First Aid - Cardiology - Pathology

Front 1

Congenital heart defects that cause blue babies (early cyanosis)

Back 1

1. Truncus arteriosis
2. Transposition of the greater vessels
3. Tricuspid atresia
4. Tetrology of Fallot
5. Total anamalous pulmonary venous return (TAPVR)

Front 2

What is the most common cause of early cyanosis in a baby?

Back 2

Tetrology of Fallot

Front 3

Truncus arteriosis

Back 3

failure of truncus atertosis to divide into pulmonary trunk and aorta - one vessel for both

Front 4

Tricuspid atresia

Back 4

characterized by absence of tricuspid valve and hypoplastic right ventricle - requires ASD and VSD for viability

Front 5

Total anomalous pulmonary venous return

Back 5

pulmonary veins drain into right heart circulation (SVC, coronary sinus, etc.)

Front 6

Left to right shunts - blue kids (late cyanosis)

Back 6

VSD (most common congeital cardiac anomaly)
ASD (loud S1; wide, fixed split S2)
PDA (close with indomethicin) - from pul. artery to aorta

Front 7

What is the most common congenital cardiac anomaly?

Back 7

VSD
VSD>ASD>PDA

Front 8

What is a consequence of left to right shunts?

Back 8

increased pulmonary resistance due to arteriolar thickening

progressive pulmonary hypertension (Eisenmenger's)

Front 9

Eisenmenger's syndrome - what causes it?

Back 9

uncorrected VSD, ASD, PDA - increased blood flow through pulmonary artery - vascular hypertrophy, progressive pulmonary hypertension. As pulmonary resistance increases, the shunt reverses from L-R to R-L - causes late cyanosis (clubbing and polycythemia)

Front 10

Tetrology of Fallot

Back 10

PROV

Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
VSD

Front 11

Boot shaped heart on x-ray?

Back 11

Tetraology of Fallot -

boot shaped because of RVH

Front 12

Congenital heart condition where kid squats?

Back 12

Tetraology of Fallot - form of blue babies

child squats to increase TPR - causing decreased R to L shunt - so more blood goes to the lungs and gets oxygenated

Front 13

What happens during embyrogenesis in tetraology of fallot?

Back 13

anteriorsuperior displacement of infundibular septum

Front 14

Transposition of great vessels

Back 14

Aorta leaves RV and pulmonary trunk leaves LV - separation of systemic and pulmonary circulation. Not compatible with life unless shunt is present to allow adequate mixing of blood (VSD, PDA or patent foramen ovale)

*without surgical correction most infants die within first few months of life

Front 15

What happens embryologically to form transposition of the great vessels?

Back 15

Failure of aorticopulmonary septum to spiral - affected by gestational diabetes

Front 16

Coarctation of the aorta 2 types

Back 16

Infantile - aortic stenosis proximal to insertion of ductus arteriosus (preductal)
Adult type: stenosis is distal to the ductus arteriosus (postductal). Associated with notching of the ribs (due to collateral circulation), hypertension in upper extremities and weak pulses in lower extremities

Associated with turner's syndrome, can cause aorta regurgitation

Front 17

What condition is associated with turners syndrome?

Back 17

coarctation of the aorta

Front 18

notching of the ribs on x-ray

Back 18

coarctation of the aorta (from collateral circulation)

Front 19

What can coarctation of the aorta cause?

Back 19

aortic regurgitation

Front 20

What is coarctation of the aorta commonly associated with?

Back 20

bicuspid aortic valve

Front 21

PDA

Back 21

in fetal period shunts blood from the pulmonary arteries to the aorta - if stays open after birth - blood flows left to right (since low resistance in lungs) - causes RVH and failure.

associated with continuous machine-like murmur. Patency is maintained by PGE synthesis and low O2

close PDA with indomethicin

uncorrected PDA can result in late cyanosis in lower extremeties

Front 22

machine like murmur

Back 22

PDA

Front 23

22q11 syndromes what congenital heart disease?

