REVIEW LIST OF TEST 1- SPECIFIC! Flashcards

Question

What is coronary heart disease?

Answer 1

Coronary artery disease involves the narrowing, stiffening and/or blockage of coronary arteries, mostly due to atherosclerosis. This eventually causes myocardial ischemia which decreases functionality of the myocytes. Due to the lack of available oxygen (O2), inflammatory chemicals are released and myocytes engage anaerobic respiration which can cause a build up of lactic acid.

Answer 2

- Family history - Increasing age > 45 males, postmenopausal females - Hypercholesterolemia - Smoking - Hypertension - Diabetes - Obesity - Physical inactivity

Answer 3

Angina is chest pain that occurs when the oxygen demand of the myocardium outweighs the available supply. It is usually transient and typically occurs with increased physical exertion or stress. Angina may be considered as: - Stable: angina is predictable (e.g. occurs with exertion) and resolves with rest or use of nitroglycerine - Unstable: angina is unpredictable, may occur at rest and is of increasing severity, length and/or frequency

Answer 4

- pallor (an unhealthy pale appearance) - diaphoresis (sweating, especially to an unusual degree) - dyspnoea (Difficult or laboured breathing)

Answer 5

Unstable angina is often associated with atherosclerotic plaque rupture, or outer erosion which results in transient episodes of thrombotic occlusion and vasoconstriction. Unstable angina is a strong predictor of myocardial infarction. Management of unstable angina generally requires some type of antithrombotic (decrease coagulation factors)

Answer 6

Myocardial infarction occurs when there is sustained myocardial ischemia. This usually occurs when an atherosclerotic plaque ruptures and a thrombus forms at the site causing coronary occlusion, but can also occur more rarely due to coronary spasm or dissection or other factors which can lead to significant ischemia/hypoxia (e.g. hypotension, anemia). Prolonged myocardial ischemia leads to irreversible hypoxic damage.

Answer 7

Heart failure, sometimes known as congestive heart failure, occurs when there is inadequate perfusion (delivery of blood) of tissues due to cardiac dysfunction. Heart muscle can't pump enough blood to meet the body's demands. There is systolic HF and diastolic HF- Both causes blood back up in lungs- Congestion/ fluid buildup. Multiple disease that can cause HF. EG- Valvular disease

Answer 8

* MI * Cardiac hypertrophy * Chronic hypertension * Systemic or Pulmonary * Heart valve stenosis / incompetence * Cardiomyopathy e.g. viral, alcoholic * Volume overload in some patients * e.g. renal failure

Answer 9

Systolic failure * Heart failure with reduced ejection fraction (HFrEF) The left ventricle loses its ability to contract normally. The heart can't pump with enough force to push enough blood into circulation

Answer 10

Heart failure with preserved ejection function (HFpEF). The left ventricle loses its ability to relax normally because the muscle has become stiff.

Answer 11

Mostly systolic but can be diastolic. The left ventricle of the heart no longer pumps enough blood around the body. 1) Blood build up in the pulmonary veins/ lungs -> 2) Pulmonary & venous BP increases to get blood out -> 3) pressure causes blood to leak into interstitial spaces of the lungs and alveoli -> 4) Pulmonary edema -> 5) Difficulty with gas exchange 6) Dyspnea, orthopnea (laying flat), crackle apon auscultation Lung compliance is reduced - they become more difficult to inflate

Answer 12

Blood back up in lungs → increased pulmonary bp → Fluid in interstitial space → pulmonary edema → difficulty gas exchange → dyspnea, orthopnea (laying tatt, crackles heard auscultation - Dyspnoea on exertion and fatigue - Cyanosis may reflect hypoxia This causes shortness of breath, trouble breathing or coughing – especially during physical activity.

Answer 13

Coronary artery disease- ischemia damages the myocardium

Answer 14

Arteriosclerosis is the thickening and hardening of the walls of arteries. This occurs due to the migration of smooth muscle cells and collagen fibres into the tunica intima with subsequent mineral deposition. Progressively this narrows the lumen of the artery. Changes in lipid, cholesterol and phospholipid metabolism contribute to these changes in the blood vessel wall. Arteriosclerosis occurs as part of the normal aging process, but may also occur in association with hypertension, decreased tissue perfusion, weakening and/or other damage of arterial walls.

Answer 15

Atherosclerosis is the most common type of arteriosclerosis. When intra-arterial fat and fibrin deposits form within the vessel wall which subsequently harden over time. Atherosclerotic plaques can form as a result of inflammation due to endothelial damage and the accumulation of LDL cholesterol within the tunica intima.

