CAP TEST Flashcards
What is the equation for mean arterial blood pressure?
Diastolic pressure + 1/3 (systolic-diastolic)
What does increases skeletal muscle activity do to the venous return to the heart?
Increases the venous return to the heart
What are the layers of the heart from superficial to deep?
(parietal serous pericardium) (CHECK)
(visceral serious pericardium)
Epicardium
Myocardium
Endocardium
What is Organogenesis? (in relation to the germ layers formed during the gastrulation stage)
The development of the primordio of all the organs of the body
What is fertilisation?
The union of the sperm and oocyte
What is cleavage?
The earliest cell divisions of the embryo
What is morphogenesis?
The formation of the body plan
What is a tetramer and give an example?
a polymer comprising four monomer units.
Haemoglobin
What would you give for a mild exacerbation of asthma?
Salbutamol via spacer in increments of 2 puffs every 5-10mins until patient responds
What would you do for persistent severe brittle asthma with worsening breathlessness and wheeze?
Ventilate and incubation
IV aminophyline
IV magnesium may buy time
What do patients with obstructive defects (like COPD) have in terms of FEV1 and FVC?
FVC - reduced/normal
FEV1 - reduced
FEV1/FVC - reduced
What do patients with a restrictive defect usually have in terms of FEV1 and FVC?
FVC - reduced
FVC1 - reduced
FEV1/FVC - normal
What will happen to the PEF where the FEV1/FVC ratio is low?
The PEF will always be reduced
What is Barrets oesophagus?
Metaplasia of squamous epithelium to columnar epithelium in the lower 1/3 of the oesophagus - due to acid reflux. IT is premalignant
50yr old man has has heartburn for many years, usually controls with antacids. Recently worsened, disrupting sleep and difficulty swallowing?
Barrett’s Oesophagus
55yr old sore stomach after swallowing (Eating) pain in epigastrium, bloating and difficulty swallowing with black stools?
Peptic Ulcer
What might peptic ulcer be caused by and describe the mechanism at which it destroys the muscoa?
H.Pylori which stimulates gastrin production which increases acid production, the increased gastric acid erodes the gastric mucosa leading to ulcer formation
70yrs old difficulty and pain on swelling, long history of Barretts never smoked?
Adenocarcinoma of the lower 1/3 of oesophagus
What cells do adenocarcinomas arise from?
Gland cells - Barretts is a risk factor
Where would squamous cell carcinoma usually affect?
The upper 2/3rd of the oesophagus and it is associated with smoking and excess alcohol consumption - it arises from epithelial cells
What does the autonomic inervation of the blood vessels do? (check)
Increases the venotone
Increases the venous return to the heart
What is the rising phase of depolarisation in the contractile ventriclar muscle cells caused by?
The fast sodium influx during phase 0 of the ventricular action potential
What is the section of the resp tract that contains the vocal cords?
The larynx
What are the muscles which elevate the larynx?
The longitudinal muscles of the pharynx which function is extremely important during swallowing so that the laryngeal inlet is greatly reduced in size
What are the layers of the lateral abdominal wall from superficial to deep?
Skin Fascia External oblique Internal oblique Transverse abdominis Trasversali fascia Parietal peritoneum
What does the scalenus anterior muscle attach to?
The scalene tubercle of rib 1 and can act as an accessory muscle of respiration
What would an enlarged and pleomorphic nuclei suggest?
Malignant process
What is the different between type 1 and type 2 resp failure? (arterial gases)
Type 1 - low PO2, PCO2 normal
Type 2 - low PO2, PCO2 high
What is the difference in FEV1 and FVC in asthma and COPD?
Asthma - decreased FEV1, normal FVC
COPD - decreased FEV1, decreased FVC
How would you differentiate between mild and moderate community acquired pneumonia?
CURB score
Measure resp rate
What is hypertrophic cardiomyopathy due to?
Left ventricular outflow tract obstruction from asymmetrical hypertrophy
What should severe community acquired pneumonia be treated with?
IV co-amoxiclav
IV clarithromycin
What should an aspiration pneumonia be treated with?
IV Amoxicillin
Gentamicin
Metronidazole
What would you treat an exacerbation of COPD with?
Oral doxycycline if allergic to penicillin - so amoxicillin would be dangerous
How long is the PR invteral normally?
0.12s-0.2s
What does the PR interval represent?
AV nodal delay
What is the P wave caused by?
Atrial depolarisation
How long is the QRS normally?
< 0.12s
When do the ventricles contract and relax in terms of ECG?
Contraint on ST segment
Relax on TP interval
What is a granuloma?
A collection of macrophages that is a manifestation of an inflammatory process. Granulomatous inflammation has many causes including infectious agents.
