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126 Cards in this Set

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VHY***
What are each of the waves due to in JVP waveformL a, c, x and v?
a-late diastole, atrial contraction

C-when blood hits the tricuspid valve during systole, ventricular contraction

x -negative pressure by blood getting sucked up pulmonary artery

V - filling of the right atrium, begining of diastole

y - when atrium is emptying, but w/o contraction
patient has absent a wave and loses S4 if they had it, dx?
A-fib
if you had a huge a wave, dx?
Tricuspid stenosis

called a giant a wave
If you had giant cv wave, DX?
tricuspid regurgitation
what produces turbitiy of plasma when you draw someones blood in a test tube?
Tryglyceride not cholesterol

two fractions that carry Tryglycerides: chylomicrons diet derived TG's and VLDLs - liver derived
How do you get a true Tryglyceride level?
Fast for at least 12 hrs because what you ate will screw it up...

But not for HDL cholesterol or Cholesterol itself.
which is more dens VLDLS or Chylomicrons?
VLDLS because they have more protein
most common lipid disorder?

Have high VLDL
type IV hyperlipoproteinemia:
patient w/ xathelasma (eyelids and achilles tendon) what causes it, DX?

what is the inheritance pattern

what is the problem?
increased cholsterol (need to check there level,

familial hypercholesterolemia (type II hyperlipoproteinemia) (xathelasma in achilles tendon is pathopneumonic)

AD

absent LDL receptor
what is the most common cause of Type IV hyperlipoproteinemia?
alchol excess
what was the first gene therapy that worked
SCID gene replacement
VHY***
How does atherosclerosis develop?
endothelial damge of muscular and elastic areteries (e.g. HTN, smoking tobacco, homocysteine, LDL)
what lesion is pathognomonic for atherosclerosis?
Fibrous cap
Atherosclarosis is the primary factor of many disease, list some examples
AAA, coronary artery sclerosis, non-traumatic limb amuptation, mesenteric angina, small bowel infarction, reval vascular HTN...
can small vessels get hardened?
yes,
hyaline arteriolosclerosis (homongenous pink staining)
what is an exelent marker for disruption of fibrous plaques
C-reactive protien
what is the most common site for atherosclerosis, why?
Abdominal aorta...because no vasovasorum(none after renal arteries)...only gets oxygen from blood in its lumen.

next is coronary artery
Diabetes and HTN produce what type of vessel damage
hyaline arteriolosclerosis

non-enzymatic glycosylation
How diabetes causes damage to our body?
Two mechanism and they both relate to excess glucose:

1.non-enzymatic glycosylation-
(glucose attaching to AA and protein)...including capillaries in the kidneys...makes BM permeable to protiens...causing hyaline change and narrowing the lumen.

2.osmotic damage - aldose reductase is found in the following tissues: lens pericytes in the retina and schwann cell, they can convert glucose to sorbitol which sucks water into it away from the other tissues and those tissues die and causing (cataracts, micoanuersysm (pericytes die), peripheral nueropathies)
How does HTN
Because diastolic blood pressure is so high it just pushes protiens through the BM of the vessels...once protein is there you get the hayline change and narrowing of the lumen...
Onion skin appearnce of the arterioles
vessel disease of malignant HTN, hyperplastic arteriosclerosis
what is an aneurysm?
area of out-pouching from weaking of the vessel wall... once it starts weaking it will contiune (law of law
what is analagous to AAA in the lungs
bronchiectasis - weaking and buldgin out, usually from cytstic fibrosis

diverticular disease
what is the most common complication of AAA?
rupture
sudden onset of left flank pain, pulsitile mass and hypotension, DX
A.A - left flank pain because it is retroperitoneal
Aotic arch aneurysm from vasculitis of vasovasorum...dx
tertiary syphilis...weakening of vessel wall from necrosis of vasovasorum and aortic wall..this also causes aortic regurgitation because stretch of annular ring.
what is the pathology of syphilis
they infect small vessels...vasculitis - chanre as well (ischemic necrosis...also destroys nerves which are near by)
most common complication of an aneurysm?
rupture
The key factor for causing a tear in the aorta, i.e. aortic dissection?

