PATHOLOGY Flashcards
Describe age-related vascular changes.
- fibrosis of intima and media
- accumulation of ground substance
- fragmentation of elastic lamellae
Give 3 non-modifiable risk factors for atherosclerosis.
- age
- sex
- low birth-weight
Give 4 possible complications of atherosclerosis.
- stroke
- embolism
- MI
- cardiac failure
- aortic aneurysm
- peripheral vascular disease
- gangrene
What are 4 effects of peripheral vascular disease?
- intermittent claudication
- pain
- ulcers
- gangrene
Name 6 types of aneurysms.
- berry
- atherosclerotic
- dissecting
- micro-aneurysms
- syphilitic
- mycotic
Define aneurysm.
localised, permanent, abnormal dilatation of blood vessel or of the heart wall
Describe the morphology of atherosclerotic aneurysms.
- saccular or fusiform
- 15-25cm in length
- wall diameter >50%
- frequently contains a mural thrombus
What are 5 possible clinical consequences of atherosclerotic aneurysms?
- thrombosis
- embolism
- rupture
- obstruction of a branch vessel
- impingement on an adjacent structure
What is the clinical symptom of a dissecting aortic aneurysm?
sudden excruciating pain in the anterior chest, radiating to between the two scapulae
What are capillary micro-aneurysm?
- hypertension
- diabetes mellitus
Define varicose veins.
abnormally dilated, tortuous veins produced by prolonged, increased intraluminal pressure and loss of vessel wall support
Give 5 risk factors for varicose veins.
- age
- sex
- heredity
- posture
- obesity
Define vasculitis and give 4 examples.
= inflammation and necrosis of blood vessels
- giant-cell (temporal) arteritis
- Takayasu arteritis (pulseless disease)
- polyarteritis nodosa
- Kawasaki disease
Give 5 symptoms of Takayasu arteritis.
- dizziness
- visual disturbances
- dyspnoea
- intermittent claudication of upper limbs
- asymmetric BP
Name three types of haemangioma.
- juvenile (strawberry)
- capillary
- cavernous
What group of patient is mots likely to develop a Kaposi’s sarcoma?
immunosuppressed
What is the function of a valve?
to allow forward flow but to prevent back flow
What are the 4 components of a valve?
- valve ring
- cusp
- chordae
- papillary muscles
Define stenosis and incompetence.
STENOSIS
narrowing of the valve outlet caused by thickening of valve cusps, or increased rigidity or scarring
INCOMPETENCE
insufficiency/regurgitation caused by incomplete seal when valves close, allowing blood to flow backwards
To which valve(s) do the 1st and 2nd heart sound respectively belong?
1st = mitral and tricuspid 2nd = aorta and pulmonary
Name 4 acquired causes of cardiac valve stenosis and incompetence.
- rheumatic fever
- MI
- age-related
- endocarditis
Give 3 causes of aortic stenosis.
- calcification of congenital bicuspid valve
- senile calcific degeneration
- rheumatic fever
What are 3 clinical symptoms of aortic stenosis?
- dyspnoea
- angina
- syncope
Give 3 causes of aortic competence.
- infective endocarditis
- rheumatic fever
- Marfan’s syndrome
Give 2 causes of mitral stenosis.
- congenital
- rheumatic fever
Define infective endocarditis.
infection of valve with formation of thrombotic vegetations
What are 3 risk factors for infective endocarditis?
- valve damage
- bacteraemia
- immunosuppression
What tissues are likely to be affected by rheumatic fever?
- heart
- joints
- connective tissue
What makes a vegetation?
- platelets
- fibrins
- bacteria
- phagocytes
What are the likely types of bacteria a vegetation?
- group D streptococcus
- gut commensals
- skin streptococci
What are 5 complications of infective endocarditis?
- cerebral and retinal emboli
- myocarditis
- splenomegaly
- anaemia
- bronchopneumonia
- pulmonary infarct
- renal infarct
- glomerulonephritis
- haematuria
- clubbing & splinter haemorrhage
What are the 4 steps of the epidemiological approach?
