Pathology Flashcards
1
Q
Early cianosis
A
Right to left shunts. Blue babies
2
Q
Right to left shunts
A
5 Ts:
- Truncus arteriosus: 1 vessel
- Transposition: 2 vessels
- Tricuspid atresia: 3= Tri
- Tetralogy of fallot: 4= Tetra
- TAPVR = 5 letters= total anomalous pulmonary venous return
3
Q
Lack of aorticopulmonary septum formation
A
Persistent truncus arteriosus
4
Q
Separation of systemic and pulmonary circulations
A
Transposition of great vessels
5
Q
Not compatible with life unless a shunt is present
A
Transposition of great vessels
6
Q
Transposition of great vessels prognosis
A
Without surgical intervention most infants die within first few months of life
7
Q
Requires both ASD and VSD for viability
A
Tricuspid atresia
8
Q
Most common cause of early childhood cyanosis
A
Tetralogy of fallot
9
Q
Anteriosuperior displacement of the infundibular septum
A
Tetralogy of Fallot
10
Q
Tetralogy of fallot
A
PROVe
- Pulmonar infundibular stenosis
- Right ventricular hypertrophy: boot-shaped heart
- Overriding aorta
- VSD
11
Q
Determinant for prognosis in tetralogy of Fallot
A
Pulmonar infundibular stenosis
12
Q
Treatment of tetralogy of Fallot
A
Early surgical correction
13
Q
Squatting effect over tetralogy of Fallot
A
it increases systemic vascular resistance, decreasing right to left shunt (lower pressure difference), thus improving cyanosis.
14
Q
Pulmonary veins drain into right heart circulation
A
TAPVR: total anomalous pulmonary venous return
15
Q
TAPVR usually associates
A
ASD or PDA to allow for right to left shunting to mantain CO
16
Q
Caused by lithium exposure in utero
A
Ebstein anomaly
17
Q
Ebstein anomaly
A
Displacement of tricuspid valve leaflets downward into RV
Artificially atrializes the ventricle
Tricuspid regugitation + Right Heart Failure
18
Q
Tet spells
A
Cyanotic episodes: crying, fever and exercise cause exacerbation of RV outflow obstruction, increasing right to left flow across VSD
19
Q
Acyanotic presentation, it may occur later
A
Left to right shunts
20
Q
Frequency of Left to right shunts
A
VSD>ASD>PDA
21
Q
Most common congenital heart defect
A
Ventricular septal defect
22
Q
Presentation of VSD
A
- asymptomatic at birth
- manifests later or remains asymptomatic
- most selfe resolve
- larger lesions lead to LV overload and HF
23
Q
May lead to paradoxical emboly
A
ASD
24
Q
Atrial septal defects are caused by defects in
A
Ostium secundum: more frequent, isolated
Ostium primum: rare, associate other cardiac anomalies
25
Continuous machine like murmur
Patent ductus arteriosus
26
Uncorrected _____ can result in late cyanosis in the lower extremities
Patent ductus arteriosus
27
Eisenmenger syndrome
Uncorrected left to right shunt: VSD, ASD, PDA
High pulmonary blood flow: pulmonary arterial hypertension: RVHypertrophy to overcompensate: shunt becomes right to left
Causes:
- Late cyanosis
- Clubbing
- Polycitemia
28
Aortic narrowing near insertion of ductus arteriosus
Coarctation of the aorta
29
Coarctation of aorta associates
1. Bicuspid aortic valve
2. Turner syndrome
3. Other heart deffects
30
Notched ribs appearence on CXR
Coarctation of aorta: intercostal arteries enlarge due to collateral circulation: arteries erode ribs
31
Hypertension in upper extremities and weak, delayed pulse in lower extremities: brachial-femoral delay
Coarctation of aorta
32
Coarctation of aorta complications
1. Heart failure
2. Risk of cerebral hemorrhage= berry aneurisms
3. Aortic rupture
4. Endocarditis
33
Alcohol exposure in utero leads to
```
VSD
PDA
ASD
Tetralogy of fallot
Left to right + TofF
```
34
Congenital rubela leads to
PDA
Pulmonary artery stenosis
Septal defects
35
Down syndrome heart deffects
AV septal defect: endocardial cushion defect
VSD
ASD
36
Infant of diabetic mother heart deffect
Transposition of great vessels
37
Marfan syndrome heart defects
Mitral valve prolapse: hiperlaxitud
Thoracic aortic aneurysm and dissection
Aortic regurgitation
38
Turner syndrome heart defects
Bicuspid aortic valve
| Coarctation of aorta
39
Williams syndrome heart defects
Supravalvular aortic stenosis
40
22q11 syndromes heart deffects
Truncus arteriosus
| Tetralogy of Fallot
41
Define hypertension
Persistent systolic BP>140, diastolic BP>90
42
90% of hypertension is...
