FPB- MST1 Flashcards
Define Osteoporosis
Decreased bone mass at least 2.5sd below the mean
Define Ostepenia
Decreased bone mass
Define Osteomalacia
Decreased mineralization of bone (vitamin D deficiency)
Define Osteodystrophy
Skeletal changes that occur in chronic renal disease
What are the stages of bone healing
Haemotoma, Inflammation, Soft Callus (Fibrocartilaginous), Hard Callus (Woven bone), Remodelling (Lamellar bone)
What is Wolff’s Law?
Increased loading on a bone will make it stronger
What are some RF’s of osteoporosis?
Low estrogen, physical inactivity, low serum calcium
What is the child version of osteomalecia and some common signs?
Rickets
Bowing (genu varus), protrusion of forehead, pigeon chest
What are some mechanisms of osteodystrophy?
Low GFR, increasing phosphate retention, which causes hypocalcemia and osteopenia
Decreased activation of vitamin D causing osteomalacia
How is primary fracture healing different from the more common secondary?
If ends are close enough together and fixed, then there is no need to form a callus and bone can be formed
What are complications of fracture?
Infection, malunion, nerve and vascular damage, fat embolism disrupting blood flow as bone marrow enters bloodstream
What are the stages of muscle injury and repair?
Degeneration, inflammation, regeneration and fibrosis
What makes fibrosis occur?
Damage to the ECM. If injury only to muscle fibres little fibrosis is needed
Why is creatine kinase not a great measure of muscle injury?
Highly variable by individual
What is the gold standard of detecting muscle injury?
Decrease in max force
What is sarcomere inhomogeneity?
Weak sarcomeres stretched by stronger ones, lengthening not uniform. Weak on descending limb of tension-length
Weak sarcomeres yield or pop
Why does loss of Ca2+ homeostasis cause muscle damage?
Cellular necrosis linked with Ca2+ homeostasis, disruption of sarcolemma
What occurs in regeneration?
Damaged fibres are degraded, and satellite cells activate and proliferate. Myoblasts derived from satellite fuse into myotubes
What are the function of tendons?
Connect muscle to bone, absorb and release energy
What is tendinopathy?
Spectrum of changes in damaged diseased tendons, usually from overuse and involving pain and decline in function
What are some risk factors for tendon patholog?
Obesity, age, systemic disease, oestrogen deficit, muscle weakness (e.g. runners load), overuse, increase in acitvity, lack of recovery, poor workplace/ergonmics
What is the Beighton scoring system?
Measure of joint hypermobility, more than 4 factors required
What is a typical tendinopathy management?
Heavy, slow resistance
What is boom bust?
In contrast to gradual load, boom bust is when you go to hard at an exercise and then ease off because of pain resulting in a reduction of activity over time
What is permissible pain for exercise?
1-4- acceptable
5-7- modify
8-10- rest
Why are ligaments wavy?
Bears load from different directions
What are ligaments composed of?
Collagen, strong stiff (type 1 strongest)
Elastin, flexible, smaller proportion
Proteoglycans, influence viscoelastic properties
Describe the stress strain curve
Toe region- crimped (wavy) fibres straighten
Elastic region- straightened fibres deform but not permanently
Plastic region- permanent deformation, microscopic failure until yield point, then macroscopic failure and rupture
What is stress and strain?
Stress is the force per unit, strain is the relative deformation
What is stiffness?
Resistance to change in ligament length
How does thickness and length affect stress?
Thicker -> small stretch -> higher stiffness
Longer will rupture at increased length but same force, therefore half as stiff
What is viscoelasticity?
V- Resistance to flow
E- ability to return to original shape
What is creep?
Fixed force, ligament elongate and gradually return to original length
What is stress-relaxation?
Stretch to fixed length, force required to maintain length decreases over time
What is strain rate sensitivity?
Load fast, stiff, high failure load
Load slow, more compliant
How does ligament injury occur?
- High stress (contact)
- High strain (overuse)
- Both (aberrant motion)
How are ligament injuries classified?
I- disruption of some collagen fibres, little functional deficit
II- considerable disruption, effusion, increased laxity, moderate functional deficit
III- complete disruption, pop, immediate pain, haeomarthrosis, significant deficit
What are the phases of ligament healing?
