flashcards (1)

Question 1

What is the definition of rheumatic fever in the context of cardiovascular pathology?

Answer 1

It is an autoimmune collagen disease characterized by widespread degenerative and inflammatory changes in collagen fibers, especially in the heart and joints.

Question 2

What is the primary causative agent implicated in the pathogenesis of rheumatic fever?

Answer 2

Group A beta-haemolytic streptococci.

Question 3

Explain the pathogenesis of acute rheumatic fever.

Answer 3

It involves hypersensitivity reactions where antibodies against streptococcal M-proteins cross-react with host antigens in the myocardium and cardiac valves, causing injury.

Question 4

What is the pathognomonic lesion of rheumatic fever?

Answer 4

The Aschoff nodule.

Question 5

Describe the microscopic composition of an Aschoff nodule.

Answer 5

It consists of central fibrinoid necrosis surrounded by inflammatory cells, Anitschkow cells, Aschoff giant cells, and encircling fibroblasts.

Question 6

What are Anitschkow cells, a feature of rheumatic myocarditis?

Answer 6

They are bloated, pale-purple-staining macrophages with a peculiar “owl-eye” appearance found in Aschoff nodules.

Question 7

What term is used to describe the inflammation of all three layers of the heart in rheumatic fever?

Answer 7

Pancarditis.

Question 8

In rheumatic myocarditis, which part of the heart is most affected by Aschoff nodules?

Answer 8

The interstitium of the myocardium, particularly in the posterior wall of the left ventricle.

Question 9

What is the characteristic gross appearance of acute rheumatic pericarditis?

Answer 9

A “bread and butter” appearance due to serofibrinous pericarditis with excess fibrin deposits on the visceral and parietal pericardium.

Question 10

What is MacCallum’s patch, a chronic lesion of rheumatic fever?

Answer 10

A white fibrous patch in the mural endocardium of the posterior left atrial wall, resulting from the healing of Aschoff nodules.

Question 11

Which two heart valves are most commonly affected by rheumatic valvulitis?

Answer 11

The mitral and aortic valves.

Question 12

Describe the characteristics of rheumatic vegetations in acute rheumatic endocarditis.

Answer 12

They are multiple, small (1-3 mm), firm, adherent, and deposited at the line of closure of the cusps.

Question 13

What are the two main outcomes of chronic rheumatic valvulitis on valve function?

Answer 13

Valve stenosis (due to fusion of cusps) and valve incompetence (due to retraction of fibrotic cusps).

Question 14

The fusion of valve cusps in chronic rheumatic valvulitis can lead to a characteristic appearance known as _____ or button-hole stenosis.

Answer 14

fish mouth

Question 15

List the five major criteria for the diagnosis of rheumatic fever (Jones criteria).

Answer 15

1. Pancarditis, 2. Fleeting arthritis, 3. Erythema marginatum, 4. Subcutaneous nodules, 5. Rheumatic chorea.

Question 16

What is the most common causative organism in subacute infective endocarditis?

Answer 16

Streptococcus viridans, accounting for 95% of cases.

Question 17

What is a key predisposing factor for the development of subacute infective endocarditis?

Answer 17

The presence of previously diseased heart valves (e.g., from chronic rheumatic valvulitis or congenital defects).

Question 18

What is the causative agent for acute infective endocarditis?

Answer 18

Highly virulent bacteria such as staphylococcus aureus, streptococcus haemolyticus, pneumococci, or gonococci.

Question 19

How do the vegetations in acute infective endocarditis differ from those in the subacute form?

Answer 19

In acute IE, vegetations are bulky, yellowish, friable, septic, and contain polymorphs and pus cells, while in subacute IE they are greyish and contain mononuclear cells.

Question 20

What is a common source of bacteremia leading to subacute infective endocarditis?

Answer 20

Dental procedures like tooth extraction or tonsillectomy, which allow normal oral flora (like Strep. viridans) to enter the bloodstream.

Question 21

What is the characteristic appearance of the kidney in focal embolic glomerulonephritis, a complication of subacute IE?

Answer 21

A “flea-bitten kidney” appearance, with reddish spots on the surface.

Question 22

What are mycotic aneurysms, a complication of subacute infective endocarditis?

Answer 22

Aneurysms formed in medium-sized arteries (e.g., cerebral) due to weakening of the vessel wall by inflammation from an impacted septic embolus.

Question 23

What are Osler’s nodules?

Answer 23

Small, tender nodules in the nail beds caused by embolic lesions in skin capillaries, seen in subacute infective endocarditis.

Question 24

Myocardial infarction is defined as the death of an area of the myocardium due to what cause?

Answer 24

A sudden cut of its arterial blood supply.

Question 25

What is the most common immediate cause of myocardial infarction?

Answer 25

Thrombosis or hemorrhage on top of an atheromatous plaque, leading to sudden complete occlusion of a coronary artery.

