1
Q
Describe age-related vascular changes.
A
- fibrosis of intima and media
- accumulation of ground substance
- fragmentation of elastic lamellae
2
Q
Give 3 non-modifiable risk factors for atherosclerosis.
A
- age
- sex
- low birth-weight
3
Q
Give 4 possible complications of atherosclerosis.
A
- stroke
- embolism
- MI
- cardiac failure
- aortic aneurysm
- peripheral vascular disease
- gangrene
4
Q
What are 4 effects of peripheral vascular disease?
A
- intermittent claudication
- pain
- ulcers
- gangrene
5
Q
Name 6 types of aneurysms.
A
- berry
- atherosclerotic
- dissecting
- micro-aneurysms
- syphilitic
- mycotic
6
Q
Define aneurysm.
A
localised, permanent, abnormal dilatation of blood vessel or of the heart wall
7
Q
Describe the morphology of atherosclerotic aneurysms.
A
- saccular or fusiform
- 15-25cm in length
- wall diameter >50%
- frequently contains a mural thrombus
8
Q
What are 5 possible clinical consequences of atherosclerotic aneurysms?
A
- thrombosis
- embolism
- rupture
- obstruction of a branch vessel
- impingement on an adjacent structure
9
Q
What is the clinical symptom of a dissecting aortic aneurysm?
A
sudden excruciating pain in the anterior chest, radiating to between the two scapulae
10
Q
What are capillary micro-aneurysm?
A
- hypertension
- diabetes mellitus
11
Q
Define varicose veins.
A
abnormally dilated, tortuous veins produced by prolonged, increased intraluminal pressure and loss of vessel wall support
12
Q
Give 5 risk factors for varicose veins.
A
- age
- sex
- heredity
- posture
- obesity
13
Q
Define vasculitis and give 4 examples.
A
= inflammation and necrosis of blood vessels
- giant-cell (temporal) arteritis
- Takayasu arteritis (pulseless disease)
- polyarteritis nodosa
- Kawasaki disease
14
Q
Give 5 symptoms of Takayasu arteritis.
A
- dizziness
- visual disturbances
- dyspnoea
- intermittent claudication of upper limbs
- asymmetric BP
15
Q
Name three types of haemangioma.
A
- juvenile (strawberry)
- capillary
- cavernous
16
Q
What group of patient is mots likely to develop a Kaposi’s sarcoma?
A
immunosuppressed
17
Q
What is the function of a valve?
A
to allow forward flow but to prevent back flow
18
Q
What are the 4 components of a valve?
A
- valve ring
- cusp
- chordae
- papillary muscles
19
Q
Define stenosis and incompetence.
A
STENOSIS
narrowing of the valve outlet caused by thickening of valve cusps, or increased rigidity or scarring
INCOMPETENCE
insufficiency/regurgitation caused by incomplete seal when valves close, allowing blood to flow backwards
20
Q
To which valve(s) do the 1st and 2nd heart sound respectively belong?
A
1st = mitral and tricuspid 2nd = aorta and pulmonary
21
Q
Name 4 acquired causes of cardiac valve stenosis and incompetence.
A
- rheumatic fever
- MI
- age-related
- endocarditis
22
Q
Give 3 causes of aortic stenosis.
A
- calcification of congenital bicuspid valve
- senile calcific degeneration
- rheumatic fever
23
Q
What are 3 clinical symptoms of aortic stenosis?
A
- dyspnoea
- angina
- syncope
24
Q
Give 3 causes of aortic competence.
A
- infective endocarditis
- rheumatic fever
- Marfan’s syndrome
25
Give 2 causes of mitral stenosis.
- congenital
| - rheumatic fever
26
Define infective endocarditis.
infection of valve with formation of thrombotic vegetations
27
What are 3 risk factors for infective endocarditis?
- valve damage
- bacteraemia
- immunosuppression
28
What tissues are likely to be affected by rheumatic fever?
- heart
- joints
- connective tissue
29
What makes a vegetation?
- platelets
- fibrins
- bacteria
- phagocytes
30
What are the likely types of bacteria a vegetation?
- group D streptococcus
- gut commensals
- skin streptococci
31
What are 5 complications of infective endocarditis?
