Guided Study Flashcards
What are the 6 aspects of chain of infection?
- infectious agent
- reservoir
- portal of exit
- mode of transmission
- portal of entry
- Susceptible host
10 actions to reduce infection?
1- patient placement/assessment of risk
2- hand hygeine
3- respiratory and cough hygeine
4- PPE
5- safe management of care equipment
6- safe management of care environment
7- safe management of linen
8- safe management of blood and fluids
9- safe disposal of waste
10- occupational saftey
what stimulates erythropoietin?
stimulates = the partial pressure of oxygen will directly regulate EPO production.
lower pO2= the greater the production of EPO.
low haemoglobin levels= stimulates EPO.
what inhibits erythropoietin?
IL-1 and TNF-alpha
what does erythropoietin do in the body?
- it acts on rbc to protect them against destruction
- stimulates stem cells of bone marrow to increase the production of rbc.
what is secondary polycythemia?
a rare disease that involves the rbc overproduction in cells due to reasons from genetic abnormalities to secondary to other diseases.
causes of secondary polycythemia?
- hypoxia due to high altitude
- local renal hypoxia
- renal artery stenosis
- congenital high affinity haemoglobin
- tumours producing epo
- drugs
- smoking (due to carbon monoxide exposure)
secondary to what can you get polycythemia?
- congenital or acquired heart disease (with right to left shunt)
- COPD
- pulmonary fibrosis
- sleep apnoea (interrupted breathing)
- chronic pulmonary embolism.
what are the effects of chronic excessive epo?
- increase in haemoglobin and haemltocrit
- increased risk of cardiovascular events (eg- ischamic stroke due to high whole blood viscosity)
what is the treatment for chronic excessive epo?
- remove hypoxia stimulus (treat the underlying disease)
- continuos or nocturnal O2 therapy
- regular venesection (removing 500ml of blood to reduce haemltocrit- this can make the patient low iron deficient)
what is residual volume
the volume of air in the lungs after a maximal expiration
how do you determine residual volume?
- the patient will be asked to perform a a maximum expiration
- when they subsequently inhale, they are connected to a spirometer of a specified volume (this will contain a known concentration of an inert marker gas like helium) (C1)
- as the helium containing air is breathed in and out by the subject, the helium will be diluted by the air in the subjects lungs.
- after equilibrium is achieved, the new concentration of helium will be measured. (C2)
what is the calculation to measure the volume of air in the subjects lungs at the start of the procedure (RV)?
C1V1= C2V2
C1= conc of He at the start of experiment
C2= the conc of He at the end of experiment
V1= the volume of the spirometer
V2= the volume of the spirometer plus the residual volume of the patient
rearrange this =
RV= (C1/C2)-1 x the volume of the spirometer
what is Functional Residual Capacity?
this is the volume in the lungs after a normal exhalation.
how do you measure the functional residual capacity? (FRC)
a similar procedure is followed (to determine residual volume), but before inhaling the air-helium mixture, the subject is asked to breathe out normally. and the same calculation will be used.
what type of pneumothorax will an elevated JVP indicate?
tension pneumothorax
in a tension pneumothorax, where will air be aspirated from?
2nd intercostal space in the mid clavicular line
list the structures in the chest wall that a needle would pass through to get to the chest cavity?
- skin
- subcutaneous tissue
- pec major
- intercostal muscles (external and internal)
- end-thoracic fascia
- parietal pleura
sponatinous pneumothorax?
- air in the pleural cavity
- this usually happens to a person who has no underlying pulmonary disease
- air enters the cavity through a defect in the visceral pleura.
- normally the pressure in the plural cavity is negative this will be lost with the entry of air and the lung deflates.
tension pneumothorax?
this can occur if there is a valvular arrangement that allows air into the pleural cavity on inspiration but it will not allow air to leave expiration.
with each breathe their may be an increase in volume of air in the thorax but with no means of escape so the pressure keeps increasing.
- causes the mediastinum to shift towards the unaffected side and reduces the venous return.
haemothorax?
blood in the pleural cavity
chylothorax?
lyphatic fluid leaks into the space between the pleural membranes
= severe cough
chest pain
difficulty breathing
Thoracic duct damage?
ABCDE
Airway
Breathing
Circulation
Disability
Exposure
ACVPU
Alert
Confusion
Verbal
Pain
Unresponsive
when may an airway adjunct be considered?
in a patient where you are performing a jaw thrust that is being tolerated
(a jaw thrust Is painful, so they are likely deeply unconscious if they are tolerating it)
what does the insertion of an oropharyngeal airway help to do?
it helps to stop the tongue and soft tissue from collapsing back and obstructing the airway.
when should a nasopharyngeal airway not be used?
if there is any facial trauma.
prior to insertion of the nasopharyngeal airway, what should you do?
it should be lubricated with a water soluble lubricant
what are the 3 main approaches to dealing with cancer?
1) surgical excision
2) radiotherapy
3) chemotherapy
what are the 4 types of traditional agents used in the treatment of cancer?
1) alkylating agents
2) antimetabolites
3) cytotoxic antibiotics
4) plant derivatives
what are the 5 main draw backs to cancer chemotherapy?
