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IHS > Things To Remember > Flashcards

Things To Remember Flashcards

0
Q

Effect of atrial natriuretic factor

A
  • from stretched cardiac atrial cells
  • dilates afferent and constricts efferent
  • increases GFR
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1
Q

RAAS stimulated by

A
  • decrease in afferent press
  • decrease in macula densa Na
  • decrease in blood vol
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2
Q

Criteria for substance to measure GFR

A
  • metabolically inert
  • filtered by kidney
  • not secreted, not reabsorbed
  • no interference with renal function
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3
Q

Anion gap calculation

A

(Na + K) - (Cl + HCO3)

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4
Q

3 types of resp VQ mismatches

A
  • diffusion barrier
  • intrapulm shunt (no vent)
  • alveolar deadspace (no perfusion)
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5
Q

Factors that decrease oxygen binding affinity to Hb

A
  • increased H
  • increased pCO2
  • increased temp
  • increased 2,3 DPG
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6
Q

Define type 1 hypoxemia

A
  • hypoxia without hypercapnia
  • VQ mismatch
  • failure of oxygenation
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7
Q

Define type 2 hypoxemia

A
  • hypoxia and hypercapnia

- inadequate ventilation

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8
Q

Causes of oedema

A
  • increased hydrostatic press
  • decreased oncotic press
  • increased permeability
  • medications
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9
Q

4 markers of Mi

A
  • myoglobin
  • troponin T
  • creatine kinase
  • lactate dehydrogenase
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10
Q

Cause of acute phase response

A

Any acute stress involving tissue necrosis

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11
Q

Effects of acute phase response

A
  • pyrexia
  • leucocytosis
  • iron sequestration in reticulo-endothelial system
  • hormonal changes
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12
Q

Positive acute phase reactants

A
  • CRP
  • a1-antitrypsin
  • fibrinogen
  • haptoglobin
  • complement
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13
Q

Negative acute phase reactants

A
  • albumin
  • transferrin
  • HDL
  • LDL
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14
Q

Why urgent to decide between pre and renal failure

A
  • pre can progress rapidly to more serious intra

- in pre one needs to replace fluids but in intra, one needs to restrict them

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15
Q

When to dialyse

A
  • patient is vol overloaded and at risk of oedema or cardiac failure
  • blood urea > 50 mmol/L
  • K > 7 mmol/L
  • bicarbonate < 10mmol/L
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16
Q

Physiological sources of H

A
  • metabolism produces non-volatile acids (excreted by kidney)
  • aerobic metabolism produces CO2 (excreted by lungs)
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17
Q

Why bicarbonate buffer system is powerful

A
  • open-ended

- regenerate (HCO3 retained and regenerated by kidney)

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18
Q

Causes of resp acidosis

A
  • depression of resp centre
  • physical inability to ventilate
  • airway obstruction
  • pulm disease causing decreased exchange
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19
Q

Causes of resp alkalosis

A
  • direct stim of resp centre
  • mechanical over ventilation
  • hypoxia
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20
Q

Causes of metabolic acidosis

A
  • gain of H
  • loss of bicarb
  • GIT loss
  • renal loss
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21
Q

Causes of metabolic alkalosis

A
  • gain of bicarb
  • loss of H
  • GIT loss
  • renal loss
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22
Q

Definition of lipoprotein

A

Particle of lipid and apoprotein in association

- found in plasma and interstitial fluid

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23
Q

In shell of lipoprotein

A
  • phospholipid
  • cholesterol
  • apoproteins
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24
Q

In core of lipoprotein

A
  • cholesterol ester
  • TAGs
  • parts of apoB
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25
Q

Tests for lipoproteins

A
  • ultracentrifuge
  • agarose electrophoresis
  • acrylamide electrophoresis
  • immunoaffinity assays
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26
Q

Requirements before fasted lipid profile

A
  • stable diet for more than 2 weeks
  • alcohol abstinence for 48hrs
  • fast over night for more than 10 hrs
  • seated for 5 mins before venesection with min tourniquet time
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27
Q

Treatment of dyslipoproteinaemia

A
  • diet
  • less cholesterol uptake
  • decrease cholesterol sysnthesis (statins)
  • PPARa activation
  • HSL inhibitors
  • Lp assembly
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28
Q

