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Foundations of Medicine JMO > Last minute (Year 1) > Flashcards

Last minute (Year 1) Flashcards

1
Q

What structures form first from the trachea, behind the oesophagus, during development?

A

Lung buds

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2
Q

What embyrological structure forms the tongue?

A

Tuberculum impar

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3
Q

What is meant by oesophageal atresia?

A

This is the formation of a blind ending oesophagus, in which there is no connection between the distal and proximal oesophagus

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4
Q

What can arise from oesophageal atresia?

A

The baby can’t swallow amniotic fluid, which it usually does to maintain homeostasis

This causes a build up of amniotic fluid around the baby known as polyhydramnios

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5
Q

What is polyhydramnios?

A

This is a build up of amniotic fluid around a baby

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6
Q

What trilaminar layer forms the lining of the respiratory tract?

A

Endoderm

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7
Q

What trilaminar layer forms the cartilage and smooth muscle surrounding the bronchial tree?

A

Visceral mesoderm

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8
Q

What stage of respiratory development occurs between 26 days and 6 weeks?

A

Embryonic

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9
Q

What stage of respiratory development occurs between 6 and 16 weeks?

A

Pseudoglandular

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10
Q

What stage of respiratory development occurs between 16 and 28 weeks?

A

Canalicular

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11
Q

What stage of respiratory development occurs between 28 and 36 weeks?

A

Saccular

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12
Q

What stage of respiratory development occurs between 36 weeks and early childhood?

A

Alveolar

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13
Q

What occurs in the embryonic period of respiratory development?

A

Respiratory diverticulum forms
Initial branching to give lungs, lobes and segments

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14
Q

What occurs in the pseudoglandular stage of respiratory development?

A

14 more generations of branching, forming the terminal bronchioles

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15
Q

What occurs in the Canalicular stage of respiratory development?

A

Terminal bronchioles branch into respiratory bronchioles and alveolar ducts

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16
Q

What occurs in the Saccular stage of respiratory development?

A

Terminal sacs form
Capillaries establish close contact

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17
Q

What occurs in the alveolar stage of respiratory development?

A

Alveoli mature

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18
Q

What type of cell forms the blood-air barrier?

A

Type I pneumocystis

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19
Q

What are the functions of the nasal cavity?

A

Warming
Moistening
Filtering
Olfaction

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20
Q

Where in the nasal cavity are the olfactory receptors?

A

Roof

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21
Q

What type of cell lines the vestibule (Opening) of the nasal cavity?

A

Keratinised stratified squamous epithelium

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22
Q

What is respiratory epithelium?

A

Pseudostartified ciliated columnar epithelium with goblet cells

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23
Q

What type of epithelium lines the nasal cavity?

A

Respiratory epithelium

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24
Q

What epithelium lines the oropharynx?

A

Non-keratinised, stratified squamous epithelium

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25
Q

What epithelium lines the anterior and upper epiglottis?

A

Non-keratinised, stratified squamous epithelium

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26
Q

What epithelium lines the distal epiglottis?

A

Respiratory epithelium

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27
Q

What type of cartilage forms the epiglottis?

A

Elastic cartilage

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28
Q

What epithelium lines the vocal folds?

A

Stratified, squamous epithelium

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29
Q

Where do most foreign objects travel in the bronchial tree?

A

Right main bronchus

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30
Q

What joins the 2 ends of the C shaped tracheal cartilage?

A

Tracheal muscle

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31
Q

Describe the changes as the move towards the terminal bronchioles

A

Hyaline cartilage lost
Goblet cells lost
Columnar -> Cuboidal

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32
Q

What are terminal bronchioles?

A

These are the smallest bronchioles that lack respiratory capability

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33
Q

What are respiratory bronchioles?

A

These form from the terminal bronchioles
They can perform respiration
They form alveoli

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34
Q

What are clara/club cells?

A

Non-cilated cells that project above the level of adjacent ciliated cells found in terminal bronchioles

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35
Q

What is the function of clara/club cells?

A

Stem cells
Detoxification
Immune modulation
Surfactant production

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36
Q

What are the 2 types of alveolar cells?

