Intro To Clinical Med: Exam 2 Part 2

Front 1

What are the 5 major diseases affecting the heart?

Back 1

1. Coronary heart disease

2. Hypertensive heart disease

3. Congenital heart disease

4. Valvular heart disease

5. Cardiomyopathies

Front 2

What are the 2 main coronary heart diseases?

Back 2

1. Angina pectoris

2. Myocardial infarction

Front 3

What are the 2 main hypertensive heart diseases?

Back 3

1. Cor pulmonale

2. Systemic hypertension

Front 4

What is the normal weight of the heart in females and males?

Back 4

Females: 250 - 300 g

Males: 300 - 350 g

Front 5

What kind of cells make up 25% of the cells of the heart but 90% of its mass?

Back 5

Myocytes

Front 6

What is Ventricular Systole?

Back 6

Time period of the contraction of the left and right ventricles (beginning of the QRS)

Front 7

Where does blood go during ventricular systole?

Back 7

Blood is ejected from the LV into the aorta and RV into the pulmonary arteries

Front 8

What is Ventricular diastole?

Back 8

Time period after contraction when the ventricles relax and blood is filling the heart

Front 9

During ventricular diastole, what happens to the pressure within the ventricles?

Back 9

Drops until below pressure in the atrium

Front 10

During ventricular diastole, blood is flowing where?

Back 10

From the left atrium into the left ventricle and from the right atrium into the right ventricle.

Front 11

Atrial systole is followed very shortly by what?

Back 11

Ventricular systole

Front 12

What is the P-Wave?

Back 12

Atrial contraction to pump just a little more blood into ventricles

Front 13

What is the first heart sound?

Back 13

Lub: sound due to vibration of the blood thrust against the closed ATRIAL valves.

Front 14

Sudden pressure increase in the ventricles at the beginning of systole does what?

Back 14

Reverses blood flow towards atrea and closes the atrial valves

Front 15

What is the left atrial valve?

Back 15

Mitral

Front 16

What is the right atrial valve?

Back 16

Tricuspid

Front 17

What is the second heart sound?

Back 17

Dub: Caused by the closure of the aortic and pulmonary valves at the end of the systole.

Front 18

The second heart sound is due to what?

Back 18

The vibration of blood being thrust against the aortic and pulmonary valves

Front 19

The second heart sound can be split into what two sounds?

Back 19

Pulmonary valve sound (P2) and aortic valve sound (A2) during inspiration

Front 20

What is occurring during the 1st and 2nd heart sounds?

Back 20

Systole

Front 21

What is the 3rd heart sound?

Back 21

Sound occurs when pulmonary and aortic valve don't close at the same time with the pulmonary valve closing slower.

Front 22

What heart condition leads to abnormal heart sounds that sound like a motorcycle engine?

Back 22

Patent Ductus Arteriosus

Front 23

What heart condition leads to the coolest heart sound?

Back 23

Mitral stenosis

Front 24

What is congestive heart failure?

Back 24

The inability of the heart to pump sufficient blood through the body

Front 25

What are 5 main causes of congestive heart failure?

Back 25

1. MI

2. Hypertension

3. Arrhythmias

4. Valve defects

5. Pulmonary hypertension

Front 26

What is the main cause of heart failure?

Back 26

VOLUME OVERLOAD = the heart has to pump too much blood

Front 27

What are 7 symptoms of congestive heart failure?

Back 27

1. Shortness of breath on light exercise (dyspnea) or at rest (orthopnea)

2. Fatigue

3. Pulmonary edema

4. Peripheral edema

5. Ascites

6. Nocturia (urinating at night)

7. Jugular vein distension

Front 28

What are the 5 non-drug related treatments of congestive heart failure?

Back 28

1. Resolve underlying cause

2. Weight reduction

3. Decrease fluid overload

4. Sodium restriction

5. Fluid restriction

Front 29

What are 5 drug treatments for congestive heart failure?

Back 29

1. Angiotensin modulating drugs (decrease blood pressure)

2. Diuretics

3. Beta blockers

4. Blood pressure treatment

5. Treat arrhythmias

Front 30

What is the most frequent primary tumor of the heart?

Back 30

Atrial myxoma

Front 31

What are atrial myxomas?

Back 31

Usually a non-cancerous proliferation of connective tissues of the heart forming a tumor. It can float around in the heart moving to various locations sometimes restricting blood through the mitral valve leading to unconsciousness.

