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47 Cards in this Set

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Anatomy of Coronary Vasculature: FA 280

1) 2 arts that supply blood to heart?

2) 2 branches of LCA?

3) SA and AV nodes are usually supplied by this artery?

4) What art usually supplies the inferior part of the Left Vent?
1) RCA and LCA

2) L CFX
LAD

3) RCA

4) RCA via the PD
1) Which art usually supplies the Ant IV septum?

2) Which coronary artery is most often occluded --> what pathology?
1) LAD

2) LAD --> Ant MI
1) Since the most posterior part of the heart is the L. atrium, enlargement of the LA can compress what 2 nerves --> what 2 sx?
1) Esophageal nerve --> dysphagia
Recurrent Laryngeal nerve --> Hoarseness
Congenital Cardiac Defect Associations:

Which congenital dz is associated w/:
1) Truncus arteriosus, TOF?
2) ASD, VSD, AV septal defect (endocardial cushion defect)
3) Septal defects, PDA, Pulm Art stenosis
4) Preductal coarctation of aorta?
5) Late aortic insufficiency
6) TFA
1) 22q11 syndromes
2) Down's syndrome
3) Congenital Rubella
4) Turner's syndrome
5) Marfans
6) Infant of diabetic mother
What type of ARTERIOsclerosis do the following describe:

1) Calcification of the tunica MEDIA;
"Pipestem" arteries

2) Hyaline thickening of small arteries;
Essential HTN;
DM

3) Fibrous plaques, fatty streaks and atheromas
1) Monckeberg

2) Arteriolosclerosis

3) Atherosclerosis
More Info on Atherosclerosis:
(Fibrous plaques, fatty streaks and atheromas)

1) This is a dz of what type of arteries?

2) What kicks off atherosclerosis?

3) When macs accum LDL what develops?

4) One part of the process of atherosclerosis is smooth muscle migration from media to intima. What stimulates this?

5) Give the 4 areas where atherosclerosis usually occurs, in order of MC --> LC?

6) NOTE:
*SX of atherosclerosis:
Angina, Claudication, Asx-ic

*Complications of atherosclerosis: Aneurysms, Ischemia, Infarcts, Periph Vasc Dz, Thrombus, Embolus
1) elastic, large and medium arts

2) Endothelial cell damage

3) Foam cells

4) PDGF and TGF-beta

5) ABD Aorta > Coronary Arts > Popliteal arts > Carotid Arts

6) NOTE:
*SX of atherosclerosis:
Angina, Claudication, Asx-ic

*Complications of atherosclerosis: Aneurysms, Ischemia, Infarcts, Periph Vasc Dz, Thrombus, Embolus
Ischemic Heart Dz:

1) What type of Angina do the following describe:
A) ST Depression;
Retrosternal chest pain upon exertion;
Secondary to Ath-sclerosis;
B) ST Elevation;
Occurs @ rest;
Secondary to coronary artery vasospasm

2) What type of angina has ST depression? ST elevation?

3) What do the following Describe:
A) Vasodilator --> shunting of blood from stenosed vessel to vessel of higher perfusion --> exacerbation of ischemia
B) Coronary art ATH-sclerosis -->
Thrombosis -->
Myocyte necrosis
C) Death within 1 hr of sx onset, usually from a lethal arrhythmia?
1)
A) STABLE angina
B) Prinzmetal's Angina

2) Stable. Prinzmetals

3)
A) Coronary steal syndrome
B) MI
C) Sudden cardiac death
MI:
1) Which coronary arts are most often occluded?

**NOTE: Sx include diaphoresis, nausea, vomiting, retrosternal pain, pain in L. arm or jaw, SOB

***NOTE: See DIT CV 31 for evolution of MI and pathological findings***
1) LAD > RCA > Circumflex

**NOTE: Sx include diaphoresis, nausea, vomiting, retrosternal pain, pain in L. arm or jaw, SOB
MI Dx:

1) Gold standard of MI dx is?
A) Transmural Infarct = what EKG 2 changes?
B) Subendocardial infarct = what EKG change?

2) Which cardiac enzyme is more sPecific than the others?

3) Why is CK-MB not as specific for MI as TnI?
A) Useful for dx-ing what?

4) Which enz could be found in cardiac, liver and skeletal muscle cells?
1) EKG
A) ST elevation; Q-waves
B) ST depression

2) TnI

3) CK-MB is also found in skeletal muscle
A) Reinfarction

4) AST
What part of heart is especially vulnerable to ischemia?
subendocardium
For the following arteries give:
Part of heart perfused; EKG leads it corresponds to

1) LAD

2) L. Circumflex

3) R. Coronary Art

4) R. Coronary Art
1) Ant wall V1-V4, V5

2) Lat Wall aVL, V5, V6

3) Inf Wall II, III, aVF

4) Post wall R. sided EKG V4
MI complications:

1) What is the most common and important cause of death from an MI?

2) What 2 types of pericarditis can occur post-MI?
1) Arrhythmia

2) Post-infarction pericarditis: 3-5 days post MI
Dressler's Syndrome:
auto-immune pericarditis several weeks post-MI
Cardiomyopathies: Probs w/ the muscle itself

1) 3 Types Cardiomyopathies?