what is the most common location?
HTN...elatic tissue fragmentation

proximal arch of the aorta...if it rupture out then they get cardiac tamponade
Patient presents w/ tearing retrosternal chest pain tha tgoes into the back, diminished pulse on the left compared to the right X-ray shows widening of the arotic nob?
Aortic dissection

diminished pulse on the left is because the lumen of the left subclavian often becomes occluded as a result.
screening test of choice for Aortic dissection, what is the test to confirm this?
chest x-ray showing proximal aortic nob widening.

prove w/ transesophageal echo
RIsk factors for Aortic dissection?
1.HTN

2.Marfan syndrome (AD, chr.15, defect in fibrilin (component of elastic tissue, so it is weak)

3.ehlers-Danlos (EDS) - defect in collagen

4.pregnancy - from having twice the amount of plasma volume
what is the most common cause of death in Marfans syndrome?
mitral valve prolapse

next is aortic dissection
What is the most common cause of death in Ehler danlos syndrome?
Dissecting aortic anuerysm
what is the most common cause of death in an aortic dissection?
cardiac tamponade
Patient w/ small cell carcinoma of the lungs and now complains of headache, retinal vein engorgment"puffiness" and blue to purple discoloration of the face, arms and shoulders, DX?
Superior venal caval syndrome-knock of the supperior vena cava
back-up of blood into the venous system
VHY***
patient has a slightly raised purple lesion on cheek and near the eye(distrubition of the trigemnial nerve) that grows as they age (present since birth), they are slightly mentally retarded, DX

what can also be seen in the brian in this person?

what is the cause of the birthmark?
sturge wever -vascular malformation an AV malformation may also be seen in the leptomeninges
why do people w/ cirrhosis get spider angiomas
becasue you can't metastasize estrogen

17-ketosteroids can't be metabolized by liver and are aromatized by adipose and get more estrogen
When is a spider angioma normal?
In pregnant women from high levels of estrogen,

spider angioma is a AV fistula-pass capillaries, disspears when compressed they blanch unlike petechiae
capillary hemangiomas tx?
leave them alone
what is the mos common benigh tumor of the liver and spleen
cavernous hemangioma..may rupture if large
patient has red spots on the skin in the mouth and in the GI tract and they are iron deficient...they blanch, DX?
Hereditary telangiectasias (AD)
THis is a malignant tumor arising from endothelial cells, associated w/ human herpesvirus 8 DX?
kaposis sarcoma
VHY***WILL BE ON BOARDS

Lesion is noly seen in AIDS patients and it looks like kaposis but is caused by a bacteria, DX?

Causative agent?
how do you visualize it?
treatment?
Bascillary angiomatosis

bartonella hensalae

seen w/ silver stain

treat w/ a sulfer drug
Angiosarcoma of the liver is caused by what two main things, what type of people are exposed to these things?
arsenic (contaminaed water and dipping your dog), vinyl chloride (people who work w/ plastic)
Patient has palpable purpura what type of vasculitis is this?

what type of Hypersensitivity and necrosis is this?

examples
small vessel vasculitis (arterioles, venules and capillaries)

fibrinoid necrosis and they are all immune complexes so its Type III hypersensitivity

Henoch-Schonlein purpura, microspcopic polyangitis
Thrombosis (results in an infarction) and aneurysm formation is what type of vasculaitis?

examples
Medium vessel (muscular arteries)
Polyarteritis nodosa wegeners granumolatosis, kawasakis - coronary vasaculitis
most common cause of an MI in kids
Kawasakis disease...coronoary artery vasculiits causing thrombosis and infarction
absent pulse or stroke is what type of vasculitis
large vessel vasculitis (elastic arteries) e.g. tayayasu arteritis, giant cell arteritis (temporal arteritis)
why is purpura do to thrombocytopenia not papable?
because it is associate w/ acute inflammation.
what do antineutrophil cytoplasmic antiboides do?
activate neutrophils causing the release of their enzymes...resulting in vessel damage
c-ANCA is associated w/
Wegeners granulomatosis...antibodies against protinease 3 in neutrophils
p-ANCA is associated w/
antibodies against myeloperoxidase and microscopic polyangitis and churg-strauss syndrome
VHY***
Young asian women has presents w/ abscent pulse, visual field defects and ends up having a stroke, DX?

