Cardioresp Flashcards
Where does the right coronary artery run?
In the sulcus between right and left ventricle
Where is the AV node located?
In the lower back section of interatrial septum
Which artery supplies the SA and AV nodes?
Right coronary
What does L or R dominant heart mean?
It means which coronary artery gives rise to posterior descending branch
What time of murmur might you find in mitral stenosis?
Mid-diastolic murmur
What type of murmur might you find in mitral regurg?
Pansystolic murmur. (Regurging at thought of being pan bc ewww men)
What is an ejection systolic murmur a sign of?
Aortic stenosis
In what heart valve problem do you have an early diastolic murmur which might often be absent or complex?
Aortic regurgitation
What is preload?
The volume of blood in ventricles at end of diastole
Where does cardiovascular system originate from embrylogically?
Mesoderm
At what day does heart start to beat?
Day 22
What heart problem is caused by a defect of the dyenein arm of microtubules?
Dextrocardia / Kartagener syndrom
(think sounds like Dunedin and paul would love to go to Cartagena)
In foetal circulation what shunts blood from umbilical vein to IVC?
ductus venosus
What does umbilical vein fibrose to?
Ligamentum teres
Name the four types of acyanotic heart lesions
ASD
VSD
Patent ductus arteriosus
coarction of aorta
What will tetralogy of fallot look like on XRAY?
Boot shaped
What are the cyanotic heart lesions?
tetralogy of fallot, persistent truncus arteriosus, transposition of great vessels
What are the four features of tetralogy of fallot?
Pulmonary stenosis, overriding aorta, right ventricular hypertrophy, ventricular septal defect
What is the only form iron can be absorbed in?
Fe2+ ferrous form
What enzyme reduces ferric Fe3+ to Fe2+ so it can be transported into cell?
Ferric reductase
What transporter brings iron into cell?
DMT-1 transporter
What can high serum ferritin indicate?
Iron deficiency anaemia - liver is making more transferrin to maximise use of little available iorn
In chronic disease what does the body produce less of to prevent pathogens using iron for metabolism?
transferritin
What regulates ferroportin activity?
Hepcidin
What are the stages of foetal RBC formation?
1) yolk sac - megoblastic stage - 3rd week
2) liver -hepatic stage - 6 weeks
3) bone marrow - myeloid stage - 3rd month onwards
What is erythropoiesis controlled by?
Eryhtropoietin (EPO) which is porduced in peritubular interstitial cells in kidney
What are RBCs broken down into?
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
What makes bilirubin conjugated?
The addition of glucaronic acid
Why can ESR be a marker of infection in the blood?
Because in an infection the amount of fibrogen increases in the plasma, this binds to RBC and causes the RBCs to clump together faster
What type of anemia does iron deficiency cause?
Microcytic. (will find low RBC count, microcytic, hypochromic rbs and low serum ferritin)
What is megaloblastic macrocytic anemia?
Condition in which bone marrow produces large, abnormal, immature RBCs due to b12 and folate deficiency
What is the most common cause of macrocytic anemia?
Low b12. b12 assists in nucleic acid synthesis, affects cell turnover
What is b12 attached to in stomach?
Haptocorrin. Gets released from from haptocorrin in the duodenum by trypsin
What might you see on blood film in macrocytic anemia?
Hyper-segmented neutrophils (6 lobes or more)
What is pernicious anemia?
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
What is the treatment for pernicious anemia?
Intramuscular hydroxocobalmin every three months for life
What is autoimmune haemolytic anemia?
when there are IgG antibodies against RBC membrane
What is the inheritance of heriditary spherocytosis ?
autosomal dominant
What is a sign of glucose-6-phosphate dehydrogenase deficiency on blood smear?
Heinz bodies - clumps of oxidised heamoglobin
In platelet plug formation what binds to underlying collagen
Von Willebrand factor
What do platelets bind to in platelet plug
GP1b receptor on VWF
What do elevated D-dimer show?
A clot formation
What binds to tPA on cell membrane to facilitate breakdown of clot?
plasminogen and gets converted to plasmin which degrades fibrin mesh releasing fibrogen and D-dimer
mutation on what chromosome causes Von Willebrand disease and how is it inherited?
