Cardiovascular Flashcards
1
Q
branch block on ECG
A
prolonged QRS
2
Q
branch block on ECG
A
prolonged QRS
3
Q
Atrial fibrillation on ECG
A
absence of P wave
4
Q
Define remodelling (heart)-
A
increase in myocardial mass
5
Q
Mitral regurgitation murmur
A
pansystolic, at apex
6
Q
Aortic stenosis murmur
A
midsystolic, Right 2nd intercostal space
7
Q
Mitral stenosis murmur
A
diastolic murmur
8
Q
Aortic regurgitation murmur
A
diastolic murmur
9
Q
Orthopnea
A
SOB which occurs when lying flat, sign of pulmonary oedema
10
Q
What’s the venous pressure in Pulmonary oedema?
A
25mmHg (15mmHg normal)
11
Q
CXR signs of pulmonary oedema
A
Batwing sign, Kerley B line (lymphatic drainage), large cardiothoracic ratio (cardiomegaly)
12
Q
Referred cardiac pain level
A
T1-T4, medial upper arm and neck/jaw
13
Q
Infarct on inferior wall referred pain
A
T5-9, epigastrium (misinterpreted as indigestion)
14
Q
J wave ECG cause
A
J wave ECG cause
15
Q
ECG of first degree heart block
A
PR interval is a fixed constant duration >200ms, regular rate
16
Q
Second degree heart block type 1
A
PR interval progressively gets longer, until skip beat
17
Q
Second degree heart block type 2
A
AV node randomly fails to respond to some atrial pulses, rate is irregularly irregular
18
Q
Third degree heart block
A
bradycardia, ventricular rhythm is independent to atrial rhythm
19
Q
Junctional rhythm on ECG
A
(AVN takes over as pacemaker), bradycardia, inverted p wave (lead II) or absent p wave.
20
Q
Supraventricular tachycardia (SVT) on ECG
A
rate 140-220 bpm, p wave absent or buried in T wave
21
Q
Bundle branch block on ECG
A
prolonged QRS complex, notch on R wave or double R wave
22
Q
What does depressed ST segment show?
A
coronary ischemia, hypokalaemia
23
Q
Left axis deviation on ECG
A
positive lead I, negative aVF
24
Q
Normal mean electrical axis on ECG
A
positive lead I and positive aVF (-30 to 90 degrees)
25
Right axis deviation on ECG
negative lead I and positive aVF
26
Definition of hypotension
27
Grade I hypertension
140-159/90-99 mmHg
28
Grade ii hypertension
160-179/ 100-109 mmHg
29
Grade III hypertension
180 />110 mmHg
30
What does hypertensive retinopathy show?
silver wire arteriole, cotton wool spots
31
Normal sodium level
135-145 mmol/L
32
Symptoms of hyponatremia
fatigue, confusion, muscle weakness, nausea & vomiting, headache, spasm, seizures, coma (due to brain swelling)
33
Optimal BP for diabetic
34
What is dextracardia?
anomaly where primitive heart tube folds to left in a mirror image of normal looping. Usually occurs in situs inversus
35
What is situs inversus?
all organ systems are reversed.
36
What molecule close ductus arteriosus?
bradykinin
37
What may reopen ductus arteriosus?
prostaglandin E2
38
Tetralogy of fallot 4 lesions
overriding aorta (above septal defect), ventricular septal defect, right ventricular hypertrophy, pulmonary stenosis
39
Persistent Truncus arteriosus, what is it and surgical repair for it
large VSD, truncus arteriosus supply both aorta and pulmonary artery. Rastelli repair.
40
Immediate procedure for transposition of the great vessel
catherisation of foramen ovale to allow mixing of blood.
41
Types of atrial septal defect
– primum atrial septal defect (ostium primum is patent as septum primum has not fused with the endocardial cushions), secundum atrial septal defect (short septum primum doesn’t overlap foramen ovale), patent foramen ovale
42
Cyanotic heart defects
tetralogy of Fallot, persistent truncus arteriosus, transposition of great vessels, tricuspid atresia
43
What does ductus arteriosus become after birth?
ligmentum arteriosum
44
Treatment for patent ductus arteriosus
prostaglandin inhibitor (ibuprofen), if fails to work surgical slip.
