Pathology Flashcards
1
Q
“blue babies”
A
early cyanosis, right-to-left shunts
2
Q
Right-to-left shunts
A
The 5 T’s
- Truncus arteriosus (1 vessel)
- Transposition (2 Vessels)
- Tricuspid atresia
- Tetralogy of Fallot
- TAPVR
3
Q
Persistent Truncus arteriosus
A
right-to-left shunt
failure of truncus arteriosus to divide into pumonary trunk and aorta; have accompanying VSD
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
5
Q
Tricuspid Atresia
A
right-to-left shunt
absence of tricuspid valve and hypoplastic RV; requires both ASD and VSD
6
Q
Tetralogy of Fallot
A
PROVe pulmonary infundibular stenosis RVH Overriding aorta VSD
7
Q
tet spells
A
Tetralogy of Fallot
8
Q
boot-shaped heart on CXR
A
right ventricular hypertrophy (part of tatralogy of fallot)
9
Q
How to improve cyanosis with tetralogy of fallot
A
Squat to increase systemic pressure shunting blood to the lungs for oxygen
10
Q
Total anomalous pulmonary venous return (TAPVR)
A
pulmonary veins drain into right heart circulation
associated with R-to-L shunting
11
Q
Most common congential cardiac defect
A
VSD (L-to-R shunt)
12
Q
Fixed split S2
A
ASD
13
Q
Paradoxical Embolus
A
DVT in this patient will lodge in the systemic circulation (brain) - from ASD
14
Q
Most common cause of ASD
A
Failure of Ostium Secundum tissue
15
Q
ASD from failure of Ostium primum
A
Associated with Down’s
16
Q
Late Cyanosis in lower extremities
A
PDA
17
Q
Congenital Rubella
A
Patent Ductus Arteriosus
18
Q
Indomethacin
A
closes PDA
19
Q
Patency of PDA
A
low oxygen tension and PGE
20
Q
holosystolic machine-like murmur
A
PDA
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
22
Q
Bicuspid aortic Valve
A
Associated with coarction of aorta
23
Q
Aorta narrowing proximal to ductus arteriosus. Associated wtih PDA
A
Infantile type Coarction of aorta
24
Q
Aorta narrowing distal to ductus arteriosus.
notching of the ribs
A
Adult type coarctation of aorta
25
HTN of upper extremities and delayed pulses in lower extremities
Adult type coarctation of aorta
26
22q11 syndromes
Truncus arteriosus, tetralogy of Fallor
27
Down Syndrome
ASD, VSD, AV septal (endocardial cushion) defect
28
Congenital Rubella
Septal defects, PDA, pulmonary artery stenosis
29
Turner Syndrome
Bicuspid aortic valve, coarctatino of aorta (preductal)
30
Marfan Syndrome
MVP, thoracic aortic aneurysm and dissection, aortic regurgitation
31
Infant of Diabetic Mother
Transposition of Great Vessels
32
Essential HTN
Most common type of HTN,(90-95%) related to increase CO and TPR
33
Secondary HTN
secondary to renal disease including fibromuscular dysplasia in young patients
34
Hypertensive emergency
>180/120mmHG, evidence of acute, on-going target organ damage
35
"string of beads"
renal artery in fibromuscular dysplasia, cause of HTN in young women
36
Renal Artery Stenosis
affected kidney atrophy, increased plasma renin
| atherosclerosis in old men, fibromuscular dysplasia in young women
37
benign HTN
mild/moderate increase in BP, clinically silent, vessels and organs are damaged over time
38
malignant HTN
sever increase in BP >200/120mmHg
| de novo or from benign HTN
39
Xanthelasma
xanthoma of eyelid
40
Plaques/nodules of lipid-laden histiocytes in the skin
Xanthoma
41
Tendinous xanthoma
Achilles tendon #1
42
Lipid deposit in cornea, appears early in life with hypercholesterolemia
Corneal arcus
43
Calcification in the media of the arteries
Monckeberg (medial calcific sclerosis)
44
Pipestem ateries on X-ray
Monckeberg (medial calcific sclerosis)
45
Thickening of small arteries in essential HTN or diabetes
Hyaline arteriololsclerosis
46
Hyperplasia of vessel smooth muscle - "onion skinning" seen in severe HTN
Hyperplastic asrteriolosclerosis
47
Dx of elastic arteries and lg and med muscular arteries
Atherosclerosis
48
Macrophage and LDL accumulation, leaves fatty streaks
Atherosclerosis
49
Most common location for atherosclerosis
Abdominal Aorta > Coronary Artery > Popliteal Artery > Carotid and internal carotid artery
50
Pulsatile Abdominal Mass
Abdominal aortic aneurysm (usually >50y/o smoking man)
51
Cystic Medial degeneration
Thoracic aortic aneurysm
52
Obliterative endarteritis of vasa vasorum
