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First Aid Cardiovascular > Pathology > Flashcards

Pathology Flashcards

1
Q

“blue babies”

A

early cyanosis, right-to-left shunts

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2
Q

Right-to-left shunts

A

The 5 T’s

  1. Truncus arteriosus (1 vessel)
  2. Transposition (2 Vessels)
  3. Tricuspid atresia
  4. Tetralogy of Fallot
  5. TAPVR
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3
Q

Persistent Truncus arteriosus

A

right-to-left shunt

failure of truncus arteriosus to divide into pumonary trunk and aorta; have accompanying VSD

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4
Q

D-transposition of great vessels

A

right-to-left shunt
aorta leave right ventricle, pulmonary trunk leaves left ventricle
failure of aorticopulmonary septum to spiral
Need PDA, VSD or patent foramen ovale

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5
Q

Tricuspid Atresia

A

right-to-left shunt

absence of tricuspid valve and hypoplastic RV; requires both ASD and VSD

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6
Q

Tetralogy of Fallot

A 
PROVe
pulmonary infundibular stenosis
RVH
Overriding aorta
VSD
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7
Q

tet spells

A

Tetralogy of Fallot

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8
Q

boot-shaped heart on CXR

A

right ventricular hypertrophy (part of tatralogy of fallot)

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9
Q

How to improve cyanosis with tetralogy of fallot

A

Squat to increase systemic pressure shunting blood to the lungs for oxygen

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10
Q

Total anomalous pulmonary venous return (TAPVR)

A

pulmonary veins drain into right heart circulation

associated with R-to-L shunting

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11
Q

Most common congential cardiac defect

A

VSD (L-to-R shunt)

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12
Q

Fixed split S2

A

ASD

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13
Q

Paradoxical Embolus

A

DVT in this patient will lodge in the systemic circulation (brain) - from ASD

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14
Q

Most common cause of ASD

A

Failure of Ostium Secundum tissue

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15
Q

ASD from failure of Ostium primum

A

Associated with Down’s

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16
Q

Late Cyanosis in lower extremities

A

PDA

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17
Q

Congenital Rubella

A

Patent Ductus Arteriosus

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18
Q

Indomethacin

A

closes PDA

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19
Q

Patency of PDA

A

low oxygen tension and PGE

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20
Q

holosystolic machine-like murmur

A

PDA

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21
Q

Uncorrected Left-to-right shunt causing increased pulm flow remodeling the vasculature leading to pHTN, RVH and shunt reverses to right-to-left.

A

Eisenmenger Syndrome

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22
Q

Bicuspid aortic Valve

A

Associated with coarction of aorta

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23
Q

Aorta narrowing proximal to ductus arteriosus. Associated wtih PDA

A

Infantile type Coarction of aorta

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24
Q

Aorta narrowing distal to ductus arteriosus.

notching of the ribs

A

Adult type coarctation of aorta

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25
Q

HTN of upper extremities and delayed pulses in lower extremities

A

Adult type coarctation of aorta

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26
Q

22q11 syndromes

A

Truncus arteriosus, tetralogy of Fallor

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27
Q

Down Syndrome

A

ASD, VSD, AV septal (endocardial cushion) defect

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28
Q

Congenital Rubella

A

Septal defects, PDA, pulmonary artery stenosis

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29
Q

Turner Syndrome

A

Bicuspid aortic valve, coarctatino of aorta (preductal)

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30
Q

Marfan Syndrome

A

MVP, thoracic aortic aneurysm and dissection, aortic regurgitation

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31
Q

Infant of Diabetic Mother

A

Transposition of Great Vessels

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32
Q

Essential HTN

A

Most common type of HTN,(90-95%) related to increase CO and TPR

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33
Q

Secondary HTN

A

secondary to renal disease including fibromuscular dysplasia in young patients

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34
Q

Hypertensive emergency

A

> 180/120mmHG, evidence of acute, on-going target organ damage

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35
Q

“string of beads”

A

renal artery in fibromuscular dysplasia, cause of HTN in young women

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36
Q

Renal Artery Stenosis

A

affected kidney atrophy, increased plasma renin

atherosclerosis in old men, fibromuscular dysplasia in young women

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37
Q

benign HTN

A

mild/moderate increase in BP, clinically silent, vessels and organs are damaged over time

