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62 Cards in this Set
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- Back
- 3rd side (hint)
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What is the difference between infant and adult coarctation of the aorta?
With what is coarctation associated? |
Infant - pre-PDA
Adult - post PDA Associate coarctation with Turner's (XO) |
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How does congenital rubella affect cardiovascular development?
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Congenital rubella can cause septal defects, PDA, or pulm artery stenosis.
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HTN and race: put them in order.
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Black > white > Asian
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What are the observable signs of hyperlipidemia?
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Xanthoma - in skin, esp eyelids or tendons like achilles
Atheroma - in BV wall Corneal arcus - lipid in cornea, nonspecific |
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What is Monckeberg arteriosclerosis?
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Monckeberg arteriosclerosis is calcification of the media of the arteries (esp radial or ulnar). This does not obstruct flow.
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What is arteriosclerosis?
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Seen in DM and HTN, arteriosclerosis is hyaline thickening of small arteries.
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If you see "onion skinning" of arteries, what should you suspect?
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Onion skinning of small arteries - think malignant HTN
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What substances contribute to the smooth muscle cell migration seen in atherosclerosis?
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PDGF and FGF-beta are involved in smooth muscle cell migration that occurs after fatty streaks are made.
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How long does it take after an MI for histological changes to appear?
What changes occur first? |
At least 4 hours, then you can see early coagulative necrosis and contraction bands (reperfusion injury)
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When after MI is risk of free wall rupture worst? What other complications can occur in this time period?
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Risk for free wall rupture is worst around 5-10 days; also at risk for tamponade, papillary muscle rupture and interventricular septal rupture.
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Which serum marker rises first following an MI? Then?
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Cardiac troponin I -> CK-MB -> AST
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What serum marker is most specific for myocardial infarction? When does it rise and how long does it last?
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Cardiac troponin I; appears after 4 hrs and lasts 7-10 days
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What ECG changes are seen in each of the following?
- Transmural infarct - Subendocardial infarct |
Transmural infarct - ST elevation and pathologic Q waves
Subendocardial infarct - ST depression |
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Dressler's syndrome
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Dressler's syndrome is an autoimmune phenomenon resulting in fibrinous pericarditis several weeks post MI
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What are the most common causes of dilated (congestive) cardiomyopathy?
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ABCCCD
- Alcohol - Beriberi (thiamine deficiency) - Cocaine, Coxsackie B virus, Chagas' - Doxorubicin Hemochromatosis, peripartum cardiomyopathy |
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What abn heart sound is present in dilated cardiomyopathy? Hypertrophic cardiomyopathy?
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Dilated cardiomyopathy - S3
Hypertrophic cardiomyopathy - S4 |
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What causes sudden death in young athletes?
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Hypertrophic cardiomyopathy -> sudden death in young athletes
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With what is hypertrophic cardiomyopathy often associated?
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It's a familial condition (AD) 50% of the time associated with Friedreich's ataxia
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How is hypertrophic cardiomyopathy Tx?
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CCB or B blockers
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What type of cardiac problem is associated with sarcoidosis, amyloidosis, lupus?
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Sarcoidosis - Restrictive cardiomyopathy
Amyloidosis - Restrictive cardiomyopathy SLE - Libman-Sacks endocarditis |
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Patient has round white spots on retina surrounded by hemorrhage. What are these and what are they related to?
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Round white spots on retina surrounded by hemorrhage are called "Roth's spots" and are suggestive of bacterial endocarditis.
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Patient has tender raised lesions on finger or toe pads. What are these called and what are they related to?
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Tender raised lesions on finger or toe pads are called "Osler's nodes" and are related to bacterial endocarditis.
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What are Janeway lesions?
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Janeway lesions - small erythematous lesions on palms and soles indicative of bacterial endocarditis.
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What are the manifestations of bacterial endocarditis?
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Bacterial endocarditis is FROM JANE
Fever Roth's spots (retinal hemorrhages) Osler's nodes (painful red lesions on palms and soles) Murmur Janeway lesions (hemorrhagic lesions on palms and soles) Anemia Nail-bed hemorrhage Emboli |
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Which organisms cause culture-negative endocarditis?
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HACEK:
Haemophilus Actinomyces (aggregatibacter) Cardiobacterium hominis Eikenella corridens Kingella kingae |
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What organisms are typical of IVDA endocarditis? Where is this?
