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Year 1 Medicine Newcastle > Case 1 > Flashcards

Case 1 Flashcards

1
Q

What binds the thorax

A

The superior thoracic aperture and the diaphragm inferiorly

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2
Q

What are the anterior and posterior boundaries of the thorax

A

Anteriorly the sternum and posteriorly thoracic vertebrae

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3
Q

What is in the superior mediastinum

A 
Aortic arch and branches
SVC
oesophagus and trachea
phrenic and vagus nerves 
cardiac plexus and sympathetic chain
thymus and thoracic duct
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4
Q

What is the boundary of the superior and inferior mediastinum

A

thoracic plane at T4/5 and rib 2

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5
Q

What is in the middle mediastinum

A 
Ascending aorta
SVC and pulmonary trunk
heart and peicardium 
trachea and bronchi 
nerves and tracheobronchial lymph nodes
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6
Q

What is in the posterior mediastinum

A 
Descending thoracic aorta
Oesophagus 
thoracic duct 
azygous and hemiazygous veins 
many arteries and the sympathitc trunk
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7
Q

At what point does the thoracic aorta become the abdominal aorta

A

when it passes through the abdominal hiatus at level T12

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8
Q

What main arteries go to the head and neck region and the arms

A

The common carotid and subclavian

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9
Q

What arteries branch off to supply the ribs

A

The posterior intercostal arteries

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10
Q

What arteries supply the bronchus

A

The bronchial arteries

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11
Q

Where does the celiac trunk branch off the abdominal aorta and what does it supply

A

At T12 to supply the stomach and liver

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12
Q

Where is the superior mesenteric artery found and what does it supply

A

L1 and it supplies the intestines

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13
Q

Where do the lumbar arteries branch off and what do they supply?

A

Each lumbar segment and they supply the posterior muscles

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14
Q

Where does the inferior mesenteric artery branch off and what does it supply

A

L3 to supply the intestines and rectum

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15
Q

Where does the aorta split into the two common iliac arteries?

A

L4

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16
Q

Where do the renal arteries branch off?

A

L1

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17
Q

What veins form the superior vena cava

A

The left and right internal jugular veins and the subclavian veins join together to form the brachiocephalic veins that join to form the SVC

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18
Q

What forms the inferior vena cava and at what levels

A

The two common iliac veins- right at L5 and left at L3

Also the lumbar, renal and hepatic veins

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19
Q

What is the extracellular matrix made up of

A

collagen and elastic fibres

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20
Q

What cells maintains the extracellular matrix

A

Fibroblasts

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21
Q

What are examples of specialised connective tissue

A

Cartilage, bone, blood and blood vessels

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22
Q

What is the order of blood vessel layers from superior to deep

A

Tunica externa (adventitia), Tunica media then tunica intima

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23
Q

What is the tunica externa made of

A

many collagen fibres and some elastic fibres and it is the thickest layer

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24
Q

What is the tunica media made of

A

smooth muscle and supported by connective tissue

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25
Q

what is the tunica intima made of

A

epithelial cells
connective tissue layers
some collagen but no fibroblasts

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26
Q

Where can you find the internal elastic lamina

A

in the tunica intima and media

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27
Q

What is the vaso vasorum

A

small blood vessels between the tunica media and externa that supply the muscles in the vessel walls

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28
Q

What is the first stage of atheroma formation

A

damage of the endothelial cells in the lining of the vessel to initiate an inflammatory response

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29
Q

What is deposited in the vessel wall to begin atheroma formation and at what layer

A

LDL move into the tunica intima and deposit cholesterol

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30
Q

What are foam cells

A

the macrophage complex with the cholesterol in the vessel wall

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31
Q

What results out of the rupturing of the fibrous cap during atheroma formation

A

A clotting cascade prevents the contents spilling out which results in the formation of a thrombus

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32
Q

What clinical manifestations can atheroma (chronic swelling) lead to

A

Aneurysm is a localised swelling of the wall of an artery that may rupture
Thrombosis is a stationary blood clot in the vessels
Embolus is a blood clot that moves around the blood system until it gets lodged
stenosis is the abnormal narrowing of a body passage
ischaemia

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33
Q

What is the difference between acute and chronic inflammation

A

Acute inflammation leads to the removal of harmful material and healing of the wound whereas chronic inflammation doesn’t lead to recovery and a constant state of alert persists in the body

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34
Q

How do you calculate the mean arterial pressure using cardiac output and total peripheral resistance

A

MAP= COxTPR

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35
Q

What is the cardiac output

A

the amount of blood the heart can pump in one minute

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36
Q

How do you calculate cardiac output using stroke volume and heart rate

A

Stroke volume x Heart rate

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37
Q

What is the simple mechanism of ACE inhibitors

A

Inhibition of the angiotensin-converting enzyme in the RAA system to prevent angiotensin I from converting to angiotensin II

