MBBS4 😎

Answer the Questions Below

What is atherosclerosis?

What is the primary cause (aetiology) of atherosclerosis?

What are the non-coronary causes of ischemic heart disease (IHD)?

What inflammatory mediators are involved in the formation of unstable plaques?

Which marker is most sensitive for detecting atherosclerosis?

What is the first step in the pathogenesis of atherosclerosis?

Describe the gross and microscopic morphology of hypertension (HTN).

What is the pathophysiology of hypertension on kidney appearance?

What type of hypertension causes this kidney appearance?

What is the colloquial term for a kidney affected by hypertension?

What are the features of each grade of hypertensive retinopathy?

Which of the following is a non-modifiable risk factor for atherosclerosis?

Smoking Diabetes Family History Hypertension High Cholesterol

What is the main complication of chronic ischemic heart disease (IHD)?

Hypertension (HTN) Heart failure (HF) Myocardial infarction (MI) Arrhythmias

At what percentage of blockage in coronary atherosclerosis do symptoms typically appear, and what factors contribute to the symptoms?

50% blockage, due to high blood pressure and blood clotting 60% blockage, due to increased cholesterol levels 70% blockage, due to lactic acid and bradykinin 80% blockage, due to inflammation and oxidative stress

Atherosclerosis is classified as which type of arteriosclerosis?

Microangiopathy Macroangiopathy

Which vessels are most commonly affected by atherosclerosis?

Pulmonary veins Coronary arteries Hepatic veins Lymphatic vessels

Which of the following is a coronary cause of ischemic heart disease (IHD) that accounts for 90% of cases?

Severe anemia Tachycardia Atherosclerosis Aortic stenosis (AS)

Which statement about a stable plaque is true?

Lipid core is larger than the fibrous cap Prone to rupture and cause embolism Fibrous cap is larger than the lipid core No calcification

What is the first macroscopic feature of atherosclerosis?

Central necrotic core Intimal ulceration Fatty streaks Foam cell necrosis

Given a blood pressure of 155/99, what type of hypertension does the patient have?

Normal Grade 1 (mild) Grade 2 (moderate) Grade 3 (severe) Isolated systolic hypertension

What are the causes of right-sided/pulmonary hypertension and their associated complications?

Right-sided hypertrophy (RVH) in chronic lung disorders Chronic: Cor-Pulmonale in chronic lung disorders, Acute: Pulmonary Embolism Acute: Cor-Pulmonale, Chronic: Pulmonary Embolism Right-sided hypertrophy (RVH) due to congestive heart failure

What are the types of arteriolosclerosis and their associated features?

Hyaline Arteriolosclerosis - Protein deposition (typical of DM) Hyaline Arteriolosclerosis - Protein deposition (typical of DM), Hyperplastic Arteriolosclerosis - Smooth muscle hyperplasia & fibrosis (typical of HTN) Hyperplastic Arteriolosclerosis - Protein deposition (typical of DM) Hyaline Arteriolosclerosis - Smooth muscle hyperplasia & fibrosis (typical of HTN)

What is the relationship between STEMI and NSTEMI in terms of infarct location?

STEMI - Subendocardial infarction, NSTEMI - Transmural infarction STEMI - Transmural infarction, NSTEMI - Subendocardial infarction STEMI - Subendocardial infarction, NSTEMI - Myocardial ischemia STEMI - Myocardial ischemia, NSTEMI - Transmural infarction

What are the physiological responses to high blood pressure that help decrease it?

ANP, BNP - diuresis Aldosterone - sodium retention Renin - vasoconstriction ADH - vasodilation

List the other causes of MI that are not atherosclerosis.

Time Period: < 4 hours

MI - GROSS:

Normal
normal w loss of glycogen
Yellow center, red border
Pale grey, thin red border

MI - MICROSCOPY:

loss of glycogen only, appears normal
Necrosis + Macrophages phagocytosing dead cells
Granulation tissue, macrophages, BV fibroblasts, collagen
Dense fibrosis (mature scar)

Time Period: 1-3 days

MI - GROSS:

Normal (loss of glycogen)
Recent dark red area
Yellow center, red border
Pale grey, thin red border

MI - MICROSCOPY:

Coagulative necrosis (normal shape but no nucleus), Hemorrhage, Neutrophils
Necrosis + Macrophages phagocytosing dead cells
Granulation tissue, macrophages, BV fibroblasts, collagen
Dense fibrosis (mature scar)

Time Period: < 2 weeks

MI - GROSS:

Normal (loss of glycogen)
Recent dark red area
Yellow center, red border
Pale grey, thin red border

MI - MICROSCOPY:

Time Period: < 8 weeks

MI - GROSS:

Normal (loss of glycogen)
Recent dark red area
Yellow center, red border
Pale grey, thin red border

MI - MICROSCOPY:

Time Period: > 8 weeks

MI - GROSS:

Normal (loss of glycogen)
Recent dark red area
Yellow center, red border
small white scar

MI - MICROSCOPY:

List 3 chronic complications of MI:

List 3 acute complications of MI:

List 3 causes of Mitral Regurgitation:

2. What is shown?

Unstable Plaque Stable Plaque Fibrous Plaque Calcified Plaque

3. What is shown?

Complex Plaque Atherosclerotic Plaque Stable Plaque Thrombotic Plaque

4. What is shown and what does it tell you about the disease time course?

MI <24 hours old. Red myocytes, pyknotic nucleus, inflammatory cells. Hemorrhage around BV. MI 48-72 hours old. Extensive fibrosis, minimal inflammation. Chronic MI. Dense collagen deposition and no inflammatory cells. Acute MI with coagulative necrosis, but no inflammatory cells or hemorrhage.

