Polishing Flashcards
Describe the coronary venous drainage
Great cardiac vein: arises at apex, runs in AV sulcus and around to the coronary sinus. Drains territory supplied by LCA
Middle cardiac vein: runs in posterior interventricular septum
Small cardiac vein: starts on right marginal side, runs in AV sulcus to drain into coronary sinus
How can CKD cause hTn?
- Kidneys cannot filter blood as effectively
- Less sodium detected by macula densa
- Renin release
- Plus: increase in blood volume because less is filtered out
What is phaeochromocytoma?
- Tumour of chromaffin cells in adrenal gland
- Overproduction of catecholamines
How can diabetes cause hypertension (two mechanisms)
Mech 1: Hyperglycaemia damages kidneys, leading to renin release and hypertension
Mech 2: Glucose stays in blood, creating an osmotic gradient that causes hypertension
List three causes of secondary hypertension
- Phaeochromocytoma
- Chronic Kidney Disease
- Diabetes
How can hypertension damage the brain
- Vascular damage
- Increased arterial clot formation
Which muscle does the long thoracic nerve supply?
Serratus anterior
Why is the long thoracic nerve vulnerable to damage?
- Long, superficial course
What property of a pressure-volume loops tells us its compliance?
Its slope (change in volume per change in pressure)
Describe the gradient of lung ventilation from the apical to the basilar regions
Ventilation is lowest at the lung apices, and highest at the lung bases.
How does the V/Q ratio change from lung base to lung apex?
It increases
Describe the four different kinds of mechanoreceptors in the lung (and, briefly, their roles)
- Stretch receptors (Hering-Breuer reflex)
- Muscle receptors (increase respiration in response to activity)
- Juxtacapillary receptors (respond to capillary engorgement and chemicals)
- Irritant receptors (cough reflex)
What receptors are on the end of bronchopulmonary C-fibres?
Juxtacapillary receptors
Effect of obstructive/restrictive lung disease on lung volumes
Obstructive: increased reserve volume
Restrictive: all lung volumes (including TLC) decreased
Are the symptoms of a STEMI and NSTEMI different?
- No
- They are the same
Recap ECG lead placement
- Leads V1-V6:
Fourth ICS parasternal right side (V1)
Fourth ICS parasternal left side (V2)
Fifth ICS mid-clav left side (V4)
Between V2 and V4 (V3)
Anterior axilla fifth ICS (V5)
Middle axilla fifth ICS (V6) - Limb leads (traffic light):
Right Arm: Red
Left Arm: Yellow
Left Foot: Green
Right foot: Black
List two non-atherosclerotic causes of myocardial infarction
- Coronary artery dissection
- Vasospasm
List some causes of Type 2 MI
- Anaemia
- Hypotension
- Sepsis
Describe conservative treatment of peripheral vascular disease
- Risk factor reduction (weight loss, smoking cessation, exercise)
- Medication (aspirin, hTn meds, diabetes medication, statin)
Describe more invasive methods of treating peripheral vascular disease
- PCI (stent placement)
- Surgical bypass
Recall some inherited and acquired causes of hypercoagulability
Inherited:
- Factor V Leiden Mutation
- Protein C/S deficiency
Acquired:
- Pregnancy
- Malignancy
- Birth control pills
- HRT
How does oestrogen increase coagulation in pregnancy, HRT, and oral contraceptive use?
- Increased factors VII, X, XII, and XIII
- Decrease protein S
What is added to plasma in aPTT testing?
- Calcium
- Phospholipids
Describe the innervation of the visceral and parietal pleura (basic overview)
Parietal:
- Mediastinal surface: phrenic nerve
- Lateral surface: intercostal nerves
Visceral:
- Autonomic
How does pneumothorax cause chest pain?
It triggers sensory fibres in the visceral (autonomic) and parietal (phrenic/intercostal) nerves
Thoracentesis vs thoracostomy
Thoracentesis: needle drainage
Thoracostomy: insertion of chest tube (continuous drainage)
Primary spontaneous pneumothorax management
In HD stable: observation and monitoring
In HD unstable: thoracostomy
How is recurrent spontaneous pneumothorax treated?
Definitive management (pleurodesis) should also occur
How is tension pneumothorax treated?
- Needle decompression
- Tube thoracostomy
How can pulmonary embolism cause transudative AND exudative effusions?
Transudative: increase hydrostatic pressure proximal to blockage
Exudative: release of vasoactive cytokines in response to blockage
What are the three types of infective pleural effusion?
