Pathology: Cardiovascular
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| 1. Most common cause of diastolic dysfunction. 2. Most common cause of systolic dysfunction. | 1. left-ventricular hypertrophy failure from essential hypertension
2. coronary artery ischemia from atherosclerosis
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| Pathogenesis of dyspnea from left heart failure | ↑LVEDV ➞ increased hydrostatic pressure in pulmonary vein from backflow ➞ transudate leaks into interstitial space ➞↑ interstitial fluid stimulates J receptors
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| 1. What is high-output heart failure? 2. How does tachycardia effect coronary artery blood flow? | 1. form of heart failure in which cardiac output is increased compared to normal values
2. since coronary vessels fill in diastole, tachycardia can result in ischemia by decreasing vessel filling time
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| Pathogenesis of: 1. Prinzmetal's angina 2. unstable angina | 1. intermittent coronary artery vasospasm
2. atherosclerosis
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| 1. How do β-blockers help patients with angina? 2. How do nitrates help with angina? | 1. decrease myocardial oxygen consumption by reducing heart rate
2. venodilation reduces preload
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| 1. What is preload 2. What is afterload | 1. equivalent to ventricular end diastolic volume
2. resistance ventricle contracts against to eject blood in systole
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| What are the two forms of ventricular hypertrophy? How are they related to preload and afterload? | 1. ↑ preload (more blood in ventricle) → eccentric hypertrophy
2. ↑ afterload (ventricle must be stronger) → concentric hypertrophy
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| What is the molecular pathologic change in: 1. Concentric hypertrophy 2. Eccentric hypertrophy | 1. sarcomeres duplcate parallel → muscles are thicker
2. sarcomeres duplicate in series causing dilation of ventricular wall
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| Causes of concentric hypertrophy | (↑ afterload)
1. essential or pulmonary hypertension
2. aortic or pulmonary stenosis
3. hypertrophic cardiomyopathy (similar to aortic stenosis)
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| Causes of eccentric hypertrophy | (↑ preload)
1. aortic/mitral regurgitation
2. tricuspid or pulmonary valve regurg
3. left to right shunt
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| How is a systolic or diastolic dysfunction clinically determined? | 1. systolic dysfunction - low ejection fraction (EF < 45%)
2. diastolic dysfunction - normal EF, physical signs of heart failure
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| Tetrology of Fallot | 1. Overriding Aorta - trunks do not partition equally. larger aorta than pulmonary
2. Pulmonary Stenosis
3. Ventricular Septal Defect (VSD)
4. Right ventricular hypertroph
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| Which direction is blood shunted in a patient with Tetrology of Fallot? | right-to-left through the VSD
difficult for blood to flow through the stenosed pulmonary valve so instead flows through VSD
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| What is Eisenmenger syndrome? | occurs when pressure in the right ventricle of a left-to-right shunt eventually overrides the left ventricle pressure and shunt reverses. Cyanosis and clubbing develop.
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| 1. Most common congenital heart disease that children present with. 2. Most common congenital heart disease that adults present with. | 1. VSD
2. ASD
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| 5 right to left shunts | 5 T's
1. tetrology of fallot
2. transposition of the great arteries
3. Truncus arteriosus
4. Tricuspid atresia
5. Total anomalous pulmonary venous connection
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| Pink upper body and cyanotic lower body in an infant | Coarctation of the aorta with PDA.
There is ↓ pressure after the coarctation and the pressure in the RV is able to push blood through the PDA to the lower extremities creating a R → L shunt.
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| 1. What maintains a patent ductus arteriosis? 2. What pharmacological intervention can be given to close a PDA? | 1. prostaglandin E
2. indomethacin
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| 1. What causes a left-to-right shunt to become right-to-left? 2. What causes hypertension in patients with coarctation of the aorta | 1. pulmonary hypertension → RV hypertrophy
2. upper extremity BP↑ from blockage of bloodflow; ↓ renal perfusion activates RAAS → water and sodium retention
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| What are the two types of myocardial infarction? How do they differ on ECG? What part of the heart do they involve? | 1. Transmural infarction involving the full thickness of the heart. , ST elevation and Q waves on ECG.
