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Flashcards in XI-The-Heart Deck (138):
1

The morphologic and clinical effects of this condition primarily result from progressive damming of blood within the pulmonary circulation. The left ventricle is hypertrophied and dilated, with secondary left atrial dilation. The lungs are heavy and boggy, with perivascular and interstitial transudate, alveolar septal edema, and intra-aleolar edema. Hemosiderin-laden macrophages are present.

Left sided heart failure(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 381

2

Hemosiderin laden macrophages are also called _______

Heart failure cells(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 381

3

This is usually the earliest and most significant compaint of patients in Left sided HF.

Dyspnea(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 381

4

Most common cause of right sided HF.

Left sided HF(TOPNOTCH)

5

This is a particularly dramatic form of breathlessness, awakening patients from sleeo with attacks of extreme dyspnea bordering on suffocation.

Paroxysmal nocturnal dyspnea(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 381

6

Isolated right sided HF occuring in patients with intrinsic lung disease that result in chronic pulmonary hypertension.

Cor Pulmonale(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 381

7

Long standing severe right-sided HF leads to fibrosis of centrilobular areas, creating this condition.

Cardiac cirrhosis(TOPNOTCH)

8

The liver is increased in size and weight, a cut section reveals congested red centers of liver lobules surrounded bybpaler, sometimes fatty peripheral regions.

Nutmeg liver (CPC of the liver)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 381

9

Right-sided HF produces a tense, enlarged spleen, achieving weights of 300-500 grams. Sinusoidal dilation present.

Congestive splenomegaly(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 381

10

This is a hallmark of right sided HF.

Pedal and pretibial edema(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 382

11

Most congenital heart disease arise from faulty embryogenesis during what AOG?

3 - 8 weeks AOG(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 382

12

An abnormal communication between chambers of the heart or blood vessels.

Shunt(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 383

13

These a typically smooth-walled defects near the foramen ovale, usually without associated cardiac abnormalities. Accompanied by right atrial and ventricular dilation, right ventricular hypertrophy and dilation of the pulmonary artery.

Ostium secundum ASD(TOPNOTCH)

14

Reversal of blood flow through a prolonged (left-to-right shunt) due to pulmonary hypertension, yielding right-sided pressures that exceed those on the left side. This causes unoxygenated blood to go into circulation, causing cyanosis.

Eisenmenger syndrome(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 383

15

These occur at the lowest part of the atrial septum and can extend to the mitral and tricuspid valves. Abnormalities of the AV Valves are usually present, forming a cleft in the anterior leaflet of the mitral valve or septal leaflet of the tricuspid valve.

Ostium primum ASD(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 384

16

Incomplete closure of the ventricular septum leading to left-to-right shunting. The right ventricle is hypertrophied and often dilated. Diameter of pulmonary artery is increased because of the increased volume by the right ventricle.

Ventricular Septal Defect(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 385

17

This arises from the left pulmonary artery and joins the aorta just distal to the origin of the left subclavian artery.

Ductus arteriosus(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 385

18

In this condition, some of the oxygenated blood flowing from the left ventricle is shunted back to the lungs. Proximal pumonary arteries, left atrium and ventricle may become dilated.

Patent ductus arteriosus(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 385

19

The most common cause of cyanotic congenital heart disease. Heart is large and "boot shaped" as a result of right ventricular hypertrophy.

Tetralogy of Fallot(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 385

20

Components of Tetralogy of Fallot.

Pulmonary valve stenosisOverriding of aortaRight ventricular hypertrophyVentricular septal defect(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 386

21

It is a discordant connection of the ventricles to their vascular outflow. The defect is an abnormal formation of the truncal and aortopulmonary septa. Right ventricular hypertrophy becomes prominent, while the left ventricle becomes somewhat atrophic.

Transposition of the Great Arteries(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 386

22

Predominant manifestation of TGA?

Early cyanosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 387

23

Characterized by tubular narrowing of the aortic segment between the left subclavian artery and the ductus arteriosus. DA is usually patent and is the main source of blood to the distal aorta. RV is hypertrophied and dilated, pulmonary trunk is also dilated.

