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DPD 2 > Cases with Kariiiiim > Flashcards

Cases with Kariiiiim Flashcards

1
Q

Cause of S3

A

As you get lub then dub, the mitral valve opens during systole, but you get a sound because of rapid ventricular filling due to VENTRICULAR DILATION

NOTE: Might be normal in athletes

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2
Q

Cause of S4

A

Atrial contraction against ventricular hypertrophy (due to htn) as the ventricle is stiff so you hear the last push of the atria

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3
Q

Ventricular hypertrophy on ECG

A

Tall R waves in lead 5
deep s wave in lead 2

If you add the s wave and r wave together above, and it’s more than 45 mm = lvh

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4
Q

What is ventricular gallop

A

All four heart sounds

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5
Q

After what BMI does death rate increase in Asians?

A

23

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6
Q

What do you do if the BP diastolic is above 140?

A

Repeat again

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7
Q

What SIGNS would you look for in hypertension

A 
S4
Heave
Bruits
Fundoscopy - papilledema
NOTE: you can't detect LVH on clinical examination, only dilatation presents with axis deviation
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8
Q

Grade 1 htn on fundus

A

Silver wiring in the middle of retinal arteries comnig from

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9
Q

Grade 2 htn on fundus

A

AV nipping - when an artery crosses a vein and narrows

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10
Q

Grade 3 htn on fundus

A

Flame shaped haemmorhages

Maybe cotton wool spots (ischemia in the area around it)

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11
Q

Grade 4

A

Flame shaped haemorrhage
Cotton wool spot
PLUS Papilloedema - no visual edge of optic disc

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12
Q

Name another cause of papillodema

A

Obstructive hydrocephalus blocking third or fourth ventricle

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13
Q

When do you get hard exudates?

A

Diabetes due to cholesterol deposition

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14
Q

What does hypertensive retinopathy mean?

A

Pt has had retinopathy for a long time

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15
Q

Six causes of secondary hypertension

A 
Phaeo
Cushings
Conns
Acromegaly
Renal artery stenosis
Coarctation of aorta
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16
Q

Which comes first, hypertension or atherosclerosis?

A

Atherosclerosis results from hypertension

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17
Q

What basic investigations do you do for hypertension and why? OSCE MATERIAL

A

FBC for polycythemia
U and E as potassium might be low, and affect renal function
ECG for LVH
Urinalysis for nephritis or renal disease

18
Q

Which part of the kidney makes renin?

A

JGA makes renin

19
Q

What controls release of aldosterone

A

Angiotensin 2 controls release for aldosterone

20
Q

If someone DOESN’T have cushings or acromegaly like clinical features, what hypertension investigations would you do?

A

Renin
Aldosterone
24hr urine for catecholamines

21
Q

High renin
High aldosterone
Everything else is normal

A

Renal artery stenosis - low pressure causes more renin production, but the high BP doesn’t get through to the kidneys because of the stenosis, so it remains high

22
Q

What imaging is done to investigate renal artery stenosis

A

Digital subtraction angiogram

23
Q

Features of phaeo

A 
nervousness
sweat down face
palpitations
episodic severe htn
severe vasoconsriction causing necrotic bowel
24
Q

First therapeutic step for phaeo

A

Alpha blockade plus saline so bp doesn’t drop too much

25
Q

Differentiate between conns and phaeo

A

conns tumour - continuous raised htn whereas

phaeo big on imaging
conns small tumour

26
Q

Why do you give beta blockers after alpha blockers for phaeo

A

b2r causes peripheral dilatation so blocking it might cause more hypertension

27
Q

Treatment for phaeo

A

Alpha blockade
Beta blockade
Localise the lesion
Surgery

28
Q

Scan for phaeo

A

MIBG scan - metaiodobenzylguanidine

precursor for something that allows phaeos to be seen

29
Q

IF someone has HTN plus BPH, treatment?

A

Alpha blockers

30
Q

HF/MI/Diabetes + HTN

31
Q

ACE intolerance (cough)
MI in past
Chronic stable angina

+ HTN

32
Q

Angina/elderly/isolated systolic hypertension + htn

33
Q

stroke prevention + htn

A

thiazide diuretics

34
Q

HTN treatment strategy

A

under 55 - A
over 55 - C

second step - A and C
third step - A C D
fourth step - add alpha blocker/beta blocker

35
Q

Treatment for renal artery stenosis?

A

ACEi/ARB
Angiography
Surgery

36
Q

Optimum treating for preventing second

A 
Intensive lifestyle modification
Aspirin to prevent second MI 
Statin 40-80mg OD to prevent second MI 
BP control 
Assessment for T2DM
37
Q

Statin intolerant patients

38
Q

Name an LDL receptor destroyer

A

PCSK9 Proprotein convertase subtilisin kexin 9 - involved in destruction of LDL receptor

39
Q

Name a drug that inhibits PCSK9

A

Evolocumab

40
Q

Who benefits from PCSK9?

A

Only really patients with Familial hypercholemia
Statin intolerant
Unctrolled lipids

41
Q

What do you use in patients with microalbuminuria and diabetes?

A

ACEi (apparently see DPD1 for explanation)

DPD 2 (22 decks)

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