I- Haemorrhage with inflammation, haeomtoma fills gap, inflammatory cells, vasodilation capillary permeability, rudimentary scar, collagen remodeling begins
II- Matrix and cellular proliferaiton, 6 weeks fibrin clot and granulation tissue fills gap, vascularization, strength of scar improves
III- Remodeling and maturation, decreased vascularity, collagen more organized, tensile strength improves, slightly disorganized and hypercellular ligament
How does ligament structure change upon healing?
Different proteoglycan, collagen types
Collagen crosslinks don’t mature
Reduced viscoelastic properties, less stiff more compliant
Reduced failure loads
Inferior creep
What is DDH?
Acetabulum cannot contain femur head, potentially due to maternal oestrogen increasing ligamentous laxity. Becomes chronically dislocated.
What are some RF’s of DDH?
Breech, incorrect swaddling, hormonal, family history
What are some DDH signs/symptoms?
Barlow sign, dislocates hip by adduction and depression of flexed femur
Ortalani sign, elevation and abduction on already dislocated flexed femur, clunk on entry
< 3months, reduced hip abduction, abnormal skin creases
3m<x<1y, reduced hip abduction, leg length discrepancy
>1y, toe walking, trendelenburg
What are the alpha and beta angles?
a- Bony acetabulum and ilium ~ >60
b- Labrum and ilium ~ <55
What is Perthes Disease?
Blood supply to femoral head disturbed (avascular necrosis), causing softening and collapse of bone and then remodeling to repair
What are signs/symptoms of Perthes?
Limping, groin pain, reduced range abduction and internal rotation
How is Perthes classfied?
A- normal lateral pillar height
B- >50%
C- <50%
What are some treatment options for Perthes?
Casting to maintain hip abductiom
Wheelchair for non-weight bearing
What is SUFE?
Femoral head slips on metaphysis due to combination of obesity, growth spurts and endocrine disorders. Neck mostly moves anteriorly and externally rotated
How is SUFE classified?
Unstable (unable to WB) or Stable
Acute or Chronic or Acute on Chronic which is sudden displacement of already slipped epiphysis
Can also be mild slip <1/3 of width, moderate <1/2 width or severe >1/2 slip
What are some signs/symptoms of SUFE?
Pain (commonly knee), no WB, antalgic gait, out toeing gait
Most reliable, flexed hip will automatically cause external rotation
What are treatment options of SUFE?
Emergency surgery, nonWB, osteotomies to reconstruct femur
What are some risk factors of Parkinson’s?
Age, pesticides, gender, head injury
What are some protective factors of Parkinson’s?
Smoking, coffee
How do we diagnose Parkinson’s?
Neuronal loss of substantia nigra
Lewy body build up
What is the pathogenesis of Parkinson’s?
Impaired protein trafficking, aggregation
Dysfunction in autophagy
Oxidative stress
Neuroinflammation
What are some cardinal features of Parkinson’s?
Bradykinesia (slow movement)
Rigidity
Tremor
Unilateral onset and persistent asymmetry
What are some non-motor symptoms of Parkinson’s?
REM sleep behaviour (act out dreams)
Anosmia (lose smell)
What are the four functions of the pain pathway?
Transduction
Transmission
Perception ‘Pain’
Descending Modulation
What do transducers do?
Ion channels that convert stimulus to electrical activity
What are first and second pains?
Immediate to deter from activity
Second delayed throbbing non-specific
What is Complex Regional Pain Syndrome (CRPS)?
Pain plus other clinical abnormalities
Swelling, discoloration starting in feet/hands
Persistent burning pain
What does descending modulation do?
Reduce or facilitate nociceptive transmission
What is nocebo hyperalgesia?
Algesia after defensive encounter promotes expectation of pain
What is the difference between sarcopenia and dynapenia?
S- Age related muscle mass loss (and function)
D- Age related muscle strength loss
How can sarcopenia be diagnosed?
Need low muscle mass, strength and physical performance
Grip strength, body composition and gait speed
What factors can control muscle mass?
Protein synthesis and degradation
Nutrition, hormones, genetics, innervation, blood flow, exercise
Which fibres undergo greatest atrophy?
