First Aid Cv - Path

Front 1

What are the five causes of Right to left shunting in the heart?

Back 1

1. Tetralogy of Fallot 2. Transposition of great vessels. 3. Truncus arteriosus 4. Tricuspid atresia 5. Total anomalous pulmonary venous return (TAPVR)

Front 2

What is Truncus arteriosus?

Back 2

Single artery from RV and LV give rise to aorta and pulmonary artery resulting in intermixing blood. Right to left shunt

Front 3

What is Total anomalous pulmonary venous return (TAPVR)?

Back 3

Rare defect where all 4 pulmonary veins are malpositioned and make anomalous connections with systemic venous connections (right atrium alsi) right to left shunt.

Front 4

What are the three types of left to right shunts?

Back 4

1. VSD 2. ASD 3. PDA

Front 5

What is the most common congenital cardiac anomaly?

Back 5

VSD

Front 6

What is heard on ascultation with ASD?

Back 6

loud S1; wide, fixed split S2

Front 7

What is the Tetralogy of Fallot?

Back 7

1. Pulmonary stenosis (most important for prognosis) 2. RVH 3. Overlying aorta (overrides the VSD) 4. VSD

Front 8

What embryologic defect causes Tetralogy of Fallot?

Back 8

Anterosuperior displacement of the infundibular septum

Front 9

How do patients compensate for Tetralogy of Fallot and what effect does it have?

Back 9

Squat: compression of femoral arteries: Compression increases resistance increasing pressure decreasing the right to left shunt and directing more blood from RV to the lungs.

Front 10

What is the lutembacher syndrome?

Back 10

Atrial septic defect with mitral stenosis

Front 11

Aorta leaves RV and pulmonary trunk leaves LV (what condition?)

Back 11

Transposition of great vessels

Front 12

Why does transposition of great vessels occur?

Back 12

Failure of aorticopulmonary septum to spiral (neural crest)

Front 13

What congential heart condition is incompatible with life unless a shunt is present?

Back 13

Transposition of great vessels

Front 14

What is the difference between infantile type and adult type coarctations of the aorta?

Back 14

Infantile: aortic stenosis proximal to insertion of ductus arteriosus. Adult type: distal to ductus arteriosus.

Front 15

Check femoral pulses for what cardiac disease?

Back 15

Coarctation of the aorta

Front 16

What 2 things is coarctation of the aorta associated with?

Back 16

1. Turner's syndrome (45, XO) 2. Bicuspid aortic valve

Front 17

What valvular problem can coarctation of the aorta lead to?

Back 17

Aortic regurgitation

Front 18

What is used to end the patency of a ductus arteriosus?'

Back 18

Indomethacin

Front 19

How is patency of ductus arteriosus maintained?

Back 19

PGE synthesis and low O2 tension

Front 20

22q11 syndromes

Back 20

Truncus arteriosus, tetralogy of Fallot

Front 21

Down syndrome is associated with what congenital cardiac defects

Back 21

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

Front 22

Congenital rubella is associated with what congenital cardiac defects

Back 22

Septal defects, PDA, pulmonary artery stenosis

Front 23

Marfan's syndrome is associated with what cardiac defect

Back 23

Aortic insufficiency (late complication)

Front 24

Offspring of diabetic mothers have what congenital cardiac defect association

Back 24

Transposition of great vessels

Front 25

What is an atheroma?

Back 25

Plaque in blood vessel walls

Front 26

Xanthelasma is

Back 26

Plaque/nodule composed of lipid-laden histiocytes on eyelid (sign of hyperlipidemia)

Front 27

Lipid desposit in cornea

Back 27

Corneal arcus (arcus senilis)

Front 28

Monckeberg arteriosclerosis: what is it, and where does it usually occur, PE finding

Back 28

Calcification in the media of the arteries, especially radial or ulnar. Usually benign; "pipestem" arteries. Intima not involved.

Front 29

What are the two types of arteriolosclerosis?

Back 29

1. Hyaline thickening of small arteries in essential HTN. 2. Hyperplastic "onion skinning" in malignant HTN.

Front 30

In hyalin arteriosclerosis: what is pathogenesis and what are common causes?