Question 26

What are the gross and microscopic findings 24 hours to 3 days after a myocardial infarction?

Answer 26

Grossly, a pale yellow dead muscle area with a congested zone; microscopically, lost muscle striations and nuclei with marked polymorph infiltration.

Question 27

What process begins to occur at the edges of a myocardial infarct between 3 and 10 days?

Answer 27

Granulation tissue develops, with infiltration by polymorphs and macrophages, and resorption of dead muscle fibers begins.

Question 28

What is the final pathological outcome of a healed myocardial infarction after several weeks to months?

Answer 28

Complete replacement of the dead muscle by white fibrous scar tissue.

Question 29

What is a potentially fatal complication that can occur within minutes to hours of a large MI?

Answer 29

Cardiac arrest and ventricular fibrillation.

Question 30

What is myomalacia cordis, and when is it likely to occur post-MI?

Answer 30

It is abnormal softening of the myocardium due to a large infiltration of polymorphs, occurring 3-14 days after infarction, which can lead to rupture.

Question 31

A cardiac aneurysm is a complication that can occur during which phase of myocardial infarction recovery?

Answer 31

The healed infarction phase (within weeks).

Question 32

What is the cause of suppurative pericarditis?

Answer 32

Pyogenic bacteria reaching the pericardium, leading to the accumulation of pus in the pericardial sac.

Question 33

What is constrictive pericarditis?

Answer 33

A condition where dense adhesions form between the visceral and parietal layers of the pericardium, often obliterating the pericardial sac and restricting heart movement.

Question 34

What is hemopericardium, and what is a common cause related to MI?

Answer 34

It is the accumulation of blood in the pericardial sac, which can be caused by the rupture of a recent myocardial infarction.

Question 35

Atherosclerosis is defined as an intimal disease characterized by patchy degeneration of the intima covered by _____.

Answer 35

fibrosis

Question 36

According to the pathogenesis of atherosclerosis, chronic endothelial injury leads to increased permeability and accumulation of which specific lipoprotein?

Answer 36

Low-density lipoproteins (LDL).

Question 37

What is the name for monocytes that migrate into the intima and ingest oxidized lipoproteins during atherogenesis?

Answer 37

Foam cells.

Question 38

What are the initial gross lesions of atherosclerosis, appearing as intimal raised yellow elevations?

Answer 38

Fatty streaks.

Question 39

What is the major complication of atherosclerosis in small arteries like the coronaries?

Answer 39

Narrowing of the lumen leading to ischemia and thrombosis, followed by infarction.

Question 40

An aneurysm is defined as a localized _____ of the arterial wall.

Answer 40

dilatation

Question 41

What is the key difference between a true aneurysm and a false aneurysm?

Answer 41

In a true aneurysm, the wall is composed of all layers of the normal vessel, whereas in a false aneurysm, the wall consists of fibrous tissue from an organized hematoma.

Question 42

Which type of aneurysm is typically large, fusiform, and most commonly affects the abdominal aorta?

Answer 42

Atherosclerotic aneurysm.

Question 43

What is the underlying pathology that leads to a syphilitic aneurysm?

Answer 43

Endarteritis and periarteritis of the vasa vasorum cause focal necrosis and scarring of the media, leading to weakening of the vessel wall.

Question 44

What occurs in a dissecting aneurysm (dissecting hematoma)?

Answer 44

Blood enters the media of the artery, typically through a tear in the intima, and splits (dissects) the layers of the media.

Question 45

What are congenital (Berry) aneurysms?

Answer 45

Single or multiple small saccular aneurysms, typically found at the bifurcation of cerebral arteries, caused by congenital defects of the media.

Question 46

Rupture of a Berry aneurysm typically causes what type of hemorrhage?

Answer 46

Subarachnoid hemorrhage.

Question 47

What is a hemangioma?

Answer 47

A benign tumor composed of proliferating vascular channels containing red blood cells, often considered a developmental malformation (hamartoma).

Question 48

Microscopically, a cavernous hemangioma is characterized by what feature?

Answer 48

Large vascular spaces lined by endothelial cells and filled with blood, separated by fibrous stroma.

Question 49

What is a glomangioma (glomus body tumor)?

Answer 49

A benign, painful tumor arising from the glomus body, a specialized arteriolar-venous anastomosis involved in temperature regulation, often found under a fingernail.

Question 50

What is an angiosarcoma?

Answer 50

An uncommon malignant vascular tumor that can affect the skin, soft tissue, breast, and liver.

Question 51

What is Kaposi sarcoma, and in which patient population is it commonly seen?

Answer 51

A malignant tumor of vascular origin, seen as multiple hemorrhagic nodules, commonly affecting patients with AIDS and other immunodeficiency diseases.

Question 52

Microscopically, Kaposi sarcoma consists of sheets of malignant spindle-shaped cells with _____.

Answer 52

vascular slits