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CV HY Path
Day 7
| Question | Answer |
|---|---|
| What are the symptoms of bacterial endocarditis? | Fever (may be only initial symptom), Roth's spots, Osler's nodes (O for Ouch!), Murmur (new onset), Janeway lesions, Anemia, Nail bed hemorrhages (splinter hemorrhages), Emboli (FROM JANE) |
| Round white spots on retina surrounded by hemorrhage | Roth's spots (rare finding in bacterial endocarditis) |
| Tender raised lesions on finger or toe pads | Osler's nodes (finding in bacterial endocarditis); think O for Ouch! |
| Painless, small, erythematous lesions on palms or soles | Janeway lesions (finding in bacterial endocarditis) |
| Which organisms cause culture negative endocarditis? | HACEK: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella |
| Bacterial endocarditis assoc'd with IV drug use involves which organisms? | S. aureus, Pseudomonas, and Candida |
| What type hypersensitivity is bacterial endocarditis? | Type 3 (circulating immune complexes can lead to glomerulonephritis) |
| Which organism is assoc'd with acute bacterial endocarditis? What type of valves does it preferentially affect? | S aureus (high virulence) on normal valves; large vegetations |
| Which organism is assoc'd with subacute bacterial endocarditis? What type of valves does it preferentially affect? | Viridans streptococci (low virulence) on diseased or prosthetic valves |
| How are valvular vegetations formed? | Following bacterial binding, tissue factor expression results in platelet and fibrin deposition which forms the vegetation. |
| Which coagulase negative staph can cause bacterial endocarditis? | Staph epidermidis |
| Which valve is most commonly affected with bacterial endocarditis? | Mitral valve |
| Verrucous (wart-like), sterile vegetations occur on both sides of the valve; can be assoc'd with mitral regurgitation and Lupus | Libman-Sacks endocarditis |
| What histologic finding is pathognomonic for rheumatic heart disease? | Aschoff bodies (granuloma with giant cells); may also see Anitschkow's cells (activated histiocytes) |
| Infection with which organism may lead to the following symptoms in a patient: migrating polyarthritis, pancarditis, sub-q nodules, erythema marginatum (serpiginous skin rash), and Sydenham's chorea? | Group A beta-hemolytic streptococci (strep pyogenes) causing pharyngitis; can result in immune mediated attack on heart valves |
| What type of hypersensitivity is Rheumatic heart disease? | Type 2 |
| Which valves are preferentially affected in rheumatic heart disease? | Mitral> aortic >> tricuspid |
| What mitral valve changes are seen in rheumatic heart disease? | Mitral valve prolapse: early Mitral valve stenosis: late |
| Pulsus paradoxus (>10mmHg difference between systolic and diastolic pulse on inspiration)and electrical alternans on EKG. | Cardiac tamponade |
| Disruption of the vasa vasorum of the aorta with resultant dilation of the aorta and aortic valve ring | Syphilitic heart disease. Syphilis-- the gift that keeps on giving! |
| Marfan patient who dies suddenly | Mitral valve prolapse with conduction defects (NOT aortic dissection; you don't die immediately from aortic dissection) |
| Two valvular lesions associated with carcinoid syndrome. | Tricuspid Insufficiency and Pulmonic Stenosis (TIPS) |
| Single most important risk factor for the development of intimal tears leading to aortic dissections. | HTN |
| Sandpaper-like heart sounds, ST segment elevations in multiple leads | Pericarditis |
| Name that sign! On inspiration, patient gets JVD. | Kussmaul's sign; assoc'd with pericarditis |
| MC primary tumor in adults | Myxoma (mostly in LA) |
| MC primary cardiac tumor in children | Rhabdomyosarcoma (little rhascals like rhabdos); assoc'd with tuberous sclerosis |
| MC heart tumor | Metastases; from melanoma and lymphoma |
| SVC-syndrome like symptoms on one side of the body (e.g., R sided face swelling, R arm swelling, engorgement of vv on R side of neck) | Brachiocephalic v obstruction |
| Decreased blood flow to skin due to arteriolar vasospasm in response to cold temperature or emotional stress | Raynaud's (disease if primary, phenomenon if secondary) |
