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Misc. Notes Year 1 > Rhodia > Flashcards

Rhodia Flashcards

1
Q

Signs of pneumonia caused by strep. pneumoniae

A

High fever, rapid onset
Herpes Labialis
Rusty Sputum

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2
Q

Signs of pneumonia caused by Haem. Influenzae

A

Exacerbation of COPD or Bronchiectasis

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3
Q

Signs of pneumonia caused by Staph. Aureus

A

Recent influenza infection

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4
Q

Signs of pneumonia caused by Mycoplasma

A

Dry cough
Atypical chest signs
Haemolytic anaemia
epidemic every 4 years

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5
Q

Signs of pneumonia caused by Legionella

A

Foreign country in contact with cooling system or water stored below 60 degrees
Hyponatraemia
Lymphopenia (low levels of lymphocytes)

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6
Q

Signs of pneumonia caused by Klebsiella

A

Alcoholic
Homeless
Red jelly sputum

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7
Q

Signs of PCP (Pneumocystis jiroveci pneumonia)

A

HIV positive

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8
Q

Causes of Resp. Acidosis

A

COPD
Decompensation (asthma/oedema)
Sedative drugs
Pickwickian syndrome (obesity hypoventilation)
Basically not being able to clear out the CO2 in ur lungs

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9
Q

Causes of Resp. Alkalosis

A 
Anxiety Hyperventilation 
P.E
CNS disorders
Altitude
Pregnancy 
Basically when you blow off too much CO2
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10
Q

Cells involved in cell mediated response

A

Helper and Cytotoxic T Cells

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11
Q

Helper T cell - CD? - MHC?

A

CD4, MHCII

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12
Q

Cytotoxic T cell -CD? -MHC?

A

CD8, MHCI

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13
Q

Cells involved in chronic and acute organ rejection

A

Helper and Cytotoxic T Cells

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14
Q

Major humoral response cell?

A

B cells

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15
Q

Antigen presenting cells

A

B cells, Macrophages & Dendritic cells

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16
Q

Responsible for hyperacute organ rejection

A

B cells

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17
Q

Cell type differentiated from B cells

A

Plasma cells

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18
Q

Cell type which produces large amounts of antibody specific to antigen

A

Plasma cells

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19
Q

Cardiac arrest during an MI is usually due to what

A

ventricular tachycardias

VT or VF usually

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20
Q

What leads to cardiogenic shock during an MI

A

A decrease in ejection fraction

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21
Q

Bradyarrhythmia which can arise during MI and when more common

A

AV block

More common in inferior MI

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22
Q

Time frame after MI for acute pericarditis plus buzzword

A

48hours

“pain relieved on sitting up”

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23
Q

Time frame after MI for Dressler’s plus what is it

A

4-6weeks

Autoimmune phenomenon- pericarditis

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24
Q

Sign of an LV aneurysm following an MI

A

Persistent ST elevation with no chest pain

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25
Q

Time frame for an LV rupture and signs

A

1-2weeks post-MI

Acute heart failure secondary to cardiac tamponade (raised JVP and muffled heart sounds)

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26
Q

Time frame for a ventricular septal rupture and signs

A

Within a week

Acute heart failure and pan-systolic murmur

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27
Q

Cardiac murmur which can arise after MI (more common in infero-posterior MI) and causes

A

Acute mitral regurge. can be down to ischaemia or rupture of the papillary muscle

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28
Q

List the immunoglobulins in order of serum abundance

A

IgG, IgA, IgM, IgD, IgE

remember GAMDE

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29
Q

Which of the immunoglobulins are monomers when secreted

A

IgG, IgD, IgE

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30
Q

Which of the immunoglobulins are dimers when secreted

A

IgA only

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31
Q

Which of the immunoglobulins are pentamers when secreted

A

IgM

remember what ben said ‘M’ has 5 lines

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32
Q

What is the role of IgG

A

Enhances phagocytosis
Fixes complement
passes on to fetal circulation

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33
Q

What is the role of IgA

A

Most commonly produced immunoglobulin
Provides localised protection on mucous membranes
Found in breast milk

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34
Q

What is the role of IgM

A

First Immunoglobulin produced during infection
Fixes complement
DOESN’T pass on to fetal circulation (think of it as being too big since it’s a pentamer)

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35
Q

What is the role of IgD

A

Role in immune system largely unknown

no one knows how to really use the D

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36
Q

What is the role of IgE

A

Binds to Fc receptors on basophils and mast cells

Provides immunity to parasites such as helminths

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37
Q

What is a neutrophil

A

The main cell involved in acute inflammation

Most common WBC

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38
Q

What do neutrophil granules contain

A

lysozyme and myeloperoxidase

probably don’t need to know

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39
Q

What is special about the neutrophil nucleus

A

Multi-lobed

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40
Q

What do basophil granules contain

A

Histamine and Heparin

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41
Q

What is special about the basophil nucleus

A

Bi-lobed

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42
Q

Which cell type are mast cells similar to and what dot heir granules contain

A

Similar to basophils

and yeh u guessed it their granules also contain histamine and heparin

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43
Q

What is special about the mast cell nucleus

A

nothing

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44
Q

What is special about the eosinophil nucleus

A

Bi-lobed

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45
Q

What is special about the monocyte nucleus

A

Kidney shaped

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46
Q

What is special about the macrophage nucleus

A

nothing

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47
Q

What is special about the NK cell nucleus

A

nothing

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48
Q

What is special about the dendritic cell nucleus

A

nothing lol

that got old quick

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49
Q

What sort of infections do eosinophils protect against

A

protozoan and helminthic

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50
Q

What cell do monocytes differentiate into

A

macrophages

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51
Q

What do NK cells do

A

Induce apoptosis in infected/tumour cells

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52
Q

What cell releases IL-1 and what is the function

A

Macrophages

acute inflammation and fever

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53
Q

What cell releases IL-2 and what is the function

A

Th1 cells

Growth and differentiation of T cell response

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54
Q

What cell releases IL-3 and what is the function

A

Activated T cells
Differentiation and proliferation of myeloid progenitor cells
(NOT GONNA COME UP)

