Week 1 - Cardio, Respiratory, GIT Flashcards
1
Q
The normal heart weighs how much?
A
~350g
2
Q
What are the 2 layers of the Pericardium?
A
Parietal and Visceral
3
Q
What types of cells can be found in the Myocardium?
A
Cardiac muscle cells and cardiocytes
4
Q
The endothelium can be found in which layer of the heart?
A
Endocardium
5
Q
Pulmonary circulation overload, pulmonary hypertension and RV hypertrophy are symptoms of which cardiac defect?
A
Left to right shunts
6
Q
What is the problem in an atrial septal defect?
A
There is a failure of the foramen ovale to close after birth.
7
Q
What is the most common cardiac defect?
A
Ventricular septal defect.
8
Q
A ventricular septal defect is a right to left shunt. True or false?
A
False.
9
Q
What is the problem in a Patent ductus arteriosus?
A
It is a failure of the closure of ductus arteriosus after birth.
10
Q
Is a patent ductus arteriosus a left to right shunt or a right to left shunt?
A
Left to right shunt
11
Q
What is a pulmonary stenotic lesion?
A
Narrowing of the pulmonary artery/valve.
12
Q
What is a symptoms of a pulmonary stenotic lesion?
A
Cyanosis due to decreased oxygenation of the blood.
13
Q
What are the four signs of Fallot’s tetralogy?
A
- Pulmonary stenosis
- High ventricular septal defect
- Overriding of the septum by the aorta
- RV hypertrophy
14
Q
What is a coarctation of the aorta?
A
Narrowing or blockage of the aorta.
15
Q
What are some of the symptoms of a coarctation of the aorta?
A
Headaches and dizziness
16
Q
What is Situs Inversus?
A
Organs are on opposite sides of the body.
17
Q
What is Dextrocardia?
A
The apex of the heart is pointing towards the right.
18
Q
What are the two classifications of disorders of the pericardium?
A
Inflammatory and non-inflammatory
19
Q
What are the two classifications of Inflammatory pericardial disorders?
A
Acute pericarditis and chronic peridcarditis
20
Q
What is the aetiology of acute pericarditis?
A
Due to bacterial/viral infections, rheumatic fever, uraemia, SLE, tumours, MI and trauma.
21
Q
What are the morphological manifestations of acute pericarditis?
A
Serous, fibrinous, suppurative or haemorrhagic
22
Q
How does rheumatic fever cause acute pericarditis?
A
Cross reactivity by antibodies due to Group A strep infection causes inflammation.
23
Q
How does ureamia cause acute pericarditis?
A
High levels of urea cause toxins to build up in the blood causing pericarditis.
24
Q
How does SLE cause acute pericarditis?
A
Autoantibodies cause inflammation.
25
How does MI cause acute pericarditis?
Inflammation to pericardium due to muscle death.
26
What causes suppurative change to the pericardial fluid?
Pyogenic infection.
27
What causes serous change to the pericardial fluid?
SLE
28
What causes fibrinous change to the pericardial fluid?
Increase in urea in blood.
29
What causes haemorrhagic change to the pericardial fluid?
Tumours in the pericardium.
30
What are some of the causes of chronic pericarditis?
Organised acute pericarditis, TB, Syphilis, SLE, radiation therapy, cardiac surgery
31
How do TB and syphilis cause chronic pericarditis?
Granulomatous or gummatous inflammation.
32
How does radiation therapy cause chronic pericarditis?
Damage to the pericardium and scar tissue formation.
33
What is Pick' disease of the pericardium?
progression of acute viral/bacterial pericarditis leading to formation of a rigid fibrous capsule which restricts diastolic filling of the heart leading to cardiac tamponade.
34
What is a classic sign of impedance of venous return?
Impedance of venous return causes increased central venous pressure which causes neck vein distention.
35
What causes impedance of venous return?
Formation of dense fibrous bands forming a rigid fibrous capsule around the heart.
36
What are some on the non-inflammatory disorders of the pericardium?
Hydropericardium, haemopericardium, pneumopericardium.
37
What is hydropericardium?
Too much fluid in the pericardium.
38
What is Haemopericardium?
Blood in the pericardium due to trauma e.g. vessel rupture.
39
What is pneumopericardium?