Chromosome 12, autosomal dominant
How is Von Willebrand treated?
with DDAVP (desmopressin)
Deficiencies of which factors cause which type of haemophillia?
Type A- defiency of factor VIII
Type B - of factor IX
What is the cardiac enzyme used to indicate myocardial damage?
Troponin
What is ticagrelor?
It is a P2Y12 receptor antagonist - it prevents ADP mediated P2Y12 dependent platelet activation. Used to treat STEMI
What are lisinopril, enalapril, catopril examples of?
ACE inhibitors
What class of drugs are amlopidine and diltiazem?
They are calcium channel blockers
What do angiotensin II receptor antagonists end in?
-artan eg valsartan
What is the nerve supply to the pleura?
medially = phrenic nerve C3-C5, laterally intercostal T2-T12, inferior laterally = both
What often causes hypertrophic cardiomyopathy
issues with beta myosin heavy chain and myosin binding protein c
What is Virchow’s triad of causes of VTE?
1) reduced or stagnant blood flow
2) vessel wall pathology
3) hypercoagulability of blood
If well’s score is above 2 what do you do?
D dimer and ultrasound
What is initial treatment for VTE?
Low molecular weight heparin (fondaparinux). Activates antithrombin, which prevents conversion of prothrombin to thrombin
What are rivaroxaban, apixaban and dabigatran examples of?
direct oral anticoagulants
rivarixaban and apixaban = Xa inhibitros
dabigatran - thrombin inhibitors
What is warfarin
A vitamin K antagonist
What is vitamin K needed for?
complete synthesis of factor 10, 9, 7, 2
What is the new treatment abelacimab an antibody against?
Factor XI antibody
What might you see on ECG for PE?
sinus tachycarda, S1, Q3, T3 = deep s wave in lead 1, Q wave in lead 3, inverted T wave in lead 3
What might you see on CXR for PE?
peripheral wedge-shaped density above diaphragm
What does Heart failure with reduced ejection fraction refer to?
left ventricular ejection fraction below 40%
mild reduced is 40-49%
What might heart failure ECGS show?
Inferior Q waves, anterior T waves, ectopics and left bundle branch block
Which sided heart failure is more likely to cause peripheral oedema?
Right sided
What genetic disease can lead to mitral valve prolapse?
Marfan’s
What illness can lead to mitral stenosis?
Rheumatic fever
What interleukins stimulate B cells to class switch to IgE?
IL4 and 13
What interleukin activates eosinophils?
IL5
What diurnal PEF variation makes asthma diagnosis likely?
20% diurnal PEF variation
What is bronchodilator reversibility testing and when can you expect asthma?
Give single dose of short acting beta 2 agonist therapy. FEV1>15% improvement might mean asthma
What are montelukast, zileuton, zafirlukast examples of?
Leukotriene receptor antagonists for asthma
What deficiency can lead to COPD
AAT (alpha-1 antitrypsin) which is a protein that can help protect lungs from inflammatory damage
What cytokines do epithelial cells release that attracts T cells in COPD
CXCL9 and CXCL10
What would COPD spirometry show?
FEV1/FVC <0.70
What do LAMAs do?
They block the binding of Ach to M3 receptors which inhibits smooth muscle contraction
What might you hear on auscultation when diagnosing IPF?
fine, high-pitched inspiratory crackles
What is the gold standard to diagnose IPF?
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
How might you treat IPF?
Pirfenidone, nintedanib and antacid therapy
What kind of drug is nintedanib?
Tyrosine kinase inhibitor (decreases FVC decline). blocks the enzymes that cause fibrosis
What T cells are prominent in the development of sarcoidosis?
T cells (TH1 DC4+)
What might you find on a CXR for sarcoidosis?
Bilateral hilar adenopathy
What is Logfren syndrome?
A type of acute sarcoidosis characterised by swollen lymph nodes, red nodules on shins and arthiritis
How is refractory sarcoidosis treated?
Infliximab
What do you treat sarcoidosis with if corticosteroids arent working?
A DMARD -
methotrexate
folic acid
azathoprine
leflunomid
mycophenolate
What will recognise RSV virus?