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55
Q

What cell releases IL-4 and what is the function

A

Th2 cells

Stimulates differentiation and proliferation of B cells

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56
Q

What cell releases IL-5 and what is the function

A

Th2 cells

Stimulates production of eosinophils

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57
Q

What cell releases IL-6 and what is the function

A

Macrophages and Th2 cells
Stimulates differentiation and proliferation of B cells
+ fever

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58
Q

What cell releases IL-7 and what is the function

A

U fool

There is no IL-7

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59
Q

What cell releases IL-8 and what is the function

A

Macrophages

Neutrophil chemotaxis

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60
Q

What cell releases IL-9 and what is the function

A

Fs

There is no IL-9

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61
Q

What cell releases IL-10 and what is the function

A

Th2

Anti-inflammatory and inhibits Th1 cytokines

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62
Q

What cell releases IL-11 and what is the function

A

No

There is no IL-11

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63
Q

Is there an IL-12

A

Yes
Released by dendritic + B cells & macrophages
It activates NK cells + differentiation of T cells into Th1

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64
Q

What cell releases TNF-a and what is the function

A

Tumour-necrosis-factor alpha is released by macrophages
Causes fever
Neutrophil chemotaxis

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65
Q

What cell releases Interferon γ and what is the function

A

Th1 cells

Activates macrophages

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66
Q

In general, what is the rule of thumb for things that cause the oxygen dissociation curve shift to the left
give examples

A 
Less of something causes left shift 
Low [H+] (alkalosis)
Low Temp 
Low 2,3-DPG
Low pCO2  (carboxyhaemoglobin)
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67
Q

In general, what is the rule of thumb for things that cause the oxygen dissociation curve shift to the right
give examples

A 
More of something causes left shift 
Raised [H+] (acidosis)
Raised Temp 
Raised pCO2
Raised 2,3-DPG
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68
Q

Define the tidal volume and give its average value

A

Volume of air entering or leaving lungs during a single breath
500mls

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69
Q

Define the inspiratory reserve volume (IRV) and give its average value

A

Extra volume of air that can be maximally inspired over and above the typical resting tidal volume
3000mls

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70
Q

Define the inspiratory capacity (IC) and give its average value

A

Maximum volume of air that can be inspired at the end of a normal quiet expiration (IC =IRV + TV)
3500ml obvs

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71
Q

Define the expiratory reserve volume (ERV) and give its average value

A

Extra volume of air that can be actively expired by maximal contraction beyond the normal volume of air after a resting tidal volume
1000mls

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72
Q

Define the residual volume (RV) and give its average value

A

Minimum volume of air remaining in the lungs even after a maximal expiration
1200mls (increases with age)

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73
Q

What is the vital capacity and how do you work it out

A

Maximum volume of air that can be moved out during a single breath following a maximal inspiration (VC = IRV + TV + ERV)
4500mls

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74
Q

What is the Functional residual capacity (FRC) and how do you work it out

A

Volume of air in lungs at end of normal passive expiration (FRC = ERV + RV)
2200mls

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75
Q

What is the total lung capacity and how do you work it out

A

Total lung capacity is the maximum volume of air that the lungs can hold
Total lung capacity = Vital Capacity + Residual Volume
Roughly 5700mls

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76
Q

What is the only lung volume you cannot measure with spirometry and what does this mean

A

Residual Volume

It means you cannot accurately calculate someone’s total lung capacity

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77
Q

Give examples of ejection systolic murmurs

A

Aortic Stenosis (the most obvious one)
Pulmonary Stenosis
HOCM
Atrial septal defect

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78
Q

Give examples of pan systolic murmurs

A

Mitral regurgitation
Tricuspid regurgitation
Ventricular septal defect

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79
Q

Give examples of early diastolic murmurs

A

Aortic regurgitation

Pulmonary regurgitation

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80
Q

Give examples of mid/late diastolic murmurs

A

Mitral stenosis

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81
Q

What does it mean if you hear a continuous machinery murmur below the left clavicle

A

Patient has a patent ductus arteriosus

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82
Q

What perforates the diaphragm at T8

A

IVC

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83
Q

What perforates the diaphragm at T10

A

Oesophagus

Vagus

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84
Q

What perforates the diaphragm at T12

A

Aorta
Azygous vein
Thoracic Duct

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85
Q

What will be the heart rate for regular sinus rhythm

A

60-100bpm

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86
Q

What is the duration of a normal PR interval

A

0.12-0.2 seconds

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87
Q

What is the duration of a normal QRS complex

A

0.06-0.12 seconds

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88
Q

What is the atrial rate in atrial fibrillation

A

> 300bpm

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89
Q

What is the ventricular rate in atrial fibrillation

A

can be slow, normal or fast

doesn’t really matter the atria are still spazzing out

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90
Q

What are the P waves like on an ECG of atrial fibrillation

A

The P waves are absent

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91
Q

What is the PR interval like on an ECG of Atrial Fibrillation

A

Well the P wave is absent so obviously, there isn’t a PR interval u idiot

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92
Q

What is the QRS complex like on an ECG of Atrial Fibrillation

A

Normal

Problem is with atria why would that affect ventricular depolarization

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93
Q

Describe the atrial rate in atrial flutter

A

pretty damn fast

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94
Q

How would you differentiate between an atrial flutter ECG and an atrial fibrillation ECG

A

There is no P wave in atrial fibrillation
There is saw tooth P waves in atrial flutter
(BUZZWORD)

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95
Q

What is the ventricular rate in atrial flutter

A

slow af compared to the atrial rate

but yeh slow compared to normal as well

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96
Q

What is the PR interval like in atrial flutter

A

Non-Measurable

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97
Q

What is the QRS complex like in atrial flutter

A

Normal

Again, the problem is with atria why would that affect ventricular depolarization

