Cardiorespiratory Anki Import

What is whooping cough caused by?

<div>Bordetella pertussis</div> Respiratory-Infections

Causes of subvalvar disease? What can this lead to?

<div>Chordae tendinae rupture</div><div>Papillary muscle dysfunction - usually ischaemic</div><div>Papillary muscle rupture</div><div><br /></div><div>Mitral regurgitation</div> Disease Heart Valvular

Signs of heart failure<div><br /></div>

<div>Cold peripheries</div><div>Cyanosis</div><div>Low bp</div><div>Narrow pp</div><div>Pulses alternans</div><div>Displaced apex</div><div>RV heave (pulm. Hypertension)</div><div>Murmur&nbsp;</div><div><br /></div> Failure Heart

What can cause a decrease in myocardial oxygen supply?

<div>Coronary artery disease</div>Atherosclerosis<div>Spasm</div><div>Post-radiation therapy</div><div>Severe aneamia</div> Angina

What is diptheria caused by and what is the type of bacteria?

<div>Corynebacterium diptheriae</div><div>Gram positive rod</div> Respiratory-Infections

Complications of heart failure?

<div>Death</div><div>Arrythmias - AF, VF, VT</div><div>MR/TR &nbsp;(mitral/tricuspid regurgitation)</div><div>PE</div><div><br /></div> Failure Heart

Symptoms of Mitral Regurgitation

<div>Dyspnoea &amp; orthopnoea due to increase in left atrial pressure</div><div>Palpitations due to atrial fib</div><div>Systemic emboli due to static blood in dilated fibrillating left atrium</div><div><br /></div> Disease Heart Valvular

In beta thalassaemia major, what haemoglobin molecules are present?

<div>HbA (α2β2) absent</div><div>HbA2 (α2δ2) increases</div><div>HbF (α2γ2) increases</div><div><br /></div> Haemoglobinpathies

What can cause eccentric hypertrophy?&nbsp;

<div>Increase in preload</div><br />Reduction in compliance leading to increased volume overload<div>Aortic &amp; mitral regurgitation<br />Systolic dysfunction<br />Hypervolemia&nbsp;</div> Anatomy Anatomy-of-the-heart

What are the pathological causes of respiratory alkalosis?

<div>Intracerebral hemorrhage, meningitis, stroke</div><div>Salicylate and Progesterone drug usage</div><div>Anxiety, hysteria, stress and pain</div><div>Cirrhosis of the liver</div><div>Sepsis</div><div>Elevated body temperature</div><div>Hypoxia</div><div>Any lung disease that leads to shortness of breath can also cause respiratory alkalosis.</div><div><br /></div> Respiratory-Acidosis/Alkalosis

What are the signs of a tonsillar hernia?

<div>Intractable headache, head tilt, neck stiffness, decreased level of consciousness, flaccid paralysis.</div> Stroke

Main clinical features of diptheria?

<div>Severe pharyngitis and pseudomembranes on tonsils</div><div><br /></div> Respiratory-Infections

What is starlings law?

<div>The greater the preload, the greater the force of contraction and therefore the greater the stroke volume</div><div><br /></div> Shock

What is Virchow's Triad?

<div>Three categories of facot to increase risk for thrombosis</div>-Stasis of blood flow<div>-Hypercoagulability</div><div>-Endothelial injury</div> Venous-Thrombosis

What are the clinical features of glandular fever?

<div>Tonsils affected and gross pharyngeal swelling</div><div>Often get enlargement of the spleen and liver</div><div><br /></div> Respiratory-Infections

What are the different types of heart failure?

<div>Type I: Heart disease present but no dyspnoea from ordinary activity.</div><div>Type II: Comfortable at rest but dyspnoea on ongoing activity.</div><div>Type III: Less than ordinary activity causes dyspnoea which is limiting.</div><div>Type IV: Dyspnoea present at rest and all activities cause discomfort.</div><div><br /></div> Failure Heart

What is reactive airways dysfunction syndrome?

=Bronchial Hyperreactivity<div>Physical and irritant stimuli provokes a cough, wheeze and breathlessness, but not severe enough to be asthma&nbsp;</div> asthma

What is the clinical features of a CXR with infection of S. Aureus?

A cavitating (loss of alveolar) bronchopenumonia Respiratory-Infections

What is a nosocomial infection?

A hospital acquired infection&nbsp; Respiratory-Infections

What is Caseous tissue?

A necrotic centre (Ghon Focus) with an aggregation of macrophages surrounding it. Type of granuloma.&nbsp; Respiratory-Infections

What interleukin is activated in asthmawhen allergens activate Th2 cells? What does this activate?

Allergens activate Th2 cells which activates IL-4 which stimulates B cells asthma

What are the local clinical manifestations of type 1 anaphylatic shock?

Allergic rhinitis, asthma, apotic eczema, angioedema, urticaria Anaphylactic-Shock

Pathophysiology behind type 2 respiratory failure

Alveolar ventilation is insufficient to excrete the carbon dioxide, due to reduced ventilation effort or inability to overcome increased resistance to ventilation Breathlessness

How would you treat mild pneumonia?

Amoxicillin Respiratory-Infections marked

How would you treat moderate pneumonia?

Amoxicillin and clarithromycin Respiratory-Infections

How would you treat severe pneumonia?

Amoxicillin, Clarithromycin, Co-amoxiclav&nbsp;<div><br /></div> Respiratory-Infections

What could a prolonged PT time indicate?

An issue with VIII Blood Haemostasis Pathophysiology marked

Clinical features of pernicious anaemia

Anaemia, glossitis, mild jaundice, neurological symptoms Anaemia Blood

What is fonduparinux? When is it used?

Analog of heparin, used in DVT/PE Venous-Thrombosis

What effect does hypotension have on the heart?

Angina due to hypoperfusion of the heart<div><br /></div> Hypertension

What are the symptoms of atheriosclerosis?

Angina, Intermittent claudication, strokes, TIA, renal inufficiency atherosclerosis

What&nbsp;procedure involves using a small plastic balloon to open a narrowed artery?

Angioplasty atherosclerosis

What are the casues of aortic root dilating diease (3)

Ankylosing spondylitis<div>Margan syndrome</div><div>Aortic dissection</div> Disease Heart Valvular

Consequences of using strepokinase in later MIs

Antibodies against strepokinase may development therefore many not be useful in the future myocaridal infarctions Myocardial-Infarct

What are the indications for aortic valve disease surgery?

Any symptoms<div>Echocardiogram shows worsening LV dilation</div><div>If the peak systolic pressure gradient is more than 50 mmHg</div> Disease Heart Valvular

What does afterload consist of?

Aorta and main arteries compliance<div>Total vascular resistance</div><div><br /></div> Shock

"What murmur could this represent?<img src=""Screen Shot 2016-11-01 at 10.37.00.png"" />"

Aortic Stenosis Anatomy Anatomy-of-the-heart

What pathologies could cause an increase in afterload that would remodel the heart?

Aortic Stenosis<br />Hypertension Anatomy Anatomy-of-the-heart

When is the S2 heart sound heard?

Aortic and pulmonary values closing in diastole Anatomy Anatomy-of-the-heart

"What could this represent?<img src=""Screen Shot 2016-11-01 at 10.40.50.png"" />"

Aortic regurgitation Anatomy Anatomy-of-the-heart

What is the likely diagonsis of an ejection systolic murmur?

Aortic stenosis Anatomy Anatomy-of-the-heart

What two other conditions are often seen with asthma?

Apotic dermatitis, eczema Lung-Disorders

What is prostacyclin dervied from?

Arachidonic acid Shock

What is the difference in blood pressure drop with a venous bleed vs an arterial bleed?

Arterial bleed drops BP immediately<div>Venous bleed reduces preload, and then cardiac output, reducing the BP secondary to that.&nbsp;</div> Shock

How does hypertension damage the retina?

Arteriolar narrowing, microaneurysms, blot &amp; flame haemorrhages with swelling of the optical disk Hypertension

What is the difference of arteriosclerosis and atherosclerosis?

Arteriosclerosis: thickening and hardening of the walls of the arteries.<div>Atherosclerosis: Deposition of fatty materials within the inner walls of arteries</div> atherosclerosis

How does type 1 respiratory failure produce low o2 but not high CO2?

As CO₂&nbsp;can still be excreted, as less functional tissue is needed for CO₂&nbsp;excretion Breathlessness

Why can muscles not produce NO at the very start of exercising?

As NOS requires O₂, and the muscle would be hypoxic Vascular-Motor-Control

How is iron stored?

As ferritin Haemoglobinpathies

Why is free iron dangerous in the body?

As it can accept/donate electrons, so can oxidise/reduce biological molecules in the body easily Anaemia Blood

"Why does volume vs. pressure show as a hysteric loops in the lungs?<img src=""paste-13941463843075.jpg"" />"

As on inflation, the lungs must overcome surface tension to inflate.&nbsp; asthma

How is it possible for a B/T cell to have autoreactive properties against the body?

As the genes that code for B/T cells randomly mutate, possible to get a mutation against a self antigen Anaphylactic-Shock

Why is LDH raised in haemolytic anaemia?

As when RBC break open they release LDH Anaemia Blood

Main pharmacological treatment for a myocardial infarction?

Aspirin + Ticagretor for anti-platelet effects<div>Diamorhpine to sedate and relieve pain</div><div>Thrombolytic therapy: tPa &amp; Strepokinase</div> Myocardial-Infarct

What is the polypill made up of?

Asprin<div>Folic Acid</div><div>3 High BP medications; thaizide, a beta blocker and an ACE inhibitor&nbsp;<br />Statin</div> atherosclerosis

What pathologies can cause respiratory acidosis?

Asthma<div>COPD</div><div>Scholiosis</div><div>Severe obesity reducing lung expansion</div><div>Anything that decreases gaseous exchange</div><div><br /></div> Respiratory-Acidosis/Alkalosis

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Atrial Fibrillation Angina ECG

"What is this?<div><img src=""paste-28767690948766.jpg"" /></div>"

Atrial Flutter Angina ECG

What do the P waves present on an ECG?

Atrial depolarisation Angina ECG

What does Atrial englargement increase the risk for?

Atrial fibrillation Anatomy Anatomy-of-the-heart

What pathology does mycoplasma pneumoniae cause?

Atypical community acquired pneumonia Respiratory-Infections

What pathology dose legionella pneumophilia cause?

Atypical pneumonia Respiratory-Infections

What does Coxiella burnetii cause? How is it transmitted?

Atypical pneumonia with Q fever<div>Burn=fever</div><div>Through animals via milk</div> Respiratory-Infections

What does pneumocystis cause? Who are at risk and how does it present?

Atypical pneumonia<div>Seen in severly immunocompromised</div><div>Presents with a non-productive cough</div> Respiratory-Infections

What is the genetic inhertance of Hereditary Spherocytosis

Autosomal Dominant Anaemia Blood

What is the definition of breathlessness?

Awareness of breathing, with a sensation of air hunger, with difficulty breathing in or out Breathlessness

What is the process that removes self reactive B/T cells? Where does this happen?

