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Yr 2 EOYS ^2 > CR EOYS4 > Flashcards

CR EOYS4 Flashcards

1
Q

Name 4 risk factors for calcification of aortic valve? [4]

A

Risk factors: hypercholesterolaemia, hypertension, smoking and diabetes.

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2
Q

Name this symptom

Janeway lesion
Oslers node
Splinter haemorrhage
Normal wear n tear

A

Name this symptom

Janeway lesion
Oslers node: Osler’s nodes are on the tip of the finger or toes and painful
Splinter haemorrhage
Normal wear n tear

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3
Q

Name this symptom

Janeway lesion
Oslers node
Splinter haemorrhage
Normal wear n tear

A

Name this symptom

Janeway lesion transient, nontender macular papules on palms or soles. NOT PAINFUL
Oslers node
Splinter haemorrhage
Normal wear n tear

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4
Q

A 17-year-old intravenous drug user presents to the hospital with low-grade fever, lethargy, and general malaise. He has tender, red, raised lesions on his palms and soles, which he reports appeared a few days ago. Cardiac auscultation reveals a pansystolic murmur in the tricuspid area. Lab investigations reveal a white blood cell count of 19000/microlitre. What is the most likely diagnosis for the lesions described?

A. Heberden nodes
B. Bouchard nodes
C. Osler nodes
D. Janeway lesions

A

A 17-year-old intravenous drug user presents to the hospital with low-grade fever, lethargy, and general malaise. He has tender, red, raised lesions on his palms and soles, which he reports appeared a few days ago. Cardiac auscultation reveals a pansystolic murmur in the tricuspid area. Lab investigations reveal a white blood cell count of 19000/microlitre. What is the most likely diagnosis for the lesions described?

A. Heberden nodes
B. Bouchard nodes
C. Osler nodes
Janeway lesions can also occur on the palms in infective endocarditis but are not painful.
D. Janeway lesions

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5
Q

Janeway lesions and Osler nodes are supporting criteria for a diagnosis of [].

A

Janeway lesions and Osler nodes are supporting criteria for a diagnosis of infective endocarditis

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6
Q

Pott’s disease is when pulmonary TB has spread to

Lymph system
Gastrointestinal system
Genitourinary system
Bone & joints
Meninges

A

Pott’s disease is when pulmonary TB has spread to

Lymph system
Gastrointestinal system
Genitourinary system
Bone & joints - Spinal
Meninges

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7
Q

Myxomatous degeneration of the cardiac valves (MDMV) occurs due to remodelling of which type of collagen?

Collagen I
Collagen II
Collagen III
Collagen IV
Collagen V

A

Myxomatous degeneration of the cardiac valves (MDMV) occurs due to remodelling of which type of collagen?

Collagen I
Collagen II
Collagen III
Collagen IV
Collagen V

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8
Q

Cerebral oedema is associated with

Respiratory alkalosis
Respiratory acidosis
Metabolic alkalosis
Metabolic acidosis

A

Cerebral oedema is associated with

Respiratory alkalosis
Respiratory acidosis
Metabolic alkalosis
Metabolic acidosis

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9
Q

A wide pulse pressure is associated with:

aortic stenosis
mitral stenosis
aortic regurgitation
mitral regurgitation

A

A wide pulse pressure is associated with:

aortic stenosis
mitral stenosis
aortic regurgitation
mitral regurgitation

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10
Q

A low volume pulse is associated with

aortic stenosis
mitral stenosis
aortic regurgitation
mitral regurgitation

A

A low volume pulse is associated with

aortic stenosis
mitral stenosis
aortic regurgitation
mitral regurgitation

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11
Q

How could a HRV nasopharyngitis infection impact asthma patients?

A

The host reaction to HRV in atopic asthmatic subjects is characterised by a T-helper (Th)2-type immune response.

Causes increased synthesis and release of cytokines, such as interleukin (IL)-4, IL-5, IL-10 and IL-13, which are capable of increasing the expression of intercellular adhesion molecule (ICAM)-1, the major HRV receptor, on the surface of bronchial epithelial cells (BECs)

Causes BECS more sus. to infection.

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12
Q

How would decide if you need to treat an acute sore throat from pharyngitis?