2. Subendocardial infarction involving inner 1/3 of heart. No Q waves. ST depression.
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| What is the pathogenesis of an acute MI? | an atheromatous plaque is disrupted & subendothelial collagen is exposed → platelets adhere to exposed collagen & form thrombus → occlusion of artery
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| 1. Diaphoresis 2. Is chest pain from an AMI relieved by nitroglycerin? | 1. sweating
2. No. pain from occluded artery. venodilation won't help
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| 1. Must common cause of death following AMI? 2. Gold standard for AMI diagnosis? | 1. ventricular fibrillation
2. cardiac troponins I and T
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| 1. Which type of AMI has a higher acute mortality rate? 2. What is the LDH ratio after an AMI? Why the change? | 1. STEMI(transmural)
2. LDH1 > LDH2; cardiac muscle contains LDH1 and releases it after injury
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| What do the following ECG changes correlate with? 1. inverted T waves 2. New Q waves 3. elevated ST segment | 1. areas of ischemia at periphery of infarct
2. areas of coagulation necrosis
3. injured myocardial cells surrounding necrosis
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| What occlusion is associated with the following infarctions 1. anterolateral 2. lateral wall 3. inferior wall 4. posterior wall 5. anteroseptal | 1. mid LAD or circumflex
2. left circumflex
3. RCA
4. PDA
5. proximal LAD
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| 1. What is the biggest determinant of diastolic blood pressure? 2. Most common cause of secondary hypertension? | 1. peripheral vascular resistance
2. renovascular
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| What role does sodium have in hypertension? | 1. increases plasma volume
2. opens calcium channels in smooth muscle cause vasocontriction
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| What is the most likely cause of renovascular hypertension in: 1. elderly men 2. young to middle aged women | 1. atherosclerotic plaque
2. fibromuscular hyperplasia
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| 1. hypertension with hypokalemia 2. Kussmaul's sign 3. Pulsus paradoxus | 1. Conn's syndrome (aldosterone secreting tumor)
2. distended neck veins on inspiration
3. >10mmHg drop in blood pressure during inspiration
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| What is Virchow's Triad of factors that contribute to thrombosis? | 1. Hypercoagulability
2. Hemodynamic changes (stasis, turbulence)
3. Endothelial injury/dysfunction
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| Holosystolic murmurs: | 1. mitral regurgitation
2. tricuspid regurgitation
3. ventricular septal defect
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| 1. Right-sided heart sounds increase in intensity with ___. 2. Left-sided heart sounds increase in intensity with ___. | 1. inspiration
2. expiration
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| 1. What is pulsus parvus et tardus? 2. What is the usual cause? | 1. weak and delayed pulses relative to ventricular contraction
2. aortic stenosis
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| 1. Diastolic murmur associated with an opening snap 2. What is the usual cause | 1. mitral stenosis
2. rheumatic fever
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| 1. Systolic murmur associated with a midsystolic click 2. continuous murmur throughout systole and diastole | 1. mitral valve prolapse
2. patent ductus arteriosus
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| Difference between atherosclerosis and arteriolsclerosis. | 1. arterosclerosis is thickening and loss of elasticity in arterial walls
2. atherosclerosis is a form of arterosclerosis is which plaques composed of cholesterol, platelets and macrophages form in artery walls
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| 1. Port wine stain on face in distribution of ophthalmic branch of trigeminal nerve 2. What is Henoch-Schonlein purpura | 1. Sturge-Weber syndrome
2. vasculitis that is a type III hypersensitivity, IgA mediated disorder following an acute infection
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| 1. What is ANCA 2. How does ANCA cause vasculitis? | 1. antineutrophilic cytoplasmic antibody
2. activates neutrophils to release their enzymes and free radicals resulting in vessel damage
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| What component of the neutrophil are the following directed against? 1. c-ANCA 2. p-ANCA | 1. proteinase 3
2. myeloperoxidase
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| Young asian women and children. Absent upper extremity pulse. | Takayusu arteritis (aorta thickens)
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| Vasculitis in children presenting with fever, erythematous rash on palms and soles and coronary artery involvement. | Kawasaki disease
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| Which antibodies are associated with the following vasculitides: 1. Wegener granulomatosis 2. Churg-Strauss 3. Microscopic polyangiitis | 1. c-ANCA
2. p-ANCA
3. p-ANCA
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| 30 year old smoker with foot ulceration | thromboangiitis obliterans (Buerger's disease)
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| 1. eosinophilia, asthma, pANCA 2. Fixed splitting of S2 | 1. Churg-Strauss syndrome
2. ASD
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| 1. Papules that do not blanch when pressure is applied. Recent respiratory tract infection 2. What is the cause? | 1. Henoch-Schonlein purpura
2. IgA immunocomplexes form in vasculature
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| How does the squatting help a patient having a Tet spell? | Tet spell is dyspnea and cyanosis in tetrology of fallot.
