Extra facts I still need to get straight Flashcards
Describe how peripheral stem cells develop into cancer
They become adenocarcinomas and then invasive adenocarcinoma
Describe how central stem cells develop into cancer
They become squamous cells and then invasive squamous cells
What causes an exudate effusion ?
Cancer
Pneumonia
TB
Empyema
What causes a transudate effusion ?
Left ventricular failure and live failure
What score is concerning on Epworth’s sleep score?
A score of 11 or above
What condition is Epworth’s sleep score used to help diagnose ?
Sleep Apnoea
What does ‘radical treatment’ mean in cancer treatment ?
Treatment with the intension to cure
If latent TB is detected is it treated ?
Yes, using a different combination of the same drugs as active TB for 3-6 months
Name the respiratory conditions caused by mainly viruses
COVID-19
Bronchitis
Bronchiolitis
Croup
Name the respiratory conditions mainly caused by bacteria
Acute epiglottitis
Tracheitis
There are different ways to delivery oxygen. How many l/min can be delivered by a nasal high flow oxygen mask ?
70
There are different ways to delivery oxygen. How many l/min can be delivered by a reservoir mask ?
15
Draw the diagram which shows the different volumes in the lungs
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What changes would move the oxygen binding graph to the right ?
Decrease pH
Increase temp
Increase PCO2
Increase [DPG]
Draw out the table or partial pressure
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What is a pack year ?
1 pack year is having a pack of cigarettes each day for 1 year. (20 cigarettes in a pack).
What drug has a drug cough ?
ACEI
Stages of sleep apnoea
0-5 Un-notable
5-15 Mild
15-30 Moderate
30+ Severe
What happens to the pH of the blood when there is an decrease in O2 and an increase in CO2 ?
pH falls there is an acidosis.
How is a pleural effusion treated ?
treat underlying cause and possibly do a chest drain
How fast does a LTRA work ?
15 mins
How do LTRAs work ?
Bind to leukotrienes which cause bronchoconstriction and therefore they prevent bronchoconstriction
What are some complications of pneumonia ?
Effusion
Empyema
What are the side effects of radiotherapy ?
lethargy, SOB and long term cardiac problems, pulmonary fibrosis.
What are the side effects of chemotherapy ?
Side effects include marrow suppression, nausea, neuropathy, and hair loss. Neutropaenic sepsis.
Name the different congenital diseases of the heart
- Downs Syndrome
- MAP-K pathways (Noonan’s, leopard and Costello)
- 22q11 deletion mutation (DiGeorge and Shpintzen)
- Williams syndrome
- Marfan’s syndrome
- Romano-Ward syndrome
- Brugade syndrome
- Hypertrophic cardiomyopathy sarcomere disease
- Turners syndrome
Describe downs syndrome in terms of congenital heart disease
15% of Downs patients will have a intraseptal defect
Describe the MAP-K pathways syndromes in terms of congenital heart disease
Noonan’s - Pulmonary stenosis, short stature, neck webbing.
Leopard - Same but also deafness
Costello - Same but also cardiomyopathy.
Describe the 22q11 deletion pathway syndromes in terms of congenital heart disease
DiGeorge - Outflow track malformation and hypoparathyroidism
Shpintzen - Outflow track malformation and characteristic face
Caused by low copy number repeats which get confused.
Describe Williams syndrome in terms of congenital heart disease
Aortic stenosis
Cocktail party manner
Describe Marfan’s syndrome in terms of congenital heart disease
Connective tissue disease
Describe Romano-Ward syndrome in terms of congenital heart disease
Long QT which causes seizures and sudden death
Describe Brugade syndrome in terms of congenital heart disease
Ventricular fibrillation
Describe Hypertrophic cardiomyopathy sarcomere disease in terms of congenital heart disease
Thickening of muscle causes obstruction and arrhythmias.
Describe pulmonary fibrosis
UIP response to chronic inflammation of the interstitium.