A

Use FeverPAIN or Centor scoring systems:

  • If FeverPAIN score is 0-1 or Centor score 0-2: No antibiotic
  • FeverPAIN score 2-3: back up antibiotic / no antibiotic prescription
  • FeverPAIN score 4-5 or Centor score 3-5: immediate antibiotic or backup antibiotic prescription
  • If symptoms are systemic (e.g. fever) and not resolved by immediate antibiotic refer to hospital.

(more common symptoms are likely to be viral, but if hospitlisation occurs then likely to be bacterial)

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13
Q

Which drugs would you use to treat a Ptx who had acute sore throat with pharnygitis?

A

Start of treatment is determined by hospital’s microbiology protocol
But:

First choice: Phenoxymethylpenicillin

If allergic:

Clarithromycin
Erythromycin

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14
Q

Treatment of which drug type is a risk factor for TB re-activation?

A

Prolonged therapy of corticosteroids

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15
Q

Investigations for TB? [5]

A

CXR (mainstay)
Sputum sample: ZN stain AND culture
Histology
Mantoux test
IFN-y assay

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16
Q

How do you diagnose if you’ve got latent TB or not? [2]

A

Tuberculin sensitivity Test – aka PPD (Purified Protein Derivative) (Manteux) test:

  • Tuberculin is injected between layers of the dermis, tuberculin is a component of the bacteria, and if a person has previously been exposed to TB, the immune system reacts to the tuberculin and produces a small, localized reaction within 48 to 72 hours; if the reaction creates a large enough area of induration (rather than just redness), it’s considered to be a positive test.

DOESNT DISTINGUISH BETWEEN LATENT AND ACTIVE TB

IFN-γ assay

  • If patient has had TB infection, T lymphocytes produce interferon gamma in response – measured and compared with control sample.
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17
Q

First line treatment for TB? [4]

A

Standard treatment of TB disease is four-drug therapy - treatment with single drug can lead to development of a bacterial population resistant to that drug:

RIPE !

  • Rifampicin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol
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18
Q

Hessel bank equation xxx

A
19
Q

What are the two leading causes of respiratory acidosis? [2]

Name 3 others causes [3]

A

Hypoventilation and ventilation-perfusion mismatch resulting in inadequate excretion of CO2

Drugs suppress breathing (powerful pain medicines, such as narcotics, and “downers,” such as benzodiazepines), especially when combined with alcohol

Brain injury impairing CNS respiratory centres

Diseases of gas exchange (such as asthma and chronic obstructive lung disease)

Diseases of the chest (such as scoliosis), which make the lungs less efficient at filling and emptying

Diseases affecting the nerves and muscles that drive lung ventilation

Severe obesity, which restricts how much lungs can expand

20
Q

How do you treat respiratory acidosis? [4]

A

Treat cause !:

  • Bronchodilator drugs to reverse some types of airway obstruction
  • Noninvasive positive-pressure ventilation (sometimes called CPAP or BiPAP) or mechanical ventilation if needed
  • Opioid drug overdose reversal with naloxone
  • Oxygen if the blood oxygen level is low – BUT must be careful with oxygen
21
Q

Why do you need to monitor when giving O2 to Ptx with respiratory acidosis? Especially if have COPD

A
  • Giving oxygen to these patients may lead to worsening CO2 retention from ventilation-perfusion mismatch: causes more acidosis.
  • Can lead to CO2 narcosis and cardio-pulmonary arrest
22
Q

What disease does excessive excretion of phosphate ions lead to? [1]

A

This requires phosphate which comes from breakdown of calcium phosphate in bone, which can lead to bone weakening and osteoporosis.

23
Q

How does resp. alkalosis cause syncope? [1]

What happens to O2 dissociation curve in resp alk? [1]

Describe what happens to Ca2+ levels during alkalosis and what effect this has [2]

A

1) Decrease CO2 content: of blood causes constriction of cerebral blood vessels – may cause syncope

2) Alkalaemia shifts the haemoglobin O2 dissociation curve to the left:, impairing O2 delivery to tissues.

