Pathology Part 2 Flashcards

1
Q

What is an aortic aneurysm?

A

Localized pathological dilation of BV

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2
Q

Abdominal aortic aneurysm is associated with _________ and occurs more frequently in _______ over the age of __________.

A

atherosclerosis, hypertensive male smokers, 50

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3
Q

Thoracic aortic aneurysm is associated with what?

A
  • Hypertension
  • Cystic medial necrosis (marfan syndrome)
  • Tertiary syphilis
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4
Q

What is an aortic dissection?

A

Longitudinal intraluminal tear forming a false lumen

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5
Q

Aortic dissection is associated with what?

A
  • Hypertension
  • Bicuspid aortic valve
  • Cystic medial necrosis
  • Inherited connective tissue disorders
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6
Q

What does aortic dissection present with?

A

tearing chest pain radiating to the back

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7
Q

CXR in aortic dissection shoes what?

A

mediastinal widening

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8
Q

The false lumen can be….

A
  • limited to the ascending aorta
  • Propagate from the ascending aorta
  • Propagate from the descending aorta
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9
Q

Aortic dissection can result in

A
  • Pericardial tamponade
  • Aortic rupture
  • Death
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10
Q

What are the ischemic heart disease manifestations?

A
  • Angina
  • Coronary steal syndrome
  • Myocardial Infarction
  • Sudden Cardiac Death
  • Chronic ischemic heart disease
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11
Q

Angina is a CAD Narrowing of _______ with no _________

A

> 75%, myocyte necrosis

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12
Q

Stable angina is mostly secondary to _______

A

Atherosclerosis

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13
Q

What is seen on ECG of stable angina? And how does it present?

A

ST depression, chest pain with exertion

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14
Q

Prinzmetal’s variant angina occurs secondary to _______

A

coronary artery spasm

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15
Q

Prinzmetal’s variant angina presents on the ECG as what?

A

ST depression

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16
Q

Unstable/crescendo angina is what?

A

Thrombosis with incomplete coronary artery occlusion

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17
Q

What is sen on ECG of Unstable/crescendo angina? and how does it present?

A

ST depression, worsening chest pain at rest of with minimal exertion

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18
Q

With coronary steal syndrome a vasodilator may do what?

A

Aggravate ischemis by shunting blood from an area of critical stenosis to an area of higher perfusion

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19
Q

Myocardial infarction is most often ______ thrombosis due to ________ with complete ________ and ________.

A

acute, coronary artery atherosclerosis, occlusion of coronary artery, myocyte necrosis

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20
Q

MI on ECG initially shows ______ progressing to _____ with ________ and ___________

A

ST depression, ST elevation, continued ischemia, transmural necrosis

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21
Q

SCD is what?

A

Death from cardiac causes within 1 hour of onset of symptoms

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22
Q

SCD is most often due to a _________

A

lethal arrhythmia (VFib)

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23
Q

SCD is associated with what in 70% of cases?

A

CAD

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24
Q

Chronic ischemic heart disease leads to a progressive onset of ________ due to chronic ischemic myocardial damage.

A

CHF

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25
Q

What are the most common coronary arteries to be occluded?

A

LAD>RCA>circumflex

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26
Q

What are the symptoms of MI

A
  • Diaphoreisis
  • Nausea
  • Vomitting
  • Severe retrosternal pain
  • Pain in L arm and/or jaw
  • Shortness of breath
  • Fatigue
27
Q

What gross and light microscope things are seen at 0-4 hours post MI?

A

None

28
Q

What are the risks at 0-4 hours post MI?

A
  • Arrythmia
  • CHF exacerbation
  • Cardiogenic Shock
29
Q

What are the gross findings of 4-12 and 12-24 hours post MI?

A

Occluded artery with area of infarct and dark mottling

Tetrazolium stain reveals pale area

30
Q

What is seen on the light microscope at 4-12 hours?

A
  • Early coagulative necrosis
  • Edema
  • hemorrhage
  • Wavy fibers
31
Q

What are the risks at 4-12 hours?

A

Arrhythmias

32
Q

What is seen on the light microscope at 12-24 hours?