Air collection in the pericardium e.g. during surgery.
40
Hydropericardium, haemopericardium, pneumopericardium can all lead to _________ __________.
Cardiac tamponade
41
What are some of the primary tumours of the pericardium?
Mesothelioma, fibrosarcoma (both very rare).
42
What is an example of a secondary tumour of the pericardium?
Bronchogenic carcinoma (more common than primary tumour)
43
What are some examples of a disorders of the myocardium?
Coronary artery insufficiency due to atherosclerosis, amyloidosis, cardiomyopathies, myocarditis, rheumatic heart disease, cor bovinum, cor pulmonale
44
What are the two manifestations of coronary artery insufficiency?
Gradual occlusion of coronary artery and sudden occlusion of coronary artery.
45
Gradual occlusion of a coronary artery can lead to _______ ________.
Angina pectoris
46
What is the cause of angina?
Ano2 metabolites build up in the myocardial tissue due to partial occlusion of the coronary arteries.
47
A sudden occlusion of a coronary artery leads to a _________ ______.
Myocardial infarction.
48
What are the four types of MI?
Transmural infarct
Subendocaridal infarct
Septal infarct
Subpericaridal infarct
49
Which coronary artery is the most common to be blocked causing MI?
Left anterior descending coronary artery (50%)
50
A blockage in the Left anterior descending coronary artery causes infarction in which area of the heart?
Anterior wall of the left ventricle, anterior part of the septum and the apex.
51
A right coronary artery occlusion causes what percentage of MI?
~30%
52
A right coronary artery occlusion causes an infarct in which area of the heart?
Posterior wall of the LV and posterior part of the septum.
53
An occlusion in the left circumflex coronary artery causes what percentage of MI?
~20%
54
An occlusion in the left circumflex coronary artery causes an infarct in which area of the heart?
Lateral wall of LV
55
What are some of the investigations done on a person suspected of an MI?
Troponins, cardiac enzymes, blood lipids, FBE, chest x-ray, nuclear scans
56
What are some of the methods of management of an MI?
```
Defibrillation
Fluid replacement
Morphine
Frusemide (allows diuresis)
O2 therapy
Inotropic agents
Antiarrhythmics
Antithrombotics
Analgesics
Rehabilitation
```
57
What are some of the sequelae of an MI?
```
Sudden death
Cardiogenic shock
Heart failure
Pericarditis
Fibrosis
Thromboembolism
Cerebral infarct
Aneurysm (cardiac aneuryms, burst apex)
Arrhythmias
```
58
How does amyloidosis affect the myocardium?
Deposits the two types of amyloid, amyloid light chain protein and amyloid associated protein, in the heart tissue.
59
What is the cause of primary amyloidosis?
Idiopathic
60
What body systems does primary amyloidosis affect?
Skeletal muscles, heart, skin, spleen, kidney, lungs.
61
What is the cause of secondary amylodisosis?
Pre-existing diseases such as RA, multiple myeloma, chronic inflammatory diseases.
62
What body systems does secondary amyloidosis affect?
Spleen, liver, adrenals
63
Amyloid is stained ______ by iodine, _____ by Congo red and you can see ______ _______ birefringence of Congo red stained tissue under polarised light.
Brown, red, apple green
64
What do deposits of amyloid in the myocardium do to cardiac function?
The waxy deposits in the myocardium causes the walls of the heart to become inflexible and interfere with cardiac function.
65
What is the definition of cardiomyopathy?
A myocardial disorder diagnosed by exclusion i.e. not due to hypertension, CHD, RHD.
66
What are some of the symptoms of cardiomyopathy?
Chest pain, palpitations, heart failure.
67
What are the three types of cardiomyopathy?
Congestive/Dilated, Hypertrophic, Restrictive
68
What happens to the ventricles in congestive/dilated CMP?
Ventricles enlarge/dilate and become "congested" with blood.
69
What are the causes of congestive/dilated CMP?
Idiopathic, viral, alcohol causes.
70
What happens to the ventricles in hypertrophic CMP?
They becomes enlarged/thickened.
71
What are the causes of hypertrophic CMP?
Idiopathic, genetic causes.
72
What happens to the ventricles in restrictive CMP?