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38
Q

How are ACE inhibitors administered and hat is their half life

A

Orally- 12 hours

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39
Q

What patients shouldn’t receive ACE inhibitors and why

A

Those ho are renally impaired as ACE inhibitors can lead to acute damage of the kidney as a result of effecting vasodilation- reducing blood flow to the organ
This may cause hyperkalaemia as the kidney is unable to remove potassium effectively

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40
Q

What are side effects of ACE inhibitors

A

Angioedema- swelling of the skin

Cough- most common

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41
Q

What is the role of angiotensin II in the body (5)

A

Increases sympathetic activity
Increased tubular Na+ and Cl- absorption and increased K+ excretion thus increased H2O retention
Increased aldosterone secretion
Increased arteriolar vasoconstriction to increase BP
Increased ADH secretion in the pituitary gland so increased permeability of the collecting duct

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42
Q

What is the common suffix of ACE inhibitors

A

-pril

43
Q

What do angiotensin receptor blockers do

A

Act as a competitive inhibitor for angiotensin II in constricting arterioles so prevent this

44
Q

Give an example of an ARB

A

Losartan

45
Q

What do calcium channel blockers do? (3)

A

inhibit the influx of calcium ions into the myocardial muscle
Inhibit formation and propagation of depolarisation in the myocardial system
Vasodilation by reducing vascular tone in the coronary and systemic circulation

46
Q

What is an example of a calcium channel blocker

A

amlodipine

47
Q

What is the mechanism of diuretics

A

Blocking the reabsorption of Na+ and Cl- to reduce water reabsorption

48
Q

What are possible side effects of diuretics and contrindications

A

Electrolyte imbalance and Addison’s disease

Old people are particularly vulnerable

49
Q

What is an example of a diruetic

A

Indapamide

50
Q

How is resistance related to the radius or diameter of a blood vessel

A

Resistance is inversely related to the radius or diameter of a vessel to the power of 4

51
Q

How is resistance related to blood viscosity or vessel length

A

Resistance is directly proportional to blood viscosity or vessel length

52
Q

hat is the difference in consequent resistance when increasing the resistance in one component of the vascular system in comparison to the organ system

A

If you increase the resistance in one part of the vascular system the total resistance increases across it
however in the organ system the organs have a parallel relationship so a change in resistance in one doesn’t effect the total resistance across every organ

53
Q

How is blood flow related to pressure and resistance

A

it is directly proportional to pressure and inversely proportional to resistance

54
Q

How does blood velocity relate to cross sectional area (number of branches and width of vessels)

A

It is an inversely proportional relationship

55
Q

What is the autonomic nervous system

A

the part of the nervous system responsible for control of the bodily functions not consciously directed, such as breathing, the heartbeat, and digestive processes.

56
Q

How does the autonomic nervous system affect arterioles in response to a stretch in the arteriole walls

A

It initiates a sympathetic response that constricts smooth muscle in the arteriole wall to vasoconstrict

57
Q

What four forces contribute Starling’s forces and when do they come into play

A

Hydrostatic and oncotic in both the interstitium and capillary
Hydrostatic capillary and oncotic interstitium at arteriole end
Oncotic capillary and hydrostatic interstitium venous end

58
Q

How do you calculate MAP using systolic pressure and diastolic pressure

A

MAP= DBP+ 1/3(SBP-DBP)
or
MAP= (SBP+2DBP)/3

59
Q

Where are high pressure baroreceptors found

A

In the wall of the aortic arch and carotid sinus nerve

60
Q

What do baroreceptors sense in order to recognise a change in BP

A

A change in the stretching of the wall of a blood vessel

61
Q

When do baroreceptors fire action potentials, hen the wall is stretching more or less?

A

More- the greater the stretch the more action potentials that are fired

62
Q

Where are low pressure baroreceptors found and what do they detect

A

In the atria and venoatrial junctions of the heart

These detect blood volume changes as oppose to pressure

63
Q

hat does increased baroreceptor firing mean f or sympathetic and vagal responses

A

Decreased sympathetic response and increased vagal response

64
Q

What happens to blood pressure when you stand up and what accommodates this

A

The blood pools to your lower limbs through gravity- decreasing the pressure in the aorta and thus baroreceptors fire off fewer action potentials to accommodate this change
This increases HR rapidly and sympathetic response

65
Q

Where are lymph nodules found

A

Around the outer cortex of a lymph node

66
Q

Where are mature T-cells located in a lymph node

A

In the paracortex

67
Q

What is the hilum of a lymph node

A

Where a blood vessel enters and leaves a lymph node and where an efferent lymphatic vessel exits