Type II Fast
What neuromuscular functions can change with ageing?
Possible demyelination
Widening of endplate
Longer nerve terminals
Fewer side branches
What’s the function of insulin and glucagon and which cells secrete them?
I- Glycogenesis, Glycolysis, Triglyceride synthesis, beta cells
G- Glycogenolysis, Gluconeogenesis, alpha cells
What is the marker for insulin levels?
C-peptide
What is the pathogenesis of T1DM?
Immune death of beta cells, alpha cell dysfunction, post-prandial hyperglucagonemia, hypoglycemic glucagon impairment
What is the pathogenesis of T2DM?
Insulin resistance, gradual onset
What are some differences between Typ1 and Type 2 DM?
Type 1: ketones common, GAD present, C peptide low, fast progression
Type 2: ketones uncommon, GAD absent, C peptide normal, gradual onset
What are some complications of hypoglycemia and hyperglycemia?
Hypo- impaired growth/development, falls, cardiac disease, coma, seizures death (impaired glucose to brain)
Hyper- DKA (diabetic ketoacidosis), Hyperosmolar hyperglycemic state, CVD, stroke, infection
What is PVD (peripheral vascular disease)?
Narrowing of arteries, hypertension, hyperlipidemia, venous insufficiency. Hyperglycemia from diabetes can cause narrowing
What is functional decline?
Reduced capability to perform self-care, physical or cognitive decline
What is multimorbidity?
2 or more chronic conditions simultaneously
What is frailty?
Dynamic state of vulnerability that causes a decline in physiologic reserve and recover from stress
What tools are used for screening and assessment of frailty?
S- Clinical Frailty Scale 1-9, 1 being very fit, 5 need help with IADLS (instrumental), 9 approaching death
A- Fried Phenotype, 1 point allocated per factor to indicate frailty, weight loss, exhaustion, physical activity, walk time, grip strength
What is carcinogenesis?
Normal cells -> cancer cells
What are RF’s for carcinogensis?
Age, carcinogens, accumulation of mutations, immunodeficiency
What is a neoplasm?
Abnormal mass of tissue from excessive tissue divide
What is the difference between tumour staging and grading?
Staging- how much cancer and how far its spread
T0-4, extent of primary tumour
N0-3, spread to lymph nodes
M0,1, metastasis
Grading- aggressiveness
1-4, 1 well differentiated resembling tissue of origin, 4 undifferentiated
What is the most common neoplasm?
Carcinomas, from epithelial tissues
How does chemotherapy assist therapy?
Cyto-toxic drugs interfere with mitosis, helps other treatments work better
How does radiotherapy assist in treatment?
External beam or radiation source, damage cell DNA to stop division
How does hormone therapy assist in treatment?
Block production of growth hormones and interfere with action
What defines a mild cognitive impairment?
Greater than expected age, does not interfere with ADLs, increased forgetfulness and compensatory tools
What is dementia?
Umbrella term for diseases affecting memory and cognitive function
Impaired learning, reasoning, language, personality/behaviour
What are RF’s for cognitive impairment?
Age, gender, genetics, Down’s syndrome
What are the common types of dementia?
Alzheimer’s- protein/chemical build up, impaired memory, learning, language
Vascular dementia- impaired blood circulation, impaired judgement, gait, instructions
Lewy body dementia- Lewy bodies develop, impaired attention, concentration, hallucinations
Fronto-temporal dementia- protein build up in lobes, change in mood, language, emotional regulation
What is delirium and what are some RFs?
Acute disorder of attention and cognition mimicking dementia. Can be hyperactive (agitation, restless), hypoactive (lethargy, withdrawal)
RF- visual and cognitive impairment, severe illness, polypharmacy, dehydration
In CT was is light and dark?
Light hyperdense
Dark hypodense
What are pros and cons of CT?
P- rapid, non-expensive, excludes large acute pathologies, useful for bone imaging
C- less parenchymal and soft tissue definition, involves radiation
What is CSF produced by?
Choroid plexus
What is hydrocephalus?
Accumulation of CSF in ventricle due to obstruction, failure to absorb or increased production
What are the pros and cons of MRI?
P- more detailed parenchymal and soft tissue, no ionizing radiation
C- more expensive, more contraindications (metal)
How is acute stroke detected?
