My Final Day Flashcards Flashcards by Emily Brown

treatment for pulmonary embolism

Admission to hospital

 Oxygen
 Analgesia
 Monitor for deterioration

 Apixaban or rivaroxaban
 Anticoagulation
 Warfarin
 NOAC
 LMWH

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sarcoidosis investigation

 CT thorax
 Chest X-ray
 MRI
 PET SCAN
 Bloods

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could you give oral steroids for sarcoidosis

yes

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could heart block be a symptom of sarcoidosis

yes
so see for tomorrow, literally just put any disease they suggest

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For long-term symptomatic relief of angina, first-line is with either, or a combination, of:

For long-term symptomatic relief, first-line is with either, or a combination, of:

Beta blocker (e.g., bisoprolol)
Calcium-channel blocker (e.g., diltiazem or verapamil – both avoided in heart failure with reduced ejection fraction)

but GTN for immediate relief

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when are: Calcium-channel blockers (e.g., diltiazem or verapamil) for symptomatic relief of angina, avoided

in heart failure with reduced ejection fraction

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secondary prevention for angina =

Medications for secondary prevention can be remembered with the “four As” mnemonic:

A – Aspirin 75mg once daily
A – Atorvastatin 80mg once daily
A – ACE inhibitor (if diabetes, hypertension, CKD or heart failure are also present)
A – Already on a beta blocker for symptomatic relief

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all those formulas like tidal

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all the drugs

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valsalva maneouvre

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chadvasc

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hasbled

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whats heparin

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vital vs tidal capacity

Vital Capacity describes the largest volume of air that can be voluntarily exhaled after a maximum inhalation.

Tidal = in AND out in one breath

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Alveolar ventilation volume is more or less than pulmonary ventilation volume

less- alveolar is what participates in gas exchange

Pulmonary (or minute) ventilation describes the total amount of air breathed in or out per minute (basically tidal volume x respiration rate). Alveolar ventilation accounts for the volume of air that gets stuck in dead space and never reaches the alveoli, so dead space volume must be subtracted from tidal volume before multiplying by respiration rate ((TV-DS) x RR), making alveolar ventilation smaller than pulmonary ventilation i.e. not all the air you breath in reaches the level of the alveoli and participates in gas exchange!

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Respiratory acidosis often accompanies severe lung pathology.

True. Most lung pathologies lead to an impairment of gas exchange for one reason or another. This impairment increases CO2 levels in arterial blood. An increase in CO2 leads to an increase in H+ concentration

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An increase in 2,3-diphosphoglycerate (DPG) in the red cells will shift the haemoglobin-O2 saturation curve to the right

Yes: DPG:reducing the affinity of haemoglobin for oxygen, and in doing so shifts the curve to the right.

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ventilation and perfusion where greatest

There is good correlation with ventilation and perfusion – both are greatest at the base of the lung (in the upright position) and both decrease with height. However blood flow declines faster than ventilation so while blood flow exceeds ventilation at the base of the lung, ventilation exceeds blood flow at the apex

base of lung
blood flow greatest at base

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A shift of the oxygen dissociation curve of haemoglobin to the right or left is seen in foetal blood, as compared with adult blood

A shift of the oxygen dissociation curve of haemoglobin to the left is seen in foetal blood, as compared with adult blood

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what does hyperventilation do

Hyperventilation will top up oxygen levels but more importantly lower CO2 levels.

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how does centric acinar occur

bronchiolar dilation
loss of alveolar tissue
little holes in the lungs

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In an acute asthma attack, how are steroids given

steroids should be given orally, or sometimes intravenously.
eg prednisalone

It’s SABA that’s given via nebuliser

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For a diagnosis of chronic bronchitis to be given, a patient should have a cough productive of sputum for how long

most days
three months
2 years

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An excess of alpha-1-antitrypsin can lead to emphysema, true or false

False
alpha-1 antitrypsin is an enzyme which breaks down other enzymes that break down alveolar tissue. A deficiency of this enzyme tips the balance towards tissue destruction, and can lead to emphysema

So its loss of alpha-1-antitrypsin = emphysema

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Washing a spacer does what to static charge

decrease it washing the spacer device leaves a coating of detergent, which will decrease the static charge. This means the drug is less likely to stick to the spacer, and increases drug delivery to the lungs. so it's a good thing

You are more likely to have asthma if your mother is asthmatic than if your father is asthmatic.

true

In assessing severity of acute asthma in adults, subjective parameters (eg. distress) are just as important as observations and blood gases. this statement is false. Why?

patients and doctors tend to underestimate asthma severity, and a life-threatening attack may not be associated with significant distress. Objective measurements such as vital observations (pulse rate, oxygen saturations, peak flow) and blood gas analysis are most useful.

Female sex is a risk factor for COPD. explain- considering that there are more males with COPD!

females smokers more likely than male smokers

In spirometry, an FEV1:FVC of 0.5 would be considered obstructive

true Because normal is 0.7-0.8

Most infections causing exacerbations of COPD are viral.