Primary=essential
43
10% of hypertension is due to
Renovascular disease
| 1º hyperaldosteronism
44
String of beads in renal artery
Fibromuscular dysplasia
45
Hypertensive urgency
>180/120 hypertension WITHOUT acute end organ damge
46
Hypertensive emergency
Severe hypertension with evidence of acute end organ damage:
- Brain: encephalopathy, stroke
- Eyes: retinal hemorrhages/exudates, papilledema
- Heart: MI/HF, aortic disection
- Kidney: injury, microangiopathic hemolytic anemia
- Eclampsia
47
Hiperlipidemia signs
1. Xanthomas: lipid-laden histiocytes. Eyelids: xanthelasma
2. Tendinous xantoma: achilles
3. Corneal arcus: common in elderly: arcus senilis
48
Calcification of internal elastic lamina and media of medium sized arteries
Mönckberg sclerosis: medial calcific sclerosis
49
Pipestem appearance on xray
Mönckberg sclerosis
50
Mönckberg sclerosis and blood flow
DOESNT obstruct
51
Types of arteriolosclerosis
1. Hyaline: thickening in essential hypertension or Dm
| 2. Hyperplasic: onion skinning in severe hypertension
52
Arteriosclerosis
Hardening of arteries with arterial wall thickening and loss of elasticity
53
Atherosclerosis
Disease of elastic arteries and large and medium sized muscular arteries: form of arteriosclerosis caused by buildup of cholesterol plaques
54
Location of atherosclerosis
Abdominal aorta > coronary artery>popliteal artery>carotid artery
55
Symptoms of atherosclerosis
Angina
| Claudication
56
Progression of atherosclerosis
endothelial cell dysfunction: macrophage and LDL accumulation: foam cell formation: fatty streaks: smooth muscle cell migration: proliferation and exrtacellular matrix deposition: fibrous plaque: complex atheromas
57
Localised pathological dilation of the aorta
Aortic aneurism
58
Palpable pulsatile abdominal mass
Abdominal aortic aneurysm
59
Abdominal aortic aneurysm is associated with
Atherosclerosis
60
Thoracic aortic aneurysm is associated with
Cystic medial degeneration
61
Risk factors for thoracic aneurysm
- HTA
- Bicuspid aortic valve
- Connective tissue disease: Marfan
- 3ary syphilis: endarteritis obliterans of vasa vasorum
62
Most frequent location of traumatic aortic rupture
Aortic isthmus: proximal descending aorta distal to origin of left subclavian artery
63
Aortic dissection
Longitudinal intimal tear forming a false lumen
64
Types of aortic dissection
Standford type A: Ascending aorta
| Standford type B: Descending aorta
65
Treatment of Standford type A aortic dissection
Surgery
66
Treatment of Standford type B aortic dissection
Medically:
- Beta blockers
- Vasodilators
67
Necrosis in angina
No myocyte necrosis
68
Chest pain due to ischemic myocardium 2º to coronary artery narrowing or spasm
Angina
69
Types of Angina
1. Stable
2. Variant-Prinzmetal
3. Unstable
70
Stable Angina
- 2º to atherosclerosis
- Exertional chest ain in classic distribution
- ST depression on ECG usually
- Resolves with rest or nitroglicerin
71
Variant Angina
- AT REST
- 2ª to coronary artery spasm
- Transient ST elevation on ECG
72
Risk factors for Variant Angina
Smoking
| HTA and hypercholesterolemia are not
73
Triggers Variant Angina
Cocaine
Alcohol
Triptans: 5HT1 agonist for migraine
74
Treatment of Variant Angina
Ca channel blockers
Nitrates
