Exam #2 Flashcards
Left Ventricle Hypertrophy (EKG)
V1-V2: deep S wave
V5-V6: tall R wave
ST-T abnormalities: V6
Right Ventricle Hypertrophy (EKG)
V1: dominant tall R wave
V5-V6: deep S wave
ST-T abnormalities: inverted T wave at V1-V3
Right Atrial Abnormalities (EKG)
Lead II: peaked P wave
Lead V1: first pos. P wave larger than second neg. P wave (80:20)
Coarctation of the Aorta is common found in pateints w
Turner Syndrome
4-24hrs post MI Morphological Changes
dark mottling - coagulation necrosis
1-3 days post MI Morphological Changes
yellow palor - neutrophil infiltrate
4-7 days post MI Morphological Changes
hyperemic border w central yellow palor - dead cells phagocytize by macrophages
7-10 days post MI Morphological Changes
yellow palor centre w depressed red-tan margins - granulation tissue at margins
10-14 days post MI Morphological Changes
red gray borders - established granulation tissues
> 2 months post MI Morphological Changes
white gray color - collagen scarring
Hypertrophic Cardiomyopathy causes
Autosomal dominant mutation in
- B myosin chain
- myosin binding protein C
Restrictive Cardiomyopathy cause
Amyloidosis leading to formation of B-pleaded sheets
heat beat box count
300 150 100 75 60 50
AV Nodal Re-Entrant Tachycardia ECG finding
Retrograde P wave following the QRS complex
Atrioventricular Re-Entrant Tachycardia (Wolff Parkinson White syndrome) EKG
Short PR interval with slurred wide QRS
Delta wave
Orthodromic AVRT motion and ekg
- through AV node then through accessory pathway back to atrium
- Retrograde P wave after QRS complex
Antidromic AVRT motion and ekg
- through accessory pathway then through AV node back to atrium
- Large wide bizarre QRS followed by retrograde P wave
AV block 2nd Degree Mobitz Type III EKG
2 P wave for every 1 QRS complex
AV block 3rd Degree EKG
Loss of conduction between atria and ventricle resulting in the ventricle pacing themselves
P wave and QRS have no correlation
Normal sinus rhythm (QRS are consistent)
Right Bundle Branch Block EKG
WIDE QRS
V1: QRS will be pointing up
V1-V3: inverted T wave
V6: pos. R wave w wide S wave
Left Bundle Branch Block EKG
WIDE QRS
V1: QRS will be pointing down
V1-V3: positive T wave
Myoglobin used in MI
to assess for reperfusion after thrombolysis
management of MI
HOBANACS
Heparin Oxygen Beta blocker Aspirin Nitroglycerin ACE inhibitor Clopidogrel (antiplatelet) Statins
Aortic stenosis murmur
(Harsh, systolic, crescendo-decrescendo murmur
Aortic Valve Regurgitation murmur
Diastolic, high pitch, blowing decrescendo murmur
Mitral Valve Stenosis murmur
Opening snap followed by mid-diastolic rumbling murmur
Acute Mitral Valve Regurgitation
S3 and systolic murmur at apex
Chronic Mitral Regurgitation
Pansytolic murmur at apex radiating to the axilla (holosystolic)
clinical for aortic stenosis symptoms
TRIAD: angina, syncope, and left sided HF
-Pulsus parvus et tardus (weak/delayed carotid pulse)
Aortic Valve Regurgitation features
- Wide pulse pressure
- Water hammer pulse
- head bobbing
Mitral Valve Stenosis causes
- rheumatic Mitral Stenosis
- pregnancy
Mitral valve stenosis can cause
Atrial fibrillation
Prophylaxis for endocarditis
standard: amoxiciliin
high Thyroxine leads to
- increases contraction
- Increases B1 receptors on heart (increase HR)
high Insulin (generally insulin resistant diabetes)
- high causes smooth muscle hypertrophy decreasing compliance of blood vessels
- increase sympathetic activity
Hypertension Effect on Kidneys
- Afferent arterial looses sensitivity to inc pressure
- Mesangial cell proliferation: line bowman’s capsule and causes less filtration
- Loss of Glomeruli: dec in GFR
Hypertension
Stage 1
Stage 2
Stage 1: 130-139 or diastolic 80-89
Stage 2: >140 or diastolic >90
Peripheral Artery Disease symptoms
- pain in lower legs on exertion due to lactic build up bc low O2,
- different BPs in different locations (should be no more than 10mm difference in different locations)
Microalbuminuria defintion and marker
early marker for renal failure