45
Acyanotic heart defects
ASD, VSD, PDA (may due to pulmonary/aortic valve atresia), coarctation of aorta (pre-ductal type)
46
Site of erythropoietin at 3rd week
yolk sac, mesothelial layer of placenta
47
Site of erythropoietin at 6 week
liver and spleen
48
Which part of the bone marrow does erythropoiesis occur?
yellow bone marrow
49
the process by which RBC pass from bone marrow into the blood capillaries
diapedesis (squeezing through the pores of the capillary membrane)
50
site of EPO production
fibroblast in proximal tubule (kidney), type 1 cell of carotid body. These sites are not subject to variation during exercise. Are sensitive to hypoxia
51
what does raised ESR indicate
-specific marker for infection in blood
52
how does RBC make ATP and NADPH?
Anaerobic glycolysis for ATP. Pentose phosphate pathway for NADPH.
53
How is old RBC in spleen recognised for break down?
old RBC contain different surface antigens (rise in level of methaemoglobin), lack of deformability of old RBC so become trapped in spleen
54
Process of RBC break down
splenic macrophage break RBC by osmotic lysis. Haem group is removed and broken down by haem-oxygenase, iron is removed for reused, left with biliverdin. Biliverdin is converted to bilirubin by biliverdin reductase.
55
Enzyme for unconjugated bilirubin ->unconjugated bilirubin
glucuronic transferase (unconjugated bilirubin is combined with glucuronic acid)
56
Diagnosis criteria for MI
rise/fall of troponin & either symptoms of ischaemia OR ECG changes
57
STEMI reperfusion therapy
Aspirin and clopidogrel (ticagrelor), GP IIb/IIIa inhibitor, PCI
58
Prevention for STEMI
aspirin, clopidogrel (ticagrelor), statin, beta-blocker, ACE-I
59
Atrial fibrillation on ECG
absence of P wave
60
Define remodelling (heart)-
increase in myocardial mass
61
Mitral regurgitation murmur
pansystolic, at apex
62
Aortic stenosis murmur
midsystolic, Right 2nd intercostal space
63
Mitral stenosis murmur
diastolic murmur
64
Aortic regurgitation murmur
diastolic murmur
65
Orthopnea
SOB which occurs when lying flat, sign of pulmonary oedema
66
What’s the venous pressure in Pulmonary oedema?
25mmHg (15mmHg normal)
67
CXR signs of pulmonary oedema
Batwing sign, Kerley B line (lymphatic drainage), large cardiothoracic ratio (cardiomegaly)
68
Referred cardiac pain level
T1-T4, medial upper arm and neck/jaw
69
Infarct on inferior wall referred pain
T5-9, epigastrium (misinterpreted as indigestion)
70
J wave ECG cause
J wave ECG cause
71
ECG of first degree heart block
PR interval is a fixed constant duration >200ms, regular rate
72
Second degree heart block type 1
PR interval progressively gets longer, until skip beat
73
Second degree heart block type 2
AV node randomly fails to respond to some atrial pulses, rate is irregularly irregular
74
Third degree heart block
bradycardia, ventricular rhythm is independent to atrial rhythm
75
Junctional rhythm on ECG
(AVN takes over as pacemaker), bradycardia, inverted p wave (lead II) or absent p wave.
76
Supraventricular tachycardia (SVT) on ECG
rate 140-220 bpm, p wave absent or buried in T wave
77
Bundle branch block on ECG
prolonged QRS complex, notch on R wave or double R wave
78
What does depressed ST segment show?
coronary ischemia, hypokalaemia
79
Left axis deviation on ECG
positive lead I, negative aVF
80
Normal mean electrical axis on ECG
positive lead I and positive aVF (-30 to 90 degrees)
81
Right axis deviation on ECG
negative lead I and positive aVF
82
Definition of hypotension
83
Grade I hypertension
140-159/90-99 mmHg
84
Grade ii hypertension
160-179/ 100-109 mmHg
85
Grade III hypertension
180 />110 mmHg
86
What does hypertensive retinopathy show?
silver wire arteriole, cotton wool spots
87
Normal sodium level
135-145 mmol/L
88
Symptoms of hyponatremia
fatigue, confusion, muscle weakness, nausea & vomiting, headache, spasm, seizures, coma (due to brain swelling)
89
Optimal BP for diabetic
90
What is dextracardia?
anomaly where primitive heart tube folds to left in a mirror image of normal looping. Usually occurs in situs inversus
91
What is situs inversus?
all organ systems are reversed.
