Integrative Flashcards
pH range
7.35-7.45
Describe HCO3 reabsorption?
Baso = HCO3 Na sym Apical = NHX
Intercalated has pump and HCO3 Na sym
From Glutamine/ a ketoglutarate and from CO2 carbonic anydrase.
Ammonia creasted rom glutamine and moves freely into lumen to trap H+
Anion gap calculation?
NAK- ClHCO3
Causes of metabolic acidosis with a normal anion gap?
REnal tubular necrosis
Diarrhoea (as HCO3 replaced by Cl-)
Body fluids and volumes in each
1/4 of ECF = plasma
ECF = 1/3
ICP = 2/3
so 12L dextrose to replace 1 L of blood
Stimulates thirst
AngioII
Hyothalamus-osmoreceptors
low saliva from tonicity
How can Diabetes lead to shock?
DKA = urinary loss of fluid
Describe types of clinical incident
Patient saftey Incident (PSI)
Near miss
Serious untoward incident (SUI)
Never event = preventaple PSI
How to report a clinical incident
Datix reporting
Inform key line managers
Describe the sites of haemopoesis in the fetus
0-2 months = yolk sac 2-5 months = liver and spleen 5-9 months = bone marrow Infants this is most bones Adults in vertebrae, ribs, sternum, sacrum, pelvis and ends of femur
What is bone marrow? Colours?
Stem cells supported by stroma
Red marrow (haemopoetic) vs yellow marrow (fatty)
All red at birth
Myeoloid progenitor vs myeloblast?
Myeoloid progenitor also produces Magakaryocyte, eythrocyte and mast cells
Describe myeloblast to neutrophul
Myeloblat Promyelocyte Myelocyte Metamyeolcyte Band cell (c shae) Neutrophil
Nucleus starts large and cytoplasm grows so it shrinks
Describe myeloid progenitor to RBC
Proerythro
Normoblast
Reticulocyte
Red cell
Haemoglobinisation of cytoplasma
Nuclear maturation and nuclear extrusion
Platelet production controlled by?
Thrombopoietin (TPO)
Structure of the spleen?
Red pulp - sinuses lined by endothelial macrophages and cords
White pulp - like lymph follicles (white cells and plasma preferentialy pass here and red through red pulp)
Descrie the functions of the sleen
Phagocytosis
Blood pooling- activation of platelets and RBCs if bleeding
Haemopoiesis (from pluripotent) Extramedullary
Immunologicao - T and B cells
Causes of splenomegaly
Massive - keukaemia, malaria, myelofibrosis
Moderate - Liver cirrhosis, portal hypertension and above
Mild- as above also infections e.h. hep and glandular fever, hepatits, endocarditis, sarcoidosis
Pancytopeia from enlarged spleen possibke
Causes of hyposplenism
Caeliac and Sickle cell
Risk of sepsis
Define aplastic anaemia
Pancytopenia with hypocellular bone marrow with no infiltration or fibrosis
Can be idiopathic
COngenital deficit in B cells?
X linked hypogammablobulinaemia Low IgA,M No tonsils Recessive Early
What is ataxia talangiectasia
Thymic hypoplasma, low B cells
BMTransplant
Neutrophil congenital deficiency
Chronic granulomatous disease
X linked recessive
Persistent infections of mucous membrane
BMT
Aquired B cell deficiency
Hypogammaglobulinaemia
Chronic lymphatic leukaemia and other lymphoproliferativevm nephrotic
Aquired T Cell immunodeficiency
HIV, Chemo, Hodgkins, immunosuppression
What is myelodysplasia
Non-functioning neutrophils
Describe cytomegalovirus
In immunocompromised patients
Pneumonitis, oesophagitis, colitis, hepatitis
Black spots?
What do Stellate cells in the liver do?
Secrete ECM so more in disease
NYHA Functional calssification of HF
Class I no syptoms/ limitations
II - slight limit and symptoms in physical
III - Marked limitation and symptoms in physical act
IV - At rest, discomfort with any phys
Heart diagram in systolic and dialstolic
Hypertrophy in dia
Dilated in systolic
Describe diastolic heart failure
Elderly and female Hypertension, DM, obesity Reduced LV compliance and relaxation Unable to compensate by increasing EDP Low cardiac output results
Normal result in clonus
2 is still normal
What is Hoffman’s sign?
Monosynaptic reflex (indicate an UMNL)
Illicit drugs RF stroke
Cocaine
What is the valsalva maneouvre?
aneuver or Valsalva manoeuvre is performed by moderately forceful attempted exhalation against a closed airway, usually done by closing one’s mouth, pinching one’s nose shut while pressing out as if blowing up a balloon
Causes of haemorrhagic stroke
Hypertension Anti coagulation Vascular abnormalit Amyloid deposition Tumour
Describe TACs and PACs
Hemianopia, hemiparesis, hemisensory loss and higher cortical dysfunction
PACS: 2 of these or higher cortical dysfunction only
Name of removal system in spleen
Reticuloendothelial system
TYpes of abnormal red cells
Spherocytes
Elloptocytes
Acanthocytes
Target cells e.g. alcohol, liver, thalassemia
Symptoms and signs of anaemia
Tierdness DIzziness Palpatations Headaches SOB Weakness Angina, claudication, confusion, HF
Palor
Tachycardoa
Sstolic flo murmur
HF
Causes of microcytic anaemia
Iron Anaemia of chronic disease Thalassemia Lead SIderoblastic anaemia (ring sideroblasts produced)
Causes of macrocytic anaemia
B12 deficiency, folate deficiency
Pernicous anaemia - autoantibody to intrinsic factor required to absorb B12
Normocytic normochromic (NORMAL SIZE)ANAEMIA CAUSES?