Preductal "infantile" coarctation of the aorta(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 387

24

Aorta is sharply constricted by a ridge of tissue at or just distal to the ligamentum arteriosum. Constricted segment is made of smooth muscle and elastic fibers that are continuous with the aortic media, and lined by thickened intima. Ductus arteriosus is closed. Proximally, the aortic arch and its vessels are dilated, LV is hypertrophic.

Postductal "adult" coarctation of the aorta(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 387

25

There is upper extremity hypertension, due to poor perfusion of the kidneys, but weak pulses and low blood pressure in the lower extremities. Claudication and coldness of the lower extremities also present. Enlarged intercostal and internal mammary arteries due to collateral circulation, seen as rib "notching" on xray.

Postductal coarctation of the aorta (without a PDA)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

26

Left-to-right or Right-to-Left shunt?Atrial septal defect

Left-to-right(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

27

Left-to-right or Right-to-Left shunt?TOF

Right-to-Left(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

28

Left-to-right or Right-to-Left shunt?VSD

Left-to-right(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

29

Left-to-right or Right-to-Left shunt?Eisenmenger syndrome

Right-to-Left (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

30

Left-to-right or Right-to-Left shunt?Transposition of great arteries

Right-to-Left(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

31

A condition wherein ischemia causes pain but is insufficient to lead to death of myocardium.

Angina pectoris(TOPNOTCH)

32

A condition wherein ischemia causes pain but is insufficient to lead to death of myocardium.

Angina pectoris(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

33

A condition wherein the severity or duration of ischemia is enough to cause cardiac muscle death.

Acute Myocardial Infarction(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

34

This refers to progressive cardiac decompensation (heart failure) following myocardial infarction.

Chronic Ischemic Heart Disease(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

35

This can result from a lethal arrythmia following myocardial ischemia.

Sudden Cardiac Death(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 388

36

How many percent should the lumen of a blood vessel be obstructed for it to be symptomatic, in the setting of increased demand?

70-75% (critical stenosis)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 389

37

How many percent should the lumen of a blood vessel be obstructed for it to be symptomatic at rest?

90%(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 389

38

Episodic chest pain associated with exertion or some other form of increased myocardial oxygen demand. Pain described as crushing or squeezing substernal sensation which can radiate to left arm. Relieved by rest or vasodilators.

Stable angina(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 390

39

Increasing frequency of pain, precipitated by progressively less exertion, episodes tend to be more intense and longer lasting.

Unstable angina(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 390

40

Angina occuring at rest due to coronary artery spasm.

Variant or Prinzmetal angina(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 390

41

Infarct involving >= 50% of the myocardial wall thickness.

Transmural infarcts(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 391

42

Most common blood vessel involved in myocardial infarction?

Left anterior descending artery (40-50%)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 392

43

Electron microscope findings 30 minutes after an ischemic event.

Microfibril relaxation, glycogen loss and mitochondrial swelling(TOPNOTCH)

44

An infarct can be readily identified by a reddish blue discoloration after how many hours after MI?

12-24 hours(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 393

45

Coagulation necrosis ensues how many hours after MI?

4-12 hrs after an irreversible injury(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 394

46

Injury to infarcts mediated in part by oxygen free radicals generated by increased number of infiltrating leukocytes facilitated by reperfusion.

Reperfusion injury(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 394

47

Cardiac enzymes that become detectable 2-4 hours post-infarct peaks at 48 hours and remains elevated for 7-10 days.

Troponin I and Troponin T(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 395

48

This cardiac enzyme is detectable in the blood within 2-4 hrs of MI, peaks at 24-48 hrs and returns to normal within approximately 72 hrs.

CKMB(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 395

49

Myocardial rupture may occur how many days after MI?

3-7 days after infarction(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 397

50

This occurs within 2-3 days of a transmural infarct and typically resolves within time. It is the epicardial manifestation of the underlying myocardial inflammation.

Pericarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 397

51

A late complication of MI, most commonly results from a large transmural anteroseptal infarct that heals with formation of a thin scar tissue.

Ventricular aneurysm(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 397

52

This type of hypertrophy develops in pressure-overloaded ventricles, with an increase in wall thickness, and reduced cavity diameter.