pathogenesis
Takayasus arteritis (pulseless disease)

large vessel vasculitis (granulomatous vasculitis involving the arch of the aorta)
patient has pain when they chew and, pain in the temporal artery and they have muscle aches and pain, they also say they are starting to have difficulty seeing.
temporal arteritis, granulomatis artertitis, treat w/ corticosteroids for 1 yr starting immediatley
only indication of SED rate is to screen for
temporal arteritis...
Patient that smokes he presents w/ raynauds, ulceration and digital vessel thrombosis, DX?
Buegers disease
...medium vessel vasculitis
child less than 4 has adesquamating rash, swelling of hands and feet , vervical adenopathy
Kawasaki disease
VHY************
14 yr old boy had an upper respiratory tract infection one week ago, he then developed palpable purpura on the thigh and buttocks and lower extremeties, had polyarteritis and hematuria (w/ RBC casts)
Henoch-schonlein purpura most common vasculitis of children, problems are from immune complex deposition...

hematuria is from glomerulonephritis (type III hypersensitivity)

palpable purpura is only in the lower extremities
most common cause vasculitis in children
henoch-schonlein purpura

IgA immune complex
VHY****
Patient presents w/ saddle nose deformity, sinus infections and upper respiraotroy, nodular masses and cresentic glomerulonephritis, DX and pathophysiology?

what is the treatment of choice?

what antibody is positive in this patient?
Wegeners granulomatosis - granulomatosis inflammation and a vasculitis (involves the airways and kidneys)

c-ANCA (highly specific)

cyclophosphamide
what are the side effects of cyclophosphamide?
bladder cancer and hemorrhagic cystitis give mesna to prevent hemorrhagic cystitis
IV drug abuse w/ chronic hepatits B nodular inflammed mass on the lower extremity and hematuria, DX?

what is antibody is positive in this patient?
polyarteritis nodosa -inflammation of medium sized arteries so you see infarctions (e.g. hematuria, kidney infarct other orgnas can be involved) will also see skin involvement (ischemic ulcer) usually on the shin...assocaited w/ hepatits B.***

p-anca
VHY****
Polyarteritis nodosa is associated w/ what other disease?
Hepatitis B surface antigen
Presentation of rocky mountain spotted fever?

what is the vector and the bug that causes this?

what cells do they infect?
little red spots (petechiae) that start on extremities and goes to the trunk,

tick is the vector Rickettsia rickettsii (all start w/ R)

endothelial cells-intranuclear microrganism***
What is the other tick born disease that you get from bein out in the woods, and you get a bulls eye rash
lyme disease - burrelia burgdorferi (spirochete)

recurrentis - spirochete but this causes relapsing fever...
VHY***
patient has diabetic kektoacidosis and develops a cerebral abscess of the brain what is the cause?
mucormycosis-wide angled non-septated

diabetics commonly have this in their sinus and go crazy when there is lots of glucose around
Patient goes out side and gets raynauds in the cold and there nose turns blue what are the two likley causes?
cryoglobulin C w/ hep C or IgM cold agluttinin
this disease first presents w/ raynauds phenomenon and is caused by a vasculitis w/ eventual fibrosis, DX?
progressive systemic sclerosis (CREST is the variation)
VHY****
clacinosis and centromere (specific for this disease)
antibody, raynauds, esophogeal dysmotility, sclerodactly and telangiectasias, DX?

what is the cause of the raynauds phenomenon?
CREST - digital vessel vasculitis
Vasoconstriction diseases that can cause Raynauds phenomenon
migrane headaches that take ergot derivatives

Buegers disease
what are the most common causes of death in HTN (1-3)?
MI, Stroke and renal failure
what racial group has the highest incidence of HTN (essential HTN, 95)
Black (elderly as well)...polygenic inheritance (multifactorial inheritance), they retain salt (kidney dosn't get rid of it as well.