aNAEMIA OF CHRONIC DISEASE
mIXED DEFICIency of Fe and V12/folate
BM failure
Causes of neutrophillia
Infection Acute inflam Smoking Drugs Acute haemorrhage Myeloproliferative disease Metabolic/ endocrine disorders Malignant disease Cytokines
Causes of monocytosis
Chronic inflammatory conditions
chronic infection eg..g. TB
Carcinoma
Myeloproliferative disaeases/ leukaemias
Causes of eosinophila
Drug hypersensitivity e.g. penicillin
Allergic disease e.g. asthma, eczema, urticaria, hay fever, aspergillus
Parasitic infection
Causes of basophilia
Hypersensitivity reactions
UC RA
MYeloproliferative
Lymphocytosis causes
Reactive e.. viral infections, bacterial, stress e.g. MI, splenectomy
Lymphoproliferative e.g. chronic lymphocytic leukaemia
Lymphoma
What is a Leucoerythroblastic film and what are the causes
Granulocyte precursors and nucleated RBC on film
Bone marrow infiltration carcinoma or haem malignancy
Sepsis/ shock
Severe megaloblastic anamia
Storage disease
What is VOn Willebrands factor (vWF)
Essential for platelet adhesion and for factor VIII
Activated by collagen and tissue factor
Describe the main platelet functions
activation - Coauglation factor activation
Secretion - encourage furthur aggregation e.g. ADP thromboxane
Aggregation - Platelet plug
Adhesion- vessel wall
How do we measure intrinsic and extrinsic pathways of clotting
Extrinsic - INR
Intrinsci - APTT
SOme problems with vessels
Hereditary haemorrhagic telangiectasia (HH) Connective tissue e.g. ehlers Danlos Senile purpura Steroids Infection e.g. measles Scurvy
Problems with vessels signs
Easy bruiding
Spontaneous bleed from small vessels skin and mucous membranes
Causes of platelet function decrease
Rare heriditary
NSAIDs clopidogred
Uraemia
Hypergammaglobulinamiia
Leads to bleeding
PRoblem with coag factors?
A = 8
B = 9
Liver disease
Vit k def
Postictal symptoms
headche
confusion
myalgia
Causes of non-epileptic seizure
Trauma
Hypoglycaemia
Hypoxia
Define hypersensitivity
The antigen specific immune response that are either inappropriate or excessive and result in harm to host
All have a sensitisation phase and an effector phase (re exposure)
Infections driving hypersensitivity against self
Rheumatic heart disease
Guillain Barre syndrome
Type 1 diabetes - Coxsakie
Examples of type I
Anaphylaxis Asthma Acute urticaria Food allergy Lts of symptoms
Pathology in Type 2
Antibody mediated complemet, cytotoxicity and modulation of cellular function
examples of type 2 immunosesnitivity reactions
Graves disease Myasthenia gravis Pernicious anaemia Goodpastures Haemalogical disease e.g. rhesus and second bby Tissue damage vs change in function
Type 3 exmamples
Deposition and tissue damage non specifically
RA
Glomerulonephritis (infectious)
SLE
Symptoms in SLE
Cardiac (pericarditis), resp, renal, joint (arthrirtis), pleura inflam, fatigue, appetitie, fever, photosensitive, butterfly rash, myalgia
Criteria for SLE
Most women
Skin
Sstemic
Laboratory - anti nuclea antibody (ANA)
Type IV examples
Tuberculin and Mantoux test Granulomatous hypersensitivity e.g. TB Leprosy Schistosomiasis Sarcoidosis Hashimotos RA Coeliac disease - lead to hyposlenism and lymphoma
Examples of nitrates
Isosorbide Mononitrate
SABA expamples
Salbutamol
Terbutaline
Nystatin use
Treat mould and yeast infections
Binds to fungal cell membrane and forms pores (K+ leakage)
Nystatin ADRS
Diarrhoea, abdo pain, hypersensitivity
Clotrimazole moa and adrs
Increases membrane permeability
Itching nausea cvomiting LFTs
Amphotericin moa and use
Systemic fungal infections
Same as nystatin
Fever chills headaches hypotension
Metronidazole ADRs
Nausea
Metallic
Loss of appeatite
Headache
Drugs to treat anaemia
Ferrous sulphate/ fumerate
Hydroxocobalamin- b12
Folic acid
MSK anticholiesterases
Neostigmine
Pyridostigmine
Isoflurant and sevoflurane MoA
GABA and glycine sesnitisation
NM blocking agents
Pancuronium
Suxamethonium chloride