Toll Like (TLR) and retionoic adid inducible gene 1 like RIG1 receptors
What’s the major receptor for rhinovirus that people with asthma often have more of?
ICAM-1 (intracellular adhesion molecule)
What makes viruses able to impede immune recognition?
High glycosylation and structural variability of surface G proteins
How do decongestants work?
They are alpha1 adrenoreceptor agonists and they decrease the swelling of nasal blood vessels
When would you not consider antibiotic for sore throat?
If feverpain score is 0 or 1 or if Centor score is 0,1 or 2
What is the first choice antibiotic for a sore throat?
Phenoxymethylpenicillin (beta lactam which inhibits cell wall synthesis)
If someone has a penicilin allergy and requires antibiotics for sore throat what will you give to them?
Clarithromycin and erythromycin which are macrolides and bind to 50s subunit inhibiting protein synthesis
What recruits NK cells?
TNF alpha and cytokines
What is consolidation on XRAY?
Consolidation means that the air in the alveoli is replaced by something else such as fluid
Where would you treat the diff CURB65 scores?
0-1 at home
2 consider admitting / outpatient management
3-5 admission
What are the drug options for pneumonia?
Doxycyline (1st choice) or amoxycillin or a macrolide eg clarithroymcin
How does SARS-Cov2 (covid) bind do ciliated secretory cells in nasal epithelium?
Via ACE-2
What oxygen mask is used when there is risk of CO2 retention such as in COPD?
Venturi mask
Which oxygen mask is most suitable for trauma and emergency use?
Non-rebreather
What might you find when checking the pulse of someone with CO2 retention?
A bounding pulse
What does type 1 and type 2 respiratory failure mean?
Type 1 = hypoxaemia only ( intrinsic lung diseases)
Type 2= hypoxaemia and hypercania - caused by hypoventilation
What FEV1/FVC ratio might you find in obstructive lung diseases?
a decreased ratio as FEV1 is more reduced compared to FVC
What enzyme converts CO2 and water to bicarbonate and hydrogen ions?
Carbonic anhydrase
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?
it can lead to osteoporosis as it comes from break down of calcium phosphate in bone
How do you treat respiratory acidosis?
Bronchodilator to reverse airway obstruction. Ventilation, oxygen.
What acid base problem does hyperventilation cause?
respiratory alkalosis
How does alkalaemia affect tissue perfusion?
It shifts the Hb O2 dissociation curve to the left which impairs O2 delivery to the tissues
What electrolyte imbalance is common in alkalosis?
Hypokalemia. Bc there is a compensatory reduced H+ excretion by kidney so another cation has to take its place
What symptoms are mainly associated with alkalosis and acidosis?
Alkalosis - hyperactivity symptoms eg tremor, jerks
acidosis - lethargy, tiredness, fatigue
What is the initial treatment for active TB?
RIPE
rifampicin
isoniazid
pyrazinamide
ethamubtol
What difference would you note between granulomas in TB vs sarcoidosis?
TB they have a casseous necrosis - necrotic cheese like core
What is Pott’s disease?
When extra-pulmonary TB has spread to the bones of the spine
What would you find in a lumbar puncture of someone with tuberculous meningitis?
lymphocytes
What is used in the Mantoux test?
a purified protein derivative of mycobacteria
When using Assays to diagnose latent TB what is measured after stimulation by antigens?
Interferon Gamma release
What is first line for latent TB?
Isoniazid (plus pyridoxine/vitb6) Or isoniazid (plus pyridoxine) and rifampicin
What TB drug can give orange tears?
Rifampicin
What’s a side effect of etambutol?
Visual disturbances
What does extremely drug resistant TB refer to?
multi drug resistant and also resistant to fluroquinolones and at least once injectable
What makes up a Gohn complex?
A gohn focus ( ) plus ipsilateral mediastinal lymphadenopathy
What effect does noradrenaline have on blood vessels?
Noradrenaline acts on alpha-1- receptors causing vasoconstriction
What effect does angiotensin II have on blood vessels
A vasoconstrictor, through acting on AT1 receptors on the endothelium
Name the three main vasodilators
Prostacyclin, NO and adenosine
What is adult haem composed of?
