Problem of the week

Question 1

What does a thrill feel like?

Answer 1

buzzing

Question 2

What type of murmur is mitral regurgitation?

Answer 2

systolic

Question 3

What type of murmur is aortic stenosis?

Answer 3

systolic

Question 4

What are the five stages of the cardiac cycle?

Answer 4

• passive filling
• atrial contraction
• isovolumetric ventricular contraction
• ventricular ejection
• isovolumetric ventricular relaxation

Question 5

What do statins do?

Answer 5

competitive inhibitor of HMG CoA reductase in the liver - decrease in hepatocyte cholesterol synthesis causes compensatory increase in LDL receptor and LDL clearance

Question 6

What do fibrates do?

Answer 6

stimulates activity of lipoprotein lipase (LPL) to increase breakdown of TAGs (via nuclear receptor (PPARα) to enhance the transcription of several genes, including that encoding LPL)

Question 7

What do PCSK9 inhibitors do?

Answer 7

monoclonal antibody inhibits binding of PCSK9 to LDLR, so increases number of LDLRs available to clear LDL, thereby lowering LDL-C levels

Question 8

What do bile acid binding resins do?

Answer 8

• cause the excretion of bile salts resulting in more cholesterol to be converted to bile salts by interrupting enterohepatic recycling
• cause decreased absorption of TAGs and increase LDL receptor expression

Question 9

What does Ezetimibe do?

Answer 9

inhibits NPC1L1 transport protein in enterocytes of the duodenum, reducing the absorption of cholesterol

Question 10

What do diuretics do?

Answer 10

block Na reabsorption in the kidneys

Question 11

What do beta blockers do?

Answer 11

block B1 and B2 receptors, reduce sympathetic activity, reduce renin release, reduce CO

Question 12

What do calcium channel blockers do?

Answer 12

block L-type Calcium Channels in vascular smooth muscle cells to prevent contraction and vasoconstriction

Question 13

What do angiotensin receptor blockers do?

Answer 13

block the agonist action of AT-II on receptors in a competitive manner

Question 14

What do potassium channel openers do?

Answer 14

cause hyperpolarization in vascular smooth muscle to promote relaxation and vasodilation

Question 15

What do alpha blockers do?

Answer 15

cause vasodilation by blocking vascular alpha 1 adrenoceptors - reduce sympathetic transmission and decrease MABP

Question 16

What so mineralocorticoid antagonists do?

Answer 16

block aldosterone receptors

Question 17

What are the common causes of peripheral vascular disease?

Answer 17

atherosclerosis is the most common
smoking
hypercholesterolaemia
hypertension
diabetes

Question 18

What vascular diseases is diabetes linked to?

Answer 18

retinopathy
nephropathy
neuropathy

Question 19

What are the clinical signs of limb ischaemia?

Answer 19

pale and cold
weak or absent pulses.
limb hair loss, skin changes (atrophic skin, ulceration, or gangrene
thickened nails

Question 20

What are the names of the pulses in the legs?

Answer 20

popliteal, femoral, dorsalis pedis, posterior tibial

Question 21

What are the 6Ps of limb ischaemia?

Answer 21

pain, pallor, paleness, perishingly cold, paraesthesia, paralysis

Question 22

What are the main drugs used to treat angina?

Answer 22

beta-blockers
calcium channel blockers
vasodilators
ivabradine
metabolic modulator

Question 23

What do beta blockers do relative to angina treatment?

Answer 23

slow heart beat, decreases preload and afterload, reduce RAAS activity, less vasoconstriction

Question 24

What do calcium channel blockers do relative to angina treatment?

Answer 24

block calcium channels - decreased contraction rate which increases efficiency and decreases myocardial strain

Question 25

What do vasodilators do relative to angina treatment?

Answer 25

dilate veins, more blood getting to areas of ischemia, decreases afterload

Question 26

What does Ivabradine do relative to angina treatment?

Answer 26

reduces pacemaker potential, takes longer to reach threshold so slows heart rate

Question 27

What do metabolic modulators do relative to angina treatment?

Answer 27

decreases calcium load on heart, slows heart rate and strain on heart

Question 28

What are the symptoms of DVT?

Answer 28

● pain, swelling and tenderness in one of your legs (usually your calf) ● a heavy ache in the affected area. ● warm skin in the area of the clot. ● red skin, particularly at the back of your leg below the knee

Question 29

What are the risk factors for venous thrombosis?

Answer 29

- surgery - lower-extremity paralysis due to spinal cord injury - lower long bone fracture - multiple trauma - prolonged immobility - contraceptive pill

Question 30

What is the pathology of DVT?

Answer 30

Thrombus formation and propagation depend on the presence of abnormalities of blood flow, blood vessel wall, and blood clotting components, known collectively as Virchow's triad

Question 31

What is an aneurysm?

Answer 31

Abnormal and persistent dilation of an artery due to a weakness in its wall

Question 32

What are the causes of aneurysm?

Answer 32

Mycotic, atherosclerotic, dissecting, congenital, arteriovenous, traumatic, syphilitic

Question 33

What are the complications of aneurysm?

Answer 33

rupture (6cm), thrombosis (result of stasis), embolism, pressure erosion of adjacent structures (not common anymore - associated with syphilis), infection

Question 34

What are the causes of atheroma?

Answer 34

``` ● Cigarette Smoking ● Hypertension ● Hyperlipidaemia ● Diabetes ● Age (older) ● Sex (males) ● Genetics ```

Question 35

What ate the effects of hypertension?

Answer 35

damage to kidneys, eyes and brain

Question 36

What is a list of differential diagnoses for acute chest pain?

Answer 36

``` ●Acute coronary syndromes including myocardial infarction ●Pulmonary embolism ●Aortic dissection ●Pneumothorax ●Herpes Zoster (shingles) ●Pericarditis ●Heartburn ●Oesophageal spasm ```

Question 37

What other conditions can troponin be raised in?

Answer 37

- hypertension - renal failure - sepsis - PE - stroke - pericarditis - post-arrhythmia

Question 38

What are the contraindications for thrombolysis?

Answer 38

``` ●suspected aortic dissection ●recent haemorrhage ●major surgery or trauma within previous two weeks ●active peptic ulceration ●CVA in previous six months ●uncontrolled hypertension ●aggressive CPR ●warfarin therapy ```