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Medical Studies 1 > Polishing > Flashcards

Polishing Flashcards

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USMLE® Step 1 flashcards
1
Q

Describe the coronary venous drainage

A

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

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2
Q

How can CKD cause hTn?

A
  • Kidneys cannot filter blood as effectively
  • Less sodium detected by macula densa
  • Renin release
  • Plus: increase in blood volume because less is filtered out
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3
Q

What is phaeochromocytoma?

A
  • Tumour of chromaffin cells in adrenal gland
  • Overproduction of catecholamines
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4
Q

How can diabetes cause hypertension (two mechanisms)

A

Mech 1: Hyperglycaemia damages kidneys, leading to renin release and hypertension
Mech 2: Glucose stays in blood, creating an osmotic gradient that causes hypertension

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5
Q

List three causes of secondary hypertension

A
  • Phaeochromocytoma
  • Chronic Kidney Disease
  • Diabetes
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6
Q

How can hypertension damage the brain

A
  • Vascular damage
  • Increased arterial clot formation
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7
Q

Which muscle does the long thoracic nerve supply?

A

Serratus anterior

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8
Q

Why is the long thoracic nerve vulnerable to damage?

A
  • Long, superficial course
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9
Q

What property of a pressure-volume loops tells us its compliance?

A

Its slope (change in volume per change in pressure)

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10
Q

Describe the gradient of lung ventilation from the apical to the basilar regions

A

Ventilation is lowest at the lung apices, and highest at the lung bases.

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11
Q

How does the V/Q ratio change from lung base to lung apex?

A

It increases

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12
Q

Describe the four different kinds of mechanoreceptors in the lung (and, briefly, their roles)

A
  • 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)
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13
Q

What receptors are on the end of bronchopulmonary C-fibres?

A

Juxtacapillary receptors

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14
Q

Effect of obstructive/restrictive lung disease on lung volumes

A

Obstructive: increased reserve volume
Restrictive: all lung volumes (including TLC) decreased

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15
Q

Are the symptoms of a STEMI and NSTEMI different?

A
  • No
  • They are the same
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16
Q

Recap ECG lead placement

A
  • 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
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17
Q

List two non-atherosclerotic causes of myocardial infarction

A
  • Coronary artery dissection
  • Vasospasm
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18
Q

List some causes of Type 2 MI

A
  • Anaemia
  • Hypotension
  • Sepsis
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19
Q

Describe conservative treatment of peripheral vascular disease

A
  • Risk factor reduction (weight loss, smoking cessation, exercise)
  • Medication (aspirin, hTn meds, diabetes medication, statin)
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20
Q

Describe more invasive methods of treating peripheral vascular disease

A
  • PCI (stent placement)
  • Surgical bypass
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21
Q

Recall some inherited and acquired causes of hypercoagulability

A

Inherited:
- Factor V Leiden Mutation
- Protein C/S deficiency
Acquired:
- Pregnancy
- Malignancy
- Birth control pills
- HRT

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22
Q

How does oestrogen increase coagulation in pregnancy, HRT, and oral contraceptive use?

A
  • Increased factors VII, X, XII, and XIII
  • Decrease protein S
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23
Q

What is added to plasma in aPTT testing?

A
  • Calcium
  • Phospholipids
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24
Q

Describe the innervation of the visceral and parietal pleura (basic overview)

A

Parietal:
- Mediastinal surface: phrenic nerve
- Lateral surface: intercostal nerves

Visceral:
- Autonomic

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25
Q

How does pneumothorax cause chest pain?

A

It triggers sensory fibres in the visceral (autonomic) and parietal (phrenic/intercostal) nerves

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26
Q

Thoracentesis vs thoracostomy

A

Thoracentesis: needle drainage
Thoracostomy: insertion of chest tube (continuous drainage)

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27
Q

Primary spontaneous pneumothorax management

A

In HD stable: observation and monitoring
In HD unstable: thoracostomy

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28
Q

How is recurrent spontaneous pneumothorax treated?

A

Definitive management (pleurodesis) should also occur

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29
Q

How is tension pneumothorax treated?

A
  • Needle decompression
  • Tube thoracostomy
30
Q

How can pulmonary embolism cause transudative AND exudative effusions?

A

Transudative: increase hydrostatic pressure proximal to blockage
Exudative: release of vasoactive cytokines in response to blockage

31
Q

What are the three types of infective pleural effusion?

A
  • Parapneumonic
  • Empyema
  • Complex parapneumonic
32
Q

Sliding vs rolling hiatus hernia

A

Sliding: gastrooesophageal junction
Rolling: fundus of stomach

33
Q

Where is haem predominantly synthesised?