Requirements for reliable blood gas analysis

A
  • arterial blood
  • anticoagulated with heparin
  • taken and kept anaerobic
  • on ice
  • analysed asap
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29
Q

Reasons for raised anion gap

A
  • alcohol
  • uraemia
  • diabetic ketoacidosis
  • drugs
  • lactate
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30
Q

Causes of elevated plasma cardiac troponin levels

A
  • MI
  • pulm embolus
  • chronic kidney disease
  • sepsis
  • burns
  • HT
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31
Q

Definition of proteinuria

A

Daily urine protein > 150 mg

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32
Q

Acquired causes of hypercholsterolaemia

A
  • hypothyroidism
  • nephrotic syndrome
  • DM
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33
Q

5 components of normal haemostasis

A
  • blood vessels
  • platelets
  • coag factors
  • coag inhibitors
  • fibrinolysis
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34
Q

Stages of haemostasis

A
  • vessel injury
  • vasoconstriction
  • platelets adhere and aggregate
  • coag systems activates fibrin
  • clot dissolution via fibronolysis
  • endothelial repair
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35
Q

Platelet agonists

A
  • collagen
  • adrenalin
  • ADP
  • thrombin
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36
Q

Steps of platelet activation

A
  • shape change
  • release of granule contents
  • synthesis of secondary agonists (thromboxane A2)
  • exposure of procoagulant phospholipids
  • cross linking with fibrin through Gp2b3a
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37
Q

Natural inhibitors of platelets

A
  • NO
  • prostacyclin
  • ecto-ADPase
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38
Q

Anti platelet drugs

A
  • asprin
  • clopidogrel
  • abciximab
  • dipyridamole
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39
Q

Phases of cell based model of coag

A
  • initiation phase
  • amplification phase
  • propagation phase
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40
Q

Natural anticoagulants

A
  • anti thrombin 3

- protein C + S

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41
Q

Thrombolytics

A
  • streptokinase

- tissue plasminogen activator

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42
Q

New anticoag drugs

A

FXa inhibitors

  • fondaparinux
  • rivaroxaban
  • dabigatran
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43
Q

Test for extrinsic pathway

A

Prothrombin time

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44
Q

Test for intrinsic pathway

A

Activated partial thromboplastin time

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45
Q

Role of vWF

A
  • binds to collagen in subendo

- has binding sites for platelets which then adhere to subendo

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46
Q

6 examples of URTIs

A
  • rhinitis
  • pharyngitis
  • sinusitis
  • tonsillitis
  • otitis media
  • epiglottitis
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47
Q

5 classic resp viruses

A
  • othomyxovirus
  • paramyxovirus
  • rhinovirus
  • adenovirus
  • coronavirus
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48
Q

Why people keep getting infected with viruses

A
  • many different viruses and serotypes
  • poor immunity
  • viruses evolve
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49
Q

When do normal flora bacteria invade

A
  • viral epi damage
  • mucus clearance by cilia is affected
  • obstruction of drainage (stasis)
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50
Q

Causes of common cold

A
  • rhinovirus

- corona virus

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51
Q

Causes of sinusitis and otitis media

A
  • influenza
  • parainfluenza
  • adenovirus
  • rhinovirus
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52
Q

Causes of laryngitis and croup

A
  • mainly parainfluenza and RSV

- also mycoplasma pneumoniae

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53
Q

Cause of epiglottitis

A
  • h. Influenzae
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54
Q

What URTIs to treat with antibiotics

A
  • sinusitis
  • epiglotitis
  • bronchitis
  • pneumonia
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55
Q

URTIs not to treat with antibiotics

A
  • colds
  • Larygitis
  • acute bronchitis
  • bronchiolitis
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56
Q

Who gets serious viral disease?

A
  • very young
  • elderly
  • pre existing heart and lung disease
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57
Q

What does Haemagglutinin bind to?

