Unit 12 Week 2 Flashcards

1
Q

Risk factors for fracture

A
  • being female (smaller and lose density quicker)
  • old age
  • smoking
  • alcohol
  • steroids
  • rheumatoid arthritis
  • Diabetes
  • previous fracture
  • family history
  • higher BMI
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2
Q

How does a blood clot contribute to right ventricular strain

A
  • dislodged emboli gets into pulmonary circulation and occludes pulmonary vasculature
  • PE = abrupt vascular occlusion
  • increase to pulmonary artery pressure
  • pressure in RV increases causing muscle stretch, increased wall tension, elevated HR and increased oxygen demand due to lack of coronary perfusion
  • Mechanical stretch and ischaemia provokes a cytokine and immune mediated inflammatory response, converting RV muscle to proinflam phenotype
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3
Q

ECG sign of myocardial ischaemia

A

inverted T waves viewed from lead 3

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4
Q

What is an embolus?

A

detached intravascular solid, liquid or gasous mass that is carried to a distant site of origin
Majoirty derive from thrombus

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5
Q

Difference between thrombus and embolus

A

Thrombus is a clot that develops in a vessel and stays, embolus gets lodged distally

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6
Q

What is a thromboembolus?

A

blood clot that has broken off and become lodged in and obstructs the pulmonary arterial system leading to severe respiratory dysfunction

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7
Q

What is a saddle pulmonary embolism

A

large pulmonary embolism that straddles the bifurcation of the pulmonary trunk, extending into the left and right pulmonary arteries

If large enough it can cause right sided heart failure

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8
Q

Signs of right sided heart failure

A

Dilated right ventricle, leftward bulge of the interventricular septum and enlargement of the pulmonary trunk

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9
Q

Causes / types of pulmonary embolism

A
  • Thrombosis via venous system accounts for majority of cases
  • Fat- following long bone fracture or orthopaedic surgery (e.g. femur)
  • Amniotic fluid- during labour if the placental membranes break at the same time as uterine veins
  • Air- following neck vein cannulation
  • Foreign bodies
  • Tumour cells
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10
Q

Major risk factors for venous thromboembolism

A
  • Surgery
  • Obstetrics
  • Lower limb issues (fractures and varicose veins)
  • Malignancy
  • Reduced mobility
  • Previous proven –VTE
  • Major trauma
  • Spinal cord injury
  • Central venous lines
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11
Q

Minor risk factors for venous thromboembolism

A
  • Cardiovascular (hypertension, stroke, heart disease and failure)
  • Osterogens (combined oral contraceptive, hormone replacement therapy)
  • Haematological (thrombotic disorders)
  • Renal (nephrotic syndrome etc)
  • COPD
  • Neurological disability
  • Occult malignancy
  • long distance sedentary travel
  • obesity
  • other chronic disaeses (IBD)
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12
Q

Pathophysiology thromboembolism disease

A

Fragment of thrombus is broken off and carried through progressively larger veins and R side of heart before entering pulmonary vasculature

-Occlusion of blood vessels, decreased gas exchange, hypoxia, damages organs ,potentially to the point of death

Often multiple embolisms at once so tend to occur close together timewise

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13
Q

Fat embolism pathophysiology

A

Micro-emboli of fat + RBC aggregates can cause occlusion

Fatty acids can also damage endothelium leading to increased platelet activation and granulocyte recruitment

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14
Q

Air embolism pathophysiology

A

commonly due to clinical procedure (e.g. laparoscopic surgery)
Due to negative pressure in blood vessels pulling in air

Air in vessel can cause intense inflam response

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15
Q

Symptoms of PE

A
  • Acute dypnea
  • Pleuritic chest pain
  • Anxiety
  • Dizziness, light headedness or fainting
  • Heart palpitations or irregular heart beat
  • Coughing (sometimes w blood)
  • Sweating
  • low blood pressure and associated symptoms

Associated w symptoms of Deep vein thrombosis so also: reddening, warming or swelling of the legs

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16
Q

Non weight bearing plaster

A

Plaster cast

Prevents movement of affected area allowing for hard callus formation when healing a fracture in a bone

17
Q

Hormone therapy woman to man process

A
  • Masculinizing therapy
  • Testosterone to suppress menstrual cycles and decrease production of oestrogen
  • many take oral contraceptive pill first in order to stop periods and target feelings of dysphoria
  • before you start have a mental health evaluation
  • routine physical (FBC, LFT, personal and family medical history)
  • discussion about future fertility
  • Testosterone is usually taken as injection
18
Q

Risks of masculinizing therapy

A
  • infertility
  • polycythaemia (too many erythrocytes)
  • dyslipidaemia (too many lipids–> atherosclerosis and heart disease)
  • worsening of underlying psychotic conditions
  • hypertension
19
Q

Gender transitioning in under 16’s

A
  • not normally done

- GnRH agonists are used instead to stop natural effects of puberty

20
Q

How to get gender reassignment therapy

A

Live in social role correlating to your preferred gender identity for at least 12 months (e.g. passport)

21
Q

Diagnosis of PE

A
  • Difficult as symptoms are similar to many other conditions
  • Chest X-ray and Ultrasound to check for blood clot in leg
  • Tests for lung function (FEV on spirometer?)
  • D-dimer
  • CTPA- computerised tomography pulmonary angiography
  • Ventilation-perfusion (V/Q) scan
  • Leg vein ultrasound
  • ECG with S1Q3T3 pattern
  • echocardiogram
22
Q

D-dimer screening

A

Offered before to try and screen for PE

a product of fibrin degradation present in blood after a blood clot undergoes fibrinolysis

2 D fragments of fibrin joined by a cross link

23
Q

ECG S1Q3T3

A

Signifies acute right side of the heart strain Prominent S wave in lead 1
Q wave and inverted T wave in lead 3
Sinus tachycardia

24
Q

Pleuritic chest pain

A

intense stabbing sharp pain on inhalation and exhalation

25
Q

Reason for post mortem

A

Discover cause of death via autopsy
Carried out by pathologists
How when and why someone died
2 kinds of post mortem

26
Q

Death certificate

Medical Certificate of Cause of Death

A

May be issued by a doctor who has provided care during the last illness and who was has seen the deceased within 14 days of death