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Year 2 > Cardioresp > Flashcards

Cardioresp Flashcards

1
Q

Where does the right coronary artery run?

A

In the sulcus between right and left ventricle

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2
Q

Where is the AV node located?

A

In the lower back section of interatrial septum

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3
Q

Which artery supplies the SA and AV nodes?

A

Right coronary

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4
Q

What does L or R dominant heart mean?

A

It means which coronary artery gives rise to posterior descending branch

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5
Q

What time of murmur might you find in mitral stenosis?

A

Mid-diastolic murmur

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6
Q

What type of murmur might you find in mitral regurg?

A

Pansystolic murmur. (Regurging at thought of being pan bc ewww men)

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7
Q

What is an ejection systolic murmur a sign of?

A

Aortic stenosis

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8
Q

In what heart valve problem do you have an early diastolic murmur which might often be absent or complex?

A

Aortic regurgitation

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9
Q

What is preload?

A

The volume of blood in ventricles at end of diastole

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10
Q

Where does cardiovascular system originate from embrylogically?

A

Mesoderm

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11
Q

At what day does heart start to beat?

A

Day 22

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12
Q

What heart problem is caused by a defect of the dyenein arm of microtubules?

A

Dextrocardia / Kartagener syndrom
(think sounds like Dunedin and paul would love to go to Cartagena)

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13
Q

In foetal circulation what shunts blood from umbilical vein to IVC?

A

ductus venosus

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14
Q

What does umbilical vein fibrose to?

A

Ligamentum teres

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15
Q

Name the four types of acyanotic heart lesions

A

ASD
VSD
Patent ductus arteriosus
coarction of aorta

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16
Q

What will tetralogy of fallot look like on XRAY?

A

Boot shaped

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17
Q

What are the cyanotic heart lesions?

A

tetralogy of fallot, persistent truncus arteriosus, transposition of great vessels

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18
Q

What are the four features of tetralogy of fallot?

A

Pulmonary stenosis, overriding aorta, right ventricular hypertrophy, ventricular septal defect

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19
Q

What is the only form iron can be absorbed in?

A

Fe2+ ferrous form

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20
Q

What enzyme reduces ferric Fe3+ to Fe2+ so it can be transported into cell?

A

Ferric reductase

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21
Q

What transporter brings iron into cell?

A

DMT-1 transporter

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22
Q

What can high serum ferritin indicate?

A

Iron deficiency anaemia - liver is making more transferrin to maximise use of little available iorn

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23
Q

In chronic disease what does the body produce less of to prevent pathogens using iron for metabolism?

A

transferritin

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24
Q

What regulates ferroportin activity?

A

Hepcidin

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25
Q

What are the stages of foetal RBC formation?

A

1) yolk sac - megoblastic stage - 3rd week
2) liver -hepatic stage - 6 weeks
3) bone marrow - myeloid stage - 3rd month onwards

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26
Q

What is erythropoiesis controlled by?

A

Eryhtropoietin (EPO) which is porduced in peritubular interstitial cells in kidney

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27
Q

What are RBCs broken down into?

A

Haem prosrthetic groups are released and are called biliverdin
billiverdin is then reduced to bilirubin in the macrophages
bilirubin then binds to albumin in macrophages

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28
Q

What makes bilirubin conjugated?

A

The addition of glucaronic acid

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29
Q

Why can ESR be a marker of infection in the blood?

A

Because in an infection the amount of fibrogen increases in the plasma, this binds to RBC and causes the RBCs to clump together faster

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30
Q

What type of anemia does iron deficiency cause?

A

Microcytic. (will find low RBC count, microcytic, hypochromic rbs and low serum ferritin)

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31
Q

What is megaloblastic macrocytic anemia?

A

Condition in which bone marrow produces large, abnormal, immature RBCs due to b12 and folate deficiency

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32
Q

What is the most common cause of macrocytic anemia?

A

Low b12. b12 assists in nucleic acid synthesis, affects cell turnover

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33
Q

What is b12 attached to in stomach?

A

Haptocorrin. Gets released from from haptocorrin in the duodenum by trypsin

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34
Q

What might you see on blood film in macrocytic anemia?

A

Hyper-segmented neutrophils (6 lobes or more)

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35
Q

What is pernicious anemia?

A

When there is autoimmune attack on gastric parietal cells leading to gastric atrophy. The parietal cells produce less intrinsic factor so there is less b12 absorbed

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36
Q

What is the treatment for pernicious anemia?

