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CSI year 2 > Case 14 NHS Health Check > Flashcards

Case 14 NHS Health Check Flashcards

1
Q
  • The NHS Health Check can tell you whether you’re at higher risk of getting certain health problems such as what?
A

Heart Disease

Diabetes

Kidney Disease

Stroke

Discuss how to reduce Dementia

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2
Q
  • What questions are asked by a health professional - often a nurse or healthcare assistant in an NHS Health Check?
  • What examinations are done by a health professional - often a nurse or healthcare assistant in an NHS Health Check?
A

Questions about your lifestyle
Questions about family history

Measurement of height and weight - calculate BMI
Take blood pressure
Do blood test - done either before or at the check

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3
Q
  • What can the personalised advice to improve your risk given in an NHS Health Check include?
A

How to improve your diet and the amount of physical activity you do

Taking medicines to lower your blood pressure or cholesterol

How to lose weight or stop smoking

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4
Q
  • If you are between what age are you invited to have a free NHS Health Check every 5 years?
A

40-74 and do not already have a pre-existing condition

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5
Q
  • Why does arterial pressure lead to vascular function and structural changes?
A

Arterial pressure → peripheral resistance → vascular structure changes and vascular function changes

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6
Q
  • What are two systemic effects of hypertension on the brain
A

TIA
Stroke

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7
Q

What are two systemic effects of hypertension on visual system

A

Retinopathy - main reason to be screened

Optic neuropathy - damage to optic nerve

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8
Q

What are two systemic effects of hypertension on renal system

A

glomerulosclerosis

kidney failure

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9
Q

What are two systemic effects of hypertension on the cardiac system

A

left ventricular hypertrophy

coronary artery disease

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10
Q

what are two microvascular effects of hypertension

A

atherosclerosis

aneurysm

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11
Q
  • Why is first BP measurement usually higher than normal and how do you avoid this?
A

It can be due to stress - ‘white coat’ hypertension when they see a healthcare professional

Best out of 3 taken

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12
Q
  • If BP still high even after best of 3, what is done?
  • If still high BP, what is done next?
  • If BP still high after this, what should be done?
A

24hr Ambulatory BP monitoring at comfort of home
or monitor self 2x in one day then 1x at night

Lifestyle advice - exercise, circulation to skin and muscles for vasodilation and increased Renal function
eat less salt

Give medication

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13
Q
  • What 4 things should be offered to all patients with hypertension?
A

Test for presence of protein in urine by sending a urine sample for estimation of albumin: creatinine ratio and test for haematuria using a reagent strip

Take a blood sample to measure glycated haemoglobin (HbA1c), electrolytes, creatinine, estimated glomerular filtration rate, total cholesterol and HDL cholesterol

Examine the fundi for the presence of hypertensive retinopathy

Arrange for a 12 lead ECG to be performed

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14
Q
  • Describe the order of the 5 electrical events in the cardiac cycle
A

SN node signal → Atrial contraction → AVN node signal → Ventricular Depolarisation → Ventricular Repolarisation

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15
Q
  • What is the name of the cell types in the SAN?
  • What is the name of the wave created by the SAN?
A

Autorhythmic myocytes

P wave

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16
Q
  • How is the AVN signal represented on ECG and is this a slow or fast signal?
A

Isoelectric line

Slow transduction to allow ventricular filling before contraction

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17
Q
  • What wave does the depolarisation of the Bundle of His show on ECG and is this slow or fast signal?
A

Isoelectric line

Fast as it is insulated

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18
Q
  • What occurs in the Q wave?
  • What does the R wave show?
  • What does the S wave show?
A

Shows septal depolarisation via bundle branches

Ventricular depolarisation by Purkinje fibres

Late ventricular depolarisation and this is in opposite direction to lead II

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19
Q

Where do the Chest Leads go

A

V1- Right sternal border 4th Intercostal Space

V2- Left sternal border 4th Intercostal Space

V3- halfway between V2 and V4

V4- Mid clavicular line, 5th intercostal space

V5- Anterior axillary line, level of V4

V6- Mid axillary line, level of V4

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20
Q
  • Which direction does electrical conduction travel from and to?
A

From negative electrode to positive electrode as depolarisation leads to a lower intracellular charge compared to extracellular charge

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21
Q

What direction do each of leads I-III go from in relation to the limbs?

A

I - RA to LA
II- RA to LL
III- LA to LL

22
Q

What artery does each lead show?

A

RCA- II, III, AVF
LAD- V1, V2, V3, V4
LCX- I, AVL, V5, V6

23
Q
  • What could t wave inversion mean?
A

Abnormally electrical impulse goes through the muscle

Myocardial Ischaemia
left ventricle wall stress

24
Q
  • What could large QRS complexes on the V leads suggest?
A

Large QRS complexes on the V leads - difference in ventricular depolarisation

Hypertrophied LV means more mass in LV so more muscle that needs to contract and so the QRS amplitude increases

25
Q
  • Explain the pathophysiology of diastolic dysfunction?
A

Increased peripheral vascular resistance so increased afterload

Adapts to this by pressure and volume related remodelling of the LV

Hypertrophy occurs and thicker muscle builds

LV remodels so much that it causes diastolic dysfunction- stiffening of heart muscle