1 - describe the health status of a population
2 - understand the natural history of the condition
3 - identify the causes of medical problems
4 - act/evaluate medical and health-promoting interventions
What are the three factors to consider when describing an epidemiological problem?
- time
- place
- person
Define epidemiological risk factor.
aspect of personal behavior, lifestyle, environmental exposure, genetic trait, which on the basis of epidemiological evidence is associated with a health-related condition or considered important to prevention
What can performance monitoring be used for?
- quality outcomes framework
- smoking cessation services
- lifestyle surveys
- outcomes for individual clinicians
Give 5 causes of pulmonary hypertension.
- hypoxia
- endothelial dysfunction
- genetics
- blockage/damage to the pulmonary blood vessels
- side-effects from some drugs
- left-sided heart failure
Give 6 types of causes of secondary systemic hypertension.
- renal disease
- diabetes
- endocrine disorders
- coarctation of the aorta
- some drugs
- eclampsia/pre-eclampsia
What are the 6 modifiable risk factors for sytemic hypertension?
- exercise
- diet
- obesity
- smoking
- alcohol intake
- stress
For which 4 types of conditions is left ventricular hypertrophy in patients with hypertension a major risk factor?
- dysrhythmia
- coronary heart disease
- sudden death
- congestive heart failure
Give 3 effects of hypertension on the vasculature.
- accelerated atherosclerosis
- stroke
- retinopathy
What is the main ECG modification for moderate hypertension?
left axis deviation
Define sepsis and septic shock?
SEPSIS
life-threatening organ dysfunction caused by a dysregulated host response to infection
SEPTIC SHOCK
a subset of sepsis in which particularly profound circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than sepsis alone
Give 4 factors that put someone at greater risk of sepsis.
- very young and older adults
- impaired immune system
- surgery/invasive procedure in last 6wks
- breach of skin integrity
- misuse of IV drugs
- indwelling lines or catheters
- pregnancy
- given birth, had a termination of pregnancy or a miscarriage in last 6wks
Give the 5 most common sources of sepsis.
- respiratory
- abdomen
- bloodstream
- skin
- urinary system
What are the 5 main factors affecting infection?
- virulence of pathogen
- bioburden
- portal of entry
- host susceptibility
- temporal evolution
What immune molecules may initiate the production of inflammatory markers in sepsis?
- toll-like receptors (TLRs)
- nucleotide-binding oligomerisation domain receptors (NOD-like receptors)
Name the three types of inflammatory markers in sepsis.
- interleukins
- tumour necrosis factor alpha
- reactive oxygen species
What are the signs of an acute phase response to TNF-alpha and IL1 on the body?
- fever
- hypotension
- increased heart rate
- corticosteroid and ACTH release
- release of neutrophils
What are the effects of TNF-alpha and IL1 on the CV system?
- generalised vasodilation
- increased vascular permeability
- intravascular fluid loss
- myocardial depression
- circulatory shock
What do SOFA and qSOFA stand for respectively?
SOFA
septic organ failure assessment
qSOFA
quick SOFA
What are the qSOFA variables?
- respiratory rate
- mental status
- systolic BP
What are the 7 SOFA variables?
- paO2/FiO2 ratio
- GCS score
- MABP
- administration of vasopressors
- serum creatinine or urine output
- bilirubin
- platelet count
What are the two causes for which you’d screen for sepsis?
- unexplained illness
- looks unwell + likely infective cause OR NEWS >4
What are the 4 main consequences of atherosclerotic coronary disease?
- chronic coronary insufficiency
- unstable coronary disease
- heart failure
- arrhythmia
Define subendocardial region.
water-shed area of perfusion that is the first to become ischaemic
What are the 3 imaging techniques for coronary arteries?
- coronary angiography
- CT angiography
- cardiac MRI
What are the three steps of atherosclerotic coronary artery disease pathology?
