Goodnotes Flashcards
What are the 4 stages of pain?
Nociception
Transmission
Perception
Modulation
Which 2 conditions make up COPD?
Emphysema and Chronic Bronchtis
What happens to troponin levels in unstable angina?
Nothing they stay the same
What happens to troponin levels during an NSTEMI?
They rise due to damage to the myocardial cells
What happens to troponin levels during a STEMI?
They rise due to damage to the myocardial cells
What is pathophysiology?
The study of how disease processes affect the functioning of the body
What does the term ‘acute’ mean?
A sudden onset of illness
There are 3 types of cellular communication, What are they?
Nerve
Endocrine
Local
Describe the process of nerve signalling
Used exclusively by neurons
Uses neurotransmitters to send chemical signals through synapse to another neurone
It is fast and can travel long distances
Has specific routes of movement
Eg Parkinson’s disease
Describe the process of endocrine signalling
Sends chemicals called hormones into the blood stream
Received by a receptor cell to stimulate an action
Slow acting and diffuse around entire body
Eg Diabetes
Describe the process of local signalling
Occurs between cells that are close together
Cells will signal damage to other cells as part of body response to damage - inflammatory mediators
Eg Sprained ankle
Which cell change is described here? ‘Decrease in cell size, organ size may change if sufficient changes occur’
Atrophy
Describe atrophy
Decrease in cell size
Organ size may change if enough cells are affected
Eg Skeletal muscle atrophy in the elderly
What type of cell change is being described here? ‘Increase in cell size and volume, organ size may change if sufficient changes occur’
Hypertrophy
Describe hypertrophy
Increase in cell size and volume may cause enlargement of organ if sufficient changes occur
Eg Pyloric stenosis - increased muscle growth due to weight training
What cell changes are being described here? ‘Increase in number of cells. Occurs due to increased cell mitosis’
Hyperplasia
Describe hyperplasia
Increase in the number of cells occurs due to increased cell mitosis either for tissue or organ generation, compensatory reason or hormonal stimulation. Abnormal hyperplasia is an abnormal increase eg endometriosis
Eg Benign prostatic hyperplasia
What cell change is being described here? ‘A specific type of cell is replaced with another type that is less specific than the first’
Metaplasia
Describe metaplasia
This is where a cell of a specific type is replaced by another less specific cell. Commonly seen in smoking. Can turn dysplasia which can eventually turn into carcinoma.
Eg Barrats oesophagus
What cell change is being described? ‘Abnormal changes and variations in shape, size and organisation of cells’
Dysplasia
Describe dysplasia
Abnormal changes and variations in the shape, size and organisation of cells, can potentially turn to carcinoma
Eg Cervical dysplasia
What are the 2 types of cellular death?
Apoptosis and necrosis
What is being described here - ‘this is programmed cell death and is planned’
Apoptosis
What is being described here? ‘Unplanned or accidental cell death due to injury or damage to the cell’
Necrosis
Describe the process of necrosis ‘accidental cell death’
Happens due to injury, toxins, infections and trauma
May initially be reversible as part of the inflammatory process
Cell contents start to swell
Cell membrane becomes deform and loses integrity/ruptures
Cell contents and organ else leak out
Leakage stimulates inflammatory and immune responses when phagocytosed
Describe the process of apoptosis ‘programmed cell death’
Cell dies at the end of its life
Cell does not become damaged or rupture
Cell membrane forms blebs which contain cell contents and organelles
Blebs are removed by inflammatory cells such as macrophages.
Cell can be coerced into its own death by the immune system
Which of the following is NOT a common cause of Type 1 respiratory failure?
COPD
PULMONARY EMBOLISM
MUSCLE DISORDERS
ASTHMA
MUSCLE DISORDERS
Asthma is a chronic disorder of the airways that causes?
Episodes of airway obstruction, bronchial hyper responsiveness, airway inflammation
Bronchiolitis normally occurs in which age group?
Under 2 years
What are congenital heart defects?
Defects occurring during foetal development
Which of the following is NOT a cardiac arrest rhythm?
SUPERVENTRICULAR TACHYCARDIA
VENTRICULAR FIBRILLATION
ASYSTOLE
PULSELESSNESS VENTRICULAR TACHYCARDIA
SUPERVENTRICULAR TACHYCARDIA
Name 4 potential causes of atherosclerosis
From childhood
Hypercholesterolemia
Smoking
Hypertension
Diabetes
What interventions can be used in ischaemic heart disease?
