Ass. 61 - Videos

Front 1

What is the cause of a harsh systolic mumur? Cause?

Back 1

Aortic stenosis

Calcification d/t age or congenital bicuspid valve

Front 2

Cause of blowing diastolic murmur? Cause?

Back 2

Aortic regurg

Luetic aneurysm, chronic HTN, dissecting aortic aneurysm, ankylosing spondylitis

Front 3

Harsh diastolic murmur? Cause?

Back 3

Mitral stenosis

Rheumatic heart disease

Front 4

What is the most commonly damaged heart valve caused by post grp A Strep?

Back 4

Mitral valve

Front 5

Blowing systolic murmur? Cause?

Back 5

Mitral regurg

MVP, Rheumatic heart disease, infectious endocarditis, papillary m. rupture 2nd to MI, CHF

Front 6

Midsystolic click? Common with?

Back 6

Mitral valve prolapse

Marfan's, Ehlers-Danlos, Fragile X

Front 7

Acyanotic congenital heart defects

Back 7

VSD
ASD
PDA

Front 8

Cyanotic congenital heart defects

Back 8

Tetrology of fallot
Transposition of great vessels
Persistent truncus arteriosus
Eisenmenger's syndrome

Front 9

Tetralogy of fallot

Back 9

-VSD
-subpulmonic stenosis
-overriding aorta
-RV hypertrophy
(cyanotic)

Front 10

Transposition of Great Vessels

Back 10

Aorta to RV
Pulmonary a. to LV

(cyanotic)

Front 11

Persistent Truncus arteriosus

Back 11

Great vessels aren't separated (rather one vessel)

Front 12

Eisenmenger's syndrome

Back 12

reversal of L--> R shunt (i.e. VSD) to a R-->L shunt (2nd to pulmonary HTN)

Front 13

All aortic coarctations are ____

Back 13

Inherited, narrowing of aorta

Front 14

Infant type v. Adult types of aortic coarctation

Back 14

Infant - preductal (narrowing prior to the ductus arteriosus)

Adult - postductal (narrowing distal to the ductus arteriosus)

Front 15

What is valve atresia

Back 15

Complete closure of the valve

Front 16

Characteristics of Stable angina

Back 16

"exercise-induced" CP (increased cardiac perfusion)
< 30 min
Relieved w/ rest, nitro

Front 17

Atherosclerotic plaque unchanged but increase in cardiac demand

Back 17

Stable angina

Front 18

Characteristics of Unstable angina

Back 18

Disruption of plaque --> formation throbosis w/ potential embolization
Pain spontaneous

Front 19

Persistent but disrupted atherosclerotic plaque w/ platelet clot formation

Back 19

Unstable angina
< 30 min

Front 20

Coronary a. spasm causes

Back 20

Prinzmetal's angina

< 30 min, relieved w/ Nitro

Front 21

Differentiate b/t Subendocardial & transmural MI

Back 21

SubE - inner 1/3 to 1/2 of cardiac m. (non Q-wave, NSTEMI)

Trans - full thickness (Q-wave, STEMI)

Front 22

Which ischemic heart disease pain relieved from Nitro

Back 22

Stable angina
Prinzmetal's

Front 23

Which ischemic heart disease causes EKG ST elevation

Back 23

Q-wave (STEMI) MI
Prinzmetal's

Front 24

Which ischemic heart disease causes positive Troponin levels

Back 24

Non-Q wave MI
Q-wave MI

Front 25

Which ischemic heart disease causes elevated CK-MB

Back 25

Unstable angina
Non-Q wave MI
Q-wave MI

Front 26

Which ischemic heart disease lasts < 30 min

Back 26

Stable angina
Unstable angina
Prinzmetal's

Front 27

Clinical features of Stable angina

Back 27

< 30 min, relieved w/ rest, nitro
ST segment depression
(-) Troponin, CK-MB

Front 28

Clinical features of Unstable angina

Back 28

< 30 min, not relieved w/ Nitro
ST segment depression
(-) Troponin
(+) CK-MB

Front 29

Clinical features of Non-Q wave MI (NSTEMI)

Back 29

> 30 min, not relieved w/ Nitro
ST segment depression
(+) troponin, CK-MB

Front 30

Clinical features of Q-wave MI (STEMI)

Back 30

> 30 min, not relieved w/ Nitro
ST segment elevation
(+) troponin, CK-MB

Front 31

Clinical features Prinzmetal's angina

Back 31

< 30 min, relieved w/ Nitro
ST segment elevation
(-) Troponin, CK-MB

Front 32

What are Acute coronary syndromes?

