Staffs Paramedic PPCS1 Flashcards
Where in the brain is Blood Glucose level detected?
Hypothalamus
How is a cell stimulated to allow glucose to pass from the blood inside?
Insulin binds to the insulin receptor site on the cell stimulating the Signal Transduction Pathway, vesicles containing Glucose transport proteins within their membrane are stimulated to migrate to the cell membrane. Glucose is able to pass through the glucose transport protein into the cell.
Alpha cells produce
Glucagon
Beta cells produce?
Insulin
Where is the Pancreas found?
Sub sternal, posterior to the xyphoid process
What are the two functions of the pancreas?
Endocrine- Hormone production
Exocrine- Enzyme production
What does insulin binding to the receptor site of a cell stimulate?
The SIGNAL TRANSDUCTION PATHWAY
What are embedded in the phospholipid bilayer of the vesicles of a cell that enable glucose to pass across the membrane?
GLUCOSE TRANSPORT PROTEINS
What are the two most common causes of pancreatitis?
Alcohol consumption
and
Gall stones
In simplistic terms what happens to the pancreas resulting in pancreatitis?
The Enzymes produced begin to digest the tissues of the organ.
Why is bruising often seen on the abdomen of a patient with pancreatitis?
Because the pancreas is situated outside of the peritoneum
Bruising seen around the Umbilicus in a patient with/suspected pancreatitis?
CULLENS SIGN
Bruising seen in the flank of a patient with/suspected pancreatitis is called?
GREYS TURNER SIGN
What are the names of the two enzymes produced by the pancreas and released into the duodenum of the GI tract that help digestion of protein?
TRYPSIN
and
CHYMOTRYPSIN
What is the name of the route taken by enzymes produced by the pancreas snd concentrated bile from the gall bladder to the GI tract (duodenum)?
Pancreatic duct
What is the name given to enzymes that digest proteins?
Protease
What is the name given to enzymes that digest Fats?
Lipase
What is the name given to the enzymes that digest carbohydrates (sugars)?
Amylase
What syndrome is the prolonged over production of cortisol?
Cushing’s Syndrome
What is Cushing’s disease?
A benign tumour of the pituitary gland
Where is the pituitary gland found?
In the brain, inferior to the hypothalamus.
Tumours of the _____________, _____________, and _________________ can result in over stimulation of the adrenal glands and over production of cortisol.
Pituitary gland, Lungs and Adrenal glands.
A patient that has been treated with what type of medication for a long time is at high risk of developing Cushing’s syndrome?
Hydrocortisone or other corticosteroids
What are the three main implications of long term exposure to high levels of cortisol?
Immune suppression, Osteoporosis, and Diabetes
What is the name of the hormone produced by the pituitary gland, that stimulates the adrenal glands to secrete cortisol?
ACTH- Adrenocorticotropic Hormone
Where are the adrenal glands located
Superior to the kidneys
What hormone is produced by the adrenal glands as a response to stressors?
Cortisol (glucocorticoid steroids)
What is the affect on the body of glucocortico steroids?
Strong anti inflammatory
What are the two types of stroke?
Ischaemic - most common- a thrombus (clot) or embolus blocking blood supply causing an area of ischaemia in the brain.
Haemorrhagic- A bleed from a blood vessel in the brain causes reduced perfusion of an area of brain tissue
Where is Mc Burney’s point, and what is considered a positive finding?
Mc Burney’s point is 1/3 of the way between the anterior superior iliac spine (ASIS) and the naval.
If pain in the lower right iliac region is relieved by applying pressure to McBurney point but immediately returns when pressure from the point is removed, this is considered a positive finding for a differential diagnosis for ?APPENDICITIS.
What is Psoas sign and what is considered a positive finding?
Psoas sign is a positive for a differential diagnosis of ?Appendicitis. A positive Psoas sign is seen if a patient presenting with right iliac region pain of no know origin is unable to lie on their back and raise their right leg without an increase in the pain. Thisn
What is Rosvings sign and what would be considered a positive finding?
Rosvings sign is a diagnostic tool to help diagnose possible appendicitis in a patient presenting with right iliac region tenderness/pain of no known cause. A positive finding is seen when pressure is applied by hand to the left lower abdomen and quickly released causing an increase in the pain in the right side on rebound.
What is the result of hyperplasia of goblet cells in the epithelium of the lower respiratory tract?