Answer 16

- family history - increasing age (>45 males, postmenopausal females) - hypercholesterolaemia (increased LDL) - smoking - hypertension - diabetes - obesity - physical inactivity

Answer 17

Peripheral artery disease is a type of peripheral vascular disease (PVD) caused by atherosclerosis within arteries. Mostly found within the lower limbs It is commonly associated with diabetes and coronary artery disease and has the same risk factors as atherosclerosis. Arterial atherosclerotic obstruction in PAD can be gradual or acute. It can be asymptomatic, or may present with symptoms

Answer 18

- intermittent claudication: pain/cramping in the lower limbs when moving/exercising - changes in skin of lower limb (e.g. temperature, colour, appearance) - leg ulcers - weak or undetectable pulse in legs or feet - severe pain with acute occlusion - gangrene

Answer 19

Anything that can reduce associated risk factors (e.g. smoking cessation, increased exercise) Management/treatment options used for any associated conditions (e.g. diabetes). Additional treatment options may include anti-platelet therapy, anti-coagulation therapy, vasodilators and if required, vascular surgery or angioplasty.

Answer 20

Thrombosis is a pathological formation of a blood clot (thrombus) within an intact vessel. This can occur in either arteries or veins, but is more common in veins. The thrombus partially (or completely) occludes the lumen of the vessels- in arteries this can cause tissue ischemia/infarction and in veins can cause localized inflammation. Deep vein thrombosis is when thrombosis occurs in the deep veins of the limbs, generally the lower limbs.

Answer 21

- surgery - immobilization - obesity - dehydration - smoking - pregnancy - coagulopathies (a condition in which the blood's ability to coagulate (form clots) is impaired)

Answer 22

Many DVTs are asymptomatic, but they may also present with Tenderness, pain in leg, increased warmth, red/blue leg, discomfort when pulled upward and/or oedema of the affected limb. Many DVTs will resolve on their own due to the breakdown of the clot, however, some DVTs may become organized and remain within the vessel- potentially becoming incorporated into the vessel wall and/or recanalising. DVTs also carry the risk of becoming dislodged and forming an embolus.

Answer 23

- mobilizing as soon as possible after periods of immobilization (e.g. due to injury or surgery) - maintaining adequate hydration - avoiding standing or sitting or long periods of time - using compression stockings when mobility will be reduced for a period of time While most DVTs will resolve on their own, if DVT is suspected it is common for anticoagulants to be used to facilitate resolution of the clot.

Answer 24

Endothelium damage Altered blood flow Hypercoagulability

Answer 25

Asthma is a chronic inflammatory condition that results in narrowing of the airways in response to various triggers (e.g. allergens). It is not known what causes asthma, but it is likely that both genetic and environmental factors play a role.

Answer 26

Trachea - Bronchi - bronchioles - alveoli - capillaries surround alveoli

Answer 27

Pollen, smoke, pollution, cold weather, mold pet dander, dust mites, fish, eggs, peanuts, soy Respiratory conditions, stress, strong emotions and exercise.

Answer 28

Coughing, wheezing, SOB, chest tightness.

Answer 29

Bronchospasm

Answer 30

Smooth muscles tighten, the endothelium bronchiole lining inflames and excess mucus production + oedema

Answer 31

The increased airway resistance reduces both air flow into and out of the lungs. Thus, there is a V/Q mismatch which leads to hypoxemia (Reduce blood oxygen), and subsequently hypoxia if not relieved. Air retention and hypercapnia (to much co2 in blood) also occur. If airflow is significantly limited, an asthma attack can be life threatening. There is no cure for asthma, but treatment options can be used both preventatively and responsively.

Answer 32

An autosomal recessive condition which results in abnormalities of secretory epithelia throughout the body (e.g. respiratory tract, pancreas, GI tract). Though significant morbidity is associated with the effects on the respiratory system.

Answer 33

In CF there are certain mutations that cause the CFTR ion channel is either not there or made incorrectly, meaning chloride ions cannot exit the cell. Broken CFTR increases activity of a different ion channel called the ENaC channel. ENaC allows sodium ions to enter the cell (leaving mucus). Due to the ion gradient osmosis occurs - water leaving the mucus

Answer 34

In the resp system the mucus so abnormally thick and sticky that the cilla cannot move it through the escalator. Leading to infection & death. Mucus can clog airways making breathing difficult.

Answer 35

Gall bladder ducts that transport bile & enzymes from the pancreas into the small intestine can lead to mucus build up in the ducts. Malnutrition occurs as the food cant get digested properly.

Answer 36

OPPOSITE OF AIRWAY AND GUT- Channels normally allow chloride ions to enter the cell. In CF chloride cannot enter the cell and accumulates outside the body. Chloride combines with sodium ions and forms salt.