A

Intramuscular hydroxocobalmin every three months for life

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37
Q

What is autoimmune haemolytic anemia?

A

when there are IgG antibodies against RBC membrane

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38
Q

What is the inheritance of heriditary spherocytosis ?

A

autosomal dominant

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39
Q

What is a sign of glucose-6-phosphate dehydrogenase deficiency on blood smear?

A

Heinz bodies - clumps of oxidised heamoglobin

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40
Q

In platelet plug formation what binds to underlying collagen

A

Von Willebrand factor

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41
Q

What do platelets bind to in platelet plug

A

GP1b receptor on VWF

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42
Q

What do elevated D-dimer show?

A

A clot formation

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43
Q

What binds to tPA on cell membrane to facilitate breakdown of clot?

A

plasminogen and gets converted to plasmin which degrades fibrin mesh releasing fibrogen and D-dimer

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44
Q

mutation on what chromosome causes Von Willebrand disease and how is it inherited?

A

Chromosome 12, autosomal dominant

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45
Q

How is Von Willebrand treated?

A

with DDAVP (desmopressin)

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46
Q

Deficiencies of which factors cause which type of haemophillia?

A

Type A- defiency of factor VIII
Type B - of factor IX

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47
Q

What is the cardiac enzyme used to indicate myocardial damage?

A

Troponin

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48
Q

What is ticagrelor?

A

It is a P2Y12 receptor antagonist - it prevents ADP mediated P2Y12 dependent platelet activation. Used to treat STEMI

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49
Q

What are lisinopril, enalapril, catopril examples of?

A

ACE inhibitors

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50
Q

What class of drugs are amlopidine and diltiazem?

A

They are calcium channel blockers

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51
Q

What do angiotensin II receptor antagonists end in?

A

-artan eg valsartan

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52
Q

What is the nerve supply to the pleura?

A

medially = phrenic nerve C3-C5, laterally intercostal T2-T12, inferior laterally = both

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53
Q

What often causes hypertrophic cardiomyopathy

A

issues with beta myosin heavy chain and myosin binding protein c

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54
Q

What is Virchow’s triad of causes of VTE?

A

1) reduced or stagnant blood flow
2) vessel wall pathology
3) hypercoagulability of blood

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55
Q

If well’s score is above 2 what do you do?

A

D dimer and ultrasound

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56
Q

What is initial treatment for VTE?

A

Low molecular weight heparin (fondaparinux). Activates antithrombin, which prevents conversion of prothrombin to thrombin

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57
Q

What are rivaroxaban, apixaban and dabigatran examples of?

A

direct oral anticoagulants
rivarixaban and apixaban = Xa inhibitros
dabigatran - thrombin inhibitors

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58
Q

What is warfarin

A

A vitamin K antagonist

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59
Q

What is vitamin K needed for?

A

complete synthesis of factor 10, 9, 7, 2

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60
Q

What is the new treatment abelacimab an antibody against?

A

Factor XI antibody

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61
Q

What might you see on ECG for PE?

A

sinus tachycarda, S1, Q3, T3 = deep s wave in lead 1, Q wave in lead 3, inverted T wave in lead 3

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62
Q

What might you see on CXR for PE?

A

peripheral wedge-shaped density above diaphragm

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63
Q

What does Heart failure with reduced ejection fraction refer to?

A

left ventricular ejection fraction below 40%
mild reduced is 40-49%

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64
Q

What might heart failure ECGS show?

A

Inferior Q waves, anterior T waves, ectopics and left bundle branch block

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65
Q

Which sided heart failure is more likely to cause peripheral oedema?

A

Right sided

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66
Q

What genetic disease can lead to mitral valve prolapse?

A

Marfan’s

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67
Q

What illness can lead to mitral stenosis?

A

Rheumatic fever

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68
Q

What interleukins stimulate B cells to class switch to IgE?

A

IL4 and 13

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69
Q

What interleukin activates eosinophils?

A

IL5

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70
Q

What diurnal PEF variation makes asthma diagnosis likely?

A

20% diurnal PEF variation

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71
Q

What is bronchodilator reversibility testing and when can you expect asthma?

A

Give single dose of short acting beta 2 agonist therapy. FEV1>15% improvement might mean asthma

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72
Q

What are montelukast, zileuton, zafirlukast examples of?