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38
Q

malignant HTN

A

sever increase in BP >200/120mmHg

de novo or from benign HTN

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39
Q

Xanthelasma

A

xanthoma of eyelid

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40
Q

Plaques/nodules of lipid-laden histiocytes in the skin

A

Xanthoma

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41
Q

Tendinous xanthoma

A

Achilles tendon #1

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42
Q

Lipid deposit in cornea, appears early in life with hypercholesterolemia

A

Corneal arcus

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43
Q

Calcification in the media of the arteries

A

Monckeberg (medial calcific sclerosis)

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44
Q

Pipestem ateries on X-ray

A

Monckeberg (medial calcific sclerosis)

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45
Q

Thickening of small arteries in essential HTN or diabetes

A

Hyaline arteriololsclerosis

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46
Q

Hyperplasia of vessel smooth muscle - “onion skinning” seen in severe HTN

A

Hyperplastic asrteriolosclerosis

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47
Q

Dx of elastic arteries and lg and med muscular arteries

A

Atherosclerosis

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48
Q

Macrophage and LDL accumulation, leaves fatty streaks

A

Atherosclerosis

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49
Q

Most common location for atherosclerosis

A

Abdominal Aorta > Coronary Artery > Popliteal Artery > Carotid and internal carotid artery

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50
Q

Pulsatile Abdominal Mass

A

Abdominal aortic aneurysm (usually >50y/o smoking man)

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51
Q

Cystic Medial degeneration

A

Thoracic aortic aneurysm

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52
Q

Obliterative endarteritis of vasa vasorum

A

Thoarcic aneurysm associate with tertiary syphilis

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53
Q

Tree bark appearance of thoracic aorta

A

Obliterative endarteritis of vasa vasorum, tertiary syphilis

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54
Q

Hypotension, Pulsatile Abdominal Mass, Flank Pain

A

Ruptured abominal aorta

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55
Q

Longitudinal intraluminal tear forming a false lumen

A

aortic dissection

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56
Q

Tearing chest pain, sudden onset radiating to the back

A

Aortic dissection

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57
Q

Complication of Aortic Dissection

A

Pericardial Tamponade

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58
Q

Reversible Chest Pain <20 minutes

A

Angina

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59
Q

exertional/emotional chest pain, resolves with rest

A

ST depression, Stable Angina

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60
Q

ST depression

A

subendocardial ischemia

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61
Q

Chest pain at rest due to coronary artery spasm

A

Variant Angina (ST elevation)

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62
Q

ST elevation

A

Transmural ischemia

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63
Q

Treatment of Variant Angina

A

CCB, Nitrates, Smoking Cessation

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64
Q

Thrombosis with incomplete coronary artery occlusion causing increased frequency or intensity of chest pain

A

Unstable/crescendo angina (ST depression)

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65
Q

Complete occlusion of coronary artery and myocyte necrosis

A

Myocardial Infarction

ST elevation if transmural ischemia, ST depression if sunendocardial ischemia

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66
Q

Death from cardiac cause within 1 hour of onset of symptoms

A

Sudden Cardiac Death

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67
Q

Severe Crushing Chest Pain >20minutes radiating to left arm or jaw

A

Myocardial infarction

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68
Q

Most common places for myocardial infarction

A

LAD > Rt Coronary artery > Left Circumflex artery

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69
Q

4-12hr after MI

A

coagulative necrosis, edema, hemorrhage, wavy fibers

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70
Q

12-24hr after MI

A

neutrophil migration starts, reperfusion injury possible band contraction
dark mottling; pale with tetrazolium stain

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71
Q

extensive coagulative necrosis, tissue surrounding infarct should acute inflammtion with neutrophils

A

1-3 days post-MI

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72
Q

chest pain and friction rub 1-3days post-transmural MI

A

Fibrinous pericarditis

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73
Q

Hyperemic border; central yellow-brown softening

Macrophages and granulation tissue at margins

A

3-14days post-MI

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74
Q

Complications of Macrophages post-MI

A

free wall rupture (tamponade); papillary muscle rupture (MR), IV septal rupture (L-to-R shunt)