A

Scialic acids linked to galactose on host cell surface

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58
Q

Drift

A

Gradual accumulation of point mutations

- RNA so no polymerase proof reading functions

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59
Q

Shift

A

Input of new genes

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60
Q

Complications of influenza

A
  • influenza pneumonia
  • secondary bacterial pneumonia
  • exacerbation asthma
  • COPD
  • Reye’s syndrome
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61
Q

Who should get flu vaccine

A
  • pregnant
  • have risk factors
  • health care workers
  • children on long term asprin therapies
  • living in old age homes
  • over 65 yrs
  • family contacts of high risk cases
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62
Q

Risk factors for influenza

A
  • chronic pulm/ cardiac disease
  • DM
  • immunosup
  • morbidly obese
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63
Q

Contraindication for flu vaccine

A
  • allergic to egg

- have acute febrile illness

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64
Q

2 M2 inhibitors

A
  • rimantadine
  • amantadine
    Inhibit uncoating of virus
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65
Q

2 neuraminidase inhibitors

A
  • oseltamivir
  • zanamivir
    Inhibit release of virus from infected cell
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66
Q

Viruses that cause lower resp tract infection

A
  • RSV

- adenovirus

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67
Q

What is contained in influenza vaccine

A

Inactivated vaccine with partially purified envelope proteins of currently circulating influenza strains

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68
Q

Analytic cohort study

A
  • group of people free of disease
  • classified into subgroups according to exposure
  • followed up
  • see how development of disease differs between groups
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69
Q

Strengths of cohort studies

A
  • good causal relationship
  • risk can be directly measured
  • can assess if single exposure has multiple outcomes
  • efficient for studying rare outcomes
70
Q

Limitations of cohort studies

A
  • expensive
  • time consuming
  • loss to follow up
  • prone to info bias
  • inefficient to study rare disease
71
Q

Case control studies

A
  • researcher begins with cases
  • selects appropriate control group
  • collects info on exposure
  • compares
  • calculates measures of association
72
Q

Strengths of case control

A
  • quick and inexpensive
  • can evaluate diseases with long latent periods
  • can asses multiple risk factors for a single disease
  • efficient for studying rare diseases
73
Q

Limitations of case control

A
  • ineff for studying rare exposures
  • prone to bias
  • cant directly calculate incidence rates
  • more difficult to establish temporal relationship
74
Q

Confounding

A

3rd variable results in apparent association between exposure and outcome

75
Q

Strengths of ecological study

A
  • simple to conduct (already have data)
  • some variables can only be measured at group level
  • useful if little variation in pop in exposure of interest
76
Q

Limitations of ecological study

A
  • findings difficult to interpret
77
Q

What makes a notifiable disease?

A
  • epidemic prone
  • preventable/ priority
  • environmental/ zoonosis
78
Q

Why do surveillance?

A
  • detect epidemics
  • help eradicate disease
  • estimate magnitude of problem
  • detect new health problems
  • facilitate epidemiological research
  • evaluate prevention/ control
  • planning and resource allocation
79
Q

Types of surveillance

A
  • passive
  • active
  • sentinel
80
Q

Limitations of surveillance

A
  • must know normal
  • under reporting
  • poor collation
  • poor analysis
  • delayed distribution
81
Q

Exogenous pathway

A

Chylomicrons transport ingested fats to adipose or liver

82
Q

Reverse cholesterol pathway

A
  • HDL transports cholesterol from peripheral tissues to liver to be excreted as bile
83
Q

Lack of ABCA1 (ATP binding cassette transporter A1)

A

Tangiers disease

84
Q

Effect of oversupply of cholesterol

A
  • inhibits HMG CoA reductase
  • activates ACAT
  • inhibits LDL receptor synthesis
85
Q

Gout

A
  • increased levels of Uric acid in plasma
  • Uric acid is poorly soluble at physiologic pH
  • crystallizes in synovial joints
86
Q

Action of allopurinol

A
  • inhibits xanthine oxidase

- binds xanthine irreversibly

87
Q

Endocrine functions of kidney

A
  • RAAS
  • erythropoietin
  • activates 1,25 hydroxycholecalciferol
88
Q

Renal lobule

A

Medullary rays and surrounding cortical labyrinth

89
Q

What does medullary ray contain?

