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Y1 Medicine > CV&R Non-Anatomy > Flashcards

CV&R Non-Anatomy Flashcards

1
Q

What are 5 risk factors for atherosclerosis?

A

Age
Male
Family history
Smoking
Obesity
Hypertension

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2
Q

What are the 4 causes of chest pain ?

A

Cardiac
Respiratory
GI
Musculoskeletal
(+others)

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3
Q

What can cause cardiac chest pain ?

A

Ischaemia
Aortic dissection
Pulmonary embolism
Aortic stenosis
Pericarditis
Myocarditis

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4
Q

What are the two classifications of cardiac chest pain ?

A

Troponin positive
Troponin negative

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5
Q

What bare Troponin Positive cardiac conditions ?

A

Type 1 and 2 MI, SCAD, coronary spasm

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6
Q

What’s are Troponin Negative cardiac conditions ?

A

Angina (stable or unstable)
Cor spasm
Micro vascular/endothelial

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7
Q

What is the investigation pathways for cardiac conditions ?

A

Exercise tolerance test ( ETT) ——— stress echo, perfusion scan, CT coronary angiogram or stress perfusion cMR ———invasive coronary angiogram

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8
Q

What shows an ischaemia on an ECG ?

A

ST wave depression (during ETT)

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9
Q

What drug treatments can be used for angina ?

A

Beta blockers (-olol)
Calcium agonists (-dipine for smooth muscle + verapamil on the heart)
Nitrates (GTN spray)

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10
Q

What are the 3 acute coronary syndromes ?

A

Unstable angina - unstable plaque without myocardial necrosis
NSTEMI - thrombus without total vessel occlusion (ST depression)
STEMI - total vessel occlusion (ST elevation)

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11
Q

What are lipids ?

A

Water insoluble
3 classes = cholesterol, triglycerides, phospholipid

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12
Q

What is cholesterol a precursor to ?

A

Steroid hormones (oestrogen, testosterone, cortisol, aldosterone )
Endogenous vitamin D production

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13
Q

What is the structure of a lipoprotein ?

A

Central hydrophobic lipid core (triglycerides and cholesterol esters)
Surface layer of polar components (phospholipids + free cholesterol + apolipoproteins)

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14
Q

What is the LDL calculation ?

A

LDL = TOTAL CHOLESTEROL — HDL — TRIGLYCERIDES/5

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15
Q

Describe anticoagulant HEPARIN mechanism of action

A

Binds to and enhances antithrombin III, this bind to and inhibits clotting factors II,IX,XI and XII

Given intravenously or sub-cutaneously

Side effects = allergic reactions, haemorrhage, HIT, hyperkalaemia

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16
Q

Describe anticoagulant Warfarin mechanism of action

A

Structural Analogue of Vit K

Blocks vit. k reductase and therefore carboxylation
Blocks coagulation factor synthesis in the liver

Oral administration

Side effects = haemorrhage, crosses placenta and BBB (foetal haemorrhage)

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17
Q

Deceive aspirins use as an anti-thrombolytic agent

A

Used in low doses

It inhibits platelet synthesis, and COX irreversibly

Prevents re infarction (lowers risk by 20%)

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18
Q

Describe tissue plasminogen activator (t-PA) as a fibrinolytic ?

A

Enzyme produced by vascular endothelium

Only activate s plasminogen bound to fibrin (clot selective)

Side effects = haemorrhage

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19
Q

What are platelets derived from ?

A

Megokaryocytes in bone marrow

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20
Q

What normally suppresses platelet activation ?

A

Prostacyclin
Nitric oxide
Antithrombin III

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21
Q

What do fibrin strands enmesh ?

A

Erythrocytes and platelets

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22
Q

What is Von Willebrand disease ?

A

A deficiency in Von Willebrand factor (binds platelets to collagen)

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23
Q

What is Haemophilia A ?

A

Deficiency of factor VIII (8)

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24
Q

What is Haemophilia B ?