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75
Q

First 6hrs of MI, Gold Std

A

ECG

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76
Q

Cardiac Troponin

A

rises 4hrs post-MI, increased for 7-10days post-MI

77
Q

CK-MB

A

useful for diagnosing reinfarction following acute MI (levels normal after 48hrs)

78
Q

Pathological Q waves

A

evolving or old transmural infarct

79
Q

ECG with Q waves V1-V4

A

Anterior Wall (LAD)

80
Q

ECG with Q waves V1-V2

A

Anteroseptal Wall (LAD)

81
Q

ECG with Q waves V4-V6

A

Anterolateral Wall (LAD of L. coronary circumflex)

82
Q

ECG with Q waves I, aVL

A

Lateral Wall (L. coronary circumflex)

83
Q

ECG with Q waves II, III, aVF

A

Inferior Wall (RCA)

84
Q

Autoimmune phenomenon following an MI resulting in fibrinous pericarditis

A

Dressler Syndrome

85
Q

Tx for MI

A

ASA/heparing, supplemental O2, Nitrate, b-blocker, ACE-I

86
Q

Most Common cardiomyopathy

A

Dilated Cardiomyopathy

87
Q

Alcohol Abuse

A

Dilated Cardiomyopathy

88
Q

beriberi

A

Dilated Cardiomyopathy

89
Q

Coxsackie B virus

A

Dilated Cardiomyopathy

90
Q

Chronic Cocaine use

A

Dilated Cardiomyopathy

91
Q

Chagas Disease

A

Dilated Cardiomyopathy

92
Q

Doxorubicin Toxicity

A

Dilated Cardiomyopathy

93
Q

Balloon appearing heart on CXR

A

Dilated Cardiomyopathy

94
Q

beta-myosin heavy-chain mutation

A

Hypertrophy Cardiomyopathy

95
Q

Cause of sudden death in young athletes

A

Hypertrophy Cardiomyopathy

96
Q

Ventricular hypertrophy, often septal predominance. Myofibrillar disarray and fibrosis

A

Hypertrophy Cardiomyopathy

97
Q

Hypertrophies septum too close to the anterior mitral leaflet

A

Obstructive Hypertrophy Cardiomyopathy

98
Q

Systolic Dysfx vs Diastolic Dysfyx Cardiomyopathies

A

Systolic: Dilated cardiomyopathy
Diastolic: Hypertrophic and restrictive cardiomyopathy

99
Q

Tx of Hypertrophic Cardiomyopathy

A

Stop high-intensity workouts, use beta-blockers or non-dihydropyridine CCB

100
Q

Tx of Dilated Cardiomyopathy

A

SAlt restriction, ACE-I, Beta-Blockers, diuretics, digoxin, ICD, transplant

101
Q

Loffler Syndrome

A

Associated with restrictive cardiomyopathy

endomyocardial fibrosis with eosinophilic infiltrate

102
Q

Major causes of Restrictive cardiomyopathy

A

sarcoidosis, amyloidosis, postradiation fibrosis, endocardial fibroelastosis

103
Q

Low EF and contractility, often secondary to ischemic heart disease of dilated cardiomyopathy

A

Systolic Dysfunction CHF

104
Q

Normal EF and contractility, impaired relaxation and decreased compliance

A

Diastolic Dysfunction CHF

105
Q

CHF drugs that decrease mortality

A

ACE-inhibitors, beta-blockers (except in acute decompensated HF), ARBs and spironolactone

106
Q

Cor pulmonale

A

right heart failure

107
Q

Left Heart Failure

A

Pulmonary Edema, Orthopnea, Paroxysmal Nocturnal Dyspnea

108
Q

Right Heart Failure

A

Nutmeg liver, peripheral edema, jugular venous distention

109
Q

“heart failure cells”

A

hemosiderin-laden macrophages found in pulmonary edema for left heart failure

110
Q

Breathless awakening from sleep

A

Paroxysmal Nocturnal Dyspnea (left HF)

111
Q

Roth Spots

A

round white spots on retina surrounded by hemorrhage

bacterial endocarditis

112
Q

Osler nodes

A

tender raised lesions on finger or toe pads assoc with bacterial endocarditis

113
Q

Janeway Lesions

A

small, painless, erythematous lesions on palm or sole assoc with bacterial endocarditis