Smoking cessation
75
Stable angina is secondary to
Atherosclerosis
76
Unstable angina is secondary to
Thrombosis
77
Unstable angina
- Secondary to thrombosis with incomplete coronary artery oclusion
- +- ST depression and or T wave inversion
- NO CARDIC biomarker elevation (unlike NSTEMI)
78
NSTEMI vs Unstable angina
Unstable angina has no cardiac biomarker elevation
79
Principle behind pharmacologic stress tests with coronary vasodilators
Coronary steal syndrome
- Dipyridamole
- Regadenoson
80
Coronary steal syndrome
Administration of vasodilators dilates normalvessels and shunts blood towards well perfused areas, diverting flow away from stenosed vessels, leading to ischemia in myocardium perfused by these
81
Sudden cardiac death
Death from cardiac causes within 1 hour of onset of symptoms, most commonly due to a lethal arrhythmia
82
Prevent Sudden cardiac death
Implantable cardioverter defibrillator
83
Sudden cardiac death is associated with _______ up to 70% of cases
Coronary artery disease
Other causes:
-Cardiomyopathy
-Hereditary ion channelopathies: long QT syndrome, Brugada syndrome
84
Progressive onset of heart failure over many years due to chronic ischemic myocardial damage
Chronic ischemic heart disease
85
Myocardial infarction most common cause
Acute thrombosis due to rupture of coronary artery atherosclerotic plaque
86
Cardiac biomarkers in myocardial infarction
Elevated (diagnostic)
- CK-MB
- Troponins
87
ST segment elevation MI
Transmural infarct
Full thickness of myocardial wall involves
ST elevation on ECG
Q waves
88
Non ST segment elevation MI
Subendocardial infarct
| ST depression on ECG
89
Part of the heart wall specially vulnerable to ischemia
Subendocardium: inner 1/3 rd
90
Occluded coronary arteries causing myocardial infarction frequency
Left anterior descending > Right Coronary Artery > Circumflex
91
Myocardial infarction symptoms
- Diaphoresis
- Nausea and vomiting
- Severe retrosternal pain
- Pain in left arm and or jaw
- Shortness of breath
- Fatigue
92
Complication 1-3 days after myocardial infarction
Fibrinous pericarditis
93
Complication 3-14 days after myocardial infarction
RUPTURES
1. Free wall rupture: tamponade
2. Papillary muscle rupture: mitral regurgitation
3. Interventricular septal rupture: macrophage-mediated structural degradation
4. Left ventricle pseudoaneurism: risk of rupture
94
Complication 0-24 hours after myocardial infarctions
1. Heart failure
2. Ventricular arrythmia
3. Cardiogenic shock
95
Complication 2 weeks-months after myocardial infarction
Dressler syndrome
Heart failure
Arrythmias
True ventricular aneurysm: risk of mural thrombus
96
Dressler syndrome
Autoimmune inflammatory reaction (pericarditis) to myocardial neo-antigens formed as a result of the MI
97
Myocardial infarction diagnoses
1. First 6 hours: ECG (GS)
2. Cardiac troponin I: rises after 4 hours, peaks at 24 hours, lasts 7-10 days. more specific
3. CK-MB: rises after 6-12 hours, peaks at 16-24 hours. Useful dx reinfarction following acute MI as it stabilises after 48 hours
98
STEMi V1-V2
Anteroseptal: LAD
99
STEMI v3-V4
Anteroapical: distal LAD
100
STEMI V4-V5
Anterolateral: LAD or LCX
101
STEMI I, aVL
Lateral: LCX
102
STEMI II, III, aVF
Inferior: RCA
103
STEMI v7-V9
