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ESA 5 > Integrative > Flashcards

Integrative Flashcards

1
Q

pH range

A

7.35-7.45

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2
Q

Describe HCO3 reabsorption?

A 
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+

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3
Q

Anion gap calculation?

A

NAK- ClHCO3

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4
Q

Causes of metabolic acidosis with a normal anion gap?

A

REnal tubular necrosis

Diarrhoea (as HCO3 replaced by Cl-)

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5
Q

Body fluids and volumes in each

A

1/4 of ECF = plasma
ECF = 1/3
ICP = 2/3
so 12L dextrose to replace 1 L of blood

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6
Q

Stimulates thirst

A

AngioII
Hyothalamus-osmoreceptors
low saliva from tonicity

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7
Q

How can Diabetes lead to shock?

A

DKA = urinary loss of fluid

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8
Q

Describe types of clinical incident

A

Patient saftey Incident (PSI)
Near miss
Serious untoward incident (SUI)
Never event = preventaple PSI

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9
Q

How to report a clinical incident

A

Datix reporting

Inform key line managers

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10
Q

Describe the sites of haemopoesis in the fetus

A 
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
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11
Q

What is bone marrow? Colours?

A

Stem cells supported by stroma
Red marrow (haemopoetic) vs yellow marrow (fatty)
All red at birth

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12
Q

Myeoloid progenitor vs myeloblast?

A

Myeoloid progenitor also produces Magakaryocyte, eythrocyte and mast cells

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13
Q

Describe myeloblast to neutrophul

A 
Myeloblat
Promyelocyte
Myelocyte
Metamyeolcyte
Band cell (c shae)
Neutrophil

Nucleus starts large and cytoplasm grows so it shrinks

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14
Q

Describe myeloid progenitor to RBC

A

Proerythro
Normoblast
Reticulocyte
Red cell

Haemoglobinisation of cytoplasma
Nuclear maturation and nuclear extrusion

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15
Q

Platelet production controlled by?

A

Thrombopoietin (TPO)

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16
Q

Structure of the spleen?

A

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)

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17
Q

Descrie the functions of the sleen

A

Phagocytosis
Blood pooling- activation of platelets and RBCs if bleeding
Haemopoiesis (from pluripotent) Extramedullary
Immunologicao - T and B cells

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18
Q

Causes of splenomegaly

A

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

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19
Q

Causes of hyposplenism

A

Caeliac and Sickle cell

Risk of sepsis

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20
Q

Define aplastic anaemia

A

Pancytopenia with hypocellular bone marrow with no infiltration or fibrosis
Can be idiopathic

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21
Q

COngenital deficit in B cells?

A 
X linked hypogammablobulinaemia
Low IgA,M
No tonsils
Recessive
Early
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22
Q

What is ataxia talangiectasia

A

Thymic hypoplasma, low B cells

BMTransplant

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23
Q

Neutrophil congenital deficiency

A

Chronic granulomatous disease
X linked recessive
Persistent infections of mucous membrane
BMT

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24
Q

Aquired B cell deficiency

A

Hypogammaglobulinaemia

Chronic lymphatic leukaemia and other lymphoproliferativevm nephrotic

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25
Q

Aquired T Cell immunodeficiency

A

HIV, Chemo, Hodgkins, immunosuppression

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26
Q

What is myelodysplasia

A

Non-functioning neutrophils

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27
Q

Describe cytomegalovirus

A

In immunocompromised patients
Pneumonitis, oesophagitis, colitis, hepatitis
Black spots?

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28
Q

What do Stellate cells in the liver do?

A

Secrete ECM so more in disease

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29
Q

NYHA Functional calssification of HF

A

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

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30
Q

Heart diagram in systolic and dialstolic

A

Hypertrophy in dia

Dilated in systolic

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31
Q

Describe diastolic heart failure

A 
Elderly and female
Hypertension, DM, obesity
Reduced LV compliance and relaxation
Unable to compensate by increasing EDP
Low cardiac output results
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32
Q

Normal result in clonus

A

2 is still normal

33
Q

What is Hoffman’s sign?

A

Monosynaptic reflex (indicate an UMNL)

34
Q

Illicit drugs RF stroke

A

Cocaine

35
Q

What is the valsalva maneouvre?

A

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

36
Q

Causes of haemorrhagic stroke

A 
Hypertension
Anti coagulation
Vascular abnormalit
Amyloid deposition
Tumour
37
Q

Describe TACs and PACs

A

Hemianopia, hemiparesis, hemisensory loss and higher cortical dysfunction

PACS: 2 of these or higher cortical dysfunction only

38
Q

Name of removal system in spleen

A

Reticuloendothelial system

39
Q

TYpes of abnormal red cells

A

Spherocytes
Elloptocytes
Acanthocytes
Target cells e.g. alcohol, liver, thalassemia

40
Q

Symptoms and signs of anaemia

A 
Tierdness
DIzziness
Palpatations
Headaches
SOB
Weakness
Angina, claudication, confusion, HF

Palor
Tachycardoa
Sstolic flo murmur
HF

41
Q

Causes of microcytic anaemia

A 
Iron
Anaemia of chronic disease
Thalassemia
Lead
SIderoblastic anaemia (ring sideroblasts produced)
42
Q

Causes of macrocytic anaemia

A

B12 deficiency, folate deficiency

Pernicous anaemia - autoantibody to intrinsic factor required to absorb B12

43
Q

Normocytic normochromic (NORMAL SIZE)ANAEMIA CAUSES?

