Formative/Practice Questions Flashcards
The right atrium possesses
an opening for the coronary sinus
The tricuspid valve is located between
right atrium and right ventricle
The azygous vein empties into the
SVC
The internal jugular vein and subclavian veins form from the
brachiocephalic vein
The brachiocephalic vein becomes the
SVC
Fossa ovalis is a depression in the
right atrium
Fossa ovalis is a remnant of
thing fibrous sheet that covered the foramen ovals during foetal development
Gap junctions are found in
cardiac muscle
Action potential is short in _____ and long in ______
skeletal
cardiac
Skeletal muscle can exhibit
tetanus
cardiac refractory period is too long so it cant
Skeletal muscle RMP is
very stable
depolarises in response to activation by motorneurone
Cardiac muscle RMP is
very unstable
randomly depolarise
are pacemakers
In development, which pair of arches give rise to the common carotid arteries/arch?
3rd pair of aortic arches
The 1st and 2nd pair of aortic arches =
disappear early
1st one forms arch of maxillary aa.
4th left aortic arch =
arch of aorta
4th right aortic arch =
right subclavian
5th aortic arch =
disappears on both sides
6th aortic arches form the
pulmonary arteries
Arterioles function as resistance vessels because
they have a narrow lumen and strong muscular wall
In the heart, the fast depolarising phase of the cardiac action potential is caused by
influx of Na+
the P wave shows
the depolarisation of atria
the QRS complex shows
ventricular depolarisation
the T wave shows
ventricular repolarisation
atrial repolarisation signal is swamped by
QRS complex
The second heart sound is when
semilunar valves close
The first heart sound is when
atrio-ventricular valves close
A HR in excess pf 150bpm is likely to
decrease preload
decrease SV
Activation of B1-adrenoreceptors on cardiac myocytes will
increase contractility
increase SV
Most significant features of pulmonary circulation =
pulmonary arterioles constrict in response to local hypoxia
During exercise, venous pressure (+ venous return to heart) may be increased by
increase in systemic filling pressure
contraction of smooth muscle around veins
increased rate and depth of respiration
rhythmic contraction of skeletal muscle
intermittent rapid regular palpitations terminated by the valsalva manoeuvre is most likely to be
supraventricular tachycardia
the valsalva manoeuvre increases
vagal (parasymp) tone
sudden severe breathlessness PND tachycardia elevated JVP lung crackles peripheral oedema SIGNS OF ....... TREATMENT =
heart failure
IV diuretic
exertional angina treated with
beta blockers
beta blockers
reduced workload of heart
reduce O2 requirements
less pain
most useful investigation for severe ‘white coat’ hypertension
24 hour ambulatory blood pressure recording
in the first trimester of pregnancy, what can be used to treat a DVT?
low molecular weight heparin
warfarin is teratogenic in which trimester?
1st
coarctation of aorta
short stature
neck webbing
gondal dysgenesis
= ????
Turner Syndrome
Downs syndrome causes
atrioventricular septal defects
hypotonic baby
reduced tone
Noonan syndrome causes
pulmonary stenosis
septal defects
Shprintzen syndrome is associated with
teratology of Fallot
Williams syndrome cause
supravalvular aortic stenosis
calf pain on exertion =
intermittent claudication
22q11 micro deletion leads to
DiGeorge syndrome
associated with teratology of Fallot
FAS mainly associated with
neurological, craniofacial defects
some atrial/ventricular septal defects
ulcer on leg
sleep interrupted by severe lower limb pain
MOST LIKELY TO BE ???
critical limb ischaemia
Marfan syndrome signs
tall joint mobility pneumothorax myopic stretch marks systolic murmur
a chest x-ray in marfan’s would show
apical blebs
an ECG in marfan’s is to assess
aortic root diameter at sinus of valsalva
clarify reason for murmur
pelvic x-ray in marinas would show
protrusio acetabulae
MRI scan of lumbar spine in marina’s would show
dural ectasia
Family history needed in Marfan’s patient
fathers details cause of death in father's brother did uncle have features? paternal grandparents signs of marina's in them all
signs of systolic murmur
dyspnoea (worsening)
causes of systolic murmur
aortic sclerosis
aortic stenosis
mitral regurgitation
mitral regurgitation clinical signs
loudest at apex
radiates to axilla
pan systolic murmur
maximal on expiration
aortic stenosis clinical signs
rising upstroke in pulse waveform
low output pulse
murmur radiating to carotid
aortic sclerosis clinical signs
does not radiate to carotids
investigations for systolic murmur
FBC
ECG
CXR
biochemical screen + thyroid function
severe aortic stenosis is fixed with
surgical aortic valve replacement
Vital capacity =
maximum volume of air that can be exhaled following a maximum inspiration
Expiratory reserve volume =
volume of air that can be voluntarily forcibly exhaled after normal expiration
Function residual capacity =
volume left in lungs after normal respiration
ERV + RV
Residual volume =
volume of air in lungs that cannot be voluntarily expired
Tidal volume =
volume of air breathed in or out at rest
Air flows into the lungs during respiration because
external intercostals and diaphragm contract
thoracic volume increases
Alveolar ventilation =
(TV - DS) x RR
the partial pressure of oxygen in mixed venous blood is usually
40mmHg (5.3 kPa)
Arterial blood pressure of oxygen will be reduced in
pulmonary oedema
What do the following conditions have in common?
anaemia (iron deficiency) anemia (vitamin B12 deficiency) blood loss (child birth) CO poisoning
decrease in total oxygen content due to lack of O2 binding to Hb or loss of Hb
O2 in solution in plasma unaffected
In chronic lung disease, arterial PCO2 levels are
elevated due to poor alveolar ventilation
In chronic lung disease, is NO safe to use? Why?
