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YEAR 1 PHARMACY > PM1A practical written test > Flashcards

PM1A practical written test Flashcards

1
Q

In an ECG the P wave is associated with?

A

atrial depolarization

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2
Q

In an ECG the QRS complex is associated with?

A

ventricular depolarization

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3
Q

In an ECG the T wave is associated with?

A

Ventricular repolarization
Duration intraventricular conduction time

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4
Q

In an ECG the PR interval is associated with?

A

conduction from atrium to ventricle

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5
Q

In an ECG the QT interval is associated with?

A

Duration of ventricular action potential - start of ventricle contraction to end of relaxation

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6
Q

In an ECG the ST interval is associated with?

A

Duration of ventricular depolarization.

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7
Q

In an ECG the TP interval is associated with?

A

period of time between end of one ventricular repolarization ( T wave) and beginning of next cardiac cycle.

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8
Q

which interval is altered the most when heart rate is increased during high intensity exercise?

A

TP interval is reduced which reflects a decreased ventricular filling time.

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9
Q

list the factors that control heart rate before, during and after exercise

A

The autonomic nervous system (ANS) plays a key role in regulating heart rate:
During exercise sympathetic nervous system (SNS) is activated to increase heart rate and force of contraction to meet the body’s increased oxygen demand, while during recovery, the parasympathetic nervous system (PNS0 is activated to slow the heart rate back down to its resting level.

Hormones: Hormones such as adrenaline and noradrenaline are released during exercise, which can increase heart rate by activating the SNS. Additionally, hormones such as acetylcholine can decrease heart rate by activating the PNS

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10
Q

Describe the mechanical and electrical events occurring during a single cardiac cycle

A
  1. Atrial depolarization- SAN triggers action potential which spreads to the atrial muscle. (P WAVE)
  2. Atrial contraction- atria contract due to action potential.
  3. Ventricular depolarization- action potential sent along conduction pathways to ventricular muscle (QRS COMPLEX).
    The AVN delays AP sent from atria ( PR INTERVAL)
    The atria begin to repolarise and enter diastole- (phase 0).
  4. Ventricular contraction- AP triggers ventricles to contract (systole) (phase 2 of AP) (QRS COMPELX AND ST SEGMENT)
  5. Ventricular repolarization- T WAVE (phase 3 of AP).
  6. Ventricle diastole- TP INTERVAL (late phase 3 and phase 4)
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11
Q

When heart rate is increased during vigorous exercise, the TP interval is reduced. What happened to the other intervals?

A

PR interval slightly reduced- indicating slight reduction in the conduction time between atria and ventricles.
ST segment slightly shorter- indicating slightly shorter plateau phase or faster repolarization.

This tells us that exercise does not change the action potential length or conduction time greatly but rather the time between events is shortened slightly.

It is the time between the heart beats which is the greatest determinate of increased heart rate. This is consistent of sympathetic stimulation in exercise which would speed the rate of action potentials generated by the SAN- but have much smaller effects on the electrical properties of the cardiac cells and conduction pathways.

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12
Q

What happened to the pulse rate in hand exercise activity?

A

Pulse rate is effectively same as heart rate and reflects the whole body’s requirement for oxygen, so is unlikely to change much due to LOCAL exercise- same as at rest.

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13
Q

What happened to the pulse amplitude during RECOVERY from hand exercise?

A

Increase in pulse amplitude due to local vasodilation in the exercising muscles of the hand.
This vasodilation is caused by local factors and release of local hormones which dilate the blood vessels in the finger.
This bring increased oxygen and nutrients to the muscle as well as to help radiate the heat.

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14
Q

Forced vital capacity (FVC) definition

A

Volume of lungs from full inspiration to forced maximal expiration.

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15
Q

Forced expiratory volume in one second (FEV1) definition

A

Volume of air exhaled in the first second of a forced maximal expiration/FVC.

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16
Q

Tidal volume (VT)

A

The volume breathed in and out during each breath during restful breathing.

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17
Q

Inspiratory capacity (IC)

A

ALL the air breathed IN during a maximal inhalation after a normal expiration.
= VT+ IRV

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18
Q

Inspiratory reserve volume (IRV)

A

The maximum volume above the tidal volume that we can inhale into our lungs.