True – although patients will often receive antibiotics for acute infective exacerbations of COPD, in the majority of cases the pathogen is a virus.

initial treatment for paediatric asthma

very low dose inhaled steroids are the initial treatment for paediatric asthma. but if more than twice a week then add LABA

A child >5 on a very low dose inhaled corticosteroid who continues to require their reliever inhaler twice a week should have a long-acting beta agonist added on to their treatment.

true

COPD is a cause of finger clubbing

false

What 4 diseases could cause finger clubbing?

lung cancer, lung infections, interstitial lung disease, cystic fibrosis or cardiovascular disease low oxygen and high CO2

Regular use of a brown inhaler in childhood can restrict adult height by up to what

0.5-1cm

Type 2 respiratory failure is a feature of severe COPD.

True – An easy way to remember type 1 vs type 2 respiratory failure is that in type 2 failure, the movement of 2 gases is impaired. In type 1 respiratory failure, there is a failure of oxygenation, but ventilation is adequate to clear CO2 (remember that CO2 dissolves much more readily than oxygen). In type 2 respiratory failure, ventilation is impaired to the point that not only does oxygenation fail, but CO2 isn’t being cleared, and CO2 levels rise. In COPD, this is a sign of advanced disease.

How do we treat latent TB

Latent TB (positive Mantoux or IGRA test in a person who has had contact with TB). The same antibiotics are used, for a slightly shorter course, usually 3 to 6 months.

does amoxicillin have much action against atypical organisms

no if atypical, treat with macrolide like co-trimoxazole

Rusty brown sputum is a symptom of staph or strep

strep

side affect of rifampicin

rifampicin causes all bodily fluids to turn orange-red, so it is best to advise patients not to wear contact lenses!

rifampicin is an antibiotic that can be used to treat TB

true

how does flu lead to secondary infections

damage to mucociliary escalator

Name the complication: involves the wide dissemination through the bloodstream of TB granulomata, and commonly involves spread to the brain and meninges.

Miliary TB

CURB-65- what are the guidelines

confused urea over 7 resp rate OVER 30 bloop pressure under 90/60 and if over age 65

How do we class latent TB

positive Mantoux or IGRA test in a person who has had contact with TB, but is asymptomatic and has a normal CXR

ethambutol can be used to treat TB, true or false

true

Pneumonia caused by Mycoplasma pneumoniae tends to occur in what yearly epidemics.

4-5

Klebsiella pneumoniae infection is typically associated with alcoholism and other causes of aspiration.

true

Moraxella catarrhalis is a typical cause of LRTIs in COPD.

true

what is a typical cause of LRTIs in COPD.

Moraxella catarrhalis

what pneumonia is associated with intravenous drug abuse.

staph

what pneumonia is classically seen following influenza infection.

staph

do we give antibiotics in ear infections like otitis media

Rifamicpin can reduce effectiveness of oral contracteptive pill

what treatment of croup and why

oral steriod eg dexamethalone for reduce inflammation causes barking cough and stridor

UIP is idiopathic

True

Pulmonary hypertension in Chronic respiratory disease occurs due to chronic hypoxia

True Reflex construction of pulmonary vessels This construction increased vascular resistance and therefore pressure of pulmonary circulation.

Pulmonary Hypertension is what

>25mmHg

UIP has basal predominance

True

There are no Granulomas in sarcoidosis

Trye

Is there necrosis one sarcoidosis

Sarcoidosis is NOT caseating Granulomas, that’s the hallmark of what:

What happens in Tb

There is a ghon focus Then ghon complex Then calcification Then fibrosis Then scar Than RANKE complex = seen on CXR

Examples of type 1

Pulmonary oedema ARDS Interstitial pbeumonitis

Caseating Granulomas is TB

CF patients are encouraged to meet other CF patients, true or false

False

Patients with CF must have a double lung transplant only

True Because high risk of recurrent infection

Many cases of sarcoidosis are mild and self limiting and don’t require treatment. If they do, then what?

Topical steroids or NSAIDS like ibuprofen is sufficient

In chronic ventilator failure, what is the pH?

Normal As elevates bicarbonate

Acute ventilator failure , oh?