Concentric hypertrophy(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 399

53

Type of hypertrophybthat develops in patients with volume overload such as aortic valve insufficiency. Characterized by hypertrophy associated with ventricular dilation.

Eccentric hypertrophy(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 399

54

In this disease the left ventricle may exceed 2.0cm in thickness and the heart may weigh >500 grams. Microscopically, myocyte diameter increases, associated with irregular nuclear enlargement and hyperchromasia ("box-car nuclei"), and increased interstitial fibrosis.

Sytemic Hypertensive heart disease(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 399

55

It is the failure of a valve to open completely, obstructing forward flow.

Stenosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 401

56

This results from failure of a valve to close completely, thereby allowing reversed flow.

Insufficiency(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 401

57

The hallmark of this disease is heaped-up calcified masses on the outflow side of the cusps, which protrude intonthe sinuses of Valsalva and mechanically impede valve opening. Cusps may become secondarily fibrosed and thickened.

Calcific aortic stenosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 401

58

This is characterized by ballooning or hooding of the mitral leaflets. Affected leaflets are enlarged, redundant, thick and rubbery. The tendinous cords are elongated, thinned and occasionally ruptured. Histologically, there is thinning of the fibrosa layer of the valve, accompanied by expansion of the middle spongiosa layer with increased deposition of mucoid material.

Myxomatous degeneration of the mitral valve(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 402

59

Patients with this disease may complain of palpitations, dyspnea or atypical chest pain. Auscultation shows a midsystolic click associated with a regurgitant murmur.

Mitral valve prolapse(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 402

60

Pathognomonic sign for rheumatic fever,consisting of of a cental zone of degenerating, hypereosinophilic ECM infiltrated by lymphocytes, ocassional plasma cells and plump, activated macrophages.

Aschoff bodies(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 402

61

These cells have abundant cytoplasm and central nuclei with chromatin arrayed in a slender, wavy ribbon (caterpillar cells) which can be found in all three layers of the heart in rheumatic fever. A component of Aschoff bodies.

Anitschkow cells(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 403

62

Characterized by organization and subsequent scarring, as a sequelae of rheumatic fever. The mitral (or tricuspid) valve is involved, with leaflet thickening, commisural fission and shortening, thickening and fusiong of the chordae tendinae. Fibrous bridging across valvular commisures create "fishmouth" or " buttonhole" deformity.

Chronic Rheumatic Heart Disease(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 403

63

Most common valve involved in RHD.

Mitral valve (upto 70% of cases with RHD)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 405

64

Major components Jones Criteria for RF.

CarditisMigratory polyarthritisSubcutaneous nodulesErythema marginatumSyndenham chorea(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 406

65

Minor components Jones criteria for RF

FeverArthralgiaElevated acute phase reactants (e.g. CRP)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 406

66

How many major and/or minor manifestations are needed to diagnose RF?

Remember: 20122 major 0 minor or1 major 2 minor(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 406

67

Endocarditis of previously normal valves, the most common causative agent is S. aureus.

Acute bacterial endocarditis(TOPNOTCH)

68

Serious infection characterized by microbial invasion of heart valves or mural endocardium, often with destruction of the underlying cardiac tissues. The heart valves are friable, bulky and potentially destructive.

Infective endocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 406

69

Endocarditis affecting previously damaged or abnormal valves, commonly caused by viridans Streptococci.

Subacute bacterial endocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 406

70

Most consistent sign of infective endocarditis.

Fever(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 407

71

Characterized by deposition of sterile, non-inflammatory, nondestructive and small (1mm) masses of fibrin, platelets and other blood components on cardiac valves, along the line of closure of leaflets or cusps.

Nonbacterial thrombotic endocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 407

72

Sterile vegetations thatvcan develop on the valves of patients with SLE. These are small, granular, pinkish vegetations 1-4mm in diameter and can be located on the undersurface of AV valves, on the cords or endocardium.

Libman-Sacks endocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 408

73

The lesions of this disease are distinctive, glistening white intimal plaquelike thickenings on the endocardial surfaces of the cardiac chambers and valve leaflets seen in patients with carcinoid tumors. The lesions are composed of muscle cells and sparse collagen fibers embedded in an acid mucopolysaccharide-rich matrix.