A
  • descending proximal straight tubule
  • ascending thick limb of Henlery
  • collecting duct
90
Q

2 types of nephrons

A
  • cortical

- juxtamedullary

91
Q

Components of glom filtration barrier

A
  • podocytes
  • BM
  • fenestrated endothelium
92
Q

Alports syndrome

A
  • thinning and splitting of BM

- collagen mutations

93
Q

5 functions of mesangial cells

A
  • structural support
  • phagocytic
  • contractile (regulate intra glom flow)
  • secretory (endothelin, prostaglandins, cytokines)
  • proliferative
94
Q

Cell types of resp epithelium

A
  • ciliated columnar cells
  • goblet cells
  • basal cells
  • small granule cells
  • brush cells
  • serous cells
95
Q

Cells in olfactory epi

A
  • basal cells
  • olfactory cells
  • olfactory serous glands
  • supporting cells
96
Q

Innate pulm defences

A
  • trapping
  • phagocytosis (alveolar macs)
  • phagocytosis and lysis (neuts)
  • complement activation
  • migration to local lymph nodes
97
Q

Adaptive pulm defenses

A
  • IgA secretion (bind bacteria)
  • IgG and IgM in fluid lining
  • T cells accumulate
98
Q

Steps of the immune response

A
  • activation of the immune response
  • antigen destruction
  • termination of immune response
  • immunological memory
99
Q

Waldeyer’s ring

A
  • palatine
  • lingual
  • pharyngeal
  • tubal
100
Q

Autoimmunity definition

A
  • influx of auto reactive immune cells and antibodies in body tissues
  • initiates inflam
  • represents failure of tolerance induction
101
Q

Types of peripheral tolerance mechanisms

A
  • immune privileged sites
  • anergy/ clonal deletion
  • regulatory T-cells
102
Q

4 mechanisms of loss of self tolerance

A
  • loss of immune privileged status (infection)
  • viral
  • reg T-cell dysfunction
  • molecular mimicry
103
Q

Grave’s disease

A

Anti-TSH receptor antibodies stimulate the production of thyroid hormones

104
Q

Myasthenia gravis

A

Anti-ACh prevent muscles from responding to neuronal impulses

  • block ACh receptors
  • no Na influx
105
Q

Atopy

A

A familial tendency to develop allergen specific IgE on exposure to environmental allergens and to suffer symptoms

106
Q

Molecules in innate system which can kill mycobacteria in macs

A
  • NO
  • hydrogen peroxide
  • cathelicidin
107
Q

Investigations to diagnose latent TB

A
  • chest X-ray
  • pos Mantoux test
  • IGRA assay
108
Q

Contraindications of immunotherapy

A
  • unreliable social circumstances
  • year round symptoms
  • uncontrolled asthma
109
Q

Reasons for failure of BCG vaccine in adults

A
  • over-attenuated virus
  • environmental mycobacteria mask protective effects
  • exposure to environmental worms (induces type 2 HS)
110
Q

Effects of histamine

A
  • vasodilation
  • bronchospasm
  • increased vascular perm
111
Q

Effect of leukotrienes

A
  • prolonged bronchospasm

- increased vascular perm

112
Q

Effect of ECP (eosinophilic cationic protein)

A
  • recruitment of eosinophils to airways
113
Q

Effect of PAF (platelet activating factor)

A
  • activation of platelets
114
Q

Effect of NCF (neutrophil chemotactic factor)

A
  • recruitment of neutrophils to airways
115
Q

Process of desensitization in immunotherapy

A
  • IgE rises then falls
  • specific IgG to antigen rises
  • specific T reg cells are induced
  • reduction of antigen-induced histamine release from basophils
  • reduction of wheal and flare reaction to antigen
  • IL 10 levels rise
116
Q

How mycobacteria survive in macs

A
  • inhibit phagolysosomal fusion
  • secrete anti-oxidants to neutralize ROS
  • ESAT-6 and CFP-10 induce membrane rupture
117
Q

Cathelicidin anti-mycobacterial activity mediated by

A
  • direct killing of MTB
  • production of ROS
  • autophagy (overcoming inhibition of phagolysosomal fusion)
118
Q

3 mol in macs that can kill mycobacteria

A
  • NO
  • granulysin
  • cathelicidin
119
Q

Causes of neg Mantoux test

A
  • early stage TB infection
  • never exposed
  • anergy due to systemic disease/ immunosup
  • anergy due to severe TB
120
Q