3) pH related changes in free Ca2+ blood levels can lead to an increase in neuromuscular excitability- increased risk arrythmias and tetany (involuntary and sustained muscle contractions)

24
Q

Explain the mechanism of renal compensation of chronic resp. alkalosis [2]

A
  1. Kidney increases bicarbonate excretion by reducing levels of carbonic anhydrase.
  2. The minimum plasma [HCO3-] achievable is about 12 mmol/L).
25
Q

What is the basic pathophysiology behind type 1 and 2 respiratory failures? [2]

Name common causes of type 1 resp. failure [3]
Name one common cause of type 2 resp. failure [1]

A

Type 1: respiratory failure occurs when the respiratory system cannot adequately provide oxygen to the body, leading to hypoxemia

Type 2: when the respiratory system cannot adequately remove carbon dioxide from the body, leading to hypercapnia

Name common causes of type 1 resp. failure [3]
3 Ps: PE, Pulmonary oedema, Pneumonia

Name one common cause of type 2 resp. failure [1]
Severe COPD

26
Q

Name 3 reasons that could be the pathology behind mitral valve prolapse [3]

Describe the physiology occuring in mitral valve prolapse [1]

What are symptoms and severity of mitral valve prolapse? [1]

Whats a sign of mitral valve prolapse? [1]

A

Pathology:
- histologically normal valves
- myxomatous degeneration (efect in the mechanical integrity of the leaflet due to the altered synthesis and/or remodeling by type VI collagen)
- Marfan, Ehlers danlos

Physiology:
- valve leaflet(s) prolapses back into LA during systole, sometimes producing Mitral Rerguit.

Symptoms:
- Usually asymptomatic

Sign:
- Late ejection click

27
Q

Define aortic stenosis [1]

Name 3 causes of aortic stenosis [3]

A

Definition:
Narrowing of the aortic valve resulting in obstruction to the left ventricular stroke volume, leading to symptoms of chest pain, breathlessness, syncope and fatigue

Causes:
- Calcific disease (hardening of aortic valve)
- Congenital bicuspid aortic valve (BAV) (valve has 2 leaflets instead of 3 due to genetic disease - this is the most common congenital heart disease) resulting in stenosis
- Rheumatic heart disease

28
Q

Signs [5] & Symptoms [4] of Aortic stenosis?

A

Symptoms:
- Dyspnoea - increase in diastolic pressure in stiff non-compliant LV. LV is thicker because has to use more energy to expel blood (hypertrophy)

  • Angina - increase O2 demand of hypertrophied LV
  • Syncope - either paroxysmal ventricular arrhythmias or exertional cerebral hypoperfusion (less blood is leaving)
  • LVF - contractile failure as ventricle dilates – causes heart failure
  • Sudden death - ventricular arrhythmias

Signs:
- slow rising carotid pulse
- S4 ejection click
- Late diastole (trying to eject blood)

29
Q

Describe the murmur that occurs from aortic stenosis [4]

A

Systolic ejection murmur (S1 –> S2)

Prominant S4 ejection click

High pitched

Crescendo / decresendo

Radiates to carotids

30
Q

What would indicate need for surgery for AS? [3]

A
  • Any symptoms of AS
  • Echocardiographic evidence of worsening LV dilatation
  • Peak systolic pressure gradient (the difference between peak left ventricular [LV] and peak aortic systolic pressures) >50 mmHg

TAVI now taking over from heart surgery for people not suitable (frail).

31
Q

What are 4 causes of aortic valve lealeft disease [4]

A

Calcific disease – stiffness of valve (hard to open / close)

Congenital bicuspid valve

Rheumatic disease

Infective endocarditis. Infection of aortic valve

32
Q

What are 3 causes of aortic regurgitation caused by aortic root dilating disease? [3]

A

Ankylosing spondylitis (is an inflammatory disease that, over time, can cause some of the bones in the spine (vertebrae) to fuse)
Marfan syndrome (cant make strong CT)
Aortic dissection

33
Q

Describe signs of aortic regurgitation

A

Heart murmur:
- Early diastolic, soft / subtle murmur at left sternal border
- Systolic ejection murmur; due to increased flow across the aortic valve

  • Corrigans pulse / collapsing pulse: rapidly appears then dissapears
  • Apex beat displaced laterally
34
Q

What investigations for aortic regurgitation?