Back 30

Increased protein deposited in vessel wall and occludes lumen. Common causes: diabetes and HTN

Front 31

In hyperplastic arteriolosclerosis, what is pathogenesis and what are common causes?

Back 31

Pathogenesis: Smooth muscle hyperplasia and basement membrane duplication. Causes: Malignant HTN, bad pulmonary HTN, scleroderma, HUS

Front 32

What does a CXR show in aortic dissection?

Back 32

Mediastinal widening

Front 33

What is the order of prevelance of atherosclerosis by location?

Back 33

Abdominal aorta > coronary artery > popliteal artery > carotid artery

Front 34

Basic pathogenesis of atherosclerosis

Back 34

Endothelial cell injury --> Macrophages and platelets adhere to damaged endothelium --> Medial SM hyperplasia, SM cells migrate to intima, Cholesterol enters SM and macrophages --> Fatty streaks --> Fibrous cap

Front 35

What is seen with stable angina on ECG? With Prinzmetal's angina?

Back 35

ST depression for stable angina. ST elevation for Prinzmetal's

Front 36

Red infarcts vs. pale infarcts: what'st he difference

Back 36

Red (hemorrhagic) infacts: loose tissues with collaterals (liver, lungs, intestines) or following reperfusion. Pale infarcts: solid tissues with single blood supply (heart, kidney, and spleen)

Front 37

Reperfusion injury is due to

Back 37

Free radical damage

Front 38

What is the order of coronary artery occlusion in most likely to least likely

Back 38

LAD > RCA > circumflex

Front 39

What is there risk for 2-4 days after MI?

Back 39

Arrhythmia

Front 40

What is there risk for 5-10 days after MI?

Back 40

Free wall rupture, tampoade, papillary muscle rupture, ventricular septal rupture

Front 41

What color is the area of infarct by 10 days?

Back 41

Hyperemic border; central yellow-brown softening - maximally yellow and soft by 10 days

Front 42

ST elevation on ECG is indicative of what type of infarct?

Back 42

Transmural infarct

Front 43

Subendocardial infarcts occur because of what and display what on eCG?

Back 43

Fewer collaterals, higher pressure; ST depression on ECG

Front 44

MI complication involving pericardium

Back 44

Fibrinous pericarditis causing friction rub (3-5 days post MI); Dressler's syndrome - autoimmune phenomenon resulting in fibrinous pericarditis (several weeks post MI)

Front 45

What is the most common cardiomyopathy?

Back 45

Dilated cardiomyopathy (90%)

Front 46

Etiologies of dialted cardiomyopathies

Back 46

chronic Alcohol abuse, wet Beriberi, Coxsackie B virus mycoarditis, chronic Cocain use, Chagas' disease, Doxorubicin toxicity, and peripartum cardiomyopathy

Front 47

What are common findings of dilated cardiomyopathy on exam? CXR? US?

Back 47

S3, dilated heart on US, ballooon appearance on cxr

Front 48

Dilated cardiomyopathy: systolic or diastolic dysfx

Back 48

Systolic dysux (Dec contractility with decreased EF)

Front 49

What are the exam findings for hypertrophic cardiomyopathy?

Back 49

Normal sized heart, S4, apical impulses, systolic murmur

Front 50

Pathophys of hypertrophic cardiomyopathy - what causes sudden death in young athletes?

Back 50

Disoriented, tangled, hypertrophied myocardial fibers - leading to sudden death in athletes due to conduction disturbances. Hypertrophied IV septum "too close" to anterior mitral valve leaflet, leading to outflow tract obstruction

Front 51

Tx for hypertrophic cardiomyopathy

Back 51

B-blocker or heart specific calcium channel blocker

Front 52

Hypertrophic cardiomyopathy: systolic or diastolic dysfunction

Back 52

Diastolic

Front 53

Thick fibroelastic tissue in endocardium of young children

Back 53

Endocardial fibroelastosis

Front 54

Some major causes of restrictive cardiomyopathy

Back 54

Sarcoidosis, amyloidosis, postradiation fibrosis, and hemochromatosis

Front 55

In pulmonary edema due to LV failure, what characteristic cells are present in the lungs?