| ST depression in V1-V3 with tall R waves
Posterior: PDA
104
Myocardial infarct complications
1. Cardiac arrythmia
2. Post infarction fibrinous pericarditis
3. Papillary muscle rupture
4. Interventricular septal rupture
5. Ventricular pseudoaneurysm formation
6. Ventricle free wall rupture
7. True ventricular aneurysm
8. Dressler syndrome
9. LV failure and pulmonary edema
105
Protect against free wall rupture
LV hypertrophy
| Previous MI
106
Autoimmune phenomenon resulting in fibrinous pericarditis
Dressler syndrome
107
Unstable angina/NSTEMI treatment
```
Anticoagulation: heparin
Antiplatelet therapy: aspirin
ADP receptor inhibitor: clopidogrel
Beta blockers
ACE inhibitors
Statin
Syptom control: nitroglycerin and morphine
```
108
STEMI treatment
```
Reperfusion therapy: Percutaneous coronary intervention >fibrinolysis
Anticoagulation: heparin
Antiplatelet therapy: aspirin
ADP receptor inhibitor: clopidogrel
Beta blockers
ACE inhibitors
Statin
Symptom control: nitroglycerin and morphine
```
109
Types of cardiomyopathies
1. Dilated cardiomyopathy
2. Hypertrophic cardiomyopathy
3. Restrictive cardiomyopathty
110
Most common cardiomyopathy
Dilated: 90% of cases
111
Balloon appearance of heart on CXR
Dilated cardiomyopathy
112
Cardiomyopathy with systolic disfunction
Dilated cardiomyopathy
113
Eccentric hypertrophy of heart
Dilated cardiomyopatht: sarcomers added in series
114
Causes of dilated cardiomyopathy
1. Idiopathic
2. Familial
3. Alcohol abuse
4. Wet Beri Beri
5. Coxsackie B viral myocarditis
6. Chronic Cocaine use
7. Chagas disease
8. Doxorubicin toxicity
9. Hemochromatosis
10. Sarcoidosis
11. Peripartum cardiomyopathy
115
Dilated cardiomyopathy treatment
1. Na restriction
2. ACE inhibitors
3. Beta blockers
4. Diuretics
5. Digoxin
6. ICD
7. Heart transplant
116
Ventricular apical ballooning due to increased sympathetic stimulation (stressful situations)
Takotsubo cardiomyopathy
117
Most common cause of hypertrophic cardiomyopathy
60-70% of cases are familial, autosomal dominant due to mutations encoding sarcomeric proteins such as myosin binding protein C and beta myosin heavy chain
118
Associated with Friedreich ataxia
Hypertrophic cardiomyopathy
119
Causes syncope during exercise
| May lead to sudden death in young athletes due to ventricular arrythmia
Hypertrophic cardiomyopathy
120
Cardiomyopathy with diastolic dysfunction
Hypertrophic
| Restrictive
121
Ventricular concentric hypertrophy: sarcomers added in parallel
Hypertrophic cardiomyopathy
122
Hypertrophic obstructive cardiomyopathy
Subset of hypertrophic cardiomyopathy
- Asymetrical septal hypertrophy + systolic anterior motion of mitral valve: outflow obstruction: dyspnea, possible syncope
123
Treatment of hypertrophic cardiomyopathy
- Cessation of high intensity atheltics
- use of beta blocker or non dihydropyridine Ca channel blockers
- ICD if patient is at high risk
124
Infiltrative cardiomyopathy
```
Restrictive cardiomyopathy:
-postradiation fibrosis
-Loffler syndrome
-Endocardial fibroelastosis
-Amyloidosis
-Sarcoidosis
-Jemocromatosis
Puppy LEASH
```
125
Sarcoidosis and hemochromatosis produce
Dilated > restrictive cardiomyopathy
126
Loeffler syndrome
Endomyocardial fibrosis with a prominent eosinophilic infiltrate