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98
Q

What is absent on an ECG of someone in asystole

A

P wave, PR interval (obvs), QRS complex

Basically everything patient is pretty much dead

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99
Q

What is the QRS complex like in a bundle branch block ECG

A

Wide

No idea why wtf even is a bundle branch block

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100
Q

What is the rate like in ventricular fibrillation

A

Non-measurable

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101
Q

What is the P wave like in ventricular fibrillation

A

It’s not there - Absent

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102
Q

What is the QRS complex like in ventricular fibrillation

A

There is no QRS complex

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103
Q

What is the PR interval like in Ventricular Fibrillation

A

Lol u fool
there’s no P wave and no QRS complex
How tf are u gonna get a PR interval

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104
Q

How can you tell the difference between a ventricular tachycardia and a supraventricular tachycardia on an ECG

A

SVT has a narrow QRS complex

VT has a wide QRS complex

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105
Q

What are two names for Type 1 hypersensitivity

A

IgE mediated

Immediate

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106
Q

Which exposure to the antigen is usually more severe in type 1 hypersensitivity

A

2nd exposure
1st exposure acts as a sensitisation, priming t cells
2nd exposure involves anaphylaxis

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107
Q

Which immunoglobulin is involved in type 1 hypersensitivity

A

IgE

That’s why it’s called IgE mediated

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108
Q

How is a type 1 hypersensitivity reaction treated

A

Anti Histamine
Corticosteroid
Adrenaline

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109
Q

What are the immune components involved in a Type 1 Hypersensitivity

A

Mast cells
IgE
B lymphocytes
T lymphocytes

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110
Q

What are 2 names for Type 2 hypersensitivity

A

Direct Cell killing

Cytotoxic

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111
Q

Give 2 examples of type 2 hypersensitivity reactions

A

Autoimmune Haemolytic Anaemia

Blood transfusion reaction

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112
Q

What immune components are involved in Type 2 hypersensitivity

A

Antibody to cell surface protein
B lymphocytes
T lymphocytes

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113
Q

What is another name for a Type 3 hypersensitivity

A

Immune complex mediated

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114
Q

Give 2 examples of type 3 hypersensitivity reactions

A

SLE (systemic lupus erythematosus)

Farmer’s Lung (hypersensitivity pneumonitis/ EAA)

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115
Q

What immune components are involved in Type 3 hypersensitivity

A

Antigen-antibody complexes
B lymphocytes
T lymphocytes

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116
Q

What are 2 names for Type 4 hypersensitivity

A

Delayed

T cell mediated

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117
Q

Give 3 examples of type 4 hypersensitivity reactions

A

Sarcoidosis (NON-CASEATING granuloma)
Tb (CASEATING granuloma)
Type 1 Diabetes

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118
Q

What immune components are involved in Type 4 hypersensitivity

A

Activated T cells and macrophages

persistently activated to form a granuloma

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119
Q

What does hyperplasia mean

A

An increase in cell number

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120
Q

What does hypertrophy mean

A

An increase in cell size

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121
Q

What does atrophy

A

A decrease in cell size & number in a normal sized organ or tissue

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122
Q

What is hypoplasia

A

Reduced size in an organ or tissue which was never normal sized

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123
Q

What is metaplasia

A

An acquired form of altered differentiation

NOT NEOPLASTIC

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124
Q

What is neoplasia

A

An abnormal tissue mass with uncoordinated growth

All cancers are neoplastic but not all neoplasms are cancer

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125
Q

What is a benign neoplasm

A

Resemble normal tissue

no necrosis or metastases

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126
Q

What are the characteristics of a malignant neoplasm

A 
invasive
rapid growth 
not encapsulated 
common necrosis 
may metastasise
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127
Q

What are the 4 types of necrosis

hahah yeh huge tb to principles

A

Caseous
Coagulative
Colliquative
Fibrinoid

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128
Q

What is the PPE pneumonic

A

AGGA

apron, gloves, gloves, apron

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129
Q

Where would you put household waste

A

Black bag

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130
Q

Where would you put recycled household waste

A

Green bag

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131
Q

Where would you put confidential waste

A

Blue bag

Yeh still never seen one

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132
Q

Where would you put low-risk special waste

A

Orange bag

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133
Q

What would you put in a yellow bucket

A

depends on the top

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134
Q

Where would you put ethical, possible infectious waste

A

in a yellow bucket with a red top

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135
Q

Where would you put medicinal waste such as drug bottles

A

yellow bucket with a blue top

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136
Q

What parts of the hand are frequently missed when washing them

A

THUMB THUMB THUMB

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137
Q

What are the 5 I’s of infection spread

A 
Inhalation
Ingestion
Inoculation
Infant (from mother) 
Intercourse (giggity)
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138
Q

Give the average asthma spirometry result

A

FEV1 decreased
FVC normal
Ratio decreased
CLASSIC OBSTRUCTIVE PATTERN

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139
Q

Give the average COPD spirometry pattern

A

FEV1 decreased
FVC decreased (due to emphysema)
Ratio DECREASED
COPD GIVES A MIXED PATTERN YEH ITS WEIRD

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140
Q

How would you class an FEV1/FVC ratio

A

> 75% is normal

<75% is reduced

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141
Q

What is the most common lung cancer in smokers

A

Squamous

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142
Q

What hormone does squamous cancer secrete

A

PTH (Parathyroid hormone)

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143
Q

What does PTH secreted by squamous cancer cause

A

Hypercalcaemia

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144
Q

Where do squamous cancers tend to occur in the lungs

A

Centrally, close to hilum

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145
Q

Which lung cancer is most often cavitating

A

Squamous

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146
Q

What is the most common lung cancer in non smokers

A

Adenocarcinoma

unlucky ppl

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147
Q

What cells is adenocarcinoma derived from

A

Gram cells

??

