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MD3001 > PATHOLOGY > Flashcards

PATHOLOGY Flashcards

1
Q

Describe age-related vascular changes.

A
  • fibrosis of intima and media
  • accumulation of ground substance
  • fragmentation of elastic lamellae
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2
Q

Give 3 non-modifiable risk factors for atherosclerosis.

A
  • age
  • sex
  • low birth-weight
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3
Q

Give 4 possible complications of atherosclerosis.

A
  • stroke
  • embolism
  • MI
  • cardiac failure
  • aortic aneurysm
  • peripheral vascular disease
  • gangrene
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4
Q

What are 4 effects of peripheral vascular disease?

A
  • intermittent claudication
  • pain
  • ulcers
  • gangrene
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5
Q

Name 6 types of aneurysms.

A
  • berry
  • atherosclerotic
  • dissecting
  • micro-aneurysms
  • syphilitic
  • mycotic
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6
Q

Define aneurysm.

A

localised, permanent, abnormal dilatation of blood vessel or of the heart wall

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7
Q

Describe the morphology of atherosclerotic aneurysms.

A
  • saccular or fusiform
  • 15-25cm in length
  • wall diameter >50%
  • frequently contains a mural thrombus
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8
Q

What are 5 possible clinical consequences of atherosclerotic aneurysms?

A
  • thrombosis
  • embolism
  • rupture
  • obstruction of a branch vessel
  • impingement on an adjacent structure
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9
Q

What is the clinical symptom of a dissecting aortic aneurysm?

A

sudden excruciating pain in the anterior chest, radiating to between the two scapulae

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10
Q

What are capillary micro-aneurysm?

A
  • hypertension

- diabetes mellitus

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11
Q

Define varicose veins.

A

abnormally dilated, tortuous veins produced by prolonged, increased intraluminal pressure and loss of vessel wall support

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12
Q

Give 5 risk factors for varicose veins.

A
  • age
  • sex
  • heredity
  • posture
  • obesity
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13
Q

Define vasculitis and give 4 examples.

A

= inflammation and necrosis of blood vessels

  • giant-cell (temporal) arteritis
  • Takayasu arteritis (pulseless disease)
  • polyarteritis nodosa
  • Kawasaki disease
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14
Q

Give 5 symptoms of Takayasu arteritis.

A
  • dizziness
  • visual disturbances
  • dyspnoea
  • intermittent claudication of upper limbs
  • asymmetric BP
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15
Q

Name three types of haemangioma.

A
  • juvenile (strawberry)
  • capillary
  • cavernous
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16
Q

What group of patient is mots likely to develop a Kaposi’s sarcoma?

A

immunosuppressed

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17
Q

What is the function of a valve?

A

to allow forward flow but to prevent back flow

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18
Q

What are the 4 components of a valve?

A
  • valve ring
  • cusp
  • chordae
  • papillary muscles
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19
Q

Define stenosis and incompetence.

A

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

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20
Q

To which valve(s) do the 1st and 2nd heart sound respectively belong?

A 
1st = mitral and tricuspid
2nd = aorta and pulmonary
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21
Q

Name 4 acquired causes of cardiac valve stenosis and incompetence.

A
  • rheumatic fever
  • MI
  • age-related
  • endocarditis
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22
Q

Give 3 causes of aortic stenosis.

A
  • calcification of congenital bicuspid valve
  • senile calcific degeneration
  • rheumatic fever
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23
Q

What are 3 clinical symptoms of aortic stenosis?

A
  • dyspnoea
  • angina
  • syncope
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24
Q

Give 3 causes of aortic competence.

A
  • infective endocarditis
  • rheumatic fever
  • Marfan’s syndrome
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25
Q

Give 2 causes of mitral stenosis.

A
  • congenital

- rheumatic fever

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26
Q

Define infective endocarditis.

A

infection of valve with formation of thrombotic vegetations

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27
Q

What are 3 risk factors for infective endocarditis?

A
  • valve damage
  • bacteraemia
  • immunosuppression
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28
Q

What tissues are likely to be affected by rheumatic fever?

A
  • heart
  • joints
  • connective tissue
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29
Q

What makes a vegetation?

A
  • platelets
  • fibrins
  • bacteria
  • phagocytes
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30
Q

What are the likely types of bacteria a vegetation?

A
  • group D streptococcus
  • gut commensals
  • skin streptococci
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31
Q

What are 5 complications of infective endocarditis?