B cells die in the bone marrow and T cells in the thymus via clonal delection Anaphylactic-Shock

What is the difference between acute and chronic respiratory acidosis?

Both have an elevated&nbsp;p_aCO₂of &gt; 45 mmHg<div>Acute respiratory acidosis has a pH of &lt; 7.35</div><div>Chronic respiratory acidosis has a metabolic compensation so pH is normal, but bicarbonate will be large &gt; 30 mmHg&nbsp;</div> Respiratory-Acidosis/Alkalosis

How is renin/angiontensin II levels affected in hypertension?

Both increased Hypertension

What is BNP?

Brain natruiretic peptide Failure Heart

What colour does the cytoplasma stain in a proerythroblast?

Bright Blue Blood Erythropoiesis

What would be seen on an ECG in mitral stenosis?

Broad P waves Disease Heart Valvular

What is the fate of the globin chain of the haemoglobin once the Hb is broken down?

Broken down into amino acids, where it makes it way back to the bone marrow for more erythropoiesis Blood Erythropoiesis

What are the 3 mains signs of asthma?

Bronchoconstriction<br />Secretion of mucus<div>Airway inflammation</div> Lung-Disorders

What symptoms would indicate a high chance of a bleeding disorder?

Bruising<br />Epitaxis<br />Dental bleeding<br />Henorrhagia Blood Haemostasis Pathophysiology

What is the pathophysiology behind respiratory acidosis?

Build up of CO2<div>Alveolar hypoventilation causes an increase in paCO2</div><div><br /></div> Respiratory-Acidosis/Alkalosis

"What is this?<div><img src=""paste-28999619182760.jpg"" /></div>"

Bundle Branch Block Angina ECG

Where is the intrinsic factor produced?

By parietal cells of the gastric mucosa Anaemia Blood

What complements activate mast cells and basophils?

C3a &amp; C5a Anaphylactic-Shock

What is the normal value for partial pressure of O2 and CO2 in the alveolar?

CO2: 36<div>O2: 105</div> Respiratory-Acidosis/Alkalosis

What is the usual values for venous blood gases?

CO2: 50<div>O2: 30-40</div> Respiratory-Acidosis/Alkalosis

How and why does respiratory acidosis affect the brain?

CO₂&nbsp;can diffuse across the BBB, and as CSF has little protein in to buffer the blood, a small increase in CO2 will make a large change in the pH<div><br /></div> Respiratory-Acidosis/Alkalosis

What disorders is chronic respiratory acidosis seen in?

COPD<div>Obesity hypoventilation</div><div>ALS</div><div>Interstitial fibrosis</div><div>Thoracic deformaties</div><div><br /></div> Respiratory-Acidosis/Alkalosis

Gold standard for PE diagnosis?

CTPA (CT pulmonary angiogram( Venous-Thrombosis

What are the causes of aortic stenosis?

Calcific disease<br />Congenital bicuspid valve<div>Rheumatic disease</div> Disease Heart Valvular

What are the causes of aortic valve leaflet disease? (4)

Calcific disease<div>Congenital bicuspid value</div><div>Rheumatic disease</div><div>Infective Endocarditis</div> Disease Heart Valvular

What does verapamil do? Class?

Calcium channel blocker, decreases HR and causes vasodilation Disease Heart Valvular

What is the Mantoux skin test?

Can diagonsis TB Respiratory-Infections

How can perfusion imaging diagonsis angina?

Can see areas of ischemia, areas of inadequate perfusion will have low wall motion&nbsp; Angina

What does vitamin K do to coagulation factors?

Carboxylates them, which is required for the factors to bind calcium Blood Haemostasis Pathophysiology

What is concentric hypertrophy?

Cardiac myotrophy; new sacromeres increase fibrous tissue, with more collagen and synthesis of abnormal proteins Anatomy Anatomy-of-the-heart

What is the role of the the basal ganglia and interal caspule?

Carry out motor compands Stroke

What neurotransmittor group increases the contractibility of the heart?

Catecholamines Shock

What is acute pharyngitis caused by?

Caused by strep A Respiratory-Infections

What does BNP do?

Causes natriresis &amp; vasodilation<div>Inhibits ADH &amp; Aldosterone</div><div><br /></div><div>Reduces systemic resistance and preload</div> Failure Heart

What is a common myeloid progenitor?

Cell committed to the production of blood cells (progenitor: biological cell committed to differentiate into a certain type of cell) Blood Erythropoiesis

How do macrophages identify old RBCs?

Cell surface antigens are different in old RBCs vs. young ones Blood Erythropoiesis

What could alos be a differential diagonsis for the symptoms for DVT?

Cellulitis, Ruptured Baker's cyst Venous-Thrombosis

What can a rise in intracranial pressure indicate?

Cerebral hypoxia Stroke

Name a NMDA antagonist

Cerestat Stroke

What is the second most common pathogen to cause atypical pneumonia?

Chlamydophila pneuomia Respiratory-Infections

What pneumonia pathologen is linked with coronary artery disease?

Chlamydophilia (heart broken when you get chlamydia) Respiratory-Infections

What mechanism is more associated with late onset asthma?

Cholinergic bronchoconstriction (cholinergic receptors are more involved) asthma

What chromosome codes for the alpha subunit of haemoglobin?

Chromosome 16 Haemoglobinpathies

Pathological consequences of free iron in the body?

Cirrhosis<div>Diabetes</div><div>Glandular dysfunction</div> Haemoglobinpathies

What is secondary hypertension? What proportion of hypertensive cases is this?

Clear underlying causes- 5% Hypertension

What can cause RBC to stick together and what are these clumps called?

Clumps called rouleaux, can be cuased by inflammatory reactions/bacterial&nbsp; Blood Erythropoiesis

What is the role of protein S in anti-coagulation?

Co-factor for activated protein C Blood Haemostasis Pathophysiology

What is the difference between compensated and decompensated shock?

Compensated: Inital stage body tries to compensate, eg. increase HR if pressure is low<div>Decompensated: End organs not perfused and start to fail</div> Shock

How does compliance change with elastic recoil?

Compliance increases with a decrease in elastic recoil&nbsp; asthma

What are the causes of rheumatic heart disease?

Complication of rheumatic fever:&nbsp;acute rheumatic fever caused by infection with Group A streptococcus Disease Heart Valvular

What is the consequence of raised intracranial pressure on the vessels?

Compresses cerebral veins, leading to loss of blood flow worsening the hypoxia Stroke

What sort of ventricular hypertrophy does hypertension increase the risk for?

Concentric hypertrophy Hypertension

Symptoms of angina

Constricting tightness<div>Radiates to arms, neck, jaw from central chest</div><div>Duration: few minutes not the whole day</div><div>Associated breathlessness</div><div>Provoked by exercise</div> Angina

What does the QRS complex represnt?

Contraction of the ventricles Angina ECG

What is the role of&nbsp;Biliverdin reductase?

Converts biliberdin to bilirubin&nbsp; Blood Erythropoiesis

What procedure involves a segment of a leg vein being used to provide an alternate pathway for blood flow past a point of obstruction between the aorta and a coronary artery?

Coronary Bypass atherosclerosis

What procedure involves using a contrast dye that is visible in x-rays to visalise the heart?

Coronary angiography atherosclerosis

What are the causes of heart failure? Main risk factor?

Coronary heart disease&nbsp;<div>Hypertension&nbsp;</div><div>Cardiomyopathy</div><div>Valvular heart disease</div> Failure Heart

What would a downward sloping or depressed ST segement indicate?

Coronary ischemia or hypokalemia Angina ECG

What are the symptoms of asthma?

Cough which is worse at night, awakened by cough, cough from physical activity Lung-Disorders

What is chronic bronchitis?

Cough without discernable cause for more than half the time over two years Lung-Disorders

Clinical Features of TB

Coughing up blood (haemoptysis)<div>Cough</div><div>Chest pain</div><div>Fever</div><div>Malaise</div><div>Weight loss</div><div>Night sweats</div><div><br /></div> Respiratory-Infections

What is haemoptysis?

Coughing up blood Blood Haemostasis Pathophysiology

What will you be able to see in an echocardiogram of a CXR?

Could see hypertrophy of cardiac muscles or ventricular dilation Failure Heart

How does IgE activate mast cells and basophils?

Cross links their surfaces Anaphylactic-Shock marked

What has a clinical feature of a seals bark stridor?

Croup<div><br /></div> Respiratory-Infections

What is iNOS controlled by?

Cytokines Vascular-Motor-Control

Tools for DVT Diagonsis

D-dimer test look at fibrin breakdown&nbsp;<div>Wells score: &gt;2 likely, &lt;1 unlikely</div><div><br /></div> Venous-Thrombosis

What would be visible on a mitral stenosis echocardiogram?

Dilated left atrium<div>Thick calcified mitral value</div><div>May should right ventricular failure</div> Disease Heart Valvular

What pathogen has toxins that reduces protein synthesis and affects the URT?

Diptheria Respiratory-Infections

What test is used to diagonsis haemolytic anaemia?

Direct Coombs test looks to see if there is an antibody on the red cell Anaemia Blood

Mechanims of strepokinase

Directly lyses the clot Myocardial-Infarct

Pathologies that increase the destruction of RBCs?

Disorders of RBCs membrane etc, like sickle cell. Immune destruction can also occur<div><br /></div> Anaemia Blood

<div>Which of these areas does NOT contain red marrow in the adult?</div><div>&nbsp; &nbsp; &nbsp; &nbsp; A) &nbsp; &nbsp;sternum</div><div>&nbsp; &nbsp; &nbsp; &nbsp; B) &nbsp; &nbsp;ribs</div><div>&nbsp; &nbsp; &nbsp; &nbsp; C) &nbsp; &nbsp;pelvis</div><div>&nbsp; &nbsp; &nbsp; &nbsp; D) &nbsp; &nbsp;distal femur</div><div>&nbsp; &nbsp; &nbsp; &nbsp; E) &nbsp; &nbsp;vertebrae</div>

Distal femur Blood Erythropoiesis

What kind of shock would an anaphylaxis cause?

Distributive shock Shock

What kind of shock would sepsis cause?

Distruptive shock Shock

What effect does hypotension have on the CNS?&nbsp;

Dizziness, impaired cognition, lethary, visual distrubances Hypertension

Symptoms of respiratory alkalosis?

Dizziness<br />Light headedness<div>Agitation</div><div>Confusion</div><div>Cramps</div><div>Tingling</div><div>Blurred vision</div> Respiratory-Acidosis/Alkalosis

Why is arterial O2 lower than alveolar O2?

Due to shunting- as not all of the perfused areas of the lungs are ventilated Breathlessness

When is a cerebral embolism most likely to occur?

During activity Stroke

Symptoms of aortic stenosis

Dyspnoea, increase in diastolic pressure as the LV is non-compliant<br />Angina: hypertrophied LV increases the oxygen demand<div>Syncope: fainting due to ventricluar arrhythmias&nbsp;</div><div>Left ventricular failure: contractile failures as the ventricule dilates</div> Disease Heart Valvular

Symptoms of left sided heart failure

Dyspnoea- back up of fluid in the lungs<div>Reduced exercise tolerance</div><div>Fatigue</div><div>Orthopnea</div><div>Nocturia</div><div>Weight loss</div> Failure Heart

Symptoms of rheumatic fever

Dyspnoea/orthopnoea<div>Palpitations due to atrial fibrillation</div><div>Systemic emboli due to static blood in left atrium</div> Disease Heart Valvular

What proinflammatory molecule do endothelial cells produce?