DWI/ADC measures water diffusion]
What is the difference between intra-axial and extra-axial tumours?
IA- from brain parenchyma
EA- arises from outside brain parenchyma e.g. meningocytes
What is the purpose of SWI?
Detects diffuse axonal injury
What are the three aspects of neuroplasticity?
Chemical (neurotransmitters), functional (way neurons work together) and structural (demands of software changes hardware)
What are some principles of neuroplasticity?
Use it or lose it
Use it and improve it
Salience matters (behaviour must be important to individual)
What is MS?
An autoimmune inflammatory demyelinating disorder of the CNS
What are RFs for MS?
HLA-DRB1*1501 genetic marker
Viral Infection
Smoking
What is the pathology of MS?
CNS inflammation -> Demyelination -> Axonal degeneration. Hallmarks are focal demyelinated plaques, astrocytic scars.
Attack on myelin producing oligodendrocytes.
Leaky BBB allows infiltration of peripheral immune cells.
Axonal damage done by oxidative injury, mitochondrial and ion channel dysfunction
What are some typical symptoms of MS?
Painful monocular visual loss
Painless diplopia
Cerebellar symptoms: Nystagmus, Vertigo, Ataxia
Spasticity
Bladder Dysfunction
Fatigue
Weakness
What is the pathology of a ischemic stroke?
Fibrin clot coming from the large arteries of the neck or heart, causing atherosclerosis and blocking blood flow to the brain, causing a cerebral infarction which in turn can cause intracranial hemorrhage
What are some methods of secondary prevention for ischemic stroke?
Lower BP
Antithrombotics e.g. aspirin
Statins regardless of baseline lipids
Carotid endarterectomy to shell out carotid stenosis
What BP do you give thrombolytics?
> 220/120
What is a transient ischemic attack?
High risk presentation that requires emergency attention. Usually last 10 minutes, if it doesn’t return to normal then it is a stroke.
What is tPA?
Tissue plasminogen activator, converts plasminogen to plasmin which break down clots. Bed rest for 24hr after taking
What are some contraindications for tPA?
Hemorrhage
Hypodensity (subacute infarct)
GI bleeding
BP >185/105
What is symptomatic intracranial haemorrhage a product of?
Damaged BBB and reperfusion
How often is tPA successful at opening arteries and what’s an alternative?
tPA is often not successful, stent retriever thrombectomies are an alternative to allow reperfusion, offering a clear cut benefit for ICA, Middle Cranial 1 and Basilar
What is a hemicraniectomy?
Large bone flap removed to allow brain to expand
How are ICH’s classified?
Deep- usually due to hypertension and rupture of deep penetrating arteries
Lobar- superficial, often secondary to amyloid angiopathy, tumour etc.
How is stroke recognized?
FAST
Face droop
Arm drift
Speech, dysarthria dysphasia
Time call 000
What are some risks to the brain during development?
Genetic abnormality
Injury in utero
Big head on weak neck
Soft cranium
What are some differences in the child brain vs the adult brain?
More likely to have diffuse injury
More actively neuroplastic
What age group of children recovered the best from traumatic brain injury?
Later injuries, <3 years old had the least recovery
What are the phases of neuroplasticity following brain injury?
Phase 1: cell death, cortical inhibitory pathways reduce
Phase 2: shift to excitatory pathways, new connections made
Phase 3: new synaptic markers, axonal sprouting, remodelling
What is a closed and open TBI?
Closed, skull not broken
Open, object penetrates
What can diagnose TBI?
Glascow Coma Scale
Mild 14 to 15 e.g. concussion
Severe 3 to 8
Points for when eyes open, motor response, verbal response
1 point for no response
What is important to optimize in TBI?
Oxygenation, ventilation and cerebral perfusion to prevent hypoxia
What are signs of stroke in children?
Headache, seizure, hemiplegic weakness, vision and speech change
When is supratentorial and infratentorial tumours common in children?
S- 2-3
I- 4-11
What are symptoms of brain tumour in children?
Headache, vomiting, head tilt, balance and coordination, behavioural changes
What is infectious encephalitis and how does it occur?