- cerebral and retinal emboli
- myocarditis
- splenomegaly
- anaemia
- bronchopneumonia
- pulmonary infarct
- renal infarct
- glomerulonephritis
- haematuria
- clubbing & splinter haemorrhage
32
What are the 4 steps of the epidemiological approach?
1 - describe the health status of a population
2 - understand the natural history of the condition
3 - identify the causes of medical problems
4 - act/evaluate medical and health-promoting interventions
33
What are the three factors to consider when describing an epidemiological problem?
- time
- place
- person
34
Define epidemiological risk factor.
aspect of personal behavior, lifestyle, environmental exposure, genetic trait, which on the basis of epidemiological evidence is associated with a health-related condition or considered important to prevention
35
What can performance monitoring be used for?
- quality outcomes framework
- smoking cessation services
- lifestyle surveys
- outcomes for individual clinicians
36
Give 5 causes of pulmonary hypertension.
- hypoxia
- endothelial dysfunction
- genetics
- blockage/damage to the pulmonary blood vessels
- side-effects from some drugs
- left-sided heart failure
37
Give 6 types of causes of secondary systemic hypertension.
- renal disease
- diabetes
- endocrine disorders
- coarctation of the aorta
- some drugs
- eclampsia/pre-eclampsia
38
What are the 6 modifiable risk factors for sytemic hypertension?
- exercise
- diet
- obesity
- smoking
- alcohol intake
- stress
39
For which 4 types of conditions is left ventricular hypertrophy in patients with hypertension a major risk factor?
- dysrhythmia
- coronary heart disease
- sudden death
- congestive heart failure
40
Give 3 effects of hypertension on the vasculature.
- accelerated atherosclerosis
- stroke
- retinopathy
41
What is the main ECG modification for moderate hypertension?
left axis deviation
42
Define sepsis and septic shock?
SEPSIS
life-threatening organ dysfunction caused by a dysregulated host response to infection
SEPTIC SHOCK
a subset of sepsis in which particularly profound circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone
43
Give 4 factors that put someone at greater risk of sepsis.
- very young and older adults
- impaired immune system
- surgery/invasive procedure in last 6wks
- breach of skin integrity
- misuse of IV drugs
- indwelling lines or catheters
- pregnancy
- given birth, had a termination of pregnancy or a miscarriage in last 6wks
44
Give the 5 most common sources of sepsis.
- respiratory
- abdomen
- bloodstream
- skin
- urinary system
45
What are the 5 main factors affecting infection?
- virulence of pathogen
- bioburden
- portal of entry
- host susceptibility
- temporal evolution
46
What immune molecules may initiate the production of inflammatory markers in sepsis?
- toll-like receptors (TLRs)
| - nucleotide-binding oligomerisation domain receptors (NOD-like receptors)
47
Name the three types of inflammatory markers in sepsis.
- interleukins
- tumour necrosis factor alpha
- reactive oxygen species
48
What are the signs of an acute phase response to TNF-alpha and IL1 on the body?
- fever
- hypotension
- increased heart rate
- corticosteroid and ACTH release
- release of neutrophils
49
What are the effects of TNF-alpha and IL1 on the CV system?
- generalised vasodilation
- increased vascular permeability
- intravascular fluid loss
- myocardial depression
- circulatory shock
50
What do SOFA and qSOFA stand for respectively?
SOFA
septic organ failure assessment
qSOFA
quick SOFA
51
What are the qSOFA variables?
- respiratory rate
- mental status
- systolic BP
52
What are the 7 SOFA variables?
- paO2/FiO2 ratio
- GCS score
- MABP
- administration of vasopressors
- serum creatinine or urine output
- bilirubin
- platelet count
53
What are the two causes for which you'd screen for sepsis?
- unexplained illness
| - looks unwell + likely infective cause OR NEWS >4
54
What are the 4 main consequences of atherosclerotic coronary disease?
- chronic coronary insufficiency
- unstable coronary disease
- heart failure
- arrhythmia
55
Define subendocardial region.
water-shed area of perfusion that is the first to become ischaemic
56
What are the 3 imaging techniques for coronary arteries?