A

Deficiency of factor IX (9)

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25
What is Haemophilia C ?
Deficiency of factor XI (11)
26
What digests fibrin I to soluble degradation products ?
Plasmin (activated by t-PA)
27
What is the treatment for venous thrombosis ?
Anticoagulants
28
What is the treatment for arterial thrombosis ?
Fibrinolytics (immediate) Antithrombotics (long-term)
29
What is coronary steal ?
During vasodilation, When blood is diverted to already well perfumed areas
30
What do beta1-adrenoceptor blockers do ?
Competitive antagonists if adrenaline and noradrenaline at cardiac beta1-adrenoceptors Decrease HR and SV, decrease myocardial O2 demand
31
What does Ivabradine do ?
Blocks Na current causing delay in SA node depolarisation Decreases HR (not force), decreases myocardial O2 demand
32
What is after-load ?
Force against which LV contracts
33
What is pre-load?
Diastolic pressure that distends LV
34
What causes reduces after-load ?
Dilation of arteries
35
What causes reduced pre-load ?
Dilation of veins
36
What is the Bainbridge Reflex ?
Initiated by increased blood in atria Causes stimulation of SA node Stimulates barorecptors in the atria, causing increased SNS stimulation
37
What does P in the ECG wave show ?
Atrial depolarisation
38
What does P-Q show in ECG waves ?
Delay at AV node
39
What happens at Q of ECG wave ?
Conduction through bundle branches
40
What also happens at Q of ECG wave ?
Conduction through purkinje fibres
41
What happens at the QRS complex of ECG waves ?
Ventricular depolarisation
42
What happens at S-T of ECG waves ?
Plateau phase of re polarisation
43
What happens at T wave of ECG ?
Rapid Repolarisation
44
What causes a U wave to sometimes be present on an ECG ?
Repolarisation of Purkinje fibres
45
Which leads are unipolar ?
aVR aVL aVL Chest leads 1-6
46
Which leads are bipolar ?
I = RA-LA II= RA-LL III= LA-LL
47
Which ECG leads are anterior ?
V1-V4
48
Which ECG leads are inferior ?
II , III, aVF
49
Which ECG leads are lateral ?
I, aVL, V5 + V6
50
What does a wave look like that is horizontal -ve to +ve from L to R ?
All positive wave
51
What does a wave look like that is horizontal -ve to +ve from R to L ?
All negative wave
52
What does an ECG wave look like that is -ve to +ve superiority to inferiorly ?
Positive and negative parts STANDARD PQRST ECG WAVE
53
How do you calculate HR from ECG ?
300/no. of big squares between each QRS OR No. of QRS complexes across ECG (10 seconds) x 6
54
What is normal angle for the QRS axis ?
-30 to +90 degrees (from limb lead I)
55
How do you find the QRS axis ?
By finding lead with most positive QRS complex
56
What shows left axis deviation ?
-30 to -90 degrees Positive QRS in I Negative in II and aVF
57
What shows normal axis ?
-30 to +90 Positive QRS in I and II
58
What shows right axis deviation ?
+90 to +180 degrees Negative QRS in I Positive QRS in aVF
59
What shows extreme axis deviation ?
+180 to -90 degrees Negative QRS in I and II Positive QRS in aVR
60
What do normal T waves show in relation to QRS ?
Same polarity
61
What is absolute risk ?
Incidence of disease in a given population
62
How do you calculate absolute risk ?
Number of new cases per population over a specified time E.g. 1000 obese, 100 develop CAD in 1 year = 10/1000 pa = 0.1
63
How do you calculate relative risk ?
Compare the absolute risk of those who have the risk factor and those who don’t Express as how many times greater or smaller among exposed
64
Case-control study calculation ?
(exposed have disease x not exposed don’t have disease) / (not exposed have disease x exposed that don’t have disease)
65
Attributable risk (AR)
AR = incidence of disease in exposed - incidence of disease in unexposed
66
AR% calculation ?
(AR/ incidence of disease in exposed ) x100
67
Population attributable risk (PAR) calculation