A

Type I pneumocytes
Type II pneumocytes

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37
Q

What is the function of type I pneumocytes?

A

Form the blood air barrier
Simple squamous epithelial cells

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38
Q

What are type II pneumocytes?

A

Polygonal shaped cells with mirovili
Contain membrane bound lamellar bodies which contain surfactant, which can be released via exocytosis

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39
Q

What are alveolar macrophages?

A

Aka dust cells or heart failure cells, which are found in the septa or migrate over luminal surfaces and phagocytose inhaled particles, before moving up the bronchial tree and getting swallowed, or moving into the septal connective tissue

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40
Q

Describe the histology of the visceral pleura

A

Simple squamous epithelium (Mesothelium)
Backed by layers of fibrous and elastic connective tissue

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41
Q

What is an ecological study?

A

Analysis of grouped data from summaries of individual data

Disease rates and exposures measured in a population and their relation is examined

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42
Q

Strengths of ecological study?

A

Rapid
Inexpensives

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43
Q

Limitations of ecological study

A

No individual data
Unsure is those with disease had exposure (Ecological fallacy)

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44
Q

What is a cross sectional study?

A

Measurement of exposure and outcome simultaneously

Asses prevalence and distribution of a disease in a population

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45
Q

Strengths of cross sectional study?

A

Provides prevalence
Better for chronic illnesses

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46
Q

Limitatuons of cross sectional study?

A

Can’t estimate incidence
Prone to bias (Those with disease more likely to remember exposure)

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47
Q

What is incidence?

A

rate of disease

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48
Q

What is prevalence?

A

Number with disease at any one time

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49
Q

What is a case control study?

A

Comparing 2 groups of people, with and without disease, and with and without exposure

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50
Q

What are some strengths of case control study?

A

Quick
Small sample size
Evaluate multiple exposures

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51
Q

Limitations of case control study?

A

Cannot determine incidence or prevalence
Cannot determine causality
Not useful for rare exposure

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52
Q

What is a cohort study?

A

Group of people with or without exposure are followed up over a long period of time to see if they develop the disease

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53
Q

What are the strengths of a cohort study?

A

Determines incidence
Detemines causality of exposure

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54
Q

What are the limitations of cohort study?

A

Expensive
Time consuming
Can lose people in the trial

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55
Q

What is pre-load?

A

Initial stretching of heart wall due to blood

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56
Q

What is after-load?

A

The force with which the heart must pump to move blood out

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57
Q

What is the Frank-Starling mechanism?

A

Increased end diastolic volume => Increased stroke volume as the heart will pump harder

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58
Q

Give the calculation for resistance to flow

A
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59
Q

What performs extrinsic control of blood vessels?

A

Nerves and hormones

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60
Q

What type of innervation innervates the vascular smooth muscle?

A

Sympathetic

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61
Q

What adrenoceptor is found in vascular smooth muscle?

A

Alpha 1

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62
Q

What is the vasomotor tone of blood vessels?

A

This is a the tonic, low level sympathetic discharge of sympathetic nerves, due to noradrenaline, causing constant, partial constriction

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63
Q

How does increased sympathetic tone affect blood vessels?

A

Vasoconstriction

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64
Q

How does decreased sympathetic tone affect blood vessels?

A

vasodilation

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65
Q

Where is adrenaline released in the body

A

Adrenal medulla of the adrenal glands

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66
Q

What are the affects of adrenaline on the body?

A

Vasoconstriction (Alpha 1)
Bronchodilation (Beta 2)

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67
Q

What are intrinsic mechanisms of blood vessels?

A

These are local changes in blood flow to match the needs of tissue

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68
Q

Which is more dominant, extrinsic or intrinsic mechanisms?

A

Intrinsic mechanisms can override extrinsic mechanisms

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69
Q

What types of stimuli can affect instrinsic mechanisms?

A

Chemical metabolites
Physical stimuli

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70
Q

What are some types of chemical metabolites that affect intrinsic mechanisms?