1) it will only target cell proliferation, not the more lethal properties of invasiveness and metastasis
2) non specific killers
3) resistance
4) leaves some remaining cells
5) patient compliance due to side effects (not completing the therapy regime)
why are where will side effects of anti cancer drugs often effect?
when will the side effects normally occur?
healthy cells with a high rate of growth and multiplication include cells of bone marrow, hair GI mucosa and skin therefore side effects often relate to these body systems
(the severity of the side effects will vary with the drug)
side effects will normally occur within 7-14 days post treatment
specific side effect: tumour lysis syndrome.
- what will it occur due to?
- what is it characterised by?
- what happens if left untreated?
- this is an acute side effect and a metabolic emergency
- it will occur due to rapid cell death and large amounts of cell metabolites in the blood.
- characterised by:
hyperuricaemia
hyperosphataemia
hyperkalaemia
hypocalcaemia - if untreated it will lead to acute renal failure, cardiac arrest and death
what are 3 locations where you are likely to experience specific side effects due to chemo?
bine marrow
gastro-intestinal
mucositis
what are 5 other side effects regarding chemo ?
1) fatigue
2) body image side effects
3) peripheral neuropathy
4) altered renal function
5) delayed effects = infertility
what are the 4 P’s of personalised medicine?
predictive
personalised
preventative
participatory
what are the aims of personalised medicine?
1) improved prevention based on underlying predisposition
2) earlier diagnosis of disease as a result of underlying abnormality earlier
3) more precise diagnosis based on the cause
4) targeted interventions
what do doctors take into account when making a cancer diagnosis? (3)
- genomic/genetic testing
- proteomic profling
- metabolic analysis
anticancer drug: imatinib
inhibits bcr-abl gene signalling pathways and is used in chronic myeloid leukaemia
anticancer drug: rituximab
targets B cells surface proteins and is used for B cell lymphoma
anticancer drug: trastuzumab
targets epidermal growth factor receptor 2 and is used for breast cancer
anapaestic lymphoma kinase (ALK) rearrangement are mutually exclusive with what?
they will be mutually exclusive with EDGF and KRAS mutations
what will be the 3 biomarkers that doctors look for in lung cancer?
EGFR mutation
KRAS mutation
ALK rearrangment
what are the 2 important biomarkers in colorectal cancer?
KRAS/NRAS
the presence of a RAS mutation will predict the lack of response to cetuximab therapy
what is a melanoma?
skin cancer
what is a prognostic factor for glioblastoma?
what does this do for the efficacy of temozolide?
MGMT promoter gene methylation
if there is high methylation this will reduce the temozolomide efficacy
what Is MGMT?
this is a DNA repair enzyme which is though to repair DNA damage caused by chemotherapy alkylating agents such as temozolomide.
how do you make an accurate diagnosis of soft tissue and bone tumours
molecular studies are used with morphological diagnosis
FISH
diagnosis of thyroid tumour
BRAF mutation
what is pharmacogenetics?
how does it work?
this refers to the study of the way a patients genome affects their response to a drug.
it works by identification of certain gremlin variants in genes involved in drug metabolism, it is possible to predict response and in particular adverse reactions to a range of common cancer chemos.
what drug is used to target PD-L1 and PD-1 binding?
Nivolumab
oedema?
this is excess fluid in and around the cells and tissues of the body. it is extravascular - not within blood vessels
what is an ejection systolic murmur?
this is a systolic murmur - when blood flows through a narrowed vessel or irregular valve
what is a regurgitant systolic murmur?
this is when blood flows back through the valve back into one of the chambers of the valve
4 classifications of heart failure
1= no limitation on physical activity, no palpitation or shortness of breathe.
2= ordinary physical activity will result in fatigue, palpation or shortness of breathe.
3= marked limitation of physical activity, comfortable at rest, less that ordinary physical activity will cause fatigue
4= unable to carry out any physical activity without discomfort, symptoms of heart failure at rest, discomfort will increase on exertion.
what is the difference between hypertrophy and hyperplasia?
hypertrophy refers to the increase in size of the individual muscle fibres
hyperplasia refers to the increase in the number of muscle fibres.
signs of cardiac failure?
cardiomegaly
upper lobe blood diversion
perihilar haziness
interstitial oedema (Kerley B sign)
pulmonary oedema (bat wing signs)
what will an echocardiogram show?
- valave haemodynamics
- left ventricular systolic function
- aortic valce anatomy
why will longstanding hypertension lead to left ventricular hypertrophy?
- increased workload on the heart
- increased preload/afterload
- frank-starling law = increased EDV- increased force of contraction.
what are symptoms/signs of aortic stenosis
- progressive dyponae
- pre syncope
- reduced exercise tolerance
- ejection systolic murmur
what is physical activity the primary prevention of?
- heart disease
- diabetes
- reduce the risk of cancer
- falls
- osteoporosis
- mental health problems
how is blood flow to different part of the body altered during exercise?
- blood will be shunted from some organs (ADH released and decreased blood flow to the kidneys)
- heart
skeletal muscle - blood is shunted from the skin, then we start to release heat m
what are the 2 main ways a news score will be used?
track = to provide a continuous record of a patients physiological stats through out the patient journey
trigger = to provide a standardised platform for the initial assessment of acute illness severity wherever assessment occurs
what is the purpose of the news score?
Determines the degree of illness of a patient and prompts critical care intervention
what are the 6 physiological parameters of the NEWS score?
- temperature
- blood pressure
- heart rate
- resp rate
- level of consciousness
- oxygen saturation
what is sepsis 6?
- take bloods
- take blood cultures
- administer oxygen
- IV antibiotics
- IV fluid
- monitor urine output