Front 32

Where are atrial myxomas most common?

Back 32

Left side of the heart

Front 33

In the picture of the man with the lesion on his cheek, what happened?

Back 33

He was bitten by a fly that caused an ulcer. He contracted New World Cutaneous Leishmaniasis which is treated with antibiotics.

Front 34

What is Cyanosis?

Back 34

Skin and tissue taking on a bluish tint due to lack of oxygen

Front 35

What is Hepatomegaly?

Back 35

Condition of having an enlarged liver - often a sign of congestive heart failure'

Front 36

What causes concentric hypertrophy in the heart?

Back 36

Pressure overload

Front 37

What causes eccentric hypertrophy (dilation of the heart)?

Back 37

Volume overload

Front 38

The heart can grow up to what mass with eccentic hypertrophy?

Back 38

1000 g

Front 39

What is coronary heart disease also called?

Back 39

Ischemic heart disease

Front 40

What is the most important cause of coronary heart disease?

Back 40

Obstruction of coronary arteries by atherosclerosis

Front 41

What causes atherosclerosis?

Back 41

Deposits of cholesterol crystals between the intima and media layers of blood vessels and subsequent proliferation of macrophages and other cells

Front 42

In the pre-clinical phase of atherosclerosis, what is the progression?

Back 42

Normal artery --> Fatty Streak --> Fibrofatty plaque --> Advanced/Vulnerable plaque

Front 43

In the clinical phase of atherosclerosis, advanced/vulnerable plaque can lead to what 3 things?

Back 43

1. Aneurysm and rupture

2. Occlusion by thrombus

3. Critical stenosis

Front 44

What are the 8 major risk factors for atherosclerosis?

Back 44

1. Increasing age

2. Male gender

3. Family history

4. Genetic abnormalities

5. Hyperlipidemia (hypercholesterolemia)

6. Hypertension

7. Smoking

8. Diabetes

Front 45

What is bad cholesterol?

Back 45

Low-Density Lipoproteins that deliver cholesterol to tissues

Front 46

What is good cholesterol?

Back 46

High-density lipoproteins that transport cholesterol from plaques to the liver for excretion

Front 47

What is the desirable level of cholesterol corresponding to lower risk for heart diseases?

Back 47

<200 mg/dL or <5.2 mmol/L

Front 48

What is the recent desired ratio of total cholesterol to high-density lipoproteins?

Back 48

Less than 5.1

Front 49

What level of cholesterol is considered high risk for heart disease?

Back 49

>240

Front 50

What is Coronary Heart disease?

Back 50

Sudden severe narrowing of the large coronary arteries normally due to atherosclerosis

Front 51

What are the two major clinical manifestations of coronary heart disease?

Back 51

1. Angina pectoris

2. Myocardial infarction

Front 52

What is Angina Pectoris?

Back 52

Ischemia leads to clinical symptoms, but NOT to death of heart muscle cells - a temporary condition often relieved with nitrites

Front 53

What is MI?

Back 53

Ischemia so severe that it leads to clinical symptoms and death of heart muscle death

Front 54

What are 5 symptoms of Angina Pectoris?

Back 54

Sudden onset of chest discomfort:

1. "pressure"

2. Heaviness

3. Burning

4. Choking sensation

5. Pain

Front 55

Angina pectoris is frequently precipitated by what 3 things?

Back 55

1. Heavy meals

2. Going from warm to cold

3. emotional or physical stress

Front 56

In angina pectoris, is an ECG normal or abnormal?

Back 56

A ECG is typically normal but a STRESS ECG may show changes

Front 57

What is Prinzmetal's angina?

Back 57

A condition that looks similar to angina pectoris but is caused by the vasospasm of coronary arteries

Front 58

What are 8 symptoms of myocardial infarction?

Back 58

1. Chest pain

2. Discomfort

3. Nausea

4. Vomiting

5. Arrhythmia

6. Loss of consciousness

7. Sudden death

8. Pain in left arm, jaw, back, stomach area

Front 59

Who don't often show standard MI symptoms?

Back 59

WOMEN. They frequently show just dyspnea, weakness, and fatigue.

Front 60

What fraction of MIs are silent?

Back 60

1/3

Front 61

How do you diagnose MIs? (2 ways)

Back 61

ECG and looking at cardiac enzymes!

Front 62

What cardiac enzymes are present after MI?