Affect disorder, congenital pyloric stenosis, type II diabetes, and gout are all also multifactorial
what does multifactorial mean
some things you can't control but some things you can that can reduce your risk.
how would you prevent gout?
keep purines down - no meat or alcohol
Why do you get and increase in systolic BP (leading to HTN) when you retain salt, called essential HTN?
Retained salt in the ECF...causes plasma volume to be increasd... stroke volume increases (so systolic BP is UP)
why does your diasatolic BP go up when you retain salt during essentail HTN?
salt goes into your smooth muscle of your perihperal resistane arterioles...which allows alcium to go in and contracts the SM increasing TPR...increasing you diastolic BP
Drug of choice for essential HTN
hydrochlorathiazide- reduce plasma volume and salt
IS essential HTN a low or high renin system?
low renin
Most common problem of HTN
left ventricular hypertrophy...afterload problem (have to contract against increase resistance)
What is systolic BP and diastolic BP?
systolic - correlates w/ stroke volume - SV=CO*HR

diastolic - volume of blood in the arteries while the heart is filling up. (depends of TPR
Common causes of death form HTN
MI, stoke and then renal failure
what is the most common cause of secondary HTN?

What is the pathogenesis?
renovascular HTN

Decreased renal arterial blood flow activates the RAAS system...angiotensin II vasoconstricts TPR...aldosterone increases sodium retention
pateint has uncontrolled severe HTN, increased plasma renin activity...involved kidney has increased renin levels whereas the univolved has decreased, DX?
renovascular HTN
what type of infarcts occur to the brain w/ HTN?
lacunar infarcts
Thick conentriacally dialted heart, what is the cause
increased afterload***, aortic stenosis, or inc. TPR
dilated and hypertrophied heart whati is the cause
increased preload***, excess volume of blood, aortic regurgitation
S1 and S2...what is the cause of the sounds.
S1 -closing of the mitral (frist, more pressure)and tricuspid

S2 (can be split w/ inspiration because more blood comes in)- arotic and pulmonic (varitation w/ inspiration)
S3 what is the cause of the sound.
blood in diastole that goes into a chamber that is overloaded...makes a turbulant sound (LHF, RHF...congested and get volume overload)
S4
Late diastole - when atrium is contracting and there is a problem w/ compliance (creating a vibration, from hypertrophy of left ventricle or all ready filled)
So w/ HTN what type of heart sound might you hear?
S4
CHF what heart sounds would you hear?
S3 and S4 gallop rythym
How can you tell if the abnormal sound is from the left or the right?
all right sided heart sounds increase in intensity on inspiration...more blood pulled in remember

On expiration if they get worse it is on the let side of the heart beacuse as the breath out pushes things out...
systolic ejection murmur, radiates into the carotids, increases on expiration and you hear an S4, what type of murmur is it?
If its systolic and ejection who is opening on systolle...aortic an pulmonic valve)...worse on inspiration so it has to aortic stenosis (diamond shape) heard best at 2nd intercostal space on the left
left side, ejection murmur increases on inspiration, DX?
pulmonic stenosis
you hear a murmur that is best heart at the apex it gets louder on expiration and has an opening snap and midiasolic rumbling during diastole.
MITRAL regurgitation, (all that blood that build up behind the atrium and rushes in creates the rumble).

underfilling the left ventricle so no hypertrophy of the left ventricle***
who closes during systole?
mitral and tricuspid valve
who is opening during diastole
aortic and pulmonic valves
Pancystolic or close to (straight line effect), apical murmur s3 and s4 increases in intensity on expiration.
Mitral regurgitation

S3 from overfilling (each time blood goes back up into atrium and end up w/ to much blood trying to be put in the ventricle

