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B. X Flashcards

1
Q

Congenital heart defects arise when

A

Week 3-8

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2
Q

Most Congenital heart defects are _____

A

Sporadic

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3
Q

Congenital heart defects often result in

A

Shunting btw. left and right

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4
Q

What is the most common Congenital heart defects?

A

VSD Ventricular Septal Defect

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5
Q

VSD Ventricular Septal Defect results in

A

Left-to-right shunt

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6
Q

Large VSD can lead to

A

Eisenmenger syndrome

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7
Q

Eisenmenger syndrome=

A

Pulmonary HTN
Reverse of flow
Cynaosis

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8
Q

Congenital heart defects (8)

A 
VSD
ASD
PDA
Tetralogy of fallot
Transposition of the great vessels
Truncus arteriosus
Tricuspid atresia
Coarctation of the aorta
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9
Q

ASD most common type

A

Ostium secundum

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10
Q

ASD ostium primum is associated with

A

Down syndrome

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11
Q

ASD result in

A

Left-to-right shunt
Split of S2 on auscultation
Paradoxial emboli

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12
Q

PDA=

A

Failure of ductus arteriosus to close

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13
Q

PDA is associated with

A

Congenital rubella

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14
Q

PDA results in

A

Left-to-right shunt btw. aorta and pulmonary artery

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15
Q

What maintains patency of ductus arteriosus?

A

PGE

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16
Q

What can lower PGE

A

Indomethacin

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17
Q

Tetralogy of fallot=

A
  1. Stenosis of right vent. outflow tract
  2. RVH
  3. VSD
  4. Aorta that overrides the VSD
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18
Q

Tetralogy of fallot results in

A

Right-to-left shunt

Early cyanosis

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19
Q

Tetralogy of fallot treatment

A

Patient squat in order to increase arterial resistance

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20
Q

Transposition of the great vessels characterized by

A

Pulmonary artery arising from left vent. and aorta arising from right vent.

