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Pathology and Disease: free practice, theory and problems
Cardiovascular diseases are among the most common causes of illness and death. You must recognise the symptoms and know what is urgent.
Contents
1. Cardiovascular disease
What is it about?
Cardiovascular diseases are among the most common causes of illness and death. You must recognise the symptoms and know what is urgent.
Diseases
- Heart attack (myocardial infarction): a coronary artery is blocked, and part of the heart muscle gets no oxygen. Typical is pressing chest pain that may radiate to the left arm, jaw or back, with cold sweat and nausea. Women, older people and people with diabetes can have atypical symptoms. Call the emergency number.
- Heart failure: the heart pumps too weakly. Causes breathlessness (worse lying flat), leg oedema, weight gain and night-time urination. Monitor weight and fluid balance.
- Atrial fibrillation: an irregular pulse. Increases the risk of stroke, so many get anticoagulants.
- High blood pressure (hypertension): often causes no symptoms, but increases the risk of stroke, heart attack and kidney failure.
2. Lung disease
What is it about?
Lung diseases cause breathlessness and low oxygen. Treatment depends on whether the problem is narrow airways, inflammation or damage to the lung tissue.
Diseases
- COPD (chronic obstructive pulmonary disease): permanently narrowed airways, most often after smoking. Some people with severe COPD risk retaining CO₂ with too much oxygen, so the doctor often sets a lower target for oxygen saturation (for example 88–92%).
- Asthma: attacks of narrowed airways that are reversible. Treated with inhaled bronchodilators (for example salbutamol) and anti-inflammatory medication.
- Pneumonia: infection in the lung tissue. Causes fever, cough, rapid breathing and often a high CRP.
- Pulmonary embolism: a blood clot in the lungs. Causes sudden breathlessness and chest pain. The risk increases with bed rest and after surgery.
3. Diabetes
What is it about?
In diabetes the blood glucose is too high because the body lacks insulin or does not respond well enough to it.
Concepts
- Type 1: the body does not make insulin (an autoimmune disease). Always treated with insulin.
- Type 2: the cells respond poorly to insulin (insulin resistance). Treated with lifestyle changes, tablets and often insulin later.
- HbA1c shows the average blood glucose over the last 2–3 months. 48 mmol/mol or higher can give the diagnosis of diabetes.
- Hypoglycaemia (blood glucose below about 4 mmol/L): sweating, trembling, restlessness, confusion. If the patient is awake and can swallow: give fast-acting carbohydrates (for example glucose tablets or juice). If the patient is unconscious: call the emergency number, never give anything by mouth.
- Ketoacidosis (usually type 1): high blood glucose, nausea, deep and rapid breathing, a smell of acetone. Life-threatening.
- Diabetes damages blood vessels and nerves over time. Check the feet for wounds.
4. Infections and sepsis
What is it about?
Sepsis is a life-threatening condition where the body's response to an infection damages its own organs. Early detection and antibiotics save lives.
Concepts
- Common sources: pneumonia, urinary tract infection, abdominal infection and skin infection.
- Signs: high or low temperature, rapid breathing, rapid pulse, low blood pressure, new confusion and low urine output.
- qSOFA is a simple check: respiratory rate 22 or higher, altered mental status and systolic blood pressure 100 or lower. Two or more suggest high risk.
- NEWS2 also picks up many septic patients.
- Treatment: blood cultures, antibiotics quickly (ideally within one hour in severe sepsis), fluids and monitoring.
- Older people may have few symptoms, for example only confusion or not "being themselves".
5. Stroke and neurology
What is it about?
In a stroke part of the brain gets too little blood, either because a blood vessel is blocked (infarction, the most common) or because it bursts (haemorrhage). The faster the treatment, the more brain tissue is saved.
Concepts
- Recognise a stroke with "Speak – Smile – Lift": slurred or confused speech, a lopsided smile, and weakness when lifting the arms. Call the emergency number at once.
- The time the symptoms started is crucial, because clot-dissolving treatment can only be given within a short time window.
- After a stroke: risk of swallowing difficulties (test before food and drink), falls and paralysis. Early mobilisation and rehabilitation are important.
- Level of consciousness is often assessed with the Glasgow Coma Scale (GCS), from 3 (deeply unconscious) to 15 (awake and oriented).
Example problems with solutions
Here are some of the problems in pathology and Disease. In the app, calculation problems get new numbers every time, so you can practise until it sticks – and take a graded practice exam before the real one.
Cardiovascular disease: Which symptom is typical of heart failure?
Answer: Leg oedema and breathlessness lying flat
Fluid builds up in the lungs and the legs.
Lung disease: What is a common oxygen saturation target for some people with severe COPD (as decided by the doctor)?
Answer: 88–92%
Too much oxygen can cause CO₂ retention in some COPD patients.
Diabetes: An awake patient with diabetes is sweaty, shaky and confused. Blood glucose 2.8 mmol/L. What do you do first?
Answer: Give fast-acting carbohydrates, for example juice or glucose
This is hypoglycaemia. Insulin would lower the blood glucose even more.
Infections and sepsis: Which three criteria are part of qSOFA?
Answer: Respiratory rate ≥ 22, altered mental status, systolic blood pressure ≤ 100
Two or more mean a high risk of a poor outcome in infection.