Lifestyle modifications
Control of hypertension
Control high cholesterol
Thrombosis development control
Glycaemic control
Symptom management
Describe some interventions used to treat acute coronary syndromes
Analgesia, GTN, opiates
Aspirin
Oxygen
Continuous monitoring - ECG
Cardiac monitor - NEWS2
Troponin T levels
CABG or PCI
Describe the physiology of emphysema
Destruction of the alveoli
Loss of surface area which reduces gas exchange
Loss of muscular surface prevents movement of air in alveoli
Causes inflammatory and immune responses causing alveolar walls to break down.
Describe the pathophysiology of chronic bronchitis
Damage to bronchus and bronchioles
Cellular damage - inflammation
Exudate
Bronchoconstriction
Bronchospasm
Hypertrophy of goblet cells
Explain how the body responds to hypotension to increase blood pressure
Renin released from kidneys in response to low perfusion in the glomerulus.
Renin diffuses into the bloodstream and converts angiotensinogen from the liver into angiotensin 1.
Angiotensin converting enzyme is released from the lungs.
ACE converts angiotensin 1 to angiotensin 2.
Angiotensin 2 causes vasoconstriction.
Suggest possible causes with examples for an acute kidney injury
Pre-renal: lack of or reduced perfusion, failure of auto regulation, perfusion needed to maintain glomerular filtration
Intra-renal: damage to kidney tissue, may be referred to by location, nephrotoxicity
Post-renal: obstruction below the kidney/lower urinary tract, full or partial blockage, likely to cause reduction in urine output, increase pressure prevents glomerular filtration
Name some causes of pre-renal AKI
Trauma
Post operative bleeding
Hypotension
Dehydration
Medication
D&V
Burns
Cardiac failure
Sepsis
Name some causes of intra-renal AKI
Ischaemia
Nephrotoxic injury
Immunity
Vascular disease
Name some causes of post-renal AKI
Tumour
Kidney stones
Urtheral blood clot
Enlarged prostate
Retention
Blocked catheter
What does renin convert angiosinogen into?
Angiotensin I
Where is angiotensin converting enzyme produced?
In the lungs
Which blood test is used to assess the functioning of the kidney?
Estimated Glomerular Filtration Rate (eGFR)
Will all patients with an acute kidney injury have a drop in urine output? YES or NO
NO
Which test is used to aid the diagnosis of COPD?
Spirometry
At which point does bronchiolitis peak in its symptoms?
3-5 days
The most common cause of bronchiolitis is?
Respiratory syncytial virus
Asthma is regarded as an allergic inflammatory response. Which type of inflammatory mediator cell releases histamine in asthma?
Mast cells
What immunoglobulin attaches to mast cells causing them to release histamine which produces the symptoms of asthma?
IgE
Which of the following assessment findings demonstrate severe asthma?
A) Increased respiratory rate
B) Normal oxygen saturation
C) Silent chest on auscultation
D) Wheeze
C) Silent chest on auscultation
What is the initial management for an AKI?
Monitor patient
Maintain circulation
Minimise further kidney insults
Manage acute illness
Define Chronic Kidney Injury
Irreversible, long term condition
Characterised by decline in kidney function over many years
Failure of homeostasis as disease progresses
Increased risk of other conditions such as CVD
Major cause of morbidity and mortality
What are the symptoms of chronic kidney disease?
Normally asymptomatic until late stages
Then: swollen ankles, hands or feet
Shortness of breath
Fatigue
Blood in urine
Urinary frequency
Insomnia
Itchy skin, muscle cramps, headache
Erectile dysfunction
Which of the following is a non-pharmacological treatment of depression?
A) Supporting the person to get over it
B) Monoamine oxidase inhibitors
C) Cognitive behavioural therapy
D) SSRIs
C) Cognitive behavioural therapy
Which neurotransmitter might be involved in an inflammatory response model of depression?
Cytokines reducing levels of serotonin
Which model of depression is explained using the ‘stress bucket’?
Stress vulnerability model
Which theory of depression links stress and the release of cortisol as the pathophysiological stimulus for depression?
Neuroendocrine dysregulation
Name and describe risk factors for depression
Gender - women are twice as likely to experience depression
Adverse childhood experience - physical/sexual abuse, parental divorce
Personality type - neuroticism, lowered ability to deal with stressful events, major life changes
Health/medication - diabetes, thyroid disorders
Where is the vomiting centre located in the brain?
