Diseases

Question 1

What are the different types of shock?

Answer 1

Hypovolaemic (haemorrhagic and non-haemorrhagic)
Cardiogenic
Obstructive
Distributive (neurogenic and vasoactive)

Question 2

Describe what happens in hypovolaemic shock.

Answer 2

Loss of blood volume
Resulting in decreased blood volume, venous return, end diastolic volume, stroke volume, CO and decreased blood pressure.
Causing inadequite tissue perfusion.

Question 3

What is shock?

Answer 3

A systemic decrease in blood flow causing whole body circulatory failure leading to cellular failure.

Question 4

What happens if there isn’t enough oxygen being delivered to cells?

Answer 4

Anaerobic metabolism will occur, leading to a decrease in ATP production and an increase in lactic acid. This is toxic to cells, so will result in multiple organ failure and death.

Question 5

What is adequate tissue perfusion dependent on?

Answer 5

Adequate bp
Adequate CO
Therefore adequate SVR, SV and HR are required

Question 6

What determines SV?

Answer 6

Preload (which is determined by venous return)
Myocardial contractility
Afterload

Question 7

How would someone with haemorrhagic shock present?

Answer 7

Decreased MAP
Cool peripheries
Tachycardic
Small volume pulse

Question 8

Describe what happens in cardiogenic shock.

Answer 8

There is decreased cardiac contractility.
Causing decreased stroke volume.
Which decreases CO and BP.
Leading to inadequate tissue perfusion.

Question 9

In cardiogenic shock there is no decrease in volume. True or false?

Answer 9

True

Question 10

Describe what happens in obstructive shock caused by tension pneumothorax.

Answer 10

Intrathoracic pressure increases causing decreased venous return (remember venous blood wants to flow high to low pressure), causing decreased EDV,
Causing decreased stroke volume.
Causing decreased CO and bp
Causing inadequate tissue perfusion.

Question 11

Describe what happens in neurogenic shock.

Answer 11

Loss of sympathetic tone to blood vessels and heart.
Causing massive venous and arterial vasodilatation.
Causing decreased venous return, SVR, HR.
Causing decreased CO and BP
Resulting in inadequate tissue perfusion

Question 12

What characterises neurogenic shock?

Answer 12

A decreased heart rate

Question 13

Describe what happens in vasoactive shock.

Answer 13

Release of vasoactive mediators.
Causing a massive venous and arterial vasodilatation and increasing capillary permeability.
Causing decreased venous return and SVR/
Causing decreased CO and BP
Resulting in inadequate tissue perfusion.

Question 14

What are the general symptoms of valvular heart disease?

Answer 14

Chest pain
Breathlessness
Collapse/dizzy spells

Question 15

What is the New York Heart Association Functional classification used for?

Answer 15

To assess the severity and degree of heart failure by assessing breathlessness

Question 16

What are the general signs of right-sided heart failure?

Answer 16

Raised JVP
Pitting oedema in the ankles and sacrum
Hepatic congestion

Question 17

What are the general signs of valvular disease?

Answer 17

Apex beat:
- tapping (mitral stenosis)
- displaced (in left ventricular dilatation)
- heaving and displaced (left ventricular hypertrophy)
Parasternal heave

Question 18

What could a parasternal heave be due to?

Answer 18

Right ventricular overload.
Cor pulmonale
Pulmonary hypertension
Congenital heart disease

Question 19

What is a murmur?

Answer 19

Audible turbulent blood flow giving a whoosh sound.

Question 20

What is a thrill?

Answer 20

A palpable murmur

Question 21

What does S1 indicate?

Answer 21

The start of systole due to the tricuspid and mitral valves closing

Question 22

What does S2 indicate?

Answer 22

The end of systole and the beginning of diastole due to the closing of the aortic and pulmonary valves

Question 23

Which type of murmur coinside with the carotid pulse?

Answer 23

Systolic

Question 24

Define myocarditis, endocarditis and pericarditis.

Answer 24

Myocarditis - inflammation of the myocytes
Endocarditis - inflammation of the endothelium of the valves
Pericarditis - inflammation of the pericardium

Question 25

what are the symptoms of myocarditis?

Answer 25

Fever Chest pain SOB Palpitations

Question 26

what are the signs of myocarditis?

Answer 26

arrhythmias | cardiac failure

Question 27

what is myocarditis most commonly caused by?

Answer 27

enterovirus

Question 28

how do you diagnose myocarditis normally?

Answer 28

viral PCR

Question 29

what is a bacteraemia?

Answer 29

Bacteria in the bloodstream

Question 30

what can bacteraemia cause?

Answer 30

septic shock and death

Question 31

what are the signs of a generator pocket infection?

Answer 31

``` localised cellulitis pain swelling discharge wound breakdown ```

Question 32

what are the non-specific signs and symptoms of infective endocarditis?

Answer 32

``` Fever chills night sweats malaise anorexia ```

Question 33

what investigations should be done if endocarditis is suspected?