No
Blunts peripheral chemoreceptor response to falling O2 levels, hypoxic drive, no control over ventilation
In chronic lung disease, patients are on _______ because _______
hypoxic drive
chronic elevation of PCO2 blunts central response to CO2
In chronic lung disease patients have
decreased sensitivity to PCO2
rely on peripheral chemoreceptors for ventilation
Shunt describes when
perfusion exceeds ventilation in L/min
Hypothermia causes the haem-ox curve to shift ________ causing ________
to the left
difficulty to offload oxygen to peripheral tissues
Hypothermia is a decrease in
body temperature
Presence of foetal haemoglobin shifts to haem-ox curve
left
higher affinity for oxygen than adult haemoglobin
Respiratory alkalosis shifts the haem-ox curve left because
decrease in [H+] pulls CO2 equilibrium to right, reducing PCO2
Running a marathon shifts the haem-ox curve right because
increase in body temp, CO2, lactic acid
oxygen extraction in peripheral tissues easier, increases oxygen delivery
Voluntary hyperventilation causes the haem-ox curve to go left because
decreases PCO2
At the costovertebral joints, the head of the 9th rib joins with the body of which vertebra(e)?
T8 and T9
same number and one above it
The cardiac notch is located
anterior border of left lung
All lung fissures contain
visceral pleura
The right lung has 2 fissures called
oblique
transverse
The left lung has a ______ fissure
oblique
The right lung contains what extra structure? Why?
eparterial bronchus in its hilum
it has three lobes
The lobes in the left lung are separated by
the oblique fissure
To investigate a patient with squamous carcinoma, abdominal pain, constipation and confusion, you should carry out a
serum calcium test
Squamous cell lung cancer is associated with
hypercalcaemia due to parathyroid hormone related protein
In a patient with a peripheral speculated opacity and an enlarged lymph node (supraclavicular) you should investigate with:
fine needle aspiration of the lymph node
to get sample of cancer type
easy access
If a patient has daytime somnolence but can sleep for 9 hours a night on holiday, this shows
poor sleep hygiene
The most likely organism infecting CF lungs is
pseudomonas aeruginosa
The most likely cause of lobar pneumonia is
streptococcus pneumoniae
normal blood Ph values =
7.37 - 7.43
normal PaO2 values are
11 - 15 kPa
normal PaCO2 values are
4.6 - 6.4 kPa
low pH, low PaO2, high PaCO2 is most likely
a severe exacerbation of asthma (too tired to do a peak flow)
A patient with new asthma who is waking up at night because of it should be treated with
inhaled CCS and beta-2-agonist
A healthy person with sudden severe chest pain, SOB is most likely a
primary pneumothorax
A patient recovering rom severe pneumonia develops rigors, poor appetite and SOB on exertion. What is wrong now?
Empyema thoracis
What is empyema thoracis?
thick-walled lung abscess = pus in pleural space
Typical cause of empyema thoracic is
consolidation of pneumonia
What do the following values show?
PaO2 = 7.8 kPa PaCO2 = 8.6kPa
Type II Resp failure
What treatment should be used in Type II rest failure?
Nebulised beta-2-agonist
Coughing up blood is also called
haemoptysis
haemoptysis is most likely to show signs of
lung cancer
what are the clinical signs of lung cancer in hands?
finger clubbing
what are the clinical signs of lung cancer felt in the abdomen?
hepatomegaly
signs of lung cancer found in the neck =
lymphadenopathy
SVC obstruction
tracheal deviation
imaging techniques used to view the extent of a lesion are
chest radiograph
CT
MRI
other than imagine, how else can lung cancer be investigated?
biopsy
bronchoscopy
4 main types of lung cancer
small cell non-small cell: - squamous - adenocarcinoma - large cell
where else does lung cancer commonly spread?
lymph nodes adrenal gland lung liver brain bone
List signs of left lower lobe pneumonia
tachypnoea tachycardia fever cyanosis reduced expansion of left chest dullness at left base bronchial breathing at left base crackles increased vocal resonance
In a healthy person, what can cause pneumonia?
chlamydia psittaci streptococcus pneumoniae mycoplasma pnemoniae staph. aureus haemophilus influenza
Investigations for pneumonia =
CXR sputum/blood culture acute + convalescent serology mycoplasma IgM atypical serology FBC ESR/CRP legionella/pneumococcal urinary antigen
What two classes of drugs can be used to treat pneumonia?
beta-lactams
macrolides
A patient has these measurements: temp 38 RR 20bpm BP 98/60mmHg HR 120bpm oxygen sats 90%
How do you manage them in hospital?
supplemental oxygen
analgesia
intravenous fluids
anti-pyretics