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148
Q

Which lung cancer has the worst prognosis

A

Small cell

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149
Q

Which cancer is most chemosensitive and why

A

small cell

has a rapid growth rate and chemotherapy targets rapidly dividing cells

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150
Q

What hormones does small cell cancer secrete

A

ACTH

ADH

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151
Q

What is Horner’s Syndrome, what causes it and what are the symptoms

A

Pancoast Tumour (apical tumour) invades the sympathetic chain, causing unilateral drooping of eyelid and loss of sweating

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152
Q

What is the pneumonic to remember how hypercalcaemia can present

A

MOANS - constipation + abdominal pain
STONES - kidney stones + frequent urination
BONES - bone aches + arching of spine
GROANS - confusion, memory loss, depression

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153
Q

Define communitarianism

A

Is the act good for everyone who will be affected by it?

p.s ethics can fuck off

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154
Q

Define deontology

A

Is the act wrong or right in itself?

p.s ethics can fuck off

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155
Q

Define consequentialism/utalitarianism

A

Is the act right or wrong depending on its consequences

p.s ethics can fuck off

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156
Q

Define religious theory

A

Does the act respect the sanctity of human life

what does that even mean fuck off ethics

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157
Q

Define virtue ethics

A

Am I being honest and consistent in my acts

I’m being honest when I say ethics is shit

158
Q

Define the 4 ethical principles

A

Autonomy: respecting the decision-making capacities of autonomous persons

Beneficence: the healthcare professional should act in a way that benefits the patient

Non-maleficence: avoiding the causation of harm

Justice: distributing benefits, risks and costs fairly

These are all obvious if ur not a retard but learn the definitions

159
Q

What is epidemiology

A

Study of determinants, frequency and distribution of a disease in a population

160
Q

What is the incidence

A

Number of new cases in a population over a given time period

161
Q

What is the prevalence

A

Number of cases of disease in the population currently

162
Q

What is sensitivity

A

Proportion of those who have the disease who have a +’ve test

163
Q

What is specificity

A

Proportion of those who don’t have the disease and have a -‘ve test

164
Q

What does stimulation of the alpha 1 receptor do

A

Vasoconstriction of SM in vasculature

Sphincters in GI tract and urinary bladder contract

165
Q

What does stimulation of the alpha 2 receptor do

A

Inhibits insulin secretion

Induces glucagon secretion

166
Q

What does stimulation of the beta 1 receptor do

A

Increases heart rate and force

167
Q

What does stimulation of the beta 2 receptor do

A

SM relaxation in airways
Increases mucociliary clearance in airways
Reduced motility in GI tract

168
Q

What does stimulation of the Muscarinic 1 receptor do

A

Increase in stomach and salivary secretions

169
Q

What does stimulation of the Muscarinic 2 receptor do

A

Slows down heart rate

no effect on force remember very little parasympathetic innervation of myocardium

170
Q

What does stimulation of the Muscarinic 3 receptor do

A

Airway SM contraction
Increased airway mucous secretion from goblet cells
Vasodilation of SM in vasculature
Increases motility of GI tract

171
Q

When can M3 stimulation cause bronchial SM relaxation

A

Via non-cholinergic synapse

regulated by NO and VIP

172
Q

What type of study is observational and prospective and what is the usual outcome

A

Cohort study

usual outcome is relative risk

173
Q

What type of study is observational and retrospective and what is the usual outcome

A

Case-control study

Usual outcome is odds ratio

174
Q

What should you consider doing for a primary pneumothorax that is under 2cm

A

Consider discharge and review in 2-4weeks

175
Q

What should you consider doing for a secondary pneumothorax that is under 2cm

A

Admit patient
High flow oxygen
monitor for 24hrs

176
Q

What should you do simple pneumothorax that is over 2cm

A

Aspirate using a 16-18G cannula

177
Q

What is the safe triangle for chest drain insertion for a pneumothorax

A

anterior border of latissimus dorsi
posterior border of pectoralis major
axial line superior to nipple

178
Q

Where would a large guage cannula be inserted to treat a pneumothorax

A

2nd or 3rd intercostal space

Mid clavicular line

179
Q

What is Henry’s Law

A

The amount of a given gas dissolved
in a given type and volume of liquid at a constant
temperature is proportional to the partial pressure
of the gas in equilibrium with the
liquid
(Horrid Henry and his partial pressure)

180
Q

What is Boyle’s Law

A

As the volume of a gas increases the pressure exerted by the gas decreases
(treating a boyle)

181
Q

What is the Law of LaPlace

A 
P= 2T/r
where:
P = inward directed collapsing pressure
T = surface tension
r = radius of the alveoli
The smaller alveoli (with smaller radius - r) have a higher tendency to collapse
182
Q

What is the Bohr effect

A

Facilitates the shifting of the oxyhaemoglobin dissociation curve to the right
(oxygen is Bohring)

183
Q

What is the Haldane effect

A

Removing O2 from Hb increases
the ability of Hb to pick-up CO2 and
CO2 generated H+

184
Q

What is the Frank-Starling curve

A

Describes the relationship between venous return, EDV and SV

The more filled the ventricle becomes during diastole, the greater the volume of ejected blood

185
Q

What is Dalton’s Law

A

The total pressure exerted by a gaseous mixture = the sum of the partial pressures of each individual component in the gas mixture

186
Q

What is Fick’s Law

A

The amount of gas that moves across a sheet of tissue in unit time is proportional to the area of the sheet but inversely proportionate to its thickness

187
Q

Name the two mechanisms via which oxygen travels in the blood

A

Bound to haemoglobin

Dissolved in plasma

188
Q

What are the 2 most commonly measured saturations of oxygen

A

SaO2 - arterial saturation - ABG machine

SpO2 - percutaneous - pulse oximeter

189
Q

What are the target O2 saturations

A

94-98% in most patients

88-92% in COPD patients

190
Q

What type of lung disease can cause CO2 retention

A 
Both 
Severe Obstructive (COPD)-most common
Severe Restrictive (obesity)
191
Q

What is respiratory drive normally driven by

A

Driven by blood CO2 levels, recognised by chemoreceptors

192
Q

What occurs in chronic hypercapnia and what does this mean for respiratory drive

A

Chemoreceptors become desensitised to the high levels of CO2 so hypoxia is the main driver of respiration

193
Q

What is the aim of O2 therapy on a patient who retains CO2

A

To increase their oxygen saturation without decreasing their respiratory drive

194
Q

How do you treat an acutely hypoxic CO2 retainer

A

Start them on oxygen through a venturi mask, blue or white (24 or 28%)
Monitor their ABG’s every 30mins

