Small group review

Question 1

Mitral valve prolapse is most commonly seen in men or women?

Answer 1

Women, especially with lean/thin habitus

Question 2

Mitral valve prolapse is most commonly seen in men or women?

Answer 2

Women, expecially with lean/thin habitus

Question 3

Libman-Sachs Endocarditis (LSE):

Answer 3

In lupus – presumed damage to valve surface  thrombus

o There can be underlying damage to valve in context of connective tissue disease … valvulitis with fibrinoid necrosis, inflammation of the valve leaflet

o Vegetations: Small or medium-sized; on either one or both sides of the valve leaflets

o Mitral and tricuspid most affected

Question 4

Nonbacterial Thrombotic Endocarditis (NBTE)

Answer 4

Coagulopathy / Hypercoagulable State:

Along line of closure
 Associations
• Cancer (especially mucin secreting carcinomas)
• Sepsis
• Hyperestrogenism
• Burns

Question 5

A + GMS/ silver stain on the mitral valve indicates what?

Answer 5

Fungal/yeast growing
- infective endocarditis

(note: bacteria is more common for infective endo)

Question 6

“Janeway Lesions”:

Answer 6

non-painful, erythematous / hemorrhagic lesions on palms and/or soles

Question 7

“Osler Nodules”:

“Roth Spots”:

Answer 7

Immune-Mediated lesions in Infective Endocarditis

“Osler Nodules”: finger tips / painful

“Roth Spots”: Retinas

Question 8

What type of lesion does arteriolosclerosis present with? What location in vessel is it?

Answer 8

Concentric

media

Question 9

What type of lesion does atherosclerosis present with? What location in vessel is it?

Answer 9

Eccentric

Intima

Question 10

“Osler Nodules”:

“Roth Spots”:

Answer 10

Both are Immune-Mediated lesions in Infective Endocarditis

“Osler Nodules”: finger tips / painful

“Roth Spots”: Retinas

Question 11

What time frame can Dark mottling be seen?

Answer 11

4-12 Ocassional dark mottling

12-24 dark mottling

Question 12

What time frame can Dark mottling be seen?

Contraction bands?

Answer 12

4-12hrs Ocassional dark mottling
- contraction bands

12-24hrs dark mottling

Question 13

What changes are seen in the heart of a pt approximately 16 DAYS status- post a myocardial infarction.

Answer 13

“Granulation tissue”

• Neovascularization
• Fibroblasts with collagen deposition
• Relatively scant mononuclear inflammatory cells

Question 14

What type of disease is known to cause small intramural vessel lesions?

Answer 14

Diabetes

Question 15

Given this scenario with “sudden death,” (assuming he had not been ignoring ongoing symptoms for hours or days) what ACUTE microscopic changes would you MOST LIKELY see in the patient’s heart at autopsy?

Answer 15

no acute changes

A patient has to survive AT LEAST 4 - 6 hours for any unequivocal histologic findings to be notable

Question 16

What % of dilated cardiomyopathy is genetic and what % of HOCM is genetic?

Answer 16

30-40% for dilated

100% for HOCM

Question 17

What % of dilated cardiomyopathy is genetic and what % of HOCM is genetic?
- which of the 2 can have mut in dystrophin protein? Myosin binding prot C (MBPC)?

Answer 17

30-40% for dilated

100% for HOCM

• Dilated! - dystrophin
• HOCM - MBPC

Question 18

A Salmon orange color on a congo red stain, and a granny apple green birefringence upon polarization of that stain indicates what?

Answer 18

Its a nonspecific finding for amyloud (but not which protein makes up the amyloid)

Question 19

heart failure cells: what are they and what do they indicate?

Answer 19

Hemosiderin-laden
macrophages
- imply that
some degree of congestive failure has been ongoing
for at least weeks

Question 20

five major morphologic categories of pericarditis

Answer 20

Serous (transudate)
Fibrinous
Hemorrhagic
Purulent
Caseous

Question 21

Annual Risk of Rupture of Aortic Aneurysm Based on Size

Answer 21

• 6 cm High (25% per year risk)