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Flashcards in Path Deck (52):

Temporal (Giant Cell) Arteritis

  • Granulomatous Vasculitis often involving Branches of Carotid
    • Thickened Tunica Intima
    • Destruction of Elastic Lamina
  • Presentations
    • Headache
    • Visual Disturbances
    • Jaw Claudication
    • Flu-Like Symptoms w/ Joint and Muscle Pain
    • Elevated ESR
  • Biopsy
    • Inflamed Vessel Wall w/ Giant Cells and Intimal Fibrosis
    • Negative biopsy DOES NOT r/o disease
  • Treatment
    • Corticosteroids


Takayasu Arteritis

  • Granulomatous vasculitis often involving aortic arch at branch points
  • Presents in younger adults (classically, Asian Females)
    • Visual and Neurological Symptoms w/ weak and absent pulse in UE
    • Elevated ESR


Polyarteritis Nodosa

  • Necrotizing vasculitis involving multiple organs (Lungs Spared)
    • Fibrinoid Necrosis
  • Presents in Young Adults as
    • Hypertension (Renal Artery Involvement)
    • Abdominal pain w/ melena (Mesenteric Artery Involvement)
    • Neurologic Disturbances
    • Skin Lesions
    • Associated w/ Serum HBsAg


Kawasaki Disease

  • Asian children <4 Years of Age
  • Coronary Artery Involvment Common and Leads to:
    • Risks for Thrombosis w/ MI
    • Aneurysm w/ Rupture
  • Presents w/
    • Fever
    • Conjunctivitis
    • Erythematous Rash of Palms and Soles
    • Enlarged Cervical Lymph Nodes


Microscopic Polyangitis

  • Necrotizing vasculitis involving multiple organs, including lungs and kidney
  • Similar to Wegener granulomatosis (granulomatosis w/ polyangitis)
    • BUT nasopharyngeal involvement and granulomas absent
  • Serum p-ANCA levels correlate w/ disease activity
  • Tx = corticosteroids and cyclophosphamide


Granulomatosis w/ Polyangitis (Wegener Granulomatosis)

  • Necrotizing granulomatous vasculitis involving nasopharynx, lungs, and kidneys
  • Presents in Middle-Aged Male w/ :
    • Sinusitis
    • Nasopharyngeal Ulceration
    • Hemoptysis w/ bilateral nodular lung infiltrates
    • Hematuria due to rapidly progressive glomerulonephritis
  • Serum c-ANCA levels correlate w/ disease activity
  • Biopsy reveals large necrotizing granulomas w/ adjacent necrotizing vasculitis


Buerger Disease

  • Necrotizing vasculitis involving digits
  • Presents w/
    • Ulceration
    • Gangrene
    • Autoamputation of Fingers and Toes
    • Raynaud Phenomenon often present
  • Highly associated w/ heavy smoking


Reagent Test Strip

  • Advantages
    • Evaluate multiple physicochemical aspects of urine
    • Results availabe in minutes
    • Low complexity
  • Disadvantages
    • Medications/Other Compounds may interfere w/ test
    • If there is discordance b/t clinical suspicion and test strip results microscopic eval is needed as well as backup chemistry tests


Hyaline Casts

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  • Hyaline Cast
    • Composed of Tamm-Horsfall Protein
    • Can be seen in:
      • Normal Urine (0-2 Low Power Field)
      • Following Strenuous Exercise and Dehydration
      • All type of renal disease


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  • Cysteine crystals
    • Cystinuria Disease


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  • Tyrosine Crystals
    • Severe Liver Disease


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  • Leucine Crystals
    • Liver Disease


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  • Cholesterol Crystals
    • Nephrotic Syndrome


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  • Bilirubin Crystals
    • Liver Disease


Normal Blood Pressure

Less than 120/80 mmHg


Elevated Blood Pressure

Systolic b/t 120-129 and Diastolic less than 80


Stage 1 Hypertension

Systolic 130-139 and Diastolic 80-89


Stage 2 Hypertension

Systolic at least 140 or Diastolic at least 90


Hypertensive Crisis

Systolic Over 180 and/or Diastolic Over 120


Monckeberg's Medial Calcific Sclerosis

  • Calcific deposits in muscular arteries in people over age 50
    • Typically do not involve the lumen




  • Disease of small arteries and arterioles associated w/ hypertension and diabetes



  • Arteriosclerosis characterized by fatty and atheromatous plaques w/in arterial lumina
    • Most frequent and clinically important pattern of ateriosclerosis


Hyaline Arteriolosclerosis

  • Arteriolar wall is thickened w/ increased plasma protein deposition and narrowed lumen
    • Chronic Hypertension
    • Diabetes Mellitus


Hyperplastic Arteriolosclerosis

  • Onion-skinning causing lumenal obliteration
    • Severe (Malignant) HTN
  • Laminations composed of smooth muscle cells w/ reduplicated, thickened basement membranes