E-selectin atherosclerosis

What would happen in the brain if glial cells did not remove potassium in the ECS

ECS potassium would rise, leading to depolarisation and hyperexitabilty of neurones--&gt; increasing neurotransmitter release and decreasing uptake Stroke

What is a polyerythroblast?

Earliest precusor in the development of a normoblast with a large nucleus Blood Erythropoiesis

What is an embolism stroke?

Embolism: forgein substance that occludes a blood vessel, could be a mass of bacteria or a clot that has broken free from a thromobus.<div>Usually develops in the left ventricle<br /><div><br /></div></div> Stroke

Where is haemoglobin initially produced in the foetus?

Embryotic yolk: Hb Gower-1 Haemoglobinpathies

What cells produce NO?

Endothelial cells Vascular-Motor-Control

What is the first stage in plaque formation and how does this happen?

Endothelial damage<div>This can be via turbenlant flow and sheer force, or via infections such as chlaymdia, toxins such as cigarette smoke, or high levels of glucose and lipids</div> atherosclerosis

What is an EVAR? (To do with the aorta)

Endovascular aorta repair atherosclerosis

How does acid pH affect iron absorption?

Enhances absorption Anaemia Blood

How does hypoxia affect iron absorption?

Enhances absorption Anaemia Blood

How does iron defieincy affect iron absoprtion?

Enhances absorption Anaemia Blood

What is emphysema?

Enlargement of air spaces distal to the terminal bronchioles , with destruction of lung stoma (connective tissue) resulting in bullae (fluid filled sac) Lung-Disorders

Where would the pain of an infarct on the inferior wall of the heart be felt?

Epigastric pain; T5-TP with potential nausea Anatomy Anatomy-of-the-heart

What causes infectious mononucleosis? (Glandular fever)

Epstein bar virus Respiratory-Infections

What is S_vO₂? Value?

Equals P₇₅&nbsp;= pressure at which 75% of the haemoglobin is saturated = 5.3 kPa Breathlessness

What is the treatment of whooping cough?

Erythromycin in catarrhal stage Respiratory-Infections

Where are RBC formed in the 6th week of foetal development

Erythropoiesis mainly in liver &amp; spleen Blood Erythropoiesis

What substance controls erythropoiesis?

Erythropoietin Blood Erythropoiesis

What two drugs can be used on top of the first line drugs for TB?

Ethambutol or Streptomycin Respiratory-Infections

How can renal issues lead to haemostasis issues?

Excess in urea &amp; toxic metabolites can impair platelet functions Blood Haemostasis Pathophysiology

What occurs with over stimulation of NMDA receptors in the brain lead to?

Excess influx of calcium into the nerve cell causing FAST excitotoxicty Stroke

What does overstimulation AMPA receptor in the brain lead to?

Excess influx of calcium into the nerve cell causing&nbsp;a slow delayed excitotoxicity Stroke

What is excitotoxicitiy?

Excess release of neurotransmitter Stroke

What is the effect of high renin and angiontensin II

Excess sodium and water retention Hypertension

How does bilirubin get from the liver to the small intestines?

Excreted as bile into the small intestines Blood Erythropoiesis

What is XDR-TB?

Extensitivly drug resistant TB- A type of MDRTB that is also resistant to fluoroquinolone and any one of the three injectable second line drugs (amikacin, kanamycin or capreomycin) Respiratory-Infections

The parameter to detect reversibility in airflow obstruction on a spirometry test is...?

FEV1 asthma marked

How is asthma diagonised?

FEV1/FVC ratio will be reduced in attack<div>Use spirometery/peak flow</div> Lung-Disorders

What factor is fibrinogen?

Factor I Blood Haemostasis Pathophysiology

What is the most common genetic cause of VTE?

Factor V Leiden Venous-Thrombosis

What is cardiogenic shock?

Failure of the heart to pump efficiently and supply blood to the body<div><br /></div> Shock

Definition of Shock?

Failure to maintain an adequate cardiac output Anaphylactic-Shock

How does the body prepare the iron to get it in the ferrous state to be absorbed?

Ferric reductase in the enterocytes brush border reduce the ferric to ferrous Anaemia Blood

What molecule stores iron in the body?

Ferritin Anaemia Blood

Prognosis if four alpha genes are defective in the Hb?

Fetus cannot live outside of the uterus, most born with hydrops fetalis. Only present Hb is Hb Barts Haemoglobinpathies

What does a D-Dimer test tell you about?

Fibrin degration Blood Haemostasis Pathophysiology

Where is erythropoietin produced?

Fibroblasts in the kidneys<br />Type 1 cells of carotid body Blood Erythropoiesis

Around the collar of lymphocytes in a granuloma, what surrounds those?

Fibroblasts<div><br /></div> Respiratory-Infections

"What is this?<br /><img src=""paste-28256589840522.jpg"" />"

First degree heart block Angina ECG

What is the affinity like in Hb vs. HbH

HbH: Four beta subunits: higher affinity for oxygen than Hb so poor release of oxygen&nbsp; Haemoglobinpathies

What are the symptoms of respiratory acidosis?

Headache, drowsiness, lethargy, anxiety, sleepiness, fatigue Respiratory-Acidosis/Alkalosis

How does a Ghon focus heal in healthy individuals?

Heals with the deposition of collagen from fibroblasts, sealing off focus and preventing bacteria escaping Respiratory-Infections

What may a prolonged/variable PR interval indicate?

Heart Block Angina ECG

What would a level of 100 pg/ml of BNP indicate?

Heart Failure Failure Heart

What happens in systolic heart failure?

Heart cannot pump with enought force Failure Heart

What is diastolic heart failure?

Heart doesn't fill with enough blood to pump out enough- ventricles cannot relax enough to fill Failure Heart

"What is the name of this equation?<div><img src=""paste-11755325489225.jpg"" /></div>"

Henderson Hasselbach Respiratory-Acidosis/Alkalosis

How to treat PCP pneumonia?

High dose co-trimoxazole Respiratory-Infections

How is histamine involved in inflammation with respect to veins/arteries?

Histamine causes an increase in permeability in post-capillary venules&nbsp;<div>Causes vasodilation of arteries causing itching</div> Anaphylactic-Shock

What inflammatory mediators do mast cells release in asthma?

Histamine, PGD3, LTC4, Kinins asthma

What can enterobacter cause?

Hospital aquired pneumonia Respiratory-Infections

What can klebsiella cause?

Hospital aquired pneumonia Respiratory-Infections

What does psudomonas aeruginosa cause?

Hospital aquired pneumonia Respiratory-Infections

What is the main risk factor for an intercerebral haemorrhage?

Hypertension Stroke

What can cause left ventricular hypertrophy

Hypertension<div>Aortic stenosis</div><div>Aortic regurgitation</div><div>Hypertrophic cardiomyopathy</div> Angina

What are the signs of chronic bronchitis?

Hypertrophy of bronchial glands<br />Hypersecretion<br />Mucous plugs<br /><br /> Lung-Disorders

Three main fatures of asthma

Hypertrophy of the airway wall muscle<div>Increased mucous production</div><div>Inflammatory cell infiltration</div> asthma

Name as many causes of shock as possible

Hypobolaemic: Haemorrhage<br />Obstructive: Pulmonary embolus/tamponade<div>Cardiogenic: Myocardial infarction/valvular diease</div><div>Distributive: Anaphylactic; lead of fluid into the tissues<br /><br /></div> Anaphylactic-Shock

What is the result of untreated beta thalassemia major?

Hypochromic, microcytic anaemia<div>Bone marrow expansion and splenomegalgy (extramedullary erythropoietc)</div><div>Bone deformatities</div><div>Failure to thrive&nbsp;</div><div>Dead by 3-4 years</div> Haemoglobinpathies

In what conditions is oxygen administered?

Hypotension<div>Metabolic Acidosis</div> Breathlessness

What kind of shock would a burn cause?

Hypovolaemic shock Shock

What is type 2 respiratory failure?

Hypoxamia pO₂&nbsp;&lt; 8 kPa<div>Hypercapnia PCO₂&nbsp;&gt; 7 kPa</div> Breathlessness

What is Type 1 respiratory failure?

Hypoxamia- low O2 in the blood<div>PaO2 &lt; 8 kPa</div> Breathlessness

How does the muscle overcome initial hypoxia at the start of exercise to produce NO?

Hypoxia --&gt; lactate production --&gt; lower pH --&gt; causes release of nitrite from a store --&gt; nitrite converted to nitrous acid --&gt; combines with reducing agent to form NO Vascular-Motor-Control

How is the reuptake of neurotransmitter affect by hypoxia in the brain?

Hypoxyia means low ATP- so neurotransmitters not taken up into the cleft&nbsp; Stroke

What factors does PT measure?

I, II, V, VII, X Blood Haemostasis Pathophysiology

What factors does APTT measure?

I, II, V, VIII, IX, X, XII Blood Haemostasis Pathophysiology

What factor is prothrombin?

II Blood Haemostasis Pathophysiology

What factors are vitamin K dependant?

II, VII, IX, X Blood Haemostasis Pathophysiology

What coagulation factors rely on reduced Vitamin K?

II, VII, IX, X Venous-Thrombosis

How is atrial natriuretic peptide affected from a venous bleed?

If preload drop, there will be a reduction in the release of atrial natriuretic peptide (which is normally released when the ventricles are stretched) Shock

What antibody do mast cells usually bind?

IgE Anaphylactic-Shock

What antibody is secreted in asthma?

IgE asthma

What antibody so allergens bind in asthma, and in what cell is this antibody found?

IgE on mast cells Lung-Disorders

What type of antibodies attatch to RBCs in autoimmune haemolytic anaemia?

IgG Anaemia Blood

What antibodies do neutrophils/monocytes usually bind?

IgG Anaphylactic-Shock

What is the antibody secreted after IgM in an immune response<div><br /></div>

IgG Anaphylactic-Shock

Pathophys. of haemolytic anaemia?

IgG antibodies attatch to RBC, and these effected cells are removed by the spleen Anaemia Blood

What is the first antibody secreted in an immune response?

IgM (think mother of all of them) Anaphylactic-Shock

What is an erythroblast?

Immature erythrocytes containing a nucleus Blood Erythropoiesis

How does alkaline pH affect iron absorption?

Impaires it Anaemia Blood

How do proton pump inhibitors affect iron absorption?

Impairs it Anaemia Blood

How does an iron overload affect absorption?

Impairs it&nbsp; Anaemia Blood

When is an aortic regurgiation heard?

In diastole when the turbulent blood leaks back into the relaxing ventricles Anatomy Anatomy-of-the-heart

Where is airway resistance larger, in small or large airways?