1- fatty streak
2- fibro-fatty plaque
3- plaque disruption (rupture or erosion)
From what percentage of lumen diameter being occupied by atherosclerosis would limitation of coronary artery blood flow happen?
50%
What are the determinants of myocardial oxygen consumption?
- tension development
- contractility
- heart rate
- basal activity
- mass of tissue
What are the 6 main causes of MI?
- plaque ruptur
- plaque erosion
- coronary embolism
- coronary artery spasm/drugs
- coronary anomaly
- spontaneous coronary dissection
Give 5 events modifying presentation of an MI.
- time of the day
- inflammatory activity
- infection
- elevation of BP
- catecholamines
How would you diagnose an MI?
- clinical history
- ECG changes
- raised cardiomyocite markers (troponin, CKMB, CPK, AST, myoglobin)
What does a tombstone ST elevation mean on an ECG?
ST segment elevation so high in the V leads because no electrical activity at the front of the heart
What are the late complications of STEMIs?
- left ventricle dilation and heart failure
- arrhythmia
- recurrent MI
What are the 4 causes of NSTEMIs?
- threatened STEMI
- small branch occlusion
- occlusion of well collateralised vessel
- lateral STEMI in territory not well seen by ECG
How would you treat bradycardia?
pacemaker
Name 5 narrow-complex tachycardias.
- atrial
- junctional
- AVNRT and AVRT
- atrial flutter
- atrial fibrillation
What are the three basic mechanisms of tachycardia?
- ectopic focus
- re-entry/circus movement
- fibrillation
How would you recognise Wolff-Prakinson-White syndrome on an ECG?
- shortened PR
- slurred upstroke of QRS
- widened QRS
Give 1 name for main class of drugs used in pharmacologic management of arrhythmias.
class 1a - disopyramide class 1b - lignocaine class 1c - flecainide
class 2 - sotalol
class 3- amiodarone
class 4- verapamil
Define cardiac failure.
failure of the heart to pump sufficient blood to satisfy metabolic demands
Which illicit drug is likely to induce systolic cardiac failure?
cocaine
Give one example of infiltrative disease that is likely to cause diastolic cardiac failure.
amyloidosis
What is the response to exercise in diastolic cardiac failure?
- tachycardia
- pulmonary acute oedema
Give 4 general causes of left and right ventricular failure.
- coronary heart disease
- hypertension
- cardiomyopathies
- drugs
- toxins
- endocrine
- nutritional
- infiltrative
What do you call combined left and right ventricular failure?
congestive heart failure
Give all 7 key features of clinical examination in patients with heart failure.
- appearance
- pulse rate
- BP
- fluid overload
- peripheral oedema
- respiratory issues
- apex displacement
What is hypertension a major risk factor for?
- cardiovascular disease
- ischaemic heart disease
- accelerated atherosclerosis
- Alzheimer type dementia
Which condition in pregnancy could cause secondary systemic hypertension?
pre-eclampsia
What are the consequences of systemic hypertension on the heart?
- left ventricular hypertrophy with fibrosis and arrhythmia
- ischaemic heart disease
- cardiac failure
Which organs are damaged in pulmonary hypertension?
- pulmonary arteries
- heart
What damages to the aorta do diabetes promote?
- ischaemia of wall
- ulceration
- generation of atheroma
What process in diabetes causes dysfunction of proteins in a systemic manner?
non-enzymatic glycation
What is the likely fatal consequence of emphysema?
cor pulmonale
What are the two proteins that can be found infiltrated between cells in amyloidosis
- amyloid-associated protein
- amyloid-light chain protein
How long until vasculitis causes loss of kidney function?
3 or 4 days
Heart failure can be caused by a dysfunction of the thyroid. Which dysfunction is it?
hypothyroidism
Which cells are involved in sarcoidosis?
T-cells
Give an example of immunosuppressive drug that endangers the heart.
Doxorubicin