Medulla oblongata
Describe the process of vomiting
- Noxious stimuli to the vomiting centre
- Vomiting centre coordinates reflex through cranial nerves
- Hypersalivation, pallor, sweat, tachycardia
- Glottis closes; soft palate rises to close of airway
- Deep inspiration, diaphragm contracts
- Gastroesophageal sprinter and fundus of stomach relax
- Abdominal muscles contract forcefully
Name some receptors of the CTZ (Chemoceptor trigger zone) that stimulate nausea and vomiting
Opioid Mu2
Histamine
Acetylcholine
Dopamine type 2
Substance P
Serotonin type 3
Name some possible causes of nausea and vomiting in newborns and infants
Overfeeding
Gastroesophageal reflux
Pyloric stenosis
Whooping cough
Small bowel obstruction
Constipation
Systemic infection
Name some causes of nausea and vomiting in older children and adolescents
Gastroenteritis
Migraine
Raised intercranial pressure
Toxic ingestion of medication
Pregnancy
Stress
Name some causes of nausea and vomiting from across the lifespan
Sensory input
Haemorrhage
Meningitis
Motion sickness
Opioids
Electrolyte imbalance
Toxins
Chemotherapy
Antibiotics
Obstruction, constipation
What are the 4 stages of vomiting?
- Noxious stimuli
- Vomiting centre initiates
- Nervous system pathways
- Pre ejection, ejection
What are the consequences of prolonged nausea and vomiting?
Dehydration
Avoidance of treatment associate with symptoms
Electrolyte disturbance
Malnutrition
Tissue damage
Metabolic alkalosis
Transmission of infection
Define ‘constipation’
Bowel movements that are infrequent, hard to pass, often associated with being hard and dry
Define ‘diarrhoea’
3 or more loose or liquid stools per day. Or more frequently than is normal for the individual
What are the 3 types of diarrhoea?
Osmotic
Motility
Secretory
Describe osmotic diarrhoea
Hyper-osmotic, non-absorbable substances and excess water are drawn into the bowel which increases weight and volume of the stool.
Causes: decreased transit time, excessive use of antacids, overuse of osmotic laxatives, lactose intolerance
Describe secretory diarrhoea
Increased mucosal secretions of fluid and electrolytes.
Causes: infection, excess bile, inflammation of the colon, overgrowth of micro biome
Describe motility diarrhoea
Decreased transit time, fluid absorption in the bowel is decreased.
Causes: short bowel, fistula formation, IBS, overuse of laxatives
Describe normal transit constipation
Known as functional constipation, involves regular passing of stools but evacuation is difficult
Associated with sedentary lifestyle, low fibre diet and low fluid intake
Name the 3 types of constipation
Normal transit constipation
Slow transit constipation
Pelvic floor dysfunction
Describe slow transit constipation
Infrequent bowel movement, straining to pass stool and mild abdominal distension by impaired colon activity
Describe pelvic floor dysfunction (constipation)
Poor action of the pelvic floor muscles or anal sphincter leading to difficulty or inability to defaecate
What are the hall marks of cancer?
Unlimited proliferation
Evading growth suppressors
Resistance to cell death
Replication immortality
Angiogenesis
Invasion and metastasis
What is a neoplasm?
A new growth of cells which is abnormal
Abnormal mass of tissues
Defined as excessive, uncoordinated and persistent
Cell death to myocardial cells following a myocardial infarction is an example of what?
Necrosis
Endocrine signalling involves the release of what?
Hormones
An increase in the severity of a pre existing disease is known as?
Exacerbation
What is the difference between ENDEMIC, EPIDEMIC and PANDEMIC?
ENDEMIC - disease constantly present in population or region, low spread
EPIDEMIC - sudden increase in cases spreading through large population
PANDEMIC - sudden increase in cases across several countries, continents or the world
The process in which a cell ingests a solid particle to form an internal vesicle is called?
Phagocytosis
Explain the term ‘acute on chronic’ and give an example
A sudden, severe and rapid deterioration of a pre existing, long term medical problem E.g Exacerbation of COPD with pneumonia
In the inflammatory process, which type of cell signalling is used by inflammatory mediators?
Local signalling
What can b cells do when they encounter a foreign antigen?