Back 62

Creatine phosphokinase MB (CK-MB) and Troponin I or T

Front 63

Ischemia for > 20-40 minutes leads to what?

Back 63

Myocyte death

Front 64

Myocyte death becomes histologically visible when? What can be seen?

Back 64

After 4-12 hours, coagulation necrosis and edema hemorrhage can be seen.

Front 65

What is seen after 12-24 after MI?

Back 65

Necrosis with infiltration of neutrophils

Front 66

2-3 days after MI, what is seen?

Back 66

Necrosis with even more inflammation

Front 67

5-10 days after MI, what is seen?

Back 67

Macrophages removing dead tissue and scar formation

Front 68

When is the danger time for myocardial rupture? Why?

Back 68

5-10 days after an MI because the tissue is the weakest

Front 69

2-4 weeks after MI, what is seen?

Back 69

Granulation tissue

Front 70

1-2 weeks after MI, what is seen?

Back 70

Proliferation of new blood vessels

Front 71

What is the treatment for MI?

Back 71

Rest, half-sitting with Morphine, oxygen, nitro, and aspirin (MONA), thrombolysis (rtPA, streptokinase, urokinase), and cardiac catheter/angioplasty

Front 72

What door to balloon time has the best chance of MI survival?

Back 72

90 minutes until opening of the artery

Front 73

What does MI rupture do?

Back 73

It fills up the pericardium with blood preventing blood contraction which is called pericardial tamponade

Front 74

Congenital heart diseases are grouped into what 3 categories?

Back 74

1. Left-to-Right shunts

2. Right-to-Left shunts

3. Obstructive congenital anomalies

Front 75

What are the 3 main left-to-right shunts?

Back 75

1. Atrial septal defect

2. Ventricular septal defect

3. Patent ductus arteriosus

Front 76

What are the 4 main right-to-left shunts?

Back 76

1. Tetralogy of Fallot

2. Transposition of the great arteries

3. Truncus arteriosus

4. Tricuspid atresia

Front 77

What are the 3 main obstructive congenital anomalies?

Back 77

1. Aortic coarctation

2. Pulmonary stenosis and atresia

3. Aortic stenosis and atresia

Front 78

What is the most common congenital heart disease?

Back 78

Ventricular septal defect (42%)

Front 79

What is the least common congenital heart disease?

Back 79

Tetralogy of Fallot

Front 80

Congenital heart disease is caused by what 2 things?

Back 80

1. Genetic defects - chromosomal abnormalities (Trisomies 21, 13, 15, 18)

2. Environmental factors: Infection (rubella!, drugs, chemicals, alcohol

Front 81

Down syndrome patients often have what common heart defect?

Back 81

Ventricular septal defect

Front 82

Is Ventricular septal defect a right-to-left shunt or a left-to-right shunt?

Back 82

Left-to-right shunt!

Front 83

Medium to large VSD lead to what?

Back 83

Hypertrophy of the right ventricle and ultimately to heart failure and death

Front 84

How is VSD detected?

Back 84

Auscultation = holosystolic murmur (during the whole systole)

Front 85

How is VSD treated?

Back 85

Surgically by closing the defect

Front 86

A super large VSD will lead to what?

Back 86

Will lead to hypertrophy of the right heart and eventually a REVERSAL of shunt

Front 87

In large VSDs, oxygen poor blood will flow from right to left and cause what?

Back 87

Cyanosis and Eisenmenger's Syndrome (a condition in which patients only have a few years to live after diagnosis)

Front 88

In the fetus, blood bypasses the lungs via what?

Back 88

Via the foramen ovale between the RA and LA

Front 89

Shortly before and after birth, what can stay open leading to an Atrial septal defect (ASD)?

Back 89

Foramen ovale between RA and LA

Front 90

Which is more severe: ASD or VSD?

Back 90

VSD!

Front 91

What eventually develops in ASD?

Back 91

Right heart hypertrophy

Front 92

What can form due to an ASD?

Back 92

Paradoxical emboli

Front 93

What kind of murmur is present in ASD patients?

Back 93

Systolic murmur

Front 94

What is the ductus arteriosus?

Back 94

A shortcut from the aorta to the pulmonary trunk seen in fetuses prior to birth.

Front 95

After birth, what do the lungs do? What happens to the vasculature?

Back 95

The lungs unfold via bradykinin and the blood is now goes through the lungs and the ductus arteriosus closes.

Front 96

If the ductus arteriosus does not close, what happens?