Almost always progresses to honeycomb lung and end stage pulmonary fibrosis.
Occurs in the elderly mainly and presents with SOB, cough, clubbing and cyanosis.
It is investigated on a CXR or CT (Gold standard) scan.
It is treated with Steroids and palliative care.
Describe hypersensitivity pneumonitis
Granulomatous response to chronic inflammation of the interstitium.
Presents with a cough, SOB
Common in farmers.
It is investigated on CXR or CT (Gold standard).
Describe diffuse alveolar damage
Acute response to inflammation of the interstitium.
Caused by major trauma, etc.
Almost always follows the pulmonary fibrosis pathway.
Describe sarcoidosis
Granulomatous response to chronic inflammation of the interstitium. Presents with a cough, SOB (which doesn’t respond to inhalers), erythematosus etc. Investigations on CT (Gold standard). Treatment is corticosteroids.
Draw the diagram of how the different restrictive lung diseases relate to each other
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Typical symptoms of cerebellar stroke
Vertigo
Poor coordination
Typical symptoms of frontal stroke
Weakness in one side of the body
Speech difficulties
Typical symptoms of occipital stroke
Light-headedness
Numbness
Typical symptoms of parietal stroke
Left sides weakness
Inability to see out of the lower left quadrant of the eye
Typical symptoms of temporal stroke
Poor memory
Inability to recognise faces
What can hypercalcaemia be a side effect of ?
Lung cancer
What does hypercalcaemia cause?
Abdominal pain, constipation and confusion
What bacteria causes rusty brown sputum in pneumonia
Streptococcus pneumoniae
What are the most common causes of community acquired pneumonia ?
Streptococcus pneumonia and Haemophilus influenzas
What is the most common cause of pneumonia ?
Streptococcus pneumoniae
What is the most common cause of hospital aquired pneumonia ?
Staphylococcus aureus
What is turners syndrome in terms of congenital heart disease?
It causes coarctation of the aorta
Short statue
Neck webbing
How is DVT treated ?
Low molecular weight heparin
When is thrombolysis used ?
STEMI
Stroke
Pulmonary embolism
What is the preload ?
The degree of cardiac stretch when the heart is at the end of diastole (i.e. about to contract).
What is the normal cardiac output at rest ?
5-6 l/min
What is the normal length of depolarisation in cardiac muscle?
< 2ms
What is the normal length of depolarisation in skeletal muscle?
2-5ms
Which vessels are resistance vessels?
Small arteries and arterioles
What are the stages in the cardiac cycle ?
Late diastole - No contraction occurs and ventricles are filling passively
Atrial systole - Atria contract and fill the already fairly full ventriculus.
Isometric ventricular contraction phase - The ventriculus start to contract but the pressure it not great enough to open the aortic and pulmonary valves.
Ventricular ejection - Valves open and blood leaves the ventriculus
Isometric relaxation phase - Aortic and pulmonary valves close, Mitral and tricuspid valves open and the heart fills
How long will a diuretic take to work ?
Up to 2 hours for a normal and 30 mins for a loop
what are some non-cardiac causes of elevated troponin?
Renal failure
PE
Pulmonary hypertension
Trauma
What are the names of the respiratory congenital conditions ?
Chronic lung disease Transient tachypnoea Congenital diaphragmatic hernia CPAM IRDS Tracheoesophageal fistula Laryngomalacia Tracheomalacia
What is chronic lung disease ?
Chronic lung disease is associated with premature birth where ongoing oxygen support is required at term. It has multifactorial causes and is associated with increases childhood respiratory morbidity.
What is Transient tachypnoea ?
Transient tachypnoea is a condition associated with caesarean section where fluid doesn’t move as effectively around the lungs as it should but it will improve by itself in 1-2 days.
What is Congenital diaphragmatic hernia ?
Congenital diaphragmatic hernia is a condition a babies may be born with. The diaphragm normally develops around week 7 and closes at week 18 however if it doesn’t close then this condition arises. It is mostly detected antenatally and will require surgical repair. Prognosis depends on degree of lung hypoplasia (underdevelopment).