A

Local metabolites
Local humeral agents
Organic nitrates

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71
Q

What are some factors that cause releases eof local metabolites and thus cause vasodilation?

A

Decreased local pO2
Increased local pCO2
Decreased local pH
Increased extra-cellular K+
Adenosine release from ATP

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72
Q

What are some local humoral agents that cause vasodilation?

A

Histamine
Bradykinin
Nitric oxide

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73
Q

What are some local humeral agents that cause vasoconstriction?

A

Serotonin
Thromboxane A2
Leukotrienes
Endothelin

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74
Q

How is nitric oxide released?

A

Stress of vascular endothelium causes the release of calcium in the cells, which activates nitric oxide synthase

Nitric oxide synthase converts L-arginine into nitric oxide in the vascular endothelium

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75
Q

What are some physical stimuli that can affect blood vessels?

A

Temperature
Myogenic response to stretch
Sheer stress

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76
Q

How does cold affect blood vessels?

A

vasoconstriction

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77
Q

How does warm affect blood vessels?

A

Vasodilation

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78
Q

What is the myogenic response to stretch?

A

The brain is tightly enclosed in the skull
This means blood vessels can’t expand
So if MAP rises, the blood vessels constrict to prevent increased intracranial pressure
If MAP falls, the blood vessels dilate to prevent decreased intracranial pressure

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79
Q

How does sheer stress affect blood vessels?

A

Dilatation f arterioles causes sheer stress in arteries upstream, making them dilate

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80
Q

What sensory nerves are involved in sneezing?

A

V1 and V2

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81
Q

Where are cough receptors located?

A

Oropharyngeal mucosa
Laryngopharyngeal muscosa
Laryngeal mucosa

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82
Q

What are carotid sheaths?

A

These are tubes of deep fascia that contain the common carotid arteries, the internal jugular vein and the vagus nerve
They attach to the bones of the posterior skull

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83
Q

What nerve sense a stimulus to cause a cough in the nasal and oral pharynx?

A

IX - Glossopharyngeal

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84
Q

What nerve senses a stimulus to cause a cough in the laryngopharynx and larynx?

A

X - Vagus

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85
Q

What nerves form the pulmonary plexus of nerves?

A

Post-synapetic parasympathetic
Vagus nerve branches
Visceral afferents

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86
Q

What nerves sense a stimulus to cause a cough in the lungs?

A

Visceral afferent nerves that travel to the medulla

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87
Q

What nerve closes the rima glottidis in a cough?

A

Vagus - X

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88
Q

What muscles cause closure of the rima glottidis?

A

Intrinsic muscles of the larynx

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89
Q

IN what direction do the external oblique muscles travel?

A

Hands in pockets

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90
Q

In what direction do internal oblique muscles travel?

A

Hands on pecs

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91
Q

IN what direction do transversus abdominus muscles travel?

A

Horizontal

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92
Q

What nerves supply motor innervation during a cough?

A

X and IX

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93
Q

Gram negative, obligate aerobic bacilli

A

Legionella
Pseudomonas

94
Q

Gram negative, aerobic diplococci

A

Neisseria gonorrhoea
Neisseria meningitides

95
Q

Small, aerobic, gram negative bacilli

A

Bordetella pertussis
Haemophilus influenza

96
Q

Gram negative, aerobic, bacilli, coliforms

A

E.coli
Klebsiella
Salmonella
Shigella

97
Q

Gram negative, obligate anaerobe, bacilli

A

Bacterioides

98
Q

Gram negative, microaerophilic curved bacilli (Coccobacilli)