5. What is shown and what does it tell you about the disease time course?

Dense collagen bundles. Old MI >8 weeks Acute MI. Evidence of necrosis and hemorrhage. Subacute MI (2-4 weeks). Fibrosis with minimal inflammation. Chronic MI with extensive calcification and fibrosis.

6. What is shown here?

Fatty Streak Fibrous Plaque Stable Plaque Atherosclerotic Plaque with necrosis

7. What is shown here and what are 3 key features?

Stable Plaque. Thick fibrous cap, lipid core, inflammatory cells Unstable Plaque. Thin fibrous cap, lipid core, hemorrhage Complex Plaque. Heavy calcification, minimal inflammatory cells Atherosclerotic Plaque. Thin cap, no lipid core, no inflammatory cells

1. List three indications for Cardiac Rehabilitation:

2. List three absolute contraindications for Cardiac Rehabilitation:

3. List three benefits of Cardiac Rehabilitation:

4. List three components of Cardiac Rehabilitation:

What are the high-risk criteria in the QLD suspected ACS pathway?

Ongoing chest pain, runs of VT/VF, haemodynamically unstable (hypotensive) Previous MI, ATSI, another episode of pain UA with no troponin rise Normal results on ECG and troponin

What actions should be taken for high-risk criteria in the QLD suspected ACS pathway?

Reperfuse, continuous cardiac monitoring, admit to CCU/HDU, refer to interventional cardiology Discharge for GP follow-up, typically for EST Consider PCI, refer to inpatient exercise stress testing No actions necessary, monitor vitals regularly

What are the intermediate-risk criteria in the QLD suspected ACS pathway?

Ongoing chest pain, runs of VT/VF, hypotensive Previous MI, ATSI, another episode of pain UA with no troponin rise Normal results on ECG and troponin

What actions should be taken for intermediate-risk criteria in the QLD suspected ACS pathway?

Reperfuse, continuous cardiac monitoring, admit to CCU/HDU Consider PCI, refer to inpatient exercise stress testing Discharge for GP follow-up No actions necessary, monitor vitals regularly

What are the low-risk criteria in the QLD suspected ACS pathway?

Previous MI, ATSI, another episode of pain UA with no troponin rise Ongoing chest pain, runs of VT/VF, hypotensive Normal results on ECG and troponin

What actions should be taken for low-risk criteria in the QLD suspected ACS pathway?

Reperfuse, continuous cardiac monitoring, admit to CCU/HDU Discharge for GP follow-up → typically for EST with referral to cardiology outpatient for angiogram Consider PCI, refer to inpatient exercise stress testing No actions necessary, monitor vitals regularly

How soon must PCI (Percutaneous Coronary Intervention) be performed after diagnosis?

Within 30 minutes of diagnosis Within 60 minutes of diagnosis Within 90 minutes of diagnosis Within 120 minutes of diagnosis

What are 3 essential criteria for thrombolysis?

Chest pain > 15 minutes and < 24 hours, ST elevation or new LBBB, can be treated with pPCI Chest pain > 30 minutes and < 12 hours, ST depression, MI not likely from history Chest pain > 30 minutes and < 12 hours, ST elevation or new presumed LBBB, MI likely from history, Cannot be treated with pPCI within 90 minutes of first medical contact Chest pain > 10 minutes and < 6 hours, ST elevation, can be treated with pPCI within 90 minutes

What are 2 absolute contraindications to PCI?

Severe hypertension, renal failure High bleeding risk (thrombocytopenia, peptic ulcer, severe coagulopathy), multiple percutaneous coronary intervention restenosis Uncontrolled diabetes, advanced age Active myocardial infarction, severe hypotension

What is the primary difference between hypertensive urgency and hypertensive emergency?

Hypertensive urgency involves a blood pressure increase >180/110 without signs of organ damage, while hypertensive emergency involves a blood pressure increase >220/140 with signs of acute organ damage Hypertensive urgency requires immediate treatment to lower blood pressure, while hypertensive emergency does not require urgent intervention Hypertensive urgency occurs only in individuals over 65, while hypertensive emergency can affect individuals of all ages Hypertensive urgency involves no risk to organs, while hypertensive emergency leads to immediate organ failure if left untreated

Which of the following are first-line pharmacotherapies for hypertension?

ACE inhibitors (ACEI), Angiotensin II receptor blockers (ARB), Dihydropyridine calcium channel blockers (DHP CCB), Thiazide diuretics Beta-blockers, Alpha blockers, Potassium-sparing diuretics Direct vasodilators, Loop diuretics, Spironolactone ACE inhibitors (ACEI), Calcium channel blockers (non-DHP), Loop diuretics

What is the recommended follow-up schedule for individuals with cardiovascular risk?