Back 55

Hemosiderin laden macrophages

Front 56

Fat emboli are associated with

Back 56

Long bone fractures and liposuction

Front 57

Virchow's triad

Back 57

Stasis, hypercoagulability, endothelial damage

Front 58

Round white spots on retina surrounded by hemorrhage seen in bacterial endocarditis

Back 58

Roth spots

Front 59

Tender raised lesions on finger or toe pads in bacterial endocarditis

Back 59

Osler's nodes

Front 60

Small erythematous lesions on palm or sole in bacterial endocarditis

Back 60

Janeway lesions

Front 61

What type of endocarditis is associated with IV drug abuse?

Back 61

Tricuspid valve endocarditis

Front 62

What is Libman-Sacks endocarditis?

Back 62

Verrucous (wartlike), sterile vegetations occur on both sides of the valve - seen in SLE

Front 63

What is Marantic endocarditis?

Back 63

Paraneoplastic syndrome. Sterile fibrin deposits randomly arranged along line of closure of valve leaflets

Front 64

Verrucous (wartlike), sterile vegetations occur on both sides of cardiac valves - seen in SLE

Back 64

Libman-Sacks endocarditis

Front 65

What is the histological features of Rheumatic heart disease?

Back 65

Aschoff bodies (granuloma with giant cells) surrounded by Anitschkow's cells (activated histiocytes)

Front 66

Signs of rheumatic fever

Back 66

Fever, Erythema marginatum, Valvular damage (vegetation and fibrosis), ESR Inc, Migratory polyarthritis (Red-hot joints), Subcutaneous nodules, St. Vitus dance (chorea) FEVERSS

Front 67

What 4 other things can pulsus paradoxus signify besides severe cardiac tamponade?

Back 67

Asthma, obstructive sleep apnea, pericarditis, and croup

Front 68

Equilibrium of diastolic pressures in all 4 chambers

Back 68

Cardiac tamponade

Front 69

What are the causes of serous pericarditis?

Back 69

SLE, RA, viral infection, uremia

Front 70

What are causes of hemorrhagic pericarditis?

Back 70

TB, malignancy

Front 71

ECG changes with pericarditis

Back 71

ST segment elevation

Front 72

Findings with pericarditis

Back 72

Pericardial pain, friction rub, pulsus paradoxus, distant heart sounds

Front 73

Most common location of cardiac myxomas

Back 73

left atrium

Front 74

Most common cardiac tumors in adult; children

Back 74

Adult myxoma. Children: rhabdomyomas (tuberous sclerosis)

Front 75

What is the most common heart tumor?

Back 75

Metastases

Front 76

What sign is seen with cardiac tumors?

Back 76

Kussmaul's sign: increase in JVP on inspiration

Front 77

Vascular, red peduncled mass that ulcerates and bleeds easily like rotten cherry. Post traumatic or associated with pregnancy

Back 77

Pyogenic granuloma

Front 78

Bengn tumor derved from arteriovenous shunts in glomus bodies. Painful red subungual (under fingernail) nodule in a digit.

Back 78

Glomus tumor

Front 79

Osler Weber Rendu syndrome

Back 79

Hereditary hemorrhagic telangiectasias. Autosomal dominant inheritance. Nosebleeds and skin discolorations

Front 80

Pathophys of Raynaud's disease

Back 80

Decreased blood flow to skin due to arteriolar vasospasm in response to cold temperature or emotional stress.

Front 81

Triad seen in Wegener's granulomatosis

Back 81

Focal necrotizing vasculitis, necrotizing granulomas in the lung and upper airway, necrotizing glomerulonephritis

Front 82

Cavernous hemangiomas in cerebellum and retina. Increased incidence of pheochromocytoma and bilateral renal cell carcinomas

Back 82

von Hippel-Lindau syndrome

Front 83

Angiomyolipomas are located where and composed of what. associated with?