92
What molecule close ductus arteriosus?
bradykinin
93
What may reopen ductus arteriosus?
prostaglandin E2
94
Tetralogy of fallot 4 lesions
overriding aorta (above septal defect), ventricular septal defect, right ventricular hypertrophy, pulmonary stenosis
95
Persistent Truncus arteriosus, what is it and surgical repair for it
large VSD, truncus arteriosus supply both aorta and pulmonary artery. Rastelli repair.
96
Immediate procedure for transposition of the great vessel
catherisation of foramen ovale to allow mixing of blood.
97
Types of atrial septal defect
– primum atrial septal defect (ostium primum is patent as septum primum has not fused with the endocardial cushions), secundum atrial septal defect (short septum primum doesn’t overlap foramen ovale), patent foramen ovale
98
Cyanotic heart defects
tetralogy of Fallot, persistent truncus arteriosus, transposition of great vessels, tricuspid atresia
99
What does ductus arteriosus become after birth?
ligmentum arteriosum
100
Treatment for patent ductus arteriosus
prostaglandin inhibitor (ibuprofen), if fails to work surgical slip.
101
Acyanotic heart defects
ASD, VSD, PDA (may due to pulmonary/aortic valve atresia), coarctation of aorta (pre-ductal type)
102
Site of erythropoietin at 3rd week
yolk sac, mesothelial layer of placenta
103
Site of erythropoietin at 6 week
liver and spleen
104
Which part of the bone marrow does erythropoiesis occur?
yellow bone marrow
105
the process by which RBC pass from bone marrow into the blood capillaries
diapedesis (squeezing through the pores of the capillary membrane)
106
site of EPO production
fibroblast in proximal tubule (kidney), type 1 cell of carotid body. These sites are not subject to variation during exercise. Are sensitive to hypoxia
107
what does raised ESR indicate
-specific marker for infection in blood
108
how does RBC make ATP and NADPH?
Anaerobic glycolysis for ATP. Pentose phosphate pathway for NADPH.
109
How is old RBC in spleen recognised for break down?
old RBC contain different surface antigens (rise in level of methaemoglobin), lack of deformability of old RBC so become trapped in spleen
110
Process of RBC break down
splenic macrophage break RBC by osmotic lysis. Haem group is removed and broken down by haem-oxygenase, iron is removed for reused, left with biliverdin. Biliverdin is converted to bilirubin by biliverdin reductase.
111
Enzyme for unconjugated bilirubin ->unconjugated bilirubin
glucuronic transferase (unconjugated bilirubin is combined with glucuronic acid)
112
Diagnosis criteria for MI
rise/fall of troponin & either symptoms of ischaemia OR ECG changes
113
STEMI reperfusion therapy
Aspirin and clopidogrel (ticagrelor), GP IIb/IIIa inhibitor, PCI
114
Prevention for STEMI
aspirin, clopidogrel (ticagrelor), statin, beta-blocker, ACE-I
115
What artery supplying the brain is most prone to blockage by emboli and what do they supply
lenticulo-striate artery which leave MCA at 90 degrees. Supply basal ganglia and internal capsule (motor commands)
116
What is penumbra
area surrounding an ischemic event such thrombotic or embolic stroke. Treatment target survival of neurones in penumbra.
117
What controls Cardiac output?
preload and heart rate, NOT afterload (which controls blood pressure).
118
What controls blood pressure?
CO and systemic vascular resistance
119
What local factors affect arteriole constriction/ dilation?