A

Leukotriene receptor antagonists for asthma

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73
Q

What deficiency can lead to COPD

A

AAT (alpha-1 antitrypsin) which is a protein that can help protect lungs from inflammatory damage

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74
Q

What cytokines do epithelial cells release that attracts T cells in COPD

A

CXCL9 and CXCL10

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75
Q

What would COPD spirometry show?

A

FEV1/FVC <0.70

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76
Q

What do LAMAs do?

A

They block the binding of Ach to M3 receptors which inhibits smooth muscle contraction

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77
Q

What might you hear on auscultation when diagnosing IPF?

A

fine, high-pitched inspiratory crackles

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78
Q

What is the gold standard to diagnose IPF?

A

Diffusing capacity of the lungs for CO (DLCO). In ILD DLCO is reduced as there is reduced uptake of CO by capillaries due to fibrosis

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79
Q

How might you treat IPF?

A

Pirfenidone, nintedanib and antacid therapy

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80
Q

What kind of drug is nintedanib?

A

Tyrosine kinase inhibitor (decreases FVC decline). blocks the enzymes that cause fibrosis

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81
Q

What T cells are prominent in the development of sarcoidosis?

A

T cells (TH1 DC4+)

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82
Q

What might you find on a CXR for sarcoidosis?

A

Bilateral hilar adenopathy

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83
Q

What is Logfren syndrome?

A

A type of acute sarcoidosis characterised by swollen lymph nodes, red nodules on shins and arthiritis

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84
Q

How is refractory sarcoidosis treated?

A

Infliximab

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85
Q

What do you treat sarcoidosis with if corticosteroids arent working?

A

A DMARD -
methotrexate
folic acid
azathoprine
leflunomid
mycophenolate

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86
Q

What will recognise RSV virus?

A

Toll Like (TLR) and retionoic adid inducible gene 1 like RIG1 receptors

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87
Q

What’s the major receptor for rhinovirus that people with asthma often have more of?

A

ICAM-1 (intracellular adhesion molecule)

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88
Q

What makes viruses able to impede immune recognition?

A

High glycosylation and structural variability of surface G proteins

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89
Q

How do decongestants work?

A

They are alpha1 adrenoreceptor agonists and they decrease the swelling of nasal blood vessels

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90
Q

When would you not consider antibiotic for sore throat?

A

If feverpain score is 0 or 1 or if Centor score is 0,1 or 2

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91
Q

What is the first choice antibiotic for a sore throat?

A

Phenoxymethylpenicillin (beta lactam which inhibits cell wall synthesis)

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92
Q

If someone has a penicilin allergy and requires antibiotics for sore throat what will you give to them?

A

Clarithromycin and erythromycin which are macrolides and bind to 50s subunit inhibiting protein synthesis

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93
Q

What recruits NK cells?

A

TNF alpha and cytokines

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94
Q

What is consolidation on XRAY?

A

Consolidation means that the air in the alveoli is replaced by something else such as fluid

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95
Q

Where would you treat the diff CURB65 scores?

A

0-1 at home
2 consider admitting / outpatient management
3-5 admission

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96
Q

What are the drug options for pneumonia?

A

Doxycyline (1st choice) or amoxycillin or a macrolide eg clarithroymcin

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97
Q

How does SARS-Cov2 (covid) bind do ciliated secretory cells in nasal epithelium?

A

Via ACE-2

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98
Q

What oxygen mask is used when there is risk of CO2 retention such as in COPD?

A

Venturi mask

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99
Q

Which oxygen mask is most suitable for trauma and emergency use?

A

Non-rebreather

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100
Q

What might you find when checking the pulse of someone with CO2 retention?

A

A bounding pulse

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101
Q

What does type 1 and type 2 respiratory failure mean?

A

Type 1 = hypoxaemia only ( intrinsic lung diseases)
Type 2= hypoxaemia and hypercania - caused by hypoventilation

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102
Q

What FEV1/FVC ratio might you find in obstructive lung diseases?

A

a decreased ratio as FEV1 is more reduced compared to FVC

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103
Q

What enzyme converts CO2 and water to bicarbonate and hydrogen ions?

A

Carbonic anhydrase

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104
Q

Protons can be added to mono-hydrogen phosphate to form dihydrogen phosphate to be excreted in urine to compensate for resp acidosis. What can a complication of this be?

A

it can lead to osteoporosis as it comes from break down of calcium phosphate in bone

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105
Q

How do you treat respiratory acidosis?

