Week 4

Question 1

What does the coronary venous blood drain into?

Answer 1

The coronary sinus into the right atrium

Question 2

What are some of the special features of the coronary circulation?

Answer 2

High basal blood flow
High capillary density
High oxygen extraction

Question 3

What is the only way to increase perfusion of the heart?

Answer 3

Increasing oxygen flow to the heart y increasing blood flow due to the extraction of o2 from haemoglobin already being max

Question 4

What changes in gas and metabolic contents cause vasodilation of the coronary arteries?

Answer 4

If Po2 decreases

Adenosine from ATP degradation

Question 5

Why can tachycardia led to poor perfusion of the heart and chest pain?

Answer 5

Due to perfusion of the left coronary arteries occurring during diastole and the tachycardia shortening diastole. Results in poor perfusion. These are perfused during diastole due to the high pressure during systole constricting sudendocardial blood flow

Question 6

What arteries make the circle of willis

Answer 6

Basilar artery (from vertebral arteries made from the subclavian arteries) and carotid arteries anastamosing

Question 7

What is the effect on cerebral blood flow to increased MAP?

Answer 7

Vasoconstriction to avoid damage of vessels

Question 8

What is the effect of A. increased B. Decreased carbon dioxide in cerebral circulation

Answer 8

A. Increased Co2; cerebral vasodilation

B. Decreased co2; cerebral vasocontriction

Question 9

Describe the physiology behind someone hyperventilating fainting

Answer 9

As they have a decreased Pco2 the cerebral vessels constrict so o2 doesnt flow to the brain causing fainting

Question 10

A young athlete suddenly dies, histologically the heart had swirled myofibres. What did they have?

Answer 10

Hypertrophic cardiomyopathy

Question 11

A man presents with multiple myeloma, and has had developed arrhythmias. What type of cardiomyopathy has he developed?

What stain could be used histologically to confirm the diagnosis?

Answer 11

Restrictive cardiomyopathy due to amyloidosis (deposition of paraproteins) reducing compliance

Histologically; congo red stain positive

Question 12

Women presents with long history of alcohol missuse and is undergoing chemotherapy with doxorubicin. She has breathlessness, fatigue and chest discomfort. Histologically on the heart there is no signs. What is the diagnosis?

Answer 12

Dilated cardiomyopathy

Question 13

What heart valve can be affected in a person that has had rheumatic fever ?

Answer 13

Mitral valve to be stenosed

Question 14

What viral infections can cause myocarditis?

Answer 14

Coxsackie A/B

ECHO virus

Question 15

What are the common causes of endocarditis?

Answer 15

Congenital defects\
Rheumatic fever
Prosthetic valves

Question 16

What action aggrevates pericarditis?

Answer 16

Posture related

Question 17

What is the function of statins?

Answer 17

To reduce cholesterol

Question 18

What are the two revascularisation techniques?

Answer 18

Cardiac cathetrisation

Coronary angioplasty

Question 19

Describe cardiac catheterisation

Answer 19

Insertion of a catheter (hollow tube) into a chamber or vessel of the heart

Question 20

Describe coronary angioplasty (PCI)

Answer 20

Using a balloon to stretch open a narrowed of blocked artery with a stent on the outside

Question 21

What does the internal mammary artery supply? (Internal thoracic artery

Answer 21

Supplies anterior chest wall and breasts

Question 22

What is cardioplegia

Answer 22

The intentional cessation of cardiac activity for cardiac surgery

Question 23

A catheter was inserted to inject contrast dye into the vessels of the heart to identify their structure and see if there were any occlusions. What diagnostic test is this called?

Answer 23

Coronary angiography

Question 24

Define an aneurysm

Answer 24

Dilation of a vessel by more than 50% of normal diameter by all its layers without a breach in the wall

Question 25

What is the epidemiology of people with aneurysms

Answer 25

Elderly, male, smoker, hypertensive

Question 26

Symptoms of abdominal aortic aneurysm?