A

Echocardiogram:
- Aortic root size compared to LV. Aortic root often much larger than normal)
- LV dimensions (LV dilation)

Doppler
- detection and quantification of regurgitant flow

35
Q

Describe the pathophysiology behind aortic rurgigation

A

Aortic regurgitation is reflux of blood from the aorta through the aortic valve into the left ventricle during diastole

  • If net cardiac output is to be maintained, the total volume of blood pumped into the aorta must increase and, consequently, the left ventricular size must enlarge resulting in left ventricle dilation and hypertrophy
  • Progressive dilation leads to heart failure
  • Furthermore due to the fact that the remaining blood in the root of the aorta supplies the coronary arteries via the coronary sinus during diastole - regurgitation causes diastolic blood pressure to fall and thus coronary perfusion decreases
  • Also the large left ventricular size is mechanically less efficient, so that the demand for oxygen is greater and cardiac ischaemia develops
36
Q

Describe the pathophysiology of mitral stenosis

A
  • Thickening and immobility of the valve leads to obstruction of blood flow from the left atrium to the left ventricle
  • In order for sufficient cardiac output to be maintained, the left atrial pressure increases and left atrial hypertrophy and dilatation occur
  • Consequently pulmonary venous, pulmonary arterial and right heart pressures also increase
  • The increase in pulmonary capillary pressure is followed by the development of pulmonary oedema - this is seen particularly when atrial fibrillation occurs, due to the elevation of left atrial pressure and dilatation, with tachycardia and loss of coordinated atrial contraction
37
Q

What are the causes [1] and symptoms [4] of mitral stenosis?

A

Causes:
- Rheumatic fever

Symptoms:
- Afib - lead to palpitations
- Progressive dyspnoea - due to left atrial dilation resulting in pulmonary congestion
- Systemic emboli - due to atrial fibrillation.
- Right ventricular failure: due to the development of pulmonary hypertension

38
Q

What are the signs of mitral stenosis?[5]

A
  • Mid-diastolic rumbling murmur: low velocity of blood flow (due to narrow area - rumbles way through). LENGTH OF RUMBLE CORRELATES TO THE INTENSITY
  • Loud S1 caused by thick valves closing
  • Tapping apex beat that is palpatable (due to loud S1)
  • Atrial fibrillation: left atrium can’t push through stenotic valve - disrupts electrical signal
  • Increase in JVP, basal creps, ankle oedema
39
Q
A

noncalcified valve
no mitral regurgitation
LA thrombus

40
Q

What are classifications of pathologies that cause mitral regurgitation? [3]

State which specific disease causes these within the classifications

A

Mitral valve leaflet disease
- Mitral valve prolapse (leaflets prolapse during systole)
- Rheumatic disease
- Infective endocarditis – infection. Disease / bacteria stop closure of the valve)

Subvalvar disease
- Chordal rupture (chordae tendinae)
- Papillary muscle dysfunction (usually ischaemic)
- Papillary muscle rupture

Functional MR
- LV dilatation

41
Q

Describe the signs of mitral regurgitation [5]

A
  • Pan-systolic murmur
  • Prominent third extra heart sound (S3) in congestive heart failure/left
    atrium overload
  • High pitched whistling
  • increased JVP, basal creps, ankle oedema due to backlog of blood
  • radiates to the left axilla
42
Q

What are symptoms of mitral regurgitation? [3]

A

Symptoms
Dyspnoea, orthopnoea due to increase in left atrial pressure
Palpitations due to atrial fibrillation
Systemic emboli due to static blood within dilated fibrillating left atrium predisposes to thrombosis

43
Q

What would indicate someone is suitable for mitral regurgitation surgery? [3]

What medical treatment would you conduct for mitral regurgitation? [3]

A

Surgery:
Symptoms that fail to respond to medical treatment
Worsening cardiovascular complications
pulmonary hypertension (MS)
LV dilatation (MR)

Medication:
Fluid retention - diuretics
AF (MS, MR) - digoxin, beta-blockers, verapamil
Anticoagulants to protect against systemic embolisation (AF)

Yr 2 EOYS ^2 (42 decks)

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