Block I - CVS, Wound Healing, Vasculitis, etc.

Question 1

What is the most important mediator in the healing process?

Answer 1

FGF. Earliest growth factor in healing; stimulates macrophages and MMPs

Question 2

What does TGF-beta do?

Answer 2

Causes fibrosis and some angiogenesis

Question 3

What synthesizes the extracellular matrix?

Answer 3

Fibronectin; responsible for cross-linking

Question 4

What secretes PDGF?

Answer 4

Activated platelets and macrophages.

Question 5

What does PDGF do?

Answer 5

Induces vascular remodeling, smooth muscle cell migration, sand stimulates fibroblast growth for collagen synthesis

Question 6

What is responsible for attachment of epithelium to extracellular matrix?

Answer 6

Integrin

Question 7

What is the maximum wound strength possibility?

Answer 7

85%; at around 4 months

Question 8

What is responsible for would contraction in burns?

Answer 8

Myofibroblasts

Question 9

What is the first step in healing?

Answer 9

Clot formation

Question 10

What would you expect to see 0-4 hours in healing?

Answer 10

Waviness of fibers

Question 11

What would you expect to see 12-23 hours in healing?

Answer 11

Contraction band necrosis

Question 12

What would you expect to see 2-3 days in healing?

Answer 12

Neutrophils peaking; causing increased vessel permeability and migration into tissue

Question 13

What would you expect to see 3-7 days into healing?

Answer 13

Macrophages predominating; clear debris via mediators and MMP to eat collagen

Question 14

What would you expect to see 7-21 days into healing?

Answer 14

Granulation tissue & Type III Collagen; angiogenesis, and wound contraction via myofibroblasts

Question 15

What would you expect to see 6-7 weeks into healing?

Answer 15

Scar formation; when repair cannot be done by cell generation alone.

Question 16

What does collagenase require in order to break down Type III collagen?

Answer 16

Zinc

Question 17

What is Keloid?

Answer 17

Abnormal scar formation due to proliferation of Type I and Type III collagen; grows outside of border of normal wound.

Question 18

How does diabetes cause problems in wound healing?

Answer 18

Enzymatic Glycosylation

Question 19

What is a Desmoid Tumor?

Answer 19

Abnormal growth from connective tissues that provide strength and flexibility; seen in bones, ligaments, muscles. Break sutures, fibroid tissue into infiltrate.

Question 20

What phase must a cell be in for regeneration?

Answer 20

G1

Question 21

How does an atheroma develop?

Answer 21

Injury to endothelial cell

Question 22

Differentiate between an atheroma and fatty streak:

Answer 22

Atheroma has a necrotic core and cholesterol clefts while fatty streak does not.

Question 23

What presents with a “beading appearance?”

Answer 23

Fibromuscular Dysplasia

Question 24

In renal artery stenosis, in which kidney is the renin level increased?

Answer 24

Increased renin in the affected kidney; causes unilateral atrophy

Question 25

What is the main cause of an abdominal aortic aneurysm?

Answer 25

Atherosclerosis

Question 26

What are two complications of an abdominal aortic aneurysm?

Answer 26

1. Formation of mural thrombus leading to impotence and gangrene. 2. Rupture if greater than 5cm in diameter.

Question 27

What is the most common cause of sudden adult death, and how does it occur?

Answer 27

Ventricular aneurysm caused by ischemia.

Question 28

A vasculitis involving small vessels, causing a necrotizing granuloma; presence of C-ANCA is what?

Answer 28

Wegeners; commonly in middle-aged male, will have nosebleeds, sinusitis, hemoptysis with bilateral lung infiltrates.

Question 29

The most common form of arteritis in adults greater than 50; commonly found in the carotid artery is what, and what is a complication?

Answer 29

Giant (Temporal) Cell Arteritis; can lead to blindness. Will have ESR levels very high usually above 100.

Question 30

What vasculitis is a granulomatous vasculitis, commonly seen in young, Asian females?

Answer 30

Takayasu; presents with weak or absent pulse in upper extremities.

Question 31

What is the main cause of aortic dissection and what is it due to?

