CR&R Final Flashcards by Spencer Barlow

What is shown here in this photo? What may it increase the risk of?

Ventricular fibrosis (likely secondary to MI, dead tissue -> replaced with fibrotic tissue)

It can increase the risk of systemic thromboembolism (dead tissue doesn’t contract, leading to blood pooling)

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What additional anatomic abnormality is found in 5% of patients with a bicuspid aortic valve?

Coarctation of the aorta

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How can aortic stenosis and a bicuspid aortic valve be differentiated?

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How can rheumatic fever and rheumatic heart disease be differentiated?

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What are these three histological features from left to right? What disease are they associated with?

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What acronym is used to describe the symptoms of infective endocarditis?

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What are major differences between valve damage in RHD vs IE?

RHD- mostly along closure line, no chordae tindinae involvement

IE- More clumped, can destroy, vegetate CT

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What type of cardiomyopathy can be precipitated by ethanol?

Dilated cardiomyopathy

*Anthracyclines (doxorubicin) are another common cause of DCM

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Identify the diferent CM and their features using this chart:

Good job!

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What is cystic medial degeneration? What 3 CT disorders is it seen in? What additional two pathologies? What is the main cause of myxoid degeneration?

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Where are arterial plexiform lesions seen?

Pulmonary hypertension

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What finding is characteristic of the exudative phase of ARDS?

Alveolar hyaline membranes

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Which respiratory tract structure is most affected by emphysema due to smoking?

Respiratory bronchiole (centriacinar pattern affects respiratory bronchiole more than alveolar duct, which would be more affected in panacinar pattern from a1anti-trypsen deficiency)

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What are major differences between centriacinar and panacinar emphysema?

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What are the two notable subtypes of NSIP pattern?

Cellular (left)
Fibrotic (right)

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What characteristic of end stage lung disease is seen here?

Honeycomb lung

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Which arrow represents subepithelial space? Which represents subendothelial space (for deposits)?

Blue- Subendothelial
Purple- Subepithelial

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What patient population would be at highest risk for a BK polyomavirus infection?

A kidney transplant patient (immunocompromised)

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Which of these pictures of acute pyelonephritis? Which is chronic?

Chronic pyelonephritis (left)- Not as many WBC casts, mostly lymphocytes in interstitium

Acute pyelonephritis (right)- Neutrophils in the tubular lumen (contributing to WBC casts)

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What type of pyelonephritis is visible here?

Chronic pyelonephritis

*Note prominant scarring

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What type of renal artery stenosis is seen here?

Fibromuscular dysplasia

*Most commonly seen in young to middle-aged women

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What is the most common disease cause of full house immunofluorescence?

Systemic lupus erthematosus

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What tumor is characteristic of a triphasic appearance? What are the three layers? What do abnormally large, hyperchromatic cells (right) indicate about that particular Wilm’s tumor?

Wilm’s tumor (epithelium, blastema, stroma)

Anaplasia: Most common in P53 mutations. resistance to chemotherapy

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Irregular spikes on silver stain are most indicative of what pathology?

Membranous glomerulonephropathy

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How does the gross presentation help to differentiate between oncocytoma and chromophobe carcinoma?

The classic brown color of the renal tissue

Glycosuria can be associated with what two conditions?

Diabetes mellitus Fanconi syndrome

What effect will NE have on HR, BP, and SVR?

BP and SVR: Increased HR: Decreased due to reflex bradycardia

Will the urine Na+ be high or low in SIADH?

Normal Na+ in urine (just ADH secreted abnormally, not aldosterone)

What syndrome can directly result from a bad PE?

ARDS

A systolic murmur with a blurred S2, which is reduced by handgrip is indicative of what valvular disease?

Aortic stenosis

Why does a handgrip/valsalva maneuver decrease the murmur in aortic stenosis?

The increased SVR translates to a higher afterload, with the ventricles unable to eject their normal amount of blood, which reduces the flow over the stenotic valve

A late systolic ejection murmur usually has what etiology?

Mitral valve prolapse (Barlow's syndrome) *A notable feature of Marfan's syndrome

What can help to increase the intensity of a late systolic ejection murmur such as that due to mitral valve prolapse?

Squatting, which increases preload and LV volume in order to better exaggerate the murmur

Using Left ventriular pressure versus atrial pressure, when does tension near its maximum?