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19
Q

Expiratory reserve volume (ERV)

A

the maximum volume we can exhale from our lungs at the end of a normal breath.

OR

The maximum volume below the tidal volume that we can exhale from our lungs

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20
Q

residual volume (RV)

A

The volume of air remaining in the lungs after a full expiration/ that which is impossible for us to expire.

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21
Q

Expiratory capacity (EC)

A

all the volume of air that we can expire after a normal inspiration. = VT+ ERV

22
Q

Functional residual capacity (FRC)

A

The volume of air remaining in the lungs at the end of a normal expiration. = RV +ERV

23
Q

Vital capacity (VC)

A

all the air that can be expired from a maximal inhalation.
= ERV + VT+ IRV

24
Q

Total lung capacity (TLC)

A

All the air that is possible for the lungs to contain.
= ERV+VT+IRV+RV or
= VC+RV

25
Q

What is dyspnea?

A

Refers to difficulty in breathing- breathing can not increase sufficiently to match the perceived CNS requirements, leading to feelings of distress and breathlessness.

26
Q

Dyspnea can be acute (coming on over mins-hrs) or chronic (developing slowly over weeks- months).

Give examples of acute illnesses and chronic illnesses of dyspnea

A

Acute- pneumonia, myocardial infarction, acute asthmatic attacks, heart failure.

Chronic- restrictive lung disease, obstructive pulmonary disease (COPD).

27
Q

Describe the physiological significance of the FEV1/FVC ratio

A

The FEV1 to FEVC ratio is an indication of an airway diameter.
The ratio also provides info on the effectiveness of how well the lungs can turn over its total air volume.

The higher the ratio value, the FASTER air can flow through the airway ( therefore the wider the airway is and there’s less resistance).

The lower the ratio value, the more likely it is that the airways are obstructed.

28
Q

Why might the forced vital capacity be less than the vital capacity i.e in patients with asthma and COPD?

A

While forcing air out of the lungs, the pressure outside the airways increases rapidly.
If this external pressure exceeds the pressure in the airways, unsupported airways can collapse.
This results in air being trapped within the alveoli and is unable to be expired and measured.

29
Q

What is the purpose of the nose clip?

A

To promote breathing through the MOUTH.
This ensures that all air breathed passes through the mouthpiece, filter and flow head.

30
Q

What is a volume that spirometers cannot measure? Hint: it is a volume that can be calculated from the patient size.

A

Residual Volume (RV) because it is the volume of air that remains in the lungs after a full expiration which is impossible for us to expire.

31
Q

How to measure blood pressure using a finger pulse transducer?

A

Arm at heart level:
1.Inflate the cuff to 30 mmHg higher than the estimated systolic BP. Note when the finer pulse signal disappears.
2. Slow deflate the cuff at a rate of 1-2 mmHg/s. Note when the finger pulse signal reappears.
3. Deflate the cuff completely when pressure falls below 50 mmHg.
Repeat with arm above head.

The first clear pulse to reappear as cuff pressure was decreasing is the systolic pressure, this is the return of blood flow back to the forearm.

32
Q

How to measure blood pressure using a cardio microphone

A
  1. Wrap the arm sphygononometer around the upper arm.
  2. Ensure the cardio microphone is positioned over the brachial artery and held in place with a Velcro strap.
  3. Inflate the cuff to 30 mmHg higher than the estimated systolic pressure.
  4. Slowly reduce the pressure in the cuff (~2–3 mmHg/s).
  5. Deflate the cuff completely after the pressure has fallen below 50 mmHg or after the disappearance of the Korotkoff sounds. Enter “slow” into the Comment panel
  6. Allow 1–2 minutes for recovery.
  7. Repeat the procedure on the same volunteer, but modify the speed at which you release the pressure in the cuff ( at medium and fast).
33
Q

What does the volume correction procedure correct in the spirometer practical?

A

corrects for the fact that expired air is of greater volume than inspired air . This is due to expired air being warmer and containing more water vapor

33
Q

What does the volume correction procedure correct in the spirometer practical?

A

corrects for the fact that expired air is of greater volume than inspired air . This is due to expired air being warmer and containing more water vapor

34
Q

Compare and contrast vital capacity, forced vital capacity and forced expiratory volume 1.