Thoarcic aneurysm associate with tertiary syphilis
53
Tree bark appearance of thoracic aorta
Obliterative endarteritis of vasa vasorum, tertiary syphilis
54
Hypotension, Pulsatile Abdominal Mass, Flank Pain
Ruptured abominal aorta
55
Longitudinal intraluminal tear forming a false lumen
aortic dissection
56
Tearing chest pain, sudden onset radiating to the back
Aortic dissection
57
Complication of Aortic Dissection
Pericardial Tamponade
58
Reversible Chest Pain <20 minutes
Angina
59
exertional/emotional chest pain, resolves with rest
ST depression, Stable Angina
60
ST depression
subendocardial ischemia
61
Chest pain at rest due to coronary artery spasm
Variant Angina (ST elevation)
62
ST elevation
Transmural ischemia
63
Treatment of Variant Angina
CCB, Nitrates, Smoking Cessation
64
Thrombosis with incomplete coronary artery occlusion causing increased frequency or intensity of chest pain
Unstable/crescendo angina (ST depression)
65
Complete occlusion of coronary artery and myocyte necrosis
Myocardial Infarction
| ST elevation if transmural ischemia, ST depression if sunendocardial ischemia
66
Death from cardiac cause within 1 hour of onset of symptoms
Sudden Cardiac Death
67
Severe Crushing Chest Pain >20minutes radiating to left arm or jaw
Myocardial infarction
68
Most common places for myocardial infarction
LAD > Rt Coronary artery > Left Circumflex artery
69
4-12hr after MI
coagulative necrosis, edema, hemorrhage, wavy fibers
70
12-24hr after MI
neutrophil migration starts, reperfusion injury possible band contraction
dark mottling; pale with tetrazolium stain
71
extensive coagulative necrosis, tissue surrounding infarct should acute inflammtion with neutrophils
1-3 days post-MI
72
chest pain and friction rub 1-3days post-transmural MI
Fibrinous pericarditis
73
Hyperemic border; central yellow-brown softening
| Macrophages and granulation tissue at margins
3-14days post-MI
74
Complications of Macrophages post-MI
free wall rupture (tamponade); papillary muscle rupture (MR), IV septal rupture (L-to-R shunt)
75
First 6hrs of MI, Gold Std
ECG
76
Cardiac Troponin
rises 4hrs post-MI, increased for 7-10days post-MI
77
CK-MB
useful for diagnosing reinfarction following acute MI (levels normal after 48hrs)
78
Pathological Q waves
evolving or old transmural infarct
79
ECG with Q waves V1-V4
Anterior Wall (LAD)
80
ECG with Q waves V1-V2
Anteroseptal Wall (LAD)
81
ECG with Q waves V4-V6
Anterolateral Wall (LAD of L. coronary circumflex)
82
ECG with Q waves I, aVL
Lateral Wall (L. coronary circumflex)
83
ECG with Q waves II, III, aVF
Inferior Wall (RCA)
84
Autoimmune phenomenon following an MI resulting in fibrinous pericarditis
Dressler Syndrome
85
Tx for MI
ASA/heparing, supplemental O2, Nitrate, b-blocker, ACE-I
86
Most Common cardiomyopathy
Dilated Cardiomyopathy
87
Alcohol Abuse
Dilated Cardiomyopathy
88
beriberi
Dilated Cardiomyopathy
89
Coxsackie B virus
Dilated Cardiomyopathy
90
Chronic Cocaine use
Dilated Cardiomyopathy
91
Chagas Disease
Dilated Cardiomyopathy
92
Doxorubicin Toxicity
Dilated Cardiomyopathy
93
Balloon appearing heart on CXR
Dilated Cardiomyopathy
94
beta-myosin heavy-chain mutation
Hypertrophy Cardiomyopathy
95
Cause of sudden death in young athletes
Hypertrophy Cardiomyopathy
96
Ventricular hypertrophy, often septal predominance. Myofibrillar disarray and fibrosis
Hypertrophy Cardiomyopathy
97
Hypertrophies septum too close to the anterior mitral leaflet
Obstructive Hypertrophy Cardiomyopathy
98
Systolic Dysfx vs Diastolic Dysfyx Cardiomyopathies
Systolic: Dilated cardiomyopathy
Diastolic: Hypertrophic and restrictive cardiomyopathy
99
Tx of Hypertrophic Cardiomyopathy
Stop high-intensity workouts, use beta-blockers or non-dihydropyridine CCB
100
Tx of Dilated Cardiomyopathy
SAlt restriction, ACE-I, Beta-Blockers, diuretics, digoxin, ICD, transplant
101
Loffler Syndrome
Associated with restrictive cardiomyopathy
| endomyocardial fibrosis with eosinophilic infiltrate
102
Major causes of Restrictive cardiomyopathy
sarcoidosis, amyloidosis, postradiation fibrosis, endocardial fibroelastosis
103
Low EF and contractility, often secondary to ischemic heart disease of dilated cardiomyopathy