Close monitoring and follow-up every 6–12 months Follow-up only every 2 years Monthly visits for intensive monitoring Follow-up every 5 years

Which of the following CVD risk factors is most important for monitoring in diabetic patients?

HbA1c and time since diagnosis of diabetes Age and sex Smoking status and family history Atrial fibrillation and BMI

What is the recommended management approach for individuals at high cardiovascular risk (greater than 10%)?

Intensive lifestyle interventions and pharmacological treatment (statins, antihypertensives, aspirin in some cases) Lifestyle changes alone, with no need for pharmacological treatment Close monitoring only every 2 years Immediate surgery for risk reduction

Which of the following is a key lifestyle factor for managing cardiovascular risk?

Physical activity Gender Age Family history of heart disease

Which of the following is a cardiovascular risk factor specifically relevant to people with diabetes?

Ratio of total cholesterol to HDL Chronic kidney disease Family history of CVD Smoking status

Which of the following is **not** an exclusion criterion for cardiovascular risk assessment?

Patients with established CVD (managed differently) Individuals with high cholesterol only Individuals with short life expectancy or severe comorbidities Young adults with no risk factors

Who should undergo cardiovascular risk assessment for individuals without known cardiovascular disease (CVD)?

All people aged 45–79 years, people with diabetes aged 35–79 years, and First Nations people aged 30–79 years People aged 18–45 years, with or without risk factors People aged 25–45 years with family history of CVD Individuals aged 30–50 years without any risk factors

1. What are cardiac causes of APO?

MI, LSHF, Hypertensive emergency MI, LSHF, Hypertensive emergency ARDS, Pneumonia, Pulmonary embolism COPD, Asthma, Pneumothorax

2. What are respiratory causes of APO?

MI, LSHF, Hypertensive emergency ARDS, Pneumonia, Pulmonary embolism ARDS, Pneumonia COPD, Asthma, Pneumothorax

3. What's the age of peak incidence for ARF in Indigenous Australians?

1-4 years 15-24 years 5-14 years 25-34 years

4. SHORT ANSWER - List 4 features that make some at high risk of contracting ARF.

5. SHORT ANSWER - Describe the pathogenesis of ARF.

6. Describe the pathophysiology of ARF? (have the first word available here so you just have to fill in the symptom associated with the condition)

7. What are 4 specific microscopic features of pericarditis?

Fibrinoid necrosis, Anitschkow cells, Aschoff body, Giant multinucleated cells Fibrinoid necrosis, Anitschkow cells, Aschoff body, Giant multinucleated cells Neutrophilic infiltration, Granuloma formation, Caseous necrosis, Fibrosis Lymphocytic infiltration, Vasculitis, Amyloid deposits, Calcification

8. What is an Aschoff body?

A collection of neutrophils in the myocardium A granulomatous lesion of fibrin surrounded by giant multinucleated cells A granulomatous lesion of fibrin surrounded by giant multinucleated cells A calcified nodule in the pericardium

9. SHORT ANSWER - Describe the clinical features of ARF.

10. Describe the diagnostic criteria of definite ARF (MCQ).

1 major OR 2 minor manifestations 2 major OR 1 major and 1 minor manifestation 2 major OR 1 major and 2 minor or 3 minor manifestations (if recurrent) with evidence of preceding GAS infection 3 major OR 2 major and 1 minor manifestation

11. What are the minor manifestations of ARF for a high-risk group individual? (MCQ).

Temp >38.5C, Monoarthralgia, ESR or CRP >30, Prolonged PR interval Temp >38.5C, Monoarthralgia, ESR or CRP >30, Prolonged PR interval Polyarthralgia, ESR >60, Fever >39C, Leukocytosis Aseptic monoarthritis, CRP >60, Prolonged QT interval, Tachycardia

12. How does that compare to the low-risk group? (MCQ).

Must have polyarthralgia or aseptic monoarthritis, ESR >60 Must have polyarthralgia or aseptic monoarthritis, ESR >60 Must have monoarthralgia, ESR >30, Prolonged PR interval Must have fever >38.5C, CRP >30, Tachycardia

13. SHORT ANSWER - What is the test that can diagnose RHD?

14. SHORT ANSWER - What is the test that indicates GAS infection?

15. SHORT ANSWER - What does a mitral valve with RHD look like?

16. SHORT ANSWER - What is the 5 steps in management for RHD?

17. SHORT ANSWER - What are some considerations when planning valve interventions?

18. SHORT ANSWER - What are 3 complications of RHD?

19. SHORT ANSWER - What is primordial, primary, secondary and tertiary prevention of ARF?

20. SHORT ANSWER - Describe the pathogenesis of HF?

21. SHORT ANSWER - What are the compensatory mechanisms in HF?

22. SHORT ANSWER - What happens in decompensation?

23. SHORT ANSWER - What is the change in the liver in CHF? Why does it appear this way?

24. SHORT ANSWER - What is level 2 vs level 3 on the NYHA level of clinical impairment scale?