Generalized inflammation of the brain caused by infection, viral, bacterial or fungal. Can be contracted by mosquito or tic
What are some symptoms of encephalitis?
Fever, seizure, headache, neck stiffness, sensitivity to light or sound
What are some symptoms of autoimmune disorders?
Confusion, ataxia, sensory changes, nausea, headache
What are burrholes, craniotomy and craniectomy?
B- drill into skull
CO- create a bone flap
CE- bone flap removed
What are types of intracranial haemorrhages?
Extradural- between dura and bone, associated with overlying fracture
Subdural- tearing of bridging vein in subdural space (trauma or atrophy)
Intracerebral- hypertension, vasuclopathies or tumour
What is a vasospasm?
Pathological constriction of blood vessels that may cause ischaemic stroke
Describe meningiomas?
Most common, benign, arise from arachnoid mater, slow growing
How do you treat vasospasm?
Triple H therapy hypertension (more blood flow), hypervolemia (more preload), haemodilution (less viscosity). All contribute to cranial perfusion pressure
Which cranial nerve does acoustic neuromas impair?
Vestibular VIII
What is normal intracranial pressure?
0-10mmHg, upper limit is 15mmHg
How do you manage raised intracranial pressure?
Head to 30 degrees improves venous drainage, hyperventilation, CSF drainage, sedation, reduce oedema
What is cauda equina syndrome?
Cauda equina compressed causing saddle anaesthesia, incontinence, foot drop
What is the ASIA scale?
Measures neurology of spinal patients
A complete, no motor or sensory to E normal motor and sensory function
What are normal cerebellar functions?
Integrates sensory information (not visual)
Compares intended action with actual movement
Balance
Coordination
Learning
How does vision influence balance and coordination?
Cerebellum does not process visual information but visual reflexes react to disturbance in static posture, which can make us feel like we’re moving when we aren’t
What are some common tests of cerebellar function?
Romberg- compares balance with different feet positions and eye open vs eyes closed
Gait- ataxic, wide-based, arms for balance
Finger-Nose test- tests coordination, whether you overshoot target
Rapid alternating movements- tests dysdiadochokinesia (slow clumsy alternating movement)
What is PPC and the aspects of it?
Postoperative pulmonary complications
Atelectasis
Pneumonia
Acute Respiratory Distress Syndrome
Pulmonary aspiration
What is the definition of an upper abdominal surgery?
Incision greater than 5cm above the umbilicus
What are the adv and dadv of laparoscopic surgery?
Less pain, PPC, faster recovery, minimal surgical trauma, can operate on higher risk patients
Longer time, difficult to remove large pieces
How does anaesthesia reduce FRC?
Reduced abnominal tone, diaphragm dysfunction, less lung compliance, less phrenic nerve activity
What is closing capacity?
The maximal lung volume at which airway closure is detected. This means the FRC is too low to keep the lung/alveoli open
What are some errors in technique during spirometry?
Cough, glottis closure, suboptimal effort, hesitation
What is spirometry?
Lung function test that measures maximal forced inspiration and expiration
What are some test contraindications of spirometry?
Coughing blood, unstable cardiovascular, collapsed lung, abdominal surgery
What are the criteria for acceptability and repeatability?
A: Max 8 trials
R: Two highest FEV1 within 150ml of each other, same for FVC
How does obstruction and restriction affect spirometry?
O: Reduced FEV1 and FEV1/FVC
R: Reduced FEV1 and FVC, normal or increased FEV1/FVC ratio
What is DLCO?
Inhale mix of CO and tracer gas, X amount goes in, Y comes out. Gives an idea of diffusion across membrane
What is Body Plethysmography?
Work out lung volume by measuring box pressure and volume (P1 and V1) and mouth pressure (P2). V2 is FRC
What is cardiopulmonary exercise test?
Maximal effort, records O2 consumption CO2 output HR RR
What are RFs for PPC?
> 80
Type of surgery
3 hour surgery
Mobility preop
What are the ERAS elements and how do they help recovery?
OPEN
Optimize anesthetic
Preop education
Early ambulation
Nutrition optimization
Helps before during and after surgery to reduce risk of PPC, and get lungs working again
What are some treatments for DDH?
Bracing to maintain contact with acetabulum and surgery
What are some treatments for Perthes?