A

Bronchodilator to reverse airway obstruction. Ventilation, oxygen.

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106
Q

What acid base problem does hyperventilation cause?

A

respiratory alkalosis

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107
Q

How does alkalaemia affect tissue perfusion?

A

It shifts the Hb O2 dissociation curve to the left which impairs O2 delivery to the tissues

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108
Q

What electrolyte imbalance is common in alkalosis?

A

Hypokalemia. Bc there is a compensatory reduced H+ excretion by kidney so another cation has to take its place

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109
Q

What symptoms are mainly associated with alkalosis and acidosis?

A

Alkalosis - hyperactivity symptoms eg tremor, jerks
acidosis - lethargy, tiredness, fatigue

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110
Q

What is the initial treatment for active TB?

A

RIPE
rifampicin
isoniazid
pyrazinamide
ethamubtol

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111
Q

What difference would you note between granulomas in TB vs sarcoidosis?

A

TB they have a casseous necrosis - necrotic cheese like core

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112
Q

What is Pott’s disease?

A

When extra-pulmonary TB has spread to the bones of the spine

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113
Q

What would you find in a lumbar puncture of someone with tuberculous meningitis?

A

lymphocytes

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114
Q

What is used in the Mantoux test?

A

a purified protein derivative of mycobacteria

115
Q

When using Assays to diagnose latent TB what is measured after stimulation by antigens?

A

Interferon Gamma release

116
Q

What is first line for latent TB?

A

Isoniazid (plus pyridoxine/vitb6) Or isoniazid (plus pyridoxine) and rifampicin

117
Q

What TB drug can give orange tears?

A

Rifampicin

118
Q

What’s a side effect of etambutol?

A

Visual disturbances

119
Q

What does extremely drug resistant TB refer to?

A

multi drug resistant and also resistant to fluroquinolones and at least once injectable

120
Q

What makes up a Gohn complex?

A

A gohn focus ( ) plus ipsilateral mediastinal lymphadenopathy

121
Q

What effect does noradrenaline have on blood vessels?

A

Noradrenaline acts on alpha-1- receptors causing vasoconstriction

122
Q

What effect does angiotensin II have on blood vessels

A

A vasoconstrictor, through acting on AT1 receptors on the endothelium

123
Q

Name the three main vasodilators

A

Prostacyclin, NO and adenosine

124
Q

What is adult haem composed of?

A

2 alpha and 2 beta subunits
A2b2= Haemoglobin A

125
Q

What does initial foetal Hb consist of? (Hb-gower1)

A

2 zeta and 2 epsilon sub units (higher affinity for oxygen)

126
Q

What is Hb F composed of?

A

2 alpha and 2 gamma

127
Q

What chromosomes cause alpha thalassemia?

A

chromosome 16

128
Q

A mutation on what chromosome causes beta thalassemia?

A

chromosome 11

129
Q

What type of anemia might you get in beta thalassemia?

A

Hypochromic microcytic anemia (bc alpha tetramers are unstable and cause destruction of developing erythroblasts)

130
Q

What are deferirprone, desferrioxamine and deferasirox examples of?

A

Iron chelating drugs to give alongside infusions

131
Q

What is sickle cell inheritance?

A

Autosomal recessive

132
Q

What can be given to sickle cell patients to enhance HbF production?

A

Hydroxyurea/hydroxycarbamide

133
Q

What from the small intestine is absorbed into lymphatic circulation?

A

Chylomicrons

134
Q

What is a chylothorax?

A

The accumulation of chyle in pleural space

135
Q

What do the horizontal inguinal lymph nodes drain from?

A

Anterior abdomen wall, perinieum and external genitalia?

136
Q

What is the most common cause of type 1 resp failure?

A

V/Q mismatch

137
Q

What imbalance causes type 2 resp failure?

A

it is an imbalance beween neural resp drive, the load of the resp muscles and the capacity of the resp muscles

138
Q

What are common causes of type 2 resp failure?

A

reduced compliance of lung eg pneumonia, rib fractures, reduced strength of resp muscles, drugs acting on the respiratory centre

139
Q

Which mask would you not use for patients with hypercapnic resp failure?

A

Simple face mask

140
Q

How do you manage acute bronchitis?

A

antipyretics and cough medicine for symptom relief

141
Q

Most common causative agent of pneumonia?

A

Streptococcus pneumoniae

142
Q

How does CRB65 differ in hospital care?