Back 96

Blood will move from the aorta (higher pressure) into the lungs causing the heart to work much harder

Front 97

Is the Tetralogy of Fallot (ToF) a right-to-left shunt or a left-to-right shunt?

Back 97

RIGHT-TO-LEFT SHUNT!

Front 98

What are the 4 components of Tetralogy of Fallot?

Back 98

1. Pulmonary stenosis

2. Large VSD

3. Overriding aorta

4. Right ventricular hypertrophy

Front 99

What is the most common cyanotic heart defect that leads to blue baby syndrome?

Back 99

Tetralogy of Fallot

Front 100

When does cyanosis manifest in ToF patients?

Back 100

several weeks after birth

Front 101

What are 6 symptoms to diagnose Tetralogy of Fallot?

Back 101

1. Cyanosis

2. Failure to thrive

3. Difficulty breathnig

4. Typical posture

5. Clubbing of fingers and toes

6. Protrusion of sternum

Front 102

What was the first surgery for congenital heart diseases?

Back 102

Blalock-Taussig (Thomas) shunt which connects the subclavian artery to pulmonary artery

Front 103

What are Tet Spells?

Back 103

Bluish lips, fingers, and toes with excessive crying in babies with tetralogy of fallot.

Front 104

What is Transposition of the Great Arteries?

Back 104

Condition in which aorta arises from right ventricle and pulmonary arteries arise from the left ventricle.

Front 105

Transposition of the great arteries is only compatible with life when what is present as well?

Back 105

Large ASD or VSD that allows for mixing of venous and arterial blood

Front 106

In the picture of the baby with raised itchy blemishes on eyelid and arm, what did the baby have? What did the histology slide show?

Back 106

Urticaria pigmentosa. The histology slide showed large amounts of mast cells

Front 107

Valvular heart disease is more important for the valves on which side of the heart? Why?

Back 107

LEFT side because of the higher pressures in the LV

Front 108

What is Stenosis?

Back 108

Failure of the valve to open completely = outflow is impaired

Front 109

What is Insufficiency?

Back 109

Failure of the valve to close completely = reflux of blood

Front 110

What is a major cause of valvular heart disease in underdeveloped country?

Back 110

Rheumatic fever

Front 111

What are 8 causes of valvular heart diseases?

Back 111

1. Damage to valves after MI

2. Infections

3. Heart dilation

4. Mitral valve prolapse

5. Senile calcific aortic stenosis

6. IV drug abuse,

7. Genetic

8. Drugs

Front 112

In order of clinical importance, rank Aortic stenosis, aortic insufficiency, mitral stenosis, and mitral insufficiency.

Back 112

Mitral insufficiency > Aortic insufficiency > Mitral stenosis > Aortic Stenosis

Front 113

Why is strep throat treated with antibiotics?

Back 113

To prevent rheumatic fever

Front 114

Rheumatic fever usually affects who?

Back 114

Children 6-15 years of age after strep throat or scarlet fever with GROUP A beta hemolytic streptococcus.

Front 115

Rheumatic fever symptoms usually occur when?

Back 115

Several weeks (2-4) after the actual strep infection

Front 116

Rheumatic fever can involve what body parts?

Back 116

Joints, hearts (it can destroy heart valves), skin, and the brain

Front 117

What is Rheumatic fever?

Back 117

An autoimmune reaction caused by antibodies formed against the Strep A that also binds to tissue in joints and the heart

Front 118

In Rheumatic fever, cell wall antigen of group A strep "M antigen" is similar to what?

Back 118

Cardiac myosin

Front 119

People with RF frequently have relapses after infection with what?

Back 119

Strep

Front 120

Who gets RF more: girls or boys?

Back 120

Girls

Front 121

Rheumatic fever incidence is up to what percentage in children with untreated strep pharyngitis?

Back 121

3%

Front 122

What are the 5 major criteria (Jones criteria) for diagnosing Rheumatic Fever?

Back 122

1. Carditis

2. Migratory polyarthritis

3. Sydenham's chorea

4. Erythema marginatum

5. Subcutaneous nodules

Front 123

What is Migratory Polyarthritis?

Back 123

Very painful inflammation of large joints moving from joint to joint seen in RF patients

Front 124

What is Sydenham's chorea?

Back 124

Rapid uncontrolled movements of hands and arms, occurs late in rheumatic fever disease seen in RF patients

Front 125

What is Erythema marginatum?