Carcinoid heart disease(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 408

74

Cardiomyopathy which is characterized by progressive cardiac dilation and contractile dysfunction. The heart is characteristically enlarged and flabby, with dilation of all chambers,the ventricular thickness may be less than, equal to or greater than normal.

Dilated cardiomyopathy(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 411

75

Alcohol intake and infection with coxsackie B virus are some of the causes of this cardiomyopathy.

Dilated cardiomyopathy(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 411

76

Characterized by myocardial hypertrophy, abnormal diastolic filling and ventricular outflow obstruction. The heart is thick-walled, heavy and hypercontracting. There is an assymetrical septal hypertrophy described as "banana-like". Histologically, there is severe myocyte hypertrophy and disarray with interstitial fibrosis.

Hypertrophic cardiomyopathy(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 412

77

Mechanism of heart failure in hypertrophic cardiomyopathy.

Diastolic dysfunction (impaired compliance)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 412

78

A common cause of sudden death in young athlethes.

Hypertrophic cardiomyopathy(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 412

79

The ventricles are of approximately normal size or slightly enlarged, the cavities not dilated, and the myocardium is firm. Biatrial dilation is common. Microscopically, there is interstitial fibrosis, varying from minimal to patchy to extensive and diffuse.

Restrictive cardiomyopathy(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 413

80

Mechanism of heart failure in restrictive cardiomyopathy.

Diastolic dysfunction or impaired compliance(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 413

81

Inflammation of the myocardium.

Myocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 414

82

Most common type of myocarditis wherein lymphocytes infiltrate the interstitium. This may resolve or heal by progressive fibrosis.

Lymphocytic myocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 414

83

Myocarditis that has interstitial and perivascular infiltrates composed of lymphocytes, macrophages and a high proportion of eosinophils.

Hypersensitivity myocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 414

84

Myocarditis characterized by widespread inflammatory infiltrates containing multinucleated giant cells interspresed with lymphocytes, eosinophils and plasma cells. Poor prognosis.

Giant-cell myocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 414

85

Myocarditis distinctive by virtue of parasitization of scattered myofibers by trypanosomes accompanied by an inflammatory infiltrate of neutrophils, lymphocytes, macrophages and occasional eosinophils.

Chagas myocarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 414

86

Viruses which account for most cases of myocarditis.

Coxsackie A and B(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 414

87

Type of pericarditis found in patients with uremia or viral infection. The exudate imparts an irregular apperance to the pericardial surface (bread and butter pericarditis).

Fibrinous pericarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 416

88

Bacterial pericarditis manifests with this type of exudate.

Fibrinopurulent (suppurative)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 416

89

Heart is completely encased by dense fibrosis that it cannot expand normally during diastole.

Constrictive pericarditis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 416

90

Normal amount of pericardial fluid in pericardial sac.

30 - 50 mL of thin, straw-colored fluid(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 417

91

Serous pericardial effusion can be caused by _________

CHF, hypoalbuminemia(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 417

92

Chylous pericardial fluid can be caused by _______

Mediastinal lymphatic obstruction(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 417

93

Rapidly developing collections of fluid within the pericardial sac can restrict diastolic cardiac filling producing this fatal sequelae.

Cardiac tamponade(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 417

94

The most common tumor of the heart.

Metastatic tumor(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 417

95

Most common primary tumor of the adult heart.

Myxoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 417

96

Major clinical manifestations of this cardiac tumor are due to valvular "ball-valve" obstruction, embolization or a syndrome of constitutional symptoms.

Myxoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 418

97

The most frequent primary tumor of the heart in infants and children. These are generally small gray-white myocardial masses composed of a mixed population of cells, the most characteristic of which are large, rounded or polygonal cells containing numerous glycogen-laden vacuoles separated by strands of cytoplasm, so-called spider cells.

