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Year 1 Medicine > More Big Resp/Cardio diseases > Flashcards

More Big Resp/Cardio diseases Flashcards

1
Q

What is hypertension?

A

High blood pressure

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2
Q

What are some causes of hypertension?

A

Primary hypertension - idiopathic
Secondary hypertension - has a known cause.

Chronic renal infection
Polycystic kidney disease
Renal artery stenosis
Cushing's
preeclampsia
Drug induced by NSAIDs/oral contraceptive
Sleep apnoea
Coarctation of the aorta.
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3
Q

What are the risk factors for hypertension?

A 
Genetics 
Diet
Diabetes
Obesity
Exercise 
Contraceptives
Stress
Afro-carribean
Age
Low birth weight
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4
Q

What are the symptoms for hypertension?

A

Often there are no symptoms - incidental finding to another condition.

Diet
Diabetes
Medications
Stress
Family history
Exercise
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5
Q

Upon examination of an individual with suspected hypertension what would be found?

A 
Tar staining
Hypercholesterolaemia
Xanthalasma
Corneal arcus
End organ damage
Retinopathy
Proteinuria 
Left ventricular hypertrophy
Radiofemoral delay
Palpable kidneys
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6
Q

What investigations aid the diagnosis of hypertension?

A

Measure blood pressure using a sphygmomanometer.

ABPM or HBPM

ECG- to look fo cause of hypertension
Urine analysis - to check kidney function

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7
Q

What are the values of stage 1 hypertension?

A

Clinical = 140/90

ABPM=135/85

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8
Q

What are the values of stage 2 hypertension?

A 
Clinical = 160/100
ABPM= 150/95
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9
Q

What are the values of severe hypertension?

A

Systolic= >180 OR Diastolic= >110

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10
Q

What is the available treatment for hypertension?

A

<55yrs old:
1- ACE inhibitor or ARB
2- Add thiazide like diuretic

> 55yrs, Afro-carribean, women of child bearing age:
1- Ca2+ channel blocker
2- Add thiazide like diuretic

All:
3- CCB + ACEI/ARB + Thiazide like diuretic
4- <4.5mmol/L give spironolactone
>4.5mmol/L give higher dose Thiazide like diuretic.

Specialist drugs: Alpha adrenoreceptor agonist
Centrally acting agents
Vasoldilators

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11
Q

What are some examples of ACEIs?

A

Ramipril

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12
Q

What are some examples of Thiazide like diuretics?

A

Indapamide

Clortalidone

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13
Q

What are some examples of CCBs?

A

Felodipine
Diltiazem
Verapamil

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14
Q

What are some examples of angiotensin II antagonists (ARBs)?

A

Losartan

Valsartan

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15
Q

What are some complications of hypertension?

A 
Atheroma
Stroke
Haemorrhage
MI
Left ventricular failure
Retinopathy

Puts more strain on organs.

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16
Q

What is Marfan’s syndrome?

A

A genetic disorder that affects the body’s connective tissue.

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17
Q

What causes Marfan’s syndrome?

A

Autosomal dominant inheritance.

Mutation to 15q21 in fibrillin-1 gene causing abnormal or absent fibrin in connective tissue.

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18
Q

What are the symptoms of Marfan’s disease?

A 
Cardiac - chest pain
murmur
palpitations
Aortic dilation
Mitral valve prolapse

Pulmonary - Pneumothorax
Dyspnoea

Eyes- Ectopia lentis
Bad vision

Skeletal - Tall stature
Long thin limbs
Scoliosis
Kyphosis
Funnel or pigeon chest 
Flat feet
Roll in on their ankles
High palate
Thumb sticks out when they make a fist.
Stretch marks
Fatigue
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19
Q

What would be seen on the examination of an individual with suspected Marfan’s?

A

12 systemic features each given a score
If patient score 7 or above then it is Marfan’s.

Systemic features are:
Face
Mitral valve prolapse
Pneumothorax
Dural ectasia
Scoliosis/kyphosis
Pectus deformity 
Striae
Myopia
Ankle deformity
Flat feet
Upper limbs exceed height
Thumb
Wrist
Reduced elbow extension.
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20
Q

What investigations are used to aid the diagnosis of Marfan’s?