Back 32

Unstable angina
non-Q wave MI
Q-wave MI

(ischemia --> cardiac injury)

Front 33

How many weeks post MI is the dead tissue replaced with scar tissue?

Back 33

8 weeks

Front 34

Typical cause of LHF

Back 34

chronic HTN
MI
Valve pathology

Front 35

Left HF leads to what?

Back 35

Pulmonary edema & fluid overload
(dyspnea, orthopnea, fatigue)

Front 36

Typical cause of RHF

Back 36

L-sided HF
Pulmonary HTN
Lung pathology

Front 37

Right HF leads to what?

Back 37

Peripheral edema & nutmeg liver
(ankle edema, JVD)

Front 38

Most common pathology of Acute Infective Endocarditis

Back 38

Skin microbes
-Staph aureus
-Streptococcus spp

Front 39

Who gets acute infective endocarditis

Back 39

No prior valve pathology
IV drug users
Diabetics

Front 40

Most common pathology of Subacute Infective endocarditis

Back 40

Mouth or GI bugs
-Strep viridans
-E.coli or G- bacteria

Front 41

Who gets Subacute Infective endocarditis

Back 41

Prior valve pathology

Front 42

What is important to do for prophylaxis if have valve pathology to prevent Subacute infective endocarditis

Back 42

ATb prior to
Dental work
Prior procedures involving the skin infected with Staph or Strep
Prosthetic heart valves

Front 43

Clinical in subacute infective endocarditis

Back 43

Insidious, slow-onset
Fatigue
Low grade fever

Front 44

Clinical in Acute infective endocarditis

Back 44

Acute onset chills
High fever

Front 45

Pathology of Acute Rheumatic fever

Back 45

Ab attack heart following Strep pyogenes infection --> pancarditis

May result in severe mitral valve damage --> rheumatic heart disease

Front 46

What is the most commonly affected valve in acute rheumatic fever?

Back 46

Mitral valve

Front 47

Pathology of Marantic endocarditis (seen in a/w what illness)

Back 47

Thrombi on endocardium

(adenocarcinoma)

Front 48

Pathology of Libman-Sacks endocarditis

Back 48

SLE pt only
vegetation of Ag-Ab complex form on valve --> severe valve damage

Front 49

What would lead you to believe pt may have endocarditis?

Back 49

New onset murmur

Front 50

Work-up for ddx endocarditis

Back 50

Blood culture
Echocardium

Front 51

Causes of Fibrinous pericarditis

Back 51

Transmural MI or Dressler syndrome

Front 52

Causes of Serous pericarditis

Back 52

Coxsackie's B virus
Uremia
Acute rheumatic fever
Scleroderma
Rheumatic heart disease
SLE

Front 53

Cause of suppurative pericarditis

Back 53

Direct invasion by organisms into pericardium
(Strep. pneumoniae or Staph aureus)

Front 54

What can pericarditis lead to

Back 54

Pericardial effusion --> Cardiac tamponade

Front 55

Type of hypersensitivity seen in Acute rheumatic fever

Back 55

Type II w/ molecular mimicry

Front 56

What is the cause of acute rheumatic fever

Back 56

Ab against cardiac cells
Post Strep. pyogenes infection (3-4 wks post resolution)

Front 57

What is Aschoff body? Who is it seen in?

Back 57

Acute rheumatic fever
-collagen, enlarged myocytes, Aschoff cells (multinucleated giant cells)

Front 58

What are the major jones criteria

Back 58

Migratory polyarthritis
Carditis (pan)
SubQ nodules
Erythema marginatum (disk-shaped pink lesions raised at the edges)
Sydenham's chorea

Front 59

Minor jones criteria

Back 59

Fever
Arthralgia
Minor jones lab indices: hi ESR, CRP, WBC
Prolonged PR
Hx previous episode rheumatic fever

Front 60

Dx of acute rheumatic fever requires

Back 60

Previous S. pyogenes infection (+ ASO titer) PLUS (1 of following)
2 MAJOR OR
1 MAJOR & 2 MINOR Jones criteria

Front 61

Define obstructive lung disease

Back 61

Increased restriction to airflow during forced expiration (air can't leave)

Front 62

Levels on PFTs seen w/ obstructive lung disease

Back 62

FEV1 - LOW
TLC - HIGH
FEV1/FVC ratio - LOW (<80%)

Front 63

Mainstay tx for all obstructive lung disease

Back 63

Beta agonist (Albuterol)
+/- Anticholinergics
+/- O2

Front 64

What is the classification of obstructive lung disease which is irreversible

Back 64

COPD

(Asthma - reversible)