Back 23

truncus arteriosus, tetraology of fallot

Front 24

down syndrome cardiac disease

Back 24

ASD, VSD, AV septal defect (endocardial cushion disease)

Front 25

Congenital rubella

Back 25

septal defects, PDA, pulmonary artery stenosis

Front 26

turner's syndrome cardiac defect

Back 26

coarctation of the aorta

Front 27

marfans syndrome cardiac defect

Back 27

aortic regurgitation (late complication)

Front 28

Infant of diabetic mother cardiac defect?

Back 28

transposition of the greater vessels

Front 29

Hypertension definition

Back 29

blood pressure greater than 140/90

Front 30

risk factors for hypertension

Back 30

age, smoking, obesity, diabetes, genetics, black>white>asian

Front 31

What of hypertension is most hypertension?

Back 31

90% is primary (essential) and related to increased CO and TPR
10% is due to renal disease
- malignant hypertension is severe and rapidly progressing - increased risk in african americans

Front 32

Signs of hyperlipidemia

Back 32

atheromas - plaques in blood vessels
xanthomas - plaques or nodules composed of lipid laden histiocytes in skin, especially on eyelids (xanthelasma)
Tendinous xanthoma - lipid deposit in tendon - especially Achilles
Corneal arcus - lipid deposit in conrnea, nonspecific (arcus senilis)

Front 33

Monckenberg

Back 33

calcification in the media of the arteries, especially radial or ulnar. Usually benign; pipestem arteries. does not obstruct blood flow; intima not involved
*Monkenberg - Media

Front 34

arteriosclerosis vs. atherosclerosis

Back 34

arteriolosclerosis - hyaline thickening of small arteries in essential hypertension or diabetes mellitus - hyperplastic onion skinning in malignant hypertension

Atherosclerosis - fibrous plaques an atheromas form in intima of arteries

Front 35

Aortic dissection

Back 35

medical emergency - ripping chest pain that radiates to the back - longitudinal intraluminal tear forming a false lumen. Associated with hypertension or cystic medial necrosis (component of Marfan's syndrome)
medistinal widening on CXR
- false lumen occupies most of the descending aorta. Can result in aortic rupture and death

Front 36

What is aortic dissection associated with?

Back 36

hypertension and cystic medial necrosis (component of Marfan's syndrome)

Front 37

widening on mediastinum on CXR?

Back 37

aortic dissection

Front 38

What is atherosclerosis a disease of?

Back 38

elastic arteries and large and medium-sized arteries

Front 39

What are risk factors of atherosclerosis?

Back 39

smoking, hypertension, DM, hyperlipidemia, family history

Front 40

What is the progression of atherosclerosis?

Back 40

endothelial cell dysfunction - macrophage and LDL accumulation - foam cell formation - fatty streaks - smooth muscle cell migration (involves PDGF and FGF-B) - fibrous plaques - complex atheromas

Front 41

What are complications of atherosclerosis?

Back 41

aneurysms, ischemia, infarcts, peripheral vascular disease, thrombus, emboli

Front 42

Location of atherosclerosis?

Back 42

abdominal aorta > coronary artery > popliteal artery > carotid artery

Front 43

Symptoms of atherosclerosis?

Back 43

angina, caludication, but can be asymptomatic

Front 44

How can ischemic heart disease present?

Back 44

angina, MI, sudden cardiac death, chronic ischemic heart disease

Front 45

angina - types and definition

Back 45

angina = CAD narrowing >75%
stable - most common type - mostly secondary to atherosclerosis - pain with exertion - ST depression on ECG
- prinzmetal's variant - occurs at rest secondary to coronary artery spasm - ST elevation on ECG
- Unstable/crescendo - thrombosis but no necrosis; ST depression on ECG (worsening chest pain at rest or with minimal exertion)

Front 46

What type of angina is coronary artery vasospasm?