A

Includes U - Urea in blood levels. Indicates whether the pneumonia has led to abnormal kidney function

143
Q

If FEV1 is 49% of what is predicted, what Gold classification of COPD is this?

A

Severe - severe is defined as 30-50% of predicted

144
Q

What is first line treatment for COPD and what does this escalate to if there has been an exacerbation that leads to hospitalisation?

A

1st line - a bronchodilator
then a long acting muscarinic antagonist

145
Q

What receptor do long acting muscarinic antagonists act on?

A

M3 muscarinic receptor antagonists. Block the binding of ACh to inhibit smooth muscle contraction

146
Q

When are corticosteroids recommended in COPD?

A

In patients with high blood eosinophils

147
Q

What sound would you here on auscultating idiopathic pulmonary fibrosis?

A

Fine, high pitched bibasilar inspiratory crackles (velcro like sounds)

148
Q

What would you see on HRCT of IPF?

A

Reticular changes associated with traction bronchiectasis and honeycombing

149
Q

What is the first drug treatment for IPF?

A

Pirfenidone

150
Q

What is the treatment for refractory sarcoidosis?

A

Infliximab

151
Q

Exhalation of what gas is a biomarker of Th2 immune response?

A

exhaled nitric oxide

152
Q

How is Fe2+ transported to the cytosol?

A

Via DMT1

153
Q

What does a low serum ferritin suggest?

A

Iron deficiency anemia

154
Q

What does anisocytosis mean?

A

RBCs are of different sizes

155
Q

Why is total binding capacity increased with iron deficiency?

A

Bc transferrin is carrying less iron, which means there’s more sites available for binding

156
Q

Who needs to be referred if they have iron deficiency anaemia?

A

urgently- anyone over 60
and anyone under 50 that has rectal bleeding.
consider all men an postmenopausal women

157
Q

How is b12 transported around blood?

A

Bound to transcobalamin

158
Q

What is pernicious aneamia?

A

No intrinsic factor. People make antibodies to their parietal cells

159
Q

What serious condition can b12 deficiency lead to?

A

subacute combined degeneration of the cord which involves degeneration of posterior and lateral columns of spinal cord

160
Q

What cancer is most strongly associated with smoking?

A

small cell carcinoma

161
Q

what lung cancer is most common in non-smokers?

A

adenocarcinoma

162
Q

What paraneoplastic syndrome is common in small cell lung cancer and what would you find on blood test?

A

syndrome of inappropriate antidiuretic hormone secretion, would find hypnonatremia

163
Q

What do central chemoreceptors primarily monitor?

A

arterial blood levels of CO2

164
Q

What is the inheritance of RhD?

A

If you inherit one copy of D it makes the individual D positive

165
Q

What does the screen in group and screen refer to?

A

antibody screen to detect any atypical antibodies

166
Q

What is radical masectomy?

A

removal of breast tissue, nipple, axillary lymph nodes and section of pec major

167
Q

Difference on xray between left and right ventricular enlargement?

A

right ventricular the apex expands up and laterally (more boot shape)

168
Q

Difference between eccentric and concentric hypertrophy?

A

concentric in hypertension etc, sarcomeres added in width, thicker walls. Think THICK like concrete
eccentric in athletes etc, sarcomeres added in series = dilated chambers

169
Q

What might mitral stenosis look like on an xray?

A

double density side from overlapping of atriums and and the left main bronchus is elevated by enlarged atrium

170
Q

Difference between aortic valve regurg and aortic valve stenosis on xray?

A

stenosis - dilated aorta that projects further to the right
regurg- enlargement of left ventricle (pushes outwards)

171
Q

What are janeway lesions and osler’s nodes a sign of?

A

bacterial endocarditis

172
Q

What does PR interval represent?

A

the conduction through AV node

173
Q

How can you quickly see if cardiac axis is normal?

A

If there is a positive R in leads 1 and aVF. Should be negative in aVR

174
Q

What is resp sinus arrhythmia and what might you see?

A

normal phenomenon, beat to beat variation in P-P interval producing irregular ventricular rate

175
Q

Why does resp sinus arrthymia happen?

A

inspiration increases heart rate by decreasing vagal tone

176
Q

What causes junctional rhythm and what will that look like on ECG?

A

Anything that damages the SA node.
Mainly causes bradycardia as AV takes over and p wave will either be absent or inverted in lead II or after QRS

177
Q

Difference between Afib and A flutter on ECG?