Answer 31

Cause: HTN Due: Endothelial tear.

Question 32

What has a sharp, severe chest pain that radiates to the back, and can cause pericardial tamponade leading to death?

Answer 32

Aortic Dissection

Question 33

What are the components of Tetralogy of Fallot?

Answer 33

1. VSD 2. Overriding Aorta 3. Pulmonary HTN 4. RVH

Question 34

What is the main cause of Eisenmerger?

Answer 34

Pulmonary HTN

Question 35

What is commonly seen in Marfan's, and describe the murmur.

Answer 35

Mitral Valve Prolapse; mid-systolic click followed by a late systolic murmur best heard at the base of the apex

Question 36

What happens to the Mitral Valve Prolapse murmur on standing or valsalva?

Answer 36

Increases; earlier systolic click, and longer murmur (note this is opposite in aortic stenosis)

Question 37

Describe the Mitral Regurgitation murmur:

Answer 37

Seen in Rheumatic Fever and chordae tendinae rupture; is a holosystolic, blowing, high-pitched murmur that radiates to the left axilla.

Question 38

Describe the Mitral Stenosis murmur:

Answer 38

Apical, mid-diastolic rumble; seen in RHD and Pulmonary HTN

Question 39

Describe the Aortic Regurgitation murmur:

Answer 39

Decrescendo, diastolic murmur present with head-bobbing, Waterhammer pulse, and pulsation of retinal arteries; also seen in Marfan's and syphilis.

Question 40

Describe the Aortic Stenosis murmur:

Answer 40

Harsh, systolic, crescendo-decrescendo with radiation to the carotids.

Question 41

What amyloid is seen in age-related amyloidosis of the heart?

Answer 41

Transthyretin

Question 42

What amyloid is seen in Multiple Myeloma?

Answer 42

Light-chain

Question 43

Describe a Ventricular Rhabdomoma:

Answer 43

Tuberosclerosis, hypopigmentation of the skin, ash-leaf spot, and kidney tumor; seen in children commonly at left ventricle.

Question 44

What causes endocarditis of healthy adults and IV drug users?

Answer 44

Staph Aureus

Question 45

What causes endocarditis of previously damaged heart valves?

Answer 45

Strep Viridans; alpha-hemolytic

Question 46

What are Roth spots and Osler's nodes due to?

Answer 46

Immune Complex Deposition

Question 47

What are Janeway lesions due to?

Answer 47

Thromboembolism

Question 48

What are the tumors of VHL?

Answer 48

Hemangioblastoma, angioma of the retina, and bilateral renal carcinoma.

Question 49

In a capillary hemangioma where the parents are worried about appearance of the child, what should you suggest?

Answer 49

Do nothing; will go away on it's own while surgical intervention can leave a scar

Question 50

What are two late complications of MI?

Answer 50

Free wall rupture (3-5 days) due to LAD occlusion, presenting with cardiac tamponade and Dressler Syndrome (5 weeks) which is pericarditis due to immune response with chest pain and fever.

Question 51

Pulmonary edema is caused by what?

Answer 51

Increased hydrostatic pressure

Question 52

What causes HOCM?

Answer 52

Obstruction of aortic outflow due to septum being too thick, and the anterior and posterior leaflets coming together to completely block outflow

Question 53

What does HOCM sound like on auscultation; and what effect does valsalva/standing have?

Answer 53

Aortic Stenosis; will increase this murmur on standing/valsalva (aortic stenosis would decrease)

Question 54

What genetic effect causes HOCM, and what does HOCM lead to?

Answer 54

Beta-myosin mutation; creates cardiac tissue with several branches, thicker, tighter muscle. Leads to death during exercise; Autosomal Dominant.

Question 55

Describe concentric hypertrophy:

Answer 55

Pressure overload (narrowing the lumen); seen in aortic stenosis or HTN

Question 56

Describe essentric hypertrophy:

Answer 56

Volume overload; seen in aortic regurgitation

Question 57

What is nutmeg liver?

Answer 57

Due to passive venous congestion; typically seen in Congestive Heard Disease, presents with fatty change around portal triad. Never caused by alcohol or hypoxia.