Back 46

prinzmetal's variant - ST elevation on ECG

Front 47

Most common cause of MI?

Back 47

acute thrombosis due to coronary artery atherosclerosis - results in myocyte necrosis

Front 48

death within 1 hour of MI is likely caused by what?

Back 48

lethal arrhythmia (V-fib)

Front 49

Chronic ischemia heart disease

Back 49

progressive onset of CHF over many years due to chronic ischemic myocardial damage

Front 50

What does chronic ischemic heart disease lead to?

Back 50

CHF - from chronic myocardial damage

Front 51

MI - most common arteries occluded

Back 51

LAD>RCA>LCX

Front 52

What are symptoms of a MI?

Back 52

diaphoresis, nausea, sweating, severe retrosternal pain, pain in left arm and/or jaw, shortness of breath, fatigue, adrenergic symptoms

Front 53

What happens during the first day of an MI?

Back 53

dark mottling of area with infarct; pale with tetrazolium stain
- no visible changes by light microscope in firs 2-4 hours. Contraction bands visible after 1-2 hours. Early coagulative necrosis after 4 hours. Release of contents of necrotic cells into bloodstream and beginning of neutrophil emigration
*risk for arrhythmia

Front 54

For how long can you not see an microscopic changes after a MI?

Back 54

2-4 hours

Front 55

What is one of the first changes to be seen after an MI?

Back 55

contraction bands

Front 56

What is seen in the heart 2-4 days post MI?

Back 56

hyperemia of the heart (increased blood flow to area)
- risk for arrythmias

tissue surrounding infarct shows acute inflammation
-PMN emigration
-muscle shows coagulative necrosis

Front 57

What is seen in the heart 5-10 days post MI?

Back 57

gross: hyperemic order; central yellow-brown softening - maximally yellow and soft by 10 days

- risk for free wall rupture, tamponade, papillary muscle rupture, interventricular septum rupture; due to fact that macrophages have degraded important structural components

- outer zone (ingrowth of granulation tissue)

Front 58

What is seen in the heart 7 weeks post MI?

Back 58

gross: recanalized artery - gray-white area

- risk for ventricular aneurysm

contracted scar is complete

Front 59

How long after a MI is the risk of ventricular aneurysm the greatest?

Back 59

7 weeks

Front 60

How do you diagnose a MI with in the first 6 hours?

Back 60

ECG

Front 61

How long after a MI do cardiac enzymes increase?

Back 61

troponin I rises after 4 hours and is elevated for 7-10 days; more specific for other markers

CK-MB is primarily found in the myocardium but can also be released from skeletal muscle

AST is non-specific and can be found in cardiac, liver, and skeletal muscle

Front 62

What enzyme is most specific for MI?

Back 62

troponin - increases 4 hours after MI - elevated for 7-10 days

Front 63

What cardiac enzyme rises quickly and falls quickly post MI?

Back 63

CK - MB - pretty specific for MI - but also can be released from skeletal muscle

Front 64

What ECG changes can you see with a MI?

Back 64

ST elevation (transmural infarct)
ST depression (subendocardial infarct)
pathologic Q waves (large Q waves) (transmural infarct

Front 65

What are the 2 types of MI's?

Back 65

transmural: increased necrosis, affects entire wall, ST elevation on ECG

subendocardial: due to ischemic necrosis of <50% of ventricle wall, subendocardium especially vulnerable to ischemia, due to fewer collaterals, higher pressure, ST depression on ECG

Front 66

When do you see ST elevation? depression?

Back 66

elevation - transmural MI
depression - subendocardial MI

Front 67

What are complications post MI?

Back 67

arrythmia, free wall rupture - cardiac tamponade, intraventricular septum rupture - VSD, aneurysm formation - decreased CO, risk of arrythmia, embolus from mural thrombus, papillary muscle rupture, heart failure and pulmonary edema, cardiogenic shock, postinfarction fibrinous pericarditis - friction rub (3-5 days post MI), dressler's syndrome (autoimmune phenomenon resulting in fibrinous pericarditis (several weeks post MI)

Front 68

dressler's syndrome

Back 68

autoimmune fibrinous pericarditis (several weeks after a MI)

Front 69

What are the types of cardiomyopathy? What type of dysfunction do they all have?