Deposits of proteins in ventricular wall inhibit diastolic filing of ventricles.
73
What are the causes of restrictive CMP?
Idiopathic, amyloidosis.
74
What are the two classifications of myocarditis?
Infective and Aseptic.
75
What are some of the causes of infective myocarditis?
Group B Coxackievirus
Type 8 Echoviruses
Toxoplasma gondii
Staphylococcus aureus
76
In western countries ______ infective myocarditis is more common whereas in developing countries __________ or ________ infective myocarditis is more common.
Viral, protozoa, bacterial
77
What are some of the causes of aseptic myocarditis?
Alcoholic, toxic, drug-related, autoimmune, idiopathic
78
What are some of the effects on the heart tissue due to RHD?
Polyarthritis
Pancarditis
Aschoff nodules (Aschoff body)
Heart valve lesions (mitral, aortic)
79
What causes RHD?
Infection with Group A strep leads to excess antibody formation in genetically predisposed individuals, react with and destroy cardiac tissue.
80
What can happen to the heart valves in RHD?
They develop lesions which cause fibrosis and calcification leading to the thickening of the cusps.
81
What is Cor bovinum?
LV hypertrophy due to systemic hypertension. It starts with concentric hypertorphy but eccentric may supervene.
82
What is Cor pulmonale?
RV hypertorphy due to various lung or valve disorders. It is an enlargement of the right ventricle due to high blood pressure in the arteries of the lungs usually caused by chronic lung disease. It starts with concentric hypertrophy but eccentric may supervene.
83
What are some of the causes of acute bacterial endocarditis?
Staphylococcus aureus, streptococcus pyogenes
84
In what population do we commonly see acute bacterial endocarditis?
IV drug users
85
What happens to the heart valves in acute bacterial endocarditis?
Dirty needles transfer staph and strep into the bloodstream. The bacteria lodge on the heart valves causing damage to the previously healthy valves. The damage can lead to thrombus formation (also called acute vegetations). The thrombi can break off and become a septic emboli.
86
What bacteria causes sub-acute endocarditis?
Streptococcus viridans
87
What happens to the heart valves in sub-acute endocarditis?
Older patients with a history of valvular damage have vegetations on already damaged valves which can lead to septic emboli.
88
In what population do we commonly see sub-acute endocarditis?
Older patients with a history of valvular damage.
89
What is the difference between a stenotic heart valve and a incompetant heart valve?
A stenotic valve does not open properly leading to less blood being able to flow through. An incompetant valve does not close properly leading to regurgitation of blood.
90
What is the difference between Raynoud's disease and Raynaud's phenomenon?
Raynaud's disease is an idiopathic disorder which causes vasospasm in the hands of young women. Raynaud's phenomenon causes Raynaud's disease symptoms which are secondary to SLE, RA and Pb poisoning.
91
What is a possible complication of Raynaud's disease?
Gangrene of the fingertips due to reduced blood flow.
92
What is the cause of Arteritis?
Inflammation of the arteries caused by Type III hypersensitivity reactions or autoimmune states e.g. SLE.
93
What is the definition of Polyarteritis nodosa?
When arteritis affects many muscular and small arteries throughout the body.
94
What is the aetiology of Polyarteritis nodosa?
Idiopathic but may be autoimmune.
95
In what population can we commonly see Polyarteritis nodosa?
Middle aged men
96
What is broncial atresia?
Narrowing of the bronchus.
97
What is hypoplasia of the lung?
Incomplete development of the lung in utero. Lungs are smaller than normal.
98
What are broncogenic cysts?
Mucous filled cysts usually atteched to the trachea.
99
What is broncopulmonary sequestration?
A portion of the lung does not communicate with the bronchial tree.
100
What happens in Kartagener's Syndrome?
Immotile cilia in the bronchus.
101
What happens in neonatal respiratory distress syndrome?
Deficiency of surfactant leading to alveolar collapse.
102
What is atelectasis?
Collapsed lung
103
What are some of the sequelae of Cystic Fibrosis?
Recurrent infections, bronchietasis, haemoptysis, hyperinflation, pneumothorax, necrosis, scarring, pulmonary hypertension and cor pulmonale.
104
Excess mucous is seen in Cystic Fibrosis. Where in the body can we see the excess mucous?