Back 125

Long lasting rash that starts as macules then forms rings seen in RF patients

Front 126

What are subcutaneous nodules?

Back 126

Aschoff bodies, painless granulomas with a necrotic center surrounded by inflammatory cells seen in RF patients

Front 127

What are the 5 minor criteria needed to diagnosis Rheumatic fever?

Back 127

1. Fever

2. Arthralgia = joint pain without swelling

3. Laboratory abnormalities

4. ECG abnormalities

5. Evidence for Group A strep infection

Front 128

When diagnosing RF, what things are needed to diagnose it?

Back 128

Either 2 major criteria or 1 major + 2 minor criteria

Front 129

What are 7 symptoms of Mitral Stenosis?

Back 129

1. Shortness of breath

2. Pulmonary edema

3. "Mitral face" with cyanosis of the lips

4. LA hypertrophy

5. Pulmonary hypertension

6. Coughing tinged with blood

7. Arrhythmia of the LA

Front 130

Is the prognosis for mitral stenosis good or bad?

Back 130

Bad

Front 131

Is the prognosis for mitral valve insufficiency good or bad? Why?

Back 131

Bad due to late detection and rapid enlargement of LA and LV

Front 132

What most frequently causes mitral valve insufficiency?

Back 132

Mitral valve prolapse

Front 133

What are 5 other causes of mitral valve insufficiency?

Back 133

1. Rheumatic fever

2. Ischemic heart disease

3. Bacterial endocarditis

4. Fen-Phen (Fenfluarmine)

5. Marfan's Syndrome

Front 134

What is the treatment for mitral valve insufficiency?

Back 134

Urgent replacement of mitral valve

Front 135

What is Aortic Insufficiency?

Back 135

Regurgitation due to dilation of the aortic root and valve disease

Front 136

Due to aortic insufficiency, what happens to the heart muscle?

Back 136

Combined concentric and eccentric LV hypertrophy

Front 137

Aortic insufficiency is typically symptomatic or asymptomatic for a long time?

Back 137

Asymptomatic

Front 138

What are "homo pulsans"?

Back 138

Elevated blood pressure which causes head nodes with heart beats

Front 139

Aortic insufficiency has what heart sound?

Back 139

Early diastolic murmur, decreasing

Front 140

Aortic stenosis has what heart sound?

Back 140

Mid-systolic murmur

Front 141

More severe aortic stenosis shows what 5 symptoms?

Back 141

1. Shortness of breath

2. Angina pectoris

3. Syncope

4. Chest pain

5. Left heart fairule

Front 142

What is Calcific aortic stenosis?

Back 142

A degenerative "wear + tear" disease due to calcification of the aortic valve

Front 143

What is the most common valve disorder in the industrialized world?

Back 143

Mitral valve prolapse

Front 144

What is the cause of mitral valve prolapse?

Back 144

Unknown

Front 145

What is Mitral valve prolapse?

Back 145

Degenerative disorder of the mitral valve usually found by ultrasound with a good prognosis

Front 146

Mitral valve prolapse can lead to what?

Back 146

Mitral valve insufficiency

Front 147

What is Bacterial Endocarditis?

Back 147

Colonization of heart valves by bacteria which leads to development of thrombi mixed with bacteria = "vegetations"

Front 148

Bacterial endocarditis is mostly bacteria but can also contain what 3 other things?

Back 148

1. Fungi

2. Rickettsia

3. Chlamydia

Front 149

Acute bacterial endocarditis quickly does what?

Back 149

Destroys heart valve and endocard and may lead to death in days and weeks

Front 150

What are the 6 clinical symptoms of bacterial carditis?

Back 150

1. Spiking fever with no clear cause

2. Bacteremia

3. Septic emboli

4. Petechiae

5. Heart murmur

6. Splinter hemorrhages

Front 151

How is bacterial endocarditis treated?

Back 151

High doses of antibiotics

Front 152

Hypertensive heart disease affects the right side of the heart due to what?

Back 152

Increased blood pressure

Front 153

What is Cor pulmonale?

Back 153

Hypertrophy or dilation of the right ventricle because of changes in the perfusion of the lungs

Front 154

What is acute cor pulmonale caused by?

Back 154

Pulmonary emboli

Front 155

What is chronic cor pulmonale caused by?

Back 155

Obstructive lung disease, loss of lung tissue, COPD

Front 156

What is the mechanism of hypertensive heart disease?

