Cardiac

Question 1

Lipid changes inc risk atherosclerosis

Answer 1

increased LDL levels,
increased levels of lipoprotein-a
decreased HDL levels.

Question 2

Most common cause rv failure

Answer 2

Lv failure, mitral stenosis specifically

Question 3

Heart changes aging

Answer 3

inc LA size, dec LV size
calcific deposits
brown atrophy and amyloid deposition myocardium
aorta tortuous

Question 4

diastolic failure

Answer 4

heart failure with preserved EF and normal valves
LVH, amyloid, myocardial fibrosis, constrictive pericarditis
>65 female HTN, risk flash pulm oedema

Question 5

hypertrophic myocytes

Answer 5

enlarged nuclei

Question 6

Pulmonary changes LHF

Answer 6

1. perivasc and interstitial oedema
2. oedematous widening alveolar septa
3. oedema in alveolar spaces
   hemosiderin laden macrophages (heart failure cells)

Question 7

Cyanotic congenital heart disease

Answer 7

R->L shunts: TOF, TGA, eisenmenger
cyanotic
pulmonary stenosis
tricuspid atresia
anomalous pulmonary venous return

Question 8

Coarctation

Answer 8

pre ductal infantile, assoc PDA (asymptomatic if no PDA) hypoplastic aortic arch
adult post ductal
50% + bicuspid aortic valve
male > female, turners

Question 9

TOF

Answer 9

pulmonary stenosis
RVH
VSD
Overriding aorta

Question 10

VSD

Answer 10

most common defect
20-30% isolated
thrill on examination

Question 11

PFO

Answer 11

80% closed by 2y
loud S1 with fixed splitting S2

Question 12

PDA examination

Answer 12

machinery murmur

Question 13

Aortic stenosis and atresia

Answer 13

isolated in 80%

Question 14

Typical LCA and RCA lesions

Answer 14

LCA - proximal and isolated
RCA diffuse

Question 15

patterns cardiac infarction

Answer 15

transmural - stemi, plaque
subendocardial - inner 1/3 wall, hypotension, plaque
multi focal microinfarction - smaller intramural vessels, micro embolism, takutsubo

Question 16

reversible damage MI

Answer 16

30m

Question 17

<4h post MI

Answer 17

tissue looks normal, sarcolemma disruption

Question 18

4-12h post MI

Answer 18

tissue dark mottling, coagulative necrosis

Question 19

12-24h post MI

Answer 19

tissue dark mottling, pyknosis nuclei, neutrophil infiltration, oedema, haemorrhage

Question 20

1-3d post MI

Answer 20

tissue yellow with mottling, loss of nucelei, neutrohils present, risk fibrinous pericarditis

Question 21

3-7d post MI

Answer 21

hyperemic tissue with yellow core, disintegration dead myofibres, ding neutrophils, macrophages peripherally (weaken vent wall)

Question 22

7-10d post MI

Answer 22

yellow/ tan soft tissue, phagocytes with granulation tissue at margins

Question 23

10-14d post MI

Answer 23

red grey borders tissue, granulation tissue with new blood vessels, collagen deposition,

Question 24

2-8w post MI

Answer 24

grey white scar, increased collagen and celularity, 2m scarring complete

Question 25

Coagulative necrosis post MI

Answer 25

4-12h

Question 26

Neutrophil infiltration post MI

Answer 26

12-24h

Question 27

Macrophage infiltration post MI

Answer 27

3-7d

Question 28

Collagen deposition post MI

Answer 28

10-14d

Question 29

Dark mottling of heart post MI

Answer 29

4-24h

Question 30

Mortality from MI

Answer 30

30% in first year 50% of deaths in <1h due to arrhythmia

Question 31

Myocardial rupture

Answer 31

2-4d post MI wall weakned by macrophages Assoc transmural vent free wall rupture most common vent septa rupture papillary muscle rupture (least common)

Question 32

dressler syndrome

Answer 32

2-3d post, fibrinous/ fibrinohaemorrhagic pericarditis

Question 33

Most common valve diseases in order

Answer 33

Aortic stenosis Aortic insufficiency (dilated ascending aorta) mitral stenosis mitral insufficiency (prolapse)

Question 34

Calcific AS

Answer 34

age 70+ younger if bicuspid calcified masses in cusps, free edges not involved 50% due to bicuspid valve

Question 35

Myxomatous degeneration mitral valve

Answer 35

assoc marfans thinning fibrosa layer with expansion spongiosa layer

Question 36

Rheumatic heart disease lesions

Answer 36

Mitral stenosis Askoff bodies (t lymph) Anishkow cells - activated macrophages stretoplysin O, DNAase

Question 37

Jones criteria rheumatic heart disease

Answer 37

major: migratory polyarthritis large joints, pancarditis, subcutaneous nodules, erythema marginatum, sydenham correa minor: fever, arthralgia, acute phase proteins 2 major/ 1 major 2 minor

Question 38

Normal valve endocarditis organisms

Answer 38

staph aureus, enterococci, HACEK, oral cavity commensals

Question 39

Damaged valve endocarditis organism

Answer 39

strep viridans 60%

Question 40

Prosthetic valve endocarditis organism

Answer 40

staph epidermidis

Question 41

Fungal endocarditis organism

Answer 41

candida

Question 42

Duke criteria

Answer 42

endocarditis 2 maj, 1 maj 3 min, 5 min maj (BE): Blood culture >2, Echo/ new valve regurge Min (timer): Temp, Immunological phenomena, 1x Micro, , Embolic lesions, Echo consistent but not diagnostic, Risk factors - predisposing lesion/ IVDU

Question 43

Liebmann sachs

Answer 43

mitral and tricuspid endocarditis, sterile vegetations, assoc SLE

Question 44

Dilated cardiomyopathy

Answer 44

,pst common (90%), reduced EF systolic dysfunction genetic AD, viral, alcoholic, doxyrubicin cobalt, takutsubo 2y survival 50% mitral regurge

Question 45

Hypertrophic cardiomyopathy

Answer 45

preserved EF, diastolic genetic, friedrich ataxia, maternal DM, 2 yr mort 50% , 5y 75%

Question 46

Restrictive cardiomyopathy

Answer 46

rare, diastolic, preserved EF amyloid, radiation, idiopathic

Question 47

Myocarditis

Answer 47

viral - coxsacki + enteroviruses, HIV, flu, CMV chagas (protozoan) Lyme drug, SLE, can become dilated cardiomyopathy

Question 48

Pericardial effusion

Answer 48

normal 30-50ml 300 can cause rupture can accomodate p to 500

Question 49

Pressure vs volume overload effect on heart

Answer 49

pressure - hypertrophy volume - dilation

Question 50

Contractile bands evidence of

Answer 50

recent reperfusion injury

Question 51

genetic risk factor atherosclerosis

Answer 51

apolipoprotein beta gene mutation

Question 52

age changes of heart

Answer 52

bigger LA, smaller LV, sigmoid shaped septum

Question 53

uraemic pericarditis type

Answer 53

serous

Question 54

Bicuspid aortic valve associations

Answer 54

Early calcification and symptomatic stenosis by 50y 50% of AS due to bicuspid valve

Question 55

Location of valve calcification rheumatic / not

Answer 55

Within cusps normal Rheumatic free edges Mitral annular at annulus