- Parapneumonic
- Empyema
- Complex parapneumonic
Sliding vs rolling hiatus hernia
Sliding: gastrooesophageal junction
Rolling: fundus of stomach
Where is haem predominantly synthesised?
Erythrocyte precursors in bone marrow (before organelles are dissolved)
Microcytic anaemia acronym
TAILS:
- Thalassaemia
- Anaemia of chronic disease
- Iron deficiency
- Lead poisoning
- Sideroblastic anaemia
Normocytic anaemia acronym
3 As, 2 Hs:
- Acute blood loss
- Anaemia of chronic disease
- Aplastic anaemia
- Haemolysis
- Hypothyroidism
Macrocytic anaemia acronym
FATRBC:
- Foetal pregnancy
- Alcohol
- Hypothyroidism
- Renal failure
- B12 and folate deficiency
- Cirrhosis/liver disease
Vulnerable stages of life to iron deficiency
- Pregnancy
- Pre-menopausal women
- Growing adolescents
Neutrophil lifespan
~2.5 days
What is the lifespan of lymphocytes (memory/non-memory)
Non-memory: weeks/months
Memory: years
Lifespan of eosinophils
2-5 days
Macrophage/monocyte lifespan
Monocyte: 1-6 day
Macrophage: months/years
Basophil lifespan
12-15 days
List the three functions of macrophages/neutrophils
- Phagocytosis
- Chemotaxis
- Killing foreign bodies
What do CD4 and CD8 bind to?
Corresponding MHC molecule (product is always 8)
What disease does Binet staging relate to?
CLL
Outline stages A, B, and C of binet staging
A: <3 lymphoid areas of involvement, no anaemia/thrombocytopaenia
B: =>3 lymphoid areas of involvement, no anaemia/thrombocytopaenia
C: Anaemia and/or thromboytopaenia
Describe the three phases of chemotherapy for haematological malignancies
Induction: Aim is to induce remission
Consolidation: Aim is to kill all remaining cancer cells once remission has been achieved
Maintenance: Given to prolong remission/stop recurrence of cancer
Name and describe the mutation that causes chronic myeloid leukaemia
- ABL gene is moved from chromosome 9 to chromosome 22
- Joins next to BCR gene from 22
- New BCR-ABL gene allows unregulated cell proliferation
Briefly describe the mechanism of anaphylaxis
Allergic reaction (usually IgE mediated) that results in release of inflammatory substances into the bloodstream, causing multi-organ involvement.
How is anaphylaxis treated
- Intramuscular adrenaline
- Antihistamines
- Airway monitoring (supplemental O2, airway management, IV fluids)
Four criteria of informed consent
- Capacity
- Voluntary
- Specific to procedure
- Must understand alternatives, risks
List some organs other than the lungs that TB can infect
- Kidneys
- Brain
- Bones
Symptoms of bronchiectasis
Transient:
- Wheezing
- Dyspnoea
- Foul-smelling mucous
- Coughing
- Clubbing
What causes S3 and S4?
S3: Ventricular filling
S4: Atrial systole
Which valvulopathy radiates to the left axilla?
Mitral regurgitation
Common features of IV-drug related endocarditis
Right-sided valve involvement
Common organism of acute native valve endocarditis
Staph aureus
Common organisms of subacute endocarditis
Enterococcus/ alpha haemolytic strep
Four levels of alpha thalassaemia
One mutated alpha globin: silent
Two: Trait
Three: HbH disease
Four: Incompatible with life
Genetic inheritance of beta thalassaemia
Autosomal recessive
Haemophilia inheritance pattern
X-linked recessive
Does ferroportin reduce iron ions?
No; that is done by an enzyme
Which family of organisms are most commonly responsible for community acquired pleural infections?
Streptococcus
What describes a positive bronchodilator response in an adult?
Increase in FEV1 (or FVC) of ≥12% and an absolute increase in FEV1 (or FVC) of ≥200 mL
True or false: obesity is a risk factor for PE
True
Does COPD cause clubbing?
No
At what level does an airway obstruction cause a stridor?
Extrathoracic (i.e. trachea, glottis etc.)
Is connective tissue disorder more likely to cause regurgitant or stenotic valvulopathies?
Regurgitant
What causes a JVP “wave”
Atrial contraction
What is more specific to myocardium: Troponin or creatine kinase MB?
Troponin
What is the most common modification of the left ventricle in mitral stenosis
Dilation