A

Campylobacter

99
Q

Gram negative microaerophilic spiral bacilli

A

Helicobacter

100
Q

Gram negative, facultative anaerobic curved rod

A

Vibrio cholerae

101
Q

Gram positive aerobic cocci in chains with alpha haemolysis

A

Streptococcus pneumoniae
Streptococcus viridans

102
Q

Gram positive aerobic cocci in chains with beta haemolysis

A

GAS (Strep progenies)
GBS

103
Q

Gram positive aerobic cocci in chains with gamma haemolysis

A

Enterococcus

104
Q

Gram positive aerobic cocci in clumps, coagulase positive

A

Staphylococcus aureus

105
Q

Gram positive aerobic cocci in clumps, coagulase negative

A

Staphylococcus epidermidis
Staphylococcus saprophiticus

106
Q

gram positive aerobic small bacilli

A

corynebacterium diphtheriae

107
Q

gram positive aerobic large bacilli

A

Bacillus cereus
Bacillus anthracis

108
Q

Gram positive anaerobic bacilli

A

Clostridioides tetani
Clostridioides difficile
Costridioides perfringens

109
Q

Antibiotic classes against cell wall

A

Penicillins
cephalosporins
glycopeptides

110
Q

Targeted by amoxicillin

A

+ve and -ve

111
Q

Targeted by flucloxicillin?

A

Staph
Strep

112
Q

Targeted by penicillin V

113
Q

Targeted by cephalosporins?

A

1st gen = gram -ve
4th gen = broad spectrum

114
Q

Glycopeptide examples

A

Vancomycin
Teicoplanin

115
Q

Targeted by glycopeptides

116
Q

Antibiotics that target nucleic acids?

A

Metronidazole
Fluoriquinolones
Trimethoprim (Folic acid)

117
Q

Antibiotics that target protein synthesis

A

Tetracyclines
Macrolides
Aminoglycosides - Gentamicin

118
Q

Side effects of gentamicin?

A

Cranial nerve damage
Nephrotoxic

119
Q

Targeted by gentamicin

A

Gram -ve aerobes, e.g. coliforms

120
Q

Types of macrolide

A

Erythromycin -ve
Clarithromycin -ve
Azithromycin +ve

121
Q

Effects of tetracyclines?

A

Staining and structural damage to teeth and bone

122
Q

colitis and bloody diarrhoea in immunosuppressed?

123
Q

C diff antibiotic regime?

A

1st: Vancomycin - 10/7
2nd: Fidaxomicin
3rd: Faecal transplant

124
Q

Reheated rice
Profuse vomiting

A

Bacillus cereus

125
Q

Raw milk
Soft cheeses
Leads to meningitis or bacteraemia

A

listeria - Advice pregnant women

126
Q

Rice water diarrhoea

A

Vibrio cholerae

127
Q

Travel to SE asia
Poultry or raw milk
IBS
Guillan-Barre

A

Camplylocater

128
Q

Eggs
Turtle stomachs
Dairy

A

Salmonella non-typhi

129
Q

Dysentery
HUS
Raw milk

A

Shigella dysenteriae

130
Q

Bloody diarrhoea
Beef or animal contact
HUS
Recent traveller

A

E.coli 0157

131
Q

Seafood

A

Vibrio non-cholera

132
Q

Carribean or India
Steatorrhoea or weight loss

A

Tropical sprue

133
Q

Diarrhoea
Steatorrhoea or weight loss
Arthritis
HLA-B27 antigen

A

Whipple’s disease (Tropheryma whipplei)

134
Q

Mimic appendicitis
Exposure to pigs
Travel to Asia

A

Yersinia enterocolitica

135
Q

Return from Indian subcontinent
Enteric fever
Headache
Constipation or diarrhoea
Dry cough

A

Salmonella type/paratyphi

136
Q

Bloody diarrhoea
Toxic megacolon risk
Weight loss
Pain
Possible liver problems

A

Amoebiasis - Entamoeba histolytica

137
Q

Swimming in lakes
Morning explosive diarrhoea
Explosive eggy burps
Malabsorptive diarrhoea
SE Asia travel

A

Giardia lamblia

138
Q

Anal itching in children

A

Enterobius

139
Q

prolonged diarrhoea in immunosuppressed
Nutritional deficiency

A

Cryptosporidium

140
Q

Signs of HUS

A

Abdominal pain
Fever
Pallor
Petechiae (Red spots on ankles)
Oliguria (Low urine output)

141
Q

Cyanotic CHDs?

A

Hypoplastic left heart syndrome
Tetralogy of Fallot
Transposition

142
Q

Acyanotic CHDs

A

VSD
ASD
PDA
Coarction or interruption of aorta

143
Q

Patent ductus arteriosus treatment?