A

aNAEMIA OF CHRONIC DISEASE
mIXED DEFICIency of Fe and V12/folate
BM failure

44
Q

Causes of neutrophillia

A 
Infection
Acute inflam
Smoking
Drugs
Acute haemorrhage
Myeloproliferative disease
Metabolic/ endocrine disorders
Malignant disease
Cytokines
45
Q

Causes of monocytosis

A

Chronic inflammatory conditions
chronic infection eg..g. TB
Carcinoma
Myeloproliferative disaeases/ leukaemias

46
Q

Causes of eosinophila

A

Drug hypersensitivity e.g. penicillin
Allergic disease e.g. asthma, eczema, urticaria, hay fever, aspergillus
Parasitic infection

47
Q

Causes of basophilia

A

Hypersensitivity reactions
UC RA
MYeloproliferative

48
Q

Lymphocytosis causes

A

Reactive e.. viral infections, bacterial, stress e.g. MI, splenectomy
Lymphoproliferative e.g. chronic lymphocytic leukaemia
Lymphoma

49
Q

What is a Leucoerythroblastic film and what are the causes

A

Granulocyte precursors and nucleated RBC on film
Bone marrow infiltration carcinoma or haem malignancy
Sepsis/ shock
Severe megaloblastic anamia
Storage disease

50
Q

What is VOn Willebrands factor (vWF)

A

Essential for platelet adhesion and for factor VIII

Activated by collagen and tissue factor

51
Q

Describe the main platelet functions

A

activation - Coauglation factor activation
Secretion - encourage furthur aggregation e.g. ADP thromboxane
Aggregation - Platelet plug
Adhesion- vessel wall

52
Q

How do we measure intrinsic and extrinsic pathways of clotting

A

Extrinsic - INR

Intrinsci - APTT

53
Q

SOme problems with vessels

A 
Hereditary haemorrhagic telangiectasia (HH)
Connective tissue e.g. ehlers Danlos
Senile purpura
Steroids
Infection e.g. measles
Scurvy
54
Q

Problems with vessels signs

A

Easy bruiding

Spontaneous bleed from small vessels skin and mucous membranes

55
Q

Causes of platelet function decrease

A

Rare heriditary
NSAIDs clopidogred
Uraemia
Hypergammaglobulinamiia

Leads to bleeding

56
Q

PRoblem with coag factors?

A

A = 8
B = 9
Liver disease
Vit k def

57
Q

Postictal symptoms

A

headche
confusion
myalgia

58
Q

Causes of non-epileptic seizure

A

Trauma
Hypoglycaemia
Hypoxia

59
Q

Define hypersensitivity

A

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)

60
Q

Infections driving hypersensitivity against self

A

Rheumatic heart disease
Guillain Barre syndrome
Type 1 diabetes - Coxsakie

61
Q

Examples of type I

A 
Anaphylaxis
Asthma
Acute urticaria
Food allergy
Lts of symptoms
62
Q

Pathology in Type 2

A

Antibody mediated complemet, cytotoxicity and modulation of cellular function

63
Q

examples of type 2 immunosesnitivity reactions

A 
Graves disease
Myasthenia gravis
Pernicious anaemia
Goodpastures
Haemalogical disease e.g. rhesus and second bby
Tissue damage vs change in function
64
Q

Type 3 exmamples

A

Deposition and tissue damage non specifically
RA
Glomerulonephritis (infectious)
SLE

65
Q

Symptoms in SLE

A

Cardiac (pericarditis), resp, renal, joint (arthrirtis), pleura inflam, fatigue, appetitie, fever, photosensitive, butterfly rash, myalgia

66
Q

Criteria for SLE

A

Most women
Skin
Sstemic
Laboratory - anti nuclea antibody (ANA)

67
Q

Type IV examples

A 
Tuberculin and Mantoux test
Granulomatous hypersensitivity e.g. TB
Leprosy
Schistosomiasis
Sarcoidosis
Hashimotos
RA
Coeliac disease - lead to hyposlenism and lymphoma
68
Q

Examples of nitrates

A

Isosorbide Mononitrate

69
Q

SABA expamples

A

Salbutamol

Terbutaline

70
Q

Nystatin use

A

Treat mould and yeast infections

Binds to fungal cell membrane and forms pores (K+ leakage)

71
Q

Nystatin ADRS

A

Diarrhoea, abdo pain, hypersensitivity

72
Q

Clotrimazole moa and adrs

A

Increases membrane permeability

Itching nausea cvomiting LFTs

73
Q

Amphotericin moa and use

A

Systemic fungal infections
Same as nystatin
Fever chills headaches hypotension

74
Q

Metronidazole ADRs

A

Nausea
Metallic
Loss of appeatite
Headache

75
Q

Drugs to treat anaemia

A

Ferrous sulphate/ fumerate
Hydroxocobalamin- b12
Folic acid

76
Q

MSK anticholiesterases

A

Neostigmine

Pyridostigmine

77
Q

Isoflurant and sevoflurane MoA

A

GABA and glycine sesnitisation

78
Q

NM blocking agents

A

Pancuronium

Suxamethonium chloride

ESA 5 (4 decks)

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