A

Vital capacity- the maximal amount of air exhaled steadily from full inspiration to maximal expiration, it’s not time-dependent and should be >80% of predicted value.
It is reduced in restrictive disease.

FVC- volume of air in lungs from full inspiration to forced maximal expiration.
Reduced in both obstructive and restrictive disease.

FEV1- volume of air exhaled in the first second of a first expiration.
Reduced in both obstructive and restrictive disease.

35
Q

Explain what the finger pulse transducer is measuring?

A

Measuring the arterial pulse in the finger. This is measured by pulse distending the membrane on the transducer and converting to electrical signals.
Higher amplitude- higher blood flow and vice verse

36
Q

What is the auscultatory gap?

A

When the korotkoff sound disappear completely for a short time and then reappear at a lower level. This can lead to errors in blood pressure measurement: underestimation of systolic blood pressure.

For this reason it’s important to first estimate the systolic pressure by palpation.

37
Q

How did deflating the cuff more quickly alter your blood pressure measurements?

A

The heart rate limits the speed at which you can accurately record the blood pressure.
The cuff needs to be deflated at a rate such that there is time for every heart beat to be detected as pressure decreases.
If a heart beat is missed, the pressure reading will be in error.

REMEMBER: for accuracy, the rate of cuff deflation must be slow enough to capture every single pulse as a korotkoff sound. The slower a person’s heart rate is the slower the cuff should be deflated.

38
Q

Explain how cuff size affects the measured blood pressure.

A

The measurement of arterial blood pressure using a sphygmomanometer cuff requires that the artery be uniformly compressed and that the pressure in the cuff is accurately transferred to the artery wall.It is essential that the right sized cuff is used for this:
- If the cuff is too narrow (small), values will be too high because it exerts excessive pressure on a smaller area, this happens because the cuff compresses the artery to a greater degree than if it were the appropriate size, leading to higher pressure readings.
- If the cuff is too wide (large), values will be too low because it exerts less pressure than it should, the cuff doesn’t compress the artery enough to prevent the flow of blood through it, leading to underestimation of arterial pressure. Notethat the error from using a cuff that is too narrow, is appreciably greater than that from using a cuff that is too wide.

When measuring blood pressure, use a larger cuff on obese or heavily muscled subjects and a smaller cuff for paediatric patients.

39
Q

What happened to the finger pulse amplitude and systolic pressure when the arm is held above the head. Why?

A

The finger pulse amplitude and systolic pressure typically decreases dramatically when the arm is held above the head.
This is because the gravitational force acting on the blood in the arm causes an increase in the hydrostatic pressure, which reduces the arterial blood pressure in the finger. Also blood flow decreases to the arm which further reduces the finger pulse amplitude.
Say this in exam: the physiological reasonfor this observation is that the hand is more poorly perfused when held above the head; so the systolic pressure is decreased by thehydrostatic pressure due to gravity.

40
Q

What factors may affect the measurement of blood pressure?

A

Noisy surroundings can affect the difficulty of hearing Korotkoff sounds.
Cuff being wrapped too tightly around the arm.
Releasing cuff pressure too quickly, resulting in diastolic pressure being measured inaccurately. Cuff Pressure should be released in accordance with heartbeat, so that it is not missed.
Positioning of patient (standing / sitting / laying down).
Patient bladder being full with urine can affect blood pressure readings as the pressure on the kidneys would be increased.
Rest sufficiently after exercise before taking measurements due to the fact that blood pressure plummets following exercise.
Eating food before a blood pressure test causes alteration within results.
Emotions

41
Q

What is the difference between local blood flow (pulse amplitude) in the finger pulp between local exercise and systemic exercise?

A

In local exercise, there is no major requirement to increase cardiac output or redirect direct blood, vasodilation is controlled by local factors (less/no change)

In systemic exercise, large amounts of blood are diverted from the extremities to the exercising muscles due to sympathetic stimulation (release of non adrenaline to the Sinoatrial Node, binding with beta adrenoceptors) and circulating adrenaline. This results in the arteries in the finger being constricted (pulse amplitude decreases).

DURING RECOVERY: local factors divert blood to extremities to radiate the heat, and in local exercise provide nutrients and oxygen- finger pulse amplitude increases.