A

Erythrocyte precursors in bone marrow (before organelles are dissolved)

34
Q

Microcytic anaemia acronym

A

TAILS:
- Thalassaemia
- Anaemia of chronic disease
- Iron deficiency
- Lead poisoning
- Sideroblastic anaemia

35
Q

Normocytic anaemia acronym

A

3 As, 2 Hs:
- Acute blood loss
- Anaemia of chronic disease
- Aplastic anaemia
- Haemolysis
- Hypothyroidism

36
Q

Macrocytic anaemia acronym

A

FATRBC:
- Foetal pregnancy
- Alcohol
- Hypothyroidism
- Renal failure
- B12 and folate deficiency
- Cirrhosis/liver disease

37
Q

Vulnerable stages of life to iron deficiency

A
  • Pregnancy
  • Pre-menopausal women
  • Growing adolescents
38
Q

Neutrophil lifespan

A

~2.5 days

39
Q

What is the lifespan of lymphocytes (memory/non-memory)

A

Non-memory: weeks/months
Memory: years

40
Q

Lifespan of eosinophils

A

2-5 days

41
Q

Macrophage/monocyte lifespan

A

Monocyte: 1-6 day
Macrophage: months/years

42
Q

Basophil lifespan

A

12-15 days

43
Q

List the three functions of macrophages/neutrophils

A
  • Phagocytosis
  • Chemotaxis
  • Killing foreign bodies
44
Q

What do CD4 and CD8 bind to?

A

Corresponding MHC molecule (product is always 8)

45
Q

What disease does Binet staging relate to?

A

CLL

46
Q

Outline stages A, B, and C of binet staging

A

A: <3 lymphoid areas of involvement, no anaemia/thrombocytopaenia

B: =>3 lymphoid areas of involvement, no anaemia/thrombocytopaenia

C: Anaemia and/or thromboytopaenia

47
Q

Describe the three phases of chemotherapy for haematological malignancies

A

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

48
Q

Name and describe the mutation that causes chronic myeloid leukaemia

A
  • 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
49
Q

Briefly describe the mechanism of anaphylaxis

A

Allergic reaction (usually IgE mediated) that results in release of inflammatory substances into the bloodstream, causing multi-organ involvement.

50
Q

How is anaphylaxis treated

A
  • Intramuscular adrenaline
  • Antihistamines
  • Airway monitoring (supplemental O2, airway management, IV fluids)
51
Q

Four criteria of informed consent

A
  • Capacity
  • Voluntary
  • Specific to procedure
  • Must understand alternatives, risks
52
Q

List some organs other than the lungs that TB can infect

A
  • Kidneys
  • Brain
  • Bones
53
Q

Symptoms of bronchiectasis

A

Transient:
- Wheezing
- Dyspnoea
- Foul-smelling mucous
- Coughing
- Clubbing

54
Q

What causes S3 and S4?

A

S3: Ventricular filling
S4: Atrial systole

55
Q

Which valvulopathy radiates to the left axilla?

A

Mitral regurgitation

56
Q

Common features of IV-drug related endocarditis

A

Right-sided valve involvement

57
Q

Common organism of acute native valve endocarditis

A

Staph aureus

58
Q

Common organisms of subacute endocarditis

A

Enterococcus/ alpha haemolytic strep

59
Q

Four levels of alpha thalassaemia

A

One mutated alpha globin: silent
Two: Trait
Three: HbH disease
Four: Incompatible with life

60
Q

Genetic inheritance of beta thalassaemia

A

Autosomal recessive

61
Q

Haemophilia inheritance pattern

A

X-linked recessive

62
Q

Does ferroportin reduce iron ions?

A

No; that is done by an enzyme

63
Q

Which family of organisms are most commonly responsible for community acquired pleural infections?

A

Streptococcus

64
Q

What describes a positive bronchodilator response in an adult?

A

Increase in FEV1 (or FVC) of ≥12% and an absolute increase in FEV1 (or FVC) of ≥200 mL

65
Q

True or false: obesity is a risk factor for PE

A

True

66
Q

Does COPD cause clubbing?

A

No

67
Q

At what level does an airway obstruction cause a stridor?

A

Extrathoracic (i.e. trachea, glottis etc.)

68
Q

Is connective tissue disorder more likely to cause regurgitant or stenotic valvulopathies?

A

Regurgitant

69
Q

What causes a JVP “wave”

A

Atrial contraction

70
Q

What is more specific to myocardium: Troponin or creatine kinase MB?

A

Troponin

71
Q

What is the most common modification of the left ventricle in mitral stenosis

A

Dilation

72
Q
A

Medical Studies 1 (90 decks)

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