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Hi Yield 6.1-7.0

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mhewett's version from 2016-06-21 16:48

Section 6.1 Vasculitis (5c-d)

Question Answer
What is vasculitis?inflammation of blood vessel walls
What vasculitides affect large vessels?Giant cell, Takayasu
What vasculitides affect medium vessels?Polyarteritis nodosa, Kawasaki, Thromboangiitis obliterans
What vasculitides affect small vessels?Wegener's, Henoch-Schonlein, Hypersensitivity arteritis, Churg-Strauss, microscopic polyangiitis, thromboangiitis obliterans
What is hypersensitivity arteritis?Type III hypersensitivity to drugs, tumors, HCV, EBV, HIV
What do you detect hypersensitivity arteritis with?p-ANCA
How does a pt with hypersensitivity arteritis present?palpable purpura +/- macules, papules (especially on butt), PAINFUL, pruritic
What is Henoch-Schonlein purpura?variant of hypersensitivity arteritis but occurs in children and has IgA immune complex deposition
How does a pt with Henoch-Schonlein purpura present?palpable purpura (especially on butt), arthralgias, bloody diarrhea, +/- glomerulonephritis
What is polyarteritis nodosa (PAN)?transmural necrotizing inflammation of medium sized arterial walls that occurs secondary to HBV, HCV, Hairy Cell leukemia
How does a patient with polyarteritis nodosa present?fever, abd pain and melena, renal disease (w/o glomerulonephritis) w/ htn, neuritis of motor neurons, diffuse myalgia, fatal in untreated cases
What is microscopic polyangiitis?transmural necrotizing inflammation but involves small vessels and is initiated by a reaction to drugs
How do you detect microscopic polyangiitis?p-ANCA
How does a pt with microscopic polyangiitis present?causes severe glomerulonephritis, pulmonary capillaritis, palpable purpura, hemoptysis, hematuria, myalgia
What is thromboangiitis obliterans?aka Buerger's disease; hypersensitivity rxn to tobacco
What aa does thromboangiitis obliterans affect?tibial and radial aa where collections of neutrophils surrounded by granulomas form
How does a pt with thromboangiitis obliterans present?severe pain in distal limb that progresses to gangrene
What is giant cell arteritis?granulomatous inflammation of large vessels
Who is affected by giant cell arteritis?females > 50 yo
What is polymyalgia rheumatica?systemic manifestation of giant cell arteritis
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Question Answer
What is Wegener's granulomatosis?granulomatous development in small vessels
How do you detect Wegener's granulomatosis?c-ANCA
How does a pt with Wegener's granulomatosis present?sinusitis --> sinus polyp formation, glomerulonephritis, lung lesions
What is Takayasu arteritis?aka aortic arch syndrome; a granulomatous vasculitis in the aortic arch
Who does Takayasu arteritis affect?15-40 yo; females; Asians
How does a pt with Takayasu arteritis present?night sweats, chest pain, weak or absent peripheral pulse (particularly weak in the upper body regions); eventual organ ischemia
What is Kawasaki disease?aka mucocutaneous lymph node syndrome; transmural necrotizing inflammation triggered by viral illness
How does a pt with Kawasaki present?fever, conjunctivitis, maculopapular rash (with erythema of hands and soles) + coronary artery aneurysms; oral mucosal erythema and cervical lymph node enlargement also
Who does Kawasaki affect?<4 yo; leading cause of acquired heart disease in children of Japan and US
What is Churg-Strauss?aka allergic angiitis; features granulomas, PAN like features, massive eosinophil invasion
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Question Answer
How do you detect Churg Strauss?p-ANCA
Who does Churg Strauss affect?most pts with hx of asthma
What is Behcet's Syndrome?not an arteritis; vasculitis of veins and venules causing recurrent painful oral and genital ulcerations (often misdiagnosed as herpes); high risk for DVTs and PEs
Who does Behcet's syndrome affect?Mediterranean, Middle East, Far East; males=females but males much more severe
How do you detect Behcet's syndrome?anti-human oral mucosa antibodies
memorize

Section 6.2 Aneurysms (5d)