Squatting increases systemic vascular resistance forcing blood through the VSD (left to right) and into the pulmonary artery.
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| What is a Tet spell | sudden hypoxemia and cyanosis in individual with Tetralogy of Fallot
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| 1. prolonged PR interval 2. progressive increase in PR interval until QRS complex is absent | 1. First degree AV block
2. Mobitz I
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| 1. What is the most common cause of atrial fibrillation? 2. sawtooth pattern on EKG | 1. atrial enlargement from congestive heart failure
2. atrial flutter
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| Why may it be dangerous to cardiovert a patient in atrial flutter? | if the ratio for conduction of atrial to ventricular beats is 2:1 (or higher) cardioversion, or carotid massage, could ↓ atrial beats so that the conduction ratio is 1:1. This would actually ↑ ventricular rhythm.
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| 1. Patient with palpitations and delta wave on EKG 2. Prolongation of the QT interval can lead to which arrhythmia? | 1. AV nodal reentrant tachycardia
2. Torsades de Pointes
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| Diagnosis: chest pain on exertion and relieved by rest. What are the common causes? | stable angina
1. atherosclerotic coronary artery disease
2. aortic stenosis or hypertension with LVH
3. hypertrophic cardiomyopathy
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| 1. cardiogenic shock? 2. friction rub immediately after an MI 3. fever and precordial rub 6-8 weeks after MI | 1. inadequate perfusion of tissues from failure of ventricles
2. pericarditis
3. autoimmune pericarditis (Dressler's syndrome)
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| 1. Best enzyme marker to diagnosis reinfarction after MI 2. Child with joint and chest pain, fever | 1. CK-MB
2. rheumatic fever
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| Most common cause of infective endocarditis: 1. overall 2. in IV drug users 3. after insertion of prosthetic valves 4. in ulcerative colotis or colorectal cancer | 1. streptococcus viridans
2. staphylococcus aureus
3. staphylococcus epidermidis
4. streptococcus bovis
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| Heart valve involved in endocarditis 1. most commonly involved 2. IV drug users | 1. mitral
2. tricuspid followed by aortic
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| 1. Endocarditis in lupus patients 2. Most common cause of myocarditis and pericarditis overall | 1. Libman-Sacks endocarditis
2. coxsackievirus
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| Fever, chest pain that is relieved when leaning forward. | Pericarditis
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| 1. Systolic ejection murmur that decreases when squatting. 2. Systolic ejection murmur that increased when squatting. | 1. Hypertrophic cardiomyopathy
2. aortic stenosis
squatting ↑ preload (via ↑ afterload) → more blodd forced through aortic valve. Stenosis of HOCM is ↓ with ↑ preload
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| Treatment for hypertrophic cardiomyopathy | 1. β-blocker: ↓ heart rate → ↑ preload
2. implantable defibrillator: prevents v-tach/v-fib
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| 1. Mass in left atrium causing syncope 2. Rhabdomyoma is associated with which disease? | 1. atrial myxoma
2. tuberous sclerosis
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| What are the two main causes of hyaline arteriosclerosis and their pathogenesis? | 1. Diabetes - glycosylation of proteins in basement membranes cause leakage of protein into vessel wall
2. Hypertension - pushes plasma proteins into the vessel wall
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| Why is an aortic aneurysm more likely to form below the renal arteries? | At this point, the aorta lacks a vaso vasorum and the arterial wall must rely on diffusion for metabolic needs. Thus the wall is markedly thinner.
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| 1. Blueish discoloration of face and arms. Retinal hemorrhage. 2. Likely cause? | 1. Superior vena cava syndrome.