Systolic Dysfunction CHF
104
Normal EF and contractility, impaired relaxation and decreased compliance
Diastolic Dysfunction CHF
105
CHF drugs that decrease mortality
ACE-inhibitors, beta-blockers (except in acute decompensated HF), ARBs and spironolactone
106
Cor pulmonale
right heart failure
107
Left Heart Failure
Pulmonary Edema, Orthopnea, Paroxysmal Nocturnal Dyspnea
108
Right Heart Failure
Nutmeg liver, peripheral edema, jugular venous distention
109
"heart failure cells"
hemosiderin-laden macrophages found in pulmonary edema for left heart failure
110
Breathless awakening from sleep
Paroxysmal Nocturnal Dyspnea (left HF)
111
Roth Spots
round white spots on retina surrounded by hemorrhage
| bacterial endocarditis
112
Osler nodes
tender raised lesions on finger or toe pads assoc with bacterial endocarditis
113
Janeway Lesions
small, painless, erythematous lesions on palm or sole assoc with bacterial endocarditis
114
S. aureus
Acute bacterial endocarditis
| large vegetations on previously normal valves usually tricuspid valves
115
Vegetations on previously damaged heart valves post dental procedure
Subacute endocarditis from Strep viridans streptococci
116
Bacterial endocarditis with a negative culture
Coxiella burnetti or Bartonella
117
vegetations on mitral valve along lines of closure resulting in regurgitation
Nonbacterial endocarditis (malignancy or hypercoagulable state or lupus)
118
bacterial endocarditis from prosthetic valves
S. epidermidis
119
bacterial endocarditis from colorectal cancer
S. bovis
120
Bacterial endocarditis with negative blood cultures
HACEK: hemophilus, actinobacillus, cardiobacterium, eikenella, kingella
121
Sterile Vegetations on both sides of the mitral valve resulting in mitral regurgitation
Libman-Sacks Endocarditis assoc with SLE
122
Vavles affected with Rheumatic Fever
mitral > aortic >> tricuspid
123
Aschoff cells
Rheumatic fever (granuloma with giant cells)
124
Anitschkow cells
Rheumatic fever (macrophages with wavy rod-like nucleus)
125
HS associated with Rheumatic Fever
Type II, antibodies to M protein cross-rxt with self-Ags
126
S&S of Rheumatic fever
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
ASO or Anti-DNAse B titer
Rheumatic fever
128
Pancarditis
Affects all 3 layers of the heart, Rheumatic fever
129
Fish mouth appearance of mitral valve due to fusion
Chronic rheumatic fever
130
Sharp pain aggrevated by inspiration, relieved by sitting up and leaning forward
Acute pericarditis
131
Serous cause of Acute pericarditis
viral or RA or SLE
132
Fibrinous Acute Pericarditis
caused by Dressler syndrome, uremia, radiation (Loud friction rub)
133
Suppurative Acute Pericarditis
bacterial infection, pneumococcus or Strep
134
Hypotension, JVD, Distant Heart Sounds
Beck triad, Cardiac Tamponade
135
Increased HR, pulsus paradoxus, Kussmal sign, ECG low voltage QRS, electrical alternans
Cardiac Tamponade
136
Pulsus Paradoxus
decrease in amplitude SBP by 10mmHg
| cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, and croup
137
Complications of Aortic Stenosis
concentric LV hypertrophy, angina and syncope with exercise, microangiopathic hemolytic anemia
138
Ballooning of MV into LA during systole
MVP
139
Myxoid degeneration of valve
MVP
140
Mid-systolic Click
MVP
141
Opening snap, followed by diastolic rumble
Mitral Stenosis
142
Widening of Pulse Pressure
Aortic regurgitation
143
Most common primary cardiac tumor
Myxoma
144
Ball-valve obstruction of left atrium
Myxoma
145
Multiple syncopal episodes associated cancer
Myxoma
146
Most common primary cardiac tumor in children
Rhabdomyoma (assoc with tubuerous sclerosis)
147
Kussmaul Sign
Increased JVP on inspiration because negative intrathoracic pressure not transmitted to heart
seen in constrictive pericarditis, restrictive cardiomyopathies, right atrial or ventricular tumors
148
Benign capillary hemangioma of infancy
Strawberry hemangioma, regress at 5-8years old
149
Benign capillary hemangioma of elderly, does not regress
Cherry Hemangioma
150
Polypoid capillary hemangioma that can ulcerate and bleed
Pyogenic granuloma (associated with trauma and pregnancy)
151
Cavernous lymphangioma of NECK.