What is one of the most important infectious causes of granulomatous inflammation?
TB
What is the ratio of amino-acids translated to protein to nucleotides?
3:1
What is there a decrease of in sepsis?
Decrease in circulating blood volume due to endotoxins causing vasodilation and intravascular fluid leaking into adjacent tissue
What is the most common cause of bacterial food positioning diagnosed in the UL?
Campylobacter
What is bacillus cereus associated with?
Eating rice which has been stored too long at room temp
What is sarcoidosis?
A gramulonatous diseases where non-ceaseting grandmas develop in many body organs including the lungs.
What might present in the lungs in sarcoidosis?
An interstitial lung disease patterns develops with symptoms of breathlessness and dry cough and clinical signs of hilar lymphadenopathy on the CXR.
What might be present on the shins ion sarcoidosis and what other symptoms might there be?
Erythema nodosum, may also see skin rashes, arthritis, joint swelling, blurred vision, dry eyes, fatigue and weight loss
Worsening cough for the last few months, coughing up fresh blood, past few days got fever and producing which green sputum?
Squamous cell carincoma
may lead to lobar pneumonia also due to fever and sputum
Describe what might cause squamous cell carcinoma and where it may develop?
Smoking and age are risk factor
More likely to develop nearer the larger airways of the lung, this can cause obstruction leading to a lobar pneumonia.
15yr old girl, severe breathlessness, wheeze and cough, increasingly breathless over the past few days and wont take puffer.
Acute exacerbation of asthma
What is asthma caused by?
Reversible airway obstruction and bronchospasm (relieved by B2 agonist)
What does RNA polymerase do?
Transcribes messenger RNA from DNA that compromises the exon (coding) regions of a gene
What is metaplasia?
The change from one mature cell type to another
What is neoplasia?
Abnormal cell proliferation
Where should the heel of the hand be places in CRP?
Heel of the hand should be placed in the centre of the patients chest
During what gives rise to the terminal bronchioles?
During the pseduoglandular stage 16 generations of branching gives rise to the terminal bronchioles
When does branching to the level of the lobar bronchi occur?
in the embryonic period
When do the resp bronchioles and alveolar ducts form?
In the canalicular period
When do the terminal sacs form and capillaries become associated with them form?
During the saccular periods
When do the alveolar mature?
The alveolar period
What is hypoxia a potent stimulus to?
Arterial smooth muscle construction causing increased pulmonary vascular resistance and associated pulmonary arterial hypertension this, leads to increased RV after load and initially compensatory RV hypertrophy followed eventually by RV dilution and failure (Cor Pulmonale)
What does repair of unresolved airway inflammation result in?
Collagen deposition in the bronchial basement membrane, mucosa and submucosa as well as smooth muscle hypertrophy which in turn results in irreversible airways obstruction in asthma
What should be minimised during resuscitation?
Pulse check, only to confirm cardiac arrest and to determine if return of spontaneous circulation has occured
What does ST elevation in leads V2-V5 indicate?
Anterior MI
What helps improve survival post MI?
Eating omega 3
What drugs will heal oesphagitis?
PPI
What would you do in a fibrous structure which was impairing feeding?
Oesophageal balls dilution for rapid relief of symptoms
How do you treat achalasia?
Ballon oesophageal ballon dilatation or cariomyotomy (for young and fit as you dont need to repeat procedures)
What would the pulse of a patient suffering from shock from substantial blood loss be like and why?
Fast pulse - due to sympathetic compensator response to low bp
What is asthmatic inflammation responsive to corticosteroids typically characterised by?
Eosinophilic airway inflammation
What type of inflammation is more typical of COPD?
Neutrophilic inflammation
What is the most common cause of renal failure in children under 5?
E.coli
What can coxiella brunet cause?
A pneumonia associated with sheep contact
What would help relieve symptoms of SOB due to acute pulmonary oedema and LVF?
IV furosemide - a loop diuretic
What type of malignant tumour arising in the colon is most common?
Adenocarcinoma
What do HIV infection cause?
Reduced cell-mediated immunity and so are suspecital to opportunistic infections
What BP would confirm high BP in ambulatory BP monitoring?
BP 140/90 or higher
What causes a right shift in the oxyheamaglobin dissociation curve?
Hyperthermia
Hyper capnia
Acidosis
Sickle cell anaemia
Where is hep A common?
in developing countries - especially places with poor hygiene
What is the typical incubation period for hep A?
28 days - jaundice is subtle at first
What is resistance to blood flow inversely proportional to?
The radius of a blood vessel to the power 4
What would the pulse in septic shock be?
Bounding due to hyper dynamic circulation
Where is the femoral artery located?
Inferior to the retroinguinal space
