Specific features of diseases

Question 1

Constrictive Pericarditis

Answer 1

dyspnoea
non-productive cough
flu-like symptoms
tachypnoea
tachycardia
right heart failure: elevated JVP, ascites, oedema, hepatomegaly
JVP shows prominent x and y descent
loud S3
chest pain: may be pleuritic. Is often relieved by sitting forwards
pericardial friction rub 
widespread 'saddle-shaped' ST elevation
PR depression: most specific ECG marker for pericarditi

Question 2

Abdominal Aortic Aneurysm

Answer 2

Aneurysm is defined as the dilation of a vessel >40% of its normal diameter.
Smoking/ Hypertension/ Diabetes/ Cholesterol
Medial generation ( increased stress on the aortic wall)
Ultrasound or CT scan - surveillance or open repair
AAA rupture - sudden onset of epigastric/central pain which can radiate to the back

Question 3

Myocardial Infarction

Answer 3

SEVERE CENTRAL CRUSHING CHEST PAIN 
Sweating/ vomiting/ nausea 
Creatinine kinase and troponin 
St elevation, T wave inversion, New LBBB
MONAC, thrombolysis or PCI

Question 4

Ischaemic Stroke

Answer 4

Thrombotic/ Embolic/ Hypoperfusion

Blood tests/CT/MRI/ Doppler/ ECG/ ECHO

Thrombolysis/ Aspirin/ Anticoagulation/ Statins/ Anti-hypertensives/ Carotid endoarterectomy/ Haematoma evacuation

Question 5

Haemorrhagic stroke

Answer 5

Hypertension/ Drugs/ Aneurysm/ Vasculitis

Question 6

Ischamic Vs Haemorrhagic stroke

Answer 6

CT and MRI brain scans can be used to differentiate between the two.

Risk factors for stroke: 
Hypertension 
Smoking 
Diabetes 
Protein C and S deficiency 
Factor V Lieden mutation

Question 7

VIRCHOW’S TRIAD

Answer 7

Injury to the vessel wall

Stasis (abnormal flow)

Hypercoaguable state

Question 8

Types of emboli

Answer 8

Air 
Fat 
Tumour 
Thrombotic
Amniotic fluid 
Septic

Question 9

Common sites for blockage by an emboli

Answer 9

Coronary vessels
Bifurcation of the aorta 
Carotid arteries 
Renal arteries 
Superior mesenteric artery

Question 10

Types of Peripheral vascular disease

Answer 10

Intermittent claudication
Rest Pain
Ulcers/Gangrene
Varicose veins

Question 11

Cardiac Tamponade

Answer 11

dyspnoea
tachycardia
hypotension
raised JVP
muffled heart sounds
pulsus paradoxus
Kussmaul's sign 

REQUIRES PERICARDIOCENTESIS

Question 12

Coarctation of the aorta

Answer 12

Hypertension
Radial-femoral pulse delay
Seen in young patients (e.g 20 yrs old)

Question 13

Aortic Dissection

Answer 13

Sudden onset chest pain at rest
Pain radiates to the back
Sinus tachycardia due to loss of blood volume

Question 14

What four defects does the tetralogy of fallot disease include?

Answer 14

VSD - Ventricular septal defect (NOT ASD) 
Overriding aorta 
RV hypertrophy 
Pulmonary stenosis
- RV outflow obstruction

Usually presents in the neonatal period with a murmur, cyanosis, or both.

Diagnosed by echocardiography.

Treatment is by surgical repair.

Question 15

Consequences of a patent ductus arteriosus

Answer 15

Cyanosed baby
Continuous machine- like heart murmur
Irregular transmission of blood between the aorta and the pulmonary artery

Question 16

Aortic incompetence

Answer 16

Collapsing pulse
Wide pulse pressure - pulse tends to have a tall upstroke then falls away
Congenital aortic bicuspid valve
symptoms often don’t appear until the patient is in their 30s/ 40s
predominant symptom is breathlessness

Question 17

What are the characteristics an treatments of Hypertrophic Obstructive Cardiomyopathy (HOCM)?

