CR EOYS4 Flashcards
What pathology should you investigate after an ECG after a TIA? [1]
arrhythmias
keratin pearls are associated which of the following?
small cell cancer
squamous cell cancer
adenocarcinoma cancer
non-small cell lung cancer
keratin pearls are associated which of the following?
small cell cancer
squamous cell cancer: HALLMARK FEATURE !
adenocarcinoma cancer
non-small cell lung cance
What type of cancer is depicted?
small cell lung cancer
squamous cell lung cancer
adenocarcinoma lung cancer
non-small cell lung lung cancer
What type of cancer is depicted?
small cell lung cancer
squamous cell lung cancer; keratin pearl !!
adenocarcinoma lung cancer
non-small cell lung lung cancer
Malignant squamous cell carcinoma can lead to
Hypercalcemia
Hyperkalemia
Hyponatremia
Hypophosphatemia
Malignant squamous cell carcinoma can lead to
Hypercalcemia Squamous cell carcinoma can cause hypercalcemia, as the tumor secretes parathyroid-hormone-related peptide, which can cause hypercalcemia.
Hyperkalemia
Hyponatremia
Hypophosphatemia
Which of the following would be caused by pneumonia induced hypoventilation
Increased resistance as a result of airway obstruction
Reduced compliance of the lung tissue/chest wall
Reduced strength of the respiratory muscles
Drugs
Which of the following would be caused by pneumonia induced hypoventilation
Increased resistance as a result of airway obstruction
Reduced compliance of the lung tissue/chest wall
Reduced strength of the respiratory muscles (
Drugs
Name two disease that would cause reduced strength of the respiratory muscles and this hypoventilation [2]
Guillain-Barré; motor neurone disease
Name two clinical signs of CO2 retention [2]
- Flap (asterixis): ask a patient to extend arms out, close eyes, should be able to hold for 30 secs
- Bounding pulse
The usual Alveolar-arterial O2 difference is not normally greater than:
1.0 kPa
1.3 kPa
2.4 kPa
2.8 kPa
3.0 kPA
The usual Alveolar-arterial O2 difference is not normally greater than:
1.0 kPa
1.3 kPa
2.4 kPa
2.8 kPa
3.0 kPA
Which of th following would be caused by obesity induced hypoventilation
Increased resistance as a result of airway obstruction
Reduced compliance of the lung tissue/chest wall
Reduced strength of the respiratory muscles
Drugs
Which of th following would be caused by obesity induced hypoventilation
Increased resistance as a result of airway obstruction
Reduced compliance of the lung tissue/chest wall
Reduced strength of the respiratory muscles
Drugs
A patient suffering from an asthma attack would use which of the following
Simple face mask
Nasal cannulae
Venturi mask
Face mask with reservoir bag
A patient suffering from an asthma attack would use which of the following
Simple face mask
Nasal cannulae
Venturi mask
Face mask with reservoir bag
A patient suffering from an sepsis attack would use which of the following
Simple face mask
Nasal cannulae
Venturi mask
Face mask with reservoir bag
A patient suffering from an sepsis attack would use which of the following
Simple face mask
Nasal cannulae
Venturi mask
Face mask with reservoir bag
A patient suffering from an acute exacerbation of COPD would use which of the following
Simple face mask
Nasal cannulae
Venturi mask
Face mask with reservoir bag
A patient suffering from an acute exacerbation of COPD would use which of the following
Simple face mask
Nasal cannulae
Venturi mask
Face mask with reservoir bag
Which part of the lung has the greatest airway resistance? [1]
Which part of the lung has the least airway resistance? [1]
The above can be determined according to which law? [1]
Medium-sized bronchi collectively have the smallest radius: greatest airway resistance.
Terminal bronchioles have the lowest resistance since, collectively, it has the largest radius
Poiseuille law
What determines the alveolar to arterial PO2 difference? [1]
What is usual Alveolar-arterial O2 difference not normally greater than? [1]
Shunting determines the alveolar to arterial PO2 difference
The normal A-a O2 difference is not normally greater than 1.3 kPa
How do you calculate normal aterial PaO2? [1]
Normal PaO2 = 13.6 – (0.044 x age in yrs) kPa
What is shunting (of the lungs)? [1]
What can shunting be caused by [1]
]
When an area of the lung is perfused but not ventilated. Blood is transported through the lungs without taking part in gas exchange
Can be caused by Arteriovenous malformations (AVMs)
Label A & B [2]
A: Lung failure
B: Pump failure
Type 2 Respiratory Failure is an imbalance between which three factors? [3]
Imbalance between:
- Neural respiratory drive
- Load of resp. muscles
- Capacity of the resp. muscles
LEARN ! Name 4 reasons that could cause hypoventilation
Increased resistance as a result of airway obstruction (e.g.COPD)
Reduced compliance of the lung tissue/chest wall (e.g. pneumonia, rib fractures, obesity).
Reduced strength of the respiratory muscles (diaphragm) (e.g. Guillain-Barré, motor neurone disease)
Drugs acting on the respiratory centre reducing overall ventilation (e.g. opiates)
Name three consequences of CO2 retention [3]
State for each their clinical signs [3[
End-organ hypoxia
- Altered mental status
- Bradycardia and hypotension (late)
Haemoglobin desaturation
- Cyanosis
CO2 Retention
- Flap (asterixis): ask a patient to extend arms out, close eyes, should be able to hold for 30 secs
- Bounding pulse
If the SpO2 is >94% the the PaO2 should be >[]kPa
If the SpO2 is >94% the the PaO2 should be >10kPa
First line of treatment for respiratory failure? [1]
Oxygen
Which type of patients would require the following?
