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Systems Patho Exam I
| Question | Answer |
|---|---|
| At what point in fetal development does the heart begin beating? | Day 22 |
| What is septation? | The process of forming walls (in the heart) |
| Which two systems does the heart connect? | Pulmonary and systemic |
| What is a congenital heart defect? | An anatomical defect of the heart and great vessels produced during fetal development and present at birth |
| What are the two artero-venous shunts? | Ductus arteriosus and foramen ovalae |
| Where is the ductus arteriosus found? | Between the pulmonary vein and aorta |
| Where is the foramen ovale found? | It connects the inferior vena cava to the left atria |
| How many live births result in some form of CHD? | 1/120 |
| What is Trisomy 13, 18 and 21 an example of? | A chromosomal abnormality that may result in a CHD |
| How are CHDs often detected? | A murmur or thrill |
| What are the Left to Right shunt diseases? | 1. Ventricular Septal Defect (VSD) 2. Atrial Septal Defect (ASD) 3. Patent Ductus Arteriosus 4. Hypoplastic left heart syndrome |
| How many Right to Left shunt diseases are there? | One |
| What is a Shuntless CHD? | A CHD that does not have a hole in the heart |
| Which is the most common CHD? To which category does it belong? | Ventricular Septal Defect; Left to right shunt diseases |
| Why does VSD cause heart failure? | The heart has to work harder to get blood to the body |
| How many cases of VSD occur per every 1000 live births? | 2-4 |
| What is the indication of atrial septal defect? | Split S2 heart sound |
| What is a split S2 heart sound? | When the aortic and pulmonic valves don't close at the same time |
| What are symptoms of atrial septal defect? | Increased fatiguability, exertional dyspnea, and clubbing of the fingers |
| What are the three types of atrial septal defects? | Ostium secundum, ostium primum, and sinus venosus |
| Where is ostium primum found? | The hole is situated close to the atrioventricular valves |
| Which is the most common type of ASD? At what percent? | Ostium secundum; 70% |
| Which CHD is commonly found in premature infants? | Patent ductus arteriosus |
| What is a common consequence of patent ductus arteriosus? | Cardiomegaly |
| What defect is caused by hypoplastic left heart syndrome? | Aortic and mitral valve atresia |
| What is atresia? | A failure to develop |
| What four requirements make up the Tetrology of Fallot? | Pulmonary stenosis, VSD, Dextroposition of the aorta, and right ventricular hypertrophy |
| Which CHD occurs when the aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle? | Transposition of the great vessels |
| What is coarctation of the aorta? | A narrowing of the aortic lumen |
| Where does coarctation of the aorta normally occur? | Distal to the origin of the subclavian artery |
| What is the presenting feature of coarctation of the aorta? | Upper extremity HYPERtension and lower extremity HYPOtension |
| Which type of ventricular hypertrophy does coarctation of the aorta cause? | Left ventricular hypertrophy |
| What is pulmonary stenosis? | The leaflets of the pulmonic valve are fused or too thick, or there are fewer than three, or localized thickening along the pulmonary trunk |
| What sound can be auscultated in a case of pulmonary stenosis? | An ejection murmur |
| Which type of hypertrophy normally presents in pulmonary stenosis? | Right ventricular hypertrophy |
| What is aortic stenosis? | Narrowing of the aortic orifice due to congenital valvular defect |
| What does aortic stenosis cause? | Left ventricular hypertrophy and ischemia |
| What is a potential complication of aortic stenosis? | Infective endocarditis |
| How many types of cardiomyopathy are there? What are they? | Three. Hypertrophic, dilated and restrictive |
| What is hypertrophic cardiomyopathy? | Cardiac hypertrophy that can't be explained by pressure or volume overload |
| What is the most common genetically transmitted heart disease? | Hypertrophic cardiomyopathy |
| What is the theory on how hypertrophic cardiomyopathy occurs? | Striated muscle isn't laid down in an organized fashion, and the fibers in the "correct" orientation hypertrophy in order to compensate |
| What is hypertrophic cardiomyopathy a common cause of? | Sudden death in young athletes |
| What is dilated cardimyopathy? | The heart muscle is weak and compliant |
| What is restrictive cardimyopathy? | Myocardial stiffness and an incompliant ventricle, i.e. - scar tissue laid down in ventricular tissue |
| What does an electrocardigram (EKG) evaluate? | The cardiac conduction system |
| To what does the P-wave of an EKG correspond? | Atrial depolarization |
| To what does the QRS-Complex of an EKG correspond? | The electrical current as it's dispersed through the bundle branches and Purkinje fibers |
| To what does the T-wave correspond? | Ventricular repolarization |