114
Q

S. aureus

A

Acute bacterial endocarditis

large vegetations on previously normal valves usually tricuspid valves

115
Q

Vegetations on previously damaged heart valves post dental procedure

A

Subacute endocarditis from Strep viridans streptococci

116
Q

Bacterial endocarditis with a negative culture

A

Coxiella burnetti or Bartonella

117
Q

vegetations on mitral valve along lines of closure resulting in regurgitation

A

Nonbacterial endocarditis (malignancy or hypercoagulable state or lupus)

118
Q

bacterial endocarditis from prosthetic valves

A

S. epidermidis

119
Q

bacterial endocarditis from colorectal cancer

A

S. bovis

120
Q

Bacterial endocarditis with negative blood cultures

A

HACEK: hemophilus, actinobacillus, cardiobacterium, eikenella, kingella

121
Q

Sterile Vegetations on both sides of the mitral valve resulting in mitral regurgitation

A

Libman-Sacks Endocarditis assoc with SLE

122
Q

Vavles affected with Rheumatic Fever

A

mitral > aortic&raquo_space; tricuspid

123
Q

Aschoff cells

A

Rheumatic fever (granuloma with giant cells)

124
Q

Anitschkow cells

A

Rheumatic fever (macrophages with wavy rod-like nucleus)

125
Q

HS associated with Rheumatic Fever

A

Type II, antibodies to M protein cross-rxt with self-Ags

126
Q

S&S of Rheumatic fever

A

FEVERSS of JONES
fever, erythema marginatum, valvular damage, increased ESR, red-hot joints (migratory polyarthritis in wrists knees or ankles), subcutaneous nodules, St. Vitus dance (sydenham chorae)

127
Q

ASO or Anti-DNAse B titer

A

Rheumatic fever

128
Q

Pancarditis

A

Affects all 3 layers of the heart, Rheumatic fever

129
Q

Fish mouth appearance of mitral valve due to fusion

A

Chronic rheumatic fever

130
Q

Sharp pain aggrevated by inspiration, relieved by sitting up and leaning forward

A

Acute pericarditis

131
Q

Serous cause of Acute pericarditis

A

viral or RA or SLE

132
Q

Fibrinous Acute Pericarditis

A

caused by Dressler syndrome, uremia, radiation (Loud friction rub)

133
Q

Suppurative Acute Pericarditis

A

bacterial infection, pneumococcus or Strep

134
Q

Hypotension, JVD, Distant Heart Sounds

A

Beck triad, Cardiac Tamponade

135
Q

Increased HR, pulsus paradoxus, Kussmal sign, ECG low voltage QRS, electrical alternans

A

Cardiac Tamponade

136
Q

Pulsus Paradoxus

A

decrease in amplitude SBP by 10mmHg

cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, and croup

137
Q

Complications of Aortic Stenosis

A

concentric LV hypertrophy, angina and syncope with exercise, microangiopathic hemolytic anemia

138
Q

Ballooning of MV into LA during systole

A

MVP

139
Q

Myxoid degeneration of valve

A

MVP

140
Q

Mid-systolic Click

A

MVP

141
Q

Opening snap, followed by diastolic rumble

A

Mitral Stenosis

142
Q

Widening of Pulse Pressure

A

Aortic regurgitation

143
Q

Most common primary cardiac tumor

A

Myxoma

144
Q

Ball-valve obstruction of left atrium

A

Myxoma

145
Q

Multiple syncopal episodes associated cancer

A

Myxoma

146
Q

Most common primary cardiac tumor in children

A

Rhabdomyoma (assoc with tubuerous sclerosis)

147
Q

Kussmaul Sign

A

Increased JVP on inspiration because negative intrathoracic pressure not transmitted to heart
seen in constrictive pericarditis, restrictive cardiomyopathies, right atrial or ventricular tumors

148
Q

Benign capillary hemangioma of infancy

A

Strawberry hemangioma, regress at 5-8years old

149
Q

Benign capillary hemangioma of elderly, does not regress

A

Cherry Hemangioma

150
Q

Polypoid capillary hemangioma that can ulcerate and bleed

A

Pyogenic granuloma (associated with trauma and pregnancy)

151
Q

Cavernous lymphangioma of NECK.