Back 69

Hypertrophic - diastolic dysfunction
Restrictive - diastolic dysfunction
Dilated - systolic dysfunction

Front 70

What is the most common cardiomyopathy? What are the etiologies?

Back 70

Dilated cardiomyopathy (90% of cases)- systolic dysfunction

etiologies: alcohol abuse, wet beribari, coxsackie B virus myocarditis, chronic Cocaine use, Chagas' disease, Doxorubicin toxicity, hemochromatosis and peripartum cardiomyopathy

Front 71

What drug toxicity can cause dilated cardiomyopathy?

Back 71

doxirubicin

Front 72

What cardiomyopathy can you get peripartum?

Back 72

dilated

Front 73

What do you find on dilated cardiomyopathy?

Back 73

S3, dilated heat on ultrasound, balloon appearance on CXR

Front 74

What cardiomyopathy do you see eccentric hypertrophy (sarcomeres added in series)

Back 74

dilated

Front 75

Hypertrophic cardiomyopathy

Back 75

hypertrophied IV is too close to mitral valve leaflet, leading to outflow obstruction. 50% of cases are familial, AD.

Associated with friedreich's ataxia. disoriented, tangled, hypertrophied myocardial fibers. Cause of sudden death in athletes

Front 76

What is a likely cause of sudden death in athletes? What else it is associated with?

Back 76

hypertrophic cardiomyopathy

also associated with fredreich's ataxia

50% of cases are familial - AD inheritance

Front 77

Findings on hypertrophic cardiomyopathy? and tx?

Back 77

normal sized heart, S4, apical impulses, systolic murmur. Treat with B-blockers or non-dihydropyridine calcium channel blocker (verapamil)

Front 78

What cardiomyopathy do you see concentric hypertrophy (sarcomeres added in parallel)

Back 78

hypertrophic cardiomyopathy

Front 79

tx for hypertrophic cardiomyopathy?

Back 79

b-blockers or non-dihydropyridine calcium channel blockers (verapamil)

Front 80

Restrictive cardiomyopathy

Back 80

diastolic dysfunction
major causes: amyloid, sarcoid, postradiation fibrosis, endocardial fibroelastosis (thick fibroelastic tissue in endocardium of young children), Loffler's syndrome (endomyocardial fibrosis with prominent eosinophilc infiltrate), hemochromatosis (can also cause dilated cardiomyopathy)

Front 81

Loffler's syndrome

Back 81

endomyocardial fibrosis with a prominent eosinophilic infiltrate

Front 82

What can cause restrictive cardiomyopathy?

Back 82

sarcoid, hemachromatosis, amyloid, postradiation fibrosis, Loffler's syndrome, endocardial fibroelastosis

Front 83

congestive heart failure

Back 83

clinical syndrome that occurs in patients with acquired or inherited abnormality of cardiac structure or function, who develop a constellation of symptoms (dyspnea, fatigue) and signs (edema, rales)

Front 84

Things present in CHF for diagnosis

Back 84

symptoms: dyspnea, fatigue
signs: edema, rales

Front 85

What is the most common cause of right heart failure?

Back 85

left heart failure

Front 86

What is the progression of CHF?

Back 86

decreased LV contractility causes 2 things:
1) decreased CO - causes 2 things: increased RAAS (increases renal Na+ and H20 absorption - increased systemic venous pressure and increased peripheral edema) and increases sympathetic - which causes increased LV contracitlity and increased renal Na+ and H20 absorption
2) pulmonary venous congestion - causes decreased RV output (get edema)

Front 87

what is the cause of dyspnea on exertion in CHF?