| During which phase does atrial repolarization occur? | During the QRS-Complex. Its wave is masked by ventricular depolarization |
| What is a cardiac arrhythmia? | An abnormal heart rhythm |
| What is a palpitation? | The conscious sensation of one's heartbeat. It's not always pathological |
| What are common signs and symptoms of arrhythmias? | Dyspnea (difficulty breathing), hypotension, dizziness, syncope (fainting) weakness, chest pain/angina, cool and clammy skin, altered level of consciousness, decreased urinary output, cyanosis (mostly of the lips) |
| Why is decreased urinary output a symptom of cardiac arrhythmia? | The kidneys require a high pressure environment to produce urine. If the patient suffers hypotension, there's not enough pressure in the system to filter the blood. |
| What are the parameters of a normal EKG? | Rate: 60-100 bpm Regular/uniform P-waves and QRS-complexes, P-wave preceding QRS-Complex PR interval: 0.12-0.2 seconds QRS duration <0.12 seconds Identical atrial & ventricular rates |
| What is sinus tachycardia? | A "faster" version of a normal EKG, >100 bpm, normal P-wave and QRS-Complex |
| What can cause sinus tachycardia? | Exercise, stress, dehydration, shock, hyperthyroidism, hypovolemia (low blood volume), pulmonary embolism, anemia, and certain drugs and/or foods |
| What is sinus bradycardia? | A "slower" version of an normal EKG, <60 bpm, normal P-wave and QRS-Complex |
| What can cause sinus bradycardia? | Athletic conditioning, increased intracranial pressure, hypothyroidism, drug interactions, incraesed vagal tone during straining (vomiting, defecation) |
| What is Paroxysmal Supraventricular tachycardia? | Regular atrial and ventricular rhythms that exceed 160 bpm. P-waves difficult to discern from preceding T-wave |
| What can cause Paroxysmal Supraventricular tachycardia? | Stress, hypoxia, hypokalemia (low potassium levels), cor pulmonae (Right ventricular hypertrophy as a result of pulmonary hypertension), hyperthyroidism, CNS stimulants, MI, valvular disease, Wolf Parkinson White syndrome |
| What is Wolf Parkinson White syndrome? | Occurs when a patient is born with ectopic pacemaker cells in the heart. At some point, these non-functional cells "come online," usually after puberty, and cause periods of arrhythmia |
| What is a First-degree AV block? | When the time between the P-wave & QRS-Complex is longer (PR interval is longer) |
| What does an EKG of a First-degree AV block look like? | As though the QRS-Complex is inverted (it's not, it's just the way it appears on the strip) |
| What can cause a First-degree AV block? | MI, Ischemia, hypothyroidism, hypokalemia, hyperkalemia |
| What is a Second-degree AV block? | A progressively widening of the PR-interval that eventually results in a missed beat. |
| What does an EKG of a Second-degree AV block look like? | Normal P-waves followed by QRS-complexes, with extra space in between some of them where there are missed beats |
| What can cause a Second-degree AV block? | CAD, MI, digoxin toxicity |
| What is a Third-degree AV block? | P-waves are independent of QRS-Complexes. No constant PR-interval. There is no communication between the atria and ventricles |
| What does an EKG of a Third-degree AV block look like? | A mess. No seriously. There's no identifiable pattern. |
| What can cause a Third-degree AV block? | Most commonly an MI. Also, congenital abnormality, rheumatic fever, and post-op valve replacement complications |
| What is PVC? How is it defined? | Premature ventricular contraction. It's defined as a regular atrial rhythm and and IRREGULAR ventricular rhythm |
| How does the EKG of a PVC appear? | As a wide and distorted QRS-complex. There's an extra QRS-complex between the first QRS-complex and the T-wave, appearing like a significant depression in the midst of a normal pattern. |
| What is ventricular tachycardia? | A ventricular rate between 100-220 bpm, typically regular |
| How does ventricular tachycardia appear on an EKG? | QRS-complex is wide and independent of P-waves. P-waves aren't discernable |
| What is heart failure defined as? | Myocardial dysfunction resulting in a characteristic pattern of hemodynamic, renal and neurohormonal responses |
| How is heart failure classified? | By the severity of symptoms |
| What is Class I heart failure? | Minimal - no limitations. Ordinary activity does not result in symptoms |
| What is Class II heart failure? | Mild - Slightly limited physical activity. Ordinary activity results in fatigue, palpitations, dyspnea or angina |
| What is Class III heart failure? | Moderate - Markedly limited physical activity. Less than ordinary activity produces symptoms |
| What is Class IV heart failure? | Unable to perform physical activity without discomfort. Symptoms may occur at rest. |
| What are the two types of ventricular heart failure? | Left and right |
| How does LV heart failure develop? | CAD, infarction, cardiomyopathy, congenital defects |