Answer 37

Difficulty breathing from clogged airways and infected airways. Malnutrition from clogged and defective ducts Salty sweat

Answer 38

In order- Caucasians, African Americans & Asians

Answer 39

Digestive enzymes and vitamin supplements. Antibiotics Mucolytics (They break up mucus) Bronchodilators ONLY HELP SYMPTOMS

Answer 40

- abscess & cyst formation - bronchiectasis (Permanent dilation of bronchi, typically as a result of inflammatory damage to bronchial walls due to previous chronic infections.) - pneumonia (fluid or pus) - pulmonary hypertension & cor pulmonale

Answer 41

chest physiotherapy positive pressure devices inhaled mucus thinning solutions antibiotics nutritional supplementation & enzymes

Answer 42

This is a chronic condition where by reflux occurs frequently. The acidic stomach contents irritate and damage the mucosal lining of the oesophagus and this can lead to persistent oesophagitis (Oesophagus inflammation) Due to incompetent sphincters at the gastroesophageal junction

Answer 43

Peptic ulcers are breaks (ulceration) in the mucosa of the stomach or duodenum. This break in the surface mucosa exposes the deeper layers of the GI tract wall to gastric acid and digestive enzymes which can then erode away those deeper layers.

Answer 44

Gastric ulcers and duodenal ulcers Most common is the duodenal ulcers.

Answer 45

Mucus and bicarbonate to neutralize the acid

Answer 46

Medications (steroids or NSAIDS), helicobacter pylori 7 increase of acid

Answer 47

Stress, alcohol, excessive caffeine, smoking, spicy food

Answer 48

Epigastric discomfort or pain or tenderness Nausea or vomiting Dyspepsia (Indigestion) Haematemesis (vomiting blood) Coffee ground blood (Vomiting digested blood) Melaena (Tarry black stool from digested blood) Iron deficiency anemia

Answer 49

Eating worsens gastric ulcer And eating improves the pain of duodenal ulcer

Answer 50

Endoscopy- Can do a biopsy to exclude cancer and a rapid urease test to see if its H. pylori

Answer 51

High dose of protein pump inhibitor - reduce acid Endoscopy- monitor ulcer & see if it heals or find more ulcers

Answer 52

Low level bleeding- anemia Life threatening- Hemorrhage Perforation- Hole in stomach. Stomach fluid can leak out into the peritoneum- Peritonitis (inflammation) URGENT- Requires surgery Scaring and strictures (an abnormal narrowing of a bodily passage). As ulcer heals, turns into scar tissue- Narrowing of the pylorus - difficulty emptying the stomach- Pyloric stenosis - Causes upper abdominal pain, nausea and vomiting, reflux, distention

Answer 53

Inflammation of Crohn’s disease starts in the submucosal layer and spreads to affect all layers of the intestine (all layers of the GI tract wall). Changes to the mucosa cause the gut to be more permeable, which can allow in toxins Exacerbations and remissions There can be so much inflammation that the lumen actually narrows and the gut may become obstructed. Often requires surgery Most commonly in the proximal colon and small intestine, but could occur anywhere along the GI tract. GUM TO BUM! The repeated inflammation can lead to fissures, fistulas, adhesions and damage to the enteric nervous system. MINI ULCERS THAT CAN OCCUR ANYWHERE IS THE DIGESTIVE TRACT. Ulcers cn causes inflammation. Can break through the wall and cause abscess. It can also result in malnutrition or nutritional deficiencies, as intestinal absorption is impacted.

Answer 54

Skip lesions – lesions will form in select places, but other parts of the gut will be normal; lesions are more common on the right side Symptoms: Diarrhoea. Because small intestine is involved, digestion and absorption are affected. May have very fatty diarrhoea. Blood can occur but is less common. Complications: Fistulae, strictures. Anemia from being unable to absorb vitamin B12

Answer 55

Inflammation breaks down the mucosal layer which can cause abscesses. Ulcerative colitis only happens in the colon (large intestine). Inflammation of the mucosa (ONLY MUCOSA) of the GI tract wall, most commonly in the distal colon (e.g. sigmoid colon). Repeated inflammation can lead to the formation of haemorrhoids, anal fissures or abscesses. Hemorrahge is also a complication of ulcerative colitis.

