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69 Cards in this Set
- Front
- Back
What is the definition of pulmonary hypertension?
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A pulmonary blood pressure > 30/15 mm Hg
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What is the pathogenic mechanism of passive (venous) pulmonary hypertension?
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Anything that raises left atrial pressure:
Mitral stenosis, left ventricular failure (systemic HTN, MI, valvulopathy, CM) |
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What is the pathogenic mechanism of hyperkinetic pulmonary hypertension?
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Increased pulmonary blood flow secondary to a congenital shunt (cyanotic or acyanotic)
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What are the two mechanisms that produce pulmonary hypertension in patients with emphysema?
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capillary destruciton and hypoxia-induced vasoconstriction
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What are the two forms of pulmonary hypertension that give rise to cor pulmonale?
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Obstructive/obliterative and vasoconstrictive
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Clinical idiopathic pulmonary hypertension is most likely to occur in which patient population?
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Females aged 20-40 years
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What are the pathologic characteristics of grade 3 pulmonary hypertension?
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intimal fibrosis
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Medial hypertrophy is associated with which grade of PH?
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Grade 1
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What is heart failure?
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Heart failure occurs when compensation mechanisms in the ventricles are unable to maintain normal flow.
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What is the significance of b-type natriuretic peptide (BNP)?
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It is produced by the left ventricle in response to volume/pressure overload and indicates the extent of cardiac failure.
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What is the most common cause of right heart failure?
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Left Heart Failure
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What are some of the effects of right heart failure?
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increased venous pressure, peripheral edema, ascites, congestive hepatomegaly
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What is the relationship between hypertension and atherosclerosis?
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Hypertension accelerates atherosclerosis
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What syndrome is associated with an adrenal cortical adenoma that secretes excessive amounts of aldosterone leading to secondary hypertension?
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Conn syndrome
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What form of arteriosclerosis is associated with circumferential calcification of arterial media, but does not cause luminal narrowing?
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Monckebergy medial calcific sclerosis
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What is the most common valvular abnormality?
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Calcific aortic stenosis
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Where are the calcified areas located in calcific aortic stenosis?
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In the cusps at the base
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What abnormality is most likely if a 52 year old patient presents with aortic stenosis?
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bicuspid aortic valve
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What is the mechanism behind rheumatic heart disease?
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M-proteins from Group A β-hemolytic streptococcal infection cross react with proteins on the endocardium
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What is pathognomonic for acute rheumatic heart disease?
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Achoff nodules
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What is the most common cause of mitral stenosis in the world?
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Chronic Rheumatic Heart Disease
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What are the characteristic signs of chronic rheumatic heart disease?
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Massive left atrial dilation, fusion of commissures & chordae tendineae, "fish-mout" appearance of mitral valve
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What vavlular abnormality is commonly seen in young women and is associated with a mid-systolic click?
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Mitral Valve Prolapse
(also associated with Marfan syndrome) |
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Histologically, what is the cause of mitral valve prolapse?
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Expansion of the spongiosa, disrupting the fibrosa causing insufficiency
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An individual with mitral valve prolapse has an increased risk of infectious endocarditis caused by which organism?
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Streptococcus viridans
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What are the clinical presentations of infective endocarditis?
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Fever, malaise, flu-like symptoms, Roth spots, SPLINTER hemorrhages
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What is marantic endocarditis associated with?
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Non-infective (marantic) thrombotic endocarditis is associated with hypercoagulable states such as cancer of DIC
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Patients with antibodies to double stranded DNA have an increased risk for which type of endocarditis?
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Libman-Sacks Endocarditis
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What is the most common valvular abnormality in elderly female patients?
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Mitral annular calcification
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What can cause damage to the tricuspid and pulmonary valves?
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Carcinoid syndrome or IV drug abuse
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What arterial changes can hypertension or diabetes mellitus cause in the kidney?
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Hyaline arteriolosclerosis
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What type of aneurysm is caused by atherosclerosis?
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fusiform aneurysms
(most common type in the elderly) |
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What is the most common site for fusiform aneurysm formation?