In large airways&nbsp; asthma

Where is IgA secreted? What is its role

In tears and digestive juices, blocks pathogen binding Anaphylactic-Shock

Where are RBC formed in the last month of foetal development

In the bone marrow Blood Erythropoiesis

Where are baroreceptors found?

In the carotid sinus Hypertension

Where is bNOS found?

In the central and peripheral neuronal cells Vascular-Motor-Control

Where is the majority of the iron from digested food absorbed?

In the duodenu by enterocytes&nbsp; Anaemia Blood

Where are beta-1 receptors found?

In the heart&nbsp;<div><br /></div> Shock

How and where is B12 absorbed?

In the ileum bound to the intrinsic factor &nbsp; Anaemia Blood

Where is foetal haemoglobin produced after 6 weeks?

In the liver &amp; spleen Haemoglobinpathies

Where is the cardiac inhibitory center and where excatly are its cell bodies?

In the medulla, with cell bodies in the reticular formation Anatomy Anatomy-of-the-heart

When is peak flow the lowest in the day?

In the morning asthma

Where do the macrophages break down the old haemoglobin?

In the spleen Blood Erythropoiesis

Where are RBC broken down?

In the spleen Haemoglobinpathies

Where do sympathetic preganglionic fibres synpase?

In the sympathetic trunk&nbsp; Anatomy Anatomy-of-the-heart

Where are RBC formed in the 3rd week of foetal development?

In the yolk sac &amp; mesothelial layers of the placenta Blood Erythropoiesis

What is homozygous beta thalassemia major?

Inability to construct beta-globins leads to underproduction of HbA (adult haemoglobin): Results in microcytic anaemia&nbsp;<br />Excess production of alpha haemoglobin<br /><div><br /></div> Haemoglobinpathies

What is thalassemia?

Inadequate quantities of one or more subunits Haemoglobinpathies

What happens to the WBC &amp; platlets in B12/Folate defieicnes?

Increase Anaemia Blood

What can cause concentric hypertrophy?

Increase in afterload due to hypertension or aortic stenosis&nbsp; Anatomy Anatomy-of-the-heart

Signs of an aortic regurgitation?

Increase in carotid pulse due to vigorous ejection of volume loaded LV<div>Early diastolic murmur due to aortic backflow</div><div>Ejection murmur due to turbulent ejection from volume loaded LV</div> Disease Heart Valvular

How is lactate dehydrogenase affected in B12 &amp; Folate defiencies?

Increase in lactate dehydrogenase Anaemia Blood

What is myocardial hypertrophy?

Increase in myocyte size &amp; collagen synthesis Anatomy Anatomy-of-the-heart

How will an increased RBC breakdown be shown in the urine?

Increase in urinary urobilinogen Anaemia Blood

How does exercise affect asthma?

Increase in ventialtion leads to increased cooling and bronchospasm asthma

What effect will a beta-1 agonist have on heart rate?

Increase it Shock

What do leukotrienes do to post-capillary venules?

Increase permeability resutling in chemotaxis: activating neutrophils Anaphylactic-Shock

How do rouleaux affect the erythrocyte sedimentation rate?

Increase the rate due to a higher density Blood Erythropoiesis

How is bilirubin affected in B12 &amp; folate defiencies

Increased as a sign of haemolysis<div><br /></div> Anaemia Blood

How is the diastolic pressure affected in aortic stenosis?

Increased diastolic pressure in the stiff non compliant left ventricle&nbsp; Disease Heart Valvular

How would bilirubin be affected in haemolytic anaemia?

Increased, due to RBCs being broken down<div><br /></div> Anaemia Blood

How does heparin affect antithrombin?

Increases anti-thrombin activity 5-10,000 fold Blood Haemostasis Pathophysiology

How does an aortic regurgiation affect preload?

Increases preload Anatomy Anatomy-of-the-heart

What is the most effective way to increase cardiac output in exercise?

Increasing the heart rate Shock

What is a pathological Q wave? Values on an ECG?

Indicates a zone of myocardial irreversible damage<div>40 ms wide, 2mm deep or more than 25% depth of the QRS complex</div> Myocardial-Infarct

What is elevated C-reactive protein indicative of?

Indicative of atheroslerosis and heart disease (and general infection) Angina

Two main causes of a stroke

Infarction (Artery blockage)<div>Haemorrhage (Artery rupture)</div> Stroke

How is Sickle Cell Disease managed?

Infection prophylaxis, analegesics, transfusions, bone marrow transplant Haemoglobinpathies

What part of the heart does the II, III, aVF leads look at?

Inferior/diaphragmatic surface- supplied by the RCA or LCr Anatomy Anatomy-of-the-heart

What does modified LDL produce endothelium to produce?

Inflammatory mediators<div>Monocyte adhesion molecules</div> atherosclerosis

What is the consequence of excitotoxicity in the brain?

Influx of calcium ions causes an increase in metabolic demand reducing the oxygen in the brain, leading to free radical formation and apoptosis Stroke

Main route of transmission for TB?

Inhalation of water droplets Respiratory-Infections

Three main long term pharmacological treatments of asthma<div>Leukotriene modifers</div><div><br /></div>

Inhaled corticosteriods<br />Long acting beta2-agonists Lung-Disorders

What is atopy?

Inherited predisposition to make IgE to common enviromental antigens<div><br /></div> Anaphylactic-Shock

Mechanism of action of heparin?

Inhibits Factor Xa and thrombin Venous-Thrombosis

How does prostacylcin affect platlets

Inhibits platelet activation&nbsp;<div><br /></div> Shock

What is the mode of action of warfarin?

Inhibits vitamin K epoxide reductase, so results in lack of reduced vitamin K<div><br /></div> Venous-Thrombosis

What is secondary haemostasis?

Insoluble fibrin formation Blood Haemostasis Pathophysiology

Which is larger, the inspiratory reserve or the expiratory reserve?

Inspiratory reserve Lung-Disorders

What do leads V3, V4 look at?

Interventricular groove which is supplied by the LAD Anatomy Anatomy-of-the-heart

Treatment of Pernicious Anaemia

Intramuscular B12, every 3 months&nbsp; Anaemia Blood

How is the Fenton reaction prevented?

Iron chelating compounds<div><br /></div> Haemoglobinpathies

What conditions would cause a decrease in production of RBC?

Iron defieciency, b12 or folate defiency, HIV, marrow infiltratoin Anaemia Blood

Why is iron found in plants more difficult to absorb than in meats?&nbsp;

Iron in plants has powerful chelators that prevent absorption Anaemia Blood

What are the first line treatments for TB? How long are they given?

Isoniazid, rifampicin, pyrazinamide: First Line<div><br /></div><div>Isoniazid and rifampin- 4 months or more</div><div>Pyrazineamine- 2 months<br /><div><br /></div><div><br /></div></div> Respiratory-Infections

How many a blockage of the lenticulo-striate arteries clinically present?

Issue with motor functions Stroke

How does afterload affect preload?

It doesn't change it, just affects the blood pressure Shock

What can the plasma ferritin be used to measure?

It is an indirect measure of the total amount of iron stored in the body- can be used to diagonsis iron defieincy<div><br /></div> Anaemia Blood

How does stroke volume change in exercise and why?

It remains the same<div>At the beginning of exercise, the heart rate increases before the venous return increases, maintain the same stroke volume&nbsp;</div> Shock

What is&nbsp;Spironolacetone

K Sparing diuretic: Keeps the body from retaining too much salt, used in heart failure Failure Heart

What restrictive disorders cause external mechanical limitation of chest volume?

Kyphoscoliosis<div><br /></div> Lung-Disorders

What is the second stage in atherosclerosis formation and how does this happen?

LDL modificatio&nbsp;via glycation or oxidisation<div><br /></div> atherosclerosis

Treatment steps for DVT?

LMW heparin/Fondaparinus/Unfractioned heparin<div>Warafin</div> Venous-Thrombosis

Does pneumonia affect the LRT or the URT?

LRT Respiratory-Infections

What is Bernard Soulier Syndrome?

Lack of GpIb Blood Haemostasis Pathophysiology

What are macrophages that fuse in the granuloma known as?

Langhan cells Respiratory-Infections

Why do sodium pumps have to work so hard in nerve cells?

Large surface area<div>Sodium floods in during an action potential</div><div>Most of the ATP is in brain is used by sodium pumps</div> Stroke

What size arteries are typically affected by atherosclerosis?

Large to medium arteries (not arterioles) atherosclerosis

What do leads V5, V6 look at?

Lateral view of the heart, supplied by LCr or the diagonal branch of the LAD Anatomy Anatomy-of-the-heart

What are the main divisions of the left coronary artery?

Left anterior descending: LAD- supples the apex anteriorly<br /><div>Left Circumflex- supplies posterior&nbsp;</div> Anatomy Anatomy-of-the-heart

<div>How would a mitral regurigiation be shown on a angiogram/CXR</div>

Left atria and left ventricle enlarged Disease Heart Valvular

Where does the left circumflex supply?

Left atrium and left ventricle posteriorly Anatomy Anatomy-of-the-heart

Which sided heart failure is likely to happen first?

Left sidedheart failure Failure Heart

Where does the left marginal artery supply?

Left ventricle Anatomy Anatomy-of-the-heart

What can cause an increase in myocardium oxygen demand

Left ventricular hypertrophy<div>Right ventricular hypertrophy</div><div>Rapid tachyarrhythmias</div> Angina

What pathogen is usually acquired at holiday resorts/cooling towers/air con?

Legionella pneumophilia&nbsp; Respiratory-Infections

What branch of the middle cerebral artery is prone to an embolus and why?

Lenticulo-striate arteries leave the MCA at 90 degrees so are prone to blockage embolism &nbsp; Stroke

How does a high conc. of leptin affect BP?

Leptin (which is high in the obese), increases sympathetic constriction increasing BP Hypertension

What is the normal time scale for a QRS complex?

Less than 120 ms Angina ECG

What are the oxygen levels in the proximal tubules determined by?

Level of Hb in the arterial blood, as not changed by exercise or BP Blood Erythropoiesis

What would be the treatment if there was isolated systolic hypertension? SBP &gt;140 but DBP &lt;90 mmHg

Lifestyle changes first before drugs implicated Hypertension

What is the basic structure of a platlet?

Lipid bilayer with a microtubular system and granules Blood Haemostasis Pathophysiology

Why is TB hard to treat?

Lipid rich cell wall&nbsp;<div>Grows very slowly</div><div>Lives inside macrophages</div><div>Naturally resistance to a number of antibiotics</div> Respiratory-Infections

What do chest x-rays show in community acquired pneumonia?

Lobar Consolidation&nbsp; Respiratory-Infections

What is class 1 hypovolemic shock?

Loss of &gt;15% blood- fully compensated Shock

What is massive transfunction syndrome?

Loss of &gt;5L in 24 hours or more than 50% in 3 hours&nbsp; Blood Haemostasis Pathophysiology

What happens to the ventricules in a bundle branch block?

Loss of synchrony Anatomy Anatomy-of-the-heart

What is distributive shock?

Loss of vasoconstriction in one or more end organs, producing excess blood flow in this system and more perfusion of other Shock

How would septic (distributive) shock present?

