Week 3

Question 1

Describe the pathogenesis of the formation of an atherosclerotic plaque

Answer 1

1. Endothelial damage
2. CAM expression increases
3. T lymphocytes and monocytes attach to endothelial cells
4. Migrate through the wall to the sub-endothelial space
5. Macrophages eat oxidised LDL
6. Then becoming lipid rich foam cells
7. Which then becomes a fatty streak leading to a fibrous plaque

Question 2

What are some risk factors for atherosclerosis?

Answer 2

Increased total cholesterol 
Smoking
Inactivity 
Hypertension
Unhealthy eating
Deprivation
Age
Family history

Question 3

How do statins reduce the risk of atherosclerosis?

Answer 3

By reducing the total cholesterol by inhibiting HMG-CoA pathway, causing LDL to be required in the liver (for its cholesterol) so it is uptaken from the peripheral tissues hence making it less likely to be deposited in the wall

Question 4

What is a clinical marker of hyperlipidemia?

Answer 4

Xanthelasma (deposits of cholesterol in eye)

Tendon xanthomas (dilation of tendon due to lipid deposits)

Tuberous xanthomas (lipid in dermis)

Eruptive xanthomas (reddish yellow papules on butt)

Question 5

What conditions can cause an increase in blood pressure?

Answer 5

Conns syndrome (excess aldosterone that increases salt and fluid retention)

Cushings syndrome (producing excess corticoidsteroid that increases salt and fluid retention)

Phaechromocytoma (producing excess adrenaline)

Question 6

During endothelial damage, what does the collagen exposed bind to causing clotting?

Answer 6

Glycoprotein Ia/IIb on platelets causing psuedopods to extend

Question 7

What do the coagulation cascade factors require to work?

Answer 7

Vitamin K

Question 8

Give examples of anti-thrombotic endogenous agents?

Answer 8

Protein C
Protein s
Antithrombin III

Question 9

Define ischaemia

Answer 9

Restriction of blood supply to tissues causing shortage of oxygen usually caused by blood vessel damage

Question 10

What are some of the risk factors for high blood pressure?

Answer 10

Obesity, smoking, diabetes, age, end organ damage, vascular disease

Question 11

Describe some secondary causes of hypertension?

Answer 11

Obstructive sleep apnoea (as sympathetic drive always stimulated)

Phaechromocytoma (excess adrenaline so get high BP, tachycardia, pale)

Renal artery stenosis (as if not high enough perfusion increases BP to compensate)

Fibromuscular dysplasia (young women)

Question 12

If you suspect someone to have high BP what should you do first:?

Answer 12

Give them ambulatory BP monitor

Question 13

Man 55 years presents with high blood pressure following ambulatory BP monitor usage. What is your next line of treatment/ investigation?

Answer 13

Calcium channel blocker like amlodipine

Question 14

Man 55 years presents with high blood pressure following ambulatory BP monitor usage and treatment with amlodipine. What is your next line of treatment/ investigation?

Answer 14

Calcium channel blocker (amlodipine)

And ACE inhibitor like bisopril

Question 15

Man 55 years presents with high blood pressure following ambulatory BP monitor usage and treatment with amlodipine and bisopril. What is your next line of treatment/ investigation?

Answer 15

Add a thiazide like diuretic like bendrofluazide

Question 16

What is the role of thromboxan A2 in coagulation of the blood?

Answer 16

Secreted from platelets to. cause;

1. vasoconstriction of smooth muscle
2. mediate release of serotonin to act on GPCR purine receptors which cause activation of platelets to aggregate.
3. Cause exposure of acidic phospholipids to cause solid clot formation

Question 17

Name some of the structure founhd in the posterior mediastinum

Answer 17

Oesophagus
Vagus nerves
Thoracic duct
Azygous vein
Sympathetic trunks
Aorta

Question 18

Where does the lymph from the upper left quadrant and lower limbs drain into? Where is this located?

Answer 18

The thoracic duct leading into the left venous angle composed of the internal jugular vein and the subclavian veins.

Located between the azygous vein and the oesophagus (duck between two gooses)

Question 19

What lymph nodes are present in the lung roots?

Answer 19

The bronchopulmonary nodes

Question 20

What lymph nodes lie in the mediastinum at the bifurcation of the trachea? What is the significance of these nodes?

Answer 20

Tracheo-bronchial nodes

When inflamed will compress the reccurent laryngeal nerve supplying the voice box causing hoarseness of voice

Question 21

What is the compostion of arterial thrombus? How would you treat for them (what medication)

Answer 21

White composed mainly of platelets in a fibrin mesh

Treat with antiplatelet

Question 22

What is the composition of venous thrombus? How would you treat for them (medicaiton)

Answer 22

Red thrombus made of mainly rbcs in a fibrin mesh

Treat with anticoagulants