random Flashcards
T/F: Picornavirus (rhinovirus), coronavirus, paramyxovirus (parainfluenza and respiratory syncytial virus), and orthomyxovirus (influenza) all have a persistent replication pattern
False, they have an acute infection pattern with replicaiton confined to respiratory mucosal surface.
Persistent replication on respiratory mucosal surface is characteristic of adenovirus
Paramyxovirus (mumps, measles) Herpesviruses (EBV, VZV, HHV6, CMV) Rubella, Picornavirus
(polio) all belong to which pattern of infeciton?
Systemic replication (dissemination) after primary replication in respiratory tract
Picornavirus (rhinovirus) Coronavirus
Paramyxovirus (parainfluenza and respiratory syncytial virus) Orthomyxovirus (Influenza) all belong to what pattern of infection?
Acute infection with replication confined to respiratory mucosal surface
T/F: Coronavirus, paramyxovirus, and orthomyxovirus are all (+) ssRNA virus?
False Coronavirus is (+)ssRNA
Paramyxo and orthoxmyxo are both (-) ssRNA
MERS/SARS
Where does orthomyxovirus and paramyxovirus replication?
Ortho - Nuclear
Para-cytoplasm
Both are enveloped
Respiratory syncytial virus, measles and mumps all belong to which virus?
paramyxovirus
croup is caused by which 2 viruses?
(paramyxovirus= (-)ssRNA replicates in cytoplasm)
parainfluenza and RSV
croup+ laryngotracheobronchitis
peak incidence in winter
barking cough in infants
Which respiratory virus is being described: Pharyngoconjunctivial fever, pneumonia, febrile upper tract infection, double stranded DNA virus
Adenovirus
Think close quarters: boot camp…under stress, younger peiople)
Military has vaccine, but not in widespread use
What virus is being described?
Symptoms: inspiratory stridor, cough hoarseness
•Peak incidence in winter
•Starts like a cold in adults and infants
•Infants may develop a distinctive barking cough, called croup
•Commonly treated at home with steam and humidifiers
•Complications: pneumonia and respiratory distress
Croup
paramyxovirus= (-)ssRNA replicates in cytoplasm)
parainfluenza and RSV
________ is a technique that allows for separation of blood components by centrifugation for removal and/or exchange
Apheresis
______ is a technique that allows for the alteration and/or removal of plasma via diffusion and/or convection
Dialysis
Anticoaguation is necessary in both apheresis and dialysis….what anticoag agents are used for both?
Apheresis: Citrate (local)
Dialysis: Heparin (Systemic)
Who needs dialysis? (AEIOU)
A: Acid-base problems E: Electrolyte problems I: Intoxications O: Overload of fluids U: Uremic symptoms
Who needs apheresis?
Autoantibodies, leukocytes, abnormal RBCs, leukemias, parasitemia, circulating immune complexes, hypercholesterolemia, malaria, systemic vasculitis
Fibrinoid necrosis is characteristic of what type of hypertenstion? What is the range of BP in this type of HTN>
Malignant HTN >180/120mmHg
This typically presents with acute end organ damange and is a medical emergency
Elevated anti-streptolysin O titer is seen in which cardiac condition involving s. pyogenes?
Suggest acute rheumatic fever which has small nondestructive verrucous vegetations
name the cardiomyopathy:
Gross Appearance: Asymmetric hypertrophy of the interventricular septum (bulges into the left ventricular outflow tract)
Histologic Appearance: Myofiber disarray
Hypertrophic cardiomyopathy
Which 2 cardiomyopathies produces diastolic dysfunction?
Diastolic dysfucntion- ventricles cant fill
Hypertrophic cardiomyopathy- ventricles cant fill due to LV hypertrophy-decrease CO
Restrictuve cardiomyopathy- decreased compliance of ventricle that restricts filling during diastole
Which cardiomyopathy produces a systolic dysfunction?
Dilated cariomyopathy
Results in systolic dysfunction wher ethe ventricles cannot pump, leading to biventricular CHF
Histology of fibrosis seen between cardiac myocytes and dilation of all 4 chambers occurs in which cardimyopathy?
Dilated cardiomyopathy
Biventricular CHF that can lead to tricuspid and mitral valve regurg because the area is spread out
Genetic mutations in sarcomere proteins and myofiber hypertrophy with disarray, box car nuclei and “replacement fibrosis” is seen in which cardiomyopathy?
Hypertrophic cardiomyopathy
A “Machinery-like” murmur is an indication of which fetal cardiac issue?