When to use antimicrobial prophylaxis

A
  • infection is common and predictable

- re infection would be very detrimental

121
Q

Disadvantages of antimicrobial prophylaxis

A
  • cost
  • adverse effects
  • antibiotic resistance
  • insuff attention to other preventative measures
122
Q

What antibiotic to use for PCP

A

Cotrimoxazole

123
Q

What antibiotic to use for cryptococcal infections

A

Fluconazole

124
Q

Choice of antibiotic to use for surgical prophylaxis

125
Q

Host defences against LRTIs

A
  • cough reflex
  • mucociliary clearance (IgA can penetrate mucus)
  • alveoli protected by phagocytes
126
Q

Risk factors for LRTI

A
  • impaired cough reflex
  • impaired mucociliary function (CF, smoking)
  • damaged alveolar macs/ alveoli (asbestosis)
127
Q

Types of organism detection

A
  • microscopy
  • culture
  • serology
  • nucleic acid amplification
128
Q

Diagnosis of pleural infections

A
  • clinical
  • X- ray
  • pleural tap
129
Q

S pyogenes enzymes

A
  • streptokinase

- DNAses

130
Q

Haemolysins and toxins in S pyogenes

A
  • streptolysin O

- erythrogenic toxin

131
Q

S pyogenes clinical manifestations

A
  • pharyngitis/ tonsillitis
  • impetigo
  • erisipelas
  • cellulitis
  • necrotising fasciitis
  • scarlet fever
132
Q

Enzymes of S aureus

A
  • coagulase
  • penicillinase
  • lipase and hyaluronidase
133
Q

Haemolysins and toxins in S aureus

A
  • enterotoxins
  • exfoliatin
  • TSST 1
134
Q

Predisposing factors for S aureus infection

A
  • foreign bodies
  • previous viral infection
  • DM
  • break in skin defences
135
Q

Nerve roots of parasympathetic nervous system

A
  • S 2,3,4

- CN 3,7,9,10

136
Q

Dilemmas of chronic illnesses

A
  • cause
  • prevalence
  • symptoms
  • diagnosis
  • management
  • education
  • adherence
  • stigma
  • relapse
  • hospitalization
  • prognosis
  • death
137
Q

contextual factors for chronic illness

A
  • religion
  • culture
  • social circumstances
  • pre-morbid functioning
  • doctor patient relationship
138
Q

Consequences of IPV

A
  • pschological health
  • mental health
  • physical health
  • social well being
139
Q

Role of doctor in IPV

A
  • manage physical and psychological injuries
  • screen for IPV
  • document and photograph injuries
  • share info with patient and refer
  • safety assessment and plan
140
Q

Forms of IPV abuse

A
  • physical abuse and violence
  • sexual abuse and rape
  • economic abuse and control
  • emotional, verbal and pschological abuse
  • intimidation
141
Q

Benefits of traditional medicine

A
  • convenient, accessible and usually cheaper
  • connect to culture
  • placebo
  • social support
  • feel more comfortable
  • believe more natural
142
Q

Risks of traditional medicine

A
  • prep not always safe
  • no standard prep
  • healers not registered or controlled
  • may delay western treatment
  • no scientific proof of efficacy
143
Q

Purpose of DSM 4

A

Structure and documents the diagnosis of mental illness for treatment and research purposes

144
Q

Axes of DSM

A 
1 - clinical disorders
2- underlying personality disorders
3- acute medical conditions and physical disorders
4- psychosocial and environ factors
5- global assessment of functioning
145
Q

Types of relievers in asthma control

A
  • short acting B2 agonists

- anticholinergics

146
Q

Types of controllers in asthma management

A
  • inhaled corticosteroids
  • oral corticosteroids
  • leukotriene receptor agonists
  • long acting B2 agonists
147
Q

Advantages of using IGRA for TB diagnosis

A
  • no cross reaction with BCG or MOTTs
  • may be more sensitive than Mantoux
  • only need 1 visit
148
Q

