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90 Cards in this Set

  • Front
  • Back
What is the cause of a harsh systolic mumur? Cause?
Aortic stenosis

Calcification d/t age or congenital bicuspid valve
Cause of blowing diastolic murmur? Cause?
Aortic regurg

Luetic aneurysm, chronic HTN, dissecting aortic aneurysm, ankylosing spondylitis
Harsh diastolic murmur? Cause?
Mitral stenosis

Rheumatic heart disease
What is the most commonly damaged heart valve caused by post grp A Strep?
Mitral valve
Blowing systolic murmur? Cause?
Mitral regurg

MVP, Rheumatic heart disease, infectious endocarditis, papillary m. rupture 2nd to MI, CHF
Midsystolic click? Common with?
Mitral valve prolapse

Marfan's, Ehlers-Danlos, Fragile X
Acyanotic congenital heart defects
VSD
ASD
PDA
Cyanotic congenital heart defects
Tetrology of fallot
Transposition of great vessels
Persistent truncus arteriosus
Eisenmenger's syndrome
Tetralogy of fallot
-VSD
-subpulmonic stenosis
-overriding aorta
-RV hypertrophy
(cyanotic)
Transposition of Great Vessels
Aorta to RV
Pulmonary a. to LV

(cyanotic)
Persistent Truncus arteriosus
Great vessels aren't separated (rather one vessel)
Eisenmenger's syndrome
reversal of L--> R shunt (i.e. VSD) to a R-->L shunt (2nd to pulmonary HTN)
All aortic coarctations are ____
Inherited, narrowing of aorta
Infant type v. Adult types of aortic coarctation
Infant - preductal (narrowing prior to the ductus arteriosus)

Adult - postductal (narrowing distal to the ductus arteriosus)
What is valve atresia
Complete closure of the valve
Characteristics of Stable angina
"exercise-induced" CP (increased cardiac perfusion)
< 30 min
Relieved w/ rest, nitro
Atherosclerotic plaque unchanged but increase in cardiac demand
Stable angina
Characteristics of Unstable angina
Disruption of plaque --> formation throbosis w/ potential embolization
Pain spontaneous
Persistent but disrupted atherosclerotic plaque w/ platelet clot formation
Unstable angina
< 30 min
Coronary a. spasm causes
Prinzmetal's angina

< 30 min, relieved w/ Nitro
Differentiate b/t Subendocardial & transmural MI
SubE - inner 1/3 to 1/2 of cardiac m. (non Q-wave, NSTEMI)

Trans - full thickness (Q-wave, STEMI)
Which ischemic heart disease pain relieved from Nitro
Stable angina
Prinzmetal's
Which ischemic heart disease causes EKG ST elevation
Q-wave (STEMI) MI
Prinzmetal's
Which ischemic heart disease causes positive Troponin levels
Non-Q wave MI
Q-wave MI
Which ischemic heart disease causes elevated CK-MB
Unstable angina
Non-Q wave MI
Q-wave MI
Which ischemic heart disease lasts < 30 min
Stable angina
Unstable angina
Prinzmetal's
Clinical features of Stable angina
< 30 min, relieved w/ rest, nitro
ST segment depression
(-) Troponin, CK-MB
Clinical features of Unstable angina
< 30 min, not relieved w/ Nitro
ST segment depression
(-) Troponin
(+) CK-MB
Clinical features of Non-Q wave MI (NSTEMI)
> 30 min, not relieved w/ Nitro
ST segment depression
(+) troponin, CK-MB
Clinical features of Q-wave MI (STEMI)
> 30 min, not relieved w/ Nitro
ST segment elevation
(+) troponin, CK-MB
Clinical features Prinzmetal's angina
< 30 min, relieved w/ Nitro
ST segment elevation
(-) Troponin, CK-MB
What are Acute coronary syndromes?
Unstable angina
non-Q wave MI
Q-wave MI

(ischemia --> cardiac injury)
How many weeks post MI is the dead tissue replaced with scar tissue?
8 weeks
Typical cause of LHF
chronic HTN
MI
Valve pathology
Left HF leads to what?
Pulmonary edema & fluid overload
(dyspnea, orthopnea, fatigue)
Typical cause of RHF
L-sided HF
Pulmonary HTN
Lung pathology
Right HF leads to what?
Peripheral edema & nutmeg liver
(ankle edema, JVD)
Most common pathology of Acute Infective Endocarditis
Skin microbes
-Staph aureus
-Streptococcus spp
Who gets acute infective endocarditis
No prior valve pathology
IV drug users
Diabetics
Most common pathology of Subacute Infective endocarditis
Mouth or GI bugs
-Strep viridans
-E.coli or G- bacteria
Who gets Subacute Infective endocarditis
Prior valve pathology
What is important to do for prophylaxis if have valve pathology to prevent Subacute infective endocarditis
ATb prior to
Dental work
Prior procedures involving the skin infected with Staph or Strep
Prosthetic heart valves
Clinical in subacute infective endocarditis
Insidious, slow-onset
Fatigue
Low grade fever
Clinical in Acute infective endocarditis
Acute onset chills
High fever
Pathology of Acute Rheumatic fever
Ab attack heart following Strep pyogenes infection --> pancarditis

May result in severe mitral valve damage --> rheumatic heart disease
What is the most commonly affected valve in acute rheumatic fever?
Mitral valve
Pathology of Marantic endocarditis (seen in a/w what illness)
Thrombi on endocardium