Answer 26

Central chest pain perhaps mimicing renal colic When ruptures can radiate to the back

Question 27

Male elderly patient with past history of smoking and hypertension presents with central pain in chest with a pulsatile mass. What investigations do you order?

Answer 27

Suspect AAA Duplex ultrasound and CT angiogram

Question 28

What are the 6 P’s of acute limb ischaemia

Answer 28

``` Pain Pallour Pulseless Perishingly cold Paraesthesia (pins and needle) Paralysis ```

Question 29

If you suspect acute limb ischaemia what investigations should you order?

Answer 29

Arterial imaging | CT angiogram

Question 30

Man presents with lower left leg feeling extremely cold, with lack of function, pulseless and painful; what is your treatment?

Answer 30

Embolectomy If it was swollen a fasciotomy may be appropriate

Question 31

What is diabetic neuropapthy?

Answer 31

Nerve damage secondary to diabetes

Question 32

What types of infectious organisms can cause diabetic foot sepsis?

Answer 32

Staph aureus E coli Enterobacteria

Question 33

Diabetic presents with a swollen foot with black patches, that is tender and ulcerated. The ulcer is pussing and the foot looks angrily red. In the redder tissues there are crepitations. What is the diagnosis?

Answer 33

Diabetic foot sepsis

Question 34

Lady presents with possible lower limb ischaemia, investigations and potential treatment?

Answer 34

Comparative BP in legs Duplex ultrasound scanning MRI Treamtnet Aspirin, statins, ace inhibitors, potential surgery or amputations

Question 35

What are the components of an arterial embolism?

Answer 35

Mostly platelet rich due to high blood flow

Question 36

What is the components of a venous embolism

Answer 36

Mainly RBCs due to stasis

Question 37

What is the function of the drugs apixaban and rivaroxaban?

Answer 37

They are Xa inhibitors so prevent clot formation in the coagulation cascade

Question 38

What are the components in virchows triad?

Answer 38

Hypercoaguable state Endothelial injury Circulatory stasis

Question 39

What is an ischaemic stroke? What is it caused by?

Answer 39

Where a clot blocks blood flow to an area of the brain Caused by thrombus, embolism and hypoperfusion

Question 40

What is haemorrhagic stroke? What can it be caused by?

Answer 40

Where bleeding is inside the brain causing an increase in pressure and decreased blood flow to an area Can be caused by hypertension, aneurysm, trauma

Question 41

What increases the risk of stroke?

Answer 41

Hypertension, TIA (transient ischemic attack), smoking, hyperlipidaemia, atrial fibrillation, obesity, smoking

Question 42

What is TIA

Answer 42

Transient ischaemic attack Brief episode of neurological dysfunction caused by loss of blood flow in the brain, spinal cord or retina without tissue death

Question 43

If you suspect stroke what investigations would you do

Answer 43

CT brain angiography, MRI with diffusion weight insquence Blood tests; to investigate cause of thrombosis or embolism so lipids, glucose, thrombophillia, hypertension

Question 44

Describe treatment of a stroke

Answer 44

If its been less than 4 hours then treat with thrombolysis medication to dissolve the clot e.g streptokinase If more than this leading to 6 hours use thrombectomy to remove the clot surgically If clot from the heart use anticoagulation like rivaroxaban, dabigatran, apixaban and edoxaban

Question 45

What are the common infectious causes of endocariditis?

Answer 45

HACEK Haemophilus, actinobacillus, cardiobacteria, eikenella, kingella

Question 46

What is included in virchows triad?

Answer 46

Hypercoaguable stgate Endothelial injury Circulatory stasis

Question 47

Pleuritic cardiac pain is aggrevated by what ?

Answer 47

Breathing deeply, it is a sharp catching pain

Question 48

What are some examples of Xa inhibitors in the coagulation cascade?

Answer 48

Apixaban and rivaroxaban