A 
ECHO - assess cardiac involvement 
MRI - assess lumbar spine 
Pelvic x-ray
Chets x-ray
Genetic test for fibrillin-1 mutation.
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21
Q

What is the treatment available for Marfan’s?

A

Annual ECHO to monitor heart.
Prophyllactive aortic surgery
Beta Blockers
ARBs.

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22
Q

What is Stroke?

A

Temporary occlusion of the blood supply to the brain causing loss of function. It last longer than 24hours.

TIA (transient ischaemic attack) lasts less than 24hours.

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23
Q

What are the causes of stroke?

A

Haemorrhage - 15%

Ischaemia - 85%

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24
Q

What are the risk factors for stroke?

A 
Male
Increasing age
Atrial fibrillation
Diabetes
Smoking 
Hypertension
Hypercholesterolaemia
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25
Q

What are the symptoms of stroke?

A 
Loss of feeling
Clumsy/weak limbs
Loss of vision 
Dysarthia - motorspeech disorder
Dysphasia - language disorder
Involuntary eye movement 
Headache
Vomiting
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26
Q

Upon examination of a patient suspected of having a stroke what would you find?

A

Tachycardia
Irregular heart rhythm
Murmur/galloping heart
Carotid bruit if carotid disease is cause.

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27
Q

What are the investigations for stroke?

A 
Full blood count
Lipid profile
Carotid doppler ultrasound 
ECG
ECHO
CT/MRI
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28
Q

What is the available treatment for stroke?

A

Thrombolysis - alteplase
Thrombolectomy - IV retrieval
Secondary prevention - Aspirin/Clopidogrel
Statins
Antihypersensitives
Diabetic control
Carotid endarterectomy - removes plaque build up in carotid.

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29
Q

What are the different types of stroke?

A

TACs (Total Anterior Circulation) - usually due to occlusion of proximal middle cerebral artery. Only 1 symptom of loss of function.

PACs (Partial Anterior Circulation) - 2/3 symptoms of loss of function. Occlusion of branches of middle cerebral artery.

Lacunar - weakness of 1 side involving 2/3 body areas. Often silent.

POCs (Posterior Circulation) - affects brainstem, cerebellar or occipital lobes.

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30
Q

What is COPD?

A

Chronic Obstructive Pulmonary Disease

Group of lung conditions that contribute to the narrowing of airway, making it difficult to empty air out of lungs.

Chronic bronchitis + Emphysema

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31
Q

What is chronic bronchitis?

A

Chronic inflammation of the bronchi that causes a build up of sputum. There is less pull on airways so elastic lining flops and becomes inflamed.

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32
Q

What is emphysema?

A

Dilation of alveoli, breakdown of walls causing a decrease in surface area and making them baggy.

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33
Q

What are the risk factors for COPD?

A 
Smoking
Occupation
Increasing age
Family history 
Alpha-1-antitrypsin deficiency
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34
Q

What are the symptoms of COPD?

A 
Progressive dyspnoea - starts on exertion but then becomes more severe. 
Chest pain
Fatigue
Cough
Sputum - green
Ankle oedema
Weight loss
Loss of appetite
Wheeze
Fever
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35
Q

What are the characteristics of COPD symptoms that distinguish it from other lung conditions?

A

Progressive
Irreversible
Non variable
Permanent

36
Q

What are the investigations that aid the diagnosis of COPD?

A 
Spirometry
Peak Flow
Full blood tests
Chest x-ray
Sputum culture
37
Q

What is the available treatment for COPD?

A

1- SABA - salbutamol
2- LAMA or LABA - salmeterol/ tioptropium
3- LAMA and LABA
4- ICS + LAMA + LABA - fostair/flutiform/symbicort

If symptoms exacerbate - hospitalisation.
Nebulisers if can’t use inhalers
Prednisolone steroid 5-7days
Oxygen

Lung reduction surgery for severe emphysema.

Stop smoking/ change lifestyle

Lung transplant - last resort!

38
Q

What is Atherosclerosis?

A

Accumulation of fat/scar tissue on the endothelial walls of arteries forming atheromas.

39
Q

What is an atheroma?

A

Central lipid core with fibrous tissue cap, filled with inflammatory cells.

