L7+8 Cardiovascular and GI Disorders

Question 1

What produces the first heart sound (‘lub’)?

Answer 1

Closure of the AV valves (tricuspid and mitral valves)

Question 2

What produces the second heart sound (‘dub’)?

Answer 2

Closure of the semilunar valves (pulmonary and aortic valves)

Question 3

What percentage of oxygen flowing through coronary arteries does the resting heart use?

Answer 3

75%

Question 4

What are the three major determinants of myocardial oxygen demand?

Answer 4

Heart rate, left ventricular contractility, and systolic pressure/myocardial tension

Question 5

What is the normal ejection fraction of the heart?

Answer 5

55-70%

Question 6

What is coronary artery disease (CAD)?

Answer 6

Changes to blood vessels leading to loss of elasticity and narrowing of the lumen, primarily caused by atherosclerosis

Question 7

What is the difference between stable and unstable plaque?

Answer 7

Stable plaque is a fixed obstruction unlikely to rupture, while unstable plaque has a thinner fibrous cap and larger lipid core making it likely to rupture, causing platelet adhesion and thrombus formation

Question 8

What happens after 10 seconds of cardiac ischaemia?

Answer 8

Decreased myocardial function that is reversible

Question 9

What happens after several minutes of cardiac ischaemia?

Answer 9

Forced anaerobic metabolism and decreased pH

Question 10

What happens after prolonged cardiac ischaemia?

Answer 10

Tissue injury or death

Question 11

What is ischaemic heart disease (IHD)?

Answer 11

A chronic condition with recurrent transient episodes of myocardial ischaemia from narrowing of coronary artery lumen due to stable atherosclerosis and/or vasospasm

Question 12

What characterises chronic stable angina?

Answer 12

Predictable relationship between demand and ischaemia, provoked by exertion or stress, relieved within 5-10 minutes by rest or nitrates

Question 13

What is silent myocardial ischaemia?

Answer 13

Heart experiences ischaemia without the patient experiencing pain

Question 14

Why are diabetic patients prone to having atypical myocardial ischaemic symptoms?

Answer 14

Due to autonomic neuropathy with sensory denervation, a common diabetic complication

Question 15

What is variant (vasospastic/prinzmetal) angina?

Answer 15

A rare form of angina caused by spasm of the coronary arteries, usually occurring during rest/minimal exercise and at night

Question 16

What is acute coronary syndrome (ACS)?

Answer 16

A spectrum of acute ischaemic heart diseases due to disruption of atherosclerotic plaque, including unstable angina, NSTEMI, and STEMI

Question 17

What is unstable angina?

Answer 17

Formation of thrombus without complete occlusion, causing no permanent myocardial damage, with rapid onset regardless of activity, lasting >20 minutes, with little or no response to nitrates

Question 18

What is the key difference between unstable angina and myocardial infarction?

Answer 18

In unstable angina there is no death of cardiac tissue, while in MI there is death of cardiac tissue

Question 19

What is the difference between STEMI and NSTEMI?

Answer 19

STEMI has ST segment elevation on ECG and involves full occlusion causing transmural damage, while NSTEMI has no ST elevation and involves partial occlusion causing subendocardial damage

Question 20

What type of shock is most likely to result from a myocardial infarction?

Answer 20

Cardiogenic shock

Question 21

What is heart failure?

Answer 21

The inability of the heart to pump sufficiently to meet the body’s needs due to any functional or structural disorder of the heart

Question 22

What is systolic dysfunction?

Answer 22

Impaired myocardial contractility leading to decreased ejection fraction and cardiac output

Question 23

What is the most common cause of systolic dysfunction?

Answer 23

Myocardial infarction with damaged ventricle

Question 24

What is diastolic dysfunction?

Answer 24

Normal ejection fraction but impaired diastolic ventricular relaxation, leading to decreased ventricular filling, preload, stroke volume, and cardiac output

Question 25

What is the most common cause of diastolic dysfunction?

Answer 25

Hypertension causing ventricular enlargement and decreased compliance

Question 26

What is the most common cause of right ventricular failure?

Answer 26

Left ventricular failure creating backlog in pulmonary circulation

Question 27

What are the key symptoms of right-sided heart failure?

Answer 27

Jugular vein distension, peripheral oedema, congestion of viscera, liver engorgement, and possibly ascites

Question 28

What are the key symptoms of left-sided heart failure?

Answer 28

Shortness of breath, productive cough, pulmonary oedema, cyanosis, and hypoxia

Question 29

What compensatory mechanisms are activated in heart failure?