S4 - from atrium contracting and spilling out extra blood that was in it.
IV drug abuser w/ fever, had a pancystolic murmur, S3 S4 murmur and got worse on inspiration at the midsternal border on the right
infectvie endocarditis creating tricuspid regurgitation.
what happens to the atrium and the ventricle walls in mitral stenosis?
atrium hypertrophies because it has to work hard against resistance

ventricle does not hypertrophy
what other common problem do you see in people who have mitral stenosis
A-fib from left atrium dialtion and hypertrophy
What clinal symptom might a patient complain of form dialtion of the left atrium?
most posterior so it could compres the esophagus and cause dysphagia
what is the most common cause of mitral stenosis
recurrent attackes of rheumatic fever
patient has a pansystolic murmur during sytole that radiates into the axilla, dyspnea and cough, DX?
mitral regurgitation (hear the murmur the whole time during sytolle)

couph and dyspnea from LHF...fluid is backing up in the lungs

will also see left ventricular hypertrophy (increased fillin of Left ventricle each time do to pushing extra blood back into the atrium)
what is the most common cause of mitral regurgitation?
mitral valve prolapse-AD inheritance assocaiated w/ Marfans and Ehler danlos as well
what is the consitency of the mitral valve from mitral valve prolapse?
myxomatous degeneration of teh leaflets from excess production of dermatan sulfate
Mid-systolic click is heard w/ a mid to late systolic murmur heard
mitral valve prolapse
what is the most comon cause of aortic stenosis
dystrhophic calcification of normal and bicuspid valves
what type of valvular lesion would most likley cause syncope and angina w/ excercise?
Aortic stenosis - dec. blood flow throught the stenotic valves during excercise means less blood for the coronaires and the breina
Patient has an early diastolic murmur (high "pitched blowing") and bounding pulses and a puslatin uvula, DX?
aortic regurgitation...

occurs in diastole because thats when the valve normally closes
most common cause of infective endocarditis?
streptococcus viridans (alpha hemolytic, no capsule (- quellung), optochin resistant and not bile soluble)
most common cause of Infective endocarditis in IV drug abusers?
Staph auerus
Most common casue of infective endocarditis in prosthetic heart valves?
staph epidermidis (catalase positive coagulse negative and novobiacin sensitive)
what valvue is usually involved in infective endocarditis?
mitral

tricuspid and aortic if IV drug abuser
how does staph A versus strep Viridans caus infective endocarditis
Viridans effects damaged valves whereas Auerus effects normal valves
what are the problems that are encounterd in infective endocarditis?
1. friable vegetations embolize producing abscesses and infarction in distant orgna sites

2. valve destruction causing regurgitation
patient presents w/ a new onset murmur, red lines under the finger nails, hematuria, fever, splenomegaly, DX?
infective endocarditis
If you find sterile vegitations on the mitral valve, what is the diagnosis?
SLE - called libman-Sacks endocarditis...can cause a murmur as well
patient present for a well visit exam w/ his doctor during the Hx the patient says the only thing he had as kid was a couple recurrent episodes of sore throat w/ polyarthritis that required antibiotics...during the visit you notice a diastolic murmur that radiates into the axilla, DX?
Endocarditis from rheuatic fever
what is the pathogenesis of rheuatic fever?
immune mediated type II hypersensitiviy rxn (cross rxn w/ step pyogenes (A) M protien w/ similar human proteins); cell-mediated immunity
what would you see on the heart valve in rheumatic fever endocarditis?

how does an acute attack vs chronic disease effect the heart valve
sterile, verrucoid-appearing vegetation that don't embolize.

Mitral reguritation in acute attack and mitral stenosis in chronic disease
what is the most common cause of death in acute rheumatic fever?

how would you make the diagnosis at atopsy
myocarditis- aschoff bodies are present (fibrinoid necrosis surrounded by antischkow cells (reactive hisotiocytes))
patient has friction rub, DX?
pericarditis
Fetal circulation?
umbilical vein (most o2)...inferior vena cava drains into left atrium though the forem ovale...aorta shunts blood up to brain...superior vena cava drains into right atrium/ventricle... from pumonary artery most blood goes to the aorta throught the patent ductus arteriosus.
what keeps the patent ductus arteriosus open?
prostaglandin E2