A

NSAIDs or clips

144
Q

Collapse at duct closure treatment?

A

Prostaglandin E2 infusion

145
Q

Common in trisomy 21 (CHD)

A

Atrio-ventricular septal defect

146
Q

Hypoplastic left heart syndrome?

A

Narrow aorta
Small left ventricle
Atrial septal defect

147
Q

Hypoplastic left heart syndrome treatment

A

TCPC - Total cavo pulmonary connection

148
Q

Tetralogy of Fallot?

A

Narrow pulmonary trunk
VSD
Large right ventricle
Pulmonary stenosis

149
Q

CXR sign of transposition of great vessels?

A

Egg on string

150
Q

Ddx narrow complex tachycardia

A

Sinus tachycardia
Supraventricular tachycardia
Atrial fibrillation
Atrial flutter

151
Q

DDx broad complex tachycardia

A

Ventricular tachycardia
Polymorphic ventricular tachycardia
Atrial fibrillation + BBB
Supraventricular tachycardia + BBB

152
Q
A

Monomorphic VT

153
Q
A

Polymorphic VT

154
Q
A

Torsades du pointes

155
Q

Unstable VT + pulse treatment

156
Q

Pulseless VT

A

Defibrillation

157
Q

Stable VT

A

1st: Amiodarone
2nd DCCV

158
Q

Torsades du pointes

A

IV magnesium

159
Q
A

Ventricular fibrillation

160
Q

Short term v-fib treatment

A

Defibrillation
Adrenaline
Amiodarone

161
Q

Long term v-fib treatment

162
Q

Premature ventricular complexes treatment?

A

ß-Blockers

163
Q
A

Atrial fibrillation

164
Q

Paroxysmal A fib treatment

A

1st: ß-blocker
Rate limiting Ca2+ blocker
Digoxin
2nd: AV node ablation

165
Q

Prolonged or permanent A fib treatment

A

1st: DCCV or Amiodarone
2nd: Left atrial ablation

166
Q
167
Q

A flutter treatment

A

Ablation or pharmacological cardioversion

168
Q

3 types of SVT

A

AVNRT
AVRT
Atrial tachycardia

169
Q

Stages of SVT treatment

A

1st: Vagal manouvres
2nd: Adenosine IV
3rd: Verapamil or ß-Blocker
4th: Synchronised DCCV

170
Q

Adenosine action

A

Slows cardiac conduction through AV node via A1 receptors

171
Q

doses of adenosine in SVT

A

1st: 6mg
2nd: 12mg
3rd: 18mg

172
Q

Atropine action?

A

Increases heart rate via blocking muscarinic synapses

173
Q

Sinus tachycardia treatment

A

ß-Blockers
Treat underlying cause

174
Q

sinus bradycardia treatment

A

Atropine
Pacing (If haemodynamic compromise)

175
Q

Asystole risk treatment?

A

1st: Atropine
2nd: Isoprenaline or adrenaline
3rd: Pacing

176
Q

Native valve acute IE treatment

A

Flucloxicillin IV

177
Q

Native valve sub-acute IE treatment

A

Amoxicillin +Gentamicin IV

178
Q

Prosthetic valve IE treatment

A

Vancomycin + gentamicin IV + Rifampicin PO

179
Q

Suspected MRSA IE treatment

A

Vancomycin + Gentamicin IV + Rifampicin PO

180
Q

PWID IE treatment?

A

Flucloxicillin

181
Q

Staph aureus treatment

A

Flucloxicillin IV

182
Q

Viridans streptococci

A

Benzylpenicillin + Gentamicin IV

183
Q

Staph epidermidis treatment

A

Vancomycin + Gentamicin IV + Rifampicin PO

184
Q

Enterococcus treatment

A

Amoxicillin/Vancomycin + Gentamicin IV

185
Q

Non severe HAP treatment?

A

PO amoxicillin
PO doxycycline if allergic

186
Q

Severe HAP treatment?