Question Answer
What causes atherosclerotic aneurysms?wall thinning d/t medial destruction secondary to intimal plaques
What causes hyaline arteriolosclerotic aneurysms?thickened basement membrane leads to medial atrophy
Who is affected by hyaline arteriolosclerotic aneurysms?>50 yo; DM
What is a syphilitic aneurysm?occurs in tertiary syphilis; treponema pallidum causes obliterative endarteritis of vasa vasorum of thoracic aorta; so causes ischemia and atrophy of media --> shrinkage causes intam to buckle leading to appearance of "tree barking" of intima; may result in aortic regurgitation
Where do berry aneurysms occur?circle of willis
What pt population has more berry aneurysms?adult polycystic kidney disease
What is an aortic dissection?intima tears and split occurs between laminar (longitudinal) planes of media, allowing for collection of blood within the aortic wall
What are the 2 classification systems for aortic dissections?Stanford Classification, DeBakey Classification
What are micro aneurysms?small cerebral aneurysms d/t htn OR small retinal aneurysms d/t diabetes
What are mycotic aneurysms?d/t infections of vessel wall - usually bacterial; infection damages media - weakens wall
Aneurysms of the aortic arch causedyspnea - d/t compression of respiratory structures
recurrent persistent cough - d/t pressure on recurrent laryngeal nerves
heart failure - if it has caused aortic regurge
rupture and death
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Section 6.3 Heart Sounds (6a)

Question Answer
What is a blowing murmur?blood flowing wrong way across valves
What is a harsh murmur?blood hitting tissue
Where are mitral murmurs heard best?apex of heart (left axilla
Where are aortic murmurs heard best?2nd right intercostal space
How will aortic stenosis sound?harsh systolic murmur
How will aortic regurgitation sound?blowing diastolic murmur
How will mitral stenosis sound?harsh diastolic murmur
How will mitral regurgitation sound?blowing systolic murmur
How will mitral valve prolapse sound?midsystolic click
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Section 6.4 Congenital Heart Defects (6a)

Question Answer
What are the acyanotic congenital heart defects?VSD, ASD, PDA
What are the 2 types of ASD?ostium primum (next to AV valve); ostium secundum (ovale fossa)
What are the cyanotic congenital heart defects?ToF, Transposition of Great Vessels, Persistent Truncus Arteriosus, Eisenmenger's Syndrome
What are the 4 aspects of ToF?VSD, subpulmonic stenosis, overriding aorta, right ventricular hypertrophy
What is persistent truncus arteriosus?great vessels aren't separated, but rather are one vessel
What is Eisenmenger's Syndrome?reversal of left to right shunt to a right to left shunt (secondary to pulm htn)
What are obstructive types of congenital heart defects?Coarctation of aorta, pulmonary or aortic stenosis or atresia
What are the 2 types of aortic coarctations?infant type (preductal) and adult type (postductal)
What is the difference between stenosis and atresia?stenosis is partial closed; atresia is completely closed
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Section 6.5 Ischemic Heart Disease (6d)

Question Answer
What are the 4 major categories of ischemic heart disease?stable angina, unstable angina, prinzmetal's angina, myocardial infarction
What is stable angina?decreased cardiac perfusion with increased demand; chest pain occurs with increased demand
What is unstable angina?disruption of plaque followed by formation of a superimposing thrombosis with potential embolization, resulting in an occlusive platelet thrombus; chest pain is spontaneous
What is prinzmetal's angina?coronary artery spasm; chest pain is spontaneous
What is MI?same as unstable angina but persists long enough to cause infarction of cardiac cells; chest pain is spontaneous
What are the 2 kinds of MI?subendocardial (no Q wave, NSTEMI); transmural (Q wave, STEMI)
What types of ischemic heart disease will have pain relief with nitroglycerin?stable angina, prinzmetal's
What types of ischemic heart disease will have elevated CK?unstable angina, non Q wave MI, Q wave MI
What types of ischemic heart disease will have troponin present?Non Q wave MI, Q wave MI
What types of ischemic heart disease will have ST elevation?Q wave MI, Prinzmetal's
memorize

Section 6.6 Myocardial Infarction (6f)

Question Answer
What is the first WBC to go to an area of inflammation?neutrophils
Dead tissue is replaced by scar tissue in how many weeks?8
What are the 4 major complications to follow an MI?arrhythmia (typically within hours), CHF, cardiogenic shock, cardiac muscle rupture (~10 days later)
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Section 6.7 Heart Failure (6f)