40
Q

What are the causes of atheroma?

A

Hypercholesterolaemia
Endothelial injury
Haemodynamic disturbance

41
Q

What are the risk factors atherosclerosis?

A 
Hypercholesterolaemia
Smoking
Hypertension
Male
Age
Sedentary lifestyle
Low birth weight
42
Q

What are the symptoms of atherosclerosis?

A 
Angina
Claudication
Tissue atrophy
MI
Stroke
Lower limb gangrene
43
Q

What is the available treatment of atherosclerosis?

A 
Angioplasty - stenting
Bypass grafting
Thrombolysis
Thrombolectomy
Endarectomy
Control of BP
Statins
44
Q

What are the complications of atherosclerosis?

A

Rupture
Embolism
Stenosis

45
Q

What are the stages of plaque formation?

A

1- fatty streak
2- early atheromatous plaque
3- fully developed atheromatous plaque

46
Q

What is aortic dissection?

A

A tear in the inner wall of the aorta caused by blood forcing the wall apart.

47
Q

What are the causes of aortic dissection?

A 
Trauma
Cardiac surgery
Marfan's
Bicuspid AV
Atherosclerosis
Hypertension
48
Q

What are the risk factors of aortic dissection?

A 
Trauma
Smoking
Cocaine
Pregnancy 
Arteritis
Hypertension
Hypercholesterolaemia
49
Q

What are the symptoms of aortic dissection?

A 
Severe tearing chest pain
Radiation to back 
Syncope
Atrial fibrillation
Externa rupture
Pericardial tamponade
Pleuritic chest pain
50
Q

What would be found on the examination of a patient with suspected aortic dissection?

A 
Reduced peripheral pulses
BP mismatch in upper limbs
Murmur of aortic regurgitation
hypo/hypertension
Pulmonary oedema
Inferior ST elevation
51
Q

What are the investigations of aortic dissection?

A

CXR- mediastinal widening, loss of aortic knob, tracheal deviation, pleural effusion
CT/MRI
Transoesophageal ECHO

52
Q

What is Cystic fibrosis?

A

Genetic condition (autosomal recessive) that affects the body’s ability to control the movement of salt and water between cells. This causes sticky mucus to build up in the lung sand digestive system.

53
Q

What causes cystic fibrosis?

A

A mutation in the CFTR gene so that it no longer codes for the protein channel that aids the movement of water and salt between cells.

54
Q

What are the symptoms of CF?

A 
Lungs: 
Recurring chest infections 
Cough
Wheeze
Dyspnoea
Purulent sputum
Digestive system: 
Pale, greasy poo
Difficulty putting weight and growing
Constipation
Physical weakness
Hunger and thirst
Severe constipation in first few days of life.
55
Q

What investigations aid the diagnosis of CF?

A

PKU heel prick test at 5 days old.
Sweat test - sample is taken to see how much salt is in it.
Genetic test - to look for abnormalities
Family testing - any brothers/sisters tested for carrier gene. Can be salvia or blood.

56
Q

What is the treatment available for CF?

A

No cure for CF so treatment is to relieve symptoms.
Multidisciplinary team required.

Antibiotics to treat chest infections
Hypertonic saline to thin mucus
Ivacaftor - new drug that reduces mucus levels.

Bronchodilators and Steroids - to help with narrowed airways.

Routine vaccinations
Enzyme supplements
Exercise
Airway clearance techniques
Dietary advice
Lung transplant - last resort!
57
Q

What is pneumonia?

A

Inflammation lung tissue caused by a bacterial infection.

58
Q

What are some of the organisms that cause pneumonia?

A 
Streptococcus pneumoniae
Staph. aureus 
Mycoplasma pneumonia
Chlamydia psittaci
Haemophilus influenza
59
Q

What are the different types of pneumonia?

A 
Community acquired
Hospital acquired
Aspiration
Recurrent
Broncho
Lobar
Atypical
60
Q

What are the symptoms of pneumonia?

A 
Cough
Sputum - thick green/yellow /brown
Possible haemoptysis
Dyspnoea
Tachycardia
Fever
Malaise
Sweating/chills
Loss of appetite
Chest pain - pleuritic
61
Q

What are the investigations that aid the diagnosis of pneumonia?