(adenocarcinoma)
Pathology of Libman-Sacks endocarditis
SLE pt only
vegetation of Ag-Ab complex form on valve --> severe valve damage
What would lead you to believe pt may have endocarditis?
New onset murmur
Work-up for ddx endocarditis
Blood culture
Echocardium
Causes of Fibrinous pericarditis
Transmural MI or Dressler syndrome
Causes of Serous pericarditis
Coxsackie's B virus
Uremia
Acute rheumatic fever
Scleroderma
Rheumatic heart disease
SLE
Cause of suppurative pericarditis
Direct invasion by organisms into pericardium
(Strep. pneumoniae or Staph aureus)
What can pericarditis lead to
Pericardial effusion --> Cardiac tamponade
Type of hypersensitivity seen in Acute rheumatic fever
Type II w/ molecular mimicry
What is the cause of acute rheumatic fever
Ab against cardiac cells
Post Strep. pyogenes infection (3-4 wks post resolution)
What is Aschoff body? Who is it seen in?
Acute rheumatic fever
-collagen, enlarged myocytes, Aschoff cells (multinucleated giant cells)
What are the major jones criteria
Migratory polyarthritis
Carditis (pan)
SubQ nodules
Erythema marginatum (disk-shaped pink lesions raised at the edges)
Sydenham's chorea
Minor jones criteria
Fever
Arthralgia
Minor jones lab indices: hi ESR, CRP, WBC
Prolonged PR
Hx previous episode rheumatic fever
Dx of acute rheumatic fever requires
Previous S. pyogenes infection (+ ASO titer) PLUS (1 of following)
2 MAJOR OR
1 MAJOR & 2 MINOR Jones criteria
Define obstructive lung disease
Increased restriction to airflow during forced expiration (air can't leave)
Levels on PFTs seen w/ obstructive lung disease
FEV1 - LOW
TLC - HIGH
FEV1/FVC ratio - LOW (<80%)
Mainstay tx for all obstructive lung disease
Beta agonist (Albuterol)
+/- Anticholinergics
+/- O2
What is the classification of obstructive lung disease which is irreversible
COPD

(Asthma - reversible)
3 types of COPD
Pulmonary emphysema
Chronic bronchitis
Bronchiectasis
Pathology of pulmonary emphysema
Enlargement airspaces --> destruction of alveolar walls
(caused by proteolytic enzyme attack of alveolar walls)
Differentiate b/t Panacinar & Centrilobular pulmonary emphysema
P - throughout lobule (alpha-1 antitrypsin deficiency)

C - center of lobule (smoking)
Clinical s/s pulmonary emphysema
Pursed-lip breathing
Barrel chest
Dyspnea
"Pink bloater"

CXR - hyperinflated lungs, depressed diaphragms
Pathology of chronic bronchitis
Prolonged exposure to non-specific bronchial irritants
Accompanied by mucus hypersecretion & bronchial structural change
Clinical s/s chronic bronchitis
Wet, productive cough
Dyspnea
Rhonchi
"blue bloater"
Pathology of bronchiectasis
Irreversible, focal bronchial dilatation (usually w/ infection)
2 types: Kartagener syndrome, CF
Kartagener syndrome
(Non-fnct cilia)
Recurrent bronchial infection --> bronchiectasis, situs inversus, male sterility, hearing deficits
Cystic fibrosis
Recurrent bronchial infections --> bronchiectasis, malabsorption, gallstones
Clinical s/s bronchiectasis
Copious sputum (purulent, hemoptysis)
Pathology Asthma (Bronchial asthma, reactive airway dz)
IgE respose --> airway obstruction & inflammation & increased airway responsiveness to stimuli
(spasm sm m., edema airway, increased mucosal secretions)
Clinical s/s asthma
Cough
Dyspnea
Expiratory wheezing
Tachypnea
(Charcot-Leyden or Curschmann spirals in mucus)
Pathology of restrictive lung disease
Restricted from taking air IN

(Fibrosis/Scarring)
PFTs for restrictive lung disease
FEV1 - N or LOW
TLC - LOW
Pathology, clinical sarcoidosis
Non-caseating granulomas --> fibrosis

(dyspnea, cough, night sweats)
CXR sarcoidosis
Bil hilar adenopathy +/- panda sign
(bil sarcoidosis parotid glands)
Pathology, clinical Adult ARDS
D/t diffuse injury to endothelium of lung --> collagen accumulates --> interstitial fibrosis
(pulmonary edema, resp. distress, hypoxemia)
Pathology, clinical neonatal ARDS (hyaline membrane disease)
Insufficient surfactant d/t immaturity (<33-34 days)

L:S (lecithin:sphingomyelin) ratio < 2.0
Pathology, clinical Pneumoconiosis
Habitual inhalation non-degradeable irritants & deposit in lung parenchyma
(mineral or metallic particles)

Macs --> ROS --> Macs die --> fibrosis
Asbestosis
Ferrguinous bodies - clubbed at ends
Lower lobes - fibrotic plaque of pleura
Increases risk for squamous cell CA & malignant mesothelioma
Anthracosis
Coal workers pneumoconiosis "Black lung"
Upper lung lobes
(bronchiectasis, pulmonary HTN, severe restrictive lung dz, RHF, resp. failure)
Berylliosis
(high-tech electroncis - fluorescent light bulbs)
Only requires 1 exposure (not repeated)
Lower lobes
Silicosis
Chronic inhalation quartz dust (sand blasting, granite cutting)
Increases risk TB
Upper lobes
Hypersensitivity pneumonitis
From repeated inhalation of particular allergens that cause inflammation response and fibrosis
Goodpastures syndrome
Autoimmune - Anti-glomerular BM Ab

(glomerulonephritis, pulmonary hemorrhage, dyspnea)
"Honeycomb lung" aka
Diffuse idiopathic fibrosis
(unknown cause)
Fatal w/i several yrs