Question Answer
What causes left-sided heart failure?chronic hypertension, MI, valve pathology
What causes right-sided heart failure?left sided heart failure, pulmonary hypertension, lung pathology
What does left sided heart failure result in?pulmonary edema, fluid overload
What does right sided heart failure result in?peripheral edema, nutmeg liver
What are s/sx of left sided heart failure?dyspnea, orthopnea, fatigue
What are s/sx of right sided heart failure?ankle edema, JVD
What's it called if the right heart fails w/out the left heart?cor pulmonale
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Section 6.8 Endocarditis (6f)

Question Answer
What are the 2 types of infective endocarditis?acute infective and subacute infective endocarditis
Which of the infective endocarditis is there prior valve pathology?subacute infective endocarditis
What causes acute infective endocarditis?skin microbes - staph aureus, strep spp.
What causes subacute infective endocarditis?mouth or GI organisms - strep spp of the viridans group (mouth), e coli (bowel)
How do pts with acute infective endocarditis?acute onset chills, high fever; high death rate within days; most common in IV drug users and diabetics
How do pts with subacute infective endocarditis?low death rate; insidious, slow onset, fatigue, low grade fever
What are the non infective endocarditis?acute rheumatic fever, marantic endocarditis, libman-sacks endocarditis
What is acute rheumatic fever?ab attack of heart following previous Strep pyogenes infection; results in severe mitral valve damage causing rheumatic heart disease
What is marantic endocarditis?thrombi develop on endocardium; high risk in pts with severe/chronic illness
What is libman-sacks endocarditis?only in SLE pts; huge vegetations comprised of ag-ab complexes on valve causing severe valve damage
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Section 6.9 Pericarditis

Question Answer
What are the 3 types of pericarditis?fibrinous, serous, suppurative
What is fibrinous pericarditis?#1 type in world; d/t transmural MI or Dressler syndrome
What is serous pericarditis?#1 type in US; d/t Cox-B virus, uremia, acute rheumatic fever, scleroderma, rheumatic heart disease, SLE
What is suppurative pericarditis?purulent; d/t direct invasion by organisms into the pericardium (Strep pneumoniae or Staph aureus)
How is pain from pericarditis relieved?sitting forward
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Section 6.10 Rheumatic Fever

Question Answer
What type of hypersensitivity reaction is acute rheumatic fever?type II
What is acute rheumatic fever?follows Strep pyogenes (3-4 wks after infection resolves); more common in children; causes pancarditis; can see Aschoff body
What is an Aschoff body?pathognomonic for rheumatic fever; focal area of myocardial inflammation; contains collagen, enlarged myocytes, aschoff cells
How are s/sxs of acute rheumatic fever described?Jones criteria - Major and minor
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Section 7.0 Obstructive Lung Disease

Question Answer
What is obstructive lung disease?increased restriction to airflow during forced EXPIRATION
What are PFTs for obstructive lung disease?low FEV1, high TLC, low FEV1/FVC ratio
What is the mainstay management of all obstructive lung disease?beta agonists (bronchodilators like albuterol) +/- anticholinergics (like ipratropium) +/- oxygen
What are the 2 types of obstructive lung disease?COPD (irreversible), asthma (reversible)
What are the 3 types of COPD?pulmonary emphysema, chronic bronchitis, bronchiectasis
What is pulmonary emphysema?enlargement of airspaces distal to terminal non respiratory bronchioles, accompanied by destruction of alveolar walls
What initiates process of pulmonary emphysema?proteolytic enzyme attack of alveolar walls
What are the 2 types of pulmonary emphysema?panacinar (throughout lobule, associated with a-1 antitrypsin), centrilobular (center of lobule, associated with smoking)
What is chronic bronchitis?associated w/ prolonged exposure to nonspecific bronchial irritants and accompanied by mucus hypersecretion and bronchial structural change
What is bronchiectasis?focal bronchial dilatation accompanied by infection; usually acquired - Kartagener syndrome, cystic fibrosis
What is kartagener syndrome?recurrent bronchial infections --> bronchiectasis, + situs inversus, + male sterility + hearing deficits
What is cystic fibrosis?recurrent bronchial infections --> bronchiectasis, + malabsorption + gallstones
What is asthma?(aka bronchial asthma, reactive airway disease) most are a type I hypersensitivity with an IgE mediate response where airway obstruction , inflammation, and increased airway responsiveness to stimuli occur
What do we see in mucus of asthma pts?sometimes Charcot-Leyden crystals and Curschmann spirals; these are eosinophils
What are the 4 major types of asthma?intrinsic (URI/stress), extrinsic (#1 form, T1 hypersensitivity; IgE), exercise-induced, drug-induced
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