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House AMP > Rheumatic Heart Disease > Flashcards

Rheumatic Heart Disease Flashcards

1
Q

Rheumatic Fever (RF) is a (local or systemic?) , post-__________ , (suppurative or non-suppurative?) inflammatory disease, principally affecting the _____,____,____,____,______

A

Systemic

streptococcal

non-suppurative

heart, joints, CNS, skin , subcut.tissues

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2
Q

The (acute or chronic?) stage of RF involves _____ layers of the heart ( _______ ) causing major cardiac sequelae referred to as Rheumatic Heart Disease (RHD).

A

Chronic

all three

pancarditis

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3
Q

RHD

Most commonly seen in (children or adults?) _____ years

When ________ infection is most frequent and intense

A

Children; 5-15

streptococcal

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4
Q

Streptococcus pharyngitis is seen (more or less?) commonly in poor socioeconomic strata of people living in damp and crowded places which promotes interpersonal spread of strep.infection
•Its incidence has declined in _______ countries.

A

More

developed

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5
Q

Both sexes are nearly equally affected in RHD

T/F

A

T

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6
Q

AETIOPATHOGENESIS of RHD

• It is generally accepted that there is a preceding _______ with ________ streptococcus of group ____ in RF

A

throat infection

beta- haemolytic

A

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7
Q

AETIOPATHOGENESIS of RHD

• the mechanism of lesions in the heart, joints and other tissues is by direct infection

T/F

If T , why
If F, then by how?

A

F

not by direct infection but by induction of hypersensitivity or autoimmunity

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8
Q

AETIOPATHOGENESIS of RHD

• However, the mechanism of lesions in the heart, joints and other tissues is not by ____ but by ___________________________
• 2 evidences support this concept.

_________ and _________

A

direct infection

induction of hypersensitivity or autoimmunity

EPIDEMIOLOGIC EVIDENCE

IMMUNOLOGICAL EVIDENCE

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9
Q

AETIOPATHOGENESIS of RHD

A. EPIDEMIOLOGIC EVIDENCE
• 1. a preceeding history of _____infection & _____ infection with this micro-organism, ___________ prior to the attack of RF.

A

pharyngeal ; URT

2 or 3 weeks

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10
Q

AETIOPATHOGENESIS • A. EPIDEMIOLOGIC EVIDENCE

• 2. Subsequent attack is generally associated with ________ of ______

• 3. administration of antibiotics leads to ____________ as well as _____ of RF and its _______

A

exacerbation of RF

lowering of the incidence

severity; recurrence

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11
Q

the latent period required for sensitization to the bacteria( streptococcus pyogenes) is??

A

2-3 weeks

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12
Q

AETIOPATHOGENESIS of A. EPIDEMIOLOGIC EVIDENCE

• 4) Patients with RF have elevated titres of _____ to the ______ of ______-haemolytic strep of group ____ such as ___________ O (ASO) & S, _______, ________ and ___________

A

Abs to the Ags

beta; A

antistreptolysin; antistreptokinase

antistreptohyaluronidase

anti-DNAase B.

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13
Q

AETIOPATHOGENESIS of RHD• A. EPIDEMIOLOGIC EVIDENCE

• 5.________ factors
• 6. _________ distribution

A

Socioeconomic

Geographic

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14
Q

AETIOPATHOGENESIS of RHD
A. EPIDEMIOLOGIC EVIDENCE

• 7. Climate: its role has been desribed by some workers. Incidence of the dx is higher in _____ and _____ regions with (cold or hot?) , damp climate near the rivers and water ways which favour the spread of the infection

A

subtropical and tropical

Cold

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15
Q

AETIOPATHOGENESIS of RHD A. EPIDEMIOLOGIC EVIDENCE

• Despite all these evidences, only a (small or large?) proportion of patients of ________ infection develop RF- the attack rate is _____%.

A

Small

strep. pharyngeal

<3

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16
Q

AETIOPATHOGENESIS of RHD: B. IMMUNOLOGIC EVIDENCE

RF appears ____ weeks after throat infection

A

2-3

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17
Q

AETIOPATHOGENESIS of RHD B. IMMUNOLOGIC EVIDENCE

• The org can not be ______ from _____ in the target tissues

• This has led to the concept that lesions are produced as a result of ______ by formation of ______ against ______

A

grown from lesions

immune response

autoAntibodies

bacteria

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18
Q

A number of components of streptococcus identify or cross- react with target human tissues in RHD

T/F

A

T

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19
Q

AETIOPATHOGENESIS of RHD: immunological evidence

• One such important component is _____ identified as ______ of streptococcus which has various antigenic types, and hence corresponding antibodies in humans which target different tissues.