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abdominal aorta
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Which type of aneurysm results from the weakening of a small portion of the circumference of an artery?
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saccular aneurysms
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What is the most common cause of large arterial saccular aneurysms?
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cystic medionecrosis
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What genetic defect underlies Marfan syndrome?
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mutation in fibrillin-1
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What are the cardiovascular effects of Marfan syndrome?
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Cystic medionecrosis, aneurysms, mitral valve prolapse/insufficiency
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What is the most common site for berry aneurysm formation?
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Branch points of the circle of Willis, especially between the anterior cerebral and anterior communicating arteries
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What causes berry aneurysms?
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Defects in the media of the vessels at branch points
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Berry aneurysms are associated with which conditions?
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polycystic kidney disease and von Hippel-Lindau syndrome
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Rupture of berry aneurysms are the most common cause of which type of hemorrhage?
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subarachnoid hemorrhage
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What is senile arteriosclerosis associated with?
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intimal thickening, medial muscle decrease and collagen increase
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What type of aneurysm is located in the proximal aorta and never leads to a dissecting aneurysm?
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syphilitic aneurysms
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What type of vasculitis is associated with positive titers of c-ANCA and p-ANCA and involvement of lungs and nasopharynx?
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Wegener granulomatosis
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What indirect immunofluorescent test is diagnostic (95%) for Wegener granulomatosis?
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cytoplasmic lysosomal serine protease (c-ANCA)
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Which vasculitis is associated with hepatitis infections?
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polyarteritis nodosa
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Which vasculitis is associated with coronary aneurysms in persons less than 4 years of age?
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Kawasaki disease
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Also known as "pulseless" disease, this condition can affect the aortic arch of young females.
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Takayasu's disease
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Where is the source of bleeding in a Charcot-Bouchard aneurysm rupture?
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lenticulo-striate artery
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What is the etiology of an aortic dissection?
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hypertension or medionecrosis
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What is the most common cause of death in an aortic dissection?
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External aortic rupture into pericardial space
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Which type of cardiac aneurysm consists of a wall of pericardium?
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False aneurysm
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How do true cardiac aneurysms form and what problems do they cause?
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They form as a result of a healing transmural infarct; problems are due to heart failure or arrhythmia
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what is the most common cause of systemic hypertension?
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Unknown causes are the most common
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Systemic hypertension in conjunction with elevated urinary VMA levels is suggestive of which underlying disease?
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pheochromocytoma
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What is the most common cardiomyopathy?
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Dilated Cardiomyopathy
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Which defective gene underlies familial dilated cardiomyopathy?
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dystrophin
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What is the most common cause of non-traumatic death in adolescents?
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Hypertrophic Cardiomyopathy
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What is the underlying genetic defect in 50% of individuals with hypertrophic cardiomyopathy?
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mutation in β-myosin heavy chain
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Amyloidosis, sarcoidosis, and hemochromatosis can all cause which form of cardiomyopathy?
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Restrictive Cardiomyopathy
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How do parasitic infections result in restrictive cardiomyopathy?
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Eosinophilia leads to Endomyocardial fibrosis
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Mutations in RyR2 cardiac ryanodine receptors can result in right heart failure do to infiltration of what substance?
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Fat
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Names the two most common reasons for heart transplants.
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Ischemic Heart Disease and Dilated Cardiomyopathy
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What histological feature of cardiomyocytes indicates hypertrophy?
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"Boxcar" nuclei
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Dilated Cardiomyopathy can be caused by?
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Alcoholism, myocarditis (Coxsackie B virus, Chagas, HIV), adriamysin therapy, cobalt
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What is the most common primary cardiac tumor in adults?
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Left atrial myxoma
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What is the most common primary cardiac tumor in children?
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Rhabdomyoma
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What additional condition is suspected when a primary cardiac tumor is found in a child?
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Tuberous sclerosis
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Secondary cardiac neoplasms are 20X more common than primary cardiac neoplasms.
True or False? |
True
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