HY - pulm + cardiac Flashcards
two organisms of lobar pneumonia
streptococcus penumoniae + klebsiella pneumoniae
lung CA of non-smoker + periphery
adenocarcinoma
four phases of lobar pneumonia
congestion, red hepaization, grey hepatization, resolution
common cause of secondary pneumonia + complicated by abscess or empyema
staph aureus
atypical/interstitial penumoniae
mycoplasma pneumoniae, chlamydia pneumoniae, RSV, CMV, influenza virus, coxiella burnettie
not visible on gram stain
mycoplasma pneumoiae; lack of cell wall, similar to eukaryotes with cholesterol components
aspiration pneumonia + right lower lobe abscess
bacterioides, fusobacterium, peptococcus
AFB stain + caseating granuloma
mycobacterium
caseating granulomase + meningites at base of brain
systemic tb
arsenic + polycyclic hydrocarbons
particularly carcinogenic features of smoking
benign coin lesions
granulomas + broncial hamartoma (disorganized tissue with lung tissue + cartilage)
keratin pearls + intercellular bridges
squamous cell carcinoma
center tumor + ADH, ACTH or eaton-lambert syndrome
small cell carcinoma
central tumor + keratin pears and intercellular bridge + PTHrP (hypercalcemia)
squamous cell carcinoma
chromogranin positive + polyp-like mass in lung
neuroendocrine tumor; carcinoid syndrome
metastasis to lung
breast and colon CA
where does lung metastasize to?
adrenal gland
lung tumor in apex
compresses sympathetic chain; horner syndrome - ptosis, miosis, anhydriosis
exertional dyspnea in a young woman
primary pulmonary HTN; inactivating BMPR2 mutation
BMPR2 inactivating mutation + plexiform lesions + atherosclerosis of pulmonary arter
pulmonary HTN
pink hyaline membranes
ARDS; develop hypoxemia + diffuse collapse of lungs
neutrophil mediated damaged to type 1 and 2 pneumocytes by proteases and FR
ARDS
complications of NRDS
persistence of PDA, necrotizing enteroclitis; supplemental oxygen increase risk of free radical injury (damage to retina causing blindness, bronchopulminary dysplasia)
centri-acinar emphysema + upper lobes
smoker emphysema
PAS + liver in someone with emphysema
A1AT deficiency with buildup in liver
prolonged expiration with pursed lips
emphysema; back pressure keeps airways open
barrel chest
emphysema; lose elastic recoil
lose elastic recoil
emphysema
increase elastic recoil
pulmonary fibrosis
main cytokines from TH2
IL 4 (class-switching), IL5 (recruit eos), IL10 (promote overall reaciton, + TH1 and X TH2)
charcot-leyden crystals
eosinophil dervied in sputum of asthmatic
SAA and AA
secondary amyloidosis
fibrosis mediator in IPF
TGF-b
secondary causes of pulmonary fibrosis
radiation, bleomycin, amiodarone
coal workers lung + RA
Caplan syndrome
anthracosis
collections of carbon-laden macrophages
pneumoconioses that increases risk of TB
silicosis; impairs phagolysosomes formation by macrophages
non-caseating granulomas in lung, hilar lymph nodes + systemic organs + aeorospace worker
berylliosis; doen’t confuse with sarcoidosis
iron ferruginous bodies
asbestosis
epithelioid histiocytes
defining cell of granuloma
asterioid body
sarcoidosis
non-caseating granuloma disease that can mimic sjogrens disease
sarcoidosis
elevated serum ACE + hypercalcemia (1-a hydroxylase activity) + non-caseating granulomas
sarcoidosis
hypercalcemia in non-caseating granulomas
high levels of 1-a hydroxylase
blood supply to papillary muscle
RCA; can rupture following ischemia with occlusion of this vessel day 4-7
pericarditis several weeks following MI
Dressler syndrome; auto-antibodies against pericardium
coagulative necrosis following MI
4-34 hrs, no inflammation cells
when would you see fibrinoid pericarditis?
transumural infarction
when develop scar post MI?
after 1 month; type 1 collagen
hemosiderin laden macrophages within lungs
herat failure cells
what do blood vessels lung do in response to hypoxemia?
constrict, makes it harder for heart to pump, can lead to cor pulmonale wh
what heart defect is associated with FAS?
ventricle septal defect
results of eisenmeger syndrome
cyanosis, clubbing, right ventircular hypertorphy
which type of ASD is associated with down syndrome?
ostium primum
congenital rubella is associated with what heart defect?