A

M-protein; surface protein

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20
Q

AETIOPATHOGENESIS of RHD: immunological evidence

• 1._________ of grp A strep forms antibodies which are reactive against ______

A

Cell wall polysaccharide

cardiac valves

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21
Q

AETIOPATHOGENESIS of RHD: immunological evidence

• 2._________ capsule of grp. A streptococcus is identical to _______ present in _____ tissues and thus these tissues are target of attack.

A

hyaluronate

human hyaluronate

joint

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22
Q

AETIOPATHOGENESIS of RHD: immunological evidence

• 3. ____ Antigens of group. A streptococcus react with ______ of _________ muscle , dermal _____ and neurons of _______

A

Membrane

sarcolemma

smooth and cardiac

fibroblasts; caudate nucleus.

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23
Q

PATHOLOGIC CHANGES of RHD

• A.______ LESIONS
• B. _______ LESIONS

A

CARDIAC

EXTRACARDIAC

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24
Q

PATHOLOGIC CHANGES • A. CARDIAC LESIONS

• The cardiac manifestations of RF are in the form of (focal or diffuse?) inflammatory involvement of the ______ tissues of the ____ layers of the heart, the so called (_______).

A

Focal

interstitial

3; Pancarditis

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25
Q

• The pathognomonic features of pancarditis in RF is the presence of distinctive __________ or ________

A

Aschoff nodules or Aschoff bodies.

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26
Q

PATHOLOGIC CHANGES :A. CARDIAC LESIONS

• Aschoff bodies are _______ or ________ shaped distinct (tiny or large?) structures 1-2mm in size occuring in the interstitium of the heart in RF

A

spheroidal or fusiform

Tiny

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27
Q

PATHOLOGIC CHANGES • A. CARDIAC LESIONS

•Aschoff bodies : They are especially found in the vicinity of __________ in the _________ and __________ and occasionally in the _______ and the ________ of the (proximal or distal?) part of the _______.

A

small blood vessels

myocardium and endocardium

pericardium & the adventitia

Proximal ; aorta

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28
Q

Aschoff bodies may be visible to naked eye.

T/F

A

T

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29
Q

cardiac histiocytes (__________ cells)

modified multinucleate cardiac histiocytes ( _______ cells)

A

Anitschkow

Aschoff

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30
Q

PATHOLOGIC CHANGES • A. CARDIAC LESIONS
• It consists of ________, plasma cells, few ________, cardiac _______ and modified ______________

A

lymphocytes

neutrophils

histiocytes

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31
Q

• Aschoff contain ___-___ cells.

A

1 to 4

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32
Q

RHEUMATIC PANCARDITIS
• all the 3 layers of the heart are affected in RF, with equal intensity in terms of their involvement

T/F

A

F

Although all the 3 layers of the heart are affected in RF, the intensity of their involvement is variable

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33
Q

RHEUMATIC ENDOCARDITIS
•______ lesions of RF may involve the ______ and _______ endocardium causing _________ and _______, respectively

A

Endocardial

valvular and mural

rheumatic valvulitis and mural endocarditis

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34
Q

__________ is chiefly responsible for the major cardiac manifestations in chronic RHD

A

Rheumatic valvulitis

35
Q

Rheumatic valvulitis

• There is formation of characteristic, (small or large?) (1- 3mm), (single or multiple?) , ______ vegetations or verrucae, chiefly along ______ of the leaflets and cusps

A

Small

Multiple; warty

the line of closure

36
Q

Rheumatic valvulitis

• The vegetations are (continuous or discontinuous?) so that the free margin of the cusps appear as _________________________

A

continuous

a rough and irregular ridge

37
Q

Rheumatic valvulitis

They are (weakly or firmly?) attached so that they are not likely to ____________, unlike the friable vegetations of ________

A

Firmly

get detached to form emboli

infective endocarditis

38
Q

Rheumatic valvulitis

The chronic stage of RHD is xterized by (temporary or permanent?) deformity of _________, especially the _____ (98%)

A

Permanent

1 or more valves

mitral

39
Q

_______ valve is almost always invoved in RHD

A

Mitral

40
Q

• Gross appearance of chronic healed mitral valve in RHD is characteristically ‘_______’ or ‘ ________ ’ stenosis