Low BP tachycardia plus a fever Shock

What are the classic signs of hypovolemic?

Low BP, High heart rate, greyish pallor, slow capillary refill Shock

What would the result of a full blood count in iron deficiency anaemia show?

Low RBC number Anaemia Blood

What is the most commonly used heparin for VTE patients? Why

Low molecular weight heparin as more predictable outcomes&nbsp; Venous-Thrombosis

In a granuloma, what surrounds the collar of macrophages?

Lymphocytes Respiratory-Infections

What is Multi-drug resistant TB?

MDR-TB is TB that is resistant to both rifampicin and isoniazid Respiratory-Infections

What is an acute myocaridal infarction?

MI caused by a plaque ruputre, leading to an occulsion of an artery. This leads to ischemia and necrosis of the cardiomyocytes Myocardial-Infarct

What is a nebulizer and when is use indicated?

Machine that produces inhaled mist for small children in severe asthma episodes Lung-Disorders

What type of anaemia does B12 or folate cause?

Macrocytic anaemia Anaemia Blood

<div>Old, damaged, or defective erythrocytes are removed from the blood by ?</div>

Macrophages Blood Erythropoiesis

What cell removes senescent RBC from the blood?

Macrophages Blood Erythropoiesis

What is angina?

Manifestation of ischemia<div>Imbalance in the myocardial oxygen supply and demand</div> Angina

What cell do IgE antibodies activate?

Mast Cells Anaphylactic-Shock

What is the mediate response to allergens binding to IgE in asthma?

Mast cells release inflammatory markers like histamine<div>Results in mucus secretion, bronchoconstriction, oedema</div> Lung-Disorders

Where is the vasomotor centre?

Medulla Shock

What are the four possible cell types a common myeloid progenitor can differentiate into?

Megokarocyte, Erythrocyte, Mast Cell or Myeloblast Blood Erythropoiesis

Where are RBC formed in adults &gt;25 years?

Membranous bones: Vertebrae, sternum, rubs, cranial bones, ilium Blood Erythropoiesis

Clinical features of vWD?

Menorrhagia<br />Bruising, epitaxis, post surgical bleeds<br />Mucosal platlet type bleeding Blood Haemostasis Pathophysiology

What type of anaemia does thalassaemia cause?

Microcytic anaemia Anaemia Blood

What sort of anemia does kidney damage lead to and why?

Microcytic anemia due to reduced EPO production Blood Erythropoiesis

What would a blood film look like in iron defiency anaemia?

Microcytic, hypochromic RBCs Anaemia Blood

When would an aortic stenosis murmur be heard?

Mid-systolic: More severe the stenosis the later it is heard as must generate pressure to move past value Anatomy Anatomy-of-the-heart

What complications can Antiphospholipid syndrome cause?

Migrane, stroke, tia, PE, coronary artery disease, DVT, Raynauds, preganncy issues, renal vein thrombosis, renal infarctoin Venous-Thrombosis

"What does this show? What could it be due to?<div><img src=""Screen Shot 2016-11-16 at 15.56.28.png"" /></div>"

Mismatch VQ due to pulmonary embolism Venous-Thrombosis

What is the pathophysiology behind breathlessness?

Mismatch in afferent and efferent signals, with the central information processing all contributing to breathlessness Breathlessness

"What could this murmur be?<br /><img src=""Screen Shot 2016-11-01 at 10.38.47.png"" />"

Mitral reguritation as it is constant throughout systole Anatomy Anatomy-of-the-heart

Causes of mitral value leaflet disease

Mitral value prolapse<div>Rheumatic disease</div><div>Infective endocarditis</div> Disease Heart Valvular

When is the S1 heart sound heard?

Mitric &amp; Tricuspid value close in systole Anatomy Anatomy-of-the-heart

Diagnostic tools for PE

Modified wells score: &gt;4 likely<div>CXR</div><div>D-Dimer</div><div>ABG</div><div>VQ mismatch</div><div><br /></div><div><br /></div> Venous-Thrombosis

What is the drug omalizumad?

Monoclonal antibody against IgE&nbsp; Anaphylactic-Shock

How do foam cells form?

Monocytes transform to macrophages once they are bound to the damaged endothelium and cross the barrier, and accumulate lipids and become foam cells atherosclerosis

Test for Epstein-Barr virus?

Monospot test, looks for IgM antibodies against EBV Respiratory-Infections

Treatment of class 3 haemorrahage shock

Most patients need plasma volume expanders or blood transfusion Shock

What state must the iron be in to be absorbed?

Must be Fe²⁺&nbsp;ferrous iron Anaemia Blood

What is Haemoglobin C?

Mutation in the beta subunit, resulting in reduced plasticity and flexibility of erythrocytes<br /><br /> Haemoglobinpathies

What is the pathophysiology of primary TB?

Mycobacteria settle in alveoli, exciting an acute inflammatory response, but the neutrophils die upon attempting to phagocytose bacterial and the nearby lung cells also die (causeous tissue) Respiratory-Infections

What is the most common atypical pathogen to cause CAP?

Mycoplasma pneumonia Respiratory-Infections

What pneumophilia pathogen commonly causes epidemics?

Mycoplasma pneumoniae Respiratory-Infections

What are the smooth muscle cells that have migrated to the intima in atherosclerosis formation called?

Myointimal cells&nbsp; atherosclerosis

Name an AMPA antagonist

NBQX Stroke

What are the two main receptors glutamate acts in the brain?

NMDA and AMPA<div><br /></div> Stroke

What anti-inflammatory molecule do endothelial cells release?

NO atherosclerosis marked

How can NO help in O₂&nbsp;delivery to the tissues?

NO can displace O₂&nbsp;in RBC, increasing delivery of oxygen to hypoxic tissue Vascular-Motor-Control

What do common lymphoid progenitor cells differentiate into?

Natural killer cells or small lymphocytes (which can become B/T cells) Blood Erythropoiesis

Where do clots form in veins?

Near the values Venous-Thrombosis

Clinical symptoms of homozygotic haemoglobin C

Nearly all Hb is HbC resulting in mild anaemia Haemoglobinpathies

What is the cause of mitral stenosis?

Nearly always rheumatic fever Disease Heart Valvular

How does a STEMI damage the heart?

Necrosis occurs via hypoxia, and the loss of perfusion means toxic metabolites arent taken away and the cell membranes burst releaseing troponin Myocardial-Infarct

What are the main cells involed in the innate immune system?

Neutrophils, Monocytes, Eosinophils, Mast Cells, Basophils&nbsp; Anaphylactic-Shock

How is NO produced?

Nitric oxide synthase reacts L-arginine with 0.5O₂&nbsp;to produce citrulline and nitric oxide Vascular-Motor-Control

How to identify atrial fibrillation on an ECG?

No p-wave is seen<div>Rate usually 100-160 bpm<br />P-R interval not measureable</div> Angina ECG

What is primary hypertension?

No underlying; cause polygenic familial trends.&nbsp; Hypertension

How do you calculate the heart rate from an ECG?

No. of R waves in 15 large squares multipled by 20 Angina ECG

What is the usual severity of inhertited disorders that are diagonsised in adulthood?

Non severe Blood Haemostasis Pathophysiology

"What does this image show?<br /><img src=""paste-24133421236430.jpg"" />"

Normal RBC vc Microcytic Anaemia Blood Erythropoiesis

"What does this image show?<br /><img src=""paste-24099061498058.jpg"" />"

Normal RBC vs Macrocytic Anemia Blood Erythropoiesis

How can a congential disorder cause aortic stenosis?

Normally aortic valve has 3 cusps, but if you are born with a bicuspid value can lead to calcification earlier on Disease Heart Valvular

What is hypovolaemic shock?

Normally due to haemorrhage Shock

"What cell is this?<br /><img src=""paste-22849226014846.jpg"" />"

Normoblast Blood Erythropoiesis

What does hypoxia do to the sodium pumps in nerve cells?

Not enough oxygen to provide ATP for the pumps, there sodium leaks into the cells causing them to swell, raising the intracranial pressure<div><br /></div> Stroke

Where is iNOS found?

Nucleated cells, partically macrophages Vascular-Motor-Control

What is a late erythroblast/normoblast?

Nucleus very condense, with it about to be ejected<br />Haemoglobin accumulates in here now Blood Erythropoiesis

Causes of folic acid deficiency

Nutritional (old age, poverty), coeliac, crohns, psoriasis, pregnancy, anitconvulsants&nbsp; Anaemia Blood

Is asthma obstructive or restrictive?

Obstructive Lung-Disorders

What kind of shock would a cardiac tamponade cause?

Obstructive shock Shock

What kind of shock would a pneumothorax cause?

Obstructive shock Shock

Symptoms of aortic regurgitation<div><br /></div>

Often non, could be dysnoea and angina Disease Heart Valvular

How many genes are there that code for the heavy chain ascept of the antibody?

One gene Anaphylactic-Shock

"Which is healthy lung? What disorder is seen in the unhealthy? What stains blue?<div><img src=""paste-10827612553454.jpg"" /><img src=""paste-10840497455343.jpg"" /></div>"

One with blue has pulmonary fibrosis: blue is collagen Lung-Disorders

How to treat a haemophilia disorder due to Vitamin K issues?

Oral Vitamin K and FFP (fresh frozen plasma) Blood Haemostasis Pathophysiology

Out of where do the post ganglionic sympathetic fibres leave the sympathetic trunk?

Out of the white rami Anatomy Anatomy-of-the-heart

What would a blood film look like in B12/Folate defiencies?

Oval macrocytes and hypersegmented neutrophils Anaemia Blood

What stimulus are erythropoietin secreting cells sensitive to?

Oxygen- hypoxia will increase RBC production Blood Erythropoiesis

How would you identify ventricular tachycardia on an ECG

P wave not seen as heart is beating so fast<br />Rate: 180-190 bpm<br />QRS complex is prolonged Angina ECG

How to idenitfy an Atrial Flutter on an ECG?

P wave replaced with multiple F (flutter) waves- sawtooth pattern<br />P-R interval not distingishable Angina ECG

How would you identify first degree heart block on an ECG?<div><br /></div>

PR interval fixed, but prolonged to &gt;200 ms<br />Conduction to the ventricles delayed Angina ECG

How to identify Wenkenback TypeI Second Degree heart block on an ECG?

PR interval gets progressively longer, until the P wave is not followed by a QRS complex Angina ECG

Signs of Sickle Cell Disease

Pain<div>Organ Damage</div><div>Ischemia&nbsp;</div><div>Hb levels: 6-8 g/dL</div> Haemoglobinpathies

What effect does hypotension have on the muscle

Paracervial ache (upper back) Hypertension

How does the partial pressure of oxygen that you breath in compare to the alveolar partial O2 pressure

Partial pressure of oxygen is lower in the alveoli compared to the atmosphere due to water vapour Breathlessness

What is P₅₀? Value?

Partial pressure of oxygen that which haemoglobin is 50% saturated- usually 3.5 kPa Breathlessness

What is the clinical features of a CXR with infection of myoplasma pneumoniae?

