Cardiothoracic Flashcards
(28 cards)
Which one of the following statements regarding the aetiology of aneurysms is NOT correct?
a. All aneurysm are acquired (vs. congenital)
b. Aneurysms may be the result of trauma
c. Aneurysms may follow an infection
d. Aneurysms Amy be the result of vascular degeneration associated with atherosclerosis
Answer: a
There are both acquired and congenital aneurysm (example of a congenital aneurysm = berry aneurysm)
- Aneurysm result of trauma = Traumatic aneurysm
- Aneurysm following an infection = Mycotic aneurysm
- Degenerative changes in the arterial wall caused by atherosclerosis weaken the vessel - making it prone to dilation and aneurysm formation
Which one of the following statements regarding aneurysms is NOT correct?
a. A popliteal artery aneurysm is a potential cause of peripheral limb ischaemia.
b. The normal infrarenal diameter of the aorta is 2cm.
c. Aneurysms are defined as permanent dilation of an artery to >/=50% of normal diameter.
d. In practice an abdominal aortic artery aneurysm is diagnosed when the diameter is >/=5cm.
Answer: d
Practical definition for AAA (abdominal aortic artery aneurysm) is >/=3cm
Which one of the following statements regarding cardiovascular effects of drugs is NOT correct?
a. Nitrates affect myocardial contractility
b. Beta-adrenergic blockers affect heart rate
c. Nitrates affect after load
d. Beta-adrenergic blockers affect myocardial contractility
Answer: a
Nitrates affect = pre-load and after-load only
- Myocardial contractility = Beta-adrenergic blockers + Calcium channel blockers
- Heart rate = Beta-adrenergic blockers + Calcium channel blockers
- After-load = Nitrates + Calcium channel blockers
- Pre-load = Nitrates
After-load: CAN
C (Calcium channel blockers)
A (After-load)
N (Nitrates)
Pre-load: No Probs
N (Nitrates)
P (Pre-load)
Heart rate: BitCH
B (Beta-adrenergic blockers)
(it)
C (Calcium channel blockers)
H (Heart rate)
Contractility: Blueberry Cheese Cake (BCC)
B (Beta-adrenergic blockers)
C (Calcium channel blockers)
C (Contractility (myocardial))
Which one of the following statements regarding arteriovenous malformations (AVMs) and aneurysms is NOT correct?
a. Aneurysms are isolated to the Circle of Willis
b. AVMs may occur throughout the body
c. Capillaries normally protect the venules and veins from the higher pressure in arteries and arterioles
d. Aneurysms often have a genetic/familiar basis
Answer: a
Aneurysms can occur in any artery throughout the body.
* Aneurysms (particularly berry aneurysms) are most common in Circle of Willis
* Common sites = aorta (AAA, Thoracic AA), popliteal artery, splenic artery etc.
- Arteries and arterioles carry blood under HIGH pressure from the heart
- Capillaries act as a high-resistance network that significantly reduces blood pressure and velocity before blood enters the LOWER pressure venous system
- AVM = protective capillary bed is absent - directly exposing the venules and veins to HIGH arterial pressure - leads to dilation, weakening, and potential rupture
- Significant genetic predisposition for certain types of aneurysms - berry aneurysms
- Genetic conditions such as Marfan syndrome are associated with increased risk of aneurysm formation
- Family history of aneurysms increases an individual’s risk
Which of the following statements is NOT correct?
a. The aorta is an elastic artery
b. Basic constituents of blood vessels include smooth muscle and endothelial cells
c. Collagen is a constituent of the extracellular matrix
d. The abdominal aorta consists of four concentric intimal, medial, adventitial and external layers
Answer: d
Blood vessels, including the aorta, have three main concentric layers:
1. Tunica intimate (endothelial cells + basement membrane)
2. Tunica media (smooth muscle cells + elastic fibres)
3. Tunica adventitia (collagen and elastic fibres + nerves + small blood vessels)
(Confirmed AAA)
In this patient which one of the following statements regarding the type of aneurysm is NOT correct?
a. It is likely to be a saccular aneurysm
b. It is likely to have a fusiform shape
c. It is more likely to be below the renal arteries
d. One would be concerned about the dissection as a complication
Answer: a
Saccular aneurysms = Cerebral aneurysms
- AAA = Fusiform aneurysm (>90%)
- Fusiform aneurysm = artery bulges / balloons out on all sides - making it wider than the surrounding section of the artery (circumferential dilation of a section of the artery - tube-like / spindle-like bulge)
- (c) 95% of AAA occur in the infrarenal segment of the aorta (below the renal arteries)
- (d) Complications = rupture + dissection
Atheroma is a risk factor for development of an AAA. In general, which of the following is NOT a risk factor for development of atheroma?
a. Smoking
b. Alcohol ingestion
c. High saturated fatty acids
d. Post-menopausal oestrogen deficiency
Answer: b (?)