- coronary angiography
- CT angiography
- cardiac MRI
57
What are the three steps of atherosclerotic coronary artery disease pathology?
1- fatty streak
2- fibro-fatty plaque
3- plaque disruption (rupture or erosion)
58
From what percentage of lumen diameter being occupied by atherosclerosis would limitation of coronary artery blood flow happen?
50%
59
What are the determinants of myocardial oxygen consumption?
- tension development
- contractility
- heart rate
- basal activity
- mass of tissue
60
What are the 6 main causes of MI?
- plaque ruptur
- plaque erosion
- coronary embolism
- coronary artery spasm/drugs
- coronary anomaly
- spontaneous coronary dissection
61
Give 5 events modifying presentation of an MI.
- time of the day
- inflammatory activity
- infection
- elevation of BP
- catecholamines
62
How would you diagnose an MI?
- clinical history
- ECG changes
- raised cardiomyocite markers (troponin, CKMB, CPK, AST, myoglobin)
63
What does a tombstone ST elevation mean on an ECG?
ST segment elevation so high in the V leads because no electrical activity at the front of the heart
64
What are the late complications of STEMIs?
- left ventricle dilation and heart failure
- arrhythmia
- recurrent MI
65
What are the 4 causes of NSTEMIs?
- threatened STEMI
- small branch occlusion
- occlusion of well collateralised vessel
- lateral STEMI in territory not well seen by ECG
66
How would you treat bradycardia?
pacemaker
67
Name 5 narrow-complex tachycardias.
- atrial
- junctional
- AVNRT and AVRT
- atrial flutter
- atrial fibrillation
68
What are the three basic mechanisms of tachycardia?
- ectopic focus
- re-entry/circus movement
- fibrillation
69
How would you recognise Wolff-Prakinson-White syndrome on an ECG?
- shortened PR
- slurred upstroke of QRS
- widened QRS
70
Give 1 name for main class of drugs used in pharmacologic management of arrhythmias.
```
class 1a - disopyramide
class 1b - lignocaine
class 1c - flecainide
```
class 2 - sotalol
class 3- amiodarone
class 4- verapamil
71
Define cardiac failure.
failure of the heart to pump sufficient blood to satisfy metabolic demands
72
Which illicit drug is likely to induce systolic cardiac failure?
cocaine
73
Give one example of infiltrative disease that is likely to cause diastolic cardiac failure.
amyloidosis
74
What is the response to exercise in diastolic cardiac failure?
- tachycardia
| - pulmonary acute oedema
75
Give 4 general causes of left and right ventricular failure.
- coronary heart disease
- hypertension
- cardiomyopathies
- drugs
- toxins
- endocrine
- nutritional
- infiltrative
76
What do you call combined left and right ventricular failure?
congestive heart failure
77
Give all 7 key features of clinical examination in patients with heart failure.
- appearance
- pulse rate
- BP
- fluid overload
- peripheral oedema
- respiratory issues
- apex displacement
78
What is hypertension a major risk factor for?
- cardiovascular disease
- ischaemic heart disease
- accelerated atherosclerosis
- Alzheimer type dementia
79
Which condition in pregnancy could cause secondary systemic hypertension?
pre-eclampsia
80
What are the consequences of systemic hypertension on the heart?
- left ventricular hypertrophy with fibrosis and arrhythmia
- ischaemic heart disease
- cardiac failure
81
Which organs are damaged in pulmonary hypertension?
- pulmonary arteries
| - heart
82
What damages to the aorta do diabetes promote?
- ischaemia of wall
- ulceration
- generation of atheroma
83
What process in diabetes causes dysfunction of proteins in a systemic manner?
non-enzymatic glycation
84
What is the likely fatal consequence of emphysema?
cor pulmonale
85
What are the two proteins that can be found infiltrated between cells in amyloidosis
- amyloid-associated protein
| - amyloid-light chain protein
86
How long until vasculitis causes loss of kidney function?
3 or 4 days
87
Heart failure can be caused by a dysfunction of the thyroid. Which dysfunction is it?
hypothyroidism
88
Which cells are involved in sarcoidosis?
T-cells
89
Give an example of immunosuppressive drug that endangers the heart.
Doxorubicin
MD3001
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