Disadvantages of using IGRA to diagnose TB

A
  • limited data on use with HIV and children
  • limited data on use in high prevalence setting
  • lab infrastructure required
  • need more local data
149
Q

3 levels of TB control

A
  • administrative
  • environmental
  • respiratory protection
150
Q

Differences between common cold and flu

A
  • clinical spectrum
  • speed of onset
  • fever
  • presentation
  • fatigue
  • course
  • complications
  • occurrence
151
Q

6 preformed mast cell mediators

A
  • histamine
  • neutral proteases
  • acid hydrolases
  • oxidative enzymes
  • chemotactic factors
  • proteoglycans
152
Q

Prerequisites for choosing immunetherapy

A
  • IgE mediated allergen sensitivity has major relevance to symptoms
  • allergen is unavoidable
  • only a single allergen responsible
153
Q

Grades of bee sting allergy

A

1- localized
2- spreads
3- bronchospasm and angioedema
4- systemic reaction with BP drop

154
Q

Contraindications for immunotherapy

A
  • extracts of unproven efficacy
  • infancy or old age
  • pregnancy
  • severe eczema
  • contraindications for use of epinephrine
  • uncontrolled asthma
155
Q

Clara cell functions

A
  • prod surfactant
  • reg Cl transport
  • secrete enzymes
  • secrete anti proteases
  • stem cells
156
Q

Blood air barrier

A
  • type 1 pneumocyte
  • BM
  • cap endo cell
157
Q

Functions of alveolar macrophages

A
  • phagocytose debris and bacteria
  • carbon uptake
  • hemosiderin uptake
  • degrades surfactant
  • stim chemotactic factors
158
Q

Role of lung surfactant

A
  • mono layer lining internal alveolar surface
  • acts as a detergent
  • prevents collapse and facilitates expansion
  • bactericidal effect
159
Q

Functions of thymus gland

A
  • maturation of T cells
  • proliferation of mature T cells
  • development of immune self tolerance
  • hormone secretion
  • haematopoiesis
160
Q

Determinants of vent preload

A
  • diastolic filling time
  • venous return
  • atrial press
  • vent compliance
161
Q

Factors affecting afterload

A
  • arterial elastic rebound
  • vascular tone
  • quality of flow
162
Q

Stages of Valsalva maneuver

A
  • pulm squeeze
  • decreased venous return (bvs constrict-compensatory tachycardia)
  • pulm decompression (press on chest released)
  • overshoot (dammed blood released)
163
Q

Classes of branch blocks

A

1- prolonged RR
2 - prolonged RR and dropped beat
3- dissociation

164
Q

How to measure Renal blood flow

A
  • clearance methods
  • electromagnetically
  • laser Doppler flowmetry
165
Q

H secretion induced by

A
  • increased pH
  • increased pCO2
  • decreased HCO3
166
Q

3 types of alveolar dead space

A
  • anatomical (trachea)
  • alveolar
  • physiological (anatomical and alveolar)
167
Q

How smoking affects O2 transport

A
  • carbon monoxide toxicity (CO binds to Hb)
  • impaired vent (mucus, cilia damage)
  • impaired diffusion (thickening of resp membranes)
  • impaired perfusion (pulm vasoconstriction)
168
Q

Local pressures in pulm oedema

A
  • pulm cap hydrostatic(towards)
  • pulm cap oncotic (away)
  • pulm interstitial fluid (towards)
  • alveolar gas (away)
  • lymphatic (away)
169
Q

ECG abnormalities after MI

A
  • ST elevation
  • T wave inversion
  • tall T wave
  • significant Q wave
170
Q

Evidence based practice

A
  • assess patient
  • ask right questions
  • assess evidence
  • appraise evidence
  • apply evidence
  • audit clinical practice
171
Q

Stages of lung development

A
  • embryonic
  • pseudo glandular
  • canalicular
  • terminal sac
    • saccular stage
    • alveolar stage
172
Q

Mechanism of warfarin

A
  • inhibits action of vit K in the synthesis of factors 2,7,9,10 and anticoag factors proteins C and S
173
Q

Clara cell Functions

A
  • surfactant
  • reg Cl transport
  • secrete enzymes
  • secrete anti proteases
  • act as stem cells

IHS (2 decks)

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