Front 65

3 types of COPD

Back 65

Pulmonary emphysema
Chronic bronchitis
Bronchiectasis

Front 66

Pathology of pulmonary emphysema

Back 66

Enlargement airspaces --> destruction of alveolar walls
(caused by proteolytic enzyme attack of alveolar walls)

Front 67

Differentiate b/t Panacinar & Centrilobular pulmonary emphysema

Back 67

P - throughout lobule (alpha-1 antitrypsin deficiency)

C - center of lobule (smoking)

Front 68

Clinical s/s pulmonary emphysema

Back 68

Pursed-lip breathing
Barrel chest
Dyspnea
"Pink bloater"

CXR - hyperinflated lungs, depressed diaphragms

Front 69

Pathology of chronic bronchitis

Back 69

Prolonged exposure to non-specific bronchial irritants
Accompanied by mucus hypersecretion & bronchial structural change

Front 70

Clinical s/s chronic bronchitis

Back 70

Wet, productive cough
Dyspnea
Rhonchi
"blue bloater"

Front 71

Pathology of bronchiectasis

Back 71

Irreversible, focal bronchial dilatation (usually w/ infection)
2 types: Kartagener syndrome, CF

Front 72

Kartagener syndrome

Back 72

(Non-fnct cilia)
Recurrent bronchial infection --> bronchiectasis, situs inversus, male sterility, hearing deficits

Front 73

Cystic fibrosis

Back 73

Recurrent bronchial infections --> bronchiectasis, malabsorption, gallstones

Front 74

Clinical s/s bronchiectasis

Back 74

Copious sputum (purulent, hemoptysis)

Front 75

Pathology Asthma (Bronchial asthma, reactive airway dz)

Back 75

IgE respose --> airway obstruction & inflammation & increased airway responsiveness to stimuli
(spasm sm m., edema airway, increased mucosal secretions)

Front 76

Clinical s/s asthma

Back 76

Cough
Dyspnea
Expiratory wheezing
Tachypnea
(Charcot-Leyden or Curschmann spirals in mucus)

Front 77

Pathology of restrictive lung disease

Back 77

Restricted from taking air IN

(Fibrosis/Scarring)

Front 78

PFTs for restrictive lung disease

Back 78

FEV1 - N or LOW
TLC - LOW

Front 79

Pathology, clinical sarcoidosis

Back 79

Non-caseating granulomas --> fibrosis

(dyspnea, cough, night sweats)

Front 80

CXR sarcoidosis

Back 80

Bil hilar adenopathy +/- panda sign
(bil sarcoidosis parotid glands)

Front 81

Pathology, clinical Adult ARDS

Back 81

D/t diffuse injury to endothelium of lung --> collagen accumulates --> interstitial fibrosis
(pulmonary edema, resp. distress, hypoxemia)

Front 82

Pathology, clinical neonatal ARDS (hyaline membrane disease)

Back 82

Insufficient surfactant d/t immaturity (<33-34 days)

L:S (lecithin:sphingomyelin) ratio < 2.0

Front 83

Pathology, clinical Pneumoconiosis

Back 83

Habitual inhalation non-degradeable irritants & deposit in lung parenchyma
(mineral or metallic particles)

Macs --> ROS --> Macs die --> fibrosis

Front 84

Asbestosis

Back 84

Ferrguinous bodies - clubbed at ends
Lower lobes - fibrotic plaque of pleura
Increases risk for squamous cell CA & malignant mesothelioma

Front 85

Anthracosis

Back 85

Coal workers pneumoconiosis "Black lung"
Upper lung lobes
(bronchiectasis, pulmonary HTN, severe restrictive lung dz, RHF, resp. failure)

Front 86

Berylliosis

Back 86

(high-tech electroncis - fluorescent light bulbs)
Only requires 1 exposure (not repeated)
Lower lobes

Front 87

Silicosis

Back 87

Chronic inhalation quartz dust (sand blasting, granite cutting)
Increases risk TB
Upper lobes

Front 88

Hypersensitivity pneumonitis

Back 88

From repeated inhalation of particular allergens that cause inflammation response and fibrosis

Front 89

Goodpastures syndrome

Back 89

Autoimmune - Anti-glomerular BM Ab

(glomerulonephritis, pulmonary hemorrhage, dyspnea)

Front 90

"Honeycomb lung" aka

Back 90

Diffuse idiopathic fibrosis
(unknown cause)
Fatal w/i several yrs