| How does RV heart failure develop? | Often d/t LV failure - blood fails to pump out to the body, which causes it to back up into the lungs, resulting in the right side of the heart having to compensate. |
| What are "heart failure" cells? Where are they found? | Heart failure cells are macrophages that consume red blood cells that have begun congestion the lungs |
| What are some of the common physical findings of LV heart failure? | Dyspnea*, fatigue*, heomptysis, productive cough, cyanosis (often of the lips), clubbing of the fingernails |
| What are some common physical findings of RV heart failure? | JVD (jugular vein distention), hepatomegaly (passive congestion of the liver), anasarca (widespread edema), ascites, anorexia |
| What are common treatments for heart failure? | Digoxin (decreases rate, increases contractility), diuretics, Beta-blockers, Coronary bypass surgery, HT transplant |
| What is the difference between wheezing and stridor? | Wheezing is a high pitched sound produced during exhalation. Stridor is a high pitched sound produced on inhalation |
| What is pulmonary hypoplasia? | A congenital disorder that results in defective development of one or both lungs |
| What is atelectasis? How many varieties of atelectasis are there? | Atelectasis = lung collapse. There are 3 varieties: Resorption (a.k.a. - obstruction), Compression and Contraction |
| What causes resorption atelectasis? | Complete airway obstruction, associated with bronchial asthma, bronchitis, bronchiectasis, and aspiration. Oxygen that's left in any of the blocked alveoli gets absorbed. Since no new air is being delivered, the lung collapses. |
| To which direction does the mediastinum shift in resorption atelectasis? | Toward the atelectatic lung |
| How does compression atelectasis occur? | It occurs when the pleural cavity is partially or completely filled by fluid, exudate, tumor, blood, or air. |
| To which direction does the mediastinum shift in compression atelectasis? | Away from the atelectatic lung |
| What occurs in contraction atelectasis? | The lung fails to inflate due to the presence of scar tissue |
| What is the primary characteristic of obstructive pulmonary diseases? | Decreased expiratory flow |
| What are the four types of COPD? | Chronic bronchitis, emphysema, asthma, and bronchiectasis |
| How is chronic bronchitis clinically defined? | A productive cough that lasts for at least 3 months in at least 2 consecutive years, in the absence of any other identifiable cause |
| What are the three types of chronic bronchitis? | Simple (no physiological evidence of airflow obstruction), chronic asthmatic (intermittent bronchospasm and wheezing), and obstructive chronic (evidence of associated emphysema) |
| What's the primary initiating factor of chronic bronchitis? | Exposure to a persistent injurious agent |
| What is the earliest feature of chronic bronchitis? | Hypersecretion of mucus |
| What is emphysema? | Loss of surface area due to abnormal permanent enlargement of the airspaces without obvious fibrosis |
| What are the four types of emphysema? | Centriacinar, panacinar, paraseptal, and irregular |
| What is the most plausible hypothesis for the pathogenic mechanism of emphysema? | The protease-antiprotease mechanism |
| Of what does the protease-antiprotease mechanism consist? | In response to a pathogenic process (congenital OR functional), free radicals interact with and inhibit the function of alpha 1-AT (antitripsin). This results in tripsin breaking down lung tissue |
| What is a classic patient sign of emphysema? | Barrel chest |
| What is the best way to diagnose emphysema? | Spirometry, looking for expiratory airflow limitation |
| What is asthma? | Reversible airway obstruction, inflammation and hyperactivity |
| What are the signs/symptoms of an asthma attack? | Severe dyspnea, coughing and wheezing brought on by bronchospasm |
| What are the two types of asthma? | Extrinsic (allergic rxn) and intrinsic (initiated by diverse, non-immune mechanisms) |
| What is atopic asthma? | Triggered by environmental antigens, generally begins in childhood, large volume of mucus often produced, urticaria, rhinitis |
| What is nonatopic asthma? | Most frequently triggered by respiratory tract infection (IgE levels normal b/c it's not an allergic rxn). Often triggered by inhaled air pollutants |
| What is drug-induced asthma? | Asthma induced by aspirin. Aspirin increases the concentration of leukotrienes, which increase broncoconstriction |
| What is occupational asthma? | Asthma as a result of exposure to fumes, organic and chemical dusts, or gases |
| What is bronchiectasis? | The terminal and permanent dilation of bronchi and bronchioles cause by the destruction of muscle and elastic tissue |
| What is the basic etiology of bronchiectasis? | Obstruction (by mucus, tumors, or foreign bodies) and infection (as a result of normal clearing mechanisms to get rid of said obstructions being impaired) |