| What is the treatment for Raynaud's? | Aspirin, dihyropyridine CCB (nifedipine), and sildenafil (goal is to vasodilate) |
| Name 3 diseases assoc'd with Raynaud's phenomenon. | SLE, CREST, and Buerger's |
| Vasculitides: Weak pulses in upper extremities | Takyasu |
| Necrotizing granulomas of lung and necrotizing glomerulonephritis | Wegener's |
| Vasculitides: Young male smokers | Buerger's |
| Vasculitides: Young Asian women | Takayasu; also Kawasaki |
| Vasculitides: Young asthmatic | Churg-Strauss |
| Vasculitides: Infants and young children; involves coronary aa | Kawasaki |
| MC vasculitis | Giant cell/Temporal arteritis |
| Vasculitides: Assoc'd with Hep B infection | Polyarteritis nodosa |
| Vasculitides: Occulsion of ophthalmic a can lead to blindness | Giant cell/Temporal arteritis |
| Vasculitides: Perforation of nasal septum | Wegener's |
| Unilateral headache with jaw claudication | Giant cell/Temporal arteritis |
| How can you differentiate Wegener's from Goodpasture's? | Wegener's granulomas can be found in the upper lung and upper airways |
| What is the treatment for Wegener's? | Cyclophosphamides and corticosteroids (c-ANCA= C for cyclophosphamides and C for Corticosteroids) |
| What are the SE of cyclophosphamide toxicity? | hemorrhagic cystitis and bladder cancer |
| What is the MCC of a saddle nose deformity in the US? | Wegener's granulomatosis |
| c-ANCA produces which antibodies? | Anti-neutrophil proteinase 3 antibodies |
| p-ANCA produces which antibodies? | anti-neutrophil myeloperoxidase antibodies |
| Port wine stain on the face in the trigeminal n distribution (ophthalmic branch) | Sturge Weber disease |
| Vascular malformation of the face and an arteriovenous malformation that predisposes to bleeding | Sturge Weber disease |
| Lower extremity palpable purpura, arthritis in knees, abdominal pain, and recent URI. Self resolves | Henoch Schonlein purpura |
| Mucocutaneous lymph node syndrome | Kawasaki disease |
| Vasculitides: Like Wegener's but lacks granulomas. p-ANCA positive | Microscopic polyangitis |
| Intermittent claudication in a heavy smoker | Buerger's |
| Hypersensitivity to intradermal injections of tobacco extracts | Buerger's |
| What is the treatment of choice for Buerger's disease? | Smoking cessation |
| Peeling of fingertips and palms, strawberry tongue, and fever in an Asian child | Kawasaki disease |
| What is the only time a child can be treated with high dose aspirin? | Kawasaki disease; also use IV immunoglobulin to treat |
| Vasculitides: p-ANCA negative; generally affects renal and visceral vessels and spares the pulmonary aa; lesions are of different ages | Polyarteritis nodosa |
| Vasculitides: Fever, malaise, weight loss, abdominal pain, and melena | Polyarteritis nodosa |
| What is the treatment for polyarteritis nodosa? | Corticosteroids and cyclophosphamide (same tx for Wegener's) |
| Young Asian woman without a pulse | Takayasu's arteritis |
| Migratory thrombophlebitis | Malignancy (always think malignancy when you see this) |
| L atrial tumor in adults that can cause syncopal episodes | Myxoma |
| Muffled heart sounds with a knock | Restrictive pericarditis |
| Muffled heart sounds with no knock | Pericardial effusion |
| High output CHF with neuro symptoms | Wet beri beri (thiamine/B1 deficiency) |
| R sided endocardial fibrosis with elevated plasma serotonin levels and elevated 5-hydroxyindoleatic acid (5HT metabolite) in the urine | Carcinoid syndrome |
| Benign raised red lesion about the size of a mole in older patients | Cherry hemangioma |
| Raised, red area present at birth, increases in size initially and then regresses over months to years | Strawberry hemangioma |
| Lesion caused by lymphoangiogenic growth factors in an HIV infected patient | Kaposi's sarcoma |
| Polypoid red lesion found in pregnancy or after trauma | Pyogenic granuloma |
| Benign, painful red-blue tumor under fingernails | Glomus tumor |
| Cavernous lymphangioma assoc'd with Turner's syndrome | Cystic hygroma |
| Skin papule in AIDS patient caused by Bartonella | Bacillary angiomatosis |
| Highly lethal malignancy of the liver assoc'd with vinyl chloride, arsenic, and thorotrast (VAT) | Angiosarcoma |
