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Cardiovascular
Cardiovascular question
| Question | Answer |
|---|---|
| Aschoff bodies are? | Interstitial myocardial granulomas found typically in acute rheumatic carditis. |
| What are plump machrophages with abundant cytoplasm and central round to ovoid nuclei with central, slender chromatin ribbons | Antischkow cells (caterpillar cells). When te larger macrophages become multinucleated they are reffered to as Aschoff giant cells. |
| Acute rheumatic fever is usually preceded by? | episode of group A streptococcal pharyngitis 10 days to 6 weeks prior. |
| Viral myocarditis produces a predominantly what type of interstitial inflammatory inflitrate? | lymphocytic, /w focal necrosis of myocytes adjacent to the inflammatory cells |
| Hypersensitivity myocarditis, as may result from a drug hypersensitivity rxn, is characterized histologically by? | Interstitial inflammatory infiltrate of mononuclear inflammatory cells and eosinophils |
| Recent travel to Latin America is associated /w what dz. that is caused by intracellular protozoan parasite Trypanosoma cruzi? | Chagas dz. |
| Chagas dz. is caused by what parasite? | Protozoan Trypanosome cruzi |
| Chagas dz. can result in a myocarditis characterized histologically by? | distension of individual myofibers /w intracellular trypanosomes |
| What histologically characterizes diphtheritic myocarditis? | interstitial infiltrate of macrophages, without the distinct Aschoff body-type granulomas seen in ARF. |
| A child who has not been immunized against diptheria is susceptible to diphtheritic myocarditis a condition resulting from? | Circulating toxin produced by a primary focus of infection in the upper aerodigestive tract (tonsillopharyngitis). |
| What congenital heart dz. that results in an anomalous connection between cardiac chambers is a normal variant in an adult pt. | Patent foramen ovale. |
| What should be considered in a pt. that has evidence of deep venous thrombosis of the extremities and has developed a stroke? | Patent foramen ovale |
| Endocardial cushion defect usually results in? | a persistent AV canal, combined /w a continuous lower atrial and upper ventricular septal defect. |
| Endocardial cushion defect is associated /w what syndrome | Down syndrome |
| What is dz. results form incomplete embryonic development of the aorticopulmonary septum, resulting in a single great vessel leaving the heart. | Persistent truncus arteriosus |
| What is always associated /w persistent truncus arteriosus | Ventricular septal defect |
| What will happen if persistent truncus arteriosus is not corrected? | This defect causes cyanosis, and, if not corrected, results in death due to congestive heart failure within the first year of life. |
| When does the ductus arteriosus normally closes? | by the 3rd month of life on response to high PaO2 of blood shunting form left to right through the ductus after birth. |
| Where does atherosclerotic plaques predominantly develope? | Large elastic arteries (aorta, carotid, and iliac arteries), and in large or medium-sized muscular arteries (coronary and popliteal arteries). |
| What artery does atherosclerotic plaques usually first start? | abdominal aorta /w lesion most prominent around the ostia of major arterial branches. Then coronary, popliteal, internal carotid, and circle of willis. Upper limbs usually spared + mesenteric and reneal except at their ostia |
| In the carotid system, the region most prone to atherosclerosis is likely where? | The carotid sinus, at the origin of the internal carotid artery. |
| Supine dyspnea that is relieved by sitting up, known as orthopnea, is a relatively specific sign of what advanced heart problem? | Left-sided heart failure |
| Pulmonary edema resulting in orthopnea can be seen in the absence of left ventricular dysfunction in patients with | mitral stenosis |
| Blowing holosystolic murmur heard best over the apex and history of dyspnea and fatigue are together suggestive of what problem? | mitral regurgitation |
| What are the erythematous, sometimes hemorrhagic,painless, macules on the sole of the foot called in bacterial endocarditis | Janeway lesions |
| Janeway lesions are the result of | septic embolization from infected cardiac valve vegetation. |
| What are the painful, papulopustules found in the pulps of the fingers and toes called found in bacterial endocarditis | osler nodes |
| What is the most common cause of ventricular fibrillation in people younger than 30yrs of age? | hypertrophic cardiomyopathy |
| congenital bicuspid aortic valves are strongly associated /w | Accelerated onset of calcific aortic stensosis. With pt.'s valves showing stenosis beginning in the sixth decase. |
| What type of pt. are predisposed to infectious endocarditis? | pt. /w prosthetic heart valves, prior valvular inflammation + scarring, which may occur following rheumatic fever |
| Rupture of chordae tendineae most commonly occurs in association /w? | endocarditis or myocardial infarciton. |
| What dzs causes myocardial fibrosis | dermatomyositis, muscular dystorphy, sarcoidosis and scleroderma |
| Myocardial hypertrophy occurs in? | prolonged uncontrolled hypertension, or can be inherited as an autosomal dominant condition. |
| What is the most common causative organism of acute infective endocarditis? | Staphylococcus aureus |
| What does the vegetations associated /w bacterial endocarditis represent? | Fibrin and platelet deposition at a site of bacterial colonization |
| What is the underlying host key predisposing insult in the development of infectious endocarditis? | endothelial damage |