Reduced diameter of the lumen
What type of COPD patient is often referred to as a BLUE BLOATER
Chronic Bronchitis
What type of COPD patient is often referred to as a PINK PUFFER
EMPHYSEMA
What is an extrinsic trigger of an asthma attack?
Allergens
What is an intrinsic cause of an asthma attack?
Non allergens
(e.g.- infection, cold air, exercise, medication (NSAIDs etc), inhalation of irritants (smoke, pollution etc)
What is the equation for mean arterial pressure?
MAP = (Systolic) + 2(diastolic) / 3
What is the equation to work out cerebral perfusion pressure (CPP)
CPP = MAP - ICP
(ICP - Inter Cranial Pressure)
Why do signals move faster through Myelinated neurones that un-myelinated neurones?
Due to saltatory conduction - the action potential is able to jump between the nodes of ranvier
What is meant by the term
Half-life when referring to a medication?
The half-life is the time it takes for the plasma concentration of a drug to reduce by half, usually as a result of elimination.
How many half-lives does it take for most medication to be completely eliminated from the blood plasma?
Five (5)
If a medication has a half life of 5 hours and it takes 5 half lives for complete elimination how long will complete elimination of the drug take?
5 X 5 = 25
It will take 25 hours for complete elimination of the drug from the blood plasma.
What is meant by the term pharmacokinetics?
What the body does with or to a drug.
A, D, M & E
Absorption, Distribution, Metabolism and Elimination.
What is meant by the term pharmacodynamics?
What a drug does to you
Pharmacodynamics is the study of the mechanisms by which medications produce biochemical or physiological changes in the body.
What are the two types of pain experienced?
Nociceptive- damage caused to the body by external stimuli triggers nociceptive pain.
Neuropathic- pain stimulated by the nerves themselves without external stimuli
What is the name of the tract in the spinal chord that action potentials generated from external stimuli pass to the thalamus in the brain for interpretation?
The Spinothalamic tract
If low blood sugar is detected by the hypothalamus in the brain the production of what hormone is stimulated and where is it made?
Glucagon.
Made by alpha cells in the Islets of Langerhans in the Pancreas.
What tissue in the body does Glucagon bind to, what is broken down and what are the products when Glucagon binds to receptor sites?
Glucagon binds to receptor sites on the cells of Adipose tissue. Triglycerides are broken down into fatty acids (ketones) and glycerol.
Describe the process of glucose production when low blood sugars are detected by the hypothalamus.
Glucagon production is stimulated in the pancreas.
Glucagon binds to adipose tissue.
Triglycerides in the adipose tissue are broken down into glycerol and Ketones (fatty acids)
Ketones are used by the liver as energy to produce new glucose from the glycerol. (GlucoNeoGenisis)
Glucagon also binds to receptor sites on liver cells releasing the glycerol stored in the liver.
What are the four main types of Diabetes?
Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Diabetes Insipidus
Gestational Diabetes
How does an expectant mother develop Gestational Diabetes?
Hormones produced by the placenta (mainly Oestrogen and cortisol) pass into the blood stream of the mother. They cause insulin resistance resulting in a rise in Blood sugars. Usually the pancreas increases insulin production to overcome resistance but in some mothers it is unable to cope with the demand.
Explain the process of the development of Type 1 Diabetes Mellitus.
In some people an auto immune response causes the destruction of some of all of the Beta cells in the Islets of Langerhans in the pancreas. Beta cells are responsible for the production of insulin and so these people are unable to produce their own insulin.
Describe the cause of Type 2 Diabetes Mellitus.
The Beta cells in the Islets of Langerhans in the Pancreas are unable to meet the demand of the body for insulin, usually as a result of the blood sugars remaining high due to poor diet or lack of exercise. The Insulin receptors on cells also become less reactive to the insulin that is produced.
What is the main aim of medication taken by Type 2 Diabetes patients?
To increase the production of insulin
and
To increase the reactivity of insulin receptors on tissue cells.
What causes Diabetes insipidus
A reduction in the production of anti diuretic hormone (ADH) causes the patient to urinate more often (Polyuria). This causes the blood to become more concentrated (as a result Blood sugar levels increase).
The S__________ T___________P___________ is stimulated by insulin molecules binding to the insulin receptor sites on cells.
Signal Transduction Pathway
Describe Bronchiectasis
Bronchiectasis is a chronic condition that causes the bronchi to widen, leading to a build up of mucus and leaving the patient more susceptible to respiratory tract infections.
What is the resultant shape of the lower airways and alveoli as a result of Bronchiectasis?