A

A fib - fibrillatory waves irregularly irregular, A flutter - saw tooth and regularly irregular

178
Q

what is AF caused by?

A

one ectopic atrial pacemaker generating re-entrant excitation going round and round
whereas a fib is multiple ectopic foci

179
Q

What causes AV nodal reentrant tachycardia?

A

When a reentrant circuit forms within or just next to AV node creating a slow and fast pathway

180
Q

What is Wolff-Parkinson-White syndrome?

A

congenital extra accessory pathway between atria and ventricles. Often an abnormally short PR interval and an inflection on the QR wave called a delta wave

181
Q

What does premature ventricular contractions look like on ECG?

A

Wide QRS as impulse isnt spread through fast His-Purkinje

182
Q

Which arrythmia is lethal if no defibrillation?

A

Ventricular fibrillation

183
Q

What would you see on ECG for first degree heart block?

A

Long PR interval (>200ms)

184
Q

Difference between Mobitz type I and type II on ECG?

A

type 1 - PR lengthen each time until they drop a QRS
type II- PR doesn’t lengthen but get sudden drop ( this is worse)

185
Q

What does type 3 heart block look like?

A

P waves are present but they are unsynchronised with QRS (means there is no association between atria and ventricles)

186
Q

What does right bundle branch look like?

A

MARROW - M shaped in V1, W shaped in V6. Other way around for left

187
Q

What does ST depression vs ST elevation mean?

A

ST elevation - full thickness of myocardium involved. ST depression - regional ischemia or subendochondral infarct

188
Q

Under normal circumstances where should you not see Q waves?

A

V1-V3

189
Q

Where is ANP and BNP synthesised from and what does it do?

A

ANP from atria
BNP from ventricles
they reduce arterial pressure, vasodilators and natriuresis action

190
Q

What receptors does noradrenaline work on to increase HR?

A

B1 adrenoreceptors

191
Q

What receptors does noradrenaline work on to constrict blood vessels?

A

alpha 1 adrenoreceptors

192
Q

What causes aldosterone to be released?

A

angiontensin II

193
Q

How would treatment of stage 1 HTN in patients under 40, 60 and 80 differ?

A

40 - specialist evaluation
60- consider starting meds with lifestyle advice
80- consider starting if they have organ damage or another comorbidity

194
Q

What is the scar after an MI composed of?

A

collagen

195
Q

What might you see one day and three day post infarct?

A

one day - wavy fibres due to oedema between fibres
three days - neutrophil infiltrate

196
Q

What might vegetations on heart valve leaflets and papillary muscles be a sign of?

A

endocarditis

197
Q

What are Aschoff bodies?

A

Granulomatous nodules in the heart formed by macrophages and lymphocytes that are a sign of rheumatic fever

198
Q

What causes rheumatic fever?

A

Streptococcus pyogenes / group A beta hemolytic streptococcus

199
Q

What heart valve does rheumatic fever mainly affect?

A

Mitral

200
Q

What might cause mitral valve prolapse?

A

Marfan and Ehlers Danlos

201
Q

What might you hear in a case of mitral valve prolapse?

A

Mid-systolic click maybe with a late systolic murmur

202
Q

Signs of mitral regurg?

A

pansystolic murmur, right ventricular heave, pulmonary oedema and basal crepitus

203
Q

What is p mitrale a sign of?

A

left atrial enlargement - MR or MS

204
Q

Signs of mitral stenosis?

A

malar flush on face due to decreased cardiac output, on auscultation opening snap and mid diastolic rumble

205
Q

What do you hear in aortic stenosis?

A

ejection systolic murmur (crescendo-descrendo)

206
Q

What might you see on ECG for left ventricular hypertrophy / aortic stenosis?

A

Large R waves and T wave inversion in V5 and V6

207
Q

What can cause aortic root dilating disease and in turn aortic regurgitation?

A

Ankylosing spondylitis, Marfan syndrome and aortic dissection

208
Q

What is the one valve problem that isn’t heard where you might expect it to be?

A

Aortic regurg - an early diastolic murmur heard on left sternal edge rather than right due to aortic backflow.

209
Q

What diff meds can you give for AF?

A

Digoxin, beta blockers, verampamil

210
Q

What valve is most effect by prolonged IV drug use?

A

tricuspid valve. Present with hepatic pain and pansystolic murmur

211
Q

What is mean arterial pressure?