A

fish-mouth

button hole

41
Q

Mitral stenosis and insufficiency are commonly combined in chronic RHD

T/F

A

T

42
Q

_________ stenosis may also be found in chronic RHD

A

Calcific aortic

43
Q

Which is more conspicuous, rheumatic mural endocarditis or rheumatic valvulitus

A

rheumatic valvulitis are more conspicuous compared to rheumatic mural endocarditis

44
Q

RHEUMATIC MURAL ENDOCARDITIS

• Grossly, seen commonly as _________

A

MacCallum’s patch

45
Q

RHEUMATIC MURAL ENDOCARDITIS

• This is the region of the endocardial surface in the (anterior or posterior ?) wall of the _______ just above the (anterior or posterior?) leaflet of the _____ valve

• It appears as a _____-like area of ________,_______, and ________ part of the endocardium

A

Posterior ; left atrium

Posterior ; mitral

map; thickened, roughened and wrinkeled

46
Q

Microscopically, Rheumatic mural endocarditis is similar to rheumatic valvulitis

T/F

A

T

47
Q

Rheumatic mural endocarditis

• Affected area shows ____, ______ change in the ____ and cellular infiltrate of lymphocytes, plasma cells and macrophages with many _______ cells

A

oedema; fibrinoid; collagen

Anitschkow

48
Q

Typical Aschkoff bodies are never found in Rheumatic mural endocarditis

T/F

A

F

Typical Aschkoff bodies may sometimes be found

49
Q

RHEUMATIC MYOCARDITIS

• In the acute stage the myocardium is ___________, in the intermediate stage, the interstitial tissue of the myocardium show __________. Later tiny ______________ may be visible throughout the myocardium

A

soft and flabby

small foci of necrosis

foci of Aschoff bodies

50
Q

RHEUMATIC MYOCARDITIS

• the diagnostic nodules found eventually in the chronic stage are scattered thruout the interstitial tissue of the myocardium and are most frequent in the __________,________, and _______

A

interventricular septum, LV and LA

51
Q

In RHEUMATIC MYOCARDITIS

Derrangement of the conduction system may be present.

T/F

A

T

52
Q

RHEUMATIC PERICARDITIS

• Usual finding is ______ pericarditis in which there is loss of normal ____ pericardial surface due to ________ and accumulation of ________________ in pericardial sac

A

fibrinous

shiny; deposition of fibrin

slight amount of fibrinous exudate

53
Q

RHEUMATIC PERICARDITIS

When the pericardium is pulled apart, it gives a shaggy appearance of ‘__________’

A

bread and butter

54
Q

RHEUMATIC PERICARDITIS

Can eventually lead to chronic ___________ pericarditis

A

chronic adhesive

55
Q

EXTRACARDIAC LESIONS: POLYARTHRITIS

• (Acute or chronic?) & (painless or painful?) inflammation of the _______ of
some of the joints. Especially the (smaller or larger?) joints of the limbs

• In about 90% of RF in (adults or children?) & less often in (adults or children?)

A

Acute; painful; synovial membranes

Larger

Adults; children

56
Q

EXTRACARDIAC LESIONS: POLYARTHRITIS

• Hyperemia, fibrinoid changr, oedema, neutrophil infiltration & _______ are observed

•___________ into the joint cavity is commonly present

A

Aschoff bodies

Serous effusion

57
Q

POLYARTHRITIS

• involves ______ polyarthritis involving _______ joints at a time

A

Migratory

2 or more

58
Q

EXTRACARDIAC LESIONS: SUBCUTANEOUS NODULES

• Occurs more often in (adults or children?) than in (adults or children?)

• (Small or Large?) 0.5-2.0cm

• Spherical, ovoid or (painful or painless?)

A

children; adults

Small

Painless

59
Q

EXTRACARDIAC LESIONS: SUBCUTANEOUS NODULES

• Often remain un-noticed because they are attached to ______ structures such as ____,______,_______, or ______

• characteristically located in the _____ surfaces of the ______,______,______ and _____

A

deeper

tendon, ligament, fascia or periosteum

extensor

wrist , elbows, ankles and knees

60
Q

EXTRACARDIAC LESIONS: SUBCUTANEOUS NODULES

• The subcutaneous nodules are (small or giant ?) ________ of the heart with ________ zones

A

Giant

Aschoff bodies ; 3 distinct

61
Q

EXTRACARDIAC LESIONS: SUBCUTANEOUS NODULES

histogically similar but clinically different from _______ of ________

A

subcutaneous lesions of RA

62
Q

ERYTHEMA MARGINATUM

• (Prurituc or Non pruritic?) erythematous rash xteristic of RF
• Occurs mainly on the _____ & prox.part of the ______

A

Non pruritic

trunk; extremities

63
Q

ERYTHEMA MARGINATUM

• The erythema is (transient or rapid?) and (static or migratory?)