Chronic infections causes inflammation that leads to the formation of fibrosis (scar tissue). The fibrosed tissue pulls the airways open causing them to be permanently dilated. Excess mucus collects in the widened airways and leaves the patient susceptible to further infections. The patient is often unable to cough up much of the collecting mucus.
Explain how gaseous exchange is reduced in patients with Bronchiectasis.
Firbrosed tissue in the alveoli results in a reduced surface area, excess mucus that is unable to be expectorated prevents air entry and inflammation increases the distance across which gaseous exchange must cross.
What type of drug is Salbutamol?
A Beta 2 adrenergic agonist
Explain the pharmacodynamics of Salbutamol.
Salbutamol binds to the adrenergic receptors on smooth muscle cells causing relaxation of smooth muscle tissue and resultant bronchodilation. It also causes a reduction in mucus production without effecting cillia action and transport of mucus out of the tract. Salbutamol also has a low affinity for Beta 1 adrenergic receptors, found on cardiac cells, and so tachycardia is induced as a side effect of thè medication.
Why might salbutamol not have as effective a response in elderly patients?
As we age the beta 2 adrenergic receptors on our smooth muscle tissues reduce in number and those that there are become less reactive. Therefore salbutamol will have more of an effect in younger patients.
Where in the brain would you find the vomiting centre?
The medulla oblongata
What kind of receptor are found in the vomiting center?
Muscarinic receptors
What is labyrinthitis?
An infection of the inner ear
How do infections of the inner ear cause nausea?
The vestibulochoclear nerve (cranial nerve VIII) is stimulated by inflammation in the ear. The signals generated arrive at the vestibular nuclei in the pons. The vestibular nuclei contains Histamine1 receptors and muscarinic receptors. Signals received by the vestibular nuclei will pass to the Chemoreceptor trigger zone (CTZ) in the Medulla oblongata and subsequently the vomiting centre causing nausea and possibly vomiting.
What is the first cranial Nerve (CN I)
Olfactory
Has there been any changes to the patients sense of smell? Get them to smell some coffee, does it smell right?
What is meant by VQ mismatch?
V = ventilation- how much air is reaching and filling the alveoli and is available for gaseous exchange into the blood?
Q= perfusion- how much blood is perfusing the blood vessels of the lungs and reaching the capillaries surrounding the alveoli for gaseous exchange?
These two factors should be identical ensuring the maximum efficiency of gaseous exchange is taking place. If there is a reduction in either factor the exchange will be compromised. This is known as a VQ mismatch.
What is a possible cause for VQ mismatch?
Pulmonary embolism
A PE causes a blockage in the blood supply to the capillary network reducing the efficiency of gaseous exchange
Any condition affecting the respiratory tract reducing air entry to the alveoli. (Eg, asthma, bronchitis Bronchiectasis etc)
What happens in a bronchiectasis patient with regards to mucus and cillia?
Bronchiectasis patients become more susceptible to airway infection due to the widening of the airways caused by the fibrosed (scar) tissue. Over time the immune response to this increased incidence of infection is Hyperplasia (increased number) and Hypertrophy (increased size) of [mucus producing] goblet cells. This causes more mucus to be produced and the patient is unable to cough it all up. Due to the new physiology of the airways the mucus becomes dry and stickier than usual exacerbating the problem. The Cillia are also damaged by the scaring of the airways reducing effectiveness and ciliary transport is reduced.
What receptors does Ondansetron inhibit?
5-HT3 receptor sites
Ondansetron is a 5-HT3 antagonist
What receptors do Ondansetron have an antagonistic action on and where are they found?
5HT-3 receptors in the Chemoreceptor trigger Zone (CTZ) in the medulla oblongata in the brain and on enterochromaffin cells in the stomach.
Ondansetron is a Serotonin antagonist
As well as 5HT-3 (Serotonin) receptors in the CTZ-
On what cells, found in the stomach, does ondansetron also have antagonistic properties?
ENTEROCHROMAFFIN CELLS
Where are Histamine1 receptors found?
In the Vestibular Nuclei in the Pons
What medications have antagonistic properties on Histamine1 receptor sites?
Promethazine, Cyclizine and Diphenhydramine
What type of receptors are found in the vomiting centre and the Vestibular Nuclei?
Muscarinic receptors
What drug is given as an antagonist of the Muscarinic receptors in the Vomiting centre and the vestibular Nuclei?
Hyoscine
Where are Dopamine 2 receptors found in the brain?