195
Q

What can kill a patient quicker, hypoxia or hypercapnia

A

Hypoxia obviously

so if a CO2 retainer dangerously hypoxic, don’t be afraid to give high flow oxygen

196
Q

What is the pneumonic for clinical features of an immunodeficiency

A

SPUR

Serious, Persistent, Unusal, Recurrent

197
Q

Define the components of SPUR

A

Serious - unresponsive to oral antibiotics
Persistent - early structural damage
Unusual - unusual sites or unusual organisms
Recurrent - 2 major or 1 major and many infections in 1 year

198
Q

What network is activated when a granuloma is formed

A

IL-12 gIFN network

Wow such a catchy name

199
Q

Which cytokine, produced by macrophages, is essential for the formation of a functional granuloma

A

TNF-alpha (Tumour Necrosis Factor alpha)

200
Q

What actually is a granuloma

A

An organised collection of activated macrophages and lymphocytes

201
Q

Name 2 diseases which involve functional granulomas and the difference between them

A

Sarcoidosis (non-caseating granuloma)

Tb (caseating granuloma)

202
Q

How do NK cells work

A

Kill cells that lack MHC molecules on their surface

203
Q

What type of cells are generated during primary immune response

A

Long-lived memory B cells

204
Q

What happens when memory B cells have a second encounter with the antigen

A

They rapidly activate, undergo clonal expansion and differentiate into plasma cells to release specific antibodies

205
Q

During primary infection, which immunoglobulin is produced first

206
Q

Name the two types of vaccines

A

Inactivated

Live attenuated

207
Q

What are the pro’s of a live vaccine

A

All relevant effector mechanisms are stimulated
Localised strong response
Usually, single dose required

208
Q

What are the cons of a live attenuated vaccine

A

Safety - may revert to virulence

Must be stored and handled carefully

209
Q

What are the pro’s of a killed vaccine

A

Can be made quickly
Easy to store
Safe

210
Q

What are the cons of a killed vaccine

A

Doesn’t stimulate clonal expansion of B and T cells
Many killed organisms don’t stimulate a good immune response
More than one dose may be needed

211
Q

What does stimulation via Gq protein do

A

Stimulation of phospholipase C

212
Q

What does stimulation via Gi protein do

A

Inhibition of adenylyl cyclase

213
Q

What does stimulation via Gs protein do

A

Stimulation of adenylyl cyclase

214
Q

What does stimulation of adenylyl cyclase do

A

Increased levels of cAMP

215
Q

What G protein is the M1 receptor coupled to

216
Q

What G protein is the M2 receptor coupled to

217
Q

What G protein is the M3 receptor coupled to

218
Q

What G protein is the B1 receptor coupled to

219
Q

What G protein is the B2 receptor coupled to

220
Q

What G protein is the a1 receptor coupled to

221
Q

What G protein is the a2 receptor coupled to

222
Q

What is the first step of the atherosclerosis pathogenesis ladder

A

Uptake of LDL from the blood into the tunica intima

223
Q

What happens to the LDL which is taken into the tunica intima (atherosclerosis pathogenesis)

A

It is oxidised to oxLDL

224
Q

Which white blood cells migrate into the tunica intima and which cell do they turn into (atherosclerosis pathogenesis)

A

Monocytes -> turn into macrophages

225
Q

What do the macrophages do the oxLDL in the tunica intima and how do they do this (atherosclerosis pathogenesis)

A

The macrophages take up the oxLDL using scavenger receptors

Uptake of oxLDL turns them into foam cells

226
Q

What occurs after the foam cells form a fatty streak in the tunica intima (atherosclerosis pathogenesis)

A

Release of inflammatory cytokines which causes division of SM cells in the tunica intima

227
Q

What does an atheromatous plaque consist of (atherosclerosis pathogenesis)

A

A lipid core (consisting of dead foam cells)

A fibrous cap covering the lipid core (consisting of smooth muscle cells and connective tissue)

228
Q

Which enzyme does aspirin block

229
Q

Which binding reaction does clopidogrel block

A

ADP binding to GPCRPY12

230
Q

Which factors does warfarin block the activation of

A 
Factor 10 (X) and factor 2 (prothrombin)
By blocking Vitamin K reductase
231
Q

How does rivaroxaban work

A

By directly inhibiting factor 10a (Xa)

232
Q

What two factors does heparin inactivate

A

10a (Xa) and 2a (thrombin)

233
Q

What is the inhibitor of coagulation through which heparin acts

A

AT3 (Antithrombin III)

234
Q

What is the difference in the way which heparin inactivates factors Xa and IIa(thrombin)

A

Heparin only needs to bind to AT3 to inactivate factor Xa

Heparin must bind to both AT3 and IIa (thrombin) in order to inactivate IIa (thrombin)

235
Q

What are the 3 embryological layers

A

Ectoderm, Mesoderm & Endoderm

236
Q

What are the three parts of the ectoderm

A

Surface ectoderm
Neural tube
Neural crest

237
Q

When are the embryological layers formed

A

Gastrulation

Came up twice in the CAP no excuses

238
Q

What is the central dogma

A

DNA undergoes transcription and splicing to become RNA

RNA undergoes translation to become protein

239
Q

What are the three main differences between RNA and DNA

A

RNA has the sugar ribose - DNA has deoxyribose
RNA is single stranded - DNA is double
RNA has Uracil instead of Thymine like DNA

240
Q

What occurs during splicing and what are the start and end products

A

Pre-mRNA has its introns removed

The exons remaining are the mature mRNA transcript and these leave the nucleus

241
Q

How many bases is a codon

242
Q

What does each codon correspond to

A

Each codon corresponds to an amino acid

243
Q

What are the 4 stages of the cell cycle and what occurs in each stage

A

G1 - Growth
S - DNA synthesis
G2 - growth + preparation for mitosis
M - Mitosis

244
Q

What ‘mode’ does a cell spend most of it’s life in

245
Q

Which enzymes ‘unzips’ the DNA strand

A

DNA helicase

246
Q

Which enzymes make a copy DNA strand and a copy RNA strand

A

DNA- DNA polymerase

RNA- RNA polymerase

247
Q

What direction is DNA copied

A

5’ -> 3’