Answer 29

Sympathetic nervous system (increases HR and contractility) and renin-angiotensin-aldosterone system (increases sodium/water retention and blood volume)

Question 30

What is cardiogenic pulmonary oedema?

Answer 30

Accumulation of fluid in lung alveoli due to left heart failure, impairing gas exchange and leading to hypoxia

Question 31

What is the normal volume of fluid in the pericardial cavity?

Answer 31

Approximately 50ml

Question 32

What is pericarditis?

Answer 32

Inflammation of the pericardium, typically caused by bacterial infection, causing friction between inflamed pericardial layers

Question 33

What is the difference between fibrinous and effusive pericarditis?

Answer 33

Fibrinous involves dry coarse deposits of fibrinogen/fibrin causing friction, while effusive contains pus, serous fluid, or blood

Question 34

What is chronic/recurrent pericarditis?

Answer 34

Condition resulting in thick/stiff pericardium with fibrous, calcified scar tissue between visceral & parietal pericardium, preventing proper filling

Question 35

What is pericardial effusion?

Answer 35

Accumulation of fluid in pericardial cavity, usually from inflammatory or infectious processes

Question 36

What is cardiac tamponade?

Answer 36

Compression of heart due to fluid/blood/pus accumulation in pericardial sac, obstructing ventricular filling and decreasing cardiac output

Question 37

What is Beck's triad?

Answer 37

Muffled heart sounds, jugular vein distension (JVD), and hypotension - indicative of cardiac tamponade

Question 38

What is an aneurysm?

Answer 38

Abnormal localised dilation of a blood vessel due to weakened wall

Question 39

What is a dissecting aneurysm?

Answer 39

Tear in intimal layer allowing blood to enter vessel wall creating blood-filled cavity

Question 40

Where do approximately 90% of aortic aneurysms occur?

Answer 40

In the abdomen (AAA - abdominal aortic aneurysm)

Question 41

At what size is surgery typically considered for a dissecting aneurysm?

Answer 41

When it reaches 5.5cm or larger

Question 42

What are common causes of aortic aneurysms?

Answer 42

Atherosclerosis and vessel degeneration

Question 43

List the organs found in the abdominal cavity.

Answer 43

Stomach, liver, gallbladder, spleen, pancreas, small intestine, kidneys, large intestine, adrenal glands

Question 44

Where are the adrenal glands located?

Answer 44

Just above the kidneys

Question 45

What landmarks create the 4-quadrant division of the abdomen?

Answer 45

Vertical midline from xyphoid process to symphysis pubis, and horizontal line across the umbilicus

Question 46

Name the 4 abdominal quadrants.

Answer 46

RUQ (Right Upper), LUQ (Left Upper), RLQ (Right Lower), LLQ (Left Lower)

Question 47

Which method is more precise for describing abdominal locations: 4-quadrant or 9-region?

Answer 47

9-region method

Question 48

What is the medical term for heartburn?

Answer 48

Pyrosis

Question 49

What is the main pathophysiological cause of GORD?

Answer 49

Transient relaxation of weak oesophageal sphincter causing backflow of gastric contents

Question 50

Where is GORD pain typically located?

Answer 50

Epigastric and retrosternal areas

Question 51

What serious complication can arise from chronic GORD?

Answer 51

Barrett's oesophagus and increased risk of oesophageal cancer

Question 52

What percentage of hiatus hernias are sliding/axial type?

Answer 52

95%

Question 53

What is a hiatus hernia?

Answer 53

Protrusion of the stomach through the oesophageal hiatus

Question 54

What condition commonly leads to oesophageal varices?

Answer 54

Cirrhosis causing portal vein hypertension

Question 55

What is the major risk of oesophageal varices?

Answer 55

Subject to rupture causing massive, sometimes fatal haemorrhage

Question 56

What is the definition of gastritis?

Answer 56

Inflammation of gastric mucosa

Question 57

Name three causes of acute gastritis.

Answer 57

Bacterial infection, aspirin/NSAIDs, alcohol

Question 58

What bacterium is a major cause of peptic ulcers?

Answer 58

Helicobacter pylori

Question 59

What are three serious complications of peptic ulcers?

Answer 59

Haemorrhage, bacterial peritonitis, GI tract obstruction

Question 60

What are the primary manifestations of gastroenteritis?

Answer 60

Diarrhoea and/or vomiting

Question 61

How long does gastroenteritis typically last?

Answer 61

Less than 7 days but no more than 14 days

Question 62

What are the main complications of gastroenteritis?