| Lymphatic malignancy associated with persistent lymphedema (e.g., post-radial mastectomy) | Lymphangiosarcoma |
| What is the treatment for bacillary angiomatosis? | Sulfa drugs |
| What is the definition of HTN? | >/= 140/90 |
| What is the definition of pre-HTN? | >/= 130/85 |
| HTN can cause which heart sound? | S4 (due to stiffened, hypertrophied LV) |
| Plaques in BV walls | Atheromas |
| Plaques or nodules composed of lipid-laden histiocytes in the skin, especially the eyelids | Xanthomas (called xanthelasmas in the eyelids) |
| Lipid deposit in the tendon, especially the Achilles tendon | Tendinous xanthoma |
| Lipid deposit in cornea, nonspecific | Corneal arcus (arcus senilis) |
| Calcification in the media of aa, esp radial or ulnar. Usually benign (does not obstruct blood flow and intima is not involved) | Monckeberg (ONLY happens in the media; there's some Monkey business in the Media!) |
| Hyaline thickening of small aa in essential HTN or diabetes mellitus. | Arteriosclerosis |
| Fibrous plaques and atheromas form in intima of aa | Atherosclerosis |
| What is the management of an abdominal aortic aneurysm greater than 5cm? | Surgery |
| What is the most important risk factor for heart disease? | Age |
| What is the progression of atherosclerosis? | Endothelial cell dysfunction--> macrophage and LDL accumulation --> foam cell formation--> fatty streaks--> smooth m cell migration (involves PDGF and TGF-beta)--> fibrous plaques--> complex atheroma; primarily mediated by sm m cells |
| What are the most common locations of atherosclerosis (in order)? | Abdominal aorta > coronary a > popliteal a > carotid a |
| What determines the integrity of an atherosclerotic plaque? | The fibrous cap (macrophages secrete metalloproteinases which can degrade the clot and lead to embolization) |
| One kidney much smaller than the other. | Renal a stenosis |
| Abdominal aortic aneurysms are assoc'd with _______ while aortic dissection is assoc'd with ___________. | Atherosclerosis; HTN (also cystic medial necrosis in Marfan's) |
| Mediastinal widening with double barrel aorta | Aortic dissection |
| Tearing chest pain radiating to back | Aortic dissection |
| When does angina become symptomatic? | CAD narrowing >75% |
| ST depression= _________ ischemia | subendocardial |
| ST elevation= __________ ischemia | transmural (pathologic Q waves also point to transmural ischemia) |
| Stable (pain on exertion) angina and unstable (pain at rest) angina produce ST _____ on EKG | depression |
| What substance can be injected to provoke vasospasms which aid in the diagnosis of Prinzmetal's angina? | Ergonovine |
| Prinzmeta's angina (coronary vasospasms) produces ST ______ on EKG | elevation |
| What is the most common cause of sudden cardiace death? | Lethal arrhythmia (e.g., v fib) |
| What pulmonary process is analagous to the formation of an aneurysm? | Bronchiectasis (weakening wall--> outpouching) |
| What is the most common site for an abdominal aorta? | Below the renal aa (b/c there is no vasa vasorum at this point) |
| Sudden severe onset of L flank pain, hypotension, and pulsatile mass on PE | Ruptured abdominal aorta |
| MCC of an aortic arch aneurysm | Syphilis (affects vasa vasorum) |
| Evolution of MI: No visible change by light microscopy | first 2-4 hours |
| Evolution of MI: Neutrophils and early coagulative necrosis | 4 hours |
| Evolution of MI: Contraction bands | 12-24 hours |
| Evolution of MI: Greatest risk for arrhytmias like V-fib | 2-4 days |
| Evolution of MI: Acute inflammation; may develop pericarditis | 2-4 days |
| Evolution of MI: Risk for free-wall rupture, cardiac tamponade, paipllary m rupture, iV septal rupture | 5-10 days |
| Evolution of MI: Granulation tissue | 5-10 days |
| Evolution of MI: Risk for ventricular aneurysm | 7 weeks |
| Evolution of MI: Gray-white sar and recanalized a | 7 weeks |
| Person comes in with pain, fever, m aches, and a pericardial friction rub (pain relieved by leaning forward) 7 weeks post-MI | Dressler's syndrome (autoimmune pericarditis) |
| Reversible or irreversible? Vacuoles and phospholipids inside the mitochondria of the heart | Irreversible damage; the cell will NOT recover =( |