- Oxygen masks / nasal cannulae
- Face mask with reservoir bag
- Venturi mask
Oxygen masks, nasal cannulae
Patient with normal vital signs (post-op)
Face mask with reservoir bag
Higher O2 concentration needed (asthma attack, pneumonia, sepsis)
Venturi mask
Controlled treatment in long-term respiratory failure (COPD)
Explain MoA of how atherosclerosis causes ischaemic stroke
Endothelial damage allows lipoproteins and monocytes to adhere to the vessel wall and enter the intima.
Monocytes differentiate into macrophages and engulf the lipoprotein and become known as foam cells.
Further accumulation of cholesterol and foam cells forms a fatty streak.
Foam cells release pro-inflammatory cytokines which leads to smooth muscle cell proliferation. and connective tissue to deposition in the fatty streak.
These changes form a fibrous cap over the lipid core.
A necrotic core can form due to the lack of capillaries.
Plaque rupture removes the endothelium which exposes the fibrous cap leading to thrombosis and occlusion of the artery
What is a watershed ischaemic stroke? [1]
Sudden BP drop by more than 40mmHg, then there is low cerebral blood flow = global ischaemia leading to ‘watershed infarcts’ in vulnerable areas of cortex between boundaries of different arterial territories
brain ischemia that is localized to the vulnerable border zones between the tissues supplied by the anterior, posterior and middle cerebral arteries
When is common to see watershed stroke?
Sepsis patients
Which drug classes would use for primary prevention of stroke? [3]
Control of which disease would allow prevention of stroke? [1]
Primary prevention:
- Cholesterol: statin
- AF: anticoagulation
- Good diabetic control
- BP: antihypertensives
What are the 3 overlying causes of cellular death in stroke? [3]
Mechanical compression
Cerebral Oedema
Excitotoxicity
Excitotoxicity of stroke
How would you treat acute ischameic stroke:
- if within 4.5 hrs of onset [1]
- if outside 4.5 hrs of onset [1]
Thromboylsis:
- using drug - Alteplase
- Must occur within 4.5 hours of onset
- haemorrhage has to be excluded
Mechanical thrombectomy
- endovascular removal of a thrombus from a large artery.
How would you manange an acute TIA?
300mg Aspirin
Refer urgently to TIA clinic (to be seen within 24 hours). In clinic: work out if was stroke or not.
Might do ECG to see if have AF
What are a common consequence of prolonged or recurrent inflammation, particularly allergic inflammation in respiratory system? [1]
Nasal polyps are oedematous protrusions of the respiratory mucosa and are a common consequence of prolonged or recurrent inflammation, particularly allergic inflammation.
Which part of the respiratory system is the main site of SABA action? [1]
Smaller airways in tracheal / bronchial tree: requires smooth muscle to be there (to relax)
Which secretory protein is associated with pathologies such as COPD and asthma? [1]
Which cell secretes? [1]
Secretory protein C16: associated with pathologies such as COPD and asthma.
non-ciliated bronchiolar Clara cells This protein increasingly appears to protect the respiratory tract against oxidative stress and inflammation
What are the histopatholigcal features of TB? [4]
Langhan cells
immune cell infiltration
granulomas; have central necrosis and cavitation
tissue destruction
Histopathological features in pneumonia? [1]
aggregates of neutrophils (almost like an abscess) in the alveolar
Name a risk factor for squamous cell carcinoma [1]
What are histological changes are induced by ^? [2]
Often centrally located close to hilum
Smoking is a risk factor:
- Leads initially to metaplasia (from respiratory to squamous epithelium) then dysplasia.
- Smoke procarcinogens can be converted to carcinogens via P450
What may be indicative of paraneoplastic syndrome due to Squamous Cell Carcinoma? [1]
Hypercalcemia may be indicative of paraneoplastic syndrome due to SCC
Histopathological features of Cytological features of Squamous cell C? ? [5]
- Small, malignant cells often very large with eonisophilic cytoplams [1] and large vesicular nucleus [1]
- High nuclear:cytoplasm ratio
- Intercellular bridges
- Keratin pearls [1]
Histopathological features of adenocarcinoma? [3]
irregular, closely packed glands effacing normal lung appearance with atypical cells lining the gland lumen
glandular hyperplasia
desmoplastic (fibrotic) stroma around them.
What type of T helper cells are found in granulomas? [1]
TH1 subtype
Describe that immune pathophysiology of granuloma formation
- Antigen taken up by macrophage & presented to CD4+ helper T cells
- CD4+ helper T cell convert to TH1 subtype
- TH1 cells screte IL-2 and INy
- T cell proliferation and macrophage activation
- Macrophages and T cells secrete TNFa
- Causes increase in inflammatory cells
- Causes repeat of TH1 cells screte IL-2 and INy etc
Label A-D of this granuloma
Name the type of lung cancer depicted
metastatic small cell carcinoma - blue cluster
note:
- orange myeloid precursors
- fat cells
- blue erythoid precursors
- megakaryocytes
subacute combined degeneration of the cord causes degeneration of which columns of the spinal cord
posterior and lateral
posterior and medial
anterior and lateral
anterior and medial
subacute combined degeneration of the cord causes degeneration of which columns of the spinal cord
posterior and lateral
posterior and medial
anterior and lateral
anterior and medial