Cystic Hygroma, associated with turner syndrome
152
Benign, painful, red-blue tumor under fingernails
Glomus tumor
153
Benign capillary skin papules found in AIDS patients caused by Bartonella henselae
Bacillary Angiomatosis
154
Blod vessel malignancy usually in elderly on sun-exposed skin and in liver after radiation of arsenic
Angiosarcoma
155
Lymphatic malignancy associated with persistent lymphedema usually after mastectomy
Lymphangiosarcoma
156
HHV8/HIV
Kaposi's sarcoma
157
Purple patches, plaques or nodules on skin that won't blanch when pressed on
Kaposi's sarcoma
158
Older Eastern European Males with purple patches on their skin
Kaposi's sarcoma
159
Unilateral HA and jaw Claudication
Temporal (giant cell) arteritis
160
May lead to irreversible blindness due to ophthalmic artery occlusion
Temporal (giant cell) arteritis
161
Flu symptoms with joint and muscle pain associated with Temporal (giant cell) arteritis
Polymyalgia rheumatica
162
Tx of Temporal (giant cell) arteritis
Corticosteroids immediately to prevent blindness, follow with temporal artery biopsy
163
Pulseless Dx
Takayasu arteritis
164
Granulomatous thickening and narrowing of aortic arch and proximal great vessels
Takayasu arteritis
165
Asian females <40y/o
Takayasu arteritis
166
Hepatitis B associated vasculitis
Polyarteritis nodosa
167
Ab pain, melena, HTN, renal damage, cutaneous eruptions, transmural inflammation of arterial wall with fibrinoid necrosis
Polyarteritis nodosa
168
Tx of Polyarteritis nodosa
Corticosteroids and cyclophosphamide
169
Organ spared in Polyarteritis nodosa
Lungs
170
Asian kid <4yr
Kawasaki Dx
171
strawberry tongue, hand and foot erythema, desquamating rash, conjunctival injection can treat with aspirin
Kawasaki Dx
172
Coronary artery aneurysm
Kawasaki Dx
173
Autoamputation of digits
Buerger Dx (Thromboangiitis obliterans)
174
Heavy smoker, males, intermittent claudication
Buerger Dx (Thromboangiitis obliterans)
175
hemoptysis and hematuria
Granulomatosis with polyangiitis (Wegener)
176
Focal necrotixing vasculitis, Necrotizing granulomas in the lungs, necrotizing glomerulonephritis
Granulomatosis with polyangiitis (Wegener)
177
cANCA, PR3-ANCA
Granulomatosis with polyangiitis (Wegener)
178
large nodular densities on CXR
Granulomatosis with polyangiitis (Wegener)
179
Tx of Granulomatosis with polyangiitis (Wegener)
cyclophosphamide and corticosteroids
180
MPO-ANCA/pANCA
microscopic polyangiitis and Churg-Strauss
181
pauci-immune glomerulonephritis and palpable purpura
microscopic polyangiitis & Churg-Strauss
182
Granulomatous necrotizing vasculitis with eosinophilia
Churg-Strauss
183
asthma, wrist/foot drop
Churg-Strauss
184
Most common childhood systemic vasculitis
Henoch-Schonlein Purpura
185
Palpable purpura on butt/legs, arthralgias, ab pain, melena that occurs after URI
Henoch-Schonlein Purpura
186
Vasculitis secondary to IgA complex deposition
Henoch-Schonlein Purpura
187
Associated with IgA nephropathy, IgA in mesangium
Henoch-Schonlein Purpura
188
Whatcha gonna do with that big fat butt?
wiggle wiggle wiggle wiggle