A

Cardiac output x systemic vascular resistance

212
Q

What does Frank starling mechanism represent relationship between?

A

stroke volume and end diastolic volume

213
Q

What are the four stages of shock?

A

1) initial
2) compensatory stage
3) progressive stage
4) refractory stage

214
Q

What characterises distributive shock?

A

a drop in peripheral vascular resistance and as a result hypotension
(septic, anaphylactic, neurogenic)

215
Q

Classes of heamorrhage based on blood loss?

A

class 1 <750
class 2 - 750-1500
class 3 - 1500-2000
class 4 - >2000

216
Q

What is a normal central venous pressure?

A

8-12 mmHg

217
Q

What kind of things would cause a problem with primary hemostasis?

A

platelet defects and collagen related disorders

218
Q

What factor does VWF carry in the blood?

A

factor 8

219
Q

What’s the inheritance of VWD type 1, 2 and 3?

A

type 1 and 2 autosomal dominant, type 3 is autosomal recessive

220
Q

What is the most common heritable risk factor for DVT?

A

Factor V Leiden mutation which causes resistance to activated protein C

221
Q

Deficiencies of what can lead to blood being hypercoaguable?

A

protein C or protein S deficiency

222
Q

What receptors can be invaded by the covid virus which leads to endothelial dysfunction?

A

ACE -2 receptors

223
Q

Difference between well’s score results for DVT and PE?

A

DVT likely- 2 points or more
PE likely - 4 points or more

224
Q

What is the main cause of death in PE?

A

Acute right sided HF leading to cardiogenic shock and or cardiac arrest secondary to arrythmias

225
Q

What is heparain-induced thrombocytopenia?

A

body produces antibodies to heparin platelet complexes which produces hypercoaguable state but paradoxically low platelet count

226
Q

How does dabigatran work?

A

It is an active direct thrombin inhibitor

227
Q

When are ribaxroxaban and apixaban contradicted?

A

in people with signif liver and end-stage kidney disease

228
Q

VTE treatment in pregnant women?

A

LMWH as warfarin and DOACS cross placenta and teratogenic

229
Q

What VTE treatment isn’t safe to use in breastfeeding?

A

DOACs

230
Q

Which type of heart failure is caused by a weakened myocardium?

A

Reduced ejection fraction

231
Q

When might you hear a third and fourth heart sound?

A

In Heart failure

232
Q

What is hepatojugular reflex?

A

If you push on liver and JVP goes up - sign of HF

233
Q

What is first line treatment for heart failure?

A

Loop diuretics - furosemide as first line and also should receive a beta blocker and some sort of RAS inhibitor

234
Q

How do ARNIs work? eg sacubitril valsartan

A

The ARB part blocks action of angiotensin 2 and the neprilysin degrades BNP

235
Q

How would you treat heart failure with preserved ejection fraction?

A

Treat underlying cause especially hypertension.

236
Q

What valve problem does dilated cardiomyopathy often lead to?

A

mitral regurg

237
Q

What is hypertrophic cardiomyopathy often caused by?

A

single mutations, often inherited autosomal dominantly

238
Q

What chest pain might you get in acute pericarditis?

A

retrosternal chest pain radiating to shoulders, increased by breathing and decreased by leading forward

239
Q

What is the fibrous cap in atherosclerosis made up of?

A

collagen fibres and smooth muscle cells

240
Q

Which kind of stroke presents with a thunder clap headache?

A

subarachnoid hem

241
Q

What is thrombolysis?

A

fibrinolytic therapy for ischemic stroke uses Altepase (tissue plasminogen activator) which breaks down clot to restore blood flow

242
Q

What should all patients get after PCI or for secondary prevention of angina when intolerant of aspirin?

A

P2Y12 receptor antagonists eg clopidogrel, prasugrel, ticagrelor

243
Q

Where does aorta travel through the diaphragm?

A

T12

243
Q

What innervates the visceral pleura?

A

pulmonary plexus

244
Q

What rib level is the cardiac notch?

A

4th rib

245
Q

Characteristic xray features of COPD?

A

hyperinflation, flattened diaphragm, narrow mediastinum

246
Q

Where are emergency airways done?

A

Through the cricothyroid ligament - (between thyroid and cricoid cartilage)

247
Q

What antiplatelet do you give for patients with STEMI undergoing PCI?

A

Prasugrel
PCI Pick Prasgurel

248
Q

Which nerve is involved in phonation and which in pitch?