– Endothelin act on ETA Receptors cause vasoconstriction. Endothelin act on ETB Receptors to release NO, cause vasodilation. Prostacyclin (from arachidonic acid) cause vasodilation. Noradrenaline and angiotensin II cause vasoconstriction (not local factor)
120
What is shock?
inadequate tissue perfusion resulting in cellular hypoxia. Either caused by inadequate blood pressure or systemic vascular resistance.
121
Meaning of diaphoresis
sweating
122
How much blood loss is life-threatening?
How much blood loss is life-threatening?
123
Most common cause of haemolytic disease of the new born?
– Rh–ve mother with first pregnancy carrying Rh+ve child, the immune system is sensitised to D antigen. Second Rh+ve child, anti-D stimulated and cross placenta and destroy foetal red blood cells.
124
Treatment for HDN?
anti-D immunoglobulin prophylaxis
125
When to stop transfusion immediately?
temperature spike >40 degrees, suggest intravascular haemolysis
126
Treament for an acute transfusion reaction
stop transfusion, IV saline (hypotension), Frusemide (maintain renal perfusion), treat DIC
127
Definition of haematoma
blood clot outside of blood vessel (in tissues)
128
What’s Virchow’s triad
reduced blood flow (stasis), vessel wall disorder, hypercoagulability
129
DVT confirmation of diagnosis
pretest probability score, D-dimer (blood test for fibrin), compression ultrasound, venography (gold standard)
130
What does ECG show for pulmonary embolism
sinus tachycardia, right heart strain, T-wave inversion anterior leads, S1Q3T3 pattern
131
Diagnostic test for PE
– CTPA (CT pulmonary angiogram), isotope lung scan (V/Q scan)
132
Two types of heparin
unfractionated heparin (UFH- immediate onset, short half life, IV), low molecular weight heparin (LMWH, longer half life, subcutaneous administration)
133
Heparin antagonist
Heparin antagonist
134
How does warfarin work
vitamin K antagonist (factors II, VII, IX, X, protein C & S)
135
What is antiphospholipid syndrome
acquired form of thrombophilia
136
Treatment for DVT/ PE
heparin then warfarin
137
What pathogen cause Rheumatic fever
group A streptococcus pyogenes
138
Heart failure what does the chest X-ray show?
bat-wing (pulmonary oedema), cardiomegaly, upper zone vessel enlargement (pulmonary venous hypertension), Kerley B lines, pleural effusion
139
Test for heart failure
– brain natriuretic peptide (secreted by myocardial cells due to overstretching, promotes natriuresis & vasodilation, inhibit ADH and aldosterone release), Doppler echo
140
Heart failure treatment
diuretics, ACE-I, ARB, Beta-bloker, spironolactone (NYHA grade III and IV, LVEF5.0)
141
Causes of aortic stenosis
rheumatic disease, calcific disease, congenital bicuspid valve
142
Lipid target
total cholesterol
143
Management of MI
– give O2, morphine (with antiemetic- metoclopramide), aspirin + clopidogrel, PCI
144
Clopidogrel mechanism of action
block platelet aggregation by stopping ADP binding, so prevent activation of GpIIb-IIIa receptor complex for fibrinogen
145
Fibrinogen binding site on platelet
GpIIb/IIIa receptor
146
Thrombolysis specific agents (2)
rTPA/tenecteplase, streptokinase
147
CVD (MI) prevention
lifestyle changes, blood pressure control/medication, ACE-I (ARB), beta-blocker, aspirin, simvastatin (cholesterol >5.0) = polypill
148
Muscle for deep inspiration
accessory muscle- scalene, SCM, pectoralis minor, serratus posterior superior
149
Muscle for quite inspiration
diaphragm, external intercostal m, interchondral part of internal intercostal
150
Muscles for deep expiration
interosseous part of internal intercostal m, abdominal muscles, serratus posterior inferior
151
Where to put needle for mid-axillary thoracocentesis? –
– mid-axillary line, 9th intercostal space (costodiaphragmatic recess), needle angled up (to avoid liver)
152
Where to put thoracostomy (chest drain)
5/6 intercostal space
153
Blood supply to lung
pulmonary artery, bronchial (enter at hilum and supply all tissues except alveoli)
154
Tumour to sympathetic chain in apex of thorax (stellate ganglion), what would this cause?