PAR = AR x prevalence of exposure
68
PAR% calculation
(PAR / incidence of disease in the population)x100
69
What are normal cholesterol ranges ?
TC = <5 mmol/L HDL = >1 mmol/L Non-HDL = <4mmol/L TC to HDL ratio = <6
70
What is the pathophysiology of asthma ?
Loss of airway epithelium Thickening of BM Hypertrophy of smooth muscle layer
71
What are possible triggers of asthma ?
Inflammation - allergy, infection, exercise Drugs - beta blockers, NSAIDs Cold air + scents
72
What is the presentation of asthma ?
Bronchospasm = wheeze, dyspnoea, exercise intolerance Inflammation = cough
73
What is the management of asthma ?
Bronchorelaxation = beta 2 agonists Anti-inflammatories = corticosteroids, leukotrine receptor blockade, monoclonal antibodies (-mab)
74
What is the maximum peak flow rate ?
900L/minute Achieved by firm but flexible airway walls
75
What are ways of airway narrowing ?
Dynamic = rapid muscle contraction, secretions Fixed = smooth muscle bulk, thickening of BM
76
What is different about smooth muscle in asthma ?
There are mast cells present
77
What do the mast cells in smooth muscle in asthma cause ?
Variable airway calibre , leading to diurnal variation (nighttime or morning)
78
How to measure asthma via enhanced nitric oxide ?
Increased eosinophilic inflammation Normal value 30ppb
79
Describe how spirometers can be used to measure asthma ?
Narrow airway relaxes in response to salbutamol (approx 15% improvement)
80
What are the 3 phases of asthma ?
1) smooth muscle only - triggered by mediator ,rare wheezy episodes 2) chronic inflammation- irritates smooth muscle, regular wheezy episodes 3) acute inflammation- viral infection, clinical exacerbations
81
Describe type 2 inflammation in asthma
Cells = lymphocytes, eosinophils and mast cells Cytokines = IL-4, IL-5 Prostanoids = PGE2, Leukotrine D4 Immunoglobulins = specific IgE
82
What does histamine in asthma mast cell mediation cause ?
Smooth muscle contraction
83
What type of immune cell fights viruses ?
Neutrophils and lymphocytes
84
What type of immune cells fight parasitic infection ?
Eosinophils
85
What type of immune cells fight bacterial infection ?
Neutrophilic
86
What is the mechanism of action of B2 Agonists ?
Bind to B-2 adrenergic receptors activating a G protein Cyclic AMP acts as a second messenger Smooth muscles relaxes widening the airway
87
What is the main side effect associated with B-2 adrenoceptor agonists such as salbutamol) ?
Tremor
88
What is the partial pressure of O2 in alveoli ?
102
89
What is the partial pressure of CO2 in alveoli ?
40
90
What is the distance between alveoli and red blood cells ?
1-2um : includes type 1 alveolar epithelium, capillary endothelium and BM
91
How quickly do red blood cells pass through capillaries ?
Less than 1 second
92
For each mmHg of Po2 how much oxygen is there ?
0.003ml/100ml of blood
93
How many ml of O2 per litre of blood in the arteries ?
3ml O2/L blood
94
How do pH and temperature effect the oxygen dissociation curve ?
High pH or high temperature decrease oxygen affinity for Hb
95
At what O2 saturation does Hb affinity loss become steep ?
60mmHg
96
What is the respiratory exchange ratio ?
Ratio of expired CO2 to O2 uptake
97
What is the respiratory exchange ratio in normal conditions?
0.8
98
Which 3 forms is CO2 carried in the blood ?
Dissolved (7%) Bound to Hb (23%) Converted to bicarbonate (70%)
99
What is the bicarbonate equation ?
H2O + CO2 —> H2CO3 —> H+ + HCO3-
100
What is the V/Q ratio for lungs ?
0.8-1.2
101
What are possible V/Q ratios for individual alveoli?
V/Q > 1 = ventilation exceeds perfusion V/Q < 1 = perfusion exceed ventilation
102
Where does the brain receive neural signals from for breathing control ?
Chemoreceptors: feedback on blood Po2, PCo2 and pH Mechanoreceptors : feedback on mechanical status of lungs, chest wall and airways