A

Cystic Hygroma, associated with turner syndrome

152
Q

Benign, painful, red-blue tumor under fingernails

A

Glomus tumor

153
Q

Benign capillary skin papules found in AIDS patients caused by Bartonella henselae

A

Bacillary Angiomatosis

154
Q

Blod vessel malignancy usually in elderly on sun-exposed skin and in liver after radiation of arsenic

A

Angiosarcoma

155
Q

Lymphatic malignancy associated with persistent lymphedema usually after mastectomy

A

Lymphangiosarcoma

156
Q

HHV8/HIV

A

Kaposi’s sarcoma

157
Q

Purple patches, plaques or nodules on skin that won’t blanch when pressed on

A

Kaposi’s sarcoma

158
Q

Older Eastern European Males with purple patches on their skin

A

Kaposi’s sarcoma

159
Q

Unilateral HA and jaw Claudication

A

Temporal (giant cell) arteritis

160
Q

May lead to irreversible blindness due to ophthalmic artery occlusion

A

Temporal (giant cell) arteritis

161
Q

Flu symptoms with joint and muscle pain associated with Temporal (giant cell) arteritis

A

Polymyalgia rheumatica

162
Q

Tx of Temporal (giant cell) arteritis

A

Corticosteroids immediately to prevent blindness, follow with temporal artery biopsy

163
Q

Pulseless Dx

A

Takayasu arteritis

164
Q

Granulomatous thickening and narrowing of aortic arch and proximal great vessels

A

Takayasu arteritis

165
Q

Asian females <40y/o

A

Takayasu arteritis

166
Q

Hepatitis B associated vasculitis

A

Polyarteritis nodosa

167
Q

Ab pain, melena, HTN, renal damage, cutaneous eruptions, transmural inflammation of arterial wall with fibrinoid necrosis

A

Polyarteritis nodosa

168
Q

Tx of Polyarteritis nodosa

A

Corticosteroids and cyclophosphamide

169
Q

Organ spared in Polyarteritis nodosa

A

Lungs

170
Q

Asian kid <4yr

A

Kawasaki Dx

171
Q

strawberry tongue, hand and foot erythema, desquamating rash, conjunctival injection can treat with aspirin

A

Kawasaki Dx

172
Q

Coronary artery aneurysm

A

Kawasaki Dx

173
Q

Autoamputation of digits

A

Buerger Dx (Thromboangiitis obliterans)

174
Q

Heavy smoker, males, intermittent claudication

A

Buerger Dx (Thromboangiitis obliterans)

175
Q

hemoptysis and hematuria

A

Granulomatosis with polyangiitis (Wegener)

176
Q

Focal necrotixing vasculitis, Necrotizing granulomas in the lungs, necrotizing glomerulonephritis

A

Granulomatosis with polyangiitis (Wegener)

177
Q

cANCA, PR3-ANCA

A

Granulomatosis with polyangiitis (Wegener)

178
Q

large nodular densities on CXR

A

Granulomatosis with polyangiitis (Wegener)

179
Q

Tx of Granulomatosis with polyangiitis (Wegener)

A

cyclophosphamide and corticosteroids

180
Q

MPO-ANCA/pANCA

A

microscopic polyangiitis and Churg-Strauss

181
Q

pauci-immune glomerulonephritis and palpable purpura

A

microscopic polyangiitis & Churg-Strauss

182
Q

Granulomatous necrotizing vasculitis with eosinophilia

A

Churg-Strauss

183
Q

asthma, wrist/foot drop

A

Churg-Strauss

184
Q

Most common childhood systemic vasculitis

A

Henoch-Schonlein Purpura

185
Q

Palpable purpura on butt/legs, arthralgias, ab pain, melena that occurs after URI

A

Henoch-Schonlein Purpura

186
Q

Vasculitis secondary to IgA complex deposition

A

Henoch-Schonlein Purpura

187
Q

Associated with IgA nephropathy, IgA in mesangium

A

Henoch-Schonlein Purpura

188
Q

Whatcha gonna do with that big fat butt?

A

wiggle wiggle wiggle wiggle

First Aid Cardiovascular (4 decks)

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