| Reversible or irreversible? Mitochondrial swelling in cardiac myocytes | Reversible damage (also myofibril relaxation, disaggregation of polysomes, disaggregation of granular and fibrillar elements, nuclear chromatin clumping, and loss of glycogen) |
| Name that heart attack marker!: non-specific, but elevated even earlier than troponin | Myoglobin (elevated b/f 4 hours) |
| Gold standard diagnostic test for MI in the first 6 hours | EKG |
| Name that heart attack marker!: rises after 4 hours and is elevated for 10 days; more specific than other protein markers; gold std | Troponin |
| Name that heart attack marker!: Useful in diagnosing reinfarction on top of acute MI | CK-MB |
| Name that heart attack marker!: non-specific; found in cardiac, liver, and skeltal m cells | AST (not really useful) |
| EKG finding seen in an acute MI that correlates with areas of ischemia at the periphery of the infarct | Inverted T wave |
| Stemi | Q wave MI; transmural infarct with ST elevation on EKG (STEMI= ST Elevation MI) |
| Non-stemi | Non-Q wave MI; subendocardial infarct with ST depression |
| Why should warfarin or heparin be given after an MI? | To prevent an embolus from a potential mural thrombus |
| Patient with an MI who develops mitral regurg a few days later | Papillary m rupture (risk is greatest 5-10 days post-MI) |
| S3, laterally displaced apical impuslse, problems with mutations in cardiac cytoskeletal proteins | Dilated (congestive) cardiomyopathy |
| Hypertrophied IV septum is too close to mitral valve leaflet leading to outflow tract obstruction | Hypertrophic cardiomyopathy |
| Sudden death in a young athlete | Hypertrophic cardiomyopathy |
| Normal-sized heart, S4, apical impulses, and systolic murmur assoc'd with Friedrich's ataxia | Hypertrophic cardiomyopathy |
| What is the treatment for hypertrophic cardiomyopathy? | Beta blocker or non-dihydropyridine CCB (e.g., verapamil) |
| Cardiomyopathy seen in Loffler's syndrome | Restrictive/obliterative cardiomyopathy (Loeffler's is endomyocardial fibrosis with a prominent eosinophilic infiltrate) |
| What disease presents with dilated cardiomyopathy with increased LV cavity size, and may present with signs and symptoms of CHF? | Hemochromatosis |
| Patient with acute onset of heart failure after recent viral infection | Dilated cardiomyopathy caused by a viral myocarditis |
| Hemosiderin containing alveolar macrophages (heart failure cells) indicate which findings in L sided heart failure? | Pulmonary congestion and edema |
| What is the treatment for acute CHF exacerbation? | Loop diuretics (furosemide), Morphine, Nitrates, Oxygen, Positioning or Pressors (LMNOP) |
| What leads to the formation of heart failure cells (hemosiderin-laden macrophages)? | Microhemorrhages from increased pulmonary capillary pressure |
| Patient with PMH significant for HTN, hyperlipidemia, and CABG procedure presents with epigastric pain 30-60min after food intake. He has experienced some weight loss because of fear of postprandial pain. | Chronic mesenteric ischemia: h/o cardiac disease suggests pt has atherosclerosis. intestinal hypoperfusion is v painful and is esp pronounced after eating meals when more blood is needed to digest an absorb nutrients |
| What is the differential for pulsus paradoxus? | Cardiac tamponade, constrictive pericarditis, severe obstructive lung disease (e.g., asthma), and restrictive cardiomyopathy; caused by any disease that restricts the ability of the R side of the heart to expand into the pericardium during inspiration |
| Fever, bilateral conjunctivitis, lymphadenopathy, and cutaneous involvement (skin peeling off fingertips). Complication? | Kawasaki disease; complication is coronary aneurysm |
| Patient with continuous machine like murmur best heard over the upper L sternal edge and a thrill felt on PE is scheduled for surgery. The derivative of which embryologic structure will be operated on? | 6th aortic arch (pt has patent ductus arteriosus) |
| When cells in the heart, brain, or skeletal m are injured, which enzyme will be elevated in circulation? | Creatine kinase |
| Differential cyanosis restricted to lower body in a child. | PDA with late-onset reversal of shunt flow (from L-->R to R-->L) |
Created by:
sarah3148
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