42
Q

Why might movement cause an artifact on both the ECG and finger pulse recordings?

A

ECG: movement causes electrical interference of the signal altering the position of the cable, this can cause noise which alters the ECG signal as relative position of electrodes changes. There can also be biological interference from electrical signals from muscles that are moving.

Finger pulse: transducer detects tiny movement in the finger pulp due to blood flow, it is extremely sensitive to movement/ vibrations.

43
Q

What other factors may influence the supply of blood to the skin and fingers during and after exercise?

A

Changes in blood supply due to changes in pH ( decreases). reduced local O2 or increased CO2 as well as hormones released at the tissue. Changes to electrolytes and sugars can also have an effect.

44
Q

What are korotkoff sounds and when do they disappear?

A

These sounds are produced by the turbulent flow as blood flows throughthe narrowed/constricted artery when pressure in the cuff is slowly released.
This turbulent flow causes vibrations in the arterial walls which is heard by the stethoscope.
The sounds disappear when the pressure in the blood exceeds that in the cuff so that the artery returns to its normal diameter.

45
Q

What are the advantages and disadvantages of using a digital meter to measure blood pressure?

A

Advantages:
Non invasive, automatically adjusts the rate of cuff deflation to match the heart rate.
Measures both systolic and diastolic blood pressure
Doesn’t listen to sounds but records vibrations- less sensitive to background noise and less open to individual interpretations making measurements more accurate and consistent between practitioners.
Easy to use and doesn’t require training allowing individuals with no background knowledge to measure their own blood pressure.

Disadvantages: can sometimes be inaccurate and produce unreliable readings- especially in people with certain heart rhythms or arteries that have hardened due to arteriosclerosis.

46
Q

Describe the advantages and disadvantages of the auscultation method (including cardio microphone) in measuring blood pressure.

A

Advantages:
Measures both systolic and diastolic blood pressure
Non invasive

Disadvantages:
Can vary from practitioner to practitioner
Hard to detect when sounds start and finish especially when room is noisy.

47
Q

Pharmacists are likely to encounter patients seeking guidance regarding BP monitors. What do you think a pharmacist can do to assist a patient with purchase of this type of device? Hints: think about factors related to the actual device and to a specific patient.

A

Pharmacists can assist patients in selecting a monitor that best suits individual needs and can ensure that patients are properly educated and comfortable using the device. e.g., Don’t place the cuff over clothing. Flex and support the subject’s arm. Routinely check batteries on electronic models and store monitor in proper place.
Factors to consider when selecting a monitor may include: cost, cuff size, ease of use, patient preference, memory features, large digital display, reliability, and accuracy. e.g. Aneroid and digital manometers may require periodic calibration.
When recommending an arm-type monitor, pharmacists should stress the importance of selecting one with the proper cuff size to obtain accurate results e.g.,
Use a larger cuff on obese or heavily muscled subjects.
Use a smaller cuff for pediatric patients.

48
Q

Understand and describe the clinical use of the Spirometry test

A

Spirometry is the most common pulmonary function test, it uses a spirometer to measure lung function by measuring air flow and the corresponding changes in lung volume directly.
Can be used to monitor how much air a patient can inhale and exhale with each breath. This is helpful in the diagnosis and monitoring of patients with lung diseases and determining the best treatments for these patients.

49
Q

How might lung volumes and capacities be altered in a 74-year-old womanwho struggles with breathlessness?

A

• Alveoli damaged over time, and she has regions in the lungs where air is trapped.
• This trapping is worsened by airways collapsing causing an obstruction that is especially marked during expiration.
• The consequence is a marked increase in her residual volume (RV). The trapped air has expanded the lungs and the work of breathing is increased significantly. This increased work of breathing contributes to her feeling of breathlessness.

50
Q

In practical use, the FEV1 and FVC are measured in litres and usually each expressed as a percentage of predicted values.
Explain what ‘predicted values’ are and mean.

A

• Predicted values represent the ‘normal average’ values expected for a healthy patient given their gender, age and height. Values are based on large scale population studies and are merely averages and apply to Caucasians.
-Values should be reduced by 7% for Asians and by 13% for Afro-Caribbeans.

YEAR 1 PHARMACY (7 decks)

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