Cardiac Pathology
Identify two structural components of an atherosclerotic plaque.
Necrotic centre
Foam cells
What are the vascular planes?
Anterior = midline, unpaired visceral branches
Lateral = paired visceral branches
Posterolateral = paired parietal branches
Pain or cramping of lower extremities induced by exercise and relieved at rest.
List the four histological changes you see with asthma.
1. Mucus hypersecretion
2. Thickened basement membrane
3. Oedema and inflammation in bronchial walls
4. Hypertrophy of bronchial smooth muscle
What is the difference in the walls of the bronchi vs bronchioles? What is the significance of this in bronchial asthma?
Bronchioles lack cartilage - the bronchioles can collapse when constricted.
List two differences between a stable or unstable plaque?
Stable: small lipid core, thick fibrous cap, low microvessel density, low macrophage content, no intraplaque hemorrhage, no cap rupture/no thrombus
Unstable: large lipid core, thin fibrous cap, high microvessel density, high macrophage content, presence of intraplaque hemorrhage, presence of cap rupture/thrombus
Where would you auscultate each of the heart valves?
Pulmonary - L 2nd intercostal space
Aortic - R 2nd intercostal space
Mitral - L 5th intercostal space
Tricuspid - para-sternal, L approx. 4th intercostal space
What is cardiac tamponade and what causes it?
Increased serous fluid around the heart - compresses it and increases the pressure so the heart can no longer fill properly - sudden drop in bp
What is the difference in elastic recoil in chronic bronchitis vs emphysema?
Normal in chronic bronchitis (blue bloater), low in emphysema (pink puffer, hyperinflation)
List 3 accessory muscles of inspiration and 3 for expiration.
Inspiration: sternocleidomastoid, scalenes, pectoralis major and minor, serratus anterior m.
Expiration: Internal intercostals, abdominals (external oblique, internal oblique, transversus abdominis, rectus abdominis)
Classify a "dissecting aneurysm" (what part of the aorta is involved) and the different management options.
Type A - Ascending aorta - surgery
Type B - Descending only - medical therapy e.g. B-blockers, vasodilators
R - Rib 2
A - Aortic arch
T - Tracheal bifurcation
P - Pulmonary trunk
A - Azygos vein
N - Nerves - loop of recurrent laryngeal
T - Thoracic duct
Name 5 risk factors for respiratory distress.
- Smoking
- Passive smoking
- Occupational exposure
- Atopy
- Pets
- Travel
What is the pathology of someone with "tram track" sign? Explain how it occurs.
Bronchiectasis. Airway dilation and scaring caused by persistent or severe infections. Resulting in cough, purulent sputum and fever.
How does the organisation of the structures at the hilum of the right and left lung differ?
Right lung - pulmonary artery more medial to primary bronchi
Left lung - pulmonary artery superior to left primary bronchi
Explain the pathogenesis of rheumatic heart disease and what it is caused by.
Molecular mimicry - antibodies for M protein in Strep. pyogenes also attach to myosin antigen in myocardium and laminin antigen in heart valves = antigen-antibody complexes that deposit in the heart
What neurovascular structures are contained within the carotid sheath?
Common carotid a.
Internal carotid a.
Internal jugular v.
Vagus n.
Write on the board a simple RAAS diagram & what it causes/changes.
Angiotensinogen --- (Renin) ---> Ang I --- (ACE) ---> Ang II
- Aldosterone release - reabsorption of NaCl and H2O
- Vasoconstriction
Name the four types of emphysema and describe each one.
Centri-acinar: resp. bronchiole but not aveolar ducts or sacs
Pan-acinar: effects the whole unit
Distal-acinar: effects aveolar ducts and sacs but not resp. bronchiole
Irregular:
1. What bones contribute to the nasal septum?
2. Which region of the nasal septum is epistaxis most likely to occur?
3. What does the nasolacrimal duct drain?
4. What drains into the semilunar hiatus?
1. Ethmoid, vomer
2. Kiesselbach area
3. Drains fluid that comes across the eye
4. Anterior ethmoidal sinus, frontonasal duct, maxillary sinus
List an example of a condition that would lead to secondary hypertension under the following categories. Renal, Endocrine, CVS, Neurologic, Drugs.
Renal - parenchymal disease, renal artery stenosis, chronic kidney disease etc.
Endocrine - hyperaldosteronism, cushings disease, congenital adrenal hyperplasia etc.
CVS - coarctation of aorta
Neurologic - intracranial HTN, sleep apnoea, acute stress
Drugs - recreational (amphetamines, cocaine), caffeine, nicotine, alcohol, corticosteroids, oral contraceptives etc.
List the major coronary arteries and veins (what do the veins drain into?) in the heart and their branches. (Explain using the most dominant layout).
Right coronary artery - posterior descending artery, right marginal artery, AV nodal and SA nodal arteries
Left coronary artery - left anterior descending artery (LAD), left circumflex artery
Veins - great, middle, small cardiac veins - drain into coronary sinus then right atrium