-marked increase in albumin in urine
Renovascular Hypertension definiton
obstruction of flow in the renal arteries w under perfusion of the kidney resulting in activation of RAAS
Renovascular Hypertension definiton key symptom
- Controlled hypertension with “flash” pulmonary edema
- string of pearls on arteriogram
Renal Parenchymal Hypertension definition and diagnosis
Any disease that causes renal damage can lead to increased bp leading to activation of RAAS
-Diagnosis: inc in BUN/creatinine and proteinuria
Primary Aldosteronism
diagnosis
recognized by hypokalemia and high aldosterone but suppressed renin levels
Cushing Syndrome diagnosis
- Diagnosis: elevation of urine free cortisol in a 24- hour urine collection
- Can also have weight gain, abdominal striae, truncal obesity
Fibromuscular Dysplasia
irregular thickening in medial and intimal hyperplasia and fibrosis of large muscular arteries
Hyaline arteriolosclerosis
plasma leaking into damaged endothelial walls resulting in vascular thickening
Nephrosclerosis
hyaline arteriolosclerosis causes vessel narrowing leading to impaired renal flow and glomerular scarring
Hyperplastic arteriolosclerosis
-appearance
thickening of vessel walls due to hyperplasia of smooth muscle
-“onion skin” appearance
Atherosclerosis effects what vessels
lower abdominal aorta > coronary arteries > popliteal arteries > internal carotid arteries > vessels of circle of Willis
postitive for PR3-ANCA, previously c-ANCA
Granulomatosis with Polyangiiti (Wegener’s granulomatosis)
Giant Cell (Temporal) Arteritis cause and treatment
can lead to blindness
treat w steroids
Polyarteritis nodosa (PAN) effects and association
- effects main organs but spares the lungs
- associated with hepatitis B w deposits containing HBsAg-HBsAb complexes
Kawasaki Disease presentation
- child w red rash of palms and soles
- red tongue
- conjunctivitis
positive for MPO-ANCA, previously p-ANCA
Eosinophilic Granulomatosis with Polyangiitisor (Churg-Strauss syndrome)
Port wine stain association
distribution of trigeminal nerve are associated with Sturge-Weber syndrome
Kaposi sarcoma cause
HHV-8
Kaposi sarcoma
- classic
- african endemic
- transplant associated
- AIDS associated
- Classic KS: Older men, uncommon in US
- Endemic African KS: Typically in HIV-seronegative individuals
- Transplant-associated KS: Occurs in solid organ transplant recipients in setting of T-cell immunosuppression
- AIDS-associated (epidemic) KS: Is AIDS-defining illness
Angiosarcoma
endothelial cell marker CD31
HF w Reduced EF (Systolic HF) cause
1 CA disease
Alc
Chemotherapy
Secondary myocarditis causes
- SLE (autoimmune), medications, chemicals
- CHEMOTHERAPIES (oxidative stress causes apoptosis)
- COCAINE
colon cancer endocarditis
Strep gallolyticus (formerly Strep bovis)
Lemierre syndrome definition, microbe, and common location
endovascular infection associated with infected thrombus and bacteremia
- Fusobacterium
- jugular vein
Infective Myocarditis causes
Adenovirus
Coxsackie
Enteroviruses
Chaga’s Disease (Trypanosoma cruzi - parasite)
mutation in what can lead to cardiomyopathy
dystrophin
Worms that effect lungs
- Ascaris lumbricoides (Giant Roundworm)
- Necator americanus/Ancylostoma duodenale(Hookworms)
- Strongyloides sterocalis (Threadworm)
scotch tape preparation used for
Enterobius vermicularis (pinworm)
Trichinellosis source and how it looks on history
- walrus, pork, bear
- spiral appearance
Gallbladder Cancer fluke
Bladder Cancer fluke
- Gallbladder Cancer: Clonorchis sinesis
- Bladder Cancer: Schistosoma
high affinity for b12
Diphyllobothrium latum
Taenia solium vs T. saginata
- Taenia solum (soo bad): can lead to Cysticercosis which is a tissue infection (cysts) that can lead to neurocysticercosis
- Taenia saginata (not-so-bad) - localized in intestines
cause lymphatic filariasis
Wuchereria bancrofti
Brugia malayi
Brugia timori
Differentiate Loa loa and Onchocerca volvulus in terms of their respective vectors, clinical presentation, and likelihood of causing vision loss
Loa Loa