2) Dilated cardiomyopathy is the MC:
A) It results in what type of hypertrophy?
B) Ets of dilated cardiomyopathy?
C) What heart sound is heard in a dilated cardiomyopathy?
1) Dilated (Congestive) Cardiomyopathy,
Hypertrophic cardiomyopathy,
Restrictive cardiomyopathy

2)
A) Eccentric hypertrophy
B) ABCCCD
Alcohol abuse,
wet Ber1 Ber1,
Coxsackie B,
Cocaine,
Chagas dz,
Doxorubicin,
Hemochromatosis,
Peripartum cardiomyopathy
C) S3
1) What type of cardiomyopathy is the result of a hypertrophied IV septum and vent --> outflow tract obstruction?

2) H-trophic cardiomyopathy is assoc w/ what neurological problem?

3) H-trophic cardiomyopathy is cause of sudden death in who?

4) H-trophic cardiomyop --> what heart sound?

5) What pulse will be increased?

6) What murmur?

7) Tx for hypertrophic cardiomyopathy?

8) What type of hypertrophy?
1) Hypertrophic cardiomyopathy

2) Friederich's ataxia

3) Young atheletes

4) S4

5) Apical impulse

6) Systolic murmur (makes sense bc it causes outflow obstruction) --> Syncope

7) beta-blocker
OR
non-dihydropyridine calcium channel blocker (Verapamil)

8) Concentric hypertrophy
Restrictive Cardiomyopathy:

1) This is the result of the deposition of stuff in the myocardium from what 4 cond'ns?
A) The deposition of this stuff in the myocardium --> what?

2) Assoc w/ what 2 cond'ns?
1) Sarcoidosis (sarcoid)
Amyloidosis (amyloid)
Fibroelastosis
Fibrosis
A) Stiff vents and TF a diastolic dysfnctn

2) Loffler's syndrome
Hemochromatosis
What is the MCC of R. heart failure?

Why might you use thiazide or loops diuretics and nitrates for CHF?
L. heart failure

Sx-ic relief
1) What Cond'n does this describe:
Infection / inflammation of the endocardium including the AV valves?

2) What type of bacterial endocarditis-
results from Staph aureus,
has LARGE vegetations on PREVIOUSLY NORMAL valves,
Rapid onset

3) What type of bacterial endocardtis -
results from Strep viridans,
SMALLER vegetations on ABNORMAL valves,
slow and insidious onset,
Result of dental procedures

4) Which valve is MCly involved? What about in IV drug users?

5) 8 s/s?
1) Bacterial (infective) endocarditis

2) Acute Endocarditis

3) Subacute Endocarditis

4) Mitral Valve
IV Rx Users: Tricuspid

5) FROM JANE
Fever (MC Sx)
Roth Spots: on Retina
Oslers Nodes: Painful on finger pads
Murmur

Janeway Lesions - Painless on P&S
Anemia
Nail-bed hemorrhage
Emboli
1) What Pathology:
Hx of beta-hemolytic strep pharyngitis now presents w/ cardiac probs?

2) 2 Pathological Findings in RF?

3) 1 lab finding in RF?

4) Give pathogenesis of RF?
A) TF what type hypersensitivity?

5) Give the JONES criteria for rheumatic fever?
1) RF (Rheumatic Fever)

2) Aschoff bodies (granulomas w/ giant cells)
Anitschkow cells (activated histiocytes)

3) Elevated ASO titers

4) Ab develop against streptococcal M PRO which looks like cardiac Ag -->
Ab attack heart
A) Type II

5) JONES
Joints: Migratory, Poly-Arthritis
Carditis
Nodules (Sub-Q)
Erythema Marginatum
Syndenham Chorea
What's the Pathology:
1) Sharp chest pain, aggravated w/ inspiration and relieved by sitting up and leaning forward?

2) MC type of pericarditis?

3) 2 other types pericarditis?
1) Pericarditis

2) Fibrinous pericarditis: Includes dressler's syndrome and uremic pericarditis

3) Serous pericarditis
Suppurative / Purulent pericarditis: infxn
What's the pathology:
1) Compression of heart from blood or effusions in pericardium --> Dec CO

2) Describe the diastolic pressures in all 4 chambers of the heart in someone w/ cardiac tamponade?

3) 1 Pulse Finding in Cardiac Tamponade?

4) 1 EKG finding in CT?
1) Cardiac tamponade

2) Equal

3) Pulsus Paradoxicus:
An exaggeration of a normal physiologic occurrence in which:
Inspiration -->
Suck more blood into right side of heart -->
right heart pushes against left heart -->
dec L. heart filling and CO -->
Drop in SBP by 10 mmHg

4) Electrical Alteranans:
Alternanting large and small QRS complexes
What pathology:
1) Dilation of aorta and aortic valve ring
+
Calcification of aortic root --> "tree bark" appearance of aorta?
1) Tertiary syphilis
Cardiac Tumors:
1) MC PRIMARY cardiac tumor in ADULTS?
A) Where are myxomas usually found?
B) Myxomas can obstruct blood flow in R. atrium and --> what?