PDA
machine-like murmur + lower extremity cyanosis
PDA; lower extermity cyanosis due to pulmonary HTN
what to close PDA?
Indomethacine, gets rid of PDE
cyanosis upon exercising + squat to relieve
R to L shunt, increase pressure on L side favoring blood flow to pulmonary circulation
boot-shaped heart
T of F
how to keep baby with transposition of great vessels alive?
keep PDA open with PGE
maternal diabetes associated with what heart defect?
transposition of great vessels
truncus arteriosus
persistent due to failure of division ; early cyanosis due to mixing of blood in ventricles
tricuspid atresia
early cyanosis since blood can’t go to pulmonary circulation
infantile coarctation of the aorta
associated with pda, between aortic arch and PDA, lower extremity cyanosis, turnery syndrome
what heart defect is turner syndrome associated with?
coarctation of the aorta with lower extremity cyanosis
adult coarctation of the aorta
HTN in UE and hypotension with weak pulses in LE; associated with bicuspid aortic valve
acute rheumatic fever
systemic complication due to immune response to M protein (molecular mimcry) = damage to human tissues with auto-antibodies
diagnosis of ARF
evidence of strep b infection with ASO or anti-DNase B titer; fever or elevated fever; J (joint, migratory polyarthralgias) O (heart, pancarditis) N (nodules, subcutaneous) E (erythema marginatum) S (sydnans chorea)
what is long term sequelae or ARF?
heart - mitral valve +/- aortic, aschoff bodies and aniskoff cellls within myocardium
what will kill patients with ARF?
myocarditis
increased risk of aortic stenosis
bicuspid aortic valve; turner syndrome
distinguish aortic dises of aortic stenosis from rheumatic disease
rheumatic disease will have fusion of valves
early, blowing diastolic murmur
aortic regurgitation
what does aortic regurgitaiton do to the pulse pressure?
widens it; patient will have head-bobbing, bounding pulses, pulsatile nail beds
mid-systolic click followed by regurgitation murmur
mitral valve prolapse
holosystolic blowing murmur louder with squatting and expiration
mitral regurgitation
what does acute vs chronic rheumatic fever do to the mitral valve?
acute = regurgitaiton (holosystolic blowing murmur; chronic = aomitral stenosis with diastolic murmur
opening snap followed by diastolic rumble
mitral stenosis
small vegetations on previously damaged valves
low virulence s viridans
large vegetations on tricuspid
highly infectious s aurea; IV drug user
endocarditis of prosthatetic valves
s epidermidis
patient is determined to have endocarditis with s bovis. what should you check next?
unerlying colorectal cancer
endocarditis with negative blood cultures
HACEK (hemophilus, actinobacillus, cardiobacterium, eikenella, kingella); paritculalrly hard to grow on cluture
what technique can be used to visualize valvular vegetations?
TEE
libman sacks endocarditis
sterile vegatations on both sides of valve; usually mitral valve with regurgitaiton
complications of dilated cardiomyopathy
valve regurgitation (mitral and tricuspid) + arrhytmia
doxorubicin + late complication of coxsackie virus + alcohol + pregnancy
dilated cardiomyopathy
acute vs late consequences of myocarditis
acute = death, later on = dilated cardiopmyopathy
mutations in _____ most common cause of hypertrophic cardiomyopathy
mutations in sarcomere
sudden death of young athlete or syncope with exercise
hypertrophic cardiomyopathy
myofier hypertrophy with disarray
hy[pertrophic cardiomyopathy
causes of restrictive cardiomyopathy
amyloidosis, sarcoidsosi, hemochromatosis, endocrdial fibroelastosis, loeffler syndrome
low voltage EKG with diminished QRS amplitudes
restrictive cardiomyopathy presenting as CHF
children + tuberous sclerosis + benign hamartoma of cardiac muscle
rhabdomyoma
