHF from LHF
    • most common cause of death: LVH → CHF due to aortic regurgitation
119
Q

describe complications of the condition seen in the image

A
  • complication:
    • arrhythmia + mural thrombus (due to stasis) → embolizes → lower limb or brain (stroke)
120
Q

describe the pathogenesis of the condition seen in the image

A
  • pathogenesis:
    • abnormal blood → endothelial injury → focal deposits of platelet-fibrin
    • bacteremia → adherence (fibronectin and polysaccharides) → invasion of valvular defects
121
Q

describe the classic triad seen in the condition in the image

A
  1. acute necrotizing granulomas of upper and lower resp. tract
  2. focal necrotizing or granulomatous vasculitis affecting small to medium-sized vessels
  3. renal disease in the form of focal, or necrotizing, often crescentic glomerulitis

Path Exam 2 (4 decks)

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