2 alpha and 2 beta subunits
A2b2= Haemoglobin A
What does initial foetal Hb consist of? (Hb-gower1)
2 zeta and 2 epsilon sub units (higher affinity for oxygen)
What is Hb F composed of?
2 alpha and 2 gamma
What chromosomes cause alpha thalassemia?
chromosome 16
A mutation on what chromosome causes beta thalassemia?
chromosome 11
What type of anemia might you get in beta thalassemia?
Hypochromic microcytic anemia (bc alpha tetramers are unstable and cause destruction of developing erythroblasts)
What are deferirprone, desferrioxamine and deferasirox examples of?
Iron chelating drugs to give alongside infusions
What is sickle cell inheritance?
Autosomal recessive
What can be given to sickle cell patients to enhance HbF production?
Hydroxyurea/hydroxycarbamide
What from the small intestine is absorbed into lymphatic circulation?
Chylomicrons
What is a chylothorax?
The accumulation of chyle in pleural space
What do the horizontal inguinal lymph nodes drain from?
Anterior abdomen wall, perinieum and external genitalia?
What is the most common cause of type 1 resp failure?
V/Q mismatch
What imbalance causes type 2 resp failure?
it is an imbalance beween neural resp drive, the load of the resp muscles and the capacity of the resp muscles
What are common causes of type 2 resp failure?
reduced compliance of lung eg pneumonia, rib fractures, reduced strength of resp muscles, drugs acting on the respiratory centre
Which mask would you not use for patients with hypercapnic resp failure?
Simple face mask
How do you manage acute bronchitis?
antipyretics and cough medicine for symptom relief
Most common causative agent of pneumonia?
Streptococcus pneumoniae
How does CRB65 differ in hospital care?
Includes U - Urea in blood levels. Indicates whether the pneumonia has led to abnormal kidney function
If FEV1 is 49% of what is predicted, what Gold classification of COPD is this?
Severe - severe is defined as 30-50% of predicted
What is first line treatment for COPD and what does this escalate to if there has been an exacerbation that leads to hospitalisation?
1st line - a bronchodilator
then a long acting muscarinic antagonist
What receptor do long acting muscarinic antagonists act on?
M3 muscarinic receptor antagonists. Block the binding of ACh to inhibit smooth muscle contraction
When are corticosteroids recommended in COPD?
In patients with high blood eosinophils
What sound would you here on auscultating idiopathic pulmonary fibrosis?
Fine, high pitched bibasilar inspiratory crackles (velcro like sounds)
What would you see on HRCT of IPF?
Reticular changes associated with traction bronchiectasis and honeycombing
What is the first drug treatment for IPF?
Pirfenidone
What is the treatment for refractory sarcoidosis?
Infliximab
Exhalation of what gas is a biomarker of Th2 immune response?
exhaled nitric oxide
How is Fe2+ transported to the cytosol?
Via DMT1
What does a low serum ferritin suggest?
Iron deficiency anemia
What does anisocytosis mean?
RBCs are of different sizes
Why is total binding capacity increased with iron deficiency?
Bc transferrin is carrying less iron, which means there’s more sites available for binding
Who needs to be referred if they have iron deficiency anaemia?
urgently- anyone over 60
and anyone under 50 that has rectal bleeding.
consider all men an postmenopausal women
How is b12 transported around blood?
Bound to transcobalamin
What is pernicious aneamia?
No intrinsic factor. People make antibodies to their parietal cells
What serious condition can b12 deficiency lead to?
subacute combined degeneration of the cord which involves degeneration of posterior and lateral columns of spinal cord
What cancer is most strongly associated with smoking?
small cell carcinoma
what lung cancer is most common in non-smokers?
adenocarcinoma
What paraneoplastic syndrome is common in small cell lung cancer and what would you find on blood test?
syndrome of inappropriate antidiuretic hormone secretion, would find hypnonatremia
What do central chemoreceptors primarily monitor?
arterial blood levels of CO2
What is the inheritance of RhD?