A

phonation - recurrent laryngeal (motor to all intrinsic except cricothyroid)
pitch - external laryngeal (motor to cricothyroid)

249
Q

What epithelium in nasal cavity?

A

cilliated respiratory (pseudostratified columnar)

250
Q

Where do most nose bleeds take place?

A

anteriorly due to Kiesselback plexus

251
Q

What is Hoover’s sign?

A

instead of ribs moving outward on inspiration there is a paradoxical inwards movement (COPD)

252
Q

What cells secrete surfactant?

A

Type 2 pneumocytes

253
Q

What infectious agent are people with bronchiecstatis at high risk for and can also lead to hot tub folliculities?

A

pseudomonas aeruginosa

254
Q

When is DLCO particularly useful?

A

Useful for early stage interstitial lung disease detection before reduction in lung volumes and other restrctive lung dseases

255
Q

What are the three main interstitial lung diseases?

A

IPF, sarcoidosis and pneumoconiosis

256
Q

What else is used in IPF besides pirenidone?

A

NAC - n-acetylcysteine (believed to break down mucus)
or nintedanib (tyrosine kinase inhibitor)

257
Q

What is Logfren syndrome?

A

erythema nodosum skin rash and bilateral hilar adenopathy with our without arthritis

258
Q

What are biomarkers for Th2 asthma?

A

raised eosinophil counts (IL5 biomarker) and exhaled nitric oxide (bc IL13 leads to more nitric oxide being produced)

259
Q

What causes microcytic anaemias?

A

TAILS
Thalassaemia
Anemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anemia

260
Q

What is ferritin?

A

an intracellular protein that stores iron and releases it in controlled fashion

261
Q

What does hepcidin bind to to decrease the delivery of iron to plasma?

A

ferroportin

262
Q

How is iron taken up into other cells other than enterocytes?

A

Fe3+ bound transferrin binds transferrin receptor and enters cytosol via receptor mediated endocytosis

263
Q

What is low serum ferritin an important diagnostic test for?

A

Iron deficiency anemia

264
Q

What is erythropoietin produced by?

A

Peritubular interstitial fibroblasts around proximal tubules

265
Q

How does glucose enter erythrocytes?

A

by facilitated diffusion using GLUT-1

266
Q

What gives faeces and urine its colour?

A

faeces - stercobilin
urine - uroglobin

267
Q

What happens to serum transferrin receptor in iron deficiency anemia and in chronic inflammation?

A

It increases in iron defiency anemia to try get as much iron in as it can
and it is low in anemia of chronic inflammatiom

268
Q

What are the three types of macrocytic anemias?

A

megaloblastic
macronormoblastic
stress erythropoiesis

269
Q

What can cause macronormoblastic erythropoeisis?

A

liver disease, alcohol toxicity, sone myelodysplastic syndromes

270
Q

Where is folate mainly absorbed from?

A

duodenum and jejenum

271
Q

What might mask b12 deficiency?

A

intake of folate as it bypasses the need for b12 in dna synthesis
(but the neurological damage may still occur)

272
Q

What do you give for TB after the initial 2 month 4 drug treatment regime?

A

next four months - isoniazid (with pyridoxine) and rifampicin

273
Q

What are signs of pancoast tumour?

A

severe pain in shoulder, atrophy of hand and arm muscles, horner syndrome, compression of blood vessels

274
Q

What are the most common paraneoplastic syndromes in lung cancer?

A

small cell lung cancer - syndrome of inappropriate antidiuretic hormone secretion
non small cell - hypercalcaemia (and suppressed PTH)

275
Q

What intracellular deficiency does glucose-6-phosphate dehydrogenase lead to?

A

Gluthiaone

276
Q

What is inheritance of G6PD deficiency?

A

x-linked

277
Q
A
278
Q

What causes microangiographic haemolytic anaemias?

A

mechanical damage from things like stress passing through defective valves

279
Q

What supplementation will people with AIHA need?

A

folic acid supplementation

280
Q

Difference between HbA and HbA2?

A

in adult majority HbA - alpha2beta2, 2-3% HbA2 - alpha2delta2

281
Q

What is increased in beta thal major/ intermedia?

A

HbF

282
Q

What mutation causes sickle cell?

A

GAG to GTG subsitution at codon 6 on beta globin chain (substitutes valine for glutamic acid)

Year 2 (10 decks)

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