The chemoreceptor trigger zone (CTZ) in the medulla oblongata
What medications are Dopamine2 antagonists?
Prochloperazine, Metochlopramide and Doperidone
Why is it important that the Chemoreceptor Trigger Zone (in the Pons) is located outside the Blood Brain Barrier?
So that chemicals in the blood are able to pass through and be detected.
If the CTZ was within the Blood Brain Barrier Chemicals in the blood would not be able to stimulate the 5HT-3 or Dopamine2 receptors leading to a vomiting response.
What could a “Thunder clap” headache be a sign of?
Sub Arachnoid haemorrhage
What are the Symptoms that trigger the Ottowa Sub Arachnoid Haemorrhage rule?
-Neck pain/ stiffness
-Age >40
-Witnessed LOC
-Onset during exertion
-Headache with immediate peak intensity- “Thunderclap headache”
-Limited neck flexion
What do the following symptoms describe?
- Increased BP
- Decreased Pulse rate
- Decreased Respiration Rate
Cushing’s Triad
Raised inter-cranial pressure
What is the name of the spaces between schwann cells along the axon of a myelinated neurone?
Node of Ranvier
What is epilepsy?
The transient occurrence of signs and symptoms due to abnormal electrical activity in the brain, leading to a disturbance of consciousness, behaviour, emotion, motor function or sensation
What is described as a seizure that lasts longer than 5 minutes or 3 or more seizures within 30 minutes?
Status Epilepticus
Can a patient suffer both epileptic and non epileptic seizures?
Yes
What is the maximum dose of Diazepam IV
20mg
Describe how Benzodiazepines prevent seizures or reduce symptoms?
Bind to benzodiazepine receptor site on chloride channels in the membrane of neurone. Cause chloride channel to open and negatively charged ions to enter the cell causing the neurone to become hyperpolarised. In its hyper-polarised state the neurone is unlikely to reach the threshold potential (charge required to stimulate an action potential to move along the neurone).
What is Kernig’s sign?
With the patient lying supine, leg flexed at the hip with knee bent 90°, extend the patients leg. If extension causes pain with other symptoms present a differential diagnosis of ?Meningitis can be made.
What is Brudzinski sign?
In a patient with symptoms suggesting meningitis whereby flexion of the head causes flexion of the patients hips and knees then a differential diagnosis of ?meningitis can be made.
What is benzylpenicilin and what is it used to treat ?
A narrow spectrum antibiotic used to treat a patient with suspected meningitis.
What is it vitally important to check before administering Benzylpenicillin to a patient with suspected meningitis?
Allergies
An allergy to penicillin precludes the use of Benzylpenicillin
What receptor sites are found in the Chemoreceptor Trigger Zone (CTZ)?
5HT-3 (Serotonin) and Dopamine2
Which white blood cell produces Elastase as part of an immune response?
Neutrophil
Which artery is most commonly involved in strokes?
Middle Cerebral Artery
What is the posterior of the spinal chord called?
Dorsal
What is the anterior of the spinal cord called?
Ventral
What are the three layers of the meninges called?
Pia Mater (inner)
Arachnoid mater (middle)
Dura Mater (Outer)
What does Dura mean?
Tough
Where do sensory fibres enter the Spinal cord?
The Dorsal aspect (Posterior)
Where do Motor fibres exit the spinal cord?
The Ventral aspect (anterior)
Which neurones are referred to as Afferent?
Sensory neurones
Which neurones are referred to as efferent?
Motor neurones
What are the two types of nerve fibre that transmit pain and temperature stimulus to the spinal cord?
Alpha Delta fibres -fast/thin myelinated fibres- Sharp pain
C Fibres - slow/ wide unmyalinayed fibres - aching pain
What type of fibre transmits soft touch and pressure sensory information to the spinal cord?
Alpha Beta fibres
What type of nerve fibre transmits sharp stabbing pain
Alpha Delta Fibre
What type of nerve fibre transmits dull aching pain?
C fibre (unmyalinated- substance P)
What is the name of the inhibitory neurotransmitter released by the secondary neurone stimulated by the Alpha Beta fibres following touch reception?
GABA
How does GABA inhibit the action potential in afferent neurones?
GABA binds to the GABA receptors on the chloride channels in the membrane of the neurone, causing negatively charged chloride ions to be able to enter, depolarising the neurone resulting in hyper-polarisation. The neurone is unable to reach the threshold potential required to trigger an action potential and therefore the signals are inhibited.
