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Key ALS facts > Block 13 > Flashcards

Block 13 Flashcards

1
Q

Briefly explain concept of Cor pulmonae

A

pulmonary vessels constrict to shunt blood away from damaged alveoli to healther alveoli to maintsain gas exchange

increases pulmonary vascular resistance -> pulmonary hypertension -> increases backflow of blood to R side of heart, R side of heart enlarges overtime to compensate => R sided HF

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2
Q

Type of HF where ventricles can’t pump hard enough during systole

A

Systolic HF or HF w reduced ejection fraction

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3
Q

Type of HF where not enough blood fills ventricles during diastole

A

Diastolic HF or HF w preserved EF

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4
Q

Adverse effects of HF

A
  • increased preload and afterload
  • reduced coronary + renal perfusion due to decreases CO
  • fluid accumulation — pulmonary oedema
  • increased K+ excretion
  • cardiomyocyte necrosis + arrhythmias
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5
Q

Impact of HF on kidneys

A

decreases CO → decreases renal blood flow → decreased GFR → RAAS activated → increased Na+ and water reabsorption

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6
Q

Age-related changes to heart

A
  • Interstitial collagen within the myocardium increases
  • myocardium stiffens
  • myocardial relaxation is prolonged
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7
Q

Symptoms of HF

A
  • dyspnoea
  • orthopnoea — SOB that’s worse when lying down
  • SOB that wakes patient up at night
  • pedal oedema
  • fatigue
  • tachycardia
  • tachypnoea
  • elevated JVP
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8
Q

2 key complications of COPD

A

Cor pulmonae

Type II respiratory failure

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9
Q

Type II respiratory failure

A

alveolar ventilation is insufficient to excrete the carbon dioxide being produced:

low oxygen

high CO2

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10
Q

Cardinal symptoms of CVD

A

Chest pain

Breathlessness

Palpitations

Syncope

Haemoptysis

Oedema

Cough

Fatigue

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11
Q

Key symptoms of angina

A

substernal pain

exacerbated by emotional stress + exertion

relieved by rest

*worse in cold, lasts 2-10mins

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12
Q

Subjective sign of disease

A

Symptom

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13
Q

Objective sign of disease discoverable on examination

A

Sign

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14
Q

Key symptoms of MI

A
  • pain at rest
  • builds up over a few mins
  • no relief w GTN or rest
  • 30mins plus
  • SOB
  • sweats
  • nausea
  • fear
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15
Q

Aortic dissection symptoms

A

tearing intense chest pain

sudden onset

pain radiates to back as well as other sites e.g. arms/legs/neck/head

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16
Q

Cardiac symptoms of Pericarditis

A
  • retrosternal pain
  • relieved by sitting forward
  • may radiate to neck + shldr
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17
Q

Orthopnea

A

type of dyspnea only occurs when a person is lying down

*caused by increased pressure in BVs of lungs

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18
Q

Paroxysmal nocturnal dyspnea

A

SOB that wakes patient at night

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19
Q

Site of ANP release

A

myocytes of RA + RV mainly

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20
Q

Action of ANP

A
  • natriuresis - sodium excretion
  • lowers BP
  • antagonises actions of angiotensin II, aldosterone
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21
Q

Effect of Beta blockers on renin

A

inhibit renin release from kidneys

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22
Q

Most common pathogen causing lower respiratory tract infections

A

Streptococcus pneumoniae

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23
Q

Type of breath sounds caused by consolidation in lobar pneumonia

A

Bronchial breathing

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24
Q

MoA of Class IV antiarrhythmic drugs

A
  • block voltage-sensitive calcium channels
  • slow conduction in the SA and AV nodes
  • shorten the plateau phase of the action potential
  • reduce force of contraction
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25
Q

MoA of Digoxin

A
  • increases vagal outflow to reduce conduction rate at AV node
  • inhibits Na+/K+ ATPase pump which increases intracellular Ca2+ => positive inotropic effect
  • increased intracellular Na+ slows extrusion of Ca2+ via the Na+/ Ca2+ exchanger decreasing Ca2+ extrusion and thus increased Ca2+ is stored in the SR and available on release
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26
Q

MoA of Class II antiarrhythmic β1-selective-Adrenoceptor antagonist

A

e.g. Atenolol

diminishes the Phase 4 depolarisation which:

  • suppresses automaticity
  • prolongs AV conduction
  • decreases HR + contractility
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27
Q

MoA of Dobutamine

A

β1 adrenoceptor agonist and α1 selective activity with some weak β2 activity

  • increases contractility + CO
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28
Q

Why is Verapamil contraindicated in HF?

A

because it blocks calcium channels and has negative inotropic effect

29
Q

Site of Spironolactone action

A

collecting ducts

30
Q

How does spironolactone help reduce pulmonary oedema in HF?

