Week 3 CVS Flashcards

Question

CT scans can see small volume leaks under 2ml a. true b. false

Answer 1

non-contrast arterial phase (looking for bleeding, aortic aneurysm, arterial stenosis) venous phase nephrogenic phase - kidney tumours, trauma delayed/wash out - washed out of tissue except for any fibrotic tissue/liver tumours/liver still lights up

Answer 2

a. true reflect back to crystal /to electricity

Answer 3

2D mode scans anatomical plane - anatomical representation of structure most common

Answer 4

shows a fixed plane OVER TIME assess heart valve movement chamber dimension and function converts 2D image onto a time axis

Answer 5

shows the direction AND velocity of blood flow as blood flow alters the frequency of US waves returning to crytsal

Answer 6

ultrasound contrast - made from microbubbles

Answer 7

a. true thousands of xray detector around patients - less motion artefacts

Answer 8

1. hypertesnion -> damage to veins -> endothelial leak -> oedma -> increased distance between vien and tissue -> impaired healing/inflammation/damage -> ulceration -> increased distance - >

Answer 9

blood to heart

Answer 10

blood coming back through valves

Answer 11

common femerol

Answer 12

just below the knee

Answer 13

a blood clot, air bubble , object is carried into blood stream and lodges in vessel and causes an obstruction

Answer 14

blood clot forms in situ within the vascular system of the body and impedes blood flow

Answer 15

Pain Pallor Pulseless Paralysis Poikilothermal (COLD) Paraesthesia (Prickling)

Answer 16

statins - artovastatin anti-platelet - clopidogrel

Answer 17

1= normal > 0.6 claudication 0.3-0.6 rest pain <0.3 impending

Answer 18

duplex ultrasound but perform magnetic resonance angiography (MRA) before any intervention

Answer 19

True. These plaques are termed “complicated” once they rupture or fissure, or haemorrhage occurs, or a thrombus forms. These events will often lead to occlusion of the vessel lumen, and therefore cause clinical consequences (such as a stroke or myocardial infarction).

Answer 20

* rupture * fissue * haemorrhage * thrombus leads to occlusion of the vessel and clinical consequences (stroke or MI)

Answer 21

True – ACE inhibitors have been shown to benefit morbidity and mortality in heart failure. They prevent conversion of Angiotensin I to Angiotensin II, thus inhibiting the RAAS and reducing preload and afterload.

Answer 22

True – thyrotoxicosis is a rare cause of angina. It causes increased metabolic demand due to pathologically elevated thyroid hormone levels.

Answer 23

False – highly stenotic (i.e. plaques that occlude a large proportion of the lumen) plaques often have a thick fibrous cap, and are less vulnerable to rupture.

Answer 24

True – remember that cells that are deprived of oxygen will undergo anaerobic respiration. Lactate is a product of anaerobic respiration, and can be detected in a blood test. A clinical application of this is that we routinely check lactate levels in patients who have sepsis, as it gives a good indication of how “sick” a person is. Sepsis raises tissue oxygen demand and also limits oxygen delivery due to vasodilation and hypotension.

Answer 25

True – ACE inhibitors can have adverse effects on the development of the foetal renal system, and are contraindicated in pregnancy.

Answer 26

False – they are alternating bands of RBCs and platelets.

Answer 27

False – fully developed atheroma have a lipid core, surrounded by a fibrous tissue cap.

Answer 28

lipid core, surrounded by a fibrous tissue cap.

Answer 29

True. Type 2 MIs occur when there is a mismatch for whatever reason between myocardial oxygen demand and myocardial oxygen supply (eg tachycardia, anaemia, etc), but the ischaemia is NOT caused by atheromatous coronary artery disease.

Answer 30

is a mismatch for whatever reason between myocardial oxygen demand and myocardial oxygen supply (eg tachycardia, anaemia, etc), but the ischaemia is NOT caused by atheromatous coronary artery disease

Answer 31

True – chronically elevated blood cholesterol levels can damage the endothelium by increasing local production of oxygen free radicals.

Answer 32

True – the most commonly used is Glyceryl Trinitrate (GTN, or “the red spray”) which can be administered under the tongue to produce vasodilation and rapid angina relief.

Answer 33

False – this describes atherosclerosis. Careful, because the words sound very similar! Arteriosclerosis is an age-related change that involves the thickening of smooth muscle, intimal fibrosis and duplication of internal elastic laminal layer – all of which also cause luminal narrowing.

Answer 34

- age-related change that involves the thickening of smooth muscle, intimal fibrosis and duplication of internal elastic laminal layer – all of which also cause luminal narrowing.