Back 83

Kidney hamartoma composed of blood vessels, muscle, and mature adipose tissue. Assoc with tuberous sclerosis

Front 84

Perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis, cough, dyspnea, hemoptysis, hematuria - sx of which vasculitis

Back 84

Wegener's granulomatosis

Front 85

Marker of Wegener's

Back 85

c-ANCA

Front 86

Tx for Wegener's

Back 86

Cyclophosphamide and corticosteroids

Front 87

What type of glomerular nephritis is wegener's and microscopic polangiitis associated with?

Back 87

Rapidly progressing crescentic glomerulonephritis

Front 88

Granulomatous vasculitis with eosinophilia. p-ANCA.

Back 88

Churg-Strauss syndrome

Front 89

What is the Churg-strauss syndrome

Back 89

Granulomatous vasculitis with eosinophilia. p-ANCA.
3 stages:
1) allergic rhinitis, sinusitis. 2) acute asthma 3) various organ systems

Front 90

Congenital vascular disorder that affects capillary sized blood vessels with port wine stian (nervus flammeus) and leptomeningeal angiomatosis (intracerebral AVM)

Back 90

Sturge-Weber disease

Front 91

Sturge-Weber disease

Back 91

Congenital vascular disorder that affects capillary sized blood vessels with port wine stian (nervus flammeus) and leptomeningeal angiomatosis (intracerebral AVM)

Front 92

Most common form of childhood systemic vasculitis

Back 92

Henoch-Schonlein purpura

Front 93

Skin rashon buttocks and legs with palpable purpura, arthralgia, intestinal hemorrhage, abdominal pain, and melana

Back 93

Henoch-Schonlein purpura

Front 94

What type of immune complexes are seen in Henoch-Schonlein

Back 94

IgA immune complexes - Ssociation with IgA nephropathy

Front 95

Buerger's disease: another name, pathophys, and type of vessels seen in

Back 95

Thromboangiitis obliterans: idiopathic, segmental, thrombosing vasculitis of small and medium peripheral arteries and veins. Seen in heavy smokers.

Front 96

Another name for thromboangiitis obliterans: idiopathic, segmental, thrombosing vasculitis of small and medium peripheral arteries and veins. Seen in heavy smokers.

Back 96

Buerger's disease

Front 97

Kawasaki's disease: pathophys, who it's found in, common complication, and clinical pres

Back 97

Necrotizing vasculitis of small/medium-sized vessels; Asian infants/kids; May develop coronary aneurysms. Fever, congested conjunctiva, changes in lips/oral mucosa "strawberry tongue", lymphadenitis

Front 98

Necrotizing immune complex inflammation of medium sized muscular arteries typically invovling renal, heart, bowel vessels. Hepatitis B seropositivity in 30% of pts. Multiple aneurysms and constrictions on angiogram

Back 98

Polyarteritis nodosa

Front 99

Polyarteritis nodosa: pathophys, what organs, seropositivity of what pathogen, angiogram finding

Back 99

Focal vasculitis; Necrotizing immune complex inflammation of medium sized muscular arteries typically invovling renal, heart, bowel vessels. Hepatitis B seropositivity in 30% of pts. Multiple aneurysms and constrictions on angiogram

Front 100

Tx for polyarteritis nodosa

Back 100

Corticosteroids, cyclophosphamide

Front 101

"Pulseless disease"

Back 101

Takayasu's arteritis

Front 102

Pathophys behind Takayasu's arteritis

Back 102

Granulomatous thickening of aortic arch and/or prox great vessels. Affects medium and large vessels.

Front 103

Vasculitis associated with an increased ESR, primarily affects Asian females < 40 yrs old

Back 103

Takayasu's arteritis

Front 104

Most common vasculitis that affects medium and large arteries, usually branches of carotid artery

Back 104

Temporal arteritis (giant cell arteritis)\

Front 105

Symptoms of temporal arteritis

Back 105

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

Front 106

Temporal arteritis is associated with

Back 106

Increased ESR. Half of pts have systemic involvement and polymyalgia rheumatica