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MD3001 > MD3001 Week 4 > Flashcards

MD3001 Week 4 Flashcards

1
Q

outline narrative ethics

A

this centres ethical dilemma squarely in patient’s life; to do right requires an understanding of the person

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2
Q

care provided by a doctor (GMC) must… (4)

A
  1. act in accordance w/ relevant legislation
  2. not treat patients unfairly
  3. not deny patients access to appropriate services or care
  4. not cause patients distress
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3
Q

how do medical students differ from doctors in their right to use conscientious objection?

A

medical students have this right but must meet GMC’s outcomes for graduates

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4
Q

4 arguments against conscientious objection

A
  1. inefficiency and inequity
  2. inconsistency
  3. commitments of a doc
  4. discrimination
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5
Q

what occurs when CO drops and blood flow to kidneys drop?

A

when this happens to CO, renin is released (RAAS)

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6
Q

negative effects of increased sympathetic activity due to cardiac failure (3)

A
  1. tachycardias, vasoconstriction
  2. increased workload of heart
  3. desensitization of beta but not alpha receptors (heart works less, but vessels still constricted)
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7
Q

why is increased RAAS due to cardiac failure bad?

A

increase of this compensatory mechanism can cause oedema in cardiac failure

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8
Q

negative effect of angiotensin II/aldosterone on heart

A

these hormones deposit fibroblasts and collagen in the ventricles leading to increased stiffness thus decreased contractility

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9
Q

what causes white reaction on skin?

A

myogenic response by stretched Ca2+ channels, causing pre-capillary sphincter contraction

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10
Q

triple response (3)

A
  1. red reaction (flush): to pre-capillary sphincters opening
  2. flare: stimuli travel anti-dromically to adjacent arterioles to dilate
  3. wheal: local oedema caused by increased capillary permeability
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11
Q

affects of adrenaline on damaged skin

A

this hormone causes white reaction due to intense pre capillary constriction

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12
Q

effect of chronic obstructive pulmonary disease on CVS

A

this disease displaces capillaries in lungs, so not enough O2 and RV pumps harder – causes cor pulmonale

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13
Q

amyloidosis

A

deposits of abnormal starch protein in tissues and organs

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14
Q

effect of COPD on CVS

A

this systemic disease can cause ischaemia as heart tissues can’t contract as well

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15
Q

sarcoidosis

A

abnormal collection of inflammatory cells forming granulomas

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16
Q

effect of sarcoidosis on CVS

A

this systemic disease can cause arrhythmias

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17
Q

what valvular heart disease can cause atrial fibrillation?

A

mitral stenosis has this affect on heart rhythm

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18
Q

infective endocarditis

A

infection of valve w/ formation of thrombic vegetations (fibrin + platelets)

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19
Q

what inflammatory disease can cause any valvular heart disease?

A

rheumatic fever can cause this

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20
Q

how are fatty streaks made?

A

monocytes in blood are recruited into tunica intima, turned into macrophages which engulf fat and turn into foam cells

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21
Q

how is fibrous cap of fibro-fatty plaque made?

A

foam cells release cytokines which attract smooth muscle from media to intima

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22
Q

how does angina appear on ECG?

A

causes ST depression

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23
Q

how does myogenic control affect BP vs Flow graph?