127
Cor pulmonale
Isolated right HF due to pulmonary cause
128
Dercrease heart failure mortality
ACE inhibitors
ARB
Beta blockers: except acute descompensated
Spironolactone
129
Presence of hemosiderin laden macrophages in lungs
Heart failure cells: pulmonary edema
130
Left heart failure produces
Orthopnea
Paroxysmal nocturnal dyspnea
Pulmonary edema
131
Right heart failure produces
Hepatomegaly: nutmeg liver
Jugular venous distension
Peripheral edema
132
Shock
Inadequate organ perfusion and delivery of nutrients for normal tissue and cellular function
133
Types of shock
1. Hypovolemic
2. Cardiogenic
3. Obstructive
4. Distributive
134
Skin in shock
Always cold and clammy except in distributive shock:
| Warm and dry
135
Hypovolemic shock treatment
IV fluids
136
Cardiogenic shock treatment
Inotropes
| Diuretics
137
Obstructive shock treatment
Relieve obstruction
138
Distributive shock treatment
IV fluids
| Pressors
139
Most common symtoms of bacterial endocarditis
Fever
140
Acute endocarditis is due to
S aureus: high virulence
| Large vegetations on previously normal valves
141
Subacute endocarditis is due to
Viridans streptococci: low virulence
| smaller vegetations on congenitally abdnormal or diseased valves
142
Endocarditis in patients with colon cancer
S bovis: gallocyticus
143
Endocarditis in patients with prostetic valves
S epidermidis
144
Marantic/thrmobotic/non bacterial endocarditis
Malignancy
Hypercoagulable state
SLE
145
Valve most frequently envolved in endocarditis
Mitral
146
Endocarditis associated with IV drug abuse
Tricuspid: dont tri drugs
147
IV drug abuse endocarditis microorganisms
S aureus
Psedomonas
Candida
148
Negative culture in suspected endocarditis
Coxiella burnetti: Q fever
Bartonella spp
HACEK: haemophilus, aggregatibacter, cardiobacterium., eikenella, kingella
149
Endocarditis findings
FROM JANE:
- Fever
- Roth spots: white in retina surrounded by hemorrage
- Osler nodes: immune complex deposition
- Murmur
- Janeway lesions: erythematous lesions in palm/soles
- Anemia
- Nail-bed hemorrage
- Emboli
- Glomerulonephritis
150
Consequence of pharyngeal infection with group A beta hemolytic streptococci
Rheumatic fever
151
Pathology findings in rheumatic fever
1. Aschoff bodies: granuloma with giant cells
2. Anitschkow cells: enlarged macrophages with rod like nucleus
3. High antistreoptolysin O titers: ASO
152
Prophylaxis of rheumatic fever
Penicillin
153
Rheumatic fever is due to
Immune mediated type II hypersensitivity. antibodies to M protein cross react with self antigens: molecular mimicry
154
JONES major criteria for Rheumatic fever
```
J♥NES
Joint migratory polyarthritis
♥Carditis
Nodules in skin subcutaneous
Erythema marginatum
Sydenham chorea
```
155
Commonly presents with:
- sharp pain
- aggravated by inspiration
- relieved by sitting up and leaning forward
Acute pericarditis
156
Complication of acute pericarditis
Pericardial effusion: friction rub
157
ECG changes in pericarditis
WIDESPREAD:
ST segment elevation
PR depression
158
Compression of the heart by fluid in pericardial space
Cardiac tamponade: low Cardiac output
159
Equilibration of diastolic pressures in all 4 chambers
Cardiac tamponade
160
Findings of cardiac tamponade
```
Beck triad!