Answer 56

Symptoms: Large, watery, often bloody diarrhoea with cramping(mild to severe) Pattern of exacerbation and remission Exacerbations can come with fever, tachycardia, 10-20 stools per day, continuous cramping Complications can include anal fissures, haemorrhoids, perirectal abscesses Colon can be obstructed – but rare. Rare perforation

Answer 57

Stomach pain Weight loss Decreased appetite Changes in bowel movements Urgent movements Fever Night sweats Tiredness Mucus and blood in stool

Answer 58

Corticosteroids, immunosuppressants & biologics (antibodies that inhibit molecules that cause gut wall inflammation)

Answer 59

Too much carbon dioxide in the blood

Answer 60

Not enough oxygen in the blood

Answer 61

Not enough oxygen to the tissues/ cells

Answer 62

Right ventricular enlargement and failure

Answer 63

Incompetent or compromised oesophageal sphincter

Answer 64

Mucosa only

Answer 65

All layers (mucosa > submucosa > muscularis externa > serosa)

Answer 66

Distal colon

Answer 67

Proximal colon & small intestine

Answer 68

Anemia is a reduction in the oxygen carrying capacity of red blood cells (decreased hemoglobin concentration and circulating RBCs). This reduction may be due to: - reduced numbers of RBCs (decreased production, increased destruction or increased loss) - reduced amount of hemoglobin in RBCs - defective RBC/hemoglobin structure or development There are many different types of anemia. Terms ending with -cytic refer to the size of the RBC and terms ending with -chromic refer to the hemoglobin content of RBCs.

Answer 69

- fatigue - feeling cold/cold peripheries - pallor

Answer 70

- dizziness - shortness of breath - heart palpitations or signs of cardiac distress - gastrointestinal effects such as nausea, abdominal pain, anorexia - neurological effects such as numbness, muscle weakness, spasticity - epithelial changes such as hair/nail brittleness, koilonychia, glossitis, stomatitis, cheilosis - jaundice

Answer 71

Iron deficiency anemia is the most common form of anemia worldwide. Anemia due to iron deficiency. In a single RBC there is thousands of haemoglobin proteins. Inside hemoglobin there are four heme molecules. In the heme molecules there is iron. Iron is what binds to the oxygen. So each heme molecule can bind to 4 oxygen molecules. Can be caused from: - inadequate dietary intake of iron - inadequate absorption of iron - increased iron requirements - excessive iron loss

Answer 72

Iron deficiency leads to impaired heme productions- Not enough heme to make a normal sized RBC- Bone marrow begins to make microcytic RBC that contain less hemoglobin- Iron deficiency is also called microcytic hypochromic anemia. These RBC cant carry enough oxygen to RBC- hypoxia Bone marrow try to pump out more RBC, subsequently forming incomplete RBC with varying shapes and sizes Also causes defective production of of mitochondrial enzymes.

Answer 73

Koilonychia (spooning of nails) Hair loss Pica (consumption of non food items like clay or dirt) Glossitis (inflammation of the tongue) Esophageal webs(are thin membranes that grow across the inside of the upper part of the esophagus and may cause difficulty swallowing)

Answer 74

DECREASED - Hemoglobin Males- less than 13.5 g/dl Females- less than 12.0 g/dl - Decrease in mean corpuscular volume (MCV)- Reflects the volume of a RBC - Low serum iron & ferritin INCREASED - Total iron binding capacity (TIBC)- Amount of unbound transferrin in the blood. - High RBC distribution width (RBW)- Different RBC size Peripheral blood smear can determine wheather a person has microcytic & hypochromic RBC

Answer 75

- Addressing the cause - Giving oral iron supplements (Ferrous sulphate) - Intravenous Iron - Severe cases call for blood transfusion

Answer 76

Macrocytic anemias are those in which the RBCs are too big, due to immaturity. Though the cells may be normochromic, the structural immaturities mean they do not have the same oxygen carrying capacity as normal RBCs (they also do not live as long). This can happen due to folate (folic acid) or vitamin B12 deficiency. Folate and vitamin B12 are required for DNA production in the developing RBCs. Without them, there is incomplete development of the erythrocytes (they remain immature) and less of them are produced.

Answer 77

- inadequate dietary consumption or absorption: linked to risks associated with poor diet or conditions affecting small intestinal absorption (e.g. Coeliac disease) - alcoholism: associated with vitamin malabsorption, decreased liver metabolism of folate & increased urinary output of folate - dialysis: increases renal loss of folate - certain medications - increased demand during pregnancy: folate is important for early neurological development of the baby (inadequate folate can lead to neural tube defects) and thus there is increased demand that may not be met by dietary intake and which may be impacted by changes in absorption of folate during pregnancy

Answer 78

- inadequate dietary consumption: linked to risks associated with poor diet or conditions affecting small intestinal absorption. More rare than folate - certain medications - lack of intrinsic factor (pernicious anemia): 1) chronic atrophic gastritis: results in destruction of parietal cells 2) removal of all/part of stomach: decreases numbers of parietal cells 3) autoimmune conditions which destroy parietal cells Why does a lack of intrinsic factor (IF) lead to vitamin B12 deficiency? Because IF is necessary for intestinal absorption of vit b12

Answer 79

Anemia of chronic disease (Anemia associated with chronic infections or inflammatory disorders (e.g. systemic lupis erythromatosis). Hemolytic anemia Post-hemmorhagic anemia Aplastic anemia Thalassemia Sickle cell anemia

Answer 80

Polycythemia is excessive RBCs. Polycythemia increases blood viscosity, thereby increasing blood pressure, and it also increases the risk for thromboembolism and associated complications. Treatment typically includes removal of some blood (phlebotomy/venesection), to maintain safe levels of hematocrit, and treating any underlying causes or complications.