A

IV amoxicillin + gentamicin
PO doxycycline if allergic

187
Q

CURB 0-2 treatment?

A

Amoxicillin
Doxycycline if allergic

188
Q

CURB 3-5 treatment?

A

Co-amoxiclav IV + Doxycycline IV
Just Levofloxacin if allergic

189
Q

ICU pneumonia treatment?

A

Co-amoxiclav IV + Clarithromycin
Just Levofloxacin if allergic

190
Q

Sensitivity

A

(True +ve) ÷ (Total with disease)
Number of people with the disease that test positive

191
Q

specificity

A

(True -ve) ÷ (Total without disease)
Number of people without disease that test negative

192
Q

PPV

A

(True +ve) ÷ (Total +ve)
Number of people who test positive that have the disease

193
Q

NPV

A

(True -ve) ÷ (Total -ve)
Number of people who test negative that don’t have the disease

194
Q

PSA tumour marker

195
Q

HCG tumour marker

A

Germ cell cancer

196
Q

AFG (Alpha-Fetoprotein)

A

Hepatocellular carcinoma

197
Q

CA125

198
Q

CA15-3

199
Q

CA19-9

A

Pancreatic or biliary

200
Q

CEA

201
Q

CgA

A

Neuroendocrine

202
Q

Most affected by PSC

203
Q

Ducts affected by PSC

A

Large or medium, extra hepatic

204
Q

Antibodies in PSC

205
Q

Most affected by PBC

206
Q

Ducts affected by PBC

A

Small, intra-hepatic

207
Q

Antibodies in PBC

208
Q

Hep A transmission

A

Faecal-oral

209
Q

Hep B transmission

A

Vertical
Blood
Sexual

210
Q

Treatment of hep B

A

Tenofivir
Entecavir

211
Q

Hep C transmission

A

Blood - tattoos, transfusions

212
Q
A

neutrophil

Multilobes nucleus
Barr body

213
Q
A

Basophil

Bilobed nucleus
Obscured by basic dye of granules

214
Q
A

Eosinophil

Bilobed nucleus
Eosin (Pink) stained granules

215
Q
A

Lymphocyte

No visible granules
Large round nucleus

216
Q
A

Kidney-bean shaped nucleus

217
Q

Squamous cell carcinoma paraneoplastic syndrome

A

Parathyroid related hormone production -> Hypercalcaemia

218
Q

Small cell carcinoma paraneoplastic syndrome

A

SIADH -> Hyponatraemia
Cushings (ACTH)
Lambert-Eaton (Anti-Ca2+ antibodies)

219
Q

Adenocarcinoma paraneoplastic syndromes

A

Gynaecomastia
Hypertrophic pulmonary osteoarthropathy

220
Q

At what level does the aorta cross the diaphragm?

221
Q

At what level does the thoracic duct cross the diaphragm?

222
Q

At what level does the azygous vein cross the diaphragm?

223
Q

What can be damaged by foreign bodied lodged in the piriform recess?

A

Internal laryngeal nerve

224
Q

What is the treatment for Whipple’s disease?

A

1 year course Co-trimoxazole

225
Q

Is the tail of the pancreas intra- or retro- peritoneal?

A

Intraperitoneal

226
Q

What is the triad of Wernickes encephalitis?

A

Ataxia
Confusion
Ophthalmoplegia

227
Q

What causes Wernickes encephalitis in alcoholic patients?

A

Vitamin B1 deficiency

228
Q

What is Gilbert’s disease?

A

This is a genetic disease resulting in a deficiency of an enzyme responsible for bilirubin conjugation, leading to increased levels of unconjugated bilirubin, which at times of stress, can cause isolated jaundice

229
Q

What respiratory disorder is CF a risk factor for?

A

Pneumothorax

230
Q

Why is prothrombin a better measure of acute liver failure than albumin?

A

It has a shorter half life

231
Q

Where do thiazide-like diuretics act and how?

A

They inhibit Na+ reabsorption by blocking the Na+Cl- symporter at the proximal end of the distal convoluted tubule

Foundations of Medicine JMO (56 decks)

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