A

Transient

Migratory

64
Q

RHEUMATIC ARTERITIS
• Involves _____,_______ & aa of various organs such as renal, mesenteric & cerebral

• Lesion is like those of ______________ or resemble _____

A

coronary, aorta

hypersensitivity angiitis

PAN

65
Q

RHEUMATIC ARTERITIS

• Occasionally, foci of __________ and ill- formed _______ may be seen close to the vessel wall

A

fibrinoid necrosis

Aschoff bodies

66
Q

CHOREA MINOR

Or _________ or ________ is a delayed manifestation of RF as a result of the involvement of the _____

A

Syndenham’s chorea; Saint Vitus’ dance

CNS

67
Q

CHOREA MINOR

Characterised by _________ movements of the trunk and extremities accompanied by some degree of __________

• Occurs more often in (younger or older ?) age, particularly (boys or girls?)

A

involuntary jerky

emotional instability

Younger; girls

68
Q

CHOREA MINOR

• Lesions located in the ________,_________, _______________

• Consist of small haemorrhages, oedema and perivascular infiltration by lymphocytes

A

cerebral hemispheres, brainstem and basal ganglia

69
Q

Involvement of the lungs and pleura occurs often in RF

T/F

A

F

rarely

70
Q

RHEUMATIC PNEUMONITIS AND PLEURITIS

• Pleuritis is often accompanied with ________________________ but definite

• Aschoff bodies are (present or absent?)

A

serofibrinous pleural effusion

Absent

71
Q

RHEUMATIC PNEUMONITIS AND PLEURITIS

• In rheumatic pneumonitis, the lungs are (small or large?) , (loose or firm ?) and _______

A

Large

Firm

Rubbery

72
Q

When RF is suspected, ______ specific test is done

A

RF has wide systemic involvement & no specific lab.test is available

73
Q

CLINICAL FEATURES of RHD

• First attack of RF occurs 2-3 wks after ________

• Subsequent ______ leads to reactivation of disease

•Generally presents with _______ and _____

A

strep.pharyngitis

pharyngitis

migratory polyarthritis & fever

74
Q

revised jones criteria

Clinical diagnosis of RF is made in a case with antecedent lab.evidence of __________ in the presence of:

• -any ________ criteria, or
• -occurrence of ______ and ______ criteria

A

strep.throat infection

2 major

1 major and 2 minor

75
Q

If the heart is spared in acute RF, the patient may have _____ without ________

However once the heart is involved it is often associated with _____________

A

complete recovery

any sequelae

reactivation & re

76
Q

MAJOR CAUSES OF DEATH IN RF & RHD

• 1) _______ Failure due to chronic _________ (young patients), ________________ in older pts

• 2)_________________, both acute & subacute may supervene due to inadequate use of antibiotics

A

Cardiac; valvular deformity

superimposed coronary heart disease

Bacterial Endocarditis

77
Q

MAJOR CAUSES OF DEATH IN RF & RHD

3)Embolism in RHD originates from ________,______, or _______ to the brain, kidney, spleen and lungs

• 4) Sudden Death as a result of ________ in the Left Atrium or due to _________ in association with ________

A

mural thrombi, atrial appendage or mitral stenosis

ball thrombus

acute coronary insufficiency; aortic stenosis

78
Q

Acute Rheumatic fever is caused by molecular mimicry

T/F

A

T

79
Q

________ is the most common cause of death during the acute phase

A

Myocarditis

80
Q

Acute rheumatic fever

Uses types of hypersensitivity reactions

__________ reactions (type ___ hypersensitivity reaction)

___________ reactions (type ___ hypersensitivity reaction):

A

Antibody-mediated ; II

T cell–mediated; IV

81
Q

Acute rheumatic fever

Antibody-mediated reactions: ______ in acute rheumatic fever.
T cell–mediated reactions :______ of rheumatic fever.

A

pancarditis

lesions

82
Q

Anitschkow or ———- cells

A

Caterpillar

83
Q

Aschoff and anitschkow cells are found in (acute or chronic?) rheumatic carditis

A

Acute

84
Q

Fish mouth valvular stenosis

Acute or chronic rheumatic heart disease?

A

Chronic

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