Rhabdomyomas(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 418

98

Serosanguinous pericardial effusion can be caused by ________

Blunt chest trauma, malignancy, ruptured MI, aortic dissection(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 418

99

The most severe pulmonary changes in congestive heart failure

Accumulation of edema fluid in the alveolar spaces (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 529

100

Morphologic finding/telltale signs of previous episodes of pulmonary edema

Hemosiderin-laden macrophages (Heart failure cells) (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 529

101

Most common underlying etiology of diastolic failure

Hypertension (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 529

102

Group of congenital heart disease characterized by increase pulmonary blood flow but are not initially associated with cyanosis

Left-to-right shunts (ASD, VSD, PDA) (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 533

103

Most common genetic cause of congenital heart disease

Trisomy 21 (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 533

104

A 24 y/o female complained of shortness of breath and orthopnea lasting several days. The patient reported having diagnosed since childhood as having "hole in the heart." Physical exam revealed holosystolic murmur most audible in the left parasternal area accompanied by thrill. Rales were heared in the bilateral lower lung field. The most likely cause of her condition:

VSD (TOPNOTCH)

105

Most common cause of myocardial ischemia

Obstructive atherosclerotic lesions in the epicardial coronary arteries (TOPNOTCH) Robbins Basic Patholgoy, 9th ed., p. 538

106

The cause of sudden cardiac death in myocardial infarction

Ventricular arrythmia (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 539

107

Irreversible cell injury in MI occur in how many minutes?

20-40 minutes (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 541

108

Irreversible injury of ischemic myocytes in MI occurs first in what zone in the heart?

Subendocardial zone (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 541

109

What blood vessel supply the posterior third of the ventricular septum in majority of the individuals?

Right coronary artery (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 541

110

Pattern of infarction caused by occlusion of an epicardial vessel

Transmural infarction (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 543

111

Pattern of infarction caused by plaque disruption or hypotension, causing circumferential myocardial damage

Subendocardial infarction (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 543

112

Pattern of infarct also referred to as an "ST elevation myocardial infarct"

Transmural infarction (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 543

113

Pattern of infarct also referred to as a "non-ST elevation infarct"

Subendocardial infarction (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 543

114

The typical changes of coagulative necrosis becomes detectable in how many hours of injury?

First 6-12 hours(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 545

115

Microscopic findings in irreversibly injured myocytes characterized by intensely eosinophilic intracellular stripes composed of closely packed sarcomeres.

Contraction bands(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 546

116

A 62 y/o obese male had sudden onset of heaviness in the chest, associated with diaphoresis and dyspnea which started 3 hours prior to consult at the ER. The biomarkers that are most sensitive and specific of myocardial damage that you will request:

Troponins I and T (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 547

117

A 72 y/o female experienced chest pain and hypotension. A posterior transmural infarct was suspected. Most common complications in this type of infarct

Conduction blocks, right ventricular involvement, or both (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 549

118

Free wall rupture, expansion, mural thrombi, and aneurysm are common in what type/location of infarct?

Anterior transmural infarct(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 549

119

Most common cause of rhythm disorder

Ischemic injury(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 550

120

A 24 y/o female presents with history of recurrent fever and joint pains accompanied by ECG changes and increased ASO titer in the past 2 years. Physical examination reveals cardiac murmur. What is the clinical impression?

Rheumatic heart disease (TOPNOTCH)

121

Characteristic anatomic change in MVP

Interchordal ballooning of mitral leaflets (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 556

122

Most frequent mechanism of SCD

Lethal arrythmia (asystole, ventricular fibrillation) (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 552

123

Earliest microscopic change in systemic hypertensive heart disease

increase in transverse diameter of myocytes (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 552

124

Most common type of VSD

Membranous (Interventricular septum) VSD(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 535

125

The common feature of pulmonary thromboembolism, obstructive sleep apnea, altitude disease, and parenchymal lung disease

Pulmonary hypertension. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 530

126

A 5 wk old infant presents with tachypnea, diaphoresis, and difficulty feeding. A harsh, continuous, machinery-like murmur was noted upon auscultation. What is the most likely diagnosis?

Patent ductus arteriosus(TOPNOTCH)

127

Presents with hypertension in the upper extremities, and manifestations of arterial insufficiency such as claudication and coldness. Produce a radiographical visible erosion (notching) of the undersurfaces of the ribs.