B cells clone and become plasma cells. Plasma cells release antibodies as an early attempt to neutralise the foreign antigen
What are the 3 ways that antibodies work to neutralise and destroy pathogens and toxins?
NEUTRALISATION - coat pathogen and prevent it from interacting with the host cell surface
OPSONISATION - coat pathogen to attract and encourage phagocytic cells
COMPLIMENT FIXATON - coat pathogen to activate blood proteins to kill the pathogen
What 2 processes occur in the vascular response to inflammation?
Vasodilation and increased vascular permeability
What is one of the processes that neutrophils perform in the inflammatory response?
Phagocytosis
Which circulating inflammatory mediators cause vasodilation in sepsis?
Histamine, nitric oxide and bradykinin
What would a drop in urine output indicate in sepsis?
Renal blood flow is related to cardiac output. As cardiac output falls, due to reduces SVR and hypotension so does renal blood flow and therefore so does urine output.
Which of the following is not a barrier in innate immune response?
A) Mucous membrane
B) Stomach acid
C) Nasal hair
D) Macrophages
D) Macrophages
What blood test is used to specifically monitor the presence of inflammation?
C reactive protein
What are the cardinal signs of inflammation?
Pain
Swelling
Redness
Heat
Loss of function
Explain the 4 events of respiration
Pulmonary ventilation - moving air in and out of the lungs
External respiration - gas exchange between pulmonary blood and alveoli
Gas transport of o2 and Co2 via blood stream
Internal respiration - gas exchange between blood and tissue cells
Which chemoreceptors detect decreased oxygen levels in the arterial blood and where are they located?
Peripheral chemoreceptors
Found in arch of aorta and carotid bodies
Name the 3 physiological characteristics of asthma
Airflow limitation - reversible with treatment
Airway hyper responsiveness
Chronic inflammation of the bronchi
Chronic inflammation in asthma is characterised by the presence of which white blood cell?
Eosinophils - release harmful proteins and reactive oxygen species which damage the lining of the airway causing remodelling
In atopic asthma IgE antibodies bind to which cells in the lining of the airways?
Mast Cells
Why do blood carbon dioxide levels rise in obstructive airway disease?
Reduced airflow through obstructed airway leads to reduced volume of air reaching the alveoli causing accumulation of Co2 in the distal airways and alveoli, and reduction of the pressure gradient between air in the alveoli and in the bloodstream. As pressure gradient reduces, diffusion also reduces and less Co2 passes into bloodstream for excretion.
Increased stimulation of sympathetic fibres to the airways causes?
Bronchodilation (to allow more airflow through the lungs)
Describe type 1 respiratory failure
Hypoxaemic respiratory failure. It is the failure of gas exchange function of lung leading to hypoxaemia with normal or low c2 levels
Describe type 2 respiratory failure
Hypercapnic/hypoxaemic respiratory failure
Failure of ventilation
Which 3 variables affect stroke volume?
Pre load
Contractility
After load
Which one is a non-modifiable risk factor for cardiovascular disease?
A) Diabetes
B) Hypertension
C) Genetic factors
D) Hypercholesterolemia
C) Genetic factors
Atherosclerosis is a chronic inflammatory response due to damage to the endothelium base layer caused by exposure to certain sources, name 3 of them?
Toxins from smoking
Low density lipoproteins
LDL
Hyperglycaemia in diabetes
Shear stress from hypertension
In atherosclerosis LDL particles activate the inflammatory response. Which white blood cells engulf LDLs and what are they called afterwards?
Macrophages
Foam cells
In which congenital heart defect does blood pass from the left to the right side of the heart causing o2 rich blood to be pumped back to the lungs instead of the body?
Ventricular septal defect - hole in the heart.
Defect occurs in the septum that separates the ventricles and allows blood to pass from the left side back to the right.
What condition is the leading cause of acquired heart disease in children?
Kawasaki disease
What are the signs and symptoms of ISCHAEMIC heart disease?
Fatigue
Dyspnoea
Chest pain on exercise - stable angina
ECG changes only present during exercise or with pain
Acute coronary syndrome encompasses a spectrum of conditions which result from the formation of a thrombus on an atherosclerotic plaque in a coronary artery. What are these conditions?
NSTEMI - myocardial infarction without ST elevation
STEMI - ST elevation myocardial infarction
UNSTABLE ANGINA
Which of the following is NOT a cardiac arrest rhythm?
