Path

Question 1

LAD

Answer 1

Anterior/anteroseptal wall of LV

Question 2

LCx

Answer 2

Lateral wall LV

Question 3

LAD+RCA

Answer 3

Septal wall

Question 4

RCA

Answer 4

Posterior wall/posterior 1/3 of interventicular septum** SA node so infarct here can result in arrhythmia

Question 5

Gross Changes Post MI0-12 h12-1824-721 wk2-3wk4-6wk

Answer 5

0-12 Hours – No changes 12-18 Hours – Pallor 24-72 Hours – White Infarct with Hyperemic Borders1 Week – Loss of Hyperemia 2-3 Weeks – Soft Gelatinous4-6 Weeks – Scarring/Fibrosis

Question 6

Systolic Murmurs

Answer 6

Aortic StenosisPulmonic StenosisMitral Regurgitation/ProlapseTricuspid RegurgitationVentricular Septal DefectHypertrophic Cardiomyopathy

Question 7

Histologic Time Sequence Post MI3-6 hr12-24 hr24 hr5-7d8-10d10-14d2-4wk4-6wk

Answer 7

3-6 Hours – Wavy fibers (non-contracting ischemic myocytes 12-24 Hours – Coagulation necrosis, hypereosinophilic myocytes24 Hours – Neutrophil infiltration peaking at 3-5 days5-7 Days – Macrophage infiltration and neutrophils regress 8-10 Days – Lipofuscin (wear and tear pigment)10-14 Days – Granulation tissue at infarct borders 2-4 Weeks – Fibroblasts depositing collagen4-6 Weeks+ - Mature Scar

Question 8

Diastolic Murmurs

Answer 8

Aortic RegurgitationPulmonic RegurgitationMitral Stenosis Tricuspid Stenosis

Question 9

Best to hear Aortic Valve

Answer 9

2nd-3rd R interspace

Question 10

best to hear pulmonic valve

Answer 10

2nd-3rd L interspace

Question 11

best to hear tricuspid valve

Answer 11

L sternal border

Question 12

best to hear mitral valve

Answer 12

apex

Question 13

Type I Atherosclerosis: Thickening of Intima

Answer 13

smooth muscle cells (HHF-35 positive) – you have more of these come inno macrophages (CD68 negative) and no lipids (oil-red-O negative)

Question 14

Type II Atherosclerosis: Intimal Xanthoma

Answer 14

Progressive thickening with macrophagesCD68 positive and Oil-red-O positiveThis is when you have the formation of FOAMY CELLS (macrophages filled with lipids)

Question 15

Type III Atherosclerosis: Pathologic Intimal Thickening

Answer 15

small cells of extracellular liquidNo symptoms at this point, because of positive remodeling Diameter of the artery changes, but the diameter of the lumen doesn’t changeThis is when you start to get worried, but this is not pathologic yet

Question 16

Type IV Atherosclerosis: Fibroatheroma

Answer 16

core of extra-cellular lipid starts to formstart to get symptoms because lumen starts to be narrowed

Question 17

Type V Atherosclerosis: Thin-cap fibroatheroma

Answer 17

Fibrous thickening of cap. Completion of formation of fibroatheroma. Fibroatheroma = well-formed lipid necrotic core surrounded by macrophages and lymphocytes with an overlying fibrous cap rich in SMCsThin-Cap Fibroatheroma = vulnerable plaque (i.e. vulnerable to disruption, leading to coronary thrombosis), since it has a thin fibrous cap infiltrated by macrophages (CD 68+) Cap – made of fibrin and smooth muscle cells, will start getting thin or thick, important to know if it is thin or thickLipid necrotic core

Question 18

Type VI Atherosclerosis: Thrombus

Answer 18

Thrombus formation after surface defectOccurs either by plaque rupture or plaque erosion

Question 19

6 Stages of Atherosclerosis

Answer 19

Thickening of IntimaIntimal XanthomaPathological Intimal ThickeningFibroatheromaThin-cap fibroatheromaThrombus

Question 20

Most Common cause of death post-MI

Question 21

Congenital Diseases predisposing to aneurysm

Answer 21

Marfan Syndrome: Fibrillin-1, elastinEhler’s Danlos Syndrome: mutation in collagen, procollagen Type III

Question 22

Libman-Sacks endocarditis

Answer 22

Non-infectiousUndersurface of valvesAssoc w/ SLESmall, sterile emboli break offTricuspid, mitral

Question 23

Aortic stenosis auscultation

Answer 23

Normal S1Ejection clickSystolic C-D murmurNormal S2Diastolic D murmur

Question 24

Aortic regurg auscultation

Answer 24

Softer S1Ejection clickBrief, early systolic murmurSingle, softer S2S3 gallop*diastolic D murmur (low pitch = severe)

Question 25

Mitral stenosis auscultation

Answer 25

Louder S1Opening snapPulmonic component S2 gets louderDiastolic murmur

Question 26

Mitral regurg ausculatation

Answer 26

S1 normal or diminished*holosystolic, steady murmurS2 sound splitting increasedDiastolic murmur possibleSoft S3 gallop