A

this mechanisms allows flow rate to stay the same with a change in BP

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24
Q

coronary flow reserve

A

maximum increase in coronary flow above the normal resting volume

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25
top 2 causes of MI
1. plaque rupture 75% | 2. plaque erosion 25%
26
difference b/w STEMI and NSTEMI
former MI is caused by fully blocked coronary artery while latter is partial
27
what type of MI implies sub-endocardial ischaemia?
NSTEMI implies this type of ischaemia
28
2nd degree heart block
partial AV block causing only some Ps leading to QRS
29
Mobitz type 2 heart block
heart block causing most Ps having QRS but once in a while no
30
Wenckebach (Mobitz type 1) block
progressive lengthening of PR until P wave fails to produce a QRS, then resets
31
2 types of blocks that can cause circus re-entry movements
1. unidirectional | 2. transient (allows some impulses but not all)
32
possible consequences of Wolf-Parkinson-White Syndrome (2)
1. paroxysmal tachycardia | 2. re-entry circuit
33
effects of Wolf-Parkinson-White Syndrome on ECG
this disease causes a delta wave which shortens PR and widens QRS
34
atrial fibrillation on an ECG
no discernible P waves and irregular QRS complexes
35
junctional (nodal) tachycardia on an ECG
normal QRS complexes but absent P waves
36
what condition causes long QRS?
L/R bundle branch blocks cause this on ECG
37
what abnormal ST is a sign of infarction?
elevation > 2mm in 2 adjacent chest leads OR elevation > 1mm in 2 adjacent limb leads
38
what is depressed ST a sign of?
this ECG characteristic is a sign of ischaemia
39
digoxin effects on ECG (2)
1. T wave inversion | 2. ST segment sloping depression
40
abnormal T wave
abnormal if inverted in I, II, and V4-6 (ischaemia/infarct)
41
L axis deviation on ECG
negative QRS deflections in II and III
42
R axis deviation on ECG
negative QRS deflection in I
43
ECG signs of hyperkalaemia
tall T wave, widened QRS
44
ECG signs of hypercalcaemia
short QT interval
45
alternate treatment of hypertension (2)
1. alpha blocker (doxazosin) | 2. spironolactone
46
treating chronic heart failure (3)
1. DAB (sacubitril-valsartan instead of ACE/ARB in severe) 2. spironolactone/epleronone 3. cardiac resynchronization therapy to those w/ long QRS (BBB)
47
sacubitril-valsartan
former inhibits Neprilysin preventing breakdown of b type natriuretic peptide (BNP), latter is an ARB
48
four causes of acute chest pain
1. non cardiac chest pain 2. troponin negative ACP 3. NSTEMI 4. STEMI
49
STEMI treatment
Emergency: Aspirin and angioplasty (if near hospital)/thrombolysis (if far). Also blood thinners: aspirin and clopidogrel/ticagrelor (blood thinners), low MW Heparin or fondaparinux
50
fondaparinux
synthetic pentasaccharide that inhibits activated factor x
51
atrial fibrillation treatment (3)
1. prevent emboli w/ Warfarin/Rivaroxaban 2. control rate w/ beta blocker or digoxin 3. control rhythm (seldom done) w/ cardioversion
52
treatment for stroke
(if NO haemorrhage) Thrombolysis for emergency, aspirin acutely and for 2 weeks, then clopidogrel
53
side effects of diuretics (3)
1. hypokalaemia (thiazide) 2. diabetes 3. gout
54
furosemide
loop diuretic used in heart failure
55
mechanism of Digoxin (2)
1. increase vagal activity, which decreases HR and AV conduction speed 2. increase contractility by inhibiting Na/K ATPase, which accumulates Na+ in SR so NCX reverses and stores more Ca2+
56
initial drug treatment for acute heart failure (3)
1. IV loop diuretics 2. IV opiates/opioids 3. IV buccal or sublingual nitrates
57
second line drug treatment for acute heart failure (3)
1. beta-agonists (dobutamine) 2. dopamine - increases renal perfusion and BP 3. adrenaline - increase contractility
58
effects of nephrosclerosis (3)
1. lose nephrons due to vascular narrowing 2. proteinuria 3. haematuria
59
in which situations does BMA support conscientious objection? (3)
1. abortion 2. fertility treatment 3. withdrawal of life-sustaining treatment
60
what type of infarct presents pathology Q waves and ST elevation in II, III, and AVF?
inferior infarct has this ECG
61
outline Janaway case
case where secretary refused to type abortion letter on conscientious objection. But you can only CO if you play a role in the actual procedure
62
outline Eweida case
Christian working for BA that was told to conceal her cross
63
human right