103
Where in the brain controls breathing ?
Brainstem
104
Where are peripheral chemoreceptors found ?
Aortic arch and carotid sinuses
105
Which nerve do aortic chemoreceptors use ?
Vagus (X)
106
What nerve do carotid chemoreceptors use ?
Glossopharyngeal (IX)
107
Where do the nerves send chemoreceptor signal to in the brainstem ?
Nucleus Tractus Solitarius (NTS)
108
What chemoreceptors are responsible for hypoxia response ?
Peripheral
109
What chemoreceptors are responsible for hypercapnia or pH decrease responses ?
Central
110
What are central chemoreceptors?
Clusters of neurones in the brainstem
111
Which type of chemoreceptor plays a major role in moment to moment breathing ?
Central
112
What do mechanoreceptors do ?
Detect movement of the lung and chest wall
113
What nerve do mechanoreceptors signal through ?
Vagus (X)
114
What are the locations and functions of mechanoreceptors?
Airway smooth muscles = terminate inspiration Airway epithelium = sigh or shortened expiration
115
What makes up the ventral respiratory group in the brainstem ?
Pattern and rhythm generating neurones
116
What do respiratory pattern generating neurones do ?
2 types : inspiratory and expiratory active during their respective phases of breathing
117
What do respiratory rhythm neurones do ?
Produce rhythmic output through the spinal nerves to respiratory muscles (diaphragm + intercostals) to produce rhythmic breathing
118
What are the 3 major components of acid-base regulation ?
Buffering Ventilation Renal regulation
119
What are buffers ?
Weak acids partially dissolved in solution
120
What is the Henderson hasselbach equation ?
CO2 + H2O —> H2CO3 —> HCO3 + H+
121
What is metabolic acidosis ?
Low HCO3 therefore low pH
122
What is metabolic alkalosis ?
high pH
123
What is respiratory acidosis ?
High CO2 therefore low pH
124
What is respiratory alkalosis ?
Low CO2 therefore high pH
125
What is the ADME pneumonic ?
Absorption Distribution Metabolism Excretion
126
Which method of drug administration is preferred ?
Oral
127
Volume of distribution calculation ?
Dose (mg) / concentration ( mg/L-1)
128
How to calculate dose for individual ?
Typical weight adjusted volume x weight
129
Dose calculation?
Dose = concentration x volume
130
What is loading dose ?
A single dose which brings a drug to its target range
131
What is the clinical significance of first pass metabolism ?
Differences (due to age + gender) Some drugs undergo more first pass metabolism than others Impact peak drug concentrations
132
What is bioavailability?
The fraction of the drug that reaches systemic circulation after oral administration F= effective dose after oral / effective does after IV (F=%effective dose)
133
What are the routes of clearance of drugs ?
Total = renal + hepatic + other
134
What is clearance ?
The rate at which drug is removed from the body
135
What is clearance proportional to ?
Drug concentration
136
What is a drug-drug interaction ?
When a second drug alters the effects of the first drug
137
What are inhibitors ? (CYP450 enzyme)
They reduce clearance by inhibiting drug metabolism, increasing half life, meaning drug can accumulate with repeated dosing
138
What do inducers do ? (CYP450)
Accelerated clearance of drugs metabolised, shorter half life
139
What are the features of type 1 respiratory failure ?
Low O2 = <8kPa Pneumonia Cardiac failure Pulmonary embolism
140
What are the features of type 2 respiratory failure ?
Low O2 = < 8kPa High CO2 = >6kPa Opiate overdose Neuromuscular weakness Advanced COPD Severe respiratory fatigue
141
What are the symptoms of heart failure ?
Breathlessness Ankle swelling (oedema) Fatigue
142
What are the 3 goals of HF treatment ?
Relief of symptoms Avoid admission or readmission Prevent premature death

Y1 Medicine (5 decks)

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