What is CPAM ?
Congenial pulmonary airway malformation (CPAM) is a condition which babies are born with where there is abnormal non-functioning lung tissue. It is mostly detected antenatally and occur sporadically. They normally resolve themselves but surgical intervention may be required.
What is IRDS ?
Respiratory distress syndrome occurs mainly in preterm infants and is due to surfactant deficiency. Treatment is done using antenatal steroids, surfactant replacement and appropriate ventilation and nutrition.
What is a Tracheoesophageal fistula ?
Tracheooesophageal fistula is where there is an abnormal connection between the trachea and the oesophagus and the majority are associated with an oesophageal atresia and it is often associated with genetic conditions. Presents with choking, colour change, cough with feeding, unable to pass NG and is often picked up postnatally. It is treated with a surgical repair and complications include tracheomalacia, strictures, leak and reflux.
What is Laryngomalacia ?
Laryngomalacia is commonly seen in infants and is when there is a floppiness of the larynx, it presents with stridor and is worse when feeding or when upset/excited. Normally it will improve within the first year and no intervention is required.
What is Tracheomalacia?
Tracheomalacia is where there is a floppiness of the trachea. It can be associated with genetic conditions and may present with a barking cough, recurrent croup, breathless on exertion and stridor/wheeze. It may be caused by external compression. Again often no intervention is required and it will get better with time and symptoms can be managed until it does i.e. use of a physio or antibiotics.
How does the kidneys control blood pressure ?
The renin-angiotensin-aldosterone pathway
Antidiuretic factor
ANP and BNP
How does the renin-angiotensin-aldosterone pathway help to control blood pressure ?
Sympathetic nerves act on the juxtaglomerular apparatus and induce the secretion of Renin from juxtaglomerular cells in the kidneys. Renin is converted to inactive angiotensinogen and then into angiotensin I. The angiotensin converting enzyme (ACE) then converts angiotensin I to Angiotensin II. Angiotensin II stimulates the release of aldosterone from the adrenal cortex which increase Na2+ reabsorption in the loop of Henle and therefore blood pressure. Angiotensin II also simulates the release of ADH from the pituitary glands which increases water permeability and therefore increases blood pressure. Angiotensin II is also a vasoconstrictor which increase TPR increasing blood pressure. This pathways is generally called the renin angiotensin aldosterone system.
How does the antidiuretic factor help to control blood pressure ?
The antidiuretic factor (ADH) is produced by the hypothalamus and released from the posterior pituitary gland. The release of ADH is triggered by a number of things including, a decreased blood volume, increases osmolarity, increased interstitial fluid and presence of circulating angiotensin II. ADH increases the water permeability of the collecting duct, reducing diuresis (urine excretion) and increasing plasma volume. ADH also causes vasoconstriction which also increased MAP.
How does the ANP and BNP pathways help to control blood pressure?
The atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are produced and released from the myocardial cells in the atria and denticules respectively. If there is an increase in MAP there will be increased tension in the ventricles which triggers the secretion of ANP and BNP. These hormones increase excretion of Na+, inhibit renin release and act on medullary CV centres to reduce BP.
What is the difference between peripheral vascular disease and arterial thromboembolism ?
peripheral vascular disease is slow progressing like angina
Arterial thromboembolism is acute like STMEI
What is the difference between chronic venous insufficiency and critical limb ischemia?
Chronic venous insufficiency occurs where there is a failure of the veins to return blood to the heart
Critical limb ischemia is where there is a blockage in the arteries of the leg causes reduced blood flow.
What happens to the heart when B1 receptors are stimulated?
Increased HR and increased contractility
What happens after the heart rate increases ?
Decreased preload
Decreased stroke volume
What kind of arrhythmias is the Valsalva maneover most likely to stop ?
Atrial ones i.e. supraventricular tachycardia