Back 87

failure of LV to increase during exercise

Front 88

What is the cause of cardiac dilation in CHF?

Back 88

greater ventricular end-diastolic volume (from back up)

Front 89

What is the cause of pulmonary edema, and paroxysmal nocturnal dyspnea in CHF?

Back 89

LV dysfuntion - increased pulmonary venous pressure - fluid accumulation in lungs - presence of hemosiderin-laden macrophages (heart failure cells) in lungs due to microhemorrhages from increased pulmonary capillary pressure

Front 90

What are heart failure cells and what causes them?

Back 90

hemosiderin laden macrophages in the lung - from increased capillary pressure and microhemorrhages

Front 91

what causes orthopnea (shortness of breath when supine) in CHF?

Back 91

increase venous return when supine - exacerbates pulmonary vascular congestion

Front 92

What causes hepatomegaly in CHF?

Back 92

back up of fluid from faulty heart - increased resistance to portal flow - rarely leads to cardiac cirrhosis

Front 93

what causes ankle, sacral edema in CHF?

Back 93

RV failure - increased capillary pressure in veins - fluid transudation

Front 94

what causes JVD in CHF?

Back 94

increased RA pressure from failing heart - increased venous pressure

Front 95

What is isolated right heart failure usually due to?

Back 95

cor pulmonale from pulmonary hypertension

Front 96

signs of bacterial endocarditis?

Back 96

FROM JANE
fever
roth spots - white spots on retina surrounded by hemorrhage
Osler nodes - tender raised lesions on finger or toe pads
Murmur - new onset - from valvular damage
Janeway lesions (small erythematous lesions on palm or sole)
Anemia
Nail bed hemorrhage (splinter hemorrhage)
Emboli

Front 97

what must you get to diagnose endocarditis?

Back 97

multiple blood cultures

Front 98

what valve is most frequently involved in bacterial endocarditis?

Back 98

mitral valve

Front 99

what valve is associated with tricuspid valve endocarditis?

Back 99

IV drug use - don't tri drugs

organisms: S. aureus, pseudomonas, Candida

Front 100

What are complications of bacterial endocarditis?

Back 100

chordae rupture, glomerulonephritis, suppurative pericarditis, emboli

Front 101

2 types of onset for endocarditis?

Back 101

acute: S. aureus (high virulence). large vegetations on previously normal valves. Rapid onset
subacute: viridans streptococci (low virulence). smaller vegetations on congenitally abnormal or diseased valves. sequela of dental procedures. more insidious onset

Front 102

What type of endocarditis happens on diseased or congenitally disformed valves?

Back 102

subacute - smaller vegetations caused by viridens (low virulence)- slower onset

Front 103

Endocarditis that is nonbacterial?

Back 103

can be secondary to malignancy or hypercoaguable states (marantic/thrombotic endocartitis).

S.bovis is present in colon cancer

S. epidermidis on prosthetic valves; HACEK organisms can cause culture negative endocarditis

Front 104

what can cause culture negative endocarditis?

Back 104

HACEK organisms

Front 105

What can cause endocarditis in people with colon cancer?

Back 105

S. bovis

Front 106

What can cause endocarditis in people with prosthetic valves?

Back 106

S. epidermidis

Front 107

marantic endocarditis

Back 107

nonbacterial endocarditis in people that have cancer

Front 108

what is the most common manifestation of SLE in the heart?

Back 108

Libman-sacks endocarditis (SLE causes LSE)

verrucous (wartlike), sterile vegitations on both sides of the valves - can lead to MR or rarely MS - can be benign

STERILE VEGETATIONS!w

Front 109

what causes libman sacks endocarditis?

Back 109

SLE

SLE causes LSE

Front 110

rheumatic heart disease is a complication of what?

Back 110

pharyngeal infection with group A beta hemolytic streptococci - early deaths due to myocarditis

Front 111

What are signs of rheumatic heart disease? What valves are most often affected?