Answer 81

Relative polycythemia is increased RBCs associated with dehydration and is readily corrected with fluid administration

Answer 82

Absolute polycythemia can occur as- - Primary polycythemia (polycythemia vera): excessive production of RBC believed to be associated with a gene mutation. This condition is very rare. - Secondary polycythemia: occurs due to increased erythropoietin (EPO) secretion. Increased EPO secretion may be associated with the presence of certain tumours or as a response to chronic hypoxia, as may occur with: - living at high altitude - COPD or coronary artery disease - smoking

Answer 83

Disseminated intravascular coagulation (DIC) is a thrombohaemorrhagic disorder that involves widespread thrombus formation throughout the microvasculature, followed by hemorrhage. DIC is triggered by events that cause severe endothelial damage such as may occur with: - sepsis - malignancy - severe trauma - pregnancy/labour complications - hemorrhage - hypovolemic shock When severe endothelial damage- excessive coagulation response- This drives widespread formation of many thrombi throughout the microvasculature- Subsequently, tissue ischemia occurs leading to hypoxic tissue damage- The damaged tissues respond by enhancing tissue factor & procoagulants, thus leading to more and more micro-thrombi formation throughout the vasculature. The widespread formation of many thrombi also leads to an increase in fibrinolysis (It prevents blood clots) via plasmin activation. Thus, as widespread clot formation occurs, widespread clot breakdown also occurs. Eventually, coagulation factors (clotting factors and platelets) are all used up and further blood clots cannot be formed. This, coupled with the ongoing fibrinolysis, leads to hemorrhage and eventually hypovolemic shock.

Answer 84

- petechiae (pinpoint non-blanching spots), purpura (occurs when small blood vessels leak blood under the skin), ecchymoses (bruise) - bleeding from minor wounds, venepuncture sites bruising - bleeding from mucous membranes - signs related to internal tissue damage and hemorrhage (e.g. respiratory distress, convulsions, signs of shock or organ failure)

Answer 85

Cancer is a group of diseases characterized by genetically altered cells. This genetic alteration leads to uncontrolled and abnormal growth of these cells and the formation of tumours or neoplasms. Tumours/neoplasms can form from any type of cell, but are not always cancerous.

Answer 86

Benign tumours contain cells that appear normal. Noncancerous. The cell growth is typically self-limiting and the tumour is encapsulated. There is no spread to other tissues. The abnormal cell growth and additional cells themselves may not be a problem, but the size or location of the tumour may impact on nearby structures, thereby potentially impacting on normal body functions.

Answer 87

Malignant tumours are cancerous. They are distinguishable from benign tumours by: - rapid or unregulated growth: not affected by normal signals that regulate growth or destroy damaged tissue - lack of cellular differentiation (anaplasia) - absence of normal tissue organization Malignant tumour growth occurs due to abnormalities and mutations in genes. The reasons for these genetic abnormalities are not always known, but there are many likely causes, including genetic predisposition and/or environmental factors.

Answer 88

The gene alterations that occur in cancer cells are permanent and result in the following changes to cellular activity & control: - uncontrolled cell proliferation: cancer cells do not respond to normal signals to reduce or stop growth (e.g. from neighboring cells) - control of growth signals: cancer cells secrete their own growth signals (autocrine secretion) and/or upregulate growth factor receptors - disables cellular apoptosis mechanisms: cancer cells do not undergo normal self-destruction - restoration of telomeres: the normal cell aging and division process leads to progressive shortening of telomeres which ultimately results in cell damage and cell death, but as cancer cells restore telomeres, they can continue to divide indefinitely

Answer 89

- proto-oncogenes - tumour-suppressor genes - DNA repair genes

Answer 90

Proto-oncogenes: genes coding for proteins that regulate normal cell growth. Genetic mutations in proto-oncogenes give rise to *oncogenes*. Oncogenes allow unregulated cell proliferation & differentiation. Oncogenes can be activated by minor alterations to the genes, resulting in altered protein activity. Oncogenes can also cause chromosome amplifications- multiple duplications of a chromosome segment, thereby increasing expression of the gene (e.g. for growth receptors).