- Vector: Deer fly and Crysops (mango fly)
- Clinical Presentation: Calabar swellings,
- Vision Loss: NO
Onchocerca volvulus
- Vector: Simulium flies (blackfly or buffalo gnat)
- Clinical Presentation: nodules in dermis and subcutaneous tissue
- Vision Loss: YES
Dracunculus medininsis treatment
Extract worm slowly 1 cm per day
Rapid Fermenters
E. Coli
Klebsiella
Enterobacter
Slow Fermenters
Citrobacter
Serratia
fermenters appearance on MacConkey agar
purple/pink
symptoms of Pseudomonas aeruginosa
(BE PSEUDO) B urns E ndocarditis P neumonia S epsis E xternal otitis U TI D rug use O steomyelitis
Pseudomonas aeruginosa
- Oxidase
- Smell
Oxidase POSITIVE
Odor: GRAPES
Red pigments
Serratia
Currant jelly sputum
Klebsiella pneumoniae
Rose Spots
Salmonella typhi
Hotel air-conditioner cooling tank
Legionella
GNR that causes Hyponatremia
Legionella
- obligate anaerobe
- Infections usually follows breach of mucosal barrier
- Commonly found with E. col/GNRs
Bacteroides fragilis
Describe the classical presentation of Salmonella typhi and how it differs from infection with non-typhoidal strains of Salmonella
Salmonella typhi
Presentation: classically seen with rose spots, high fever, and slow pulse pressure
Non-typhoidal strains normally present with nausea, vomiting, cramps, and bloody diarrhea but NO fever
E. coli 0157:H7 most commonly and symptoms
EHEC
HUS
Thrombocytopenia
Acute renal failure (uremia)
Positive Fecal Leukocyte Test
EIEC, Salmonella, Shigella
EHEC: EIEC: EPEC: ETEC: characterization
EHEC: hemorrhagic
EIEC: shigella like toxin
EPEC: children’s diarrhea
ETEC: traveler’s diarrhea (clear, watery)
Ehrlichia vs Anaplasma
- tick
- cell type
Ehrlichia: monocyte
- Lone Star Tick
Anaplasma: neutrophil
- Ixodes scapularis
Bartonellosis
Oganism:
Animal Vector:
Presentation:
Oganism: Bartonella henselae
Animal Vector: cats (fleas)
Presentation: erythemous and swollen where cat scratched leading to regional lymphadenopathy
Chronic: red striations (similar to stretch marks)
Brucellosis
Oganism:
Animal Vector:
Brucellosis
Oganism: Brucella melintensis
Animal Vector: goats/sheep, cows, pigs and dogs (meat processor0
Psittacosis
Oganism:
Animal Vector:
(“Parrot Fever”)
Oganism: Chlamydophila psittaci
Animal Vector: parrot feces (pet store owner)
Q fever
Oganism:
Animal Vector:
Oganism: Coxiella burnetiI
Animal Vector: Goats, Sheep and Cattle
Tularemia
Oganism:
Animal Vector:
Presentation
Oganism: Francisella tularensis
Animal Vector: rabbits, ticks, deer flies
Presentation: ulceroglandular form most common
cyclical fever, skin ulcers where contact was made, and swollen/painful regional lymphadenopathy
pneumonic is most serious form
Pasteurellosis
Oganism:
Animal Vector:
Presentation:
Oganism: Pasteurella multocida
Animal Vector: normal mouth flora of cats and dogs
Presentation: Rapid onset of pain, tenderness, swelling/erythema following scratch or bite
conjunctival suffusion
Conjunctival Suffusion: appears early in Weil’s disease which leads to liver damage (jaundice), renal failure, & bleeding
-leptospirosis
Explain how leptospirosis is transmitted, describe a classical case
- Transmission: infected animals shed in urine and contaminates water
- Classic Case: surfer/swimmer in tropics (freshwater)
Match the pathogens, vector and illness name for the three rickettsias discussed in class
R. prowazekii (Epidemic typhus)
Vector: body lice
R. typhi (Murine typhus)
Vector: Rat flees
R. rickettsia (Rocky Mountain Spotted Fever)
Vector: Dog Tick (Dermacentar
list the triad of symptoms caused by RMSF
R. rickettsia Triad of Symptoms: -Headache -Fever -Rash: starts on wrist and spreads everywhere (includes palms and soles)
Identify the cause of bubonic plague and its vector; describe a Bubo.
Yersinia pestis
Vector: rat/prairie dog/ squirrel flea bites
Bubos: intense swollen lymph nodes
- Erythema and edema of overlying skin
- Inguinal region most frequent
Turbulence equation
velocity x vessels diameter x blood density / viscosity
moderate/severe mitral regurg can lead to
diastolic murmur
