Comprehensive Exam 1 Review: Patho

5 cardinal signs of inflammation

1. redness (rubor)

2. swelling (tumor)

3. heat (color)

4. pain (dolor)

5. loss of function (functio laesa)

Phases of necrosis:

cell swells, blebbing, cell lysis w/ inflammation

Phases of apoptosis:

cell shrinks, budding, phagozytosed w/ no inflammation

What is a marker of acute inflammation?

C reactive protein

What are the 4 stages of sepsis?

SIRS, Sepsis, Severe sepsis, septic shock

What infections are most likely to cause sepsis?

pneumonia, abdominal infection, UTI, bacteremia

Symptoms of sepsis:

SEPSIS

Shiver, fever or very cold; Extreme pain or discomfort; Pale or discolored skin; Sleepy, difficult rouse, confused; I feel like I might die; Short of breath

common complication of sepsis:

DIC, ARDS, AKI, hemodynamic compromise

what are the 4 types of hypersensitivity immune responses?

ACID

allergies (IgE), cell mediated, immune complex, delayed (T cell)

What is the tell-tale sign of SLE?

butterfly rash

When is HIV classified as AIDS?

CD4 < 200 cells/mm3

What are the tell-tale signs of AIDS?

opportunistic infections, liver and spleen enlargement, thrush, wt loss

What is the most common cause of pneumonia in AIDS patients?

pneumocystis jiroveci

What are causes of pneumonia in AIDS patients?

pneuomocystis jiroveci, MAC, C neoformans

What form of cancer is found almost exclusively in AIDS patients?

Kaposi’s sarcoma

An MI in the inferior wall will lead to ischemia and damage to what area of the heart?

RV

What are the 3 ways the heart remodels itself in cardiomyopathies?

dilate, hypertrophy, restrictive

Which form of cardiac remodeling lead to thin heart layers?

DCM

What is the most common type of CM?

dilated

Hypertrophic cardiomyopathy most affects what region of the heart?

septum

What CM is the #1 cause of sudden death in young athletes?

HOCM

What is unique about the cardiac cells in HOCM?

cells are disorganized: appear as whorls

What is the rarest form of CM and characterized by a stiff, fibrotic ventricle?

restrictive

The more distal the pacemaker site is, the ___ the heart rate

slower

What is the EF % to classify HF?

25%

How do catecholamines and inotropic drugs increase contractility?

increasing Ca++ uptake

What are some signs of SSS?

sinus pause, winded, low energy, occasional junctional rhythm

What causes SA node dysfunction?

increased vagal tone, increased age, drugs (B blocker, Ca+ channel blockers)

During junctional rhythm what node is in charge?

AV node

EKG signs of AV node dysfunction

long PR interval

complete cessation of AV node activity leads to

total heart block

Which degree of AV block is evident when there is long AV conduction (long PR interval) but still 1:1 AV conduction?

1st degree

Which degree of AV block is evident when not all atrial impulses are conducted to the ventricles resulting in lonely P waves?

2nd degree

Which degree of AV block is evident when there is no association between atrial and ventricular activity?

3rd degree

What causes AV node dysfunction?

increasing age, increased vagal input, drugs, congenital and acquired disorder

What diseases is indicated if the PR wave gets longer and longer followed by a dropped QRS complex?

Wenkebach

What disease is indicated if a QRS complex randomly doesn’t get through?

Mobitz II

What 3 mechanisms cause tachycardia?

increased depolarization, triggered tachycardias, reentry tachycardias

Triggered tachycardias occur when a special event happens during the …

relative refractory period

Increased automaticity of the SA node leads to what type of tachycardia?

increased depolarization

What type of tachycardia is seen in some patients taking procainamide or quinidine and digoxin toxicity?

Polymorphic ventricular tachycardia (Torsade de Pointes)

What type of tachycardia can be triggered if there is severe chest impact within a very specific point of the cardiac cycle triggering V. fib?

Commotio cordis

What is it called when the tissue repolarizes slowly leading to a long refractory period, leaving a longer window for a triggered event to happen?

Long QT syndrome

What drugs cause QT interval prolongation?

AABCDDE

antiArrhythmics, antiAnginals, antiBiotics, antiCychotics, antiDepressants, Diuretics, antiEmetics

AVNRT is frequently caused by? What is the HR for pts with AVNRT?

PACs; ~150 bpm

What is the most common reentry tachycardia? What causes it?

WPW; accessory AV connection

If a pt has WPW what would be a giveaway on the EKG?

delta wave and short PR

If the QRS complex is narrow the tachycardia is stemming from what source?

Atrial

If the QRS complex is wide the tachycardia is stemming from what source?

Ventricular

60 year old male presents to the clinic lightheaded. His EKG shows long QT interval. What arrhythmia is he most susceptible to?

triggered tachycardia

What would show on the EKG of a pt in SVT?

narrow QRS complex

What area of the heart will cause a 2.3 second pause when damaged?

SA node

Pt presents to the clinic with lightheadedness and feeling dizzy. EKG shows no association between P waves and the QRS complexes. What type of heart block is this?