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IVDA - tricuspid valve endocarditis:
- S aureus - Candida - Pseudomonas |
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How does SLE-derived heart dz present?
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SLE --> LSE (Libman-Sacks endocarditis)
- sterile, wartlike (verrucous) vegetation on both sides of valve that can cause regurgitation (usually mitral) |
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If you see Aschoff bodies and Anitschkow cells on histo, what test should you order and what is the dz?
What are each of these? |
Aschoff bodies - granuloma with giant cells
Anitschkow's cells - activated histiocytes These are indicative of rheumatic fever and you should order an ASO titer (anti strep-O antigen) |
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What type of reaction causes rheumatic fever? Post-strep glomerulonephritis?
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Rheumatic fever - type II hypersensitivity (antibodies to M protein)
Glomerulonephritis - type III immune complex mediated (subendothelial humps) |
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What symptoms are associated with rheumatic fever?
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FEVERSS
Fever Erythema marginatum Valvular damage ESR increased Red-hot joints (migratory polyarthritis) Subcutaneous nodules (Aschoff bodies) St. Vitus' dance (chorea) |
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Patient has pulsus paradoxus (Kusmaul's pulse), JVD and distant heart sounds. What are you thinking?
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Cardiac tamponade or pericarditis but JVD points more towards tamponade - pulsus paradoxus, JVD, distant heart sounds
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What can cause serous pericarditis?
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Serous pericarditis - SLE, rheumatoid arthritis, viral infection and uremia
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What can cause fibrous pericarditis?
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Fibrous pericarditis - Uremia, MI (Dressler's syndrome), rheumatic fever
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What can cause hemorrhagic pericarditis?
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Hemorrhagic pericarditis - TB, malignancy
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"Tree bark" appearance of aorta?
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Tree bark aorta = 3o syphilis
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What is the most common tumor of the heart in adults?
Where is this usually? What does this typically produce? |
Myxomas are the most common tumor of the heart, and usually appears in the L atrium. Myxomas often produce VEGF.
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What is the most common tumor of the heart in children and what is this tumor associated with?
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Children's heart tumors - rhabdomyoma associated with tuberous sclerosis
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Osler-Weber-Rendu syndrome
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Osler-Weber-Rendu syndrome is hereditary hemorrhagic telengiectasia (arteriovenous malformation) - AD with symptoms of recurrent epistaxis, skin discolorations, mucosal telangiectasias and GI bleeds.
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Child presents with mucosal telangiectasias, frequent nosebleeds and a positive guiac test. How is this syndrome inherited?
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This is hereditary hemorrhagic telengiectasia (Osler-Weber-Rendu syndrome) and is inherited Autosomal Dominant.
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What causes varicose veins?
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Chronically increased venous pressure --> varicose veins
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Patient has hemoptysis, hematuria with red cell casts, mastoiditis and chronic sinusitis.
1. What is the most likely disease and it's serum marker? 2. How is it Tx? |
Wegener's granulomatosis triad:
1. Focal necrotizing vasculitis 2. Necrotizing granulomas in upper airway and lung 3. Necrotizing glomerulonephritis c-ANCA is indicative |
Tx Wegener's granulomatosis with cyclophosphamide and corticosteroids
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Match the marker with the vascular disease:
- c-ANCA - p-ANCA - IgA immune complexes - |
c-ANCA - Wegener's granulomatosis
p-ANCA - microscopic polyangitis or Churg-Strauss syndrome IgA immune complexes - Henoch-Schonlein puprpura (IgA nephropathy) |
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What is like Wegener's but lacks granulomas? What vessels do these Wegener's and this dz affect?
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Wegener's minus granulomas is microscopic polyangitis. Both of these affect small vessels.
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Patient presents with asthma, sinusitis, skin lesions and foot drop.
1. What is the dz? 2. What is the histological picture? 3. What serum marker is seen? |
Churg-Strauss syndrome - granulomatous vasculitis with eosinophilia
Associated with p-ANCA |
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What is Sturge-Weber dz and what are the major worries with it?
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Sturge-Weber is congenital capillary malformation that manifests as port-wine stains and can cause leptomeningeal angiomatosis (intracerebral AVM) that results in seizures or early-onset glaucomas.
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What is the most common form of childhood systemic vasculitis?