2) What is the MC PRIMARY cardiac tumor in KIDS?

3) What is the MC cardiac tumor OVERALL (primary and otherwise)?

4) Cardiac tumors may show what PE sign?
1) Myxomas (usually L. atrium)
A) L. Atrium
B) Syncopal episodes

2) Rhabdomyoma

3) Mets from melanoma or lymphoma

4) Kussmaul's Sign: Inc JV Pressure on inspiration
What Pathology:
1) Dilated, tortuous veins due to increased venous pressure?

2) 2 sequlae of varicose veins?

3) Is thromboembolism from varicose veins common?
1) Varicose veins

2) Poor wound healing
Venous stasis ulcers

3) No, it's rare. Thromboemobolism from deep veins are common.
What pathology:
1) Dec blood flow to skin - esp fingers and toes- due to arteriolar vasospasm in cold temps or after emotional stress?

2) Assoc w/ what 3 AI cond'ns?

3) Why is Raynaud's called the "Patriotic Dz"
1) Raynaud's

2) Mixed CT dz
SLE
CREST Scleroderma

3) Red, White and Blue Extremities

White: Initial dec blood flow
Blue: LT dec blood flow
Red: Reperfusion
VASCULITIDES (singular vasculitis)
VASCULITIDES (singular vasculitis)
1) Name that vasculitis:
Elderly females
Unilateral HA
Jaw Claudication
High ESR

2) Major complication?
A) from obstruction of which artery?

3) Tx?

4) Definitive dx?
1) Temporal (giant cell) arteritis

2) Blindness
A) Obstruction of ophthalmic art

3) High Dose steroids

4) Temporal Art Biopsy
Name That Vasculitis:
1) Asian Females
Weak UE pulses
Inc ESR
Takayasu's Arteritis
Name that vasculitis:
1) Hep B
Spares vessels of lungs
p-ANCA
Immune Complex mediated

2) Tx of PAN?
1) Polyarteritis Nodosa

2) Corticosteroids,
Cyclophsphamide
Name that vasculitis:
1) Asian kids < 4
Fever
Conjunctivitis
Changes in mucosa of lips and mouth
"Strawberry tongue"
Dequamation

2) 1 really bad AE?

3) 2 Tx?
1) Kawasaki's

2) Coronary aneurysm

3) IVIg and ASA
Name that vasculitis:
1) Heavy smokers
Males > 40
Claudication
Raynaud's

2) 1 Tx?
1) Buerger's dz (thrombophlebitis obliterans) - NOTE this is NOT the kidney buerger's dz

2) Stop smoking
Name that vasculitis:
1) Palpable purpura that's p-
No granulomas
Pauci-immune glomerulonephritis (FX kidney arts)
ANCA positive
1) Microscopic polyangitis
Name that vasculitis:
1) URIs
LRIs
Hematuria & Casts
c-ANCA

2) What's the classic triad of wegener's granulomatosis?

3) Tx?
1) Wegener's Granulomatosis

2) Focal necrotizing vasculitis
Necrotizing granulomas in lung and upper airway
Necrotizing glomerulonephritis

3) Cyclophosphamide, Corticosteroids
Name that vasculitis:
1) EOSINOPHILIA
Asthma
Peripheral Neuropathy (foot and wrist drop)
p-ANCA
1) Churg-Strauss Syndrome
Name That Vasculitis:
1) MC childhood vasculitis
post-URI
Palpable purpura on butt and legs
Arthralgia
GI abd pain and melena
IgA complexes!!
1) Henoch-Shoenlein Purpura
DONE w/ VASCULITIDES
DONE w/ VASCULITIDES
Name That Pathology:
Port-wine stain (nevus flemmeus) on face
Intracerebral AVM --> Leptomeningeal angiomatosis
Seizures
Sturge-Weber
VASCULAR TUMORS
VASCULAR TUMORS
Name That Vascular Tumor:
Benign Capillary Hemangioma of infancy
Grows rapidly
Spontaneously regresses
Strawberry Hemangioma
Benign Capillary Hemangioma
Elderly
DOES NOT regress
Cherry Hemangioma
Hemangioma that ulcerates and bleeds
Assoc w/ trauma and preggos
Pyogenic Granuloma
Cavernous lymphangioma of neck
Assoc w/ turner's syndrome
Cystic Hygroma
Red blue tumor UNDER fingernails
Glomus tumor
AIDS pts
Infxn in Bartonella henselae
Mistaken for Kaposi's Sarcoma
Bacillary Angiomatosis
HIGHLY LETHAL Malig of liver
Exposure to Vinyl Chloride, Arsenic, ThO2 (Thorotrast)
Angiosarcoma
Angiosarcoma is a highly lethal malignancy of what organ?
Liver
Lymphatic malignancy assoc w/ persistent lymphedema often times post-radical mastectomy
Lymphangiosarcoma
Endothelial malig of skin assoc w/ HHV-8 and HIV

Mistaken for Bacillary Angiomatosis
Kaposi's Sarcoma