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21
Q

Transposition of the great vessels is associated with

A

Maternal diabetes

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22
Q

Transposition of the great vessels present with

A

Early cyanosis

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23
Q

Transposition of the great vessels treatment

A

Creating of a shunt in order for the blood to mix and surgery

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24
Q

Transposition of the great vessels results in

A

RVH

Left vent. atrophy

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25
Truncus arteriosus=
Single large vessel arising from both vent.
26
Tricuspid atresia=
Tricuspid valve orifice fails to develop | Right vent. is hypoplastic
27
Coarctation of the aorta=
Narrowing of the aorta
28
Coarctation of the aorta is devided to
Infantile | Adult
29
Infantile Coarctation of the aorta is associated with
PDA | Turner syndrome
30
Adult Coarctation of the aorta, coarctaition lies
After to aortic arch
31
Adult Coarctation of the aorta present with
HTN in upper extermitis | Hypotension in lower extermitis
32
How can we discover clacified aortic valve?
Chest radiograph/autopsy
33
Calcium deposits usually affect the
Leaflets of the aortic valve
34
Mitral valve prolapse may be seen in what syndrome?
Marfan
35
Mitral valve prolapse AKA
Click-murmur syndrome
36
Valvular lesions generally result in (2)
Stenosis | Regurigation
37
Valvular disorders (7)
``` Acute rheumatioc fever Chronic rheumatioc fever Aortic stenosis Aortic regurgitation Mitral valve prolapse Mitral regurgitation Mitral stenosis ```
38
Rheumatioc fever order of valve affecting
Mitral Aortic Tricuspid
39
What is the consequence of Chronic rheumatioc fever
Valve scarring Stenosis "Fish mouth"
40
Chronic rheumatioc fever leads to thickening of the
Chordae tendineae
41
Complication of Chronic rheumatioc fever
Infectious endocarditis
42
Atherosclerosis=
Intimal plaque that obstructs blood flow
43
Atherosclerosis consist of
Necrotic lipid core (cholesterol) | Fibromuscular cap
44
FIbrous cap contains
Smooth muscle cell MPH Lymphocytes Collagen
45
Necrotic center contains
``` Smooth muscle cell MPH Foam cells Lymphocytes Cholesterol crystals Calcium Cell debris ```
46
Atherosclerosis involves
Large and medium vessels
47
Atherosclerosis- | Which vessels are commonly affected
Abdominal aorta Coronary a Popliteal a Internal carotis a
48
Atherosclerosis modifiable risk factors
HTN Hypercholesterolemia Smoking Diabetes
49
Atherosclerosis non-modifiable risk factors
Age Gender (Estrogen is protective) Genetics
50
Atherosclerosis pathogenesis
1. Endot. damage 2. Lipids leak into intima 3. Lipids are oxidize 4. Consumed by MPH 5. Result in foam cells 6. Inflammation and healing- SMC prolif. and EC matrix deposition
51
Atherosclerosis morphologic stages
1. Fatty streaks | 2. Atheroma
52
Fatty streaks=
Flat yellow lesion of the intima consist of Lipid-laden MPH
53
Atherosclerosis complication (4)
1. Meidum vessels stenosis 2. Plaque rupture and thrombosis 3. Plaque rupture with embolization 4. Aneurysm
54
Acute rheumatic fever myocardial inflammatory lesions are called
Aschoff bodies
55
Aschoff bodies=
``` Collection of lymphocytes, plasma cells, Anitschkow cells (pulp activated MPH) ```
56
In rheumatic fever, the Ab which the immune system generates against the M proteins may cross react with
Heart muscle cell protein myosin
57
Most common cause of endocarditis
Strep. viridans
58
Strep. viridans infects previously
Damaged valves
59
Endocarditis results in
Small vegetations that do not destroy the valve
60
What is the most common cause in IVDU?
Staph. aureus
61
Staph. aureus Endocarditis results in
Large vegetationsthat destroy the valve
62
Staph. epidermidis is associated with
Endocarditis of prosthetic valves
63
Negative culture Endocarditis is associated with what organisms
HACEK ``` Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella ```
64
How can we detect bacterial Endocarditis in imaging?
Transesophageal echocardiogram
65
Nonnacterial thrombotic endocarditis is due to
Sterile vegetations that arise in association with hypercoagulable state / adenocarcinpma
66
SLE associated Endocarditis
Libman-Sack Endocarditis
67
In what case can we see vegetations in both sides of the heart valve?
Libman-Sack Endocarditis
68
Define cardiomyopathy