Coarctation of the aorta (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 537

128

Major cause of infective endocarditis among intravenous drug abusers

Staphylococcus aureus (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 559

129

Most common cause of endocarditis of native but previously damaged or otherwise abnormal valves

Streptococcus viridans (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 559

130

Predominant manifestations of RF

Carditis and arthritis(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 559

131

Classic hallmark of Infective endocarditis

Vegetations on heart valves(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 559

132

A 72 year old hypertensive female last seen apparently well 3 days ago, is found dead in her bathroom with rigor mortis and no signs of foul play. At autopsy, her heart showed left ventricular hypertrophy and a pale tan area at the anteroseptal wall. There are no thrombi in the heart chambers. The valves are unremarkable. Microscopic examination of the pale area showed well-established granulation tissue with new blood vessels and collagen deposition. Neutrophils are rare. She died of (A) an MI that occured 1 hour prior to demise (B) an MI 12 hours prior to demise (C) an MI 2 days prior to demise (D) something else entirely

something else entirely (evolution of morphologic changes in myocardial infarction) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P 393

133

In hypertensive heart disease, there is concentric thickening of the left ventricular wall. A concomitant left atrial dilatation may also be seen due to (A) volume overload from a ventricle with narrowed lumen (B) pressure overload from a ventricle with narrowed lumen (C) cytokines secreted by hypertrophic ventricular myocytes cause atrophy of atrial myocytes (D) cytokines secreted by hypertrophic ventricular myocytes cause metaplasia of atrial myocytes

volume overload from a ventricle with narrowed lumen (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P 399

134

What feature in a stenotic aortic valve suggests rheumatic valvular disease, rather than calcific aortic stenosis? (A) bicuspid valve (B) masses of calcium on the outflow side of cusps (C) fibrotic cusps (D) fusion of the commmissures

fusion of the commisures (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P402

135

A 20 year old asymptomatic female is found to have a midsystolic click on her preemployment physical examination. A 2D echo showed mitral valve prolapse. The involved leaflet would show (A) numerous fibroblasts with and dense collagen deposition (B) thinning of the fibrosa layer and myxoid expansion of the spongiosa layer (C) deposition of amorphous material that shows apple-green birefringence when stained with Congo red (D) fibrous stroma with gland-like structures secreting mucin

thinning of fibrosa layer and myxoid espansion of the spongiosa layer (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P402

136

A 5 year old male who had a sore throat 3 weeks ago develops fever and joint pains. Auscultation revealed a friction rub, and ASO titers are increased. Which of the following is expected in the patient? (A) friable vegetations on the mitral valve containing fibrin, neutrophils and gram-positive cocci (B) small vegetations on the mitral valve with abundant eosinophils (C) myocardium with circumscribed aggregates of mononuclear cells and macrophages with prominent nucleoli (D) myocardium with poorly-circumsccribed aggregates of multinucleated giant cells

myocardium with circumscribed aggregates of mononuclear cells and macrophages with prominent nucleoli (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P 403-404

137

A 19 year old football player dies suddenly during one training session. At autopsy, his heart showed myocardial hypertrophy with disproportionate thickening of the septum, and a narrowed left ventricular lumen. Microscopic examination showed myocyte hypertrophy, myofiber disarray, and interestitial fibrosis. These findings are due to (A) a mutation in one of his genes encoding sarcomeric proteins (B) a silent Coxsackie virus B infection (C) an undisclosed 3 year history of alcohol intake (D) anabolic steroids he has been taking for 6 months

a mutation in one of his genes encoding sarcomeric proteins (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P. 412-413

138

A 34 year old female on routine checkup is found to have a diastolic murmur. 2D echo showed a pedunculated 3 cm mass in her left atrium attached to the atrial septum. She has no other known masses on workup. She undergoes heart surgery where the atrial mass is resected. Which of the following is its most likely histology? (A) stellate cells admixed with endothelial and fibroblastic cells embedded in an abundant extracellular matrix (B) sheets of large polygonal cells containing glycogen-containing vacuoles arranged around a central nucleus (C) fascicles of fibroblasts and interspersed collagen bundles (D) sheets of pleomorphic cells lining vascular spaces, some with intracytoplasmic lumens, with atypical mitoses and areas of necrosis

stellate cells admixed with endothelial and fibroblastic cells embedded in an abundant extracellular matrix (TOPNOTCH) Robbins Basic Pathology, 8th ed. Pp 417-418