Answer 33

Blood culture then echo but if blood culture -ve then use serology

Question 34

Describe when and how many blood cultures should be taken.

Answer 34

taken prior to starting antibiotics | three sets optimally filled should be taken from peripheral sites at different times (only 2 if severe sepsis)

Question 35

If it is early prosthetic valve endocarditis, what bug is usually responsible?

Answer 35

Staphylococcus epidermidis or staph aureus

Question 36

Gram +ve is ___ | and gram -ve is ___

Answer 36

``` +ve = purple -ve = pink ```

Question 37

What is the treatment for prosthetic valve endocarditis?

Answer 37

vancomycin and gentamicin (for added effect)

Question 38

Describe the differences in endocarditis for PWID? (3)

Answer 38

affects the RHS affects the tricuspid valve normally staph aureus plus septic emboli

Question 39

How can endocarditis be prevented?

Answer 39

pre-surgery prophylaxis antibiotics

Question 40

what is the mortality of endocarditis?

Answer 40

up to 25%

Question 41

which valve and side of the heart is usually affected in endocarditis?

Answer 41

mitral and aortic valves | LHS

Question 42

list the 4 most common causes of endocarditis.

Answer 42

Staphylococcus aureus Viridans group streptococci Enterococcus sp Staphylococcus epidermidis

Question 43

What is staph epidermidis normally caused due to?

Answer 43

Plastic or metal or skin contaminant

Question 44

How do you detect a-typical causes of endocarditis?

Answer 44

Serology - antibody detection blood test

Question 45

Give and example of an a-typical organism causing endocarditis

Answer 45

coxiella burnetii bartonella legionella

Question 46

What is the treatment for fungi caused endocarditis?

Answer 46

immediate surgery as antibiotics wont work

Question 47

what are predisposing factors to endocarditis? (4)

Answer 47

Heart valve abnormality (calcification/sclerosis in elderly, CHD, post rheumatic fever) prosthetic heart valve IV drug user IV lines

Question 48

You can get endocarditis from poor dental hygeine/dental treatment. True or false

Answer 48

True

Question 49

What can happen if vegitation forms in a patient with endocarditis?

Answer 49

it can break off causing septic emboli to enter the lungs or brain for example. Or cause abscess or haemorrahge

Question 50

what are the symptoms of acute endocarditis?

Answer 50

severe sepsis and cardiac failure

Question 51

What are the sub-acute symptoms of endocarditis?

Answer 51

``` Fever malaise weight loss tiredness SOB ```

Question 52

what are the signs of sub-acute endocarditis? (9)

Answer 52

``` Fever new or changing murmur finger clubbing splinter haemorrhages splenomegaly roth spots Janeway lesions Osler nodes Microscopic haematuria ```

Question 53

How is endocarditis diagnosed?

Answer 53

Two positive blood cultures with organisms typical for infective endocarditis then an echo. BUT if serology -ve then serology

Question 54

what is the empirical treatment of native valve endocarditis?

Answer 54

Amoxicillin and gentamicin IV

Question 55

what is the empirical treatment of prosthetic valve endocarditis?

Answer 55

vancomycin and gentamicin IV add rifampicin in day 3-5 often valve replacement too

Question 56

what is the treatment for endocarditis in PWID?

Answer 56

Flucloxacillin IV

Question 57

what is the specific treatment for staph aureus in endocarditis?

Answer 57

flucloxacillin IV

Question 58

what is the specific treatemnt for viridans strep in endocarditis?

Answer 58

benzylpenicillin and gentamicin IV

Question 59

what is the specific treatment for enterococcus sp in endocarditis?

Answer 59

Amoxicillin/vancomycin and gentamicin IV

Question 60

what is the specific treatment for staph epidermidis in endocarditis?

Answer 60

Vancomycin and gentamicin IV and rifampicin

Question 61

Cocci in chains is?

Answer 61

Streptococci (like a strip)

Question 62

Cocci in clusters is?

Answer 62

staphylococci

Question 63

If alpha haemolytic strep (green) think? in endocarditis

Answer 63

Viridans group strep

Question 64

what is hypovolaemic shock due to? list examples (4)

Answer 64

loss of blood volume | eg: haemorrhage, vomiting, diarrhoea, excessive sweating

Question 65

what is cardiogenic shock due to?

Answer 65

the heart not pumping effectively: sustained hypotension due to decreased cardiac contractility

Question 66

what could cause obstructive shock?

Answer 66

(tension) pneumothorax

Question 67

what is neurogenic shock due to?

Answer 67

loss of sympathetic tone to the blood vessels and heart

Question 68

what causes vasoactive shock?

Answer 68

release of vasoactive mediators (causing vasodilation)