Myocardial disease that result in cardiac dysfunction
69
Dilated cardiomyopathy=
Dilation of all 4 chambers of the heart
70
What is the most commn form of cardiomyopathy
Dilated cardiomyopathy
71
Dilated cardiomyopathy results in
Systolic disfunction (vent. cant pump)
72
Most common origin of Dilated cardiomyopathy
``` Idiopathic Genetics Myocarditis (Coxsackie A/B) Alcohol Drugs Pregnancy ```
73
Hypertrophic cardiomyopathy=
Massive hypertrophy of the left ventricle
74
Hypertrophic cardiomyopathy is usually due to
AD Genetic mutation in sarcomere proteins
75
Hypertrophic cardiomyopathy clinical features
Decreased CO Sudden death dur to arrhythmia Syncope with exercise
76
Hypertrophic cardiomyopathy- why do we see Decreased CO?
Ventricles cannot fill
77
Restrictive cardiomyopathy=
Decreased compliance of the vent. endomyocardium that restricts filling during diastole
78
Restrictive cardiomyopathy causes (5)
``` Amyloidosis Sarcoidosis Hemochromatosis Endocardial fibroelastosis Loeffler syndrome ```
79
Restrictive cardiomyopathy presents as
Congestive heart failure
80
Most common cause of Myocarditis
Coxsackieviruses A/B CMV HIV Influenza virus
81
Non-viral myocarditis causes
Trypanosoma cruzi Toxoplasma gondii Trichomonas spirallis Borrelia burgdorferi
82
Non-infectious causes of Myocarditis
SLE | Drugs HSN
83
Myocarditis microscpically appearance
Edema Inflammatory infiltrates Myocyte injury Lymphocytic infiltrate
84
Vasculitis=
Vessel wall inflammation
85
Most common pathogenic mechanisms of vasculitis are (2)
Immune mediated inflammation | Direct vascular invasion by infectious pathogens
86
Large vessel vasculitis 2
Temporal Giant cell arteritis Takayasu arteritis TG!! Like Tia and Guy
87
Medium vessel vasculitis 3
Polyarthritis nodosa Kawasaki disease Burger disease PiKaBu!!!
88
Small vessel vasculitis 4
Wegener granulomatosis Microscopic polyangitis Churg-strauss syndrome Henoch-Schonlein purpura
89
Temporal Giant cell arteritis involves which arteries?
Carotid s branches
90
What is the most common cause of vasculitis in older adults >50
Temporal Giant cell arteritis
91
Temporal Giant cell arteritis presets as
Headach (temporal a involvment) Vision symp, Jaw claudicayion
92
Temporal Giant cell arteritis is a _______ vasculitis
Granulomatous
93
Temporal Giant cell arteritis lesion are segmental/non-segmental
Segmental
94
Temporal Giant cell arteritis biopsy reveals
Inflamed vessel wall with giant cells and intimal fibrosis
95
Temporal Giant cell arteritis treatment
Corticosteroids
96
Takayasu arteritis is a _____ arthritis
Granulomatous
97
Takayasu arteritis clasically involves
Aortic arch at branch points
98
Takayasu arteritis is present in what population
Adult < 50 | Young asian female
99
Takayasu arteritis presents as
Visual and neurological symp. with weak or absent pulse in the upper extremities
100
Takayasu arteritis is also called
Pulseless disease
101
Which arthritis causes weak or absent pulse in the upper extremities?
Takayasu arteritis
102
Takayasu arteritis treatment
Corticosteroids
103
Polyarthritis nodosa=
Necrotizing vasulitis
104
Which organ is spared in Polyarthritis nodosa
Lungs
105
Polyarthritis nodosa common in what population
Young adults
106
Polyarthritis nodosa symp.
HTN (renal artery) Melena (mesenteric a) Skin lesion Neurologic disturbance
107
Polyarthritis nodosa is associated with what Ag
HBsAg
108
What kind of lesions are present in Polyarthritis nodosa
Varying stages
109
Imaging appearance of Polyarthritis nodosa
String of pearls
110
Why do we see String of pearls in Polyarthritis nodosa
Necrosis that heals with fibeosis
111
Which vasculitis classicaly affects asian children < 4 years old
Kawasaki disease
112
Kawasaki disease symp.
Fever Conjunctvitis Rash on palms and soles Enlarged cervical lymph nodes
113
Kawasaki disease commonly involves which artery?
Carotid
114
Kawasaki disease treatment
Aspirin | IVIG
115
Which medium vessels vasculitis is self limited
Kawasaki disease
116
Buerger disease=
Necrotizing vasculitis involving digits
117
Buerger disease involves the
Digits
118
Buerger disease presents as
Ulceration, gangrene and autoamputation of fingers and toes
119
Which phenomenon is often present with Buerger disease
Raynaud
120
Raynaud phenomeno=
Spasm of arteries cause episodes of reduced blood flow. | Typically, the fingers
121
Buerger disease is highly associated with
Smoking אתה מחזיק את הסיגריות באצבעות