Airways, GIT, pancreatic ducts, reproductive tract, increased bile in bile duct.
105
What happens to the lungs during chornic venous congestion?
Reduced LV output leads to rupture of the alveloar capillaries, hameorrhage, necrosis and fibrosis. We can also see brown induration (haemosiderosis).
106
What is haemosiderosis?
Break down of haemoglobin causes macrophages to engulf haemosiderin.
107
What are some of the causes of pulmonary oedema?
Congestive heart failure, infections, toxic gas inhalation, radiation.
108
What are some of the consequences of pulmonary oedema?
Can lead to dyspnoea and hypostatic pneumonia (due to oedematous fluid in the alveoli).
109
In what population do we commonly see pulmonary infarction?
Elderly, post-operative or patients with heart failure may lead to development of thromboemboli.
110
What is the cause of primary pulmonary hypertension?
Idiopathic, rare and difficult to treat.
111
What is the cause of secondary pulmonary hypertension?
Due to lung or heart disease
112
What is the definition of COPD?
A disease state characterised by persistent airflow limitation that is not fully reversible.
113
What is the definition of emphysema?
An increase in the size of alveolar spaces and loss of elastic recoil distal to the terminal bronchiole.
114
What is the defect in familial emphysema?
Due to an inherited defect in the a1-antiproteinase (a1-antitrypsin)
115
What is the cause of acquired emphysema?
Smoking
116
What happens to the lungs in acquired emphysema?
Smoking causes a decrease in a1-antiproteinase therefore a1-antiproteinase cannot inactivate elastases which are release by neutrophils. The elastases go on to destroy elastic tissue in the alveolar walls.
117
What is the definition of bronchiectasis?
A permanent, abnormal dilatation of the bronchi and bronchioles.
118
What are some of the symptoms of bronchiectasis?
Recurrent cough, copious mucous
119
What is the cause of bronchiectasis?
Due to chronic infections such as TB, sarcoidosis, smoking, scarring, dust inhalations, tumours, cystic fibrosis, immotile cilia syndrome.
120
What is the definition of chronic bronchitis and bronchiolitis?
Airway narrowing caused by mucous hypersecretion, inflammation of the airways.
121
What is the cause of chronic bronchitis and bronchiolitis?
Due to smoking, dust/fume inhalation, infections/inflammations.
122
What is the definition of asthma?
A reversible borncospasm causing wheezing and excess mucous, mediated by Type I hypersensitivity.
123
What are some of the causes of extrinsic asthma?
Allergic, environmental triggers
124
what are some of the causes of intrinsic asthma?
Exercise, stress, psychogenic triggers.
125
What are some of the sequelae of asthma?
Mild disease, status asthmaticus, chronic asthma, COPD
126
What is status asthmaticus?
Hyperinflated lungs - air cannot escape due to mucous plugs in the airways and blood vessel constriction.
127
What is a sequelae of status asthmaticus apart from death?
Mucous casts produced due to mucous plugs in the airways.
128
What is a cause of tracheitis?
Toxic fume inhalation
129
What are some of the causes of tracheo-bronchitis?
Whooping cough, Hib, Strep pneumoniae
130
What are some of the causes of bronchiolitis?
Viruses such as CMV.
131
What are some of the bacterial causes of pneumonia?
Staphylococcus aureus
| Streptococcus pneumoniae
132
What is an examply of a cause of pleurisy?
Ureamia.
133
What is the population associated, bacterial cause, morphological features and sequelae of Lobar Pneumonia?
Young adults
S. pneumoniae
Whole lung lobes, 8 day course
Resolution
134
What is the population associated, bacterial cause, morphological features and sequelae of bronchopneumonia?
Age extremes
Different flora
Patchy lesions and irregular course length
Pus and fibrosis
135
What are some of the VIRAL causes of pneumonia?
```
Influenza
Rhinovirus
Coxsackievirus
Echovirus
SARS
CMV
```
136
What are some of the FUNGAL causes of pneumonia?
Aspergillus spp
Cryptococcus spp
Candida albicans
Pneumocystis jirovecii
137
What is Sarcoidosis?
An idiopathic, multisystem disease causing non-caseating granulomatous inflammation.
138
In what population can we commonly see sarcoidosis?
