Cp Iib: Path (Wks 3-5)

Front 1

If an unnamed branch of an artery has significant atherosclerosis, what does the pt. probably also have?

Back 1

Diabetes

Front 2

What is the number one risk factor for atherosclerosis?

Back 2

high LDL

Front 3

What is the key lesion of atherosclerosis?

Back 3

atheroma or plaque

Front 4

What disease leaves cholesterol esters all over the tissues? (hint: orange tonsils)

Back 4

tangier's disease

Front 5

Risk factors for atherosclerosis? (lonnnng list)

Back 5

LDL, smoking, HTN, DM, lack of exercise, (hereditary) hypercoagulable blood, metabolic syndrome (X), elevated homocysteine, chronic kidney disease/uremia, adult onset growth hormone deficiency

Front 6

According to Friedlander, you can eat what you please if your cholesterol remains under what?

Back 6

200 mg/dl

Front 7

What causes death do due ischemic heart disease?

Back 7

Rhythm disturbances
Muscle loss
Rupture (free wall, septum, papillary muscle)
Aneurysm formation, mural thrombi
Chronic ischemic heart disease

Front 8

What can cause subendocardial watershed infarcts?

Back 8

hypotension, shock

Front 9

What can you see in minutes 0-30 of MI?

Back 9

Wavy fibers (glycogen loss)

Front 10

What can you see in 1-2 hours of MI?

Back 10

Mitochondrial calcification, maybe contraction bands,
maybe hydropic change / fatty change

Front 11

What can you see in 4-8 hours of MI?

Back 11

Earliest nuclear changes; neutrophils appear;
Maybe dark mottling grossly

Front 12

What can you see in 8-24 hours of MI?

Back 12

Pallor grossly, coagulation necrosis, soft by 24 hr

Front 13

What can you see in 24-72 hours of MI?

Back 13

Lots of polys, obvious necrosis, yellow grossly

Front 14

What can you see in 3-7 days of MI?

Back 14

Macrophages and polys; granulation tissue at rim

Front 15

What can you see in 10 days of MI?

Back 15

Macrophage cleanup, good granulation tissue

Front 16

What can you see in 2-6 weeks of MI?

Back 16

Macrophage cleanup continues; scar develops

Front 17

Match the occluded vessel w/ its transmural infarct type:
Left anterior descending
Left circumflex
Left main
Right main

Back 17

Left anterior descending: Anteroseptal infarct
Left circumflex: Anterolateral infarct
Left main: Entire anterior wall
Right main: Inferior wall

Front 18

What is Lipomatosis cordis?

Back 18

excessive epidardial fat; patients are not necessarily overweight

Front 19

What are the 3 ways that atherosclerosis causes harm?

Back 19

1. occluding arteries slowly over time (i.e. angina)
2. occluding arteries suddenly by rupture of plaques or hemorrhages into plaques
3. weakening the wall os arteries (aneurysms)

Front 20

In descending order, top 5 manageable risk factors for atherosclerosis?

Back 20

high LDL, smoking, HTN, DM, lack of exercise

Front 21

What does smoking do to LDL

Back 21

oxidizes it yo

Front 22

What is the main molecular problem w/ DM causing atherosclerosis?

Back 22

glycosylation end-products (non-enzymatic glycosylation of proteins)

Front 23

Pt. has near-zero HDL, orange tonsils, low LDL, defect of ABCA1 gene. What disease?

Back 23

tangier disease

Front 24

What may elevate homocysteine?

Back 24

1. inborn error of metab.
2. low intake of folic acid
3. low intake of vit. B12

Front 25

What are 3 bad effects of homocysteine?

Back 25

1. mitogen for vascular smooth muscle
2. damages endothelium
3. makes blood hypercoagulable

Front 26

In atherosclerosis, what are the innocent precursors, time bombs, and the killers

Back 26

fatty streaks, fibrous plaques, and complicated plaques

Front 27

If injury in atherosclerosis reaches the media, what will surely happen?

Back 27

activation of the clotting cascade, smooth muscle cells will migrate in, and fibrosis will occur

Front 28

How do you know the dominant coronary artery?

Back 28

whichever supplies the posterior descending coronary artery

Front 29

What is cardiac syndrome x?

Back 29

classic angina clinically but wide-open coronaries
smooth muscle of BV's don't dilate or constrict to easily

Front 30

Two most common causes of MI?
Other (possible) causes?