Answer 35

True – anything that increases the coagulability of the blood will increase risk of DVT. Burns or severe trauma will increase the circulating coagulation factors in the blood as the body attempts to heal.

Answer 36

False – total occlusion of an artery often follows plaque rupture, as this exposes the highly thrombogenic plaque contents to the bloodstream and provokes thrombus formation. It causes non-reversible ischaemia, and can lead to tissue infarction.

Answer 37

False – this is usually a combination of a “supply” and a “demand” issue. As the heart rate and stroke volume increases with exercise, the oxygen demand of the tissue increases as it works harder. Supply is unable to increase to meet this demand, often due to narrowing of the coronary arteries by atheromatous disease, and the tissue becomes ischaemic. There may also be a slight reduce in supply, as the coronary arteries fill during diastole (remember that diastole is reduced as heart rate increases), but this does not cause symptoms in a healthy heart.

Answer 38

False – we tolerate a slightly higher blood pressure in people over 80, as the risks associated with multiple drug treatments including increased risk of falls becomes more of a concern. People over 80 should have a target blood pressure <145/85mmHg.

Answer 39

False – this is a clinical finding in coarctation of the aorta.

Answer 40

coarctation of the aorta

Answer 41

True – reduced cardiac output is registered by the body as reduced circulating volume, and so the salt and water is retained through RAAS activation in an attempt to raise this.

Answer 42

True – rheumatic fever causes inflammation of the heart, and this includes the endocardium, of which the valves are part. Inflammation of the valves can result in valve stenosis, regurgitation, or vegetations, all of which may be clinically detected as murmurs.

Answer 43

False – it is virtually the only cause of mitral stenosis.

Answer 44

True – this is one of the standard investigations performed in suspected acute coronary syndromes. Be aware, however, that any state which places stress on the heart (e.g. sepsis, myocarditis, severe tachycardia) can result in a troponin rise, so this is not sufficient to diagnose ACS in isolation.

Answer 45

False – the heart undergoes a process of coagulative necrosis, where the architecture of the dead tissue is largely maintained. Colliquative necrosis involves breakdown of the tissue to a liquid. If this occurred in the heart, we would see ventricular rupture post-MI much more frequently than we do (although it does happen). The brain undergoes colliquative necrosis after an infarction.

Answer 46

True – three large clinical trials have shown no benefit over medical treatment of secondary hypertension due to renal artery stenosis from atherosclerosis. This is compared to renal artery stenosis due to fibromuscular dysplasia, where hypertension can be reversed by angioplasty and stenting of the renal artery.

Answer 47

False – most commonly, the long saphenous VEIN is used.

Answer 48

True – damage to endothelial lining is the first stage of atheroma formation. This results in a chronic inflammatory response as the artery heals. These two stages occur in a cycle and result in the development of atheromatous plaques.

Answer 49

False. Regardless of whether it is from ambulatory home monitoring or in the clinic, this would be termed stage 2 hypertension.

Answer 50

False – normal myocardium will take up tracer. An absence indicates compromised blood supply to the myocardium.

Answer 51

True – this may appear after exercise during an exercise tolerance test, indicating cardiac ischaemia. ST segment depression may also indicate fixed or ongoing ischaemia, as in a Non-ST-elevation myocardial infarction (NSTEMI)

Answer 52

False – older people have lower renin levels, therefore using ACE inhibitors (drugs which block the conversion of Angiotensin I to Angiotensin II) is less likely to be effective, and they are not the firstline treatment choice in this age group.

Answer 53

False – a careful approach still needs to be taken, as overly-rapid correction of blood pressure can precipitate ischaemic events. Aim to lower blood pressure by 10-20% within the first hour, and then to 160/100mmHg over the next 6 hours.

Answer 54

False. Rheumatic fever is a disease of disordered immunity, and classically presents with inflammation of the heart and joints. This typically affects large joints, such as wrists, elbows, knees and ankles.

Answer 55

False – MIs are classified based on the presence or absence of elevation of the ST segment.

Answer 56

True – orthostatic hypotension is commonly seen in association with hypertension, and is common in the elderly. Management is tricky, and will usually involve a combination of non-pharmacological techniques, and changing drug doses and timing.

Answer 57

True – corneal arcus refers to a pale ring of lipid deposit visible in the peripheral cornea. This is most significant in young patients. It is considered normal in the elderly.

Answer 58

False – the most common source of thromboembolism originates in the deep venous system of the legs. This can travel up the vena cava to the right side of the heart, and then into the pulmonary artery, where it becomes a pulmonary embolism.

Week 3 CVS Flashcards

(87 cards)