Patent ductus arteriosus
Associated with maternal rubella infection, may predispose to infective endocarditis
Left ventricular output is shunted into the pulmonary circulation
Increased volume and pressure of blood in the pulmonary circulation eventually leads to pulmonary hypertension
Why might you see high pulmonary bp with PDA?
Left ventricular output is shunted into the pulmonary circulation
Increased volume and pressure of blood in the pulmonary circulation eventually leads to pulmonary hypertension
_______ Syndrome (507):
Delayed form of pericarditis
Develops 2 to 10 weeks after infarction (or cardiac surgery)
Formation of antibodies to heart muscle
Physical examination finds a friction rub along with increased jugular venous pressure and pulsus paradoxus (excess blood pressure drop with inspiration)
Dressler’s Syndrome
Treatment: Steroids
A thrombotic occlusion of the left circumflex artery occurs in a 50-year-old male with severe coronary atherosclerosis. Within an hour after the thrombus forms, which of the following complications is most likely to occur?
Ventricular fibrillation Autoimmune Pericarditis Myocardial rupture Ventricular aneurysm Thromboembolism
V-fib
Complications of Myocardial Infarction (505):
High yield, good setup for test questions
Virtually all patients who have a myocardial infarct have abnormal cardiac rhythm at some time during their illness
Arrhythmias are the earliest complication of MI
Hearing a mid-systolic click is an indication of which type of valvular problem?
Mitral Valve Prolapse (518):
Mitral valve leaflets become enlarged and redundant, billowed leaflets prolapse into the left atrium during systole
Physical Exam: Mid systolic click (due to prolapse of redundant leaflets), late systolic murmur (if mitral regurgitation is present)
Name this condition:
A 4 yo child presenting with
(1) Pulmonary stenosis
(2) Ventricular septal defect
(3) Dextroposition of the aorta so that it overrides the ventricular septal defect
(4) Right ventricular hypertrophy
Radiographic Appearance: “Boot shaped” heart (due to hypertrophy)
Tetralogy of Fallot (493):
Clinical Presentation: Retarded development, cyanotic episodes, dyspnea, may be complicated by endocarditis with septic emboli
A 32-year-old North American Caucasian female presents with increasingly severe symptoms of congestive heart failure over 2 weeks. She has no previous history of heart disease. An electrocardiogram shows some runs of ventricular tachycardia, and an endomyocardial biopsy shows focal myocyte necrosis along with a lymphocytic infiltrate. She is most likely to have an infection with which of the following organisms?
T. cruzi S. viridans Coxsackievirus A Toxoplasma gondii S. aureus
Coxsackievirus A
The presence of hemorrhage and contraction bands in necrotic myocardial fibers is most likely to be seen in which of the following?
Subendocardial infarct resulting from diffuse narrowing of coronary arteries
Transmural infarct caused by complete thrombotic occlusion of a coronary artery
Transmural infarct complicated by mural thrombosis
Transmural infarct that is reperfused by thrombolytic therapy
A healing transmural myocardial infarct
Transmural infarct that is reperfused by thrombolytic therapy
Reperfusion: contraction band necrosis
_________ is an atypical form of angina that occurs at rest
Caused by coronary artery spasm
Treatment: Nitrates or Calcium channel blockers
Prinzmetal Angina
Which type of cardiomyopathy is associated with doxorubicin cardiotoxicity?
Dilated cardiomypoathy
Histologic appearance shows vacuoliztion and loss of myofibrils
Becks Triad of (1) Hypotension, (2) JVD, (3) Muffled heart sounds, is associated with what cardiac condition?
Tamponade
A 4-year-old boy with a history of mental retardation and seizures is brought to the physician with a 3-month history of worsening shortness of breath. During physical examination, the physician notices numerous acne like papules on the patient’s face. Echocardiography shows significant left ventricular outflow obstruction. Which of the following is the most likely diagnosis for this patient’s heart condition?
Coronary artery disease Dilated cardiomyopathy Myxoma Rhabdomyoma Transposition of the great vessels
Rhabdomyoma is the most common primary pediatric cardiac tumor…it is a benign harmartoma of cardiac muscle
Occurs in association with tuberous sclerosis
Myxoma is the most common primary adult cardiac tumor
Which type of arteriolosclerosis is due to malignant HTN? (hyaline or hyperplastic)
hyperplastic -thickening of wall due to hyperplasia of smooth muscle…may lead to fibrinoid necrosis
Hyaline is caused by benign HTN and diabetes… thickening of vessel wall due to proteins leaking into it