3 degree AV block

What are the positions of the valves during a systole murmur? What can cause a systole murmur?

Mc Ao; murmur due to aortic stenosis or mitral regurgitation

What are the positions of the valves during a diastole murmur? What can cause a diastole murmur?

Mo Ac; murmur due to aortic regurgitation or mitral stenosis

What are the three cardinal symptoms of AS?

CP, syncope, HF

Which valvular disease has a long latent period in which the obstruction slowly increases prior to symptoms appearing?

aortic stenosis

If a pt has AS, what might you notice on a physical exam?

pulsus parvus and pulsus tardus with palpation of carotid, displaced apical impulse, mid systolic murmur, soft S2

What will an AS murmur sound like?

crisp, crescendo-decrescendo, high pitched aortic systolic click after S1 w/ soft or absent S2

What is a normal AVA? What is it in critical AS?

3.5-4 cm²; <0.8 cm²

What is it called when the LV wall thickens at the same rate while the cavitary radius remains unchanged, indicating AS?

concentric hypertrophy

What type of murmur do you hear in pts with HOCM? What would happen during valsalva?

crescendo-decrescendo systolic murmur; louder

What might you find during PE of a pt with chronic AR?

pounding pulses, apical impulse hyperdynamic and laterally displaced, murmur

What murmur is heard in pts with AR?

high pitched early diastolic, diastolic rumble (Austin Flint)

*may also hear 3rd heart sound

What might you find during PE of a pt with acute AR?

peripheral signs absent, LV impulse normal, soft diastolic murmur, soft or absent 1st heart sound

*if Austin Flint murmur present in will be short

This condition is seen in pts with AR and presents as an additional increase in LV thickness due to systolic pressure staying unchanged.

Eccentric hypertrophy

Which type of valvular heart disease has no true isovolumic period, decreases DBP, increases SBP, and inc PP?

aortic regurgitation

What are the cardinal features of AR:

hypertrophied LV, inc SV, wide PP, diastolic murmur

Symptoms of MS

orthopnea, fatigue, hemoptysis, neurologic signs, murmur, rales, SOB

A pt presents to the clinic with MS. What type of murmur would you hear upon auscultation?

late low-pitched diastolic rumble

Cardinal features of MS:

elevated LA pressure, LA enlargement, opening snap, diastolic murmur

What is the most common type of MS?

rheumatic

How big is the mitral valve area in a healthy pt? In a pt with MS?

5-6 cm²; <1 cm²

What is it called when the LA enlargement seen in pts with MS impinges on the laryngeal nerve?

hoarseness (ornter syndrome)

Symptoms of MR:

dyspnea, easy fatiguability, palpitations, pulmonary edema

*angina if secondary to CAD

What type of murmur can be heard in pts with MR?

holosystolic high pitched regurgitant murmur

If MR is severe what can be heard in addition to the murmur?

3rd heart sound

What is the most common cause of MR?

mitral valve prolapse (MVP)

Cardinal features of MR:

systolic back flow into LA, LAE, LVH, prominent v wave, holosystolic murmur

What is the most common symptom associated with CAD?

chest pain

*does NOT worsen with deep breath

What is the most common cause of CAD?

atherosclerosis

If the ischemic myocardium is perfused in a timely manner, how quickly does systolic function return?

very promptly

Irreversible stage of injury can occur if perfusion is not restored how fast?

within 40-60 minutes

If the ischemic myocardium is perfused in a timely manner, how quickly does diastolic function return?

up to 40 minutes

When someone has a stunned myocardium due to prolonged ischemia, how long might it take for them to restore ventricular function?

up to 1 month

What are the symptoms of CAD?

CP, 4th heart sound, SOB, shock, bradycardia, nausea, tachycardia

If a pt suffered damage on the inferior wall of their heart during an MI, which artery was blocked?

RCA

What neurotransmitter raises HR post MI in order to maintain SV?

catecholamines

What are some causes of pericarditis?

infections, Collagen-Vascular disease, neoplasm, metabolic, injury, idiopathic

What are symptoms of pericarditis?

severe chest pain, friction rub, pericardial effusion, elevated JVP, hepatomegaly, ascites

What murmur is heard in pericarditis?

To & Fro murmur: high pitched squeaking sound

A pt presents to the clinic with severe chest pain that worsens with deep inspiration. What is the likely cause of this pain?

pericarditis

Pts with pericarditis often experience increase in JVP level upon inspiration due to the increase of RAP. What is this called?

Kussmual sign

Symptoms of pericardial effusion:

SOB, elevated JVP, hypotension, paradoxical pulse, muffled heart sounds

What is it called when arterial pressure drops with inspiration?

paradoxical pulse

What is the difference between pericardial effusion and pericardial tamponade?

tamponade occurs suddenly

What causes pericardial effusion?

CP, pericardial rub, any cause of pericarditis

Pericardial tamponade is associated with Becks Triad. What symptoms are within this triad?

hypotension, elevated JVP, muffled heart sounds

What hormone causes platelet aggregation and vasoconstriction?

Thromboxane A2

What hormone promotes vasodilation?

prostacyclin