Atherosclerosis

Question 1

NICE staging of hypertension (clinical measurements)

Answer 1

Stage 1: >140/90
Stage 2: >160/100
Stage 3: >180/120

Question 2

NICE staging of hypertension (ABPM measurements)

Answer 2

Stage 1: 135/85

Stage 2: 150/95

Question 3

Causes of secondary hypertension

Answer 3

Renal disease
Endocrine
Drugs
Vascular
Apnoea
Pregnancy

Question 4

How is end organ damage risk quantified before starting hypertension treatment?

Answer 4

ASSIGN risk calculator

Question 5

Target blood pressure for hypertensive patients

Answer 5

135/85 for those under 80 years old

145/85 for those over 80 years old

Question 6

What combination drug therapy technique is used for treating hypertension?

Answer 6

Low doses of several drugs

Question 7

Step 1 hypertension treatment

Answer 7

Over 55 or afrocaribbean: antihypertensive with calcium channel blocker or thiazide diuretic

Under 55: ACE inhibitor/ARB (not safe in pregnancy)

Question 8

Step 2 hypertension treatment

Answer 8

Add thiazide diuretic to calcium channel blocker/ACEI/ARB

Question 9

Step 3 hypertension treatment

Answer 9

Add calcium channel blocker, ACEI, ARB all together

Question 10

Treatment of Stage 1 hypertension

Answer 10

Promote lifestyle change (as always)
Offer antihypertensive only to patient with one of:
target organ damage, CVS disease, renal disease, diabetes, >80 years old

Question 11

Treatment of Stage 2 hypertension

Answer 11

Offer antihypertensive drug to all stage 2 patients and follow stepped approach

Question 12

Treatment of resistant hypertension

Answer 12

Consider compliance issues
Consider higher doses
Consider further diuretics

Question 13

Difference between hypertensive emergency and urgency

Answer 13

Emergency= evidence of organ damage
Urgency= no evidence of organ damage

Question 14

Atheroma definition

Answer 14

Formation of plaques in intima of large/medium sized arteries

Question 15

Arteriosclerosis definition

Answer 15

Age related change in muscular arteries

Smooth muscle hypertrophy, intimal fibrosis and therefore reduced vessel diameter

Question 16

What makes an atheroma compicated?

Answer 16

Haemorrhage into plaque
Plaque rupture/fissuring
Thrombosis

Question 17

Most important cause of atheroma

Answer 17

Hypercholesterolaemia

Question 18

3 features of plaque vulnerable to rupture

Answer 18

Thin fibrous cap
Large lipid core
Prominent inflammation

Question 19

Virchow’s triad

Answer 19

Changes in vessel wall
Changes in blood constituents
Changes in blood flow

Question 20

What is virtually the only cause of mitral stenosis?

Answer 20

Rheumatic heart disease

Question 21

Transmural infarction definition

Answer 21

Ischaemic necrosis affects full thickness of myocardium

Question 22

Subendocardial infarction definition

Answer 22

Ischaemic necrosis mostly limited to zone of myocardium under lining on heart

Question 23

Investigations for angina

Answer 23

Bloods
ECG
CXR
Exercise tolerance test
Invasive angiography

Question 24

Angina definition

Answer 24

Discomfort in chest and/or adjacent areas with myocardial ischaemia but without myocardial necrosis

Question 25

Angina severity scoring

Answer 25

1: angina only on significant exertion 2: slight limitation in normal activity, symptoms on climbing> 1 flight of stairs 3: marked limitation, symptoms on climbing 1 flight of stairs 4: symptoms on any activity

Question 26

Medical treatments for stable angina

Answer 26

``` ACE inhibitors Statins Aspirin Beta blockers Calcium channel blockers ```

Question 27

Percutaneous coronary intervention vs CABG in terms of symptoms and prognosis

Answer 27

PCI effective for symptoms but no prognostic benefit | CABG can have prognostic benefits

Question 28

What conditions count as acute coronary syndrome

Question 28

What conditions count as acute coronary syndrome

Answer 28

Unstable angina NSTEMI STEMI Sudden cardiac death

Question 29

Stroke definition

Answer 29

Neurological deficit of sudden onset which lasts more than 24 hours and is of vascular origin

Question 30

What is a TIA?

Answer 30

Same as stroke but less than 24 hours

Question 31

Percentage of strokes that are caused by infarction vs haemorrhage

Answer 31

Infarction: 85-90% Haemorrhage: 10-15%

Question 32

Most important risk factor for stroke

Answer 32

Hypertension

Question 33

Penumbra definition

Answer 33

Part of ischaemic stroke at risk of progressing to infarction but is still salvageable if reperfused

Question 34

What thrombolytic is used for stroke treatment?

Answer 34

Alteplase

Question 35

Difference between type A and B aortic dissection

Answer 35

Type A involves ascending aorta