A

Blocks aldosterone action in CD which:

increases Na+ and water excretion

so decreased fluid volume = decreased pulmonary oedema

31
Q

Canon ball lesions in all lung fields indicate

A

Metastatic cancer

32
Q

Important side effect of ACE inhibitors:

A

first-dose hypotension

33
Q

Therapy for NSTEMI

A

Antiplatelet therapy, LMWH, statins and anti-ischaemics

34
Q

D-dimers are

A

biomarkers for ongoing thrombosis

35
Q

1st Degree heartblock on ECG

A
  • regular QRS complexes

- p waves present BUT delay at AV node, P-R interval prolonged => 1st degree heart block

36
Q

Slow or blocked conduction through AV node is

A

HEART BLOCK

37
Q

Effect of adenosine on AV node

A

BLOCKS AVN

38
Q

Effect of atropine on AV node

A

STIMULATES AV node

39
Q

Common presentation of atrial flutter on ECG

A
  • 150bpm

- narrow QRS complex

40
Q

Common causes of tachycardia

A
  • Hyperthyroidism
  • Anxiety
  • Heart failure
  • Hypovolaemia
  • Septicaemia
41
Q

Commonest pathogen causing lower respiratory tract infections in ALL age groups

A

Streptococcus pneumoniae

42
Q

Patchy shadowing in lung fields on X-ray

A

BRONCHO-PNEUMONIA

43
Q

Antiarrhythmic drugs that:

slow conduction in the SA + AV noded

shorten the plateau phase of the AP

decrease force of contraction

A

CLASS IV anti-arrhythmic drugs

44
Q

Beta 1 selective receptor agonist used to treat acute but reversible HF e.g. cardiogenic or septic shock

A

DOBUTAMINE -> increases cardiac output + contractility

45
Q

Type of calcium channel receptors that Verapamil acts on

A

L-type Ca2+ channels

46
Q

The pathogen that generally causes pneumonia after a preceding viral illness

A

Staphylococcus aureus

47
Q

Mechanism of Action of Theophylline

A

competitively inhibits type III + type IV phosphodiesterase

WHICH prevents cAMP breakdown

LEADING TO: bronchial SM relaxation; bronchodilation

48
Q

What clinical finding distinguishes L. pneumophilia from other pneumonias?

A

HYPONATREMIA!

49
Q

In what pathologies are hyper-inflated lungs normally seen?

A

COPD - as air gets trapped within the lungs

50
Q

Typical therapy for NSTEMI

A

LMWH - inactivates thrombin + activated factor X prevent further thrombin activation and fibrin formation

Statins - maintain plaque stability

Anti-ischaemic medications - maintain perfusion and prevent ischaemia

Anti-platelet therapy - prevent further platelet recruitment to the thrombus

51
Q

Briefly explain atrial flutter

A

ATRIA contract v fast

BUT, AV node is refractory so only conducts a proportion of impulses

52
Q

Torsades de Pointes

A

specific type of polymorphic ventricular tachycardia:

common cause: decreased K+ AND decreased Mg2+

53
Q

How to calculate HR in bpm from an ECG?

A

300 / no. of lrg squares

54
Q

What is heart block?

A

slow/blocked conduction through AV node

55
Q

Sinus Arrest

A

failure of sinus node discharge ==> no atrial/ventricular depolarisation

56
Q

3 classes of class I anti-arrhythmic drugs

A

MODERATE

  • Quindine
  • Procainamide

WEAK

  • Lidocaine
  • Phenytoin

STRONG

  • Propafenome
  • Flecainide
57
Q

Non-selective beta blockers

A

Propanolol

Timolol

Nadolol

58
Q

Cardioselective beta blockers

A

Atenolol

Carvedilol

Bisoprolol

Metoprolol

59
Q

MoA of Ca2+ channel blockers

A

inhibit Ca2+ influx during membrane depolarisation

EFFECTS:

  • reduces LV contraction
  • dilates BVs
  • reduces myocardial oxygen demand
60
Q

Main aetiological agents of acute bronchitis

A 
VIRUSES:
Rhinoviruses
Adenoviruses
Parainfluenza
Influenza A+B
61
Q

Exacerbation of COPD is usually:

A

acute bronchitis!!!

62
Q

Which groups of ppl are more susceptible to bronchopneumonia?

A

infants AND elderly

63
Q

Which organisms commonly cause cavitating pneumonia?

A

S. aureus

Klebsiella

Mycobacteria TB

64
Q

Majority of community acquired pneumonia is caused by

A

BACTERIA

70% - 90% caused by Streptococcus pneumoniae

65
Q

Which class of antibiotic should be used to treat Legionnaire’s?

A

Macrolides or Quinolones (penicillins don’t work!!!)

66
Q

Pneumonia occurring 48hrs after hospital admission or discharge

A

Hospital acquired pneumonia

67
Q

Where are ACE inhibitors activated in the body?

A

phase 1 metabolism in liver

68
Q

Where are baroreceptors located?

A

Carotid sinus AND aortic arch

Key ALS facts (6 decks)

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