| To what other disease is bronchiectasis often seen as secondary? | Cystic fibrosis - A defect in chloride transport leads to impaired secretion of ions into muchus, low sodium and water content, which results in thick, viscous secretions |
| What are some signs/symptoms of bronchiectasis? | Severe and persistent cough, hemoptysis, foul-smelling expectorant, dyspnea and/or orthopnea |
| What defines restrictive pulmonary diseases? | Reduced expansion of the lung parenchyma - aka: a decrease in the total volume of air the lungs are able to hold |
| What can cause a restrictive pulmonary disease? | Decreased elasticity, often d/t scar tissue |
| What is idiopathic pulmonary fibrosis? | Lung scarring of unknown origin |
| What is Pneumoconiosis? | Disease induced by the inhalation of organic or inorganic particulates |
| On what factors does pneumoconiosis depend? | Amount of dust inhaled and retained, the size/shape of the particles (buoyancy), solubility and physiochemical reactivity |
| What are three types of pneumoconiosis? | Anthracosis (inhaling coal), silicosis (inhaling sand or glass), and asbestosis |
| What are predisposing factors to pulmonary emboli, hemorrhages and infarcts? | Long-term immobility, recent surgery, trauma (fractures), and (to an extent) obesity |
| What may emboli consist of? | Air, fat, bacteria, amniotic fluid, talc, tumor cells |
| What type of trauma results in high risk of a pulmonary embolus? | Hip fractures |
| Why are central venous lines risk factors for pulmonary emboli? | They act as a nidus for a right atrial thrombus |
| What is a saddle embolus? | A large clot that forms at the bifurcation of the pulmonary arteries |
| What is pneumonitis? | Pulmonary infection, a.k.a. - pneumonia |
| What can cause a respiratory infection? What causes the vast majority? | Bacteria, viruses or fungi; Viruses |
| How is pneumonia normally contracted? | Via the respiratory route |
| Where are terminal pneumonias often acquired? | In the hospital - patient's with chronic diseases contracted them while hospitalized |
| What is lobar pneumonia? | An entire lobe of the lung is affected |
| What is segmental/lobular pneumonia | Patches within a lobe are affected |
| What is bronchopneumonia? | A pattern of pneumonia that includes the bronchi |
| What is interstitial pneumonia? | Viral pneumonia |
| Which two forms of pneumonia are bacterial? | Lobar and segmental/lobular |
| How does interstitial pneumonia appear on an x-ray? | As small wisps spread throughout most of the lung tissue |
| What does the term "atypical" denote in regards to pneumonitis? | No physical findings of consolidation |
| If the alveoli appear to be full of white blood cells, is that bacterial or viral pneumonitis? | Bacterial |
| If the alveoli are *not* full of white blood cells, but the interalveolar septal walls appear to be dilated, is that bacterial or viral pneumonitis? | Viral |
| What are the two categories of pleural effusion? | Inflammatory and non-inflammatory |
| What three types of pleural effusion fall under the inflammatory category? | Serofibrinous pleuritis - d/t serofibrinous exudate, a result of collagen vascular disease Suppurative pleuritis - d/t pus as a result of suppurative infection in adjacent lung Hemorrhagic pleuritis - d/t bloody exudate as a result of tumor |
| What are the three types of non-inflammatory pleuritis? | Hydrothorax - d/t transudate, seen in CHF Hemothorax - d/t blood, as a result of trauma or ruptured aoritc aneurysm Chylothorax - d/t Chyle (lymph), often seen when a tumor obstructs normal lymphatics |
| What is a lung abscess? | Local suppurative process w/in the lung, characterized by necrosis of LU tissue |
| What frequently causes an abscess? | Aspiration of infective material. Abscesses may also occur after a antecedent (blood bourne) primary bacterial infection |
| What is a septic embolism? | And infected embolus from thrombophlebitis in any portion of the venous system. May also be d/t right sided bacterial endocarditis |
| What is cavitation? How is it specific to lung abscesses? | Cavitation is the formation of a cavity. When lung tissue goes necrotic, WBC arrive to the site and become an abscess |
| What is malignant mesothelioma? | It is a mixed type neoplasia |
| What percentage of mesotheliomas are asbestos related? | 90% |
| Where to malignant mesotheliomas typically arise? | From either the visceral or parietal pleura |
| How does mesothelioma progress? | It begins in the pleura and works its way in, slowly decreasing available lung space |
| What does epithelioid mesothelioma consist of? | Cuboidal, columnar, or flattend cells forming tubular or papillary structures resembling adenocarcinoma |
| What does sarcomatoid mesothelioma look like? | It appears more muscular looking |
Created by:
eippolito
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