Answer 62

Dehydration, shock, and death

Question 63

What is the hallmark feature of IBS?

Answer 63

Abdominal pain relieved with bowel motion

Question 64

What percentage of the world population has IBS?

Answer 64

Up to 20%

Question 65

Which part of the GI tract does Crohn's disease most commonly affect?

Answer 65

Small intestines (can affect anywhere)

Question 66

Which condition is isolated to the rectum and large intestines?

Answer 66

Ulcerative colitis

Question 67

What appearance does Crohn's disease give to the intestinal wall?

Answer 67

Cobblestone appearance

Question 68

Define diverticulum.

Answer 68

Herniation of mucosa through muscle layer of colon wall

Question 69

What is the difference between diverticulosis and diverticulitis?

Answer 69

Diverticulosis: diverticula present but asymptomatic; Diverticulitis: inflamed/perforated diverticula

Question 70

Name three causes of diverticular disease.

Answer 70

Low residual diet, irregular bowel habits, aging

Question 71

What is the most common cause of appendicitis?

Answer 71

Calcified faecal 'stone'

Question 72

What age group typically gets appendicitis?

Answer 72

5-30 years, but can occur at any age

Question 73

What is the life-threatening complication of appendiceal rupture?

Answer 73

Peritonitis

Question 74

What are the two types of intestinal obstruction?

Answer 74

Mechanical and functional

Question 75

Why is strangulated hernia life-threatening?

Answer 75

Cuts off blood supply to small intestine, can lead to perforation and gangrene

Question 76

What are the two types of peritonitis?

Answer 76

Chemical and bacterial

Question 77

What are the three layers of the peritoneum?

Answer 77

Outer (parietal), inner (visceral), and peritoneal cavity (space between)

Question 78

At what percentage of hepatic functional capacity loss does liver failure occur?

Answer 78

80-90%

Question 79

What is fetor hepaticus?

Answer 79

Musty, sweetish breath odour in advanced liver failure

Question 80

What causes gynecomastia in liver disease?

Answer 80

Inability to metabolise oestrogen normally, creating hormone imbalance

Question 81

What is the medical term for gallstones?

Answer 81

Cholelithiasis

Question 82

What percentage of acute cholecystitis cases are associated with gallstones?

Answer 82

85-90%

Question 83

What is biliary colic?

Answer 83

Dull pain in URQ due to gallstones, coming in waves

Question 84

What causes acute pancreatitis?

Answer 84

Auto-digestion of pancreatic tissue by prematurely activated enzymes

Question 85

Name two main causes of acute pancreatitis.

Answer 85

Alcohol abuse and gallstone obstruction

Question 86

What happens when chronic pancreatitis damages the islets of Langerhans?

Answer 86

Diabetes mellitus (affected insulin secretion)

Question 87

What is renal colic?

Answer 87

Colicky pain from stretching of collecting system or ureter

Question 88

How is renal colic pain often described?

Answer 88

One of the most severe pains, begins in flank and radiates

Question 89

What does frank blood in stool indicate?

Answer 89

Lower GI bleed (bright red blood)

Question 90

What is melena?

Answer 90

Dark, tar-like stool indicating upper GI bleed

Question 91

What is coffee ground vomitus?

Answer 91

Vomitus that looks like coffee grounds, indicating lower GI bleed

Question 92

What is the most common site for ectopic pregnancy?

Answer 92

Fallopian tubes

Question 93

At what gestational age does ectopic pregnancy typically occur?

Answer 93

Before 12 weeks gestation

Question 94

What is the classic presentation of ectopic pregnancy?

Answer 94

Severe unilateral abdominal pain, shock, missed menstrual period

Question 95

What is pyrosis?

Answer 95

Medical term for heartburn

Question 96

What is emesis?

Answer 96

Vomiting

Question 97

What is encephalopathy?

Answer 97

Brain damage or disease

Question 98

What is ascites?

Answer 98

Fluid accumulation in the abdomen

Question 99

What is the difference between epigastric and retrosternal?

Answer 99

Epigastric = above the stomach; Retrosternal = behind the sternum

Question 100

What can GORD be easily confused with?

Answer 100

Angina

Question 101

What are the classic symptoms of acute abdomen?

Answer 101

Sudden, severe abdominal pain likely requiring surgery

Question 102

Why is UTI a common cause of sepsis?

Answer 102

It's one of the most common reasons for abdominal pain and frequently leads to infection spread

Question 103

What additional consideration should be made for women of childbearing age presenting with abdominal pain?

Answer 103

Ectopic pregnancy, especially if presenting with shock and severe unilateral pain