248
Q

What is the structure of the DNA strands and what does this mean when it comes to DNA replication

A

Antiparallel (the strands run in opposite directions)

There will be a leading strand and a lagging strand

249
Q

Which enzyme creates a copy of the lagging strand

3’ -> 5’ strand

A

Still DNA polymerase u mong

250
Q

What are the short DNA fragments copied on the lagging strand called

A

Okazaki Fragments (Davie Loh what)

251
Q

Which enzyme joins the Okazaki fragments together on the lagging DNA strand

A

DNA ligase

252
Q

What are the differences between mitosis and meiosis

A

Mitosis produces 2 genetically identical daughter cells

Meiosis produces 4 genetically variable daughter cells

253
Q

Define a polymorphism

A

A DNA variant which has a population frequency of more than 1%

254
Q

Define a mutation

A

A DNA variation which causes or predisposes to a specific disease

255
Q

What gender does an autosomal dominant disease affect

A

Both obviously

sorry all 63*

256
Q

What is the risk of having an affected child in the case of an autosomal dominant disease

257
Q

What is the risk of having an affected child in the case of an autosomal recessive disease

258
Q

Define expression

A

The process by which information from a gene is used in the synthesis of a functional gene product

259
Q

Define penetrance

A

The extent to which a particular gene is expressed in the phenotype of the individual carrying it

260
Q

What are the indications of a severe asthma attack

A

HR >110bpm
PEFR <50%
Can’t complete sentences
Resp Rate ≥25/min

261
Q

What the indications of a life-threatening asthma attack

A 
HR <60bpm
Confusion
Lack of breath sounds
PEFR <33%
Cyanosis
PaO2 <8kPa
262
Q

What is the QRISk 2 score

A

A score which calculates the risk of a cardiovascular event in the next 10 years

263
Q

What is the CHA2 DS2 - VASc score

A

Used to determine the need to anti-coagulate a patient with AF

264
Q

What is the normal cardiac axis

A

-30 to +90 degrees

265
Q

What indicates right axis deviation

A

An axis greater than +90 degrees

266
Q

What indicates left axis deviation

A

An axis less than -30 degrees

267
Q

What does an irregularly irregular pulse indicate

A

Atrial fibrillation

yeh pretty obvious

268
Q

What does a slow-rising pulse indicate

A

Aortic stenosis

no shit

269
Q

What does a collapsing pulse indicate

A

Aortic regurgitation

270
Q

What does a bounding pulse indicate

A

Acute Co2 retention
Hepatic failure
Sepsis

271
Q

What does radio-femoral delay indicate

A

coarctation of the aorta

272
Q

What is the buzzword sign on a CXR for coarctation of the aorta

A

Notching of the inferior border of the ribs

273
Q

What does a jerky pulse indicate

A

Mitral regurgitation

HOCM

274
Q

What does pulsus bisferiens mean

A

A pulse with 2 peaks

275
Q

What does pulsus bisferiens indicate

A

Mixed aortic valve disease

HOCM

276
Q

What does pulsus paradoxus indicate

A

Constrictive pericarditis

Cardiac tamponade

277
Q

What is pulsus paradoxus

A

an abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mmHg

278
Q

What does a raised, fixed JVP indicate

A

SVC obstruction

279
Q

What does a JVP rising on inspiration indicate

A

Cardiac tamponade

Constrictive pericarditis

280
Q

What do large V waves in the JVP indicate

A

Tricuspid regurgitation

281
Q

What do absent A waves in the JVP indicate

A

Atrial Fibrillation

282
Q

What do cannon A waves in the JVP indicate

A

Complete heart block
AV dissociation
Ventricular arrhythmias

283
Q

What does malar flush indicate

A

Mitral stenosis

284
Q

What does pulsatile hepatomegaly indicate

A

Tricuspid regurgitation

285
Q

What is Corrigan’s sign and what does it indicate

A

Carotid pulsation

Indicates Aortic regurgitation

286
Q

What is De Musset’s sign and what does it indicate

A

Head bobbing

Indicates Aortic regurgitation

287
Q

What is Quincke’s sign and what does it indicate

A

Capillary pulsations

Indicates Aortic regurgitation

288
Q

What is Traube’s sign and what does it indicate

A

Pistol shot femoral pulse
Indicates Aortic regurgitation
This one has literally come up once

289
Q

What are Roth’s spots and what do they indicate

A

retinal hemorrhages

They indicate infective endocarditis

290
Q

What are Janeway lesions and what do they indicate

A

Small, nodular, painless lesions on the palms or soles

Indicate infective endocarditis

291
Q

What are Osler’s nodes and what do they indicate

A

Painful, tender lesions
Indicate infective endocarditis
They’re called fkin Osler’s nodes ofc they’re painful

292
Q

What would be the indications of an atrial septal defect

A

Wide, fixed 2nd heart sound

Ejection systolic murmur in the 2nd intercostal space

293
Q

What would be the signs of a ventricular septal defect

A

Harsh, pan-systolic murmur over left sternal edge

294
Q

Where would you hear a patent ductus arteriosus and what would it sound like

A

A continuous machinery murmur heard below the left clavicle

295
Q

How would transposition of the great vessels present

A

Cyanosis on the 1st day of life

Egg shaped ventricles on CXR

296
Q

How would Tetralogy of Fallot present

A

Cyanosis during 1st month of life

A boot-shaped heart on CXR

297
Q

Name 7 respiratory causes of clubbing

A 
Bronchial carcinoma
Bronchiectasis 
Lung Abscess
Empyema
Cystic Fibrosis
Idiopathic Pulmonary fibrosis
Mesothelioma 
Tb
298
Q