Answer 91

Cancer inhibits the tumour suppressor genes: Tumour suppressor genes coding for proteins that: - slow or stop cell division - initiate DNA repair - enhance immune system detection & destruction of cancer cells - trigger apoptosis

Answer 92

DNA repair genes: genes coding for proteins involved in repairing damaged DNA DNA damage occurs daily in cells- in normal circumstances DNA repair genes are activated to repair the damage with no sustained effects. If there is a defect, or mutation, in these genes and DNA repair cannot occur appropriately, this can give rise to cancerous development of cells. Different types of DNA repair genes have been implicated in different types of cancers.

Answer 93

Immunity, inflammation & infection, Chemical exposure, Radiation, Dietary factors

Answer 94

Cancer staging outlines the tumour size and level of spread, with higher stages attributed to larger sized tumours and more spread. There are different cancer grading systems, but most systems account for: - tumour location, size and/or type - involvement of lymph nodes - involvement of other tissues (metastasis)

Answer 95

Abnormal cells are present but have not spread to nearby tissue. Also called carcinoma in situ, or CIS. CIS is not cancer, but it may become cancer.

Answer 96

Cancer is present. The higher the number, the larger the cancer tumor and the more it has spread into nearby tissues.

Answer 97

The cancer has spread to distant parts of the body.

Answer 98

tumour grading compares the tumor cells to the host tissue cells and awards a grade based on the level of resemblance Cancer staging is about the size tumour and level of spread. In both cases the higher the grade/stage the more severe the cancer is

Answer 99

T= Size and the extent of the tumour N= Number of lymph nodes with cancer M= Whether or not metastasis occurs

Answer 100

Leukaemia is cancer of blood-forming tissues, including bone marrow. 1) Blast immature cells accumulate in bone marrow 2) cells cant mature 3) cytopenia (Decrease cells: WBC, RBC & platelets) 4) Immature cells spill into blood and accumulate in other tissues. It is related to excessive proliferation of particular hematopoietic cells which may remain undifferentiated or are not fully mature/functional. The cell type, and it's stage of differentiation, determine the different types of leukemia which may be either acute or chronic

Answer 101

Acute leukemia develops rapidly with the highly proliferative blast cells taking up space in the bone marrow and preventing the normal development of all types of blood cells, resulting in cytopenia. Eventually the malignant blast cells spill out into circulation and may then spread to other organs and tissues in the body. Acute: there is rapid proliferation of undifferentiated **blast cells** (immature blood cells) - Acute lymphoblastic leukemia (ALL): lymphoid stem cell lineage - Acute myeloid leukemia (AML): myeloid stem cell lineage

Answer 102

Chronic: there is slower proliferation of more differentiated cells in the lineage, but the cells do not achieve full maturity - Chronic lymphocytic leukemia (CLL): lymphocyte cell lineage - Chronic myeloid leukemia (CML): myeloid cell lineage

Answer 103

Like other cancers, leukemia is associated with the development of abnormalities in the genes of the affected cells (e.g. chromosomal translocation). These genetic abnormalities may be inherited or acquired. Though the specific cause of the genetic damage may not be known, some of the following factors are believed to increase the risk: - other genetic/hereditary conditions (e.g. Down syndrome) - exposure to certain toxins/chemicals, such as benzene - chemotherapy or radiation therapy - other blood cancers or disorders - certain infections (e.g. HIV)

Answer 104

Lymphomas are neoplasms that develop from lymphocytes within the lymphatic system. There are two main types of lymphoma: - Non-Hodgkin's lymphoma - Hodgkin's lymphoma In either case there are genetic abnormalities that develop within lymphocytes- B-cells (most commonly), T-cells or NK cells- that result in uncontrolled proliferation of malignant cells. The growing neoplasms disrupt the normal function of healthy WBCs within the lymphatic system, decreasing effectiveness of the immune & lymphatic systems in fighting infections.

Answer 105

- painless lymphadenopathy (common sites: cervical, axillary & inguinal lymph nodes) - B symptoms. (Unexplained fever, drenching night sweats and weight loss) - fatigue - pruritis (Itchy skin is an irritating sensation that makes you want to scratch) - abdominal symptoms (associated with abdominal masses or hepatosplenomegaly) - mediastinal mass, cough or chest pain (associated with mediastinal node involvement)

Answer 106

Non-Hodgkin lymphoma more commonly occurs in middle age and the tumour cells readily spread to other lymphoid tissues and organs, which may be sporadic. Sub-types may be of the aggressive (fast-growing) or indolent (slow-growing) variety. Risk factors ****include: - family history - certain toxins/chemicals - irradiation - certain viral infections (e.g. Epstein-Barr, HIV) - *Helicobacter pylori* infection