A
  • cerebral and retinal emboli
  • myocarditis
  • splenomegaly
  • anaemia
  • bronchopneumonia
  • pulmonary infarct
  • renal infarct
  • glomerulonephritis
  • haematuria
  • clubbing & splinter haemorrhage
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32
Q

What are the 4 steps of the epidemiological approach?

A

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

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33
Q

What are the three factors to consider when describing an epidemiological problem?

A
  • time
  • place
  • person
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34
Q

Define epidemiological risk factor.

A

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

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35
Q

What can performance monitoring be used for?

A
  • quality outcomes framework
  • smoking cessation services
  • lifestyle surveys
  • outcomes for individual clinicians
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36
Q

Give 5 causes of pulmonary hypertension.

A
  • hypoxia
  • endothelial dysfunction
  • genetics
  • blockage/damage to the pulmonary blood vessels
  • side-effects from some drugs
  • left-sided heart failure
37
Q

Give 6 types of causes of secondary systemic hypertension.

A
  • renal disease
  • diabetes
  • endocrine disorders
  • coarctation of the aorta
  • some drugs
  • eclampsia/pre-eclampsia
38
Q

What are the 6 modifiable risk factors for sytemic hypertension?

A
  • exercise
  • diet
  • obesity
  • smoking
  • alcohol intake
  • stress
39
Q

For which 4 types of conditions is left ventricular hypertrophy in patients with hypertension a major risk factor?

A
  • dysrhythmia
  • coronary heart disease
  • sudden death
  • congestive heart failure
40
Q

Give 3 effects of hypertension on the vasculature.

A
  • accelerated atherosclerosis
  • stroke
  • retinopathy
41
Q

What is the main ECG modification for moderate hypertension?

A

left axis deviation

42
Q

Define sepsis and septic shock?

A

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

43
Q

Give 4 factors that put someone at greater risk of sepsis.

A
  • 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
44
Q

Give the 5 most common sources of sepsis.

A
  • respiratory
  • abdomen
  • bloodstream
  • skin
  • urinary system
45
Q

What are the 5 main factors affecting infection?

A
  • virulence of pathogen
  • bioburden
  • portal of entry
  • host susceptibility
  • temporal evolution
46
Q

What immune molecules may initiate the production of inflammatory markers in sepsis?

A
  • toll-like receptors (TLRs)

- nucleotide-binding oligomerisation domain receptors (NOD-like receptors)

47
Q

Name the three types of inflammatory markers in sepsis.

A
  • interleukins
  • tumour necrosis factor alpha
  • reactive oxygen species
48
Q

What are the signs of an acute phase response to TNF-alpha and IL1 on the body?

A
  • fever
  • hypotension
  • increased heart rate
  • corticosteroid and ACTH release
  • release of neutrophils
49
Q

What are the effects of TNF-alpha and IL1 on the CV system?

A
  • generalised vasodilation
  • increased vascular permeability
  • intravascular fluid loss
  • myocardial depression
  • circulatory shock
50
Q

What do SOFA and qSOFA stand for respectively?

A

SOFA
septic organ failure assessment

qSOFA
quick SOFA

51
Q

What are the qSOFA variables?

A
  • respiratory rate
  • mental status
  • systolic BP
52
Q

What are the 7 SOFA variables?

A
  • paO2/FiO2 ratio
  • GCS score
  • MABP
  • administration of vasopressors
  • serum creatinine or urine output
  • bilirubin
  • platelet count
53
Q

What are the two causes for which you’d screen for sepsis?

A
  • unexplained illness

- looks unwell + likely infective cause OR NEWS >4

54
Q

What are the 4 main consequences of atherosclerotic coronary disease?

A
  • chronic coronary insufficiency
  • unstable coronary disease
  • heart failure
  • arrhythmia
55
Q

Define subendocardial region.

A

water-shed area of perfusion that is the first to become ischaemic

56
Q

What are the 3 imaging techniques for coronary arteries?

A
  • coronary angiography
  • CT angiography
  • cardiac MRI
57
Q

What are the three steps of atherosclerotic coronary artery disease pathology?

A

1- fatty streak
2- fibro-fatty plaque
3- plaque disruption (rupture or erosion)

58
Q

From what percentage of lumen diameter being occupied by atherosclerosis would limitation of coronary artery blood flow happen?

A

50%

59
Q

What are the determinants of myocardial oxygen consumption?