A 
CXR 
Sputum culture
Full Blood count
Mycoplasma IgM
Atypical serology
Pneumococcal urinary antigen.
62
Q

What is the treatment available for pneumonia?

A

Antibiotics - beta-lactams and macrolides
Fluids
Analgesia
Supplemental oxygen

63
Q

What are the possible complications of pneumonia?

A 
Pleurisy
Pleural effusion
Empyema
Organisation to form mass lesion
Lung Abscess
Bronchiectasis
Recurrent pneumonia
64
Q

What is bronchiectasis?

A

Pathological dilation of the bronchi due to severe infection, recurrent infections, proximal bronchial obstruction or lung parenchymal destruction.

Chronic condition that causes a build up of mucus and makes individual more prone to infection.

65
Q

What are the symptoms of bronchiectasis?

A

Persistant cough
Dyspnoea
Gets worse if develop aa lung infection.

66
Q

What is the treatment available for bronchiectasis?

A

Antibiotics to treat infections.
Airway exercises to aid clearance of mucus.
Nebulisers or bronchodilators to aid breathing
Hypertonic saline to thin mucus.

67
Q

What is an arrhythmia?

A

An abnormal heart rhythm.

68
Q

What are the symptoms of arrhythmias?

A 
Asymptomatic 
Palpitations
Dyspnoea
Chest pain
Fatigue
Embolism
69
Q

What are the investigations that aid the diagnosis of arrhythmias?

A

ECG- 12 lead 24hr recording
Blood tests - especially thyroid function
ECHO - to look for cause.

70
Q

What is supreventrivcular tachycardia?

A

AV nodal re-enterant tachycardia.

Episodes of abnormally high heart rate at rest.

71
Q

What is atrial fibrillation?

A

Heart beats irregularly and faster than normal.

72
Q

What is atrial flutter?

A

Abnormally rapid but regular contraction of the atria.

73
Q

What is ventricular fibrillation?

A

Heart quivers instead of pumping due to disorganisation in ventricles. Basically cardiac arrest.

74
Q

What is ventricular tachycardia?

A

Regular fast heart rate from improper electrical activity in the heart.

75
Q

What is first degree heart block?

A

PR interval is >0.2secs.

76
Q

What are the causes of first degree heart block?

A 
Increased vagal tone 
Electrolyte disturbance
Myocarditis
Mitral valve surgery
Inferior MI
AV node blocking drugs
77
Q

What is second degree heart block?

A

Mobitz type 1 - progressive prolongation of PR interval, culminating in a non-conducted p wave.

Mobitz type 2- intermittent non conducted p waves without PR interval prolongation.

78
Q

What is third degree heart block?

A

No correlation between P wave and QRS complex. Complete AV block

79
Q

What is the treatment for heart block?

A

Atropine
Temporary pacemaker
Permanent pacemaker

80
Q

What is endocarditis?

A

Infection of the endocardium, valves, septa, chordae tendinae or intra-cardiac devices.

81
Q

What are the causes of endocarditis?

A 
Bacterial or fungal infection
Rheumatic fever
Valvular disease
Invasive surgery
Congenital heart disease
Gingivitis
82
Q

What are the risk factors for endocarditis?

A 
Age
Male
Invasive procedures
Prosthetic valves
IV drug abuse
Immunocompromised
Diabetes
AIDs
Burns
83
Q

What are the symptoms of endocarditis?

A 
Fever 
Malaise
Fatigue
Chills
Arthralgia
Weight loss
Headache
84
Q

What would be seen on examination of a patient with suspected endocarditis?

A 
Fever
Roth spots
Osler's nodes
Malaise
Janeway lesions
Anaemia
Nepthritis
Emboli
85
Q

What investigations aid the diagnosis of endocarditis?

A 
Full Blood count
C-reactive protein 
Erythrocyte sedimentation
Urea and electrolytes
Blood culture - 3 sets from different sites 6hrs in-between. 
Urinalysis
ECG - wide QRS complex
CXR
Transthoracic ECHO
86
Q

What is the treatment available for endocarditis?

A

IV antibiotics or 2 oral at once.

Year 1 Medicine (37 decks)

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