Answer 17

Thickened LV
Poor CO due to obstruction of the outflow tract
AF/ heart failure/ angina - common consequences
Causes severe chest pain/ S.O.B and sudden death in otherwise healthy young individuals

TREATMENT;

• Anticoagulation (AF)
• Rate/ Rhythm control e.g beta.blockers/ verapamil/ amiodarone/ diltiazem e.t.c
• Low dose diuretics / ACE I/ARB (Heart failure)
• Calcium channel blockers/ Beta- blockers/ Nitrates (angina symptoms)
• ICD implantation
• Cardiac transplant

Question 18

What are the characteristics and treatments of ; CPVT - Catecholaminergic Polymorphic VT ?

Answer 18

Autosomal Dominant
Polymorphic VT and VF
Triggered by emotional stress and physical activity (adrenergic induced)

TREATMENT; 
Beta- blockers
Flecainide 
Avoidance of strenuous activities 
ICD implantation 
Left cardiac sympathetic denervation can be considered

Question 19

Characteristics and treatment of Congenital LQTS

Answer 19

QT prolongation (due to ion current dysfunction causing prolonged depolarisation) 
Leads to torsade de pointes and polymorphic VT 

TREATMENT;
long - term oral potassium (e.g from diet)
~ Increases the function of the K+ channel and thus normalises QT

Question 20

Characteristics of Brugada Syndrome

Answer 20

Autosomal Dominant
AF is common and there is a risk of polymorphic CT and VF
St elevation and RBBB in V1-V3

Question 21

What would the appropriate treatment be if a patient presented with critical limb ischaemia in which there is pain in the leg at rest and no palpable pulses?

Answer 21

Percutaneous transluminal angioplasty

Question 22

What is the difference in structure of the wall of a false and true aneurysm?

Answer 22

A false aneurysm has only a single layer of fibrous tissue which forms the aneurysm whereas a true aneurysm involves all 3 layers of the arterial wall.

Question 23

What should be the first line of treatment/management for a patient with with red oedematous legs and non-painful, uneven non-healing ulcers

Answer 23

Pressure Stockings

Question 24

what kind of necrosis can be seen in the arterioles of patients with malignant hypertension?

Answer 24

Fibrinoid Necrosis

Question 25

Sudden heart failure, Raised JVP, pulsus parodies and recent MI would suggest what?

Answer 25

Left ventricular free wall rupture

Question 26

ST elevation following MI but no chest pain would suggest what?

Answer 26

Left ventricular aneurysm

Question 27

Other than aortic stenosis, what else can cause a 4th heart sound?

Answer 27

HOCM

Question 28

Why can systemic emboli occur post M.I and what do they cause

Answer 28

Systemic emboli come from the LEFT side of the heart due to stasis of blood following a myocardial infarction. They can cause a stroke as the brain is supplied by the systemic circulation. They will not cause a PE as this would only occur with the venous system - e.g from a DVT in the leg.

Question 29

Why can atrial fibrillation occur after an MI?

Answer 29

Death of the heart muscle affects the currents that run through the heart and thus arrhythmias can occur as a consequence

Question 30

Why can mitral stenosis cause a cough productive of frothy sputum?

Answer 30

Mitral stenosis affects the left side of the heart and thus can cause pulmonary hypertension and pulmonary oedema - leading to frothy sputum.

Question 31

What is vasovagal syncope?

Answer 31

Normal fainting - e.g due to standing for too long in the heat

Question 32

What is meant by ‘first-dose hypertension’?

Answer 32

Fainting after starting a new medication

Question 33

What medication should a patient be on after an MI?

Answer 33

Aspirin and Clopidogrel 
Ace inhibitors or ARB
Beta-Blockers
Statins
Nitrates 
Possibly warfarin

Question 34

What is aortic coarctation and how does it usually present?

Answer 34

Aortic coarctation is a focal narrowing in in the aorta through which blood struggles to get through

• It usually presents with a delay between the upper and lower pulses
• systolic ejection murmur
• bicuspid aortic valve

Question 35

A small rise in troponin can be seen in which disease? (Not MI)

Answer 35

Acute pericarditis

Question 36

The presentation of aortic dissection can seem very similar to a STEMI, but what is different about the pain in aortic dissection?

Answer 36

The pain is ‘tearing’ in nature and radiates to the back