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Phase 1c > Cardio > Flashcards

Cardio Flashcards

1
Q

hypertension variants

A

masked
white coat
isolated systolic

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2
Q

clinical features of hypertension

A

asymptomatic
headaches
dizziness, tinnitus, blurred vision
strong bounding pulse
flushed
underlying cause

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3
Q

hypertension IX

A

history and physical exam
look for signs of target organ damage
electrolytes (HTN meds can alter these so collect baseline stats)
renal function tests
TSH - screen for hyperthyroidism
urinalysis - albumin or blood in urine
BP - 2 readings on 2 occasions

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4
Q

causes of secondary HTN

A

thyroid disease
fibromuscular dysplasia
renal parenchymal disease
coarctation of the aorta
obstructive sleep apnoea
hyperaldosteronism
renal artery stenosis

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5
Q

HTN mx

A

lifestyle

meds:
1 - age < 55 - ACE inhibitor, age >55 or black - CCB
2 - ACE inhibitor + CCB
3 - ACEi + CCB + thiazide-like diuretic
4 - consider further diuretic or beta blockade or alpha blocker

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6
Q

nephroprotective HTN meds

A

good for pts with DM or renal problems

ACEi - pril drugs like lisinopril, captopril, enalapril
ARBs - artan drugs like lorsartan or valsartan

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7
Q

examples of thiazide diuretics

A

hydrochlorothiazide
chlorthalidoine

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8
Q

examples of CCBs

A

dihydropyridine
amlodipine
nifedipine

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9
Q

pulmonary HTN signs and symptoms

A

exertional dyspnoea/syncope
exertional chest pain
cyanosis
fatigue
hoarseness
cough, haemoptysis
jugular vein distention
loud second heart sound
signs of RHF - palpitation, hepatojugular reflex
nail clubbing

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10
Q

pulmonary HTN Ix

A

transthoracic echocardiography:
- tricuspid regurg, underfilling of left heart chambers, look for RV pressure overload (hypertrophy)

right heart catheterisation

ECG:
- right ventricular hypertrophy
- right axis deviation
- p pulmonale - big tall peaked p waves

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11
Q

pulmonary HTN Mx

A

acute: oxygen and diuretics
cause dependent: pulmonary vasodilators, pulmonary endarterectomy, anti-coagulants, fix cardiac valves, treat underlying lung pathology

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12
Q

pulmonary vasodilators examples

A

endothelin receptor antagonist (bosentan)

PDE 5 inhibitor - sildenafil

prostaglandin analogs - iloprost

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13
Q

orthostatic hypotension causes

A

hypovolemia
autonomic dysfunction
drugs + alcohol
diuretics, anti-hypertensives, anti-depressants, sedatives
old ppl
diabetes, parkinsons

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14
Q

management of hypotension

A

fluid and sodium intake
remove offending drugs
compression stockings

med:
short acting pressors like midodrine (alpha agonist) or volume expanders like fludrocortisone

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15
Q

hyperlipidaemia signs and symptoms

A

xanthoma
xanthelasma
hepatic steatosis, pancreatitis
premature atherosclerosis

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16
Q

diagnosis of hyperlipidaemia

A

fasting lipid profiles

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17
Q

hyperlipidaemia mx

A

lifestyle (low fat, alcohol avoidance)
statins (+/- other lipid lowering agents)
omega 3 fatty acids
fibrates

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18
Q

clinical and serum findings in familial hyperchylomicronaemia

A

pancreatitis
hepatosplenomegaly
xanthoma

high chylomicrons
elevated TG

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19
Q

findings for familial hypercholesterolaemia

A

early atherosclerosis
tendon xanthoma
high lLDL

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20
Q

familial dysbetalipoproteinaemia findings

A

early atherosclerosis
palmar xanthoma
high LDL, chyomicrons, triglycerides

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21
Q

familial hypertriglyceridemia findings

A

pancreatitis

high VLDL and TG

22
Q

abetalipoproteinemia findings

A

steatorrhoea
fat soluble vit deficiencies

no chylomicrons
no VLDL

23
Q

peripheral vascular disease summary

A

acute limb ischaemia
- sudden decrease in limb perfusion

intermittent claudication
- pain on exertion

critical limb ischaemia
- pain at rest

24
Q

acute limb ischaemia symptoms

A

6 Ps

pain
pale
pulseless
paralysis
paraesthesia
perishingly cold

25
Q

chronic peripheral vascular disease symptoms

A

hair loss
numbness in feet/legs
brittle, slow growing toenails
ulcers
absent pulses
atrophic skin