2. Primary lung tumor
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| 1. Unilateral headache that may present with ipsilateral blindness and jaw claudication. 2. What test is used to confirm diagnosis? | 1. Temporal (Giant cell) arteritis
2. Erythrocyte sedimentation rate
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| Where does coarctation of the aorta occur in: 1. infants 2. adults | 1. before the ductus arteriosus
2. After the ligamentum arteriosus (remnant of ductus arteriosum)
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| 1. Without any other complications, a patent ductus arteriosus is a __ to __ shunt. 2. What type of necrosis occurs in a heart attack? | 1. left to right
2. coagulation necrosis
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| 1. What causes rheumatic heart disease after strep A infection? 2. Vasculitis associated with hepatitis B seropositivity. | 1. type II hypersensitivity - antibody complexes to M protein cross-react with heart tissue
2. polyarteritis nodosa
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| 1. Most common causes of hemorrhagic pericarditis? 2. Most common cause of fibrinous pericarditis? 3. Most common cause of constrictive pericarditis? | 1. tuberculosis and tumor metastasis
2. uremia from renal failure
3. tuberculosis (worldwide), cardiac surgery (US)
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| Pathology associated with the following: 1. Fibrillar-1 2. KCNQ-1 3. NOTCH 4. Transthyretin | 1. Marfans
2. Long QT syndrome
3. Tetrology of Fallot
4. cardiac amyloidosis
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| Which type of pericarditis (fibrinoid or constrictive) is related to pericardial tamponade? | constrictive
amt of fluid and fibrin are not great so no tamponade occurs in fibrinous pericarditis
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| What is the pathological cause of splinter hemorrhages, Janeway lesions and infarctions seen in infective endocarditis? | microemboli formation from blood clots and clumping of bacteria
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| Which type of arteriosclerosis is seen in: 1. Malignant hypertension 2. long standing hypertension | 1. hyperplastic arteriosclerosis
2. hyaline arteriosclerosis
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| Biggest risk factor for early, accelerated, and advanced atherosclerosis? | Diabetes
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| 1. Pericardial knock 2. Most common cause of MI in children? 3. Congenital heart disease associated with congenital rubella | 1. constrictive pericarditis
2. Kawasaki disease
3. patent ductus arteriosus
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| Causes of pulsus paradoxus | 1. pericardial effusion
2. ↓ lung compliance: interstitial fibrosis, severe pulmonary edema
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| 1. What is a mycotic aneurysm? 2. Bacillary angiomatosis is caused by.. 3. Ruptured aneurysm in lenticulostriate vessels due to chronic hypertension | 1. weakening of a cerebral vessel wal secondary to an infectious process
2. Bartonella (same organism as cat scratch disease)
3. Charcot-Bouchard aneurysm
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| 1. What is the usual cause of death in a patient with severe Coronary Artery Disease? 2. CKMB peaks in __ days and disappears in __ days. | 1. ventricular fibrillation
2. 1 day; 3 days
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| How does the Valsalva maneuver effect ventricular volume? | ↑ positive intrathoracic pressure → ↓ filling of right heart (in contrast to squatting →↑venous return to right heart)
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| What mitral valve anomaly occurs in: 1. acute rheumatic fever 2. chronic rheumatic fever | 1. mitral regurgitation
2. mitral stenosis (can lead to regurg)
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| 1. How does hypercalcemia affect the QT interval? 2. Pathogenesis of mitral valve prolapse | 1. shortens the QT
2. myxomatous degeneration of the valve leaflet
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| 1. How long after an MI do ruptures occur? 2. Most common cause of death in acute MI? 3. Mitral regurgitation 4 days after an acute MI? | 1. 3-7 days
2. ventricular fibrillation
3. posteromedial papillary muscle rupture
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| 1. Tall, peaked T waves on EKG? 2. Temporal headache, ipsilateral blindness with flu-like symptoms and joint pain | 1. hyperkalemia
2. polymyalgia rheumatica (temporal arteritis + joint pain)
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| 1. only vasculitis that involves the neurovascular compartment adjacent to the artery. 2. Which arteries are involved in Kawasaki disease | 1. Thromboangiitis obliterans (Buerger's)
2. coronary arteries
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| Benign condition in which the tunica media of muscular arteries acquires calcification. | Monckeberg arteriosclerosis (medial calcification)
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| atrial septal defects: 1. most common 2. associated with Down syndrome | 1. ostium secundum
2. ostium primum
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| What is a truncus ateriosus? | a single great artery receiving blood from both ventricles
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| Congenital conditions associated with: 1. Aortic dissection 2. coarctation of the aorta 3. PDA 4. transposition of the great vessel 5. Mitral valve prolapse | 1. Marfans, Ehler's Danlos
2. Turner's syndrome
3. rubella
4. diabetic mother
5. arfans, Ehler's Danlos
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| 1. When is Kussmaul sign usually seen? 2. When can be acute? | 1. CHRONIC pericarditis, restrictive cardiomyopathy, tricuspid stenosis
2. cardiac tamponade
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| Non-bacterial thrombotic endocarditis associated with cancer? | marantis endocarditis (cancer causes hypercoagability resulting in thrombi that in turn cause endocarditis
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| Which developmental cardiac defect is associated with the following: 1. DiGeorge syndrome 2. Friedreich's ataxia 3. Tuberous sclerosis | 1. ostium primum ASD, regurgitant AV valves
1. tetralogy of Fallot
2. hypertrophic cardiomyopathy
3. rhabdomyomas
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| Severe nosebleeds, pink lesions on oral and nasal mucosa, face and arms | Olser-Weber-Rendu syndrome.