68
Q

What does lymph travel through to enter and exit a lymph node

A

The afferent lymph vessel enters the lymph node and the efferent exits it

69
Q

Where does most lymph drain through

A

The thoracic duct

70
Q

Where does lymph from the thoracic duct drain back into

A

the left venous angle in the venous system

71
Q

What is the role of the lymph (3)

A

Drains interstitial fluid from the extracellular space
Transports dietary lipids in the lacteals
Works with the immune response as a defence mechanism

72
Q

What do lymphatic capillaries drain

A

Interstitial fluid

73
Q

Where are the lacteals found

A

The small intestine

74
Q

How does the lymph act in an immune response (2)

A

It acts as a phagocytic filter to prevent unwanted particles from entering circulation
It also provides a site for lymphocytes to come into contact with antigens to increase the immune response- this occurs in the cortex of a lymph node

75
Q

How is the lymphatics system flow maintained (2)

A

hydrostatic pressure pressure between the interstitial fluid and lymph as hydrostatic pressure goes through an expansion and compression phase
Peristalsis of the gut also assists movement

76
Q

What happens to the valves between the interstitium and lymph during expansion phase and what does this result in

A

primary microvalves open whilst secondary close

this allows interstitial fluid to flow into the lymphatic system through a hydrostatic pressure gradient

77
Q

What is the role of the thymus

A

T-cell development and maturation

78
Q

What is the role of the spleen

A

filters blood cells and is the site of an immune response, destroying erythrocytes

79
Q

What cells does the bone marrow produce

A

B-cells, T-cells and macrophges and red blood cells

80
Q

What is anchoring

A

Relying too heavily on the first bit of information we are given

81
Q

What is confirmation bias

A

when we think of a hypothesis and only search for the evidence that supports our theory

82
Q

What is epidemiology

A

The study of how often diseases occur in certain populations and why

83
Q

What are health inequalities

A

Differences in health between different groups within a society such as social class/socioeconomic status, social deprivation and/or ethnicity

84
Q

What does mortality of a disease refer to

A

The number of deaths from a disease divided by the population

85
Q

What does incidence of a disease mean

A

The incidence of a disease is the rate at which new cases occur in a population during a specified period

86
Q

What is prevelance

A

The proportion of people in a population who are found to be affected by a medical condition at a specific time

87
Q

What are the social determinants of health

A

The conditions in which people are born, grow, live, work and age

88
Q

What is the inverse care law

A

The availability of good medical care varies inversely with the need for the population served

89
Q

What is Vd- the volume of distribution

A

The volume of fluid that a drug would need to be dissolved in order for the known amount given to produce a measured plasma concentration fo the drug

90
Q

What is C0

A

The initial concentration of the drug in the plasma at t=0 and corresponds to the highest plasma concentration

91
Q

what is T 1/2

A

the half life of a drug- the length of time it takes for the plasma concentration of a drug to half

92
Q

What is Cl in pharmacokinetics

A

Clearance of plasma- the volume of plasma cleared of drug per unit time and is an index of how well the drug is cleared from the circulation irreversibly

93
Q

How do we work out the clearance of a drug using the elimination rate constant and Vd

A

Cl= Kel x Vd

94
Q

How do we work out the elimination rate constant using the half life of a drug

A

t1/2= 0.693/kel

95
Q

What is D with regards to a drug

A

D is the initial dose of a drug

96
Q

What is the dosing rate of a drug

A

The rate at which a drug must be administered in order to achieve and maintain the desired plasma concentration of the drug

97
Q

How do you work out Vd using C0 and D

A

Vd= D/C0

98
Q

What does first order mean with regards to the removal of a drug as you add more of the drug

A

As you add more of the drug then more metabolising enzymes are recruited and the rate of removal is greater

99
Q

What does zero order mean with regards to the rate of removal of a drug as you add more of the drug

A

This is when the metabolising enzymes are all saturated so the rate at which the drug plasma concentration reduces will be constant as they can’t recruit more enzymes to speed this up

100
Q

What is a steady state of a drug

A

This is when, upon administration of a drug, the amount of drug administered exactly replaces the amount going out at an equilibrium point

101
Q

What does a loading dose do

A

It attempts to reach the therapeutic range of a drug immediately by putting a large initial dose of the drug in however this can be risky as overshooting is a possibility

102
Q

How do you calculate a loading dose using Vd and Css (steady state plasma concentration)

A

Loading dose= Vd x desired Css

103
Q

What is a maintenance dose and how can it be calculated using Cl and Css

A

A maintenance dose is the dose required to keep a drug within its therapeutic range and can be calculated by Cl x Css

Year 1 Medicine Newcastle (8 decks)

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