If you inherit one copy of D it makes the individual D positive
What does the screen in group and screen refer to?
antibody screen to detect any atypical antibodies
What is radical masectomy?
removal of breast tissue, nipple, axillary lymph nodes and section of pec major
Difference on xray between left and right ventricular enlargement?
right ventricular the apex expands up and laterally (more boot shape)
Difference between eccentric and concentric hypertrophy?
concentric in hypertension etc, sarcomeres added in width, thicker walls. Think THICK like concrete
eccentric in athletes etc, sarcomeres added in series = dilated chambers
What might mitral stenosis look like on an xray?
double density side from overlapping of atriums and and the left main bronchus is elevated by enlarged atrium
Difference between aortic valve regurg and aortic valve stenosis on xray?
stenosis - dilated aorta that projects further to the right
regurg- enlargement of left ventricle (pushes outwards)
What are janeway lesions and osler’s nodes a sign of?
bacterial endocarditis
What does PR interval represent?
the conduction through AV node
How can you quickly see if cardiac axis is normal?
If there is a positive R in leads 1 and aVF. Should be negative in aVR
What is resp sinus arrhythmia and what might you see?
normal phenomenon, beat to beat variation in P-P interval producing irregular ventricular rate
Why does resp sinus arrthymia happen?
inspiration increases heart rate by decreasing vagal tone
What causes junctional rhythm and what will that look like on ECG?
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
Difference between Afib and A flutter on ECG?
A fib - fibrillatory waves irregularly irregular, A flutter - saw tooth and regularly irregular
what is AF caused by?
one ectopic atrial pacemaker generating re-entrant excitation going round and round
whereas a fib is multiple ectopic foci
What causes AV nodal reentrant tachycardia?
When a reentrant circuit forms within or just next to AV node creating a slow and fast pathway
What is Wolff-Parkinson-White syndrome?
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
What does premature ventricular contractions look like on ECG?
Wide QRS as impulse isnt spread through fast His-Purkinje
Which arrythmia is lethal if no defibrillation?
Ventricular fibrillation
What would you see on ECG for first degree heart block?
Long PR interval (>200ms)
Difference between Mobitz type I and type II on ECG?
type 1 - PR lengthen each time until they drop a QRS
type II- PR doesn’t lengthen but get sudden drop ( this is worse)
What does type 3 heart block look like?
P waves are present but they are unsynchronised with QRS (means there is no association between atria and ventricles)
What does right bundle branch look like?
MARROW - M shaped in V1, W shaped in V6. Other way around for left
What does ST depression vs ST elevation mean?
ST elevation - full thickness of myocardium involved. ST depression - regional ischemia or subendochondral infarct
Under normal circumstances where should you not see Q waves?
V1-V3
Where is ANP and BNP synthesised from and what does it do?
ANP from atria
BNP from ventricles
they reduce arterial pressure, vasodilators and natriuresis action
What receptors does noradrenaline work on to increase HR?
B1 adrenoreceptors
What receptors does noradrenaline work on to constrict blood vessels?
alpha 1 adrenoreceptors
What causes aldosterone to be released?
angiontensin II
How would treatment of stage 1 HTN in patients under 40, 60 and 80 differ?
40 - specialist evaluation
60- consider starting meds with lifestyle advice
80- consider starting if they have organ damage or another comorbidity
What is the scar after an MI composed of?
collagen
What might you see one day and three day post infarct?
one day - wavy fibres due to oedema between fibres
three days - neutrophil infiltrate
What might vegetations on heart valve leaflets and papillary muscles be a sign of?
endocarditis
What are Aschoff bodies?
Granulomatous nodules in the heart formed by macrophages and lymphocytes that are a sign of rheumatic fever
What causes rheumatic fever?
Streptococcus pyogenes / group A beta hemolytic streptococcus
What heart valve does rheumatic fever mainly affect?
Mitral
What might cause mitral valve prolapse?
Marfan and Ehlers Danlos
What might you hear in a case of mitral valve prolapse?
Mid-systolic click maybe with a late systolic murmur
Signs of mitral regurg?
pansystolic murmur, right ventricular heave, pulmonary oedema and basal crepitus
What is p mitrale a sign of?
left atrial enlargement - MR or MS
Signs of mitral stenosis?
malar flush on face due to decreased cardiac output, on auscultation opening snap and mid diastolic rumble
What do you hear in aortic stenosis?
ejection systolic murmur (crescendo-descrendo)
What might you see on ECG for left ventricular hypertrophy / aortic stenosis?