– Horner’s syndrome= pupil constriction, drooping of eyelid, sunken eye
155
Tumour to thoracic duct, what would this cause
chylothorax, effusion of lymph into pleural cavity
156
What is upper respiratory tract?
nasocavity, larynx, pharynx
157
Commonest bacterial cause of pneumonia
streptococcus pneumoniae
158
Identification of streptococcus pneumoniae
catalase negative, alpha haemolytic
159
Causes of atypical pneumonia
Mycoplasma pneumoniae, chlamydia pneumoniae, legionella pneumophilia, coxiella burnetil (Q fever)
160
Pneumonia treatment
beta-lactams (amoxicillin), not effective against Mycoplasma pneumoniae
161
What organisms cause TB?
mycobacterium tuberculosis, m. bovis, m. africanum, m. microti (aerobic, lipid rich cell wall)
162
Stain for TB
Ziehl-Neelsen stain, auramine (fluoroscopy)
163
What stain is BCG vaccine made from
M. bovis
164
Common infections of upper respiratory tract
colds, pharyngitis (sore throat), tonsillitis, sinusitis, otitis media
165
Common cause of pharyngitis (sore throat)
group A streptococcus (beta-haemalytic)
166
Cause of common cold
rhinovirus
167
Complication of group A streptococcus
rheumatic fever, glomerulonephritis
168
Whooping cough cause
Bordetella pertussis
169
Stages of whooping cough
catarrhal phase (week 1), paroxysmal stage (2-4 weeks, whooping cough & haemorrhage)
170
Cause of diphtheria
Corynebacterium diphtheria
171
What does Epstein Barr virus cause
glandular fever
172
Neuraminidase inhibitor (influenza treatment)
zanamavir
173
Cause of acute respiratory bronchiolitis
respiratory syncytial virus (RSV)
174
What immunoglobulin activate mast cell?
IgE
175
How does innate immune cells bind to antibody (e.g. IgG)
Fc receptor
176
What is atopy?
inherited disposition to make IgE to common environmental antigens (hypersensitivity)
177
What is type 1 hypersensitivity?
mast cell activation, release histamine (increase permeability of venule), leukotriene (increase permeability), prostaglandin
178
Clinical manifestation of type 1 hypersensitivity
local (asthma, allergic rhinitis, atopic eczema), systemic= ANAPHYLACTIC SHOCK
179
Symptoms of anaphylactic shock
hypotension (dilation of great vein, fluid lead into ISF), angioedema, urticaria (hives), bronchoconstriction…
180
Acute treatment of anaphylactic shock
IM adrenaline (Epipen), oxygen, IV fluid, antihistamine (chlorpheniramine), glucocorticosteroids (hydrocortisone)
181
What’s the difference between anaphylactic and anaphylactoid shock?
anaphylactoid shock doesn't involve IgE
182
What activate mast cells & basophils?
IgE, complement C3a&C5a, substance P (axon reflex of sensory nerves), direct contact with pathogen
183
What medication for hereditary angioedema
C1 esterase inhibitor (doesn't respond to adrenaline)
184
Definition of respiratory failure
PaO2 6.7kPa (50mmHg)
185
Type 1 respiratory failure
hypoxic (with/without low PCO2), PaO2
186
Causes of type 1 respiratory failure
reduced perfusion (emphysema, pulmonary emboli, pulmonary arterial hypertension), reduced ventilation (pneumonia, obstructed airway, pleural effusion, atelectasis, muscle weakness)
187
Treatment of type 1 respiratory failure
give oxygen
188
How does peripheral chemo-sensitive area react to hypoxia
carotid and aortic bodies have oxygen sensitive K+ channels and haem based mitochondrial cytochrome enzymes responsive to local PO2 concentration. When PO2 increase ventilation.
189
Type 2 respiratory failure
Raised PaCO2 (with/without hypoxia), PaCO2 > 6.7kPa (50mmHg)
190
Definition of atelectasis
partial collapse or incomplete inflation of the lung.
191
How does chemo-sensitive area react to increase PCO2?
– effect via central chemo-sensitive area. Increase in arterial PCO2 increase CSF PCO2, lead to increase H+ ion and CSF acidosis -> increase rate and volume of breathing.