right to freedom of thought, conscious and religion. However subject to limitations in interest of public safety, protection of public order, health or morals, or protection of rights and freedoms of others
64
define afterload
force the heart must generate to eject blood from heart
65
normal ejection fraction
50-65% of EDV pumped out
66
define systolic ventricular dysfunction
impaired cardiac contractility (ejection fraction <40%)
67
define diastolic ventricular dysfunction
normal ejection fraction but impaired diastolic ventricular relaxation and decreased filling
68
common causes of systolic dysfunction (3)
1. contractility (cardiomyopathy) 2. volume overload 3. pressure overload (ex. stenosis, hypertension)
69
causes of diastolic dysfunction (4)
1. constricted ventricular expansion (ex. constrictive pericarditis) 2. increased wall thickness (ex. hypertrophy) 3. delayed diastolic relaxation (ex. aging) 4. increased HR
70
direct result of R heart failure
this type of heart failure causes congestion of peripheral tissues
71
direct results of L heart failure (2)
1. decreased CO | 2. pulmonary congestion
72
4 compensatory mechanisms of decreased CO
1. sympathetic activity 2. RAAS 3. Frank-starling 4. fluid movement
73
problem w/ increased Frank-starling in cardiac failure
this compensatory mechanism increases EDV -> muscle stretch -> O2 consumption
74
what heart condition can COPD cause?
this lung disease can cause cor pulmonale - R hypertrophy caused by pulmonary hypertension
75
define angina
mismatch of supply (coronary blood flow) and demand (myocardial O2 consumption)
76
3 degrees of heart blocks
1. affected AV 2. partial block 3. full block (separate A V innervation)
77
Mobitz type 1 heart block
heart block causing QRS to occur occasionally after P
78
Wolf-Parkinson-White Sydrome
condition characterized by "accessory" electrical connection b/w atria and ventricles (usually L); no delay in accessory so depo reaches ventricle early
79
normal P wave
<0.25mV
80
normal QRS complex
<0.12s, >5mm
81
ventricular tachycardia on ECG
wide QRS complexes
82
P-mitrale on ECG
bifid P wave denoting L atrial hypertrophy
83
P-pulmonale on ECG
peaked P wave denoting R atrial hypertrophy
84
ECG sign of L ventricular hypertrophy
R wave in V5 (isoelectric line to tip) >25mm/2.5mV
85
ECG sign of R ventricular hypertrophy
- dominant R wave in V1 (ie. bigger than S) - T wave inversion in V1-3 - deep S wave in V6
86
how to measure QT interval
measure from Q to end of T and use QTc = QT/√RR
87
normal QTc interval
0.38-0.42s
88
drugs to prolong survival in angina (4)
Statin Aspirin ACE inhibitor Beta blocker
89
drugs to relieve symptoms of angina
sequentially: 1. BB 2. Ca2+ or NO 3. coronary angioplasty 4. ivabradine/ranolazine 5. coronary artery surgery
90
side effects of ACE inhibitors (4)
1. cough | 2. renal dysfunction
91
tirofiban
glycoprotein IIb/IIIa inhibitor (anti platelet) for ongoing chest pain
92
causes of stroke (3)
1. cerebral thrombosis 2. cerebral embolus 3. cerebral haemorrhage
93
side effects of beta blockers (3)
1. bradycardia/heart block 2. tired 3. asthma
94
spironolactone
aldosterone blocker
95
ARB used in chronic heart failure
candesartan
96
define forward and backward failure
former is caused by reduced perfusion of tissues. backwards is due to increased venous pressures
97
pulmonary hypertension
pulmonary BP >30mmHg
98
barriers to exercise
- too tired - not in mood - don't know how - fear - no time
99
define cardiac rehab
process by which patients w/ cardiac disease, in partnership w/ multidisciplinary team of health professionals, are encouraged and supported to achieve and maintain optimal physical and psychological health
100
SMART goals in cardiac rehab
``` Specific Measurable Achievable Realistic Time based ```
101
steps for NHS exercise for cardiac rehab (3)
1. 15m warm up 2. 20m conditioning phase (circuit based, comfortably short of breath) 3. 10m cool down
102
FITT principle of exercise
Frequency Intensity Time Type
103
macro and microscopic changes 1-2 days after MI
macro: pale, oedematous micro: oedema, neutrophil
104
macro and microscopic changes 3-4 days after MI
macro: yellow, rubbery centre micro: inflammation and early granulation tissue
105
macro and microscopic changes 1-3 weeks after MI
macro: infarcted area more pale micro: granulation tissue, some fibrosis
106
macro and microscopic changes 3/6 weeks after MI
macro: silvery scar micro: dense fibrosis

MD3001 (10 decks)

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