Path 2 quiz 3

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Path 2 quiz 3
2010-08-19 07:11:29

Path 2 midterm info
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  1. Bacterial endocarditis
    • Bacterial colonies develop on the cusps of the aortic valve (MC) or mitral valve (2nd MC)
    • Colonies are loosely attached & can be dislodged into the circulation causing an ischemic stroke due to embolism
    • More common in young women
  2. Common portals of entry for bacterial endocarditis
    • Dental infections
    • Tonsillitis
    • Genitourinary infections (ovaries/prostate)
    • Strep cutaneous infections
    • Pulmonary infections
    • Gallstones
  3. Predisposing lesions for bacterial endocarditis
    Congenital or acquired biscupid aortic valve, small ventricular septal defect, tetralogy of fallot, patent ductus arteriosus, mild residual changes of rheumatic mitral valve stenosis
  4. Acute bacterial endocarditis
    • Caused by staph aureus
    • More dangerous
  5. Subacute bacterial endocarditis
    • Caused by strep viridans (aka strep mitis)
    • More benign
  6. Manifestations of bacterial endocarditis
    • Clubbing of the fingernails
    • Nail hemorrhages
    • Hemorrhages of the retina
    • Petechial rash of the hands, mouth, kidneys, & spleen
    • Enlarged distal phalanx
  7. Complications of bacterial endocarditis
    • Perforation of heart valves by bacterial enzymes
    • Bacterial embolism leading to ischemic infarction
    • Lung infarction due to non-obliterated ductus arteriosus- vegetations of bacteria in the pulmonary trunks can go into the lungs, very painful
    • Complete obliteration of the ductus arteriosus-> fatal
    • Ischemic-hemorrhagic stroke
  8. Ischemic hemorrhagic stroke
    • Ischemic stroke caused by bacterial embolus
    • Once the bacterial embolus settles, the bacteria release destructive enzymes that perforate the blood vessels-> hemorrhage
  9. Arteriosclerosis
    loss of artery wall elasticity
  10. Atherosclerosis
    Plaquing of the arterial wall
  11. Monckeberg's medial calcific sclerosis
    • Ring like calcification within the media of medium to small muscular arteries of obscure cours
    • Occurs in people over 50
    • Typically the femoral, tibial, ulnar, & radial arteries & the arteries to the sexual organs
    • Never results in lumen narrowing
  12. Hyaline arteriosclerosis
    • Glass like protein deposits in the wall of small vessels (due to increase pressure)
    • Homogenous enlargement/thickening of vessel under microscope
    • Long term hypertension is a risk factor
    • Vessel may undergo obstruction or rupture
    • May occur in elderly w/o hypertension
    • Common in diabetes mellitus
    • Causes benign nephrosclerosis- kidney contraction (especially in diabetics)
    • Narrowing of lumen
    • Can happen in young people
  13. Hyperplastic arteriosclerosis
    • Thickening of the basement membrane; hyperplasia of smooth muscle cells (looks like onion)
    • Malignant hypertension (diastolic > 120, can't be controlled, increase mortality rate, 1-2 years)
    • Appears laminated under microscope
    • Causes necrotizing arteriolitis of the kidneys (development of fibronoid necrosis within vascular walls
  14. Ischemic heart disease/coronary artery disease
    • A group of closely related disorders which are caused by the imbalance b/w myocardial oxygen demands & blood supply
    • Caused primarily by atherosclerosis- formation of plaques in the subentimal layer of the vessel wall-> lumen obstruction (MC arteries- coronary, cerebral, mesenteric, & arteries of lower extremities)
    • 75% of vessel obstruction (critical stenosis) needed for clinical manifestations
    • Leads to MI
  15. Controllable risk factors of Ischemic heart/coronary artery disease
    • Smoking (60/1000)
    • Hypercholesterolemia or hypertension (60/1000)- both together (90/1000), both + smoking (200/1000)
  16. Critical areas of atherosclerosis
    • Brain- stroke
    • Kidneys- extrarenal stenosis
  17. Pathogenesis of ischemic heart disease
    • 1. Acute changes in heart morphology (atheroma)
    • 2. Platelet aggregation (formation of a platelet plug)
    • 3. Coronary artery thrombosis
    • 4. Coronary artery vasospasm aka Prinzmetal's variant- increased concentration of vasoconstrictors (thromboxane) that are released w/ sympathetic activity-> causes death
  18. Atheroma
    • 1. Calcification
    • 2. Ulceration & breaking of plaques
    • a. debris may go into opening-> emboli
    • b. hemorrhage into atheroma-> ballooning of atheroma-> obstruction (immediate death)
    • c. thrombosis-> MC & most serious- activation of von Willebrand factor
    • 3. Roughening of wall leading to injury of passing cells-> promotes formation of thrombis
    • 4. Lumen narrowed-> turbulent blood flow-> thrombosis
  19. 3 components of atheromas
    • Fat
    • Connective tissue cap
    • RBC's & smooth muscle cells