Answer 107

Hodgkin lymphoma is distinguished from Non-Hodgkin lymphoma by the presence of Reed-Sternberg (RS) cells. (Reed-Sternberg cells are large, abnormal lymphocytes (a type of white blood cell) that may contain more than one nucleus) Spread also tends to occur in a more continuous pattern (e.g. from one group of lymph nodes to another). There are two major sub-types: classical Hodgkin lymphoma and nodular lymphocyte predominant Hodgkin lymphoma. Lymphoma tends to affect young adults or more elderly adults. Risk factors include: - previous infections with Epstein-Barr virus - HIV infection Treatment options vary based on the specific type of lymphoma and the staging of the disease, but most treatment includes chemotherapy and/or radiation. Stem cell transplant might be an option in some cases and in other cases drug therapy may be beneficial.

Answer 108

Lymphatic system

Answer 109

Incubation: pathogen is replicating, but no signs/symptoms have developed. Different pathogens have different incubation periods. Prodrome: initiation of signs/symptoms (typically mild & vague) while pathogen continues to replicate. Illness: period of significant signs/symptoms (typically more severe) specific to the infection. Decline: decline in signs/symptoms as elimination of pathogen enhances. Convalescence/Resolution: signs/symptoms disappear, infection has been contained/eliminated.

Answer 110

Human papillomavirus (HPV). Group of non enveloped DNA virus's. Specifically infection human epithelia cells. Categorised by what epithelium it infects- Can affect cutaneous tissue or mucus membranes. There are 200+ different varieties of HPV. Can cause begine tumors, warts and carcinomas. Transmission: skin-skin contact (particularly with broken skin), sexual contact (some varieties).

Answer 111

Warts, precancerous lesions and carcinomas

Answer 112

6 and 11. Classed as low risk HPVs and they dont ever really progress further than warts

Answer 113

- High flow oxygen - Beta-agonist drugs: inhaled or intravenous - Anticholinergics (bronchodilators) - Corticosteroids - Adrenaline - CPAP (continuous positive airway pressure) - SaO2 & Cardiac monitoring - Severe forms may require sedation, intubation and mechanical ventilation - Antibiotics - Chemotherapeutics

Answer 114

Oxygen saturation levels below 92% in room air, and patients should be weaned from oxygen when the saturation level exceeds 94%

Answer 115

Sympathomimetics (bronchodilators) relax bronchial smooth muscle via stimulation of the enzyme adenylcyclase Immediate relief medications include: - Salbutamol (Brand name ventolin) - Terbutaline They are short acting and target beta 2 adrenergic receptors on bronchial smooth muscle

Answer 116

Sympathomimetics (bronchodilators) relax bronchial smooth muscle via stimulation of the enzyme adenylcyclase Immediate relief medications include: - Salbutamol (Brand name ventolin) - Terbutaline Long acting relief: Salmeterol (Brand: servent) - Long acting inhaler, prevent inflammation, promotes bronchodilation

Answer 117

Tachycardia, palpitations, tremor and anxiety

Answer 118

Ipratropium (Brand: Atrovent) Inhibits bronchoconstriction

Answer 119

Hydrocortisone- IV for asthma 100-200mg Both glucocorticoid and mineralcorticoid properties These types of drugs switch on/off specific genes that code for proteins involved in the inflammatory process or its regulation. They can take hours to exert the full therapeutic effect. USED ONLY IN SEVERE CASES

Answer 120

Methylxanthines- (Intravenous Brand: Aminophylline) (Oral Brand: Theophylline) - Inhibits bronchoconstriction

Answer 121

CPAP Applies continuous positive airway pressure to keep airways open throughout the breathing cycle In spontaneously breathing patients low levels of mask CPAP may improve respiratory rate, dyspnoea, and work of breathing in asthma There is a danger that CPAP may worsen lung hyperinflation If patients are intolerant of the mask or do not benefit, CPAP should be withdrawn In hypercapnic patients CPAP alone may not improve ventilation

Answer 122

Diuretics Sympathomimetics – α, β receptor drugs, nerve terminal drugs α, β receptor drugs, nerve terminal drugs – calcium channel blockers Antigiotensin antagonists - ACE inhibitors, receptor blockers Anticoagulants Statins

Answer 123

Used to increase cardiac contractility E.g digoxin or decrease contractility E.g. β2 agonists dilate skeletal and coronary arteries and therefore decrease “afterload” and myocardial workload aswell used for CF