A
  • tension development
  • contractility
  • heart rate
  • basal activity
  • mass of tissue
60
Q

What are the 6 main causes of MI?

A
  • plaque ruptur
  • plaque erosion
  • coronary embolism
  • coronary artery spasm/drugs
  • coronary anomaly
  • spontaneous coronary dissection
61
Q

Give 5 events modifying presentation of an MI.

A
  • time of the day
  • inflammatory activity
  • infection
  • elevation of BP
  • catecholamines
62
Q

How would you diagnose an MI?

A
  • clinical history
  • ECG changes
  • raised cardiomyocite markers (troponin, CKMB, CPK, AST, myoglobin)
63
Q

What does a tombstone ST elevation mean on an ECG?

A

ST segment elevation so high in the V leads because no electrical activity at the front of the heart

64
Q

What are the late complications of STEMIs?

A
  • left ventricle dilation and heart failure
  • arrhythmia
  • recurrent MI
65
Q

What are the 4 causes of NSTEMIs?

A
  • threatened STEMI
  • small branch occlusion
  • occlusion of well collateralised vessel
  • lateral STEMI in territory not well seen by ECG
66
Q

How would you treat bradycardia?

A

pacemaker

67
Q

Name 5 narrow-complex tachycardias.

A
  • atrial
  • junctional
  • AVNRT and AVRT
  • atrial flutter
  • atrial fibrillation
68
Q

What are the three basic mechanisms of tachycardia?

A
  • ectopic focus
  • re-entry/circus movement
  • fibrillation
69
Q

How would you recognise Wolff-Prakinson-White syndrome on an ECG?

A
  • shortened PR
  • slurred upstroke of QRS
  • widened QRS
70
Q

Give 1 name for main class of drugs used in pharmacologic management of arrhythmias.

A 
class 1a - disopyramide
class 1b - lignocaine
class 1c - flecainide

class 2 - sotalol

class 3- amiodarone

class 4- verapamil

71
Q

Define cardiac failure.

A

failure of the heart to pump sufficient blood to satisfy metabolic demands

72
Q

Which illicit drug is likely to induce systolic cardiac failure?

A

cocaine

73
Q

Give one example of infiltrative disease that is likely to cause diastolic cardiac failure.

A

amyloidosis

74
Q

What is the response to exercise in diastolic cardiac failure?

A
  • tachycardia

- pulmonary acute oedema

75
Q

Give 4 general causes of left and right ventricular failure.

A
  • coronary heart disease
  • hypertension
  • cardiomyopathies
  • drugs
  • toxins
  • endocrine
  • nutritional
  • infiltrative
76
Q

What do you call combined left and right ventricular failure?

A

congestive heart failure

77
Q

Give all 7 key features of clinical examination in patients with heart failure.

A
  • appearance
  • pulse rate
  • BP
  • fluid overload
  • peripheral oedema
  • respiratory issues
  • apex displacement
78
Q

What is hypertension a major risk factor for?

A
  • cardiovascular disease
  • ischaemic heart disease
  • accelerated atherosclerosis
  • Alzheimer type dementia
79
Q

Which condition in pregnancy could cause secondary systemic hypertension?

A

pre-eclampsia

80
Q

What are the consequences of systemic hypertension on the heart?

A
  • left ventricular hypertrophy with fibrosis and arrhythmia
  • ischaemic heart disease
  • cardiac failure
81
Q

Which organs are damaged in pulmonary hypertension?

A
  • pulmonary arteries

- heart

82
Q

What damages to the aorta do diabetes promote?

A
  • ischaemia of wall
  • ulceration
  • generation of atheroma
83
Q

What process in diabetes causes dysfunction of proteins in a systemic manner?

A

non-enzymatic glycation

84
Q

What is the likely fatal consequence of emphysema?

A

cor pulmonale

85
Q

What are the two proteins that can be found infiltrated between cells in amyloidosis

A
  • amyloid-associated protein

- amyloid-light chain protein

86
Q

How long until vasculitis causes loss of kidney function?

A

3 or 4 days

87
Q

Heart failure can be caused by a dysfunction of the thyroid. Which dysfunction is it?

A

hypothyroidism

88
Q

Which cells are involved in sarcoidosis?

A

T-cells

89
Q

Give an example of immunosuppressive drug that endangers the heart.

A

Doxorubicin

MD3001 (9 decks)

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