Hypertension, Atheroma and Thrombosis

Question 1

What is Conn’s Syndrome an excess of?

Answer 1

excess Aldosterone

Question 2

What is Cushing’s Syndrome an excess of?

Answer 2

excess excess corticosteroid

Question 3

What is Phaeochromocytoma an excess of?

Answer 3

noradrenaline

Question 4

What can left hypertrophy cause?

Answer 4

Increased LV Load
Poor perfusion 
Interstitial fibrosis
Micro infarcts
Diastolic dysfunction

Question 5

What does subarachnoid haemorrhage involve rupture of?

Answer 5

Berry aneurysm

Question 6

In maligant hypertension, what is the diastolic blood pressure?

Answer 6

> 130-140

Question 7

What is papilloedema?

Answer 7

Swelling of optic disc

Question 8

Hypertension and proteinuria during pregnancy suggests what?

Answer 8

pre-eclampsia

Question 9

What does this describe: Narrowing of arterial lumen, reduced elasticity, reduced flow in systole, tissue ischaemia?

Answer 9

Arterial stenosis

Question 10

What happens if aterial stenosis occurs in peripheral arteries?

Answer 10

Claudication and food/leg ischaemia

Question 11

What does plaque rupture often trigger?

Answer 11

thrombosis

Question 12

What does this describe: Splitting within the media by flowing blood?

Answer 12

arterial dissection

Question 13

Which syndrome is a risk for arterial dissection?

Answer 13

Marfan’s

Question 14

What is ischaemia the result of?

Answer 14

impaired vascular perfusion depriving the affected tissue of nutrients

Question 15

Can ischaemia be reversed?

Answer 15

yes (depending on many factors)

Question 16

What is infarction?

Answer 16

ischaemic necrosis (death) of a tissue or organ secondary to occlusion/reduction of the arterial supply or venous drainage

Question 17

What are the 3 aspects of Virschow’s triad?

Answer 17

• Change in blood flow (stasis or turbulence)
• Change in coagulability (hypercoagulability)
• Change in vessel wall (endothelial damage)

Question 18

What produces the EC matrix?

Answer 18

endothelial cell

Question 19

What is blood flow normally in vessels?

Answer 19

laminar

Question 20

Do arterial thrombi show lines of Zahn?

Answer 20

Yes

Question 21

What are phlebothromboses?

Answer 21

venous thrombi

Question 22

What colour are venous thrombi?

Answer 22

reddish/blue

Question 23

In what circumstance do venous emboli do cause infarcts in peripheral arterial circulation?

Answer 23

Atrial/Ventricular Septal Defect
‘Paradoxical Embolus’
Exceptionally rare

Question 24

Arteriosclerosis is the generic term for which 3 disease patterns?

Answer 24

-Atherosclerosis (Intimal)
-Monckeberg Medial Calcific Sclerosis (Calcification of medium sized arteries in those >50yrs)
Arteriolosclerosis (Small arteries and arterioles, Hyaline and hyperplastic types)

Question 25

What is arteriosclerosis associated with?

Answer 25

Associated with diabetes mellitus and hypertension

Question 26

Does changing posture/position help pericarditis?

Answer 26

Yes

Question 27

What are symptoms of a DVT?

Answer 27

pain, swelling, redness, hot/inflamed

Question 28

What imaging can be done for a DVT?

Answer 28

Duplex scanning

Question 29

How long should TED compression stockings be given for a DVT?

Answer 29

6 weeks

Question 30

What are symptoms of a PE?

Answer 30

SOB Collapse Pleuritic Chest Pain Haemoptysis

Question 31

What are signs of a PE?

Answer 31

``` Wheeze Tachycardia Fourth heart sound Accentuated pulmonic component of the second heart sound Pleural Rub Oligemia on CXR (segmental loss of pulmonary vasculature) Signs of Pleural effusion Consolidation on CXR ```

Question 32

What drug treatment is associated with a lower rate of recurrent PE?

Answer 32

Induction period with heparin of 5 days

Question 33

What does this describe: the patient is pain-free at rest, but after variable periods of exercise develops ischaemic pain in the affected limb, which is relieved by further rest.

Answer 33

Intermittent claudication

Question 34

What are non invasive investigations in chronic lower leg ischaemia?

Answer 34

Measurement of ABPI (Ankle Brachial Pressure Index) | Duplex ultrasound scanning

Question 35

What are invasive investigations in chronic lower leg ischaemia?

Answer 35

Magnetic resonance angiography CT angiography Catheter angiography

Question 36

What are symptoms of critical leg ischaemia?

Answer 36

``` Pain at rest Requires strong analgesia Worse at night Helped by sitting and putting the leg in a dependent position Helped by getting up and walking about ```

Question 37

Are males or females more likely to develop aortic aneurysms?

Answer 37

Males

Question 38

What are investigations for aortic aneurysms?

Answer 38

Ultrasound Scan | CT Scan

Question 39

Which leg veins are deep?

Answer 39

tibials, popliteal femoral

Question 40

Which leg veins are superficial?

Answer 40

saphenous and perforators

Question 41

What are varicose veins?

Answer 41

Dilated, tortuous superficial veins, due to transmission of deep vein pressure

Question 42

Do you often get varicose veins after a DVT?

Answer 42

yes

Question 43

Are varicose veins more prominent standing or sitting?

Answer 43

standing

Question 44

What is chronic venous insufficiency?

Answer 44

irreversible skin damage as result of sustained ambulatory venous hypertension

Question 45

When are compression stockings contraindicated?

Answer 45

low ABPI