192
Causes of type 2 respiratory failure
decreased ventilation due to loss of lung ventilator capacity (consolidation, PE, COPD), loss of chest wall ability to ventilate, failure of central control of respiration (head/brain stem injury, acclimatisation to high PaCO2, sleep)
193
Treatment of type 2 respiratory failure
controlled oxygen therapy, ventilator support- drugs (doxapram, acetazolamide, progesterone) or CPAP, BIPAP or intubation
194
What oxygen saturation is aimed for people with hypercapnia respiratory failure?
88-92% e.g. in COPD
195
FEV1/VC of obstructive defect
196
Examples of obstructive defects
asthma, COPD, upper airway obstruction
197
FEV1/VC of restrictive defect
>75%
198
Examples of restrictive defects
lung fibrosis, reduced chest wall movement and muscle disease
199
Diagnosis of asthma with peak flow
>20% diurnal variation for 3days/week for 2 weeks on PEFR diary
200
Asthma response to bronchodilator
FEV1 > 15% and 200ml
201
How is TLC measured
dilution of helium
202
How is gas transfer in the lung measured
TLCO= KCO x Va, single breath of air + CO + He. Calculate total CO transfer TLCO.
203
What factors affect gaseous exchange?
Fick Principle – volume of gas, surface area of alveoli, thickness, difference in pressure, permeability (Graham’s Law- molecular weight)
204
How does emphysema and fibrosis change compliance of lung
emphysema increase compliance, fibrosis decrease compliance
205
What’s airway resistance
pressure difference between alveolae and mouth
206
What’s the maximum altitude people can stay at (death zone)
7500m
207
Response to rapid ascend
low PaO2, increase sympathetic activity (HR, BP), increase pulmonary vasoconstriction, cause pulmonary arterial hypertension
208
Mechanism of acclimatisation
metabolic acidosis (increase excretion of HCO3-, decrease excretion of H+, activate central and peripheral chemoreceptors to increase ventilation), increase kidney EPO secretion & increase haematocrit, pulmonary vascular resistance fall (reduced hypoxic vasoconstriction response)
209
How does acute mountain sickness occur
hypoxia-driven hyperventilation response (chemoreceptor in carotid body) inhibited by respiratory alkalosis (hyperventilation and hypocapnea), cause hypoxemia.
210
Acute mountain sickness treatment
descend, oxygen, acetazolamide (Diamox- carbonic anhydrase inhibitor cause metabolic acidosis), dexamethasone
211
Acute mountain sickness symptoms
headache, poor sleep, tiredness, loss of appetite, vomiting, nausea, dizziness
212
Pathophysiology of HACE (high altitude cerebral oedema)
hypoxaemia, lack supply of ATP to brain cell, Na+ pump not working, Na+ leak into nerve cell and pull water in cause brain cells to swell. Raise intracranial pressure and block cerebral veins
213
Treatment Of HACE
descend, acetazolamide. Oxygen, dexamethasone, hyperbaric chamber
214
Symptoms of HACE
ataxia, nausea/vomiting, hallucination/disorientation, confusion, soma
215
Symptoms of HAPE (pulmonary oedema)
dyspnoea, reduced exercise tolerance, dry cough, blood stained sputum, crackles
216
Pathophysiology of HAPE
hypoxia induce pulmonary vasoconstriction, cause pulmonary arterial hypertension, fluid leave blood and enter alveoli.