Women with immune anomalies
139
What is a common test used to detect sarcoidosis?
The Kveim-Siltzback skin test (+ve in 80% of patients)
140
What are some of the causes of Adult Respiratory Distress Syndrome (ARDS)?
Septicaemia, major trauma, toxic smoke/fume inhalation, amniotic fluid embolism, DIC, radiation injury, chemotherapy
141
What are the sequelae of ARDS?
70% die in acute phase
20% die due to chronic impairment
10% recover
142
What is the size of the particles inhaled in dust inhalation diseases?
< 5um
143
What are some of the ORGANIC dust inhalation diseases?
Byssinosis
Bagassosis
Farmer's lung
Suberosis
144
What is Byssinosis?
Type 1 hypersensitivity due to inhalation of cotton protein.
145
What is Bagassosis?
Type I hypersensitivity due to inhalation of sugar cane refuse.
146
What is Farmer's Lung?
Type III hypersensitivity due to inhalation of mouldy hay
147
What is Suberosis?
Inhalation of cork dust.
148
What are some of the INORGANIC pneumoconioses?
Anthracosis, Silicosis, Silicoanthracosis, Beryllisois, Silicosiderosis, Asbestosis
149
What is Anthracosis?
Inhalation of carbon from smoking/pollution. Least harmful of inorganic pneumoconioses.
150
What is Silicosis?
Inhalation of silica by quarry workers and stone masons.
151
What are some of the sequelae of silicosis?
Predisposes to TB, COPD, RH problems.
152
What is Silicoanthracosis?
Inhalation of carbon and silica. Seen in coal miners. Predisposes to TB, COPD, RH problems.
153
What is Berryliosis?
Inhalation of beryllium by miners and electronic industry. Leads to granulomas and COPD.
154
What is Silicosiderosis?
Inhalation of silica and iron by miners and iron ore workers. Predisposes to TB and lung malignancy.
155
What is Asbestosis?
Inhalation of asbestos in miners, building and automotive workers. Most harmful of inorganic pneumoconioses.
156
What causes carcinoma of the bronchus?
Smoking, X-rays, gamma rays, radon gas, asbestosis, silicosiderosis, mining of nickel and chromium.
157
In carcinoma of the bronchus, a central mass is found in ___% of cases, a peripheral mass is found in ___% of cases and a diffuse mass is found in ___% of cases?
55%, 40%, 5%
158
What are some of the effects of a peripheral mass in carcinoma of the bronchus?
It may give rise to paraneoplastic syndromes like Pancoast Syndrome and Horner's Syndrome.
159
What is Pancoast Syndrome?
Where a peripheral mass of carcinoma of the bronchus spreas to the brachial plexus causing pain in the shoulder, arm and hand.
160
What is Horner's Syndrome?
Damage to the sympathetic nerves that supply the eye by a peripheral mass of carcinoma of the bronchus leading to eyelid drooping and pain.
161
How is carcinoma of the bronchus diagnosed?
CXR, Bronchoscopy and biopsy, Needle biospy of lymph nodes, sputum cytology, MRI/CT, bone and brain scans.
162
What is the treatment for carcinoma of the bronchus?
Surgery, radiotherapy, chemotherapy, combined treatments.
163
Carcinoma of the bronchus is caused by a squamous cell carcinoma in ___% of cases.
50%
164
What treatments does squamous cell carcinoma respond well to?
Surgery and radiotherapy.
165
Small cell anaplastic carcinoma, also known as ____ ____ carcinoma, can be seen in ___% of cases of carcinoma of the bronchus and has the _____ prognosis.
Oat Cell, 20%, worst.
166
What treatments does small cell anaplastic carcinoma respond well to?
Chemotherapy and radiotherapy.
167
Large cell anaplastic carcinoma occurs in ___% of cases of carcinoma of the bronchus.
10%.
168
What treatments does large cell anaplastic carcinoma respond well to?
Chemotherpay and radiotherapy.
169
Adenocarcinoma occurs in ___% of cases of carcinoma of the bronchus?
15%
170
What treatments does adenocarcinoma of the bronchus respond well to?
Surgery, radiotherapy.
171
Alveolar cell carcinoma of the bronchus occurs in ___% of cases.
