Step 1: Cardiac Diseases Part 2

Front 1

There are three types of cardiomyopathies. Dilated, Hyperdrophic, and...?
- major causes of this last one?

Back 1

Restrictive obliterative.
- sarcoidosis, amyloidosis, Loffler's syndrome (endomyocardial fibrosis w/ eosinophilic infiltrate) and heomochromotosis.

Front 2

Hemochromatosis can cause which two types of cardiomyopathy?

Back 2

Dilated and Restrictive obliterative.

Front 3

What type of dysfunction (systolic/diastolic) do the following cause:
- dilated cardiomyopathy
- hypertrophic cardiomyopathy
- obliterative cardiomyopathy

Back 3

systolic (can't contract well enough)

diastolic

diastolic

Front 4

Most common cause of rt heart failure?

What if it's completely isolated?

Back 4

left heart failure.

cor pulmonale (due to lung dz)

Front 5

What causes a nutmeg liver?

Back 5

Rt heart failure/CHF --> blood backs up into liver and it becomes congested.

Front 6

What cells might you expect to find and why in the lungs of someone w/CHF?

Back 6

hemosiderin laden macrophages from the microhemorrages caused by increased pressure.

Front 7

Walk through the cycle of CHF?

Back 7

decrease in LV contractility --> \\CO which ^^renin / sympathetic actv / renal Na abs --> ^^systemic venous pressure --> ^^PL for compensation.

At the same time, the \\LV contractility is causing pulmonary venous congestion --> backs up and overloads RV, which causes even more peripheral edema.

Front 8

Pt presents with fever, round white spots on retina surrounded by hemorrhage, tender raised lesions of fingers/toe pads are noted. Pt also has a new onset murmur, small erythematous lesions on palm or sole, anemia, and splinter hemorrhages on nail bed. Likely pathology?

Most common acute cause?

Subacute?

Most frequently involved valve? Howabout in IV drug users? Pathogens in them?

Back 8

Bacterial endocarditis.
retinal spots = roth spots
finger/toe raised lesions = Osler's nodes
erythematous lesions on palms/soles = Janeway lesions

"bacteria FROM JANE"

Staph

Viridans streptococci.

Mitral

Tricuspid--> assoc w/ staph, pseudonoas, Candida

Front 9

What causes bacterial endocarditis on prosthetic valves?

Can bacterial endocarditis cause glomerulonephritis?

Back 9

S. epidermidis.

yes.

Front 10

Sterile vegetations appearing on both sides of a valve... associated with mitral regurgitation and less commonly mitral stenosis. Dz?
- what do the vegetations look like?
- most common ht manifestation of which systemic dz?

Back 10

Libman-Sacks endocarditis
- look like warts (verrucous)
- SLE

Front 11

Pt presents w/ fever and pink rings on the limbs/trunk that come and go. Pt also complains of arthritis, but says it seems to move around between joints. On PE, pt has many subQ nodules, and has marked chorea.

Dx?

Cause?

Expect to see which two types of cells on histology?

Effect on ASO titers?

Back 11

Rheumatic heart dz.

Type II hypersensitivity = body made IgG against M-protein of Group A strep pyogenes and now it's cross reacting.

Granuloma w/ giant cells (Aschoff bodies)

Activated histiocytes (Anitschokow's cells)

Elevated.

Front 12

What is Pulsus paradoxus?
- how is this different from paradoxical splitting?
- cause?
- effect on diasolic pressure in all chambers?

Back 12

Kussmaul's pulse: exaggerated \\ in amplitutde of pulse during inspiration.

Has to do with amplitude, not orientation of AP closures.

Compression of the heart by cluid in pericardium leaving to decreased CO = Cardiac Tamponade

equalizes them (squeezed from all sides)

Front 13

Hypotension, increased JVD, distant heart sounds, increase in HR, and pulsus paradoxus all make us think...

Back 13

cardiac tamponade.

Front 14

Uremia, MI (Dressler's syndrx), and rheumatic fever can cause this type of pericarditis.

SLE, RA, Viral infection, and uremia cause this type of pericarditis.

TB, malignancy (e.g. melanoma, etc.) can cause this type of pericarditis?

Back 14

fibrinous
serous
hemorrhagic

Front 15

Pt presents with chest pain that increases w/ breathing, pulsus paradoxus, distant heart sounds, and a squeaking, grating sound on ascultation. Dx?
- expect to see what on ECG?
- possible outcomes?

Back 15

Likely pericarditis. This is pericardial pain, w/ a friction rub on ascultation.
- ST-segment elevation i/multiple leads..
- can resolve w/o scarring, or can lead to chronic adhesive or chronic constrictive pericarditis.

Front 16

Which stage of syphilis can affect the heart/great vessels? Changes seen?

Back 16

Tertiary (3rd). Calcifications of aortic root and ascending aortic arch --> tree bark appearance.

Front 17

What are the most common primary cardiac tumors in adults?
- 90% occur in what location?
- most common description?
- known to produce what factor?

Most common primary tumor in kids?
- associated with what systemic dz?

Most common heart tumor overall?

Sign frequently seen in heart tumors?

Back 17

Myxomas.
- atria (mostly LA)
- "ball-valve" obstruction associated with multiple syncopal episodes (intermittant obstruction)
- VEGF

Rhabdomyomas
- tuberous sclerosis

Met's.

increase in JVP on inspiration (opposite of what's supposed to happen = pulsus paradoxis) [Kussmal's sign]

Front 18

Pt presents with recurrant epistaxis, skin discoloration, mucosal telangiectasia, and GI bleeds. Pt was confirmed to have multiple arteriovenous malformations in small vessels. Dz?
- inheritance type?