A
  • Contraction bands from reperfusion injury
  • Release of necrotic cell content into blood
  • Beginning of neutrophil migration
33
Q

What are the risks at 12-24 hours?

A

Arrhythmias

34
Q

What are the gross findings at 1-3 days?

A

Hyperemia

35
Q

What is the light microscope finding at 1-3 days?

A
  • Coagulative necrosis
  • Tissue surrounding infarct shows acute inflammation
  • Neutrophil migration
36
Q

What are the risks at 1-3 days?

A

Fibrinous pericarditis

37
Q

What are the gross findings at 3-14 days?

A
  • Hyperemic border

- Central yellow brown softening (maximum at 10 days)

38
Q

What are the light microscope findings at 3-14 days?

A

Macrophage infiltration followed by granulation tissue at the margins

39
Q

What are the risks at 3-14 days?

A
  • Free wall rupture leading to tamponade
  • Papillary muscle rupture
  • Ventricular aneurysm
  • Interventricular septal rupture (because of macrophages that have degraded important structural components)
40
Q

What are the gross findings at 2 weeks-months?

A

Gray-white area

41
Q

What are the light microscope findings at 2 weeks-months?

A

Contracted scar complete

42
Q

What are the risks at 2 weeks-months?

A

Dressler’s syndrome

43
Q

In the first 6 hours ______ is the gold standard for diagnosing MI

A

ECG

44
Q

What arises after 4 hours and is elevated for 7-10 days?

A

Cardiac troponin

45
Q

What is the most specific protein marker for MI?

A

Cardiac troponin

46
Q

What is predominantly found in myocardium but can also be released from skeletal muscle?

A

CK-MB

47
Q

CK-MB is useful in diagnosing reinfarction following acute MI because _________

A

its levels return to normal after 48 hours

48
Q

ECG changes include…

A
  • ST elevation (transmural infarct)
  • ST depression (subendocardial infarct)
  • Pathologic Q wave (transmural infarct)
49
Q

What are the characteristics of transmural infarcts?

A
  • Increased necrosis
  • Entire wall
  • ST Elevation on ECG with Q waves
50
Q

What are the characteristics of subendocardial infarcts?

A
  • Due to ischemic necrosis of <50% of ventricle wall
  • Especially vulnerable to ischemia
  • ST depression on ECG
51
Q

Anterior wall (LAD) leads to Q waves where?

A

V1-V4

52
Q

ANteroseptal (LAD) leads to Q waves where?

A

V1-V2

53
Q

Anterolateral (LCX) leads to Q waves where?

A

V4-V6

54
Q

Lateral Wall (LCX) leads to Q waves where?

A

I, avL

55
Q

Inferior Wall (RCA) leads to Q waves where?

A

II, III, aVF

56
Q

What are the complications of MI?

A
  • Cardiac Arrhythmias
  • LV failure and pulmonary edema
  • Cardiogenic shock
  • Ventricular free wall rupture
  • Ventricular aneurysm formation
  • Postinfarction fibrinous pericarditis
  • Dressler’s syndrome
57
Q

What is an important cause of death before reaching the hospital and is common in the first few days?

A

Cardiac Arrhythmia

58
Q

Cardiogenic shock uccurs when when there is a ________ and there is a _______

A

large infarct, high risk of mortality

59
Q

Free wall rupture leads to what?

A

Cardiac tamponade and papillary muscle rupture

60
Q

Tamponade and pap muscle rupture leads to what?

A

Severe mitral regurgitation and interventricular septum rupture (leads to VSD)

61
Q

Ventricular aneurysm formation leads to what?

A
  • Decreased CO
  • Risk of arrhythmia
  • Embolus from mural thrombus
62
Q

When is the greatest risk for ventricular aneurysm formation?

A

1 week post MI

63
Q

What is postinfarction fibrinous pericarditis? When does it occur?

A

Friction rub, 1-3 days post MI

64
Q

What is Dressler’s syndrome? When does it occur?

A

Autoimmune phenomenon resulting in fibrinous pericarditis, several weeks post-MI