What is a precipitating factor and what is the pathophysiology of this condition? |
The most common form of childhood systemic vasculitis is Henoch-Schonlein purpura, which presents with the triad of 1. Skin (palpable purpura) 2. Joint, and 3. GI problems.
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Henoch-Schonlein purpura follows URI's and is caused by IgA immune complexes.
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Patient is a child who recently had URI and now complains of a raised rash on buttocks and stomach pain.
What other symptoms might you expect in this dz? What is the dz? |
Post URI rash --> Henoch-Schonlein purpura
Classic triad: 1. Skin 2. Joints 3. GI (instestinal hemorrhage, melena) |
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What vascular disease is often seen in heavy smokers and causes intermittent claudication? What size vessels are affected?
How is this condition Tx? |
Heavy smokers are disposed to Buerger's dz (thromboangiitis obliterans) which is an idiopathic, segmental, thrombosing vasculitis of small and medium peripheral arteries and veins.
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Tx thromboangiitis obliterans (Buerger's Dz) with smoking cessation
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Patient is an Asian child who presents with fever, conjunctivitis, strawberry red tongue and a desquamative rash.
What is the disease? What is the major complication that can arise? What is the Tx? |
Kawasaki disease is an acute, self-limiting necrotizing vasculitis in infants and children that occurs more frequently in those of Asian ethnicity. The major complication is coronary aneurysm
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Tx for Kawasaki disease is IV Ig and aspirin
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What size vessel is affected by each of the following?
- Buerger's dz - Kawasaki dz - Polyarteritis nodosa - Sturge-Weber dz - Wegener's granulomatosis - Takayasu's arteritis - Temporal arteritis |
Buerger's - small and medium
Kawasaki - small and medium Polyarteritis - small and medium Sturge-Weber - small Wegener's - small Takayasu - medium and large Temporal - medium and large |
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What is the pathophysiology of polyarteritis nodosa?
What is descriptive of the lesions? |
Immune-complex mediated transmural vasculitis with fibrinoid necrosis
Lesions are of different ages. |
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What is the most common antigen found in polyarteritis nodosa?
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30% of patients with polyarteritis are Heb B seropositive.
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Patient is 55 yo Asian female presenting with fever, arthritis and night sweats. On PEx she has weak pulses.
What are you thinking? |
Takayasu's arteritis: "pulseless dz" that affects primarily Asian women > 40 yrs.
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What are the symptoms of Takayasu's disease?
What vessels are affected? |
Takayasu's --> FAN MY SKIN On Wednesday
Fever Arthritis Night sweats Myalgias Skin nodules Ocular disturbance Weak pulses in upper extremities |
Takayasu's causes granulomatous thickening of aortic arch and/or proximal great vessels.
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What is the most common vasculitis to affect medium and large arteries?
How is it treated? |
Temporal arteritis is the most common arteritis of medium and large arteries.
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Tx temporal arteritis with high dose steroids
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Strawberry hemangioma vs. cherry hemangioma
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Strawberry - infantile, grows with child then spontaneously regresses
Cherry - senile, does not regress and frequency increases with age |
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What kind of hemangioma is associated with trauma or pregnancy?
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Trauma / pregnancy - pyogenic granuloma - a capillary hemangioma that can ulcerate and bleed
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What two skin disorders are often mistaken in HIV patients?
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HIV: bacillary angiomatosis and Kaposi's sarcoma
Bacillary angiomatosis - benign capillary skin papule caused by Bartonella henselae infection Kaposi's sarcoma - endothelial malignancy associated with HHV-8 |
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What is a glomus tumor and where is it found?
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Glomus tumor is a benign, painful, red-blue tumor under the fingernail that arose from the SMC of the glomus body.
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What is an angiosarcoma and with what is it associated?
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Angiosarcoma is a highly lethal malignancy of the liver associated with vinyl chloride, arsenic and ThO2 (Thorotrast) exposure.
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Vinyl chloride, arsenic or Thorotrast exposure is associated with what vascular tumor?
Where in the body is this tumor found? |
Vinyl chloride, arsenic or Thorotrast exposure --> angiosarcoma, a lethal tumor of the liver
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To what does persistent lymphedema predispose?
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Lymphangiosarcoma - lymphatic malignancy associated with persistent lymphedema.
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