What are the names of the three opioid receptors in the body?
Mu
Delta
Kappa
What side effects are caused when opiates bind to MU opioid receptors?
Respiratory depression
Nausea
Blood pressure reduced
What happens when an opiate such as Morphine binds to Delta receptors?
Analgesic pain relief
Respiratory depression
Which of the three opioid receptors cause pain relief but do not cause respiratory depression when bound to an opioid such as Morphine?
Kappa
What is the medical name for Croup?
LaryngoTracheoBronchitis
What are you likely to see on the ECG of a patient suffering from a PE?
Peaked P waves
PE aked
W
A
V
E
S
In Pleural effusion what is the primary cause of exudate fluid?
Inflammation
What neurotransmitter are Parkinson’s sufferers particularly deficient of?
Dopamine
What symptoms would you expect to see in a patient with an upper motor neurone lesion?
Unilateral facial palsy below the level of the eyes.
What medication is prescribed for patients with osteoporosis?
Alendronic acid
Which ion causes snare proteins to fuse with the neurotransmitter vesicles in the presynaptic membrane?
Calcium
What are the four ways a medication or drug affect the body?
Alter metabolic processes
Bind to receptor sites
Change the physical properties of a cell
Combine with existing chemicals to illicit a change
How does Ipratropium bromide work to dilate the lower respiratory tract of an asthmatic patient?
Ipratropium is an Acetylcholine antagonist - it binds to the acetylcholine neurotransmitter receptor sites - preventing signals from the parasympathetic nervous system that signal to the smooth muscle of the bronchioles to contract, causing them to relax and the subsequent widening of the lumen. The onset of action is slower than that of Beta agonists like Salbutamol, but the effects are longer lasting.
What type of Beta agonist is Salbutamol?
Short Acting Beta Agonist
SABA
What is meant by the term Parasympathetic nervous system?
The parasympathetic nervous system is one of two divisions of the autonomic nervous system. It is predominant during times of rest when we are not feeling stressed or threatened and is often referred to as “rest and digest”.
What is the name of Thyroid hormone T3?
TriIodoThyronine
What is the name of the thyroid hormone T4?
Thyroxine
What hormone is metabolised to produce the active Thyroid hormone and where does it take place?
Thyroxine (T4) is metabolised in the brain, Liver and Kidneys into TriIodothyronine (T3)
Approximately how much of the Triiodothyronine required by the body is produced by the thyroid gland?
About 20%
Approximately how much of the Thyroxine (T4) required by the body is produced by the thyroid gland?
About 80%
What is a Goitre the result of?
Hyperplasia and Hypertrophy of thyroid cells.
What is the most common auto immune disease that results in HypOthyroidism
HashimOtoO’s disease
(HypOthyroidism)
What is the term for a life threatening emergency associated with life threatening or undertreated hypothyroidism, marked by confusion, hypothermia and cardiovascular instability?
Myxoedemic coma
Untreated or poorly managed hypERthyroidism can lead to a life threatening condition called
Thyroid Storm
What is a Common treatment for hyperthyroidism
Radioactive iodine therapy
What is the most common cause of HypERthyroidism?
Graves Disease - an Auto immune disease that produces TSI (Thyroid stimulating immunoglobulins) that mimic Thyroid stimulating hormone.
What ECG changes are you likely to see in a Pt with Hypothyroidism?
Bradycardia with flattened or inverted T- waves
What is substance P?
A pain neurotransmitter released by C fibres (slow)
What neurotransmitter is released by Alpha Delta Fibres?
Glutamate (fast)
How does Hydrocortisone work to reduce the exacerbation of Asthma and COPD?
Hydrocortisone is converted in the body into Lipocortin. Lipocortin is a Phospholipase inhibitor and it prevents Phospholipids being Hydrolysed into Aracadonic acid. Therefore preventing the production of Leukotrienes and the bronchoconstriction they cause.
What is Hydrocortisone converted into in the body?
Lipocortin
What are the three processes of metabolism?
Oxidation
Hydrolysis
Hydroxylation
What is secreted by neutrophils
Elastase
What is produced by the body and inhibits the elastase produced by neutrophils
A1 Anti-Trypsin
Why do we give Magnesium Sulphate for exacerbation of Asthma?
Magnesium Sulphate is a broncho dilator that works by blocking calcium channels preventing snare protein activation and acetylcholine neurotransmitter release from vesicles in efferent neurones of the parasympathetic nervous system.