Large R waves and T wave inversion in V5 and V6
What can cause aortic root dilating disease and in turn aortic regurgitation?
Ankylosing spondylitis, Marfan syndrome and aortic dissection
What is the one valve problem that isn’t heard where you might expect it to be?
Aortic regurg - an early diastolic murmur heard on left sternal edge rather than right due to aortic backflow.
What diff meds can you give for AF?
Digoxin, beta blockers, verampamil
What valve is most effect by prolonged IV drug use?
tricuspid valve. Present with hepatic pain and pansystolic murmur
What is mean arterial pressure?
Cardiac output x systemic vascular resistance
What does Frank starling mechanism represent relationship between?
stroke volume and end diastolic volume
What are the four stages of shock?
1) initial
2) compensatory stage
3) progressive stage
4) refractory stage
What characterises distributive shock?
a drop in peripheral vascular resistance and as a result hypotension
(septic, anaphylactic, neurogenic)
Classes of heamorrhage based on blood loss?
class 1 <750
class 2 - 750-1500
class 3 - 1500-2000
class 4 - >2000
What is a normal central venous pressure?
8-12 mmHg
What kind of things would cause a problem with primary hemostasis?
platelet defects and collagen related disorders
What factor does VWF carry in the blood?
factor 8
What’s the inheritance of VWD type 1, 2 and 3?
type 1 and 2 autosomal dominant, type 3 is autosomal recessive
What is the most common heritable risk factor for DVT?
Factor V Leiden mutation which causes resistance to activated protein C
Deficiencies of what can lead to blood being hypercoaguable?
protein C or protein S deficiency
What receptors can be invaded by the covid virus which leads to endothelial dysfunction?
ACE -2 receptors
Difference between well’s score results for DVT and PE?
DVT likely- 2 points or more
PE likely - 4 points or more
What is the main cause of death in PE?
Acute right sided HF leading to cardiogenic shock and or cardiac arrest secondary to arrythmias
What is heparain-induced thrombocytopenia?
body produces antibodies to heparin platelet complexes which produces hypercoaguable state but paradoxically low platelet count
How does dabigatran work?
It is an active direct thrombin inhibitor
When are ribaxroxaban and apixaban contradicted?
in people with signif liver and end-stage kidney disease
VTE treatment in pregnant women?
LMWH as warfarin and DOACS cross placenta and teratogenic
What VTE treatment isn’t safe to use in breastfeeding?
DOACs
Which type of heart failure is caused by a weakened myocardium?
Reduced ejection fraction
When might you hear a third and fourth heart sound?
In Heart failure
What is hepatojugular reflex?
If you push on liver and JVP goes up - sign of HF
What is first line treatment for heart failure?
Loop diuretics - furosemide as first line and also should receive a beta blocker and some sort of RAS inhibitor
How do ARNIs work? eg sacubitril valsartan
The ARB part blocks action of angiotensin 2 and the neprilysin degrades BNP
How would you treat heart failure with preserved ejection fraction?
Treat underlying cause especially hypertension.
What valve problem does dilated cardiomyopathy often lead to?
mitral regurg
What is hypertrophic cardiomyopathy often caused by?
single mutations, often inherited autosomal dominantly
What chest pain might you get in acute pericarditis?
retrosternal chest pain radiating to shoulders, increased by breathing and decreased by leading forward
What is the fibrous cap in atherosclerosis made up of?
collagen fibres and smooth muscle cells
Which kind of stroke presents with a thunder clap headache?
subarachnoid hem
What is thrombolysis?
fibrinolytic therapy for ischemic stroke uses Altepase (tissue plasminogen activator) which breaks down clot to restore blood flow
What should all patients get after PCI or for secondary prevention of angina when intolerant of aspirin?
P2Y12 receptor antagonists eg clopidogrel, prasugrel, ticagrelor
Where does aorta travel through the diaphragm?