217
Treatment of HAPE
descend, sit upright, nifedipine (Calcium channel blocker- block constriction of pulmonary arteries), hyperbaric chamber, Viagra (slow down breakdown of cyclic GMP= vasodilator produced by nitric oxide, cause pulmonary artery relaxation)
218
Meaning of epistaxis
noseblood
219
4 sinuses
frontal, ethmoid air sinus, sphenoid, maxillary
220
4 tonsils
adenoid, tubal, palatine, lingual tonsil
221
Where does palatine tonsil lay
between palatoglossal and palatopharyngeus, in tonsillar bed
222
Where could foreign body lodge in pharynx
tonsil, base of tongue, vallecular, pyriform fossa
223
Where is oesophagus likely to have strictures
cricopharyngeus, left main bronchus cross oesophagus, cardia
224
Level of hyoid
C3
225
Level of cricoid cartilage
C6
226
Position of thyroid isthmus
2/3rd tracheal ring
227
Damage of what nerve cause voice hoarseness
recurrent laryngeal nerve
228
Damage to what nerve cause absent of choking reflex
superior (internal) laryngeal nerve
229
What nerve supply cricothyroid muscle
superior (external) laryngeal nerve
230
Types of exercise
dynamic (rhythmical contraction), static (maintained contraction, e.g. lifting)
231
What is VO2 max
highest oxygen uptake during dynamic exercise. Reflect aerobic physical fitness of a person.
232
Redistribution of blood flow during exercise mechanism
increase sympathetic activity, local control (nitric oxide, tissue factors- adenosine, inorganic phosphate, carbon dioxide, H+, K+ released from muscle)
233
What is excess post-exercise oxygen consumption
eliminate oxygen debt, ATP and creatinine phosphate resynthesized, lactate -> glucose and glycogen
234
How does macrophage uptake LDL
apolipoprotein B100, LDL receptor mediated endocytosis (negative feedback), modified LDL through scavenger receptor (no negative feedback)
235
2 types of smooth muscle
resting (contractile), proliferating (secrete ECM)
236
Desirable level of blood cholesterol
Total cholesterol
237
Genetic risk factor to arteriosclerosis
homocysteinaemia, lipoprotein a
238
What chromosome is gene coding for alpha subunit of haemoglobin on
16
239
What chromosome is gene coding for beta subunit of haemoglobin on
11
240
Definition of anaemia (adult)
241
Definition of anaemia (6months- 6years)
242
Definition of anaemia (6yrs -14yrs)
243
Normal MCV
76-96fl
244
Causes of microcytic anaemia
deficiency, thalassaemia
245
Causes of normocytic anaemia
acute blood loss, cancer, chronic disease (e.g. rheumatoid arthritis, renal disease-EPO), haemolytic anaemia
246
Causes of macrocytic anaemia
B12/folate deficiency, alcohol/liver disease, myelodysplasia, bone marrow failure (aplastic anaemia), drugs (anticonvulsants, chemotherapy)
247
Feature on blood film of b12/folate deficiency
macrocytic anaemia, hypersegmented neutrophils, oval macrocyte, (bone marrow- megaloblastic marrow)
248
Who are more likely to get pernicious anaemia
fair hair, blue eyes, blood group A
249
Pathophysiology of pernicious anaemia
autoimmune – autoantibodies against gastric mucosa (parietal cells) and intrinsic factor, lead to gastric atrophy, achlorhydria (lack of acid production). IF is needed for B12 absorption in ileum.
250
Difference between symptoms of B12 & folate deficiency
B12 deficiency causes neuropathy. (same symptoms include- anaemia, glossitis, jaundice_
251
Feature on blood film of haemolytic anaemia
spherocytosis, polychromatic (reticulocyte)
252
Extravascular causes of haemolytic anaemia
sickle cell, Thalassaemia, antibody-induced, Rh mismatch, hereditary spherocytosis
253
Intravascular causes of haemolytic anaemia
ABO mismatch, snake bite, infection, G6PD deficiency
254
Clinical features of G6PD deficiency
neonatal jaundice, acute haemolysis with oxidant drugs/ fava beans (G6PD reverses oxidation of Hb)
255
Life span of platelet
8-14days
256
Cell membrane of platelet
glycoprotein molecule (GpIIb/IIIa, receptor for coagulation factors, platelets etc), phospholipid (prostaglandin synthesis)
257
Organelle of platelet
dense body, alpha-granules (VWF, fibrinogen, platelet factor 4, β-thromboglubulin)
258
What is haemarthroses?
joint bleeding
259
Feature on blood film of iron deficiency anaemia
microcytic anaemia, pencil cell
260
What is chyle
fat lymph
261
Left and right Lymph drainage
right quadrant= right lymphatic duct -> right venous angle, left= cisterna chyle -> thoracic duct -> left venous angle