- Hypotension
- Distended neck veins
- Distant heart sounds
High heart rate
Pulsus paradoxus
```
161
Cardiac tamponade ECG
Low voltage QRS
| Electrical alternans: swinging movement of heart in large effusion
162
Pulsus paradoxus
Decreasing in amplitude of systolic blood presure by >10 mmHg during inspiration
- Cardiac tamponade
- Asthma
- Obstructive sleep apnea
- Pericarditis
- Croup
163
Calcification of aortic root, ascending aortic arch and thoracic aorta
Syphilitic heart disease
164
Tree bark appearance of aorte
Syphilitic heart disease: result in aortic aneurysm or insufficiency
165
Most common heart tumor
Metastasis
166
Most common primary cardiac tumor
Mixoma
167
90% of mixomas occour in
Atria: left atrium
168
Ball valve obstruction in left atrium + multiple syncopes
Myxoma
169
Most frequent primary cardiac tumor in children
Rhabdomyomas
170
Associated with tuberous sclerosis
Rhabdomyomas
171
Kussmaul sign
Rise in Jugular venous pressure on inspiration instead of a normal dicrease:
- constrictive pericarditis
-restrictive cardiomyopathies
-right atrial or ventricular tumors
Impaired filling of ventricle: blood backs up into venae cavae
172
Large vessel vasculitis
1. Giant cell (temporal) arteritis
| 2. Takayasu arteritis
173
Medium vessel vasculitis
1. Polyarteritis nodosa: PAN
2. Kawasaki disease: mucocutaneous lymph node syndrome
3. Buerger disease: thromboangiitis obliterans
174
Small vessel vasculitis
1. Wegener Granulomatosis
2. Microscopic polyangiitis
3. Churg-Strauss granulomatosis
4. Henoch-Schönlein purpura
175
Jaw claudication and unilateral headache in an elderly female
Giant cell arteritis
176
Vasculitis with high ESR (VSG)
Giant cell arteritis
| Takayasu arteritis
177
Treatment of giant cell arteritis
High dose corticosteroids prior to temporal artery biopsy to prevent blindness
178
Complication of giant cell arteritis
1. Irreversible blindness due to ophtalmic artery occlusion
| 2. Polymialgia rheumatica
179
Weak upper extremity pulses, fever, night sweats, arthitis, myalgias, skin nodules, ocular disturbances in <40 years old asian woman
Takayasu arteritis
180
Granulomatous thickening and narrowing of aortic arch and proximal great vessels
Takayasu arteritis
181
Renal microaneurysms
Polyarteritis nodosa
182
Pulmonary affection in polyarteritis nodosa
None
183
Vasculitis with 30% hepatitis B seropositivity
Polyarteritis nodosa
184
kawasaki disease presentation
```
-Asian children <4 years old
CRASH
-Conjunctival injection
-RASH: polymorphous, desquamating
-Adenopathy cervical
-Strawberry tong: oral mucositis
-Hand foot changes: edema, erythema
-Fever
```
185
Kawasaki disease treatment
IV immunoglobulin
| Aspirin
186
Vasculitis that may develop coronary artery aneurysms
Kawasaki disease
187
Vascultisi in heavy smoker males younger than 40 years old
Buerger disease
188
Treatment of Buerger disease
Smoking cessation
189
High PR3-cANCA
Wegner granulomatosis
190
Wegener granulomatosis findings
1. Upper respiratory: Perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis
2. Lower respiratory: hemoptysis, cough, dyspnea
3. Renal: hematuria, red cell casts
191
Wegner granulomatosis triad
1. Focal necrotizing vasculitis
2. Necrotizing granulomas in the lung and upper airway
3. Necrotizing glomerulonephritis
192
Wegener granulomatosis treatment
Cyclophosphamide
| Corticosteroids
193
Eosinophilic granulomatosis
Churg-Strauss
194
pANCA and high IgE
Churg-Strauss granulomatosis
195
Most common childhood ssytemic vasculitis
Henoch-Schönlein vasculitis
196
Follows upper respiratory infection
Henoch-Schönlein vasculitis
197
Associated with IgA nephropathy (Berger disease)
Henoch-Schönlein vasculitis
198
Vasculitis secondary to Ig A immune complex deposition
Henoch-Schönlein vasculitis
199
Henoch-Schönlein vasculitis triad
1. Skin: palpable purpura on buttocks/legs
2. Artharlgias
3. Abdominal pain
200
Osler-Weber-Rendu syndrome
hereditary hemorrhagic telangiectasia
201
Osler-Weber-Rendu syndrome findings
1. Telangiectasia
2. Recurrent epistaxis
3. Skin discolorations
4. Arteriovenous malformation
5. GI bleeding
6. Hematuria