Which two common respiratory diseases do not cause clubbing

A

Asthma

COPD

299
Q

What are the indications to diagnose stage 1 hypertension

A

Clinic Bp > 140/90

ABPM/HBPM > 135/85

300
Q

What are the indications to diagnose stage 2 hypertension

A

Clinic Bp > 160/100

ABPM/HBPM > 150/95

301
Q

What are the indications of severe/malignant hypertension

A

Bp > 180/110

302
Q

What is white coat hypertension

A

When the patients Bp appears higher than it is because they are in clinic
“in front of a white coat”

303
Q

What is masked hypertension

A

When the patients Bp appears lower than it is because they are in clinic
i.e freaks who are relaxed when seeing doctors

304
Q

What are the requirement for ABPM

A

At least 2 measurements per hour during waking hours

305
Q

What are the requirements for HBPM

A

2 consecutive seated measurements, 1minute apart, twice a day for 4-7 days (ideally 14)
Discard first day results because patient will be shitting it a bit

306
Q

What provides immediate symptomatic relief for anginal pain

307
Q

What is the long-Mterm therapy for Angina

A

Isosorbide mononitrate

308
Q

What do you have to be careful of with nitrates

A

Leave 8 hours a day nitrate free to avoid tolerance build-up

309
Q

-What is the drug therapy ladder for Angina

A

Aspirin

Beta blocker or CCB (not both)

310
Q

What other drugs can you offer to someone with Angina

A

Statins

Ivabradine or nicorandil

311
Q

What are the total cholesterol level targets

A

< 5mmol/L for healthy adults

< 4mmol/L for those at risk

312
Q

What are the LDL cholesterol level targets

A

< 3mmol/L for healthy adults

< 2mmol/L for those at risk

313
Q

What are the HDL cholesterol level targets

A

> 1mmol/L for healthy adults

314
Q

What is the HDL cholesterol level target for those at risk

A

same as healthy adults - > 1mmol/L

u judgemental bastard

315
Q

What is the triglyceride level target for everyone

A

< 1.7mmol/L

316
Q

What is the first step in treating Acute Atrial fibrillation

A

Treat the underlying cause

e.g. MI, HF, PE

317
Q

What is the drug treatment to treat ventricular rate in acute atrial fibrillation

A

Beta blocker or CCb (first line)

Add digoxin or amiodarone (second line)

318
Q

What do you do after controlling the patient’s ventricular rate in acute atrial fibrillation

A

Anti-coagulate with heparin

Consider cardioversion

319
Q

What is the treatment ladder for Chronic Atrial fibrillation

A

Control ventricular rate same as Acute AF (say it in ur head)
Anti-coagulate with warfarin (more long term than heparin)

320
Q

What is the treatment ladder for paroxysmal Atrial fibrillation

A 
BAD-A
Beta blocker for older patients or verapamil in younger patients (because of it's -'ve inotropic effect) - 1st line
Amiodarone - 2nd line
Digoxin - 3rd line 
Antocoagulate
321
Q

What three things could cause supraventricular tachycardia

A

Av nodal re-entry
Accessory pathway tachycardia (e.g WPW syndrome)
Ectopic atrial tachycardia

322
Q

What is the management of acute SVT

Pneumonic

A

VAV
Vagal manoeuvres (Valsalva/carotid massage)
Adenosine (IV)
Verapamil (IV)

323
Q

What is the treatment for chronic SVT

A

Avoid stimulants

Ablation

324
Q

What is the management for sinus tachycardia

A

Rate control using beta bloicker

325
Q

What is the treatment for stable VT

A

Amiodarone

326
Q

What is the treatment for unstable VT

A

Cardioversion

Amiodarone

327
Q

What is the treatment for Acute VT

A

High Flow O2
Adenosine or CCb or Beta blocker
Amiodarone or cardioversion

328
Q

What is the treatment for Torsades De Points

A

Magnesium Sulphate

Basically a buzzword

329
Q

How would you describe Torsades De Points

A

VT with varying amplitude

330
Q

What are the two types of pacemakers

A

Single and Dual chamber

331
Q

Where are single chamber pacemakers located

A

Either in the RA or the RV

332
Q

Single chamber pacemakers in the RA are used to treat what

A

SA nodal disease

333
Q

Single chamber pacemakers in the RV are used to treat what

A

Atrial fibrillation

334
Q

Which chambers does a dual chamber pacemaker manage

335
Q

What condition are Dual chamber pacemakers used to treat

A

AV nodal disease

336
Q

What is the pneumonic for remembering what channels the anti-arrhythmic drugs act on

A

Seumas Barker Pulls Cammy
Class I, II, III, IV
Sodium, Beta, Potassium, Calcium

337
Q

Which of the classes of anti-arrhythmic drugs are rhythm control and which ones are rate control

A

Class I, II, III, IV

Rhythm, Rate, Rhythm, Rate

338
Q

What is sotalol and how does it work

A

Class III anti-arrhythmic drug
BLOCKS K+ CHANNELs
NOT A BETA BLOCKER

339
Q

What is infective endocarditis

A

Infection of the endothelium of heart valves

340
Q

What is the pathogenesis of infective endocarditis

A

Heart valve damaged or abnormal - turbulent blood flow
Bacteria settle in damaged area and vegetate
Bacteria break off and lodge in the next capillary bed
Normally mitral and aortic valves involved

341
Q

Which heart valve tends to be involved in IV drug users

A

Tricuspid

Think about it, you moron, they inject into their veins and the bacteria will hit the tricuspid valve first

342
Q

How do you diagnose infective endocarditis

A

Send 3 sets of blood cultures

Echocardiogram

343
Q

What should you consider if all 3 sets of blood come back negative but you still suspect infective endocarditis

A

Consider serology for an atypical organism

344
Q

Pneumonic for Native valve endocarditis treatment

native valve subacute

A

Aboriginal GENTleman

Amoxicillin(IV) + GENTamicin (IV)

345
Q

Pneumonic for Prosthetic valve endocarditis treatment

or Staph Epidermidis

A

Very Good Replacement
Vancomycin(IV) + Gentamicin(IV) + Rifampicin(PO)
also consider valve replacement

346
Q

Pneumonic for IV drug user endocarditis

or native valve severe sepsis

A

Fucktards

Flucloxacillin(IV)