Patchy bilateral bronchopneumonia Respiratory-Infections

What is an embolus?

Pathological clot that breaks off to obstruct a smaller vessel Venous-Thrombosis

What is thrombus?

Pathological formation of a blood clot Venous-Thrombosis

What is PEFR?

Peak expiratory flow rate asthma

What antibiotic is TB well known to be resistant to?

Penicillin Respiratory-Infections

What is cardiac tamponade?

Pericardium (sac surrounding the heart) fills up with fluid resulting in compression of the heart Failure Heart

Symptoms of right sided heart failure

Peripheral odema<div>Ascites</div><div>Nausea</div><div>Anorexia</div><div>Epistaxis</div><div>Pulsation in neck (fluid build up in the SVC)</div> Failure Heart

Pathology when a neonate doesn't have a reduction in pulmonary arterial resistance?

Persistent pulmonary hypertension of the newborn<div><br /></div> Vascular-Motor-Control

What is obstructive shock?

Physical obstruction to vessels entering/leaving the heart Shock

How is massive transfusion syndrome treated?

Platlets, coagulation concentrates,&nbsp;cryoprecipitate Blood Haemostasis Pathophysiology

What restrictive disorders cause difficulty in producing chest movements?

Pleural thickening<div>Neuromuscular weakness</div> Lung-Disorders

Signs for PE

Pleuritic chest pain<div>Haemoptysis</div><div>Dizziness</div><div>Pyrexia</div><div>Cyanosis</div><div>Tachypnoea/cardia</div> Venous-Thrombosis

What is atypical pneumonia?

Pneumonia not due to streptococcus pneumoniae<div>Doesn't respond to beta-lactam conventional therapy</div> Respiratory-Infections

Causes of Type 1 Respiratory Failure

Pneumonia, pulmonary failure, pulmonary embolism, pneumothorax, collapse, primary muscle disorders Breathlessness

What restrictive disorders cause loss of lung volume and increase recoil?

Pneumonia<div>Pneumothorax</div><div>Pulmonary fibrosis</div> Lung-Disorders

What is the most common mutation in beta thalassemia?

Point mutation on chromosome 11 Haemoglobinpathies

Are all cocci bacteria gram negative or positive?

Positive Respiratory-Infections

How would a NSTEMI present on an ECG?

Potentially slight T wave changes Myocardial-Infarct

What enviroment does legionella pneumophilia prefer, and how does this relate to its transmission?

Prefers warm water, well adapted to hot water storage so outbreaks are associated with cooling towers/spas/air con Respiratory-Infections

What two main factors control stroke volume?

Preload and myocardial contractility Shock

"What cell is this?<br /><img src=""paste-22673132355706.jpg"" />"

Proerythroblast Blood Erythropoiesis

How does pregnancy cause breathlessness?

Progesteone directly stimulates respiratory centre. Also an increase in CO2 Breathlessness

What is the role of HMG-CoA

Promotes intracellular cholesterol synthesis atherosclerosis

What is PG₁₂?<div><br /></div>

Prostacylin Shock

What is the pathophysiology behind early stage haemolysis

Proteins holding RBC in biconcave shape may break and cell may pop out into a sphere; a spherocyte Anaemia Blood

What is PT and what pathway does it measure?

Prothrombin time, it measures the extrinsic pathway Blood Haemostasis Pathophysiology

Complications of a mitral value stenosis

Pulmonary congestion<br />Atrial fib<br />Reduced CO<br />Embolism can collect in left ventricle Anatomy Anatomy-of-the-heart

Clinical example of what could lead to obstructive shock?

Pulmonary embolism Shock

What can cause right ventricular hypertrophy

Pulmonary hypertension<div>Pulmonary stenosis</div> Angina

Signs of mitral stenosis

Pulse shows atrial fibrillation<div>Ausculation: loud S1 due to the opening snap of the mitral value mid-diastole</div><div>Volume overload increases JVP, basal creps and ankle oedema</div><div><br /></div> Disease Heart Valvular

How would you identify third degree heart block on an ECG?

QRS complex and P waves are indepedant of each other<br />Due to ventricles creating their own escape beats<br />Mean there is bradycardia present Angina ECG

How to identify&nbsp;Type II Second Degree Heart Block on an ECG?

QRS complex usually wide<div>PR complex interval fixed, but a random QRS complex is dropped</div> Angina ECG

How to identify a bundle branch block on an ECG?

QRS duration is prolonged, as there is a delay in depolarisatoin throughout the whole ventricular muscles Angina ECG

What is haemolytic anemia caused by?

Shortened RBC survival Anaemia Blood

What pathology is HbS seen in?

Sickle Cell:&nbsp;&nbsp;A₂B^s₂ Haemoglobinpathies

What is challenge testing in asthmatics?

Similar to reversibility testing, but administer an exacerbating factor such as histamine or an allergen asthma

How would an obstructive shock present?

Similar to tension pneumothorax, breath sounds would be absent if that was the cause on the affected hemiothorax&nbsp; Shock

What is factor IX?

Single chain vitamin K dependant serine protease Blood Haemostasis Pathophysiology

"What pathology is this?<br /><img src=""paste-27887222653091.jpg"" />"

Sinus Bradycardia Angina ECG

"What is this?<br /><img src=""paste-27943057227943.jpg"" />"

Sinus Tachycardia Angina ECG

What are some reversible risk factors for angina?

Smoking, obesity, hypertension, physical inactivity, diet, hyperlipidaemia Angina

What cells accumulate in the intima wall in atherosclerosis?

Smooth muscle cells and foam cells atherosclerosis

What is the third stage in atherlorosis formation?

Smooth muscle proliferation atherosclerosis

What do RBC use ATP for?

Sodium pumps &amp; GLUT1 transporters Blood Erythropoiesis

What is the main excluded osmotically active particle in living cells?

Sodium, especially in the brain Stroke

Clinical features of pharyngitis

Sore throat&nbsp;<div>May have nose/cough/sneezing</div> Respiratory-Infections

What happens to the extracellular space in the brain during hypoxia? Why?

Space goes from 20-5% as the cells swell due to sodium pumps not working. Swelling causes cells to exert pressure on each other<div><br /></div> Stroke

How can you &nbsp;differentiate between haemophilia A &amp; B?

Specific assays Blood Haemostasis Pathophysiology

What is the difference between stable and unstable angina?

Stable: Exertion angion, symptoms subside after 3-10 minutes rest- at rest O2 supply is adequate<div>Unstable: Seen at rest, may have elevated/depressed angina</div> Angina

How does hypotension cause breathlessness?

Stagnant hypoxia, therefore low pO2 in peripheral chemoreceptors, increasing firing of baroreceptors Breathlessness

In emphysema, what does cigarette smoke stimulate/inhibit?

Stimulates PMN (polymorphonuclear leucocytes)<div>Inhibits elastase inhibitor alpha-antitrypsin (protects cells from inflammatory enzymes)</div> Lung-Disorders

How does pulmonary oedema cause breathlessness?

Stimulating J receptors in the lung Breathlessness

What is otitis media caused by most commonly?

Streptococus pyogenese Respiratory-Infections

"What is this ECG indicative of?<div><img src=""paste-3208340570468.jpg"" /></div>"

Stress test: ST depression: indicative of angina Angina

What is the role of subendothelium bound vWF in inital plug formation?

Subendothelium bound vWF binds to GpIb in the platlet to form an intial monolayer Blood Haemostasis Pathophysiology

What substance activates mast cells and basophils that is released by sensory nerves&nbsp;

Substance P Anaphylactic-Shock

What mutation is responsible for sickle cell disease?

Substition mutation changes glutamic acid to valine at codon 5 of beta chain Haemoglobinpathies

What is a Intracerebral Haemorrhage? Clinical features/presentation?

Sudden onset with a severe headache<div>Can cause stupor or a coma</div> Stroke

"What is this?<div><img src=""paste-28802050687126.jpg"" /></div>"

Supraventricular Tachycardia Angina ECG

Symptoms of an MI

Sweating<div>Intense, unremitting pain for 30-60 minutes</div><div>Pain reterosternally, radiating to the neck, shoulders, jaw and ulnar side of the arm</div><div>Pain: pressure squezzing, aching, burning</div><div>Epigastric: fullness/gas/ingegestion</div> Myocardial-Infarct

What symptoms does sympathetic activation cause in an AMI

Sweating<div>Vomitting</div><div>Tachycardia</div><div><br /></div> Myocardial-Infarct

What is pneumonia? How does it clinically present?<div><br /></div>

Symptoms and signs consistant with an acute LRTI associated with new radiographic shadowing with no other explanation Respiratory-Infections

When does a mitral regurgitation occur?

Systole Anatomy Anatomy-of-the-heart

What is hypotension?

Systolic &lt;90 or diastolic &lt;60 mmHg Hypertension

What is postural hypertension?

Systolic BP drops by &gt;20 mmHg or diastolic by &gt; 10 mmHg when standing Hypertension

When would a mitral regurgitation be heard?

Systolic murmur: heard between lub/dub Anatomy Anatomy-of-the-heart

Where is ischaemic pain referred to? (Dermatones)

T1-T4: medial upper arm, neck or jaw Anatomy Anatomy-of-the-heart

What does the&nbsp;Bacillus Calmette-Guérin vaccine protect against?

TB Respiratory-Infections

How would you identify ventricular fibrillation on an ECG?

Rhythm is irregular, beat is 300+ bpm, very disorganised<br />QRS complex not recognizable<div>P wave not seen</div> Angina ECG

Where does the right coronary artery supply?

Right atrium and right ventricle Anatomy Anatomy-of-the-heart

What artery supplies the SA node?

Right coronary artery&nbsp; Anatomy Anatomy-of-the-heart

Where does the right marginal artery supply?

Right ventricle and apex Anatomy Anatomy-of-the-heart

What does the LAD supply?

Right ventricle, left ventricle, 2/3 interventricular septum and apex Anatomy Anatomy-of-the-heart

What shape/type is the tuberculosis bacteria?

Rod-shaped mycobacterium Respiratory-Infections

What pathogen is assocaited with pneumonia post influenze?

S. Aureus Respiratory-Infections

What is the most common cause of community acquired pneumonia (CAP)?

S.pneumonia Respiratory-Infections

How would a STEMI present on an ECG?

ST-depression Myocardial-Infarct

How to identify a STEMI on an ECG?

ST-elevation<div>Rate- 80 bpm</div><div>Rhythm, QRS complex and P wave all normal</div> Angina ECG

"What does this ECG show?<div><img src=""paste-29180007809182.jpg"" /></div>"

STEMI Angina ECG

What happens in the coronary arteries in a STEMI vs a NSTEMI<div><br /></div>

STEMI- complete artery occulsion (transmural)<div>Non-STEMI- partially occluded artery</div> Myocardial-Infarct

How is the SV, cardiac output, and HR affected in a dilated heart?

SV low, so to maintain cardiac output HR must increase<div><br /></div> Anatomy Anatomy-of-the-heart

What bronchiodilator is usually given in a reversibily test in asthmatics?