| Pt. with endocardial thickening due to fibrosis present /w | signs of heart failure due to restrictive cardiomyopathy. |
| Myxomatous degeneration often affects what valve | mitral valve resulting in mitral valve prolapse, and is seen in the setting of connective tissue dz. such as Marfan syndrome |
| What are the normal morphological change in the heart that are associated /w aging? | decrease in left ventricular chamber apex-to-base dimensions, development of a sigmoid-shaped ventricular septum, myocyte atrophy /w interstitial fibrosis, and accumulation of cytoplasmic lipofuscin pigment. |
| hypertensive heart dz. is associated /w what type of hypertrophy of the left ventricle? | concentric |
| What are the histological findings in chronic ischemic heart dz? | Myocardial hypertrophy, diffuse subendocardial vacuolization, and fibrotic scars of previously healed infarcts. |
| What is the description of chest pain of pericarditis origin? | sharp and pleuritic in nature |
| What decreases the pain associated /w pericarditis? | pt. sits up and leans forward |
| Fibrinous or serofibrinous pericarditis in most instances is causes by? | Myocardial infarction, rheumatic fever, or uremia, though a viral infeciton may occasionally cause a fibrinous exudate to accumulate in the pericardial space. |
| What is the name for a paradoxical increase in jugular venous pressure /w inspiration | Kussmaul's sign |
| Where is Kussmaul's sign most often found? | chronic constrictive pericarditis, a condition that takes months or years to develop. |
| In the absence of tamponade (as is true for a normaltensive pt.)we would not expect Kussmaul's sign in a case of | acute pericarditis |
| What is the differential diagnosis for Kussmaul's sign? | cardiac tamponade, restrictive cardiomyopathy, severe right-sided heart failure, and tricuspid stenosis. |
| The presence of an S3 heart sound reflects? | A rapid rate of diastolic ventricular filling with a large volume of blood (as in ventricular volume overload) and/or reduced ventricular compliance (diastolic dysfunction). |
| What is called a drop in systolic blood pressure of 20mmHg or more during inspiration? | Pulsus paradoxus |
| When is pulsus paradoxus found? | Cor pulmonale, constrictive pericardial dz, and cardiac tamponade. |
| What is a brief, high frequency precordial sound heard in early diastole (shortly after S2) in pt. with constrictive pericarditis? | Pericardial knock |
| Pericardial knock can be confused /w ? | Opening snap of mitral stenosis |
| What is the most striking physical finding of acute-onset pericarditis: fibrinous or serofibrinous? | pericardial friction rub. |
| Ingestion of fenfluramine, dexfenfluramine, and phentermine for more than three months' duration has been associated /w the development of? | secondary pulmonary hypertension. |
| Pt. /w pulmonary htn generally present /w? | Exertional dyspnea(and possible exeertional pre-syncope), due to an inability of the right heart to adequately increase cardiac output against increased pulmonary vascular resistance during exercise. systemic bp may fall during exercise |
| Cerebral berry aneurysms are associated /w genetic disorders such as autosomal dominant? | polycystic kidney dz, and Ehlers-Danlos syndrome |
| Bilateral upper lobe pulmonary fibrosis may be caused by? | progressive massive fibrosis (coal worker's pneumoconiosis and silicosis), tuberculosis, histoplasmosis, sarcoidosis, allergic bronchopulmonary aspergillosis, and ankylosing spondylitis. |
| Renal vascular sclerosis may result from | atherosclerosis, fibromuscular dysplasia, or systemic vasculitis (polyarteritis nodosa). |
| MI results in what type of necrosis | coagulative necrosis |
| irreversible ischemic injury to the brain tissue results in what type of necrosis | liquefactive |
| Where is fibrinoid necrosis seen? | vasculitides |
| Caseous necrosis results from? | tuberculosis |
| Fat necrosis results form? | enzymatic action of abnormally released pancreatic lipases on adipose tissue. |
| Histologic pattern of injury seen in the walls of blood vessels affected by immune complex vasculitis | fibrinoid necrosis |
| When the hypercoagulability is the result of the procoagulant effects of circulating products of cancers, the resulting resulting cardiac valve vegetations may also be called? | marantic endocarditis |
| The pathophysiology of nonbacterial thrombotic endocarditis is similar to that of ? which may also be induced by disseminated cancer | Trousseau's syndrome (migratory thrombophlebitis) |
| Lambert-Eaton syndrome is what type of syndrome? | Autoimmune paraneoplastic myasthenic syndrome |
| What does Lambert-Eaton syndrome affect? | Presynaptic calcium channels, resulting in decreased presynaptic acetylcholine relese |
| In most cases Lambert-Eaton syndrome is associated in most cases /w | Oat cell carcinoma of the lungs |
| Cancer metastases to the heart usually involves what part of the heart? | pericardium or myocardium. Valve metastases are less frequent. |
| Humoral hypercalcemia of malignancy, the most common causes of hypercalcemia in hospitalized pt, is due to? | Production of parathyroid hormone like substance by tumors |
| Small, sterile, non-destructive fibrinous vegetations along the lines of closure of cardiac valve cusps are characteristic of? | Non-bacterial thrombotic endocarditis |
| There is a particularly strong association of NBTE /w what type of cancers | Mucinous adenocarcinomas of the pancrease and adenocarcinomas of the lung |
| When there is acute infective endocarditis to the aortic valve what usually happens | aortic regurgitation |
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schrla
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