T12
What innervates the visceral pleura?
pulmonary plexus
What rib level is the cardiac notch?
4th rib
Characteristic xray features of COPD?
hyperinflation, flattened diaphragm, narrow mediastinum
Where are emergency airways done?
Through the cricothyroid ligament - (between thyroid and cricoid cartilage)
What antiplatelet do you give for patients with STEMI undergoing PCI?
Prasugrel
PCI Pick Prasgurel
Which nerve is involved in phonation and which in pitch?
phonation - recurrent laryngeal (motor to all intrinsic except cricothyroid)
pitch - external laryngeal (motor to cricothyroid)
What epithelium in nasal cavity?
cilliated respiratory (pseudostratified columnar)
Where do most nose bleeds take place?
anteriorly due to Kiesselback plexus
What is Hoover’s sign?
instead of ribs moving outward on inspiration there is a paradoxical inwards movement (COPD)
What cells secrete surfactant?
Type 2 pneumocytes
What infectious agent are people with bronchiecstatis at high risk for and can also lead to hot tub folliculities?
pseudomonas aeruginosa
When is DLCO particularly useful?
Useful for early stage interstitial lung disease detection before reduction in lung volumes and other restrctive lung dseases
What are the three main interstitial lung diseases?
IPF, sarcoidosis and pneumoconiosis
What else is used in IPF besides pirenidone?
NAC - n-acetylcysteine (believed to break down mucus)
or nintedanib (tyrosine kinase inhibitor)
What is Logfren syndrome?
erythema nodosum skin rash and bilateral hilar adenopathy with our without arthritis
What are biomarkers for Th2 asthma?
raised eosinophil counts (IL5 biomarker) and exhaled nitric oxide (bc IL13 leads to more nitric oxide being produced)
What causes microcytic anaemias?
TAILS
Thalassaemia
Anemia of chronic disease
Iron deficiency
Lead poisoning
Sideroblastic anemia
What is ferritin?
an intracellular protein that stores iron and releases it in controlled fashion
What does hepcidin bind to to decrease the delivery of iron to plasma?
ferroportin
How is iron taken up into other cells other than enterocytes?
Fe3+ bound transferrin binds transferrin receptor and enters cytosol via receptor mediated endocytosis
What is low serum ferritin an important diagnostic test for?
Iron deficiency anemia
What is erythropoietin produced by?
Peritubular interstitial fibroblasts around proximal tubules
How does glucose enter erythrocytes?
by facilitated diffusion using GLUT-1
What gives faeces and urine its colour?
faeces - stercobilin
urine - uroglobin
What happens to serum transferrin receptor in iron deficiency anemia and in chronic inflammation?
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
What are the three types of macrocytic anemias?
megaloblastic
macronormoblastic
stress erythropoiesis
What can cause macronormoblastic erythropoeisis?
liver disease, alcohol toxicity, sone myelodysplastic syndromes
Where is folate mainly absorbed from?
duodenum and jejenum
What might mask b12 deficiency?
intake of folate as it bypasses the need for b12 in dna synthesis
(but the neurological damage may still occur)
What do you give for TB after the initial 2 month 4 drug treatment regime?
next four months - isoniazid (with pyridoxine) and rifampicin
What are signs of pancoast tumour?
severe pain in shoulder, atrophy of hand and arm muscles, horner syndrome, compression of blood vessels
What are the most common paraneoplastic syndromes in lung cancer?
small cell lung cancer - syndrome of inappropriate antidiuretic hormone secretion
non small cell - hypercalcaemia (and suppressed PTH)
What intracellular deficiency does glucose-6-phosphate dehydrogenase lead to?
Gluthiaone
What is inheritance of G6PD deficiency?
x-linked
What causes microangiographic haemolytic anaemias?
mechanical damage from things like stress passing through defective valves
What supplementation will people with AIHA need?
folic acid supplementation
Difference between HbA and HbA2?
in adult majority HbA - alpha2beta2, 2-3% HbA2 - alpha2delta2
What is increased in beta thal major/ intermedia?
HbF
What mutation causes sickle cell?
GAG to GTG subsitution at codon 6 on beta globin chain (substitutes valine for glutamic acid)