As LV pressure > atrial pressure

What are the four types of shock?

Hypovolemic Cardiogenic Distributive Obstructive

What are the expected changes in RAP, SVR, and CO in hypovolemic shock?

Increased: SVR Decreased: RAP, CO

How is hypovolemic shock treated?

Restore normal volume status (i.e. isotonic IV fluids, blood products etc)

What is the expected change in PCWP, SVR, and CO in cardiogenic shock?

Increased: PCWP, SVR Decreased: CO

What is the treatment for cardiogenic shock?

1) Improve contracility with inotropes (dobutamine) 2) Diuresis 3) PCI for acute MI, or mechanical circulatory support in HF

What are the expected changes in RAP, SVR, and SvO2 in distributive shock?

Increased: SvO2 Decreases: RAP, SVR

What is distributive shock?

Hemodynamic derangement of inability to maintain vascular tone (low arteriolar/venous tone/low DBP)

What are the three classic types of distributive shock?

1) Septic shock 2) Anaphylactic shock 3) Neurogenic shock

What are the three treatments for septic shock?

1) Antimicobials to target infection ASAP 2) Increase preload with Iv fluids (i.e. LR) 3) Increased MAP with vasopressors (NE is first line)

How can anaphylaxis lead to shock?

IgE binds to mast cells/basophils leading to massive histamine release -> dilation of arterioles and veins, tachycardia, hypotension etc

How is anaphylactic shock treated?

What is neurogenic shock? How is it diagnosed? How is it treated?

What are the expected changes in RAP, SVR, and CO in obstructive shock?

Increased: RAP, SVR Decreased: CO

What are three possible causes of obstructive shock?

What are the appropriate treatments for the three possible causes of obstructive shock?

Why does hyperkalemia lead to the changes on MAP seen in A (black is normal, green is hyperkalemia)?

Hyperkalemia increases the resting MP from around -85 to less negative (maybe -60) and thus repolarization is achieved more quickly

What pathways (G protein and second messenger) are used by alpha 1 and 2 as well as beta 1 and 2 receptors?

What are the four classic features of tetrology of fallot?

What are the different criteria used to diagnose RHD from IE?

RHD: Jones criteria IE: Duke criteria

What is the acronym used to remember the symptoms associated with IE?

Which type of cardiomyopathy is more associated with an S3 heart sound? Which is associated with an S4?

DCM: An S3 can often be auscultated HCM: An S4 can often be auscultated

What is one common manuever to treat SVT and one common pharmacologic intervention?

Carotid massage Adenosine

What are the four stages of heart failure? What are criteria for each stage?

What are the four classes of HF according to the NYHA?

What are two characteristic features on atrial fibrillation on EKG?

1) No visible P waves 2) Irregularly irregular rythym

What type of medication can cause the change in ventriclar myocyte action potentials as seen here? Give one example. What result is seen on EKG?

What type of medication can cause the change in SA nodal cell action potentials as seen here? Give one example. What result is seen on EKG?

What type of medication can cause the change in ventriclar myocyte action potentials as seen here? Give one example. What result is seen on EKG?

How can diuretics lead to contraction alkalosis? What effect does alkalemia have on potassium-hydrogen ion exchange?

What type of medium-vessel vasculitis is most likely given this presentation? What lab findings would be significant? What disease is it associated with? What is the most likely complication?

1) Polyarteritis Nodosa 2) Elevated ESR, possibly creatinine and BP as well 3) Hepatitis B 4) Pseudoaneurysm

What heart disease is characterized by an anterior displacement of outflow tract portion of the IV septum?

Tetrology of Fallot

What are the 5 T's of Cyanotic CHD?

What is the medication of choice in ToF patients to decrease their R to L shunt?

Phenylephrine

What is a TET spell? Treatment involves increasing or decreasing SVR? What about PVR? What are four treatments?

What mutations cause Down syndrome, Turner syndrome, and DiGeorge syndrome? What heart defects are common in each of these?

What is Eisenmenger syndrome? What type of shunt is involved? What resulting acute complication can result?

Using the table, recall the formulas for: EER CER RR RRR RRI ARR ARI NNT NNH

What pathology is indicated by the EM image shown?