Maintain hip abduction with bracing, restrict activity with wheelchair
What are some treatments for SUFE?
Emergency surgical stabilization, reconstruct femur
What are some general treatments for apophysitis?
Activity modification, NSAIDS, rest, post, stretching
What are some indications for MSK imaging?
fracture, dislocation, sprain, neoplasm
What are the adv and dadv for Xray?
Cheap, quick, easy to interpret
Limited sensitivity and specificity, radiation
What two projections are used in Xray?
AP and lateral
What is fibromyalgia?
Severe musculoskeletal pain disorder, pain in all 4 quadrants of the body
What is spondyloarthropathy?
Inflammatory joint disease with main effect on axial skeleton
What are RFs of joint disorders?
Age, genetics, joint injury, obesity, occupation
What is the pathophysiology of OA?
Cartilage erosion, subchondral bone sclerosis, osteophyte formation, joint space narrowing
What are some symptoms of OA?
Joint pain, morning stiffness, pain on motion
How is OA managed?
Prevent- e.g. lower obesity
Disease modifying drugs
Treat pain, dysfunction
What is the pathophysiolgy of RA?
Synovitis, destruction, deformity
What are some symptoms of RA?
Tiredness, pain, swelling, joint tenderness, effusion
What are the radiologic features of hydrocephalus?
Ventriculomegaly (enlarged ventricles), periventricular lucency (fan shaped hypodensity), sulcal effacement (mass effect)
What are the stages of lung development?
Embryonic
Pseudoglandular
Canicular
Saccular
Alveolar
What occurs in the embryonic stage of lung development?
Lung bud arises from primitive foregut, branching leads to primitive airways
What occurs in the pseudoglandular stage of lung development?
Secondary and tertiary bronchi, epithelial cell differentiate, develop arteries veins
What occurs in the canalicular stage of lung development?
Immature bronchioles and alveolar ducts enlarge, blood gas barrier, surfactant
What occurs in the saccular stage of lung development?
Increase surfactant, alveoli enlarge
What occurs in the alveolar stage of lung development?
Proliferation to smaller alveoli, high gas exchange capability
What are short term consequences of preterm birth?
Surfactant too low, respiratory distress, worse gas exchange may need oxygen supplementation
How does the cardiorespiratory system compare in adults and children?
Horizontal ribs children, angled adult
Primary cartilage children, ossified ribs adult
Larger tongue relative to mouth Floppier epiglottis
Shorter less rigid trachea
Poorly developed cilia
Smaller diameter airway
Describe how asthma affects the lungs
Smooth muscle tighten on expiration, may result in permanent damage
Describe how CF affects the lungs
Sticky, dehydrated mucous due to ion channel transport inhibition.
Repeated lung infection and mucous plugging
Describe how bronchiectasis affects the lungs
Inability to clear mucous, bacterial infection, airways dilated
Describe how prematurity associated lung disease affects the lungs
Abnormal lung structure from poor development, increased risk of COPD
Describe how primary ciliary dyskinesia affects the lungs
Dysfunction to cilia, mucous build up airway obstruction
Describe how bronchiolitis obliterans affects the lungs
Inflammatory lung condition causing scarring which can obstruct airways
Describe how neuromuscular weakness affects the lungs
Progressive muscle weakness, inefficient cough leads to infection
What is obstructive lung disease?
Increase in airway resistance and decrease in expiratory flow
How is obstructive disease diagnosed?
Reduced FEV1 compared to FVC, <70%
What are some mechanisms of obstructive lung disease?
Smooth muscle constriction, hypertrophy, mucosal inflammation
What is COPD?
Inflammatory disease caused by inhalation of noxious particles
What is the clinical presentation of COPD?
Chronic bronchitis (blue bloater)- overweight, oedema, wheezing
Emphysema (pink puffer)- older, thin, dyspnea (breathlessness)
Describe COPD pathophysiology
Mucous gland hypertrophy and mucous production
Destruction of ciliated epithelial cells
Small airway fibrosis
Increase bronchial smooth muscle
Destruction of capillary bed
What are the consequences of COPD pathophysiology?
Airflow limitation
Lung hyperinflation, increase residual volume, as harder to expire
How is bronchiectasis clinically presented?