Back 156

Right ventricle has to pump too hard to move blood through the lungs and the right heart tries to compensate

Front 157

What are the most frequent causes of chronic cor pulmonale?

Back 157

COPD (chronic obstructive airway disease) and chronic bronchitis, and loss of lung tissue

Front 158

Chronic cor pulmonale leads to what?

Back 158

Congestive heart failure

Front 159

Hypertrophy of the right ventricle is caused by what in chronic cor pulmonale?

Back 159

Caused by changes in the pulmonary blood vessels

Front 160

What are Extrinsic Cardiomyopathies?

Back 160

Etiology outside of the heart muscle

Front 161

What are Intrinsic Cardiomyopathies?

Back 161

Etiology within the heart muscle

Front 162

What are the 3 forms of Intrinsic Cardiomyopathies and their percent of occurrence?

Back 162

1. Dilated cardiomyopathy (90%)

2. Hypertrophic cardiomyopathy (7%)

3. Restrictive cardiomyopathy (3%)

Front 163

Patients with intrinsic cardiomyopathies are patients with what?

Back 163

Signs of heart disease and enlargement in the absence of coronary disease, valvular disease or hypertension!

Front 164

What percentage of people die within 5 years of cardiomyopathy diagnosis? Males? Blacks?

Back 164

70%. Males live half as long as women, and blacks live half as long as whites

Front 165

What is the most common cause of dilated (congestive) cardiomyopathy?

Back 165

Alcoholism!

Front 166

What is found in dilated cardiomyopathy?

Back 166

All four chambers are dilated and there is also hypertrophy

Front 167

What is the most common form of hypertrophic cardiomyopathy? How does it result?

Back 167

Idiopathic hypertrophic subaortic stenosis (IHSS) results from asymmetric interventricular septal hypertrophy resulting in the left ventricular outflow obstruction.

Front 168

What is found in Restrictive Cardiomyopathy?

Back 168

The myocardium is infiltrated with a material that results in impaired ventricular filling.

Front 169

What are the two most common causes of Restrictive Cardiomyopathy?

Back 169

Amyloidosis and hemochromatosis

Front 170

What is idopathic cardiomyopathy?

Back 170

Cardiomyopathy with unknown cause

Front 171

What are the 4 infections that can cause cardiomyopathy?

Back 171

1. Viral (Coxsackie B)

2. Fungi

3. Bacteria

4. Parasites (Chagas disease = Trypanosoma cruzi, Trichinosis, roundworm)

Front 172

What toxins/drugs cause cardiomyopathies?

Back 172

1. Alcohol!!!

2. Chemotherapeutic agents (Cyclophosphamide, Doxorubicin)

Front 173

What are 5 metabolic causes of cardiomyopathy?

Back 173

1. Hemochromatosis

2. Starvation

3. Vitamin deficiency

4. Hypothyroidism

5. Acromegaly

Front 174

What are the 7 etiologies of cardiomyopathy?

Back 174

1. Idiopathic

2. Infection

3. Toxins/Drugs

4. Metabolic

5. Storage disorders

6. Neuromuscular

7. Immunologic

Front 175

What is the most common cause of viral myocarditis?

Back 175

Coxsackie B virus

Front 176

What is Chediak-Higashi Syndrome?

Back 176

Autosomal recessive disorder that is caused by a mutation on the LYST gene that regulates lysosomal proteins. It decreases phagocytosis. Patients often show albinism and photosensitivity. There is no cure but bone marrow transplants and antibiotics can help.

Front 177

What is Temporal Arteritis?

Back 177

It is an inflammatory disease of blood vessels most commonly involving large and medium arteries of the head. The most serious complication is occlusion of the ophthalmic artery, a medical emergency which can cause irreversible ischema and blindness if not treated promptly. The pathological mechanism seems to start when dendritic cells in the vessel wall recruit T cells and macrophages to form granulomatous infiltrate.

Front 178

In the picture of the man in bed with oxygen and large hands, what did he have?

Back 178

Acromegaly

Front 179

What is acromegaly?

Back 179

Excess production of growth hormone due to tumor on the pituitary gland (hypophysis).

Front 180

Acromegaly shows what signs?

Back 180

Course facial features, large extremities and organs, limited blood supply, congestive heart failure, prone to infections and fractures.

Front 181

In viral myocarditis, what immuno cells are seen?

Back 181

Lymphocytes