Back 111

FEVERSS
Fever
Erythma marginatum
valvular damage (vegetation and fibrosis)
ESR increased
Red-hot joints (migratory poyarthritis)
Subcutaneous nodules (aschoff bodies)
St. Vitus dance (chorea)

mitral valve>aortic valve>tricuspid valve
*high pressure valves affect most

Front 112

What is early and late rheumatid heart disease associated with? What else is seen in it?

Back 112

early - mitral prolapse
late - MS

associated with aschoff bodies (granuloma with giant cells), anitschkow's cells (activated histiocytes), elevated ASO titers

Front 113

aschoff bodies

Back 113

granuloma with giant cells - see in rheumatic heart disease

Front 114

anitschkow's cells

Back 114

activated histocytes - seen in rheumatid heart disease

Front 115

pathogenesis of rheumatic heart disease?

Back 115

after strep infection - antibodies against M protein of bacteria - react to M protein in the heart and damage the heart valves - type II hypersensitivity

Front 116

Cardiac tamponade

Back 116

compression of heart by fluid (blood or effusions) in percardium, leading to decreased CO. Equilibration of diastolic pressure in all 4 chambers

Front 117

equilbration of diastolic pressures in all 4 chambers

Back 117

cardiac tamponade

Front 118

What are the findings in cardiac tamponade?

Back 118

hypotension, increased venous pressure, distant heart sounds, increased HR, pulsus paradoxus, electrical altercans (from swinging heart - high amplitude and low amplitude readings)

Front 119

pulsus paradoxus

Back 119

exaggerated decrease in amplitude of pulse during inspiration. seen in pericarditis, tamponade, croup, asthma, obstructive sleep apnea

Front 120

electrical altercans seen in what condition?

Back 120

cardiac tamponade

Front 121

Types of pericarditis?

Back 121

serous, fibrinous, hemorrhagic

Front 122

serous pericarditis

Back 122

caused by SLE, rheumatoid arthritis, viral infection, uremia

*clear straw colored protein rich exudate containing inflammatory cells

Front 123

fibrinous pericarditis

Back 123

uremia, MI (dresslers syndrome), rhemuatic fever

*fibrin rich exudate

Front 124

hemorrhagic pericarditis

Back 124

from TB or malignancy (melanoma)
*bloody inflammatory exudate - from cancer invasion of percardium

findings: pericardial pain, friction rub, pulsus paradoxus, distant heart sounds, ECG changes with ST elevation in multiple leads

can resolve without scarring or lead to chronic adhesive or chronic constrictive pericarditis

Front 125

pericarditis seen in people with malignancy?

Back 125

hemorrhagic pericardidits - from invasion of cancer into the pericardium

- can also be caused by TB

Front 126

How does syphilus affect the heart?

Back 126

tertiary syphilus affects the vaso vasorum of the aorta with consequent dilation of the aorta and valve ring

can see calcification of the aortic root and ascending aortic arch - leads to tree bark appearance of aorta

can result in aneurysm of the ascending aorta and AR

Front 127

tree bark appearance of aorta?

Back 127

caused by tertiary syphilis - affects the vasa vasorum of the aorta and aortic ring

Front 128

what is the most common primary cardiac tumor in adults?

Back 128

myxoma - 90% occur in atria (most commonly left atria). ball-valve obstruction in the left atria (associated with many syncopal episodes)

Front 129

What cardiac tumor is associated with many syncopal episodes?

Back 129

myxoma - 90% in the atria (most commonly left atria) - ball-valve obstruction

Front 130

What is the most common primary cardiac tumor in children?

Back 130

rhabdomyoma - associated with tuberous sclerosis

Front 131

What cardiac tumor is associated with tuberous sclerosis?

Back 131

rhabdomyoma

Front 132

What is the most common heart tumor?

