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Year 2 > Case 15 > Flashcards

Case 15 Flashcards

1
Q

MOA of loop diuretics used in HF

A

Decrease NaCl and KCl reabsorption in thick ascending limb of loop of Henlé
Increasing excretion of salt and water
Reduces cardiac preload and afterload
Reducing pulmonary/ peripheral oedema

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2
Q

MOA of aldosterone antagonists used in HF

A

Block cytoplasmic aldosterone receptors in collecting tubules
increasing salt and water excretion
and reducing remodelling

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3
Q

MOA of ACEI used in HF

A

Inhibits angiotensin converting enzyme so angiotensin I is not converted to angiotensin II
Arteriolar/ venous dilation
Reduces aldosterone secretion
Reduces cardiac remodelling

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4
Q

MOA of ARB used in HF

A

Antagonise angiotensin II effects at AT1 receptor
Arteriolar/ venous dilation
Reduces aldosterone secretion
Reduces cardiac remodelling

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5
Q

MOA of B-blockers used in HF e.g. carvedilol

A

Competitively blocks B1 receptors

Reduces bp and heart rate

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6
Q

MOA of cardiac glycosides used in HF e.g. digoxin

A

Inhibits Na+/K+-ATPase resulting in reduced Ca2+ expulsion and increased Ca2+ stored in SR

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7
Q

MOA of natriuretic peptides used in HF e.g. nesiritide

A

Activates BNP receptors, increases cGMP

Vasodilation and diuresis

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8
Q

MOA of bipyridines used in HF e.g. milrinone

A

Phosphodiesterase type 3 inhibitor
Decreases cAMP breakdown
Vasodilator
Increases cardiac contractility

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9
Q

What is the central venous pressure if the JVP is visible when the patient is sat upright?

A

At least 10cmH2O - elevated venous pressure

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10
Q

How can the JVP be differentiated from the carotid pulse?

A

JVP - non palpable as low pressure

Arterial pulse - palpable

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11
Q

When do you get large/giant a waves?

A

Obstruction to active right ventricular filling during right atrial contraction
Pulmonary hypertension, pulmonic stenosis, tricuspid stenosis

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12
Q

When do you get cannon a waves?

A

Right atrial contraction against closed tricuspid valve
or simultaneous contraction of right atrium and right ventricle
AV dissociation - complete heart block or ventricular tachycardia

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13
Q

When are a waves absent?

A

Atrial fibrillation

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14
Q

When do you get large v waves?

A

Tricuspid regurgitation

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15
Q

What does the JVP reflect?

A

Right ventricular filling pressure

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16
Q

What is the normal range of central venous pressures and how is it measured?

A

5-9 cm H2O
Distance from right atrium to right internal JVP
Sternal angle used as reference point - 5cm above right atrium
Normal JVP is 0-4cm above sternal angle (can only really see 2cm or over as clavicle in the way)

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17
Q

What is the most accurate external reference point for the right atria?

A

Midaxillary line, 4th intercostal space = mid right atria

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18
Q

What happens to the JVP during inspiration?

A

Declines

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19
Q

What is Kussmaul’s sign?

A

JVP increases during inspiration

Caused by an inability of the heart to accommodate increased venous return caused by negative intrapleural pressure

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20
Q

What is classed as a positive abdominojugular reflux sign?

A

Increase in JVP of greater than 3cm H2O

That is sustained for longer than 15 seconds

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21
Q

What do the a, c, x, v and y waves represent?

A

a: right atrial contraction
c: tricuspid valve closes as ventricles contract
x: ventricular contraction
v: passive right atrial filling (tricuspid valve still closed)
y: tricuspid opens and blood fills right ventricle

22
Q

What are the layers of a vessel? Which is breached first in formation of atherosclerotic plaque?

A

Intima, media, adventitia

Intima

23
Q

What do chylomicrons do?

A

Carry triglycerides
From intestines
To skeletal muscle, adipose tissue and liver

24
Q

What do VLDL do?

A

Carry triglycerides
From liver
To adipose tissue

25
Q

What do IDL do?

A

Intermediate between VLDL and LDL

26
Q

What do LDL do?

A

Carry cholesterol
From liver
To cells of body

27
Q

What do HDL do?

A

Collect cholesterol
From tissues
Back to liver

28
Q

How do statins work?

A

Competitive inhibitors of HMG CoA reductase

So HMG-CoA not converted to mevalonate (so no mevalonate to be converted to cholesterol)

29
Q

What is the main adverse drug effect of statins?

A

Myositis - inflammatory, degenerative muscle disease

30
Q

What is the most specific manifestation of hypercholesterolaemia and what causes hypercholesterolaemia?

A

Tendon xanthoma

Lack/ no LDL receptors

31
Q

What is triglyceride/ triacylglycerol made of?

A

1 glycerol

3 fatty acids

32
Q

What does omega 3 mean?

A

1st carbon carbon double bond is on carbon no 3

33
Q

What does (C 18 : 1) mean?

A

18 carbons

1 double bond

34
Q

Which is the omega 3 which is the omega 6;
alpha linolenic acid
linoleic acid
arachidonic acid

A

Alpha linolenic acid (3 words) - omega 3
Linoleic acid - omega 6
Arachidonic acid - omega 6

35
Q

What is phospholipid made of?

A

1 glycerol
2 fatty acids
1 phosphate attached to choline

36
Q

What makes the coat of a lipoprotein?

A

Phospholipids
Apolipoproteins
Unesterified cholesterol

37
Q

What makes the lipid core of a lipoprotein?

A

Triglycerides

Cholesteryl esters

38
Q

What is sarcopenia?

A

Decline in skeletal muscle mass and strength that occurs with advancing age

39
Q

What is cachexia?

A

Severe wasting accompanying disease states

40
Q

Frailty is characterised as 3 or more of…?

A 
Unintended weight loss 
Exhaustion 
Weakness 
Slow gait speed
Low physical ability
41
Q

What causes hypertension in Liddle’s syndrome?

A

Overexpression of Na+ channel in collecting duct

42
Q

What causes hypertension in metabolic syndrome?

A

Increase in proximal convoluted tubule Na+-H+ exchange

43
Q

What is frailty?

A

Increased vulnerability to poor resolution of homeostasis after a stressor event

44
Q

What is sarcopenic obesity?

A

Lean body mass decreases

Fat mass preserved/ increases (intramuscular and visceral fat increase, subcutaneous fat decrease)

45
Q

What’s AVRC?

A

Arrhythmogenic right ventricular cardiomyopathy

46
Q

What 2 things to ACE inhibitors prevent?

A

Prevent proline from binding to active site of ACE

Prevent catalytic activity of Zn2+ in active site of ACE

47
Q

How is water added to the body? Source of most first

A

Drink
Food
Oxidation

48
Q

How is water lost from the body? Greatest loss first

A

Urine
Respiration
Sweat
Stool

49
Q

What’s the best way for detecting fibrosis of the heart?

A

Cardiac MRI

50
Q

Where are the longitudinal muscle fibre layers of the heart found and which way do they contract?

A

Sub-epicardial - clockwise rotation

Sub-endocardial - anticlockwise rotation

51
Q

Describe diastolic and systolic HF in terms of eccentric and concentric hypertrophy

A

Diastolic HF - pressure overload - increased wall thickness and decreased radius - concentric hypertrophy

Systolic HF - volume overload - increased wall thickness and radius - eccentric hypertrophy

Year 2 (13 decks)

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