Recurrent lung infection, chronic cough, chest pain, dyspnea
What is the pathophysiology of COPD?
Initial infection, inflammation, inability to mucous clear, remodeling more obstructed
What is the P wave and how should it look?
Depolarization of atria, small bump
What is the PR wave and how should it look?
Delay of AV node, flat
What is the QRS complex and how should it look?
Ventricular depolarization, dip then spike up and down
What is the T wave and how should it look?
Ventricular repolarization, small bump
What is the ST segment and how should it look?
Beginning of ventricular repolarization, should be flat
What heart rates are classified as bradycardia and tachycardia?
B- below 60
T- above 100
How is atrial fibrillation presented on an ECG?
No P waves, narrow QRS
How is atrial flutter presented on an ECG?
P wave sawtoothed
How is ventricular tachycardia presented on an ECG?
No P wave, QRS wide and bizarre
How is ventricular fibrillation presented on an ECG?
No P, QRS or T
What is troponin a sign of?
Heart muscle damage
What is acute coronary syndrome?
Manifestation of atherosclerotic coronary plaque erosion including ischaemia and necrosis
How is unstable angina clinically presented?
Crushing, tight chest pain, dyspnea, pain to jaw/left arm
How is ACS managed?
Lifestyle
Bypass grafts or stents
Medication (antiplatelet, anticoagulant)
What is the gold standard test for coronary artery antamoy?
Cardiac catheterization (angiography)
Which coronary artery is most affected in coronary artery disease?
LCA
What is heart failure?
Inability of heart to meet demand of tissue
What is the difference between systolic and diastolic heart failure?
Systolic- ventricles cant pump hard enough
Diastolic- not enough blood fills ventricles
What are the stages of prenatal cardiac development?
Primitive heart tubes
Embryonic heart division, atria, ventricles, forms septa
Vascular heart connections, complete AV and semilunar valves
Maturation and growth, more defined four chambers, foramen ovale
What are consequences on cardiac system for preterm birth?
Immature myocardium, pulmonary hypertension, altered cardiac structure, heart failure
What causes congenital heart defects?
Genetic conditions, maternal health problems, maternal age
What is atrial septal defect and its consequences?
Hole between LA RA
O2 blood passes to right side
Enlarged RV, heart failure in later life
What is ventricular septal defect and its consequences?
Hole between LV RV
Large VSD, increased lung circulation, poor growth, dypsnea
What is tetralogy of fallot?
VSD
Narrowing of pulmonary valve, Right ventricular hypertrophy
Overriding aorta
What is hypoplastic left heart syndrome and its consequences?
Left side does not develop, RV becomes pumping chamber
What is tricuspid atresia?
Tricuspid valve does not develop
Blood diverted from RA to LA
What are symptoms of congenital heart conditions?
Blue lips, skin
Dyspnea
Respiratory infections
How are intrinsic and extrinsic restrictive disorders different?
I- lung parenchyma
Parenchymal inflammation, fibrosis
E- pleura, chest wall, neuromuscular etc.
Impacts respiratory pump
What are some characteristics of restrictive lung disorders?
Reduced lung compliance and volume
Dyspnea
Hypoxemia
Cough, clubbing of nails and crackles
How is hypoxaemia different in intrinsic and extrinsic lung disorders?
I- Mismatched V/Q ratio
E- hypoventilation, poor respiratory pump
How are intrinsic and extrinsic respiratory disorders managed?
I- Antifibrotics, immunosuppressant, oxygen therapy
E- Lose weight, surgical management for scoliosis
How is intrinsic respiratory disorders caused?
Interstitial lung disease- inflammation scarring
Pneumonitis- filling of air spaces with exudate
What is idiopathic pulmonary fibrosis?
Most common intrinsic lung disease, hypoxia and pulmonary hypertension
What is sarcoidosis?
Granulomatous inflammation in variety of organs
What is occupational lung disease?
Inorganic dust exposure causing intrinsic lung disease
What are some pleural disorders?
Pleural effusion
Pneumothorax, collection of air in pleural cavity
Tumours
Fibrosis
What are some chest wall disorders?
Deformity
Obesity
Pregnancy
Burns