26
Q

PVD Ix

A

Beurger’s test. <20 degrees indicates severe limb ischaemia

Ankle-Brachial pressure index (ABPI)
normal range 0.9-1.2
< 0.5 indicates CLI

full cardio risk assessment (BP, HR, bloods (GBC, fasting glucose, lipids)
ECG

colour duplex ultrasound
magnetic resonance angiogram

27
Q

Leriche syndrome sx

A

buttock claudication
impotence
absent/weak distal pulses

28
Q

arterial ulcer sx

A

appearance:
punched out
distal
well defined
pale base (grey granulation tissue)

hair loss, shiny pale skin
calf muscle wasting
absent pulses
night pain

29
Q

venous ulcer sx

A

appearance
large and shallow
less well-defined
gaiter region

swelling
itching
aching
stasis eczema
atrophie blanche
hemosiderin deposition
lipodermatosclerosis

30
Q

arterial ulcer ix

A

dupler USS of lower limbs
ABPI
percutaneous angiography
ECG
bloods:
- fasting serum lipids
- HbA1c
- blood glucose
- FBC

31
Q

venous ulcer ix

A

duplex USS of lower limbs
measure SA of ulcer to monitor progression
ABPI
swab for microbiology if indicated
biopsy if possibility of Marjolin’s ulcer

32
Q

venous ulcer treatment

A

graded compression stockings
debridement and cleaning
abx if needed
moisturising cream

33
Q

AAA definition

A

localised enlargement of the abdominal aorta where the diameter is >3cm or >50% larger than normal diameter
most occur below renal arteries

34
Q

AAA RFs

A

smoking, male, connective tissue diseases, old age, HTN, inflammatory disorders

screening population = males >65 yrs old

35
Q

AAA Sx

A

unruptured:
usually asymptomatic
may have pain in back, abdo or groin

ruptured:
sudden severe pain in back, abdo, groin
syncope
shock

signs:
pulsatile and expansile mass on palpation
abdominal bruit
Grey-Turner’s sign (ruptured)

36
Q

AAA Ix

A

g.s: abdo US (can’t tell if ruptured)

bloods
CT angiogram (can detect rupture)
MR angiogram (can detect rupture. contrast allergy or renal impairment)

37
Q

aortic dissection classification

A

Debakey - type I to type IIIb
Stanford - type A and type B

ascending + descending aorta = type I/ type A

ascending aorta only = type II/ type A

descending only above diaphragm = type IIIa/ type B

descending only below diaphragm = type IIIb/ type B

38
Q

aortic dissection RFs

A

smoking
male
connective tissue disorders
HTN
congenital abnormalities eg aortic coarctation
crack cocaine

39
Q

aortic dissection symptoms and signs

A

sudden central tearing pain can radiate to back
symptoms caused by blockages to branches
carotid - blackout, dysphasia
coronary - angina
subclavian - LOC
renal - anuria, renal failure

hypertension
blood pressure difference between two arms (>50%)
murmur on the back
signs of aortic regurgitation
signs of connective tissue disease

40
Q

aortic dissection Ix

A

bloods
ECG (normal) to rule out MI
CXR
g.s. = CT angiogram

41
Q

varicose veins RFs

A

age
female
obesity
FHx
caucasian

42
Q

varicose veins causes

A

idiopathic valvular incompetence (mostly this)

DVT
AV malformations
venous outflow obstruction

43
Q

varicose veins Sx

A

visible dilation of veins
leg aching
swelling and itching
bleeding

veins feel tender or hard
tap test
auscultation of bruits
Trendelenburg test

44
Q

varicose veins Ix

A

g.s. = duplex USS
- locates incompetent valve and excludes DVT

45
Q

varicose veins Mx

A

conservative:
- compression stockings
- lifestyle changes

endovascular treatment:
- radiofrequency ablation
- endovenous laser ablation
- liquid or foam microinjection scleropathy

surgery:
- stripping of the long saphenous vein
- saphenofemoral ligation
- avulsion of varicosities

46
Q

varicose veins complications

A

venous ulcer
stasis eczema
lipodermatosclerosis
hemosiderin deposition

sclerotherapy:
skin staining, local scarring

surgery:
haemorrhage, infection, recurrence, paraesthesia, peroneal nerve injury

47
Q

gangrene causes

A

tissue ischaemia and infarction
physical trauma
gas gangrene caused by Clostridium Perfringens

48
Q

gangrene RFs

A

DM
immunosuppression
steroid use
PVD
ulcers

49
Q

gangrene Ix

A

Bloods: FBC, U&Es, glucose, CRP, blood culture
MC&S
x-ray of affected area may show gas produced in gas gangrene

50
Q

DVT Sx

A

erythema
warmth
painless
varicosities
swollen limb
may be asymptomatic
Homan’s sign

51
Q

DVT Ix

A

RR, O2 sats, HR

g.s: doppler US
impedance plethysmography
D-dimer
ECG, CXR, ABG (if PE suspected)

risk stratified using Well’s criteria (different to PE Well’s score)

52
Q

DVT Mx

A

DOACs (apixaban, rivaroxaban)
LMWH
3 months both for maintenance
10 days for initiation

warfarin for maintenance if contraindications

prevention:
compression stocking
advise physical activity and mobilisation

Phase 1c (13 decks)

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