Most frequent causes of aortic stenosis

  1. Wear and Tear
  2. RHD


Most frequent cause of aortic insufficiency

  1. Dilation of Aortic Arch (Due to Hypertension and Aging)
  2. RHD


Most frequent cause of mitral stenosis

  1. Post-Inflammatory Scarring of RHD


Most frequent cause of mitral insuffiency

  1. Myxomatous Degeneration
  2. RHD


Congenital Bicuspid Aortic Valve

  • 1.4% of Live Births
  • Asymptomatic Early
  • Predisposes to Early Calcific Stenosis
  • Often Diagnosed in Young Adulthood
  • Larger Cusp Often has Midline Raphe


  • Proteoglycans Deposited in Spongiosa
    • Collagen and Elastin Loose and Disorganized

Mitral Valve Prolapse (Myxomatous Valve)

  • Midsystolic Click
  • Ballooning/Parachute-Like Leaflets


*More common in women than men*


Bread and Butter Pericarditis

Acute Rheumatic Heart Disease


Most Common of All Valvular Diseases

Aortic Stenosis


  1. Angina
  2. Syncope During Exertion
  3. Congestive Heart Failure
  4. Heart Palpitations
  5. Sudden Cardiac Death from Arryhthmia

Aortic Stenosis


  1. Dyspnea on Exertion
  2. Fatigue
  3. Decreased Exercise Tolerance
  4. Sensation of Forceful Heartbeat w/ HBP

Aortic Regurgitation/Insufficiency


  1. Dyspnea w/ Exertion at First and at Rest Later (With increased severity)
  2. Fatigue
  3. Pulmonary Hypertension
  4. Right Sided Heart Failure

Mitral Stenosis


Use of Fen-Phen

Mitral Regurgitation


Anitschkow Cells "Caterpillar Cells"

Rheumatic Heart Disease


What valve disease is pretty much universal in Chronic Rheumatic Heart Disease?

Mitral Stenosis


Acute Infective Endocarditis

  • Explosive, Rapidly Progressive Illness
    • High Fever
    • Shaking Chills
  • Staph aureus commonly
  • Often arises in previously normal heart valves


Subacute Infective Endocarditis

  • Low-Grade Fever, often w/ nonspecific constitutional symptoms
  • Strep viridans most common w/ native valves
  • Epidermidis most common w/ prosthetic valves
  • Typically arise in damaged/congenitally abnormal heart valves


  • Intravenous Drug Abuse
  • May be complicated by pulmonary emboli and infarcts
    • Pneumonia
    • Lung abscesses
  • May result in CHF

Right-Sided Endocarditis


  • Sterile, small vegetations of platelets and fibrin, loosely adherent to valve leaflets along closure lines w/o significant inflammation or valve damage
  • Setting of cancer of prolonged chronic illnesses

Non-Bacterial Thrombotic Endocarditis 


  • Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome
  • Valve Scarring
  • Small/Medium-Sized Fibrinous, Sterile Vegetations on Either or Both Sides of the Valve Leaflets

Libman-Sachs Disease


Fusion of Commisure of Aortic Valve

Post-Rheumatic Heart Disease


  • Occur in Skin, Subcutaneous Tissues, Mucous Membranes, Liver, Spleen, and Kidneys
  • Bright Red to Blue, Vary from a few millimeters to several centimeters in size
  • Microscopically are unencapsulated aggregates of closely packed, thin walled capillaries
    • Vessels separated by scant connective tissue stroma 

Capillary Hemangioma


  • Composed of larger vessels than seen in capillary hemangiomas

Cavernous Hemangioma


  • Rapidly growing pedunculated red nodule on the skin of mucus membrane
  • Bleeds easily, often ulcerated
  • Usually reach 1-2 cm in size within a few weeks
  • May develop after trauma
  • Microscopically are composed of closely packed small capillaries in a lobular configuration w/ stromal edema

Lobular Capillary Hemangioma


  • Predominantly in head and neck region, and axillary subcutaneous tissues
  • Look like hemangioma, except vessels do not contain blood

Simple Capillary Lymphangioma 


  • Typically found in head and neck region or axilla of children
  • May be enormous, up to 15 cm
  • Not encapsulated. Composed of large, dilated vessels, w/o blood in the lumen

Cavernous Lymphangioma


Malignant Primary Cardiac Tumors

  • Angiosarcoma
  • Rhabdomyosarcoma
  • Leiomyosarcoma
  • Kaposi Sarcoma
  • Fibrosarcoma
  • Lymphoma


Most Common Metastatic tumors to Heart

  • Melanoma
  • Breast Carcinoma
  • Lung Carcinoma
  • Renal Cell Carcinoma
  • Germ Cells Tumors
  • Childhood Rhabdomyosarcoma