Back 132

mets - lymphoma and melanoma

Front 133

Kussmal's sign

Back 133

increased JVP on inspiration

Front 134

Telangiectasia

Back 134

AV malformations in small vessels - dilated vessel on skin and mucous membrane - affects small vessels

Front 135

AV malformations in small vessels

Back 135

telangiectasia

Front 136

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)

Back 136

AD inheritance. Presents with recurrent epistaxis, skin discolorations, mucosal telangiectasias and GI bleeds

Front 137

recurrent epitaxis, skin discoloration, mucosal telangiectasias, GI bleeds

Back 137

hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
AD inheritance

Front 138

Varicose veins

Back 138

dilated, tortuous superficial veins due to chronically increased venous pressure - predisposes to poor wound healing and varicose ulcers

Front 139

What predisposes to poor wound healing and varicose ulcers?

Back 139

varicose veins - dilated, tourtous veins due to chronically increased venous pressure

Front 140

What is rare in varicose veins?

Back 140

thromboembolism (compare with stasis of deep veins - high risk of thromboembolism)

Front 141

Raynaud's syndrome

Back 141

decreased blood flow to the skin due to arteriolar vasospasm in response to cold temperature or emotional stress. Most often in the fingers and toes.

affect small vessels

Front 142

Raynaud's syndrome vs. Raynaud's phenomenon

Back 142

Called raynaud's phenomenon when secondary to mixed connective tissue disease: SLE or CREST syndrome

Front 143

what syndromes can cause raynauds phenomenon?

Back 143

SLE and CREST syndromes

Front 144

arteriolar vasospasm in small arteries causes what?

Back 144

Raynaud's disease

Front 145

Wegener's granulomatosis triad

Back 145

focal necrotizing vasculitis, necrotizing granulomas in lung and upper airway, and necrotizing glomerulonephritis

Front 146

symptoms of wegener's granulomatosis?

Back 146

hemoptysis, hematuria, perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis, cough, dyspnea

Front 147

Findings with wegener's granulomatosis and tx.

Back 147

c-ANCA is a strong marker for disease; CXR may reveal large nodular densities; hematuria and red cell casts
tx. cyclophosphamide, corticosteroids

Front 148

c-ANCA

Back 148

Wegener's granulomatosis

Front 149

p-ANCA

Back 149

microscopic polyangiitis and churg-strauss syndrome

Front 150

vasculitis limited to the kidneys

Back 150

primary pauci-immune crescentric glomerulonephritis
* paucity of antibodies

Front 151

Churg-Strauss syndrome

Back 151

granulomatous vasculitis with eosinophilia. Most often presents with asthma, sinusitis, skin lesions, and peripheral neuropathy (wrist/foot drop); can also involve heart, GI, and kidneys

p-ANCA

Front 152

Sturge-Weber disease

Back 152

congenital vascular disorder that affects capillary-sized blood vessels. Manifests with port-wine stain (aka nevus flammeus) on face, ipsilateral leptomeningeal angiomatosis (intracerebral AVM), seizures, and early-onset glaucoma

Front 153

port-wine stain + ipsilateral leptomeningeal angiomatosis (intracerebral AVM)

Back 153

sturge-weber disease - also see seizures and early onset glaucoma

Front 154

Henoch-Schonlein purpura

Back 154

most common form of childhood systemic vasculitis. Skin rash on buttocks and legs (palpable purpura), arthralgia, intestinal hemorrhage, abdominal pain, and melena. Follows URI's. IgA immune complexes. Associated with IgA nephropathy

triad: skin, joints, GI

Multiple lesions of same age

Front 155

multiple lesions of same age on skin, joints and GI

Back 155

Henoch-schonlein purpura - most common form of childhood systemic vasculitis. Following URI

IgA immune complexes - associated with IgA nephropathy

Front 156

palpable purpura in a child

Back 156

Henoch-Schonlein purpura

Front 157

Buerger's disease

Back 157

aka thromboangiitis obliterans; idiopathic, segmental, thrombosing vasculitis of small and medium perhipheral arteries and veins. Seen in heavy smokers

Front 158

Symptoms of Buerger's disease and tx

Back 158

intermittent claudication, superficial nodular phlebitis, cold sensitivity (Raynaud's phenomenon), severe pain in affected part. May lead to gangrene and amputation of digits
tx. smoking cessation
- affects small and medium vessels

- medium vessel diseases cause thrombosis/infarction of arteries

Front 159

What does medium vessel disease cause?