26
Q

What is the difference between Concentric and Eccentric

A

Concentric- pressure overload, hypertrophic muscle in LV

eccentric- volume overload, dilatation of LV

size of cardiomyocytes in both instances increase

27
Q
  • How does calcium channel blocker lead to reduction in blood pressure?
A

Inhibit L-type calcium channel

decreasing calcium influx in vascular smooth muscle leading to downstream inhibition of myosin-like chain

this prevents cross-bridge formation and smooth muscle contraction

leading to dilation which reduces blood pressure

28
Q
  • What is the difference between dihydropiridenes and non-dihydropiridenes?
A

Non-dihydropiridenes - more myocardial selective, weaken heart rate (weaken effect of muscle)

Dihydropiridenes - more potent vasodilators, vascular selective

29
Q

If a patient has hypertension and type 2 diabetes, or does not have diabetes but is less than 55yrs and is not black African or African Caribbean

What is the first line drug

What is the second line drug

What is the third line

A

ACEi or ARB

ACEi or ARB + CCB or thiazide like diuretic

ACEi or ARB + CCB + TLD

30
Q

If a patient is hypertensive but does not have type two diabetes and is over55 or black Caribbean/ African Caribbean

What is first line drug

What is the second line drug

What is the third line

A

CCB

ACEi or ARB or thiazide like diuretic

ACEi or ARB + CCB + TLD

31
Q
  • Why are hypertensive patients less receptive to ACEi or ARB?
A

Less responsive to Renin and so are less receptive to ACEi or ARB as they have high salt

salt sensitive hypertension

May be of black African or African-Caribbean family origin

32
Q

Why can blood pressure still be high after hypertensives

A

non compliance
side effects
white coat syndrome
multiple medications needed
ethnicity

33
Q

what are the common side effects of hypertensives

A

Ankle oedema - swelling of the ankles (most common)

Change in bowel habits - Calcium channels present in gut mucosa therefore affected gut motility and changes in these

Palpitations - decreasing blood pressure which is detected by baroreceptors and so the heart is pumped harder to increase pressure which the patient feels the heartbeat for

Headaches and flushing- Dilated blood vessels so more blood to head and this gives flushing and headaches

34
Q
  • What is the SA node?
  • What is the function of the SA node?
A

Group of pacemaker cells in the upper right quadrant of the right atrium

Generates signal for the atria to contract

35
Q
  • How does the depolarisation wave in the right atria reach the left atria?
A

Atrial internodal tracts - Bachmann’s bundle

36
Q
  • Other than the atrial myocytes, what other structure does the SA node send signals to?
A

AV node

37
Q
  • What causes the conduction to slow at the AV node?
  • Why is this delay useful?
A

Smaller diameter so more resistance
Slower Ca2+ channels used rather than faster Na+ channels

Allows time for ventricular filling

38
Q
  • Describe the path of the conduction after AV node?
A

AV node → Bundle of His → Bundle branches in interventricular septum → Purkinje Fibres

39
Q
  • If the SA node pacemaker cells fail to send out a signal to contract what happens?
A

(Ectopic pacemakers - Not in SA node)

Other Atrial pacemaker cells send signal at 60-80 per minute

If these fail, AV node pacemaker cells send signal at 40-60 per minute

If these fail, ventricular pacemaker cells send signals at 20-40 per minute

40
Q
  • How is the PR interval measured and what does it show?
A

From beginning of P wave and end of isoelectric line

Time between start of atrial contraction and ventricular contraction

41
Q
  • What are the limb electrodes?
A

The limb electrodes are placed on the right arm, left arm, left leg and right leg

The right leg is used as a neutral and so the left leg is used to show the signal directions on ECG

Together they make leads I, II, III, aVF, aVL, aVR

42
Q

– What are the precordial electrodes?

A

They are the chest electrodes of V1-V6 placed across the chest

43
Q
  • Which are the inferior leads?
  • What are the inferior leads supplied by?
A

Leads II, III, AVF are inferior leads

Right coronary artery

44
Q
  • Which are the lateral leads?
  • What are the lateral leads supplied by?
A

Leads I, aVL, V5, V6

Circumflex artery

45
Q
  • Which are the septal leads?
  • What are the septal leads supplied by?
A

V1, V2, V3, V4

Left anterior descending artery

46
Q
  • What does the P wave signify?
  • What is the isoelectric line after the P wave a show of?
A

Atrial depolarisation via SA node

AV node depolarisation and this shows the slow signal transduction which is protective of the ventricular filling

47
Q
  • How is the PR interval measured and what does it show?
  • What is a normal PR interval?
A

From beginning of P wave and end of isoelectric line

Time between start of atrial contraction and ventricular contraction

0.12-0.20s
3-5 small boxes

48
Q
  • What does the Q wave signify?
A

Signal passing through the bundle branches in which there is septal depolarisation

This is shown as negative deflection as the signal goes through all the myocytes in the thick intraventricular septum which shows it to be in opposite direction of lead II

49
Q
  • What causes the R wave?
A

Signal conduction through large Purkinje fibre going through left ventricle

50
Q
  • What causes the S wave?
A

Negative deflection caused by late ventricular depolarisation in the right ventricle via Purkinje fibres

CSI year 2 (8 decks)

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