Back 30

1. atherosclerosis
2. cocaine
Others: prinzmetals coronary spasm, myocardial bridging, vasculitis, emobolization, syphilis, dissecting hematoma, shock + LHF

Front 31

What are some common complications of MI's?

Back 31

rhythm disturbances, LHF, cardiogenic shock (>40% necrosis), rupture (softest on days 3-7), aneurysm formation, mural thrombus, and embolization

Front 32

Post MI rupture of free wall results in what? rupture of septum? rupture of papillary muscle?

Back 32

free wall: hemopericardium, tamponade, and instant death
septum: sudden L-R shunt
papillary: severe MR

Front 33

Causes of sudden cardiac death?

Back 33

coronary atherosclerosis (most common, usually 75% concentric stenosis of all 3 coronaries)
cocaine heart
coronary malformations (e.g. having only one)
inflow problems (atrial myxoma)
outflow problems (AS, cor pulmonale)
WPW
amyloid in bundle of HIS
commotio cordis (blow to chest)
glue sniffing
hemochromatosis (iron overload)
myocarditis (even just a patch)
VSDs involving bundle of His
long QT
brugada syndrome (Na channel): elev. ST in V1,2,3,

Front 34

What vitamin protects from heart problems (sudden cardiac death)?

Back 34

vit. E.... goldstrich says no though...... who to believe... neither?

Front 35

What size dust particle are deposited at respiratory bronchioles (the bad ones)?

Back 35

1-3 microns

Front 36

RA or SLE or PM-DM w/ inorganic pneumoconiosis

Back 36

caplan's syndrome

Front 37

Coal dust increases risk for what cancer?

Back 37

stomach cancer

Front 38

What about the structure of silica is essential to its fibrogenicity?

Back 38

tetrahedral configuration

Front 39

Before 1970, where could one get the heaviest exposure to asbestos?

Back 39

shipyards

Front 40

What is the principal risk factor for mesothelioma?

Back 40

asbestos

Front 41

Asbestosis most often causes which cancer?

Back 41

common bronchogenic carcinoma.... did he trick you?

Front 42

A pt. whose occupation was in the "rocket and fluorescent bulb" industry presents w/ interstitial lung fibrosis. Closer look reveals granulomas w/ activated macrophages and Th cells. DIagnosis?

Back 42

berylliosis

Front 43

IgE-mediated type III-injury vasculitis.... spores from moldy hay... diagnosis?

Back 43

hypersenitivity pneumonitis (farmer's lung)

Front 44

Pt. exposed to mold in dry sugar cane. now has ... bad lungs. diagnosis?

Back 44

bagassosis

Front 45

I gots the 'monday asthma' after returning to the cotton fields. diagosis?

Back 45

byssinosis (cotton lung)

Front 46

Down's syndrome: most likely heart defect?

Back 46

endocardial cushion defect

Front 47

turner's syndrome: most likely heart defect?

Back 47

PDA and preductal coarcation

Front 48

kartagener's... what happens to the heart?

Back 48

dextrocardia

Front 49

fetal alcohol syndrome. likely heart defect?

Back 49

VSD

Front 50

How do you pathologically define cyanosis?

Back 50

5gm/dL or greater of UNoxygenated hemoglobin in art blood

Front 51

pulmonary artery and aorta are single vessel overriding a VSD. diagnosis?

Back 51

truncus arteriosis

Front 52

Most common type of ASD?

Back 52

ostium secundum defect (90%)

Front 53

mitral stenosis + ASD...

Back 53

lutembacher's syndrome

Front 54

machinery murmur, pathognomonic for ?

Back 54

PDA

Front 55

Tricuspid valve is way to low!

Back 55

ebstein's anomaly

Front 56

Diabetes and prolonged HTN can do what to arterioles?

Back 56

hyaline arteriolar sclerosis

Front 57

malignant HTN, scleroderma, and HUS can do what do vasculature?

Back 57

hyperplastic (onion-skinning) atereriolar sclerosis... and probably necrotizing sclerosis later

Front 58

Hepatitis B infection in the past. ANCAS. migraine, vague aches, stroke, heart attack, bowel infarcts, gangrene. THREE-layer vasculits?

Back 58

polyarteritis nodosa

Front 59

type III injury of venule w/ palpable purpura

Back 59

leukocytoclastic vasculitis

Front 60

eosinophilic vasculitis w/ asthma

Back 60

churg-strauss disease

Front 61

lung cavities, segmental necrotizing glomerulonephritis, granulomas, anti-proteinase 3....