Alcohol ingestion in general is NOT a primary or consistent risk for atheroma
- (a) Smoking = Endothelial damage, inflammation and plague formation
- (c) High saturated fatty acids = Increase LDL cholesterol - promoting plague buildup in arterial walls
- (d) Post-menopausal oestrogen deficiency = oestrogen is protective against atherosclerosis - after menopause risk increases
Which one of the following statements regarding the pathophysiology of atheroma and atherosclerosis is NOT correct?
a. The condition is characterised by intimal lesions (plagues).
b. Plagues protrude into the lumen and also weaken the adjacent adventitial layer.
c. Prevalence is increasing in developing countries.
d. The abdominal aorta is usually affected more than the thoracic aorta.
Answer: b
Plaque does NOT typically affect the adventitia directly
Plague develop in the tunica intima + may also affect the media
- (a) Atherosclerosis = the formation of atherosclerotic plagues within the INNERMOST layer of the artery (tunica intima)
- (d) Abdominal aorta is more prone to atherosclerosis due to lower shear stress and branching turbulence
Which one of the following statements regarding medical management of coronary artery disease is NOT correct?
a. Dietary modification should be considered
b. Nitroglycerin is used to dilate coronary arteries
c. Calcium channel blockers are prescribed
d. Beta-adrenergic stimulants play an important role
Answer: d
Beta-adrenergic stimulants (also known as beta agonists) = Increase HR, contractility, and oxygen demand
* Beta-adrenergic BLOCKERS may an important role in CAD management
CAD Medical Management:
* (a) Diet modifications = diet low in saturated and trans fact, cholesterol, and sodium + diet high in fruit, vegetables, and whole grains = Lower cholesterol, control BP, manage weight, and improve overall cardiovascular health
* (b) Nitroglycerin (a nitrate) = Potent vasodilator = dilates systemic veins (reducing preload) + dilates coronary arteries (especially areas of spasm) = improves blood flow and oxygen supply to the heart muscles
* (c) Calcium channel blockers (CCBs) = blocks the influx of calcium into smooth muscles cells in the heart and blood vessels = vasodilation (reducing after-load + improving coronary blood flow) + reduces HR and contractility (decreasing the heart’s workload and oxygen demand)
More-severe coronary artery disease (CAD) requires procedural intervention. Which one of the following would NOT be an objective of the available procedures?
a. Preservation of left ventricular function
b. Reversal of myocardial ischaemia
c. Regeneration of cardiac muscle cells
d. Prolonged patient survival
Answer: c
Focus = preventing further cell death or rescuing still viable but ischaemic cells.
Once cardiac muscle cells have died due to prolonged ischaemia they can NOT be regenerated by current surgical or interventional procedures.
- (b) Reversal of myocardial ischaemia = Re-establish blood flow to areas of the heart muscle that are starved of oxygen (ischaemia) due to narrowed or blocked coronary arteries,
Aims of intervention:
* Improve myocardial blood supply
* Reduce the risk of heart attack
* Preserve cardiac function
Which one of the following is NOT a complication of atheromatous plaques?
a. Patchy calcification
b. Ulceration and liberation of micro-emboli
c. Thrombosis and occlusion at the sit of the plaque
d. Aneurysm formation due to medial hypertrophy
Answer: d
Medial hypertrophy = thickening of the middle layer of the artery = vessel wall becomes thicker and stiffer = opposite of what causes an atherosclerotic aneurysm
- Atherosclerotic aneurysm = due to atrophy and wearing of the tunica media underneath the plaque - loss of structural integrity causes subsequent dilation/bulging of the artery = aneurysm
Which one of the following statements regarding hypertension is NOT correct?
a. Elevated blood pressure affects strict and function of blood vessels.
b. Hypertension accelerates the development of atheromatous disease.
c. Hypertension is defined as a sustained systolic blood pressure of >150mm of mercury and diastolic pressure of >100mm of mercury.
d. Approximately 25% of the general population are hypertensive.
Answer: c
Hypertension is defined as sustained resting BP of 140/90mmHg (lecture notes).
(Quiz answer = 135/85mmHg)
Hypertension may play a role in the development of an AAA. In general, which on of the following statements does NOT apply to hypertension?
a. Primary hypertension is much more common than secondary.
b. Primary hypertension is treatable whereas secondary is not.
c. Day and night time blood pressures may differ in a patient.
d. A severe headache may be a sign of a hypertensive emergency.
Answer: b
Both primary and secondary hypertension are treatable.
Secondary hypertension often has an identifiable and sometimes reversible cause (i.e. kidney disease or endocrine disorders) - makes targeted treatment possible.
- (a) 90-95% of cases are primary hypertension.
Which one of the following is NOT a cause of secondary hypertension?
a. Chronic renal disease
b. Hyperthyroidism
c. Circulatory compensation due to low intracranial pressure
d. Coarctation of the aorta
Answer: c
Low intracranial pressure does not cause a compensatory response (no affect on BP)
Secondary Hypertension causes:
* Renal disease - chronic kidney disease (a) (diabetes), renal artery stenosis, glomerulonephritis
* Endocrine (e.g. adrenal tumours)(Hyperthyroidism - increased cardiac output and systemic vascular resistance)
* CVS (e.g. aortic coarctation)(d)
Which one of the following is NOT a manifestation of hypertensive target organ damage?
a. Kidneys - nephrosclerosis
b. Brain - dementia
c. Heart - arrhythmias
d. Eyes - cataracts
Answer: d
Cataracts are not a complication of hypertension.
