Week 3 Flashcards
Describe the pathogenesis of the formation of an atherosclerotic plaque
- Endothelial damage
- CAM expression increases
- T lymphocytes and monocytes attach to endothelial cells
- Migrate through the wall to the sub-endothelial space
- Macrophages eat oxidised LDL
- Then becoming lipid rich foam cells
- Which then becomes a fatty streak leading to a fibrous plaque
What are some risk factors for atherosclerosis?
Increased total cholesterol Smoking Inactivity Hypertension Unhealthy eating Deprivation Age Family history
How do statins reduce the risk of atherosclerosis?
By reducing the total cholesterol by inhibiting HMG-CoA pathway, causing LDL to be required in the liver (for its cholesterol) so it is uptaken from the peripheral tissues hence making it less likely to be deposited in the wall
What is a clinical marker of hyperlipidemia?
Xanthelasma (deposits of cholesterol in eye)
Tendon xanthomas (dilation of tendon due to lipid deposits)
Tuberous xanthomas (lipid in dermis)
Eruptive xanthomas (reddish yellow papules on butt)
What conditions can cause an increase in blood pressure?
Conns syndrome (excess aldosterone that increases salt and fluid retention)
Cushings syndrome (producing excess corticoidsteroid that increases salt and fluid retention)
Phaechromocytoma (producing excess adrenaline)
During endothelial damage, what does the collagen exposed bind to causing clotting?
Glycoprotein Ia/IIb on platelets causing psuedopods to extend
What do the coagulation cascade factors require to work?
Vitamin K
Give examples of anti-thrombotic endogenous agents?
Protein C
Protein s
Antithrombin III
Define ischaemia
Restriction of blood supply to tissues causing shortage of oxygen usually caused by blood vessel damage
What are some of the risk factors for high blood pressure?
Obesity, smoking, diabetes, age, end organ damage, vascular disease
Describe some secondary causes of hypertension?
Obstructive sleep apnoea (as sympathetic drive always stimulated)
Phaechromocytoma (excess adrenaline so get high BP, tachycardia, pale)
Renal artery stenosis (as if not high enough perfusion increases BP to compensate)
Fibromuscular dysplasia (young women)
If you suspect someone to have high BP what should you do first:?
Give them ambulatory BP monitor
Man 55 years presents with high blood pressure following ambulatory BP monitor usage. What is your next line of treatment/ investigation?
Calcium channel blocker like amlodipine
Man 55 years presents with high blood pressure following ambulatory BP monitor usage and treatment with amlodipine. What is your next line of treatment/ investigation?
Calcium channel blocker (amlodipine)
And ACE inhibitor like bisopril
Man 55 years presents with high blood pressure following ambulatory BP monitor usage and treatment with amlodipine and bisopril. What is your next line of treatment/ investigation?
Add a thiazide like diuretic like bendrofluazide
What is the role of thromboxan A2 in coagulation of the blood?
Secreted from platelets to. cause;
- vasoconstriction of smooth muscle
- mediate release of serotonin to act on GPCR purine receptors which cause activation of platelets to aggregate.
- Cause exposure of acidic phospholipids to cause solid clot formation
Name some of the structure founhd in the posterior mediastinum
Oesophagus Vagus nerves Thoracic duct Azygous vein Sympathetic trunks Aorta
Where does the lymph from the upper left quadrant and lower limbs drain into? Where is this located?
The thoracic duct leading into the left venous angle composed of the internal jugular vein and the subclavian veins.
Located between the azygous vein and the oesophagus (duck between two gooses)
What lymph nodes are present in the lung roots?
The bronchopulmonary nodes
What lymph nodes lie in the mediastinum at the bifurcation of the trachea? What is the significance of these nodes?
Tracheo-bronchial nodes
When inflamed will compress the reccurent laryngeal nerve supplying the voice box causing hoarseness of voice
What is the compostion of arterial thrombus? How would you treat for them (what medication)
White composed mainly of platelets in a fibrin mesh
Treat with antiplatelet
What is the composition of venous thrombus? How would you treat for them (medicaiton)
Red thrombus made of mainly rbcs in a fibrin mesh
Treat with anticoagulants