Salbutamol asthma

"What is shown in this X-Ray?<div><img src=""Screen Shot 2016-11-14 at 14.06.14.png"" /></div>"

Secondary TB wtih an apical lesion that is cavitating Respiratory-Infections

Signs of Respiratory failure?

Tachypnoea &gt;25 bpm<div>Use of accessory muscles</div><div>Nasal Flaring</div><div>Intercostal or suprasternal recession</div><div>Increased sympathetic tone</div><div>End-organ hypoxia</div><div>Hemoglobin destruction</div><div>CO₂&nbsp;retention</div> Breathlessness

What tests would you run if an atypical pneumonia was suspected?

Serodiagnosis/antigen detection Respiratory-Infections

How do blood results of iron defieincy vs. thalassemia differ? (Serum iron/TIBC/MCV)

Serum iron low in iron &amp; ferritin deficieny but normal in thalassemia<div>TIBC (total iron binding capacity) is increased in iron deficiency but normal in thalassemia</div><div>Thalassemia has a more reduce MCV</div> Haemoglobinpathies

What would a CURB-65 of more than 3 indicate?

Severe pneumonia-&nbsp;high risk of death and require urgent hospital admission Respiratory-Infections marked

How would a severe aortic stenosis affect the pressure gradient across the value?

Severe stenosis if the gradient is over 50 mmHg&nbsp; Disease Heart Valvular

What is the mechanism of rivaroxban?

Targets factor Xa<div>Anti-coagululant</div><div><br /></div> Venous-Thrombosis

How to treat hospital acquired pneumonia?

Tazocin Respiratory-Infections

How to remember the classes of shock % losses?

Tennis scores- 15,30,40 Shock

How to treat atypical chlamydophilia pneumonia?

Tetracyclin Respiratory-Infections

What does the alveolar gas equation tell you?

That the partial pressure of alveolar oxygen equals the partial pressure of inspired oxygen minus the partial pressure of the amount of oxygen leaving the blood Breathlessness

What happens to the RBC to cause it to age over time?

The RBC gets oxidised (G6DP prevents this) Anaemia Blood

Where do the lenticulo-striate arteries supply?

The basal ganglia and interal caspule Stroke

How does respiratory alkalosis affect potassium?

The decrease in proton excretion by the kidneys means that an ion must replace the proton to keep electrical neurality- so potassium is excreted: gypokalaemia&nbsp; Respiratory-Acidosis/Alkalosis

What does peak flow monitor?

The effectiveness of treatment for a lung disease Lung-Disorders

What is metabolic compensation in respiratory acidosis?

The high proton conc. in the blood stimulates the kidneys to generate and retain bicarbonate, bringing the ratio of [HCO₃^-] and p_aCO₂&nbsp;back to normal, thus pH.<div>Protons will be excreted and potassium will be retained (hyperkalemia)</div> Respiratory-Acidosis/Alkalosis

What happens once an innate immune cells binds with an antibody?

The innate immune cell pulls in the antibody and undergoes phagocytosis Anaphylactic-Shock

What pathway does APTT measure?

The intrinsic pathway (and common)<div><br /></div> Blood Haemostasis Pathophysiology

What part of the heart do I, aVL look at?

The lateral side of the heart supplied by the LCr or the diagonal branch of the LAD Anatomy Anatomy-of-the-heart

Which cerebral artery is the most commonly affected in a stroke?

The middle cerebral artery Stroke

With CO increasing in exercise, how does the pulmonary arterial pressure not increase drastically?

The pulmonary arteries dilate, reducing the resistance. This occurs via sympathetic nervous system and the increase in oxygen increasing the activity of eNOS Vascular-Motor-Control

What do leads V1, V2 look at?

The right ventricle at the interventricular surface (septal), which is supplied by the LAD Anatomy Anatomy-of-the-heart

What layer of the vessel does the plaque form?

The tunica intima atherosclerosis

How is smoking and asthma linked?

The usual steriod response to inflammation by the steriod HDAC2 which is secreted by theophyllines is blocked.&nbsp;<div>Oxidative stress is increased via NF kB</div> asthma

Why are spherocytes prone to degration?

Their shape means they are more fragile when passing through capillaries&nbsp; Anaemia Blood

What prevents erythrocytes from sticking to each other?

Their surface is negatively charged Blood Erythropoiesis

What does endothelial damage cause cells to release?

There is an increase in cell adhesion molecules and procoagulants, and a decrease in anti-coagulant and thrombotic molecules atherosclerosis

What is the pathology behind type 1 respiratory failure?

There is perfusion but there is no ventilation, due to damaged lung tissue Breathlessness

Why does B12 &amp; folate defiency cause macrocytic anemia?

They are needed for DNA synthesis, causing failure of mitosis producing oversized RBC Anaemia Blood

How do the innate immune system cells detect pathogens?

They have antigen like receptors called TOLL or lectins&nbsp; Anaphylactic-Shock

How does haemolysis affect reticulocytes?

They increase as the production of RBCs increases Anaemia Blood

What is the role of sodium pumps in cerebral hypoxia?

They maintain cell size and shape by stopping the cell swelling via osmotic forces by pumping sodium out. They maintain the membrane potential Stroke

What is Haemoglobin H disease?

Type of Thalassamia: 3 defective alpha genes. Results in two unstable tetramer haemoglobins in the blood; Haemoglobin barts: gamma4 and Haemoglobin H: beta4&nbsp; Haemoglobinpathies

What does&nbsp;Staphylococcus aureus post influenza cause?

Typical Community Acquired Pneumonia Respiratory-Infections

What two types of pathogen can be responsible for pneumonia?

Typical and atypical&nbsp; Respiratory-Infections

How do CXR different in typical/atypical infections?

Typical tends to be unilateral<div>Atypical tends to be bilateral</div> Respiratory-Infections

What are the signs/symptoms of peripheral vascular disease?

Ulcers, peripheral neuropathy, gangrene atherosclerosis

What is DIC (disseminated intravascular coagulation)

Uncontrolled coagulation<div>Continous intravascular deposition of firbin</div> Blood Haemostasis Pathophysiology

How is DIC treated?

Underlying cause must be treated<div>In the meantime, FFP can be given with cryoprecipitate and platelets</div> Blood Haemostasis Pathophysiology

Difference in half life between UFH and LMWH?

Unfractioned heparin: 60-90 half life<div>Low molecular weight heparin: 4 hours</div><div><br /></div> Venous-Thrombosis

What happens to the alpha tetramer Hb in the blood?

Unstable therefore precipitate on the erythrocyte membrane<br />This results in intra-medullary destruction of developing erythroblasts: ineffective erythropoiesis&nbsp; Haemoglobinpathies

What is the U in CURB-65

Urea, point if &gt; 7mmol Respiratory-Infections

What is conjugated-bilirubin converted to the small intestines?

Urobilnogen via bacteria Blood Erythropoiesis

How do you determine the severity of pneumonia?

Use CURB-65<div>C- confusion</div><div><div>U - Urea &gt; 7 mmol</div><div>R - Respiratory rate &gt; 30</div><div>B - Blood pressure &lt; 90 mmHg</div><div>65 - age &gt; 65</div></div><div><br /></div><div>1 point for each, 3 of more = high risk of death and require urgent hospital admission</div> Respiratory-Infections

What is the main cause of respiratory alkalosis

Usually due to hyperventilation Respiratory-Acidosis/Alkalosis

What is epiglottitis caused by?

Usually haemophilus influenzae B Respiratory-Infections

Where would the block be for a&nbsp;Type II Second Degree Heart Block?

Usually in the infranodal level&nbsp; Angina ECG

Why is gaseous exchange impaired in asthma?

V/Q mismatch from plugged up bronchi, leading to hypoxic pulmonary vasoconstriction asthma

A prolonged APTT time could indicate issues with which factors?

VII, IX, XII Blood Haemostasis Pathophysiology

What is the role of factor VIII

VIII is a cofactor for VIII in the conversion of X to Xa Blood Haemostasis Pathophysiology

What parasympathetic nerve supplies the heart? Where does it synpase?

Vagus nerve- synpases on or near the heart Anatomy Anatomy-of-the-heart

What pathologies could cause a volume overlorad leading to the heart being remodelling?

Valvular regurgitation<br />Hypervolaemia Anatomy Anatomy-of-the-heart

What effect does noradrenaline have on arterioles in end organs?

Vasoconstriction Shock

What is the role of angiotensin II and endothelin I

Vasoconstrictors atherosclerosis

What is the role of NO and prostcyclins?

Vasodilators atherosclerosis

What is the role of prostacyclins?

Vasodilators atherosclerosis

What hormones does the hypothalamus release to increase blood pressure?

Vasopressin (ADH) Shock

Gold standard diagonistic tool for DVTs?

Venography Venous-Thrombosis

Where is BNP secreted from?

Ventricles during overstretching Failure Heart

"What is this?<br /><img src=""paste-28110560952487.jpg"" />"

Ventricular Fibrillation Angina ECG

"What is this?<br /><img src=""paste-28076201214122.jpg"" />"

Ventricular Tachycardia Angina ECG

How do RBC make ATP?

Via anaerobic glycolysis&nbsp; Blood Erythropoiesis

How is vitamin K synthesised?

Via bacteria in the gut Blood Haemostasis Pathophysiology

How are platlets removed from the body

Via the reticuloendothelial system Blood Haemostasis Pathophysiology

How is blood flow restored after a stroke pharmacologly?

Via tissue plasminogen activators Stroke

What usually causes sinusitis?

Viral origin,&nbsp;rhinoviruses, coronaviruses, and influenza Respiratory-Infections

What causes Croup? What age does it affect?

Viruses; RSV, Parainfluenza 1-3<div>Occurs between 3 months and 3 years</div> Respiratory-Infections marked

Mechanism of action of warafin?

Vitamin K antagonist; acts on II, VII, X, proteins C &amp; S Venous-Thrombosis

What does FEV1 measure?

Volume you can exhale in one second Lung-Disorders

What is vWD?&nbsp;

Von Willebrand disease- defiecency in vWF Blood Haemostasis Pathophysiology

Signs of DVT

Warm, tender, swollen calf<div>Mild fever</div><div>Pitting oedema</div><div>Unilateral</div><div><br /></div> Venous-Thrombosis

What are the two phases of whooping cough?

Week1: Catarrhal phase<div>Week3: Paroxysmal phase</div> Respiratory-Infections

"What is this?<br /><img src=""paste-28355374088315.jpg"" />"

Wenkenback TypeI Second Degree heart block&nbsp; Angina ECG

What is an arterial thrombus?

White clot: Platelets and fibrin Venous-Thrombosis

What is STEMI reperfusion?

Wire inserted into the coronary circulation and a stent placed to open up the occulded artery Myocardial-Infarct

How is mild/moderate haemophilia treated?

With DDAVP Blood Haemostasis Pathophysiology

How is vWD treated?

With DDVAP<br />Tranexamic acid<div>vWF concentrate</div> Blood Haemostasis Pathophysiology

How is MDRTB treated?

With a fluoroquiolone and an injectable aminoglycoside/capreomycin Respiratory-Infections

How does atypical pneumonia present?