Hereditary condition with arterovenous malformations.
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| 1. Lymphedema of hands and feet in newborn. 2. Difference between ostium secundum ASD and a patent foramen ovale? | 1. Turner's syndrome; defective lymphatics
2. OS ASD is abnormal growth and delopment while patent foramen ovale is normal but a failure to close at birth
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| 1. Adult with fibrosis of the tricuspid and pulmonary valves is usually seen in... 2. What is the underlying cause? | 1. Carcinoid heart disease
2. carcinoid syndrome leading to increased production of serotonin, bradykinin, etc.
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| ST segment on EKG 1. Stable angina 2. Prinzmetal's variant 3. Unstable angina | Subendocardial in depression. Transmural is elevation.
1. ST depression
2. ST elevation
3. ST depression
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| sudden drop of QRS complex with no gradual lengthening of PR interval | Mobitz II
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| 1. 30 year old male with renal failure, bloody diarrhea neurologic disturbances. Artery biopsy reveals transmural inflammation 2. What is the only organ not involved? | 1. polyarteritis nodosa
2. lung
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| What two conditions can lead to fibrinoid necrosis? | 1. malignant hypertension
2. vasculitis - infectious or immunologic
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| 1. Treatment for Kawasaki disease 2. Treatment for polyarteritis nodosa | 1. aspirin (only time can give children aspirin)
2. corticosteroids, cyclophosphamide
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| Chronis sinusitis, hemoptysis, glomerulonephritis. | Wegener's granulomatosis involves:
1. nasopharynx
2. lungs
3. kidneys
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| Difference in pathogenesis of thrombi and emboli in atherosclerosis? | 1. thombi: plaque reuptures and expresses subendothelial collagen which activates coagulation cascade
2. emboli: plaque breaks off clots a further site
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| What sizes arteries are effected by: 1. atherosclerosis 2. hyaline arteriosclerosis 3. hyperplastic arteriosclerosis 3. Moncheberg calcific sclerosis | 1. medium
2. small
3. small
4. medium
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| Which section of the aorta wall does blood flow through in an aortic dissection? | media
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| Which valvular disorder: 1. acute rheumatic fever 2. chronic rheumatic fever | 1. mitral regurgitation
2. mitral stenosis (2nd is aortic stenosis)
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| Patient with increased pulse pressure and bounding pulse. | aortic regurgitation
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| Nonbacterial, sterile vegetations along mitral valve in patient with adenocarcinoma. | Nonbacterial thrombotic endocarditis arise in hypercoagulable state or underlying adenocarcinoma
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| Endomyocardial fibrosis with an eosinophilic infiltrate. | Loeffler syndrome
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| 1. Cause of S3 2. Cause of S4 | 1. volume overload
2. stiff LV wall
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| Which type of cardiomyopathy: 1. doxorubicin 2. alcohol 3. amyloidosis 4. viral myocarditis 5. hemochromatosis | 1. dilated
2. dilated
3. restrictive
4. dilated
5. either restrictive or dilated
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| Congenital long QT syndrome with sensorineural deafness | Jervell and Lange-Nielsen syndrome
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| Where is the infarct if the following leads have Q waves: 1. V1-V4 2. V1-V2 3. V4-V6 | 1. Anterior wall (LAD)
2. Anteroseptal (LAD)
3. Anterolateral (LCX)
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| Where is the infarct if the following leads have Q waves: 1. I, aVL 2. II, III, aVF | 1. Lateral wall (LCX)
2. Inferior wall (RCA)
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| Which heart block is associated with syncope? | 3rd degree; primary and secondary are asymptomatic
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| 23 year old woman with fatigue is found to have a systolic murmur and higher than normal cardiac output. What is the differential? | Anemia
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