Low

What are central apnoeas

Absence of respiratory drive ie detected by one chest wall movement

Most common apnoea

Obstructive apnoea Negative pressure generated by respiratory movengx if chest walk, = draws upper airways inwards and obstructs the airway

You can get respiratory failure from obstructive sleep apnoea, why

CO2 retention

What big cardiac issue could you get with obstructive sleep apnoea

Cor pulmonale

Pleura from where

Pleura from mesoderm Embryonic lung are from the endoderm like the gut

Hernias are more common in which side

Left side

Can babies be diagnosed before birth and is there an issue with this

Yes Slightly increased risk of miscarriage (eg chorionic villus sampling, amniotic fluid sampling)

Pressure in all systemic arteries are the same, true or false

True

What is Map equal to

Average pressure in arteries throughout cardiac cycle Roughly equal to diastolic pressure plus a third of pulse pressuee

What’s pulse pressure

The difference between the upper and lower numbers of your blood pressur

Do capillaries have smooth muscle

No Therefore they cannot vary their resistance

MAP in aorta is about equal to what in the pulmonary trunk

1/5th Pressure is 1/5th

Gradual closing of K+ channels = contributes to pacemaker potential

Yes

Sympathetic fibres, innervation g heart to increase contractility, acts on what

Noradrenaline acts on beta 1 receptors

PR interval is normally under 0.2 seconds

Yes If over that, = 1st degree heart block

What does the PR interval indicate

Time between the start of atrial depolarisation, and the start of ventricular depolarisation.

What is the plateau phase of the cardiac action potential maintained by

Entry of L type voltage gated Ca2+

Initial fast depolarising stage of action potentials is mediated by what

Voltage gated Na2+ channels

Concerning the cardiac cycle: the left atrial pressure rises at the start of systole

True Because when ventricle contracts, mitral and tricuspid valves close, and bulge into the atria, until the aortic and pulmonary valves actually open

End systolic volume is about what

60 ml

Smooth muscle surrounding arterioles expresses beta 2 receptors

True Heart and skeletal muscle is where arterioles express many beta 2 receptors

Most blood vessels are nine rated only by what

Sympathetic

How does sympa in vessels lead to vasoconstriction

Noradrenaline, activated alpha 1 receptors, therefore vasoconstriction. Only genitalia and salivary gland VESSElS are exceptions- have para

Local arteriolar dilation, as occurs in exercising muscle, may cause oedema.

True As dilation will increase hydrostatic pressure in downstream capillaries, and increase amount of fluid filtered out

More K+ = what in the heart

Depolarise and therefore approach threshold and randomly fire action potentials

Cardiac muscle cells are capable of tetanus contractions.

False

Cardiac muscle has a long action potential

Yes Therefore long refractory period So not capable of tetanus contraction

Plateau phase in non pace maker action potential: caused by:

Decreased permeability to K+ and less K+ leaving the cell And increased Ca2+ entering

T wave = ventricular depolarisation

True

What does the U wave represent

Nobody knows

Second heart sound is what

Closure of aortic and pulmonary valves Because it’s diastole

3rd heart sound = 4th heart sound =

Rapid filling phase Active filling stage

What closes the mitral valve?

Pressure in left ventricle exceeding pressure in left ventricle

Stenosis of which valves could cause a systolic murmur?

Aortic and pulmonary valves

Stenosis of which valves could cause diastolic murmur

Mitral and tricuspid

Adrenaline and noradrenaline bind to what in the sinoatrial node, to do what

B1 Increase heart rate

Does the vagus nerve alas innervate sinoatrial nose

Yes

What happens to after load and SV when TPR increases

After load increases and SV decreases

Does arteriolar construction decrease end diastolic volume?

No What does though is increased venomotor tone, pump, resp pump, skeletal muscle pump

Why does t arteriolar constriction have affect on EDV

Because it’s “after” the heart. But arteriolar constriction DOES increase TPR and afterload

Does increasing after load, increase MAP?

It means the same thing really Yes After load IS the result of a higher pressure system

An increase in after load will decrease stroke volume, true or false

True

Increases preload increases stroke volume

True

Clefts are between endothelial cells, pores are across Or is it the other way around

No that’s teye

Capillaries- can have no pores or clefts?

True In blood brain barrier

Capillaries have a narrow lumen?

Truw

What does increases binding of adrenaline and noradrenaline to what causes arteriolar constriction

Alpha 1 receptors

Which arterioles supplying what mostly express Beta 2?

Cardiac and skeletal muscel

Alpha 1 is usually smooth muscle contraction and arteriolar constriction, am I right?

Yes you are right

Explain structure of an atheromatous plaque

Atheromas have lipid cores and a fibrous tissue cap

Severe burns are a risk factor for DVT

Yea Anything that increases coagulability of the blood will increase risk of DVT

Arteriosclerosis vs atherosclerosis

Arteriosclerosis = age related thinking of smooth muscle, Initial fibrosis and duplication of internal elastic laminal layer

Decrease in peripheral vascular resistance = decrease in blood pressure and vice versa

Trye

How quickly to correct blood pressure

Slowly

Atheromatous plaque formation = what cells

Monocytes to atrial intima in response to damage, then they transform to foamy macriphages

Intervranial bleeding = what risks for theombolyiss

Patients with recent stroke and a stemi

Rheumatic fever is what bacteria

Strep

Emergency vs urgency for hypertensive damage

Urgent = oral and can be revised in 24 hours Emergency = admission and usually IV therapy

Heart when infarcted is what type of necrosis

Coagulation

Heart failure = activation of RAAS system why

Because reduced CO is registered as reduced circulating volume, so salt and water is retained by RAAS