347
Q

Pneumonic for Strep Viridans endocarditis

A

Very Slutty Big Girls

Viridans strep - Benzylpenicillin(IV) + Gentamicin(IV)

348
Q

Pneumonic for MRSA endocarditis

A

Van Rentals

Vancomycin(IV) + Rifampicin(PO)

349
Q

What is the treatment for non-severe C.difficile infection

A

Metronidazole PO (10days)

350
Q

What is the treatment for severe C.difficile infection

A

Vancomycin PO ± Metronidazole IV

351
Q

Which gut pathogen can cause HUS (Haemolytic Uraemic Syndrome)

A

E. Coli O157

352
Q

What is the most common hepatitis in developing countries and what is it’s incubation period

A

Hep. A

28days

353
Q

Which leukotriene is released from airway eosinophils and mast cells

A

Leukotriene D4

354
Q

Which nerve supplies somatic sensory nerve fibres to the face

A

Trigeminal

355
Q

Name the layers of the heart from deep –> superficial

A

Endo-, Myo-, Epicardium

356
Q

Which drug will give rapid relief of symptoms of hyperthyroidism

A

Beta Blockers

357
Q

What is the only cranial foramen that is in the anterior aspect of the skull

A

Cribriform plate of the ethmoid bone

358
Q

Name the parts of the mandible

A 
Mental process
Mental foramen 
Inferior border + body
Angle
Ramus
Condylar process (posterior)
Coronoid process (anterior)
359
Q

Name the cranial foramina from POSTERIOR to ANTERIOR

A 
Hypoglossal canal 
Jugular foramen
Internal acoustic meatus 
Foramen ovale 
Foramen rotundum 
Superior orbital fissure
Optic canal 
Cribriform plate of the ethmoid bone
360
Q

What is the curative treatment for achalasia

A

Heller’s Cardimyotomy

361
Q

Describe the pathology of Barrett’s Oesophagus

A

Metaplasia of squamous epithelium to columnar epithelium

362
Q

Describe the pathology of a peptic ulcer

A

Gastric acid erosion of the gastric mucosa

363
Q

What kind of cancer can arise from Barrett’s oesophagus

A

Adenocarcinoma

364
Q

Describe the pathology of an adenocarcinoma as a result of Barrett’s Oesophagus

A

Uncontrolled proliferation of mucous gland cells in the lower 1/3 of the oesophagus

365
Q

What is the chance that a man with an X-linked condition will pass it onto his daughter

A

100% u fool cos he only has the faulty X gene to pass on

366
Q

Why is there decreased blood volume in sepsis

A

Due to endotoxins released which cause leakage from vasculature

367
Q

During CPR what is the indication to check the patient’s pulse

A

If they show purposeful movement

368
Q

What is the rate of rescue breathing given to an adult in respiratory arrest

369
Q

The venous angle is formed between which two vessels

A

Subclavian vein

Interal Jugular vein

370
Q

What is the most common causative orgaism of bronchiolitis

371
Q

In chronic asthma, sensitisation of airway smooth muscle to inflammatory mediators leads to what

A

Airway hyper-sensitivity

372
Q

What are defensins

A

Anti-microbial proteins secreted by epithelial cells at mucosal surfaces

373
Q

what are the treatment options for unstable angina

A

give oxygen fucking obviously
GTN (if not -> B-blocker if not -> CCB)
Also give aspirin, Tirofiban(anti-platelet) & Heparin

374
Q

What is treatment for Chronic Heart Failure

A

ACE inhibitors + Beta Blockers 1st Line
Spironolactone 2nd line
Diuretics if fluid overloaded

375
Q

What is the treatment for Acute Heart Failure

A

Sit them up (obviously)
Give High flow oxygen
IV Furosemide
Once resus’d continue Beta blocker therapy

376
Q

When can you discharge someone from hospital if they come in for Acute HF

A

Once they have been stable for 48hours

377
Q

What treatments can you offer someone once they have been discharged following acute HF

A

Ace inhibitor & spironolactone

378
Q

What diameter must an AAA reach to indicate surgery

A

> 5.5cm

Yes, it is a bit random

379
Q

What are the 6 steps to treating sepsis

A

Give high flow oxygen (spo2 between 94-98%)
Fluid resuscitation (500ml saline)
Take blood cultures (and other relevant cultures: urine, wounds, sputum)
Give antibiotics
Measure lactate and FBC (elevated lactate is an indicator of tissue death)
Monitor hourly urine output (indicative of kidney function)

380
Q

What drugs do you give to someone with sepsis

Pneumonic

A

AGM

Amoxicillin, Gentamicin, Metronidazole IV

381
Q

Wtf is Fexofenadine

A

A competitive H1 receptor antagonist used to treat allergic rhinitis.
fkin nerd

382
Q

What is indicated by a positive p-ANCA

A

Churg-Strauss Syndrome

-Eosinophilic Granulomatosis with Polyangiitis (EGPA)

383
Q

What does the presence of anti-CCP antibodies indicate

A

rheumatoid

384
Q

What side effects can methotrexate cause

A

Lung fibrosis

Abnormal LFT’s

385
Q

What are the rules for diagnosing an STEMI

A

≥1mm elevation in 2 or more adjacent limb leads

≥2mm elevation in 2 or more continuous precordial leads

386
Q

Which of the clotting factors are glycoprotein precursors of the active factors

A

2, 7, 9, 10

Require vitamin K to be activated

387
Q

What can you give a patient to counteract a Warfarin overdose

A

Vitamin K

Think about the meme

388
Q

What are the two types of chemoreceptors

A

Central (located near medulla)

Peripheral (Located in aortic and carotid bodies)

389
Q

What do the central chemoreceptors monitor

A

H+ conc. of the CSF

Co2 in blood

390
Q

What do the peripheral chemoreceptors monitor

A

Monitor O2 conc. of the blood

391
Q

Which chemoreceptors are active in COPD patients and why

A

Peripheral (hypoxic drive)

The central chemoreceptors have become desensitized to chronic hypercapnia

Misc. Notes Year 1 (13 decks)

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