With a non-productive cough, fever, headache, and a chest x-ray more abnormal that a clinical examination would suggest Respiratory-Infections

How does legionella pneumophilia usually present?

With atypical pneumonia<div>Hyponatraemia (low sodium)</div><div>Urea raised</div><div>Liver function tests abnormal</div> Respiratory-Infections

How is severe haemophilia treated?

With coagulation factor concentrates Blood Haemostasis Pathophysiology

How do patients with community acquired pneumonia normally present?

With sudden onset of chills, followed by fever, pleuritic chest pain and productive cough Respiratory-Infections

Effect of gender on asthma

Woman may have worse asthma whilst menstrating asthma

How does a chest infection affect asthma?

Worsens it asthma

What would be the apperance of a flow-volume loop in a restrictive disease?

Would be tall and narrow Lung-Disorders

What is the inhertinace pattern of G6PD deficiency?&nbsp;

X-linked Anaemia Blood

What type of bone marrow does most erythropoiesis occur in?

Yellow bone marrow Blood Erythropoiesis

What stain would you use to diagonsis TB in a culture?

Zielh Neilson Respiratory-Infections

How is chlamydia psittaci acquired?

Zoonosis; acquired from birds (psitacci:parrot) Respiratory-Infections

What receptors reduce local blood flow in exercise via vasoconstriction?

alpha-1 receptors Vascular-Motor-Control marked

Which types of NOs are calcium dependant

bNOS and eNOS Vascular-Motor-Control

"What cell are these?<br /><img src=""paste-22750441767048.jpg"" />"

early earythroblast Blood Erythropoiesis

Which factor does vWF act as a carrier for?

f VIII Blood Haemostasis Pathophysiology

What is the Fenton reaction?

free iron reacting with hydrogen peroxide to form a hydroxyl ion and a hydroxyl radical Haemoglobinpathies

What would serum ferritin look like in iron defiency anaemia?

low Anaemia Blood

What would the pH and p_aCO₂be in respiratory alkalosis?

pH &gt;7.44<br />p_aCO2&nbsp;&lt;35 mmHG Respiratory-Acidosis/Alkalosis

What is the usual pH and pCO₂&nbsp;in respiratory acidosis?

pH &lt;7.35<br />pCO₂&nbsp;&gt; 45 mmhG Respiratory-Acidosis/Alkalosis

How is tPA involed in anti-coagulation

tPA converts plasminogen to plasmin, which causes firbin degradation Blood Haemostasis Pathophysiology

What does the Henderson-Hasselbach equation tell us?

that pH is controlled by the ratio between [HCO3-] and the partial pressure of carbon dioxide Respiratory-Acidosis/Alkalosis

What do the alpha granules in platlets contain?

vWF, platlet factor 4, fV, fibrinogen, and fibronectin Blood Haemostasis Pathophysiology marked

What cell adhesions molecules are produced by the endothelial?

"<div>o<span class=""Apple-tab-span"" style=""white-space:pre""> </span>VCAM (vascular cellular adhesion molecule)</div><div>o<span class=""Apple-tab-span"" style=""white-space:pre""> </span>ICAM (intracellular adhesion molecule)</div><div>o<span class=""Apple-tab-span"" style=""white-space:pre""> </span>MCP and IL8</div><div>o<span class=""Apple-tab-span"" style=""white-space:pre""> </span>Monocytes will stick to all of the above as they flow past</div><div><br /></div>" atherosclerosis

What is the normal arterial blood gas values for oxygen, carbon dioxide and bicarb?

"<div>•<span class=""Apple-tab-span"" style=""white-space:pre""> </span>HCO3- = 24</div><div>•<span class=""Apple-tab-span"" style=""white-space:pre""> </span>PaCO2 = 40</div><div>•<span class=""Apple-tab-span"" style=""white-space:pre""> </span>PaO2 = 95</div><div><br /></div>" Respiratory-Acidosis/Alkalosis

Signs of Mitral Regurgitation

"<div>•<span class=""Apple-tab-span"" style=""white-space:pre""> </span>Pulse: SR/AF</div><div>•<span class=""Apple-tab-span"" style=""white-space:pre""> </span>Ausculatation: Pansystolic mumur</div><div>•<span class=""Apple-tab-span"" style=""white-space:pre""> </span>Volume overload: Increase JVP, basal creps and ankle oedema (back log of blood)</div><div>•<span class=""Apple-tab-span"" style=""white-space: pre; ""> </span>S3 heart sounds</div><div><br /></div>" Disease Heart Valvular

Symptoms of a stroke

"<div>•<span class=""Apple-tab-span"" style=""white-space:pre""> </span>Weakness/numbness of face, arms leg, normally unilateral</div><div>•<span class=""Apple-tab-span"" style=""white-space:pre""> </span>Confusion, trouble speaking or understanding</div><div>•<span class=""Apple-tab-span"" style=""white-space:pre""> </span>Trouble seeing in one or both eyes</div><div>•<span class=""Apple-tab-span"" style=""white-space:pre""> </span>Trouble walking, dizziness, loss of balance or coordination</div><div>•<span class=""Apple-tab-span"" style=""white-space:pre""> </span>Severe headaches with no cause (indicating a haemorrhagic stroke)</div>" Stroke

What is the OMT for angina (optimal medication treatment)

"<div>•<span class=""Apple-tab-span"" style=""white-space:pre""> </span>β blocker ± CAB</div><div>•<span class=""Apple-tab-span"" style=""white-space:pre""> </span>Sublingual GTN</div><div>•<span class=""Apple-tab-span"" style=""white-space:pre""> </span>Aspirin, statin, ±ACE-I</div><div>•<span class=""Apple-tab-span"" style=""white-space:pre""> </span>Lifestyle modification</div>" Angina

"<img src=""Screen Shot 2016-11-01 at 10.13.08.png"" />"

"<img src=""Screen Shot 2016-11-01 at 10.13.45.png"" />" Anatomy Anatomy-of-the-heart

"<img src=""Screen Shot 2016-11-01 at 10.14.49.png"" />"

"<img src=""Screen Shot 2016-11-01 at 10.14.57.png"" />" Anatomy Anatomy-of-the-heart

"What type of anaemia is this?<br /><img src=""paste-4582730105063.jpg"" />"

"<img src=""paste-4569845203289.jpg"" /><br />Macrocytic: B12/Folate defiency" Anaemia Blood

What are the different granuloma layers?

"Centre: Cauesous necrosis (Ghon Focus)<div>Centre surrounded by macrophages</div><div>Macrophages surrouned by lymphocytes</div><div>Lymphocytes surrouned by fibroblasts</div><div><img src=""paste-7958574399864.jpg"" /></div>" Respiratory-Infections

Signs of aortic stenosis

"Slow rising carotid pulse<div>S4 Gallop</div><div>Crescedo-Decrescendo ejection systolic murmur</div><div>Ejaction click due to abrupt halting of valve openign&nbsp;</div><div><img src=""paste-46428596469883.jpg"" /></div>" Disease Heart Valvular

How much does PEFR vary throughout the day in asthmatic patients?

"Variance of 20% in readings from AM to PM, gives a saw tooth pattern<img src=""v7GLMMDxLv7aM90fHJA04g.jpg"" />" asthma

What is class 3 shock? Clinical features?

&gt; 30% of blood loss- persistant drop in BP. Patient will be anxious or confused<div><br /></div> Shock

What is sinus tachycardia?

&gt;100 bpm Angina ECG

What is the volume of RBC in macrocytic anemia?

&gt;100 fL Blood Erythropoiesis

When an asthma patient is give a bronchodilator how much is their FEV1 expected to change by?

&gt;15% or &gt;200 ml asthma

What pressure indicates pulmonary venous hypertension?

&gt;25 mmHg Anatomy Anatomy-of-the-heart

How much blood loss is life threatening?

&gt;40% blood volume acutely Shock

What is class 4 shock?

&gt;40% loss of blood volume<div>Patient confused/unconscious with marked tachycardia</div><div>No urine output</div><div>Life treatening</div> Shock

What is the ejection fraction in diastolic heart failure?

&gt;50% Failure Heart

Volume of RBC for macrocytic anaemia?

&gt;96 fL Anaemia Blood

What is severe haemophilia, and what are the clinical features?

&lt;1 u/dL- spontaneous bleeding, especially in joints Blood Haemostasis Pathophysiology

What Hb range is considered anemia in a&nbsp;infant 6 months-6years

&lt;11 g/dL Anaemia Blood

What Hb range is considered anemia in a&nbsp;woman?

&lt;11.5 g/dL Anaemia Blood

What Hb range is considered anemia in a man?

&lt;13.5 g/dL Anaemia Blood

What is the ejection fraction in systolic heart failure?

&lt;40% Failure Heart

What is the FEVC1/FVC ratio in a SEVERE obstruction?

&lt;45% Lung-Disorders

Volume of RBCs in microcytic anaemia

&lt;76 fL Anaemia Blood

What is the volume of RBC in microcyctic anemia?

&lt;80 fL Blood Erythropoiesis

What do most novel anticoagulants end in?

-aban Venous-Thrombosis

What does 1 small square equal in an ECG?

0.04 s Angina ECG

What is the usual interval for a p-wave?

0.08s Angina ECG

What does 1 large square equal in an ECG?

0.2 seconds Angina ECG

Requirements of B12 per day

1 ug/d Anaemia Blood

What proportion of the RBCs do reticulocytes make up?

1% Blood Erythropoiesis

What are the two main causes of aortic regurgitation?

1) Aortic valve leaflet disease<div>2) Aortic root dilating diseases</div> Disease Heart Valvular

Three main causes of mitral regurgitation

1) Mitral valve leaflet disease<div>2) Subvalvar disease</div><div><br /></div> Disease Heart Valvular

What is moderate haemophilia coagulation concentrations? Clinical features?

1-5 u/dL- severe bleeding after mild trauma<div><br /></div> Blood Haemostasis Pathophysiology

5 Types of treatment for anaphylactic shock<div><br /></div>

1. Intramuscular Adrenaline&nbsp;<div>2. Oxygen high flow</div><div>3. Fluid IV</div><div>4. Antihistamines: Chlorpheniramine</div><div>5. Glucocorticosteriods</div> Anaphylactic-Shock

What level of vWF would indicate a severe defiency?

1/1000000 Blood Haemostasis Pathophysiology

What proportion of the total body cells do RBC account for?

1/3 Anaemia Blood

What is the clincial feature of Heterozygous haemoglobin C?

1/3 of Hb is HbC- no anaemia develops Haemoglobinpathies

What is the CO₂&nbsp;retainer?

10% of all COPD patients lose their hypoxic drive when oxygen is administered, so body fails to ventilate, will show severe signs of hypercapnia Breathlessness

What level of BNP indicates heart failure?

100 pg/ml Failure Heart

How much B12 is the body able to store?

1000 ug Anaemia Blood

What Hb range is considered anemia in a&nbsp;chid 6-14 years

12 g/dL Anaemia Blood

What is the minimum amount of bicarbonate the kidneys can generate in compensatory metabolic alkalosis?

12 mmol/L Respiratory-Acidosis/Alkalosis

Life span of a RBC