Back 61

wegener's granulomatosis

Front 62

Pt over 60. jaw claudication. polymyalgia rheumatica. granulomatous thickening of the inner portions of the branches of the external carotids. elevated sed rate. heachache

Back 62

temporal (giant-cell) arteritis.... oh and his temporal arteries were tender

Front 63

Young adult pt. aortic arch and its branches undergo thickening. granulomas. weak pulse in upper extremities.

Back 63

takayasu's pulseless disease

Front 64

febrile toddler pt. Japanese. non-purulent conjunctivitis in both eyes. rash. red, cracked lips. red palms and soles....

Back 64

Kawasaki's disease

Front 65

Young smoker. inflamed/scarred neurovascular bundles. neutrophils adjacent to epithelioid giant cells deep inside thrombi....

Back 65

buerger's disease (thromboangiitis obliterans)

Front 66

What diameter of abdominal aorta constitutes an aneurysm?

Back 66

3 cm (5 cm or more is likely to burst)

Front 67

What bug may infect atherosclerotic aortic aneurysm?

Back 67

salmonella

Front 68

tree bark grooves on the intima of the aortic root dilation

Back 68

syphilitic aneurysm

Front 69

What genetic conditions can increase risk for an aortic dissection (not peeps w/ HTN)?

Back 69

marfans and ehler danlos

Front 70

What is responsible for the stasis pigmentation inf ischemic stasis ulcers?

Back 70

hemosiderin

Front 71

What usually causes trosseau's migratory thrombophlebitis?

Back 71

cancer of the pancreas

Front 72

resembles erectile tissue, but nothing special happens when you rub it

Back 72

hemangioma

Front 73

giant hemangioma over skin, hemangion in the meninges.... common is what syndrome?

Back 73

sturge-weber

Front 74

painful tumor of smooth muscle of a little thermoregulatory structure (vestigial)?

Back 74

glomus tumor

Front 75

You see these red spots (vascular malformations) most often on the lips in this disease....

Back 75

hereditary hemorrhagic telangiectasia (Osler-weber-rendu)

Front 76

AIDS pt. HHV-8. nasty skin lesions.

Back 76

kaposi's sarcoma

Front 77

Pt. presents w/ deep reddening of the skin in a streak up his arm w/ warmth, lymphandentitis, and a raised border around the affected area.

Back 77

lymphangitis

Front 78

What is a characteristic feature of an EM of endothelium?

Back 78

Weibel-Palade bodies

Front 79

Heart is big, but emptying fine. myocytes are thicker w/ sarcomeres laid down alongside existing ones. accompanied by AS

Back 79

concentric hypertrophy

Front 80

Big heart. NOT empyting properly. myocytes are longer and laid down beyond existing ones.

Back 80

eccentric hyperptrophy

Front 81

hypertrophic heart. uneven fiber enlargement and scrambling

Back 81

hypertrophic cardiomyopathy

Front 82

Causes of high-output HF?

Back 82

anemia, hyperthyroidism, high fever, shunts b/w artery and vein (beriber, paget's)

Front 83

neutrophilic myocarditis. probably caused by what?

Back 83

meningococcemia

Front 84

eosinophilic myocarditis w/ fibrosis of the endocardium... what is it?

Back 84

loeffler's

Front 85

eponym of idiopathic giant-cell myocarditis

Back 85

fiedler's myocarditis

Front 86

EKG w/ epsilon wave. fatty ingrowth and fibrosis in the wall of the RV. diagnosis?

Back 86

ARVC/ARVD (fibrolipomatosis)

Front 87

What conditions can lead to dilated cardiomyopathy?

Back 87

alcoholism, pregnancy, acromegaly, polymyositis-dermatomyositis, myocarditis, sarcoidosis, chagas, radiation, etc.

Front 88

Very enlarged trabeculae w/ blood lakes in the wall of one or both ventricles. can produce dilated or restrictive pattern. what is it?

Back 88

noncompaction cardiomyopathy

Front 89

Most common cause of sudden death in competitive athletes?

Back 89

hypertrophic cardiomyopathy

Front 90

Amyloid, bouncing heart....

Back 90

restrictive cardiomyopathy

Front 91

How much fluid is required to produce a tamponade?

Back 91

~150 ml, rapid accumulation (but this is FRIEDLANDER'S estimate... Johnston says 250... so great)

Front 92

2 probable causes of hemorrhagic pericarditis?

Back 92

TB and cancer

Front 93

Marker for CHF?

Back 93

natriuretic peptide (BNP)