Hypertension can cause blurred vision - papilloedema, retinal haemorrhages.
(In this patient CPB was for coronary artery disease) Which one of the following statements regarding significant coronary artery disease is NOT correct?
a. There is a decrease in myocardial contractility.
b. Ventricular compliance is reduced.
c. Sudden death is common.
d. It is associated with high output cardiac failure.
Answer: d
CAD leads to LOW-output heart cardiac failure.
CAD:
* Reduced blood flow to the myocardium = ischaemia and reduced contractility
* Ischaemia + scarring from infarction = stiffening of the ventricular walls = reduced ventricular compliance + affected diastolic filling
* Sudden cardiac death (SCD) due to arrhythmias (ventricular fibrillation) = complication of CAD
Which one of the following statements regarding vessels that are used for coronary artery bypass grafting is NOT correct?
a. The saphenous vein may be used.
b. The internal mammary artery may be used.
c. The femoral artery may be used.
d. Grafts have a high expectation of potency - up to 90%.
Answer: c
Femoral artery is NOT used - not suitable or practical due to role as a major artery in the leg - use would risk limb perfusion
- (b) The left internal mammary artery is the most commonly used material graft for CABG - excellent long term potency (>90%).
Which of the following statements regarding atherosclerosis is NOT correct?
a. The condition involves thickening and loss of elasticity in arterial walls.
b. Atherosclerosis is the commonest form of arteriosclerosis.
c. It is a common condition in developed countries but is emerging as a problem in South Africa as communities increasingly ‘westernise’ their diets.
d. Atheromatous plaques in blood vessels generally weaken the vessel wall and cause rupture of the adventitial layer.
Answer: d
Atheromatous plaques primarily develop in the INTIMAL layer of arteries.
Which one of the following is NOT recognised as significantly raising to risk of atherosclerosis in an individual?
a. Presence of hypertension.
b. Positive family history.
c. Diagnosis of metabolic syndrome.
d. Female gender.
Answer: d
Non-modifiable risk factor = MALE gender
(+postmenopausal female)
Atherosclerosis risk factors (slide 5 - Neurology)
Non-modifiable:
* Increasing age
* Male gender, postmenopausal female
*Family history (genetics)
Modifiable:
* Tobacco smoking
* Hypertension
* Diabetes mellitus (metabolic disease)
* Hyperlipidaemia (hypercholesterolaemia)
Which one of the following statements regarding pathogenesis of atherosclerosis is NOT correct?
a. Atheromatous plaques involve intimal thickening and lipid accumulation.
b. Progression of atheromatous lesions involves macrophages and T-lymphocytes.
c. The thoracic aorta is usually affected more than the abdominal aorta.
d. Vessel wall injury and inflammation both contribute to the condition.
Answer: c
Lower abdominal aorta is more commonly affected. (due to haemo-dynamic factors such as turbulent blood flow and lower shear stress in the abdominal segment, as well as differences in vascular biology.)
(Other commonly affected vessels = coronary arteries, popliteal arteries, internal carotid artery, vessels of the circle of Willis)
Which one of the following is NOT a consequence of atherosclerosis in arterial walls?
a. Intestinal infarction
b. Bladder infarction
c. Cerebral infarction
d. Myocardial infarction
Answer: b
The bladder has a rich collateral blood supply and is RARELY infarcted.
More common causes of extremely rare bladder infarction = severe embolism, trauma, or surgical complication.
Which one of the following statements regarding atherosclerotic disease prevention and health promotion is NOT correct?
a. individuals with a strong family history of atherosclerosis at a young age should be closely monitored.
b. Attentions should be paid to modifiable risk factors e.g. by motoring haemoglobin A1c levels in diabetics.
c. A secondary prevention programme would be directed at people who have evidence of atheromatous plaques but have never experienced an atherosclerotic complication.
d. A primary prevention programme would involve at-risk individuals who have no clinical evidence of the disease.
Answer: c
No clinical event with atheromatous plaques = PRIMARY prevention
- Secondary prevention = preventing recurrence or progression in individuals who have already experienced clinical manifestation of disease.
Which one of the following statements regarding venous thromboembolic disease is NOT correct?
a. It is a major cause of morbidity.
b. Clinical diagnosis that is based on a good history and examination is the gold standard in terms of accuracy.
c. The problem of venous thrombosis may arise in medical and surgical patients.
d. Untreated deep vein thrombosis carries a 30-50% risk of pulmonary embolus.
Answer: b
True gold standard for diagnosis of DVT:
* Compression ultrasonography
* CT pulmonary angiography
* D-dimer testing + Wells score
Which one of the following CAD risk factors is NOT correct?
a. Family history plays a role.
b. Low levels of LDL cholesterol are of particular concern.
c. Diabetes mellitus is a common factor.
d. Physical inactivity is commonly associated.
Answer: b
HIGH levels of LDL cholesterol are of particular concern.
LDL cholesterol = “bad” cholesterol that contributes to atherosclerosis