Back 18

Osler-Weber-Rendu syndrx
- AD

Front 19

Do Varicose veins often cause thromboembolism?
- predispose to what?

Back 19

no.
- poor wound healing (poor circulation) and varicose ulcers.

Front 20

What size vessels does Raynaud's dx (or phenomenon, if it's secondary to a systemic disorder) affect?

Back 20

small vessels --> arteriolar vasospasm in response to cold temperatures or emotional stress.

Front 21

Pt comes in with hemoptysis and hematuria. PE noted perforation of nasal septum. Hx of chronic sinusisits, otitis media, chronic cough, and persistant dyspnea.
- tests to help w/suspected dx?
- if they're positive, what dz is this?
- tx?

Back 21

Run c-ANCA and do a CXR to look for large nodular densities. Look for RBC casts in urine.
- Wegener's Granulomatosis: characterized by *triad* of focal necrotizing vasculitis, necrotizing granulomas in lung and upper airway, and necrotizing glomerulonephritis.
- cyclophosphamide and corticosteroids.

Front 22

Pt comes in w/ positive p-ANCA. Would you expect granulomas?
- what would you call it if the vasculitis was limited to kidney and no granulomas were found?
- what is granulomas were found, and there was also a eosinophil predominance?

Back 22

Depends on other findings.
- Pauci immune crescentic glomerulonephritis.
- Churg-Strauss syndrome.

Front 23

Pt presents with asthma, sinusisits, skin lesions, and wrist/foot drop. positive p-ANCA. RBC casts and nephrotic range proteinuria were seen. dz?
- what other systems can be involved?

Back 23

Churg-Strauss.
- heart GI, and kidneys

Front 24

Pt presents with port-wine stain (nevus flammeus) on face, and evidence of one-sided AVM intracerebrally.
- likely dz?
- be worried about what CNS sx?
- what other sx might come on early?

Back 24

Sturge-Weber Dz
- seizures
- early onset glaucoma

Front 25

What is the most common form of childhood SYSTEMIC vasculitis?
- what type of immune complexes would you expect to see?
- what would you expect in hx?
- associated w/what kidney pathology?

Back 25

Palpable skin rash on buttocks and legs (palpable purpura), joint pains, intestinal hemorrhage, abdominal pain, and melana. = Henoch-Schonlein purpura
- IgA
- recent URI.
- IgA nephropathy.

Front 26

Child presents with a bumpy rash on lower extremitites. Complains of join pains and abdominal pains. Black-tar-like stools were reported (melana).
- test for what?
- specificly ask in history about what?

Back 26

IgA immune complexes
recent URI

Front 27

Young Asian female child presents with fever, red conjunctiva, and a reddish-swollen tongue. on PE lymph nodes are swollen and tender (lymphadenitis).
- Likely dz?
- likely course?
- check for what type of rash?
- affects what sized vessels?
- be worried about what type of aneurysms?
- tx?

Back 27

Kawasaki dz
- acute, self-limiting necrotizing vasculitits in infants/children
- desquamatous
- small and medium.
- coronary.
- IV Ig and aspirin.

Front 28

Adult pt presents with fever, WL, malaise, belly pain, black tarry stools, HA, myalgia, HTN. Has evidence of neurologic dysfunction, w/ cutaneous eruptions. Hepatitis B seropositivity.
- dx?
- % that are HBV +?
- type of necrosis seen?
- which vessels are usually spared?
- tx?

Back 28

polyarteritis nodosa.
- 30%
- fibrinous
- pulmonary vessels usually spared.
- cyclophosphamide, corticosteroids.

Front 29

What is the most common vasculitits affecting medium and large arteries, usually branches of the carotid artery?

Back 29

Temporal arteritis (Giant cell arteritis)

Front 30

Older Woman presents with *unilateral* HA, jaw blaudication, and impaired viz/vascular blindness.
- what type of cell should we look for?
- likely dz?
- tx?

Back 30

- granulomas!
- Temporal arteritis (Giant cell arteritis)
- high dose steroids.

Front 31

What highly lethal tumor of the liver is associated with vinyl chloride, arsenic, and ThO2 exposure?

Back 31

Angiosarcoma

Front 32

HHV-8 and HIV.... = ?

- frequently mistaken for? Cause?

Back 32

Kaposi's sarcoma = endothelial malignancy of the skin.

Bacillary angiomatosis = benign capillary skin papules found i/AIDS pts. Bartonella henselae.

Front 33

What is a Glomus tumor?
- can be mistaken for?

Back 33

benign, painful red-blue tumor underneath fingernails arising from glomus body that physiologically modulates temperature.
- melanoma.

Front 34

What is Turner's syndrome?
- vascular tumor associated with it?

Back 34

absence of a sex chromosome.
- cystic hygroma: cavernous lymphangioma of the neck.

Front 35

Are strawberry hemangiomas and cherry hemangiomas dangerous? What are they?

Back 35

No. Benign capillary hemangioma of the infants and elderly respectively. Infants will regress, while dlerly will NOT regress.

Front 36

Polypoid capillary vascular tumor that can ulcerate and bleed associated with trauma and pregnancy.

Back 36

Pyogenic granuloma.

Front 37

Lymphatic malignancy associated with persistent lypmedema (e.g. post radical mastectomy).

Back 37

Lymphangiosarcoma.