Back 159

thrombosis/infarction of arteries

Front 160

Kawasaki disease, symptoms and tx.

Back 160

Acute, self limiting necrotizing vasculitis in infants/children. Association with Asian ethnicity.
symptoms: fever, conjunctivitis, changes in lips/oral mucosa (strawberry tongue), lymphadenitis, desquamative skin rash - may develop coronary aneurysms
tx. IV immunoglobulin, aspirin

*disease of small and medium vessels

Front 161

strawberry tongue in asian child

Back 161

kawasaki disease - necrotizing vasculitis

can develop coronary aneurysms

Front 162

Polyarteritis nodosa symptoms, findings, tx.

Back 162

immune complex - mediated transmural vasculitis with fibrinoid necrosis
symptoms: fever, weight loss, malaise, abdominal pain, melena, headache, myalgia, HTN, neurologic dysfunction, cutaenous eruptions
findings: hep B seropositivty in 30% of patients, multiple aneurysms and constrictions on arteriogram

- affects renal and visceral vessels not pulmonary arteries
- affects small and medium sized vessels
- lesions are different ages
tx. corticosteroids, cyclophsphamaide (same for wegner's granulomatosis)

Front 163

Takayasu's arteritis and symptoms

Back 163

pulseless disease - granulomatous thickening of aortic arch and/or proximal great vessels. Associated with increased ESR. Primarily affects asian females < 40 years of age

symptoms: FAN MY SKIN On Wed

Fever, arthritis, night sweats, myalgia, SKIN nodules, ocular disturbances, Weak pulses in upper extremities
- affects medium and large arteries

Front 164

pulseless disease

Back 164

takayasu's arteritis

Front 165

Temporal arteritis

Back 165

most common vasculitis affecting medium and large arteries, usually branches of carotid artery. Focal, granulomatous infammation. affects elderly females

Front 166

symptoms of temporal arteritis

Back 166

unilateral headache, jaw claudication, impaired vision (occlusion of ophthalmic artery that may lead to irreversible blindness)

Front 167

findings and tx. of temporal arteritis

Back 167

associated with increased ESR. half of patients have systemic involvment and polymyalgia rheumatica

tx. high dose steroids

- affects medium and large arteries

Front 168

benign capillary hemangioma of infancy. initially grows with child then spontaneously regresses

Back 168

strawberry hemangioma

Front 169

cherry hemangioma

Back 169

benign capillary hemangioma of the elderly. Does not regress. Frequency increases with age.

Front 170

Pyogenic granuloma

Back 170

polypoid capillary hemangioma that can ulcerate and bleed. Associated with trauma and pregnancy

Front 171

Cystic hygroma

Back 171

cavernous lymphangioma of the neck. Associated with turner's syndrome

Front 172

Glomus tumor

Back 172

benign, painful, red-blue tumor under fingernails. Arises from modified smooth muscle cells of glomus body

Front 173

bacillary angiomatosis

Back 173

benign capillary skin papules round in AIDS patients. caused by bartonella henselae infections. Frequently mistaken for Kaposi's sarcoma

Front 174

Angiosarcoma

Back 174

highly lethal malignancy of the liver. associated with vinyl chloride, arsenic, and ThO2 (thorotrast) exposure

Front 175

Lymphangiostarcoma

Back 175

lymphatic malignancy associated with persistent lymphedema (eg. post radical masectomy)

Front 176

Kapoi's sarcoma

Back 176

endothelial malignancy of the skin associated with HHV-8 and HIV. Frequently mistaken for bacillary angiomatosis