A) Ventricular fibrillation
B) Superventricular tachycardia
C) Asystole
D) Pulseless ventricular tachycardia
B) Superventricular tachycardia
Hypertension of no known cause is known as?
Essential hypertension
Discuss the immediate management required for caring for an adult or child experiencing a seizure (4)
Remove danger if safe to do so
Protect airway as best as possible - put person on side and support in this position
Time the seizure
Provide head protection and limbs if possible
Commence high flow o2
Describe 2 possible psychosocial implications of seizures
Feelings of isolation
Loss of self esteem
Psychological distress
Embarrassment
Depression and anxiety
How many episodes of loose stool are required in one day to meet the definition of diarrhoea?
3 episodes
What are the key differences between anorexia and anorexia nervosa?
Anorexia - physiological stimulus that produce hunger remain intact but there is lack of desire to eat due to stress, drugs, other diseases
Anorexia nervosa - low body weight accompanied by persistent pattern of behaviour to prevent the restoration of normal weight
When introducing nutrition after a period of starvation, which 3 electrolytes should be closely monitored?
Magnesium
Phosphate
Potassium
Cancer is a disease of dividing cells. Describe what type of cancer is sarcoma?
Sarcoma is a cancer arising from cells found in supporting tissues: bones, cartilage, fat, muscle and connective tissues
If cancer cells were described as poorly differentiated how would these look compared to well-differentiated cells?
Cancer looks very abnormal and not arranged in a normal way
More spaces between cells
Irregular and not similar structure or shape to original cell
More likely to invade surrounding tissue
In the hallmarks of cancer explain what happens to the cell that results in replicative immortality
Protective ends of DNA (telomeres) shorten after each round of DNA replication. In cancer mutations the telomeres do not shorten or there is constant lengthening which results in immortality of the cancer cells.
List the six hallmarks of cancer
Evading growth suppressors
Inducing angiogenesis
Unlimited proliferation
Evading cell death
Invasion and metastasis
Replicative immortality
Name the 2 types of nociceptors
A delta and C fibres
Which 2 excitatory neurotransmitters are used in transmission across the dorsal horn?
Substance p and glutamate
What do we call the conversion of noxious stimuli into nerve impulses?
Nociception
Which part of the neuron is damaged by hyperglycaemia leading to diabetic neuropathy?
The Schwann cells
Hba1c is a measurement of what and what is the normal range?
The amount of glycated haemoglobin and gives an overall picture of blood glucose levels over a period of 3 months.
Normal is below 42mmol/mol or 6%
Hyperosmolar hyperglycaemic state (HHS) - why will there not be any serum ketones?
HHS is associated with type 2 diabetes where there is still beta cell function. Therefore some insulin still being secreted to prevent lipolysis and ketogenesis.
In DKA, what is present in the urine?
Glucose and ketones
Glomerular nephritis can be the cause of what type of acute kidney injury?
Intrinsic or intrarenal
Angiotensin II causes vasoconstriction and also the release of aldosterone from the adrenal glands; how does aldosterone work to increase blood pressure?
Aldosterone acts on distal tubule and collecting duct.
It stimulates the reabsorption of sodium and promotes secretion of potassium.
The increase in sodium increases the volume of plasma and therefore blood pressure.
In type 1 diabetes which cells in the pancreas stop producing the hormone insulin?
Beta cells
Which excitatory neurotransmitter is linked to increased neuron activity and seizures?
Glutamate
Describe the 2 stages of a tonic clonic seizure
Tonic stage - muscles become ridges and contracted
Clonic stage - rhythmic relaxation and contraction which looks like “classic” whole body seizure convulsions
What’s the difference between a generalised and focal seizure and give an example of each one
Generalised - abnormal electrical activity in both brain hemisphere (tonic-clonic, myoclonic, atonic)
Focal - abnormal electrical activity in one area of the brain. Motor, sensory, autonomic depends on which are of the brain is affected. They can be simple (remain conscious) or complex (loss of consciousness)
Febrile seizures are multi factorial but which inflammatory mediators is thought to have a causality effect?
Cytokines and interleukin
In the monoamine theory of depression, which neurotransmitters are thought to be reduced?
Noradrenaline, dopamine and serotonin
In the neuroendocrine dysregulation theory of depression, which hormone is found to be elevated?
Cortisol