5%
172
What treatments does alveolar cell carcinoma respond well to?
Surgery and radiotherapy. Best prognosis.
173
What is the average 5 year survival rate of carcinoma of the bronchus?
<10%
174
What structures of the mouth does carcinoma of the oral cavity affect?
Lips (esp lower), tongue, buccal mucosa, pharynx
175
In what population do we commonly see carcinoma of the oral cavity?
Males who smoke pipes/cigars
176
What is the morphology of carcinoma of the oral cavity?
Squamous cell carcinoma
177
What is the treatment for carcinoma of the oral cavity?
Surgical excision, radiotherapy.
178
What is Stomatitis?
Inflammation of the mouth
179
What microbes can cause inflammation of the oral cavity?
HSV Type 1
EBV
Coxsackievirus
Candida albicans
180
What is Sialadenitis?
Inflammation of the salivary glands.
181
What is a characteristic in the morphology of SCC of the oral cavity?
Keratin pearls in whorl like formation.
182
What causes oesophagitis?
Inflammation of the oesophagus due to GORD or infections e.g. Candida albicans.
183
What causes oesophageal varices?
Dilated veins due to cirrhosis of the liver and protal hypertension.
184
What is Plummer -Vinson Syndrome?
Abnormal peristalsis and mucosal webs affecting the oesophagus.
185
What are some of the features of Plummer-Vinson Syndorme?
```
Females
Iron deficiency anaemia
Difficulty swallowing
Atrophic glossitis
Congenital
Koilonychia
SCC
```
186
What causes SCC of the Oesophagus?
Smoking, alcohol, chronic oesophagitis, Plummer-Vinson Syndrome.
187
What are the symptoms of SCC of the Oesophagus?
Late dysphagia, haematemesis, choking sensation.
188
A rolling hiatus hernia occurs in ___% of cases.
5%
189
A sliding hiatus hernia occurs in ___% of cases.
95%
190
What causes a hiatus hernia?
Congenital weakness in the diaphragm, obesity, overloading of the stomach.
191
What are the symptoms of a hiatus hernia?
The same as GORD.
192
What is the treatment for a hiatus hernia?
Surgery/small meals/weight reduction.
193
What are some of the causes of Acute (erosive) gastritis?
Alcohol, aspirin, H. pylori, NSAIDs.
194
What are some of the categories of chronic gastritis?
- Chronic H. pylori associated (hypertrophic) gastritis (Most common, good outcome)
- Chronic atrophic (autoimmune) gastritis (Poor prognosis)
- Reactive gastritis (Good prognosis)
195
What causes chronic atrophic (autoimmune) gastritis?
Auto-antibodies aginst mostly parietal cells which can lead to gastric carcinoma. Leads to loss of folds inside stomach.
196
What causes reactive gastritis?
Due to chemicals/reflux: NSAIDs or bile refluxing into lower part of stomach.
197
What is the sequelae of acute peptic ulcers?
Usually heal, may progress to chronic peptic ulcer.
198
In what population do we see chronic peptic ulcers?
30 - 45 year olds
199
What causes chronic peptic ulcers?
Genetics, smoking, increased HCl, decreased blood supply, decreased mucous, H. pylori
200
What type of pain would you see in an gastric ulcer?
Gnawing pain in the epigastrium, 1 - 3 hours a meals
201
What type of pain would you see in a duodenal ulcer?
Steady pain in the mid-epigastrium 2 - 4 hours after meals.
202
What are the sequelae of chronic peptic ulcers?
- Most heal
- Stenosis of stomach if too much fibrous tissue is formed. Stomach takes an hourglass appearance
- Melaena (black tarry stools)
- Haematemesis
- Perforation
- Malignancy may supervene
203
A chronic peptic ulcer may lead to a gastric carcinoma. True or false?
False, it may lead to an Adenocarcinoma.
204
In what population do we commonly see adenocarcinoma of the stomach?
Males of around 50 years of age.
205
What are some of the causes of adenocarcinoma of the stomach?
Due to diet, genetics (blood group A), H. pylori, premalignant disease.
206
What are the sites affected by carcinoma of the stomach?
Pylorus - 50% cases
Lesser curvature - 25% cases
Cardia, greater curvature and diffuse - 25% cases
