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21 Cards in this Set
- Front
- Back
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... pericarditis:
-Blood mixed with a fibrinous or suppurative effusion -Usually due to ... -May also be seen in tuberculosis, other bacterial infections, and following cardiac surgery -May lead to ... pericarditis |
Hemorrhagic
malignant neoplasm constrictive |
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... Pericarditis:
Caseation within pericardial sac -From ... until proven otherwise Rare If untreated is most common cause of fibrocalcific chronic ... pericarditis |
Caseous
tuberculosis constrictive |
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*... Pericarditis*
-Heart encased in fibrous or fibrocalcific scar tissue -... is obliterated by the scar tissue (concretio cordis) -May resemble a plaster mold -Diastolic expansion and cardiac output impaired -May not elicit history of prior acute pericarditis -Treatment: ... |
Constrictive
Pericardial sac pericardiectomy |
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*... *
Failing heart replaced with heart from suitable donor (orthotopic) Most common reasons -... cardiomyopathy because they have a poor prognosis -... cardiomyopathy – because they’ve reached end stage atherosclerosis After transplant -follow up with endomyocardial ... to assess for ... |
Cardiac Transplantation
Dilated Ischemic biopsies rejection |
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*Chronic Complications*
Coronary ... (atherosclerosis) -may lead to silent MI, congestive heart failure ... – due to immunosuppressive drugs Malignancies (lymphomas) – also due to immunosuppression Overall -70-80% one year survival -~60% five year survival |
Arteriopathy
Infection |
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A 66 year old man is found to have a pericardial effusion. A pericardiocentesis yields bloody fluid. The most likely etiology for the findings in this case is
1. Systemic lupus erythematosus 2. Cancer 3. Rheumatic fever 4. Acute myocardial infarction 5. Infection |
2. Cancer
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A 66 year old man is found to have a pericardial effusion. A pericardiocentesis yields purulent fluid . The most likely etiology for the findings in this case is
1. Systemic lupus erythematosus 2. Cancer 3. Rheumatic fever 4. Acute myocardial infarction 5. Infection |
5. Infection
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A 46 year old woman has multiple granulomas in both lungs and caseous pericarditis. The most likely organism responsible for these findings is
1. Aspergillus fumigatus 2. Mycobacterium tuberculosis 3. Candida albicans 4. Staphylococcus aureus 5. Group A streptococcus |
2. Mycobacterium tuberculosis
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A 45 year old woman had an orthotopic heart transplant ten years ago. She is afebrile with worsening fatigue, orthopnea, and peripheral edema over the past year. Auscultation of the lungs reveals bibasilar crackles. Which of the following is the most likely cause of her problems?
1. Myocarditis 2. Coronary arteriopathy 3. Angiosarcoma 4. Pulmonary hypertension 5. Pericarditis |
2. Coronary arteriopathy
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A 65 year old woman has had chronic worsening dyspnea on exertion for 5 years. An echocardiogram shows decreased diastolic filling and decreased cardiac output but no evidence of chamber dilation or hypertrophy. She has no history of pericarditis. Which is the most likely cause of her symptoms?
1. Constrictive pericarditis 2. Rheumatic fever 3. Alcoholic cardiomyopathy 4. Hemochromatosis 5. Coxsackie A virus infection |
1. Constrictive pericarditis
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start lecture 61 – valvular heart disease
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Aortic stenosis:
Middle Aged patient -... AV -... Disease Older patient -degenerative ... |
Bicuspid
Rheumatic Heart calcification |
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start lecture 62
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...:
General Information -Most common cause of isolated mitral regurgitation -Occurs in ~3-5% of adult population -Affects ... > ... -Known pathologically as “... degeneration of the mitral valve” -Most cases are sporadic and the cause is ... -Associated with ... syndrome and ... syndrome and a minority of MVP patients will have one of these syndromes -Mitral valve is “floppy” or incompetent |
mitral valve prolapse
women > men Myxomatous unknown Marfan and Ehler-Danlos |
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Mitral valve prolapse:
Clinical -Most patients are ... -Minority have chest pain fatigue, dyspnea, psychiatric problems (depression, anxiety) -... click -... to ... systolic murmur -Confirmed on ... *Parasternal view with >=... mm systolic displacement of one or both of the mitral valve leaflets into the left atrium superior to the mitral annulus |
asymptomatic
Midsystolic Mid to late echocardiogram 2 |
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A 30-year-old woman presents with chest pain for one day. The pain is in the center of her chest and is worse with deep inspiration and coughing. She reports that it improves when she leans forward while sitting on the examining table. An ECG in the office shows ST segment elevation in all leads. What is the most likely diagnosis?
1. Aortic dissection 2. Acute myocardial infarction 3. Acute pancreatitis 4. Acute pericarditis 5. Pulmonary embolism |
4. Acute pericarditis
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Four days after being hospitalized for a myocardial infarction, a 75 year old man suddenly has altered mental status. His blood pressure falls to 80/40 from 115/75. Exam is notable for JVD, pulsus paradoxus, and distant heart sounds. What is the cause of this patient's condition?
1. Acute pulmonary edema due to right heart failure 2. Arrhythmias caused by damage to conduction pathways 3. Compression of heart chambers by blood in the pericardial space 4. Pericardial inflammation 5. Rupture of a papillary muscle |
3. Compression of heart chambers by blood in the pericardial space
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While examining a 43-year-old woman with a chief complaint of palpitations, you auscultate a diastolic murmur loudest at the left lateral fourth intercostal space. On questioning, the patient says that she has had the murmur since she was a child. What is the most likely etiology of the murmur?
1. Aortic annulus dilation 2. Atrial septal defect 3. Pulmonic valve stenosis 4. Patent ductus arteriosus 5. Repeated bouts of acute rheumatic fever |
5. Repeated bouts of acute rheumatic fever
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A 25 year man old man undergoes aortic valve replacement with a porcine valve. Twelve years later he needs to have the porcine valve replaced. What is the most likely problem necessitating replacement of his bioprosthetic valve?
1. Valve dehiscence 2. Calcification with stenosis of valve 3. Endocarditis 4. Thrombosis of valve 5. Strut failure |
2. Calcification with stenosis of valve
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A 75 year old woman has had leg swelling with 4+ pitting edema to above the knees for 4 months. Her jugular venous pulse is visible to the angle of the mandible. A chest X-ray shows bilateral pleural effusions with prominence of the right heart border. Which valve problem is the most likely in this case?
1. Mitral stenosis 2. Tricuspid regurgitation 3. Pulmonic atresia 4. Aortic regurgitation 5. Common atrioventricular valve |
2. Tricuspid regurgitation
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A 64 year old man has a history of endocarditis and is scheduled for a tooth extraction. He also has a diastolic murmur with an opening snap best heard at the cardiac apex. EKG shows a biphasic P wave in lead V1 and a broad notched P wave in lead II. Patients with these findings should always have?
1. Balloon valvotomy 2. Valve replacememt 3. Digitalis therapy 4. Endocarditis prophylaxis 5. Warfarin therapy |
4. Endocarditis prophylaxis
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