Answer 124

Beta blockers e.g. metoprolol, propranolol Competitively block beta1 adrenergic receptors on the S.A. and A.V. nodes of the heart as well as on the ventricular muscle cells Reduce heart rate and contractility therefore ↓cardiac output and blood pressure Because the heart rate is reduced there is also more time for blood to move from the aorta to other areas of the circulation Aortic blood pressure therefore reaches lower levels during diastole and so afterload is reduced

Answer 125

Advantages of beta blockers -The reduction in rate and force of contraction reduce cardiac output and BP - This →↓ myocardial workload and oxygen consumption This class of drugs may sometimes be used to treat angina and heart failure. Caution using these drugs in heart failure because while they may reduce myocardial workload if cardiac output declines it may make the situation worse - Proven over 30 years to reduce blood pressure and incidence of fatal and non-fatal stroke Also used in treatment of myocardial infarction and heart failure but less validated

Answer 126

Disadvantages of beta blockers - Fatigue/depression - Vivid or bad dreams - Provocation of asthma also block β2 receptors on bronchiole smooth muscle ⇒bronchoconstriction metoprolol more selective for β1 receptors than earlier drugs such as propranolol - Cold peripheries blockade of β2 receptors that dilate some blood vessel - Possible conduction block or heart failure - May increase serum triglycerides

Answer 127

E.g. nifedipine, felodipine Vascular smooth muscle cells have only small amounts of stored calcium ions, Calcium ions are necessary for muscle contraction because they permit the interaction of actin and myosin Calcium ions enter through voltage gated calcium channels when the muscle cell is depolarised Blocking these channels in vascular smooth muscle causes less calcium to be available intracellularly and so the force of contraction is reduced → vasodilation and reduced TPR Unwanted effects ‐ excessive vasodilation, hypotension, dizziness, flushing, ankle oedema. Calcium channel blockers may also worsen heart block and heart failure Verapamil is a calcium channel blocker that binds more to calcium channels on cardiac muscle and pacemaker cells so may be more useful in treating some arrhythmias e.g. SVT

Answer 128

Omeprazole, Pantoprazole and other “prazole” medications are drugs that affect out proton pump inhibitors in the stomach wall They are the most potent inhibitors in the gastrointestinal tract Omeprazole irreversibly inhibits the H+/K+-ATPase ie. proton pump which is the final step in the acid secretory pathway They reduce the acid secretion by up to 99% Omeprazole is a neutral pH but because it is a weak baseit accumulates in the canaliculi of parietal cells where it is activated and has specific action on these cells Unwanted effects are uncommon but may include: headache, diarrhoea, rashes, dizziness, pain in muscles & joints

Answer 129

Clinical uses of penicillins The first penicillins were the naturally occurring benzylpenicillins Benzylpenicillin (penicillin G) remains a useful antibiotic, active against a wide range of bacteria (provided these organisms are beta-lactamase negative) including: Streptococcal infections Pneumococcal infections Gonococcal infection Meningococcal infection Treponema (syphilis) Clostridium (tetanus, gas gangrene) Diptheria, anthrax, leptospirosis

Answer 130

Phenoxymethylpenicillin (V) - Similar antibacterial spectrum as benzylpenicillin but less active - Gastric acid stable - Not be given for serious infections because absorption is unpredictable - Mainly used for: respiratory tract infections in children streptococcal tonsillitis continued oral treatment Benzylpenicillin (G) - Inactivated by gastric acid - Best given by injection - Allergic reactions can cause convulsion at higher doses - Beta-lactamase positive

Answer 131

Aminopenicillins Piperacillin & Ticeracillin Flucloxacillin

Answer 132

unable to pump → myocardial damage → cant contract Forcefully → Pumps

Answer 133

1) Most common: ischemia ( CAD) → Damage to myocardium. 2) long standing HTN: Increased in bp in systemic circ → hard to pump blood in high pressure system → muscle hypertrophy → Increased 02 demand, for the Increased in muscle → Increased muscle squeezes the CA → tissue ischima x hypoxia → weaker contraction 3) Dilated cardiomyopathy: LV dilated to fill more blood & increase contraction strength → work for a bit → muscle walls get to thin & weak → unable to pump

Answer 134

Cant relax during diastole

Answer 135

1) long standing HTN → concentric hypertrophy → less filling room 2) Aortic stenosis (aortic valve narrows and blood cannot flow normally) → concentric hypertrophy 3) Hypertrophic cardiomyopathy (Build of muscle mass) → less filling room 4) restrictive cardiomyopathy → stifter & less compliant → cant stretch & fill

Answer 136

reduation blood to kidneys → renin-Angiotenin Aldosterone system → fluid retention → increased filling reload → increased contraction strength → Good for a while → blood retention in the blood vessels → leak into tissues → Fluid build up in lung & body

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