122
Wegener granulomatosis involves which vessels
Nasopharynx Lungs Kidneys
123
lassic presentation of Wegener granulomatosis
Middle aged male with sinusitis, hemoptysis and hematuria
124
Serum levels of ____ correlate with Wegener granulomatosis
c-ANCA
125
Wegener granulomatosis treatment
Cyclophosphamide steroids
126
Microscopic polyangitis involves
Multiple organs
127
Microscopic polyangitis involves especially
Lung | Kidney
128
What is the difference btw Microscopic polyangitis and Wegener granulomatosis?
Microscopic polyangitis doesnt involve the nasopharynx
129
Serum levels of ____ correlate with Microscopic polyangitis
p-ANCA
130
p-ANCA + vasculitis
Microscopic polyangitis | Churg-Strauss syndrome
131
Churg-strauss syndrome=
Necrotizing granulomatous inflammation with eosinophils
132
Churg-strauss syndrome involves mostly
Lung | Heart
133
What is often present in Churg-strauss syndrome
Asthma | Peripheral eosinphilia
134
Serum levels of ____ correlate with Churg-strauss syndrome
p-ANCA
135
What is the most common vasculitis in children?
Henoch-Schonlein purpura
136
Henoch-Schonlein purpura=
Vasculitis due to IgA immune complex deposition
137
Henoch-Schonlein purpura treatment
Mostly self limited
138
Henoch-Schonlein purpura symptoms
Palpable purpura on buttocks and legs GI pain and bleeding Hematuria (IgA nephropathy)
139
Leading cause of death in US
Ischemic Heart Disease
140
MI=
Necrosis of cardiac myocytes
141
MI happens usually due to
Rupture of an atherosclerotic plaque with thrombosis and comlete occlusion of a coronary artery
142
MI symp.
Crushing chest pain Sweating Dyspnea
143
Infarction usually involves ___
Left vent.
144
What is the most common involved artery in MI
LAD
145
LAD-> where is the MI?
Ant wall and septum of LV
146
Initial phase of infarction leads to ______ necrosis
Subendocardial
147
Continued ischemia leads to _____ necrosis
Transmural
148
MI cardiac enzymes
Troponin I peak at 24 hours post MI | CK-MB
149
MI treatment
``` Aspirin O2 Nitrates (vasodilation) B-blockers (lowering HR) ACE inhibitors (decreases LV dilation) ```
150
Gross change in MI + Which cells are present? | <4 h
``` None None Cardiogenic shock CHF Arrhythmia ```
151
Gross change in MI + Which cells are present + complication | 4-24 h
Dark discolaration Coagulative necrosis Arrhythmia
152
Gross change in MI + Which cells are present + complication | 1-3 d
Yellow pallor Neut. Fubrinous pericarditis
153
Gross change in MI + Which cells are present + complication | 4-7 d
Yellow pallor MPH Rupture of wall
154
Gross change in MI + Which cells are present + complication | 1-3 w
Red border | Granulation tissue, collage, blood vessels
155
Gross change in MI + Which cells are present + complication | 1 month
White scar Fibrosis Aneurysm
156
Types of angina
Stable Unstable Prinzmetal
157
Angina is due to
Atherosclerosis of coronary a > 70%
158
Stable angina arises when
Exortion or emotional stress
159
ECG of stable angina
STD due to subendothelial ischemia
160
Stable angina is relived with
Rest | Nitroglycerin
161
Unstable angina is usually due to
Rupture of atherosclerotic plaque and thrombosis and incomplete occlusion of a coronary artery
162
Prinzmetal angina=
Episodic chest pain due to coronary artery vasospasm
163
Prinzmetal angina ECG shows
STE due to transmural ischemia
164
Most common etiology of sudden cardiac death
Acute ischemia | Fetal ventricular arrhythmia
165
CHF occurs when
The heart cannot generate sufficient output to meet metabolic demands of the tissues
166
Left CHF is due to
``` Ischemia Hypertension Dilated cardiomyopathy MI Restrictive cardiomyopathy ```
167
Clinical features in LCHF are due to
Decreased forward perfusion | Pulmonary congestion
168
Pulmonary congestion leads to
Pulmonary edema
169
Pulmonary edema leads to
Dyspnea | Small alveolar capiilaries may burst ->Intraalveolar hemorrhage -> Laden MPH
170
In Left sided heart failur, decreased flow to kidneys cause
Activation of renin-angiotensin mechanism
171
Right sided heart failure is most commonly due to
Left sided heart failure But also Left to right shunt Chronic lung disease
172
What chronic disease causes Right sided heart failure
Chronic lung disease (cor-pulmonale)
173
Right sided heart failure symp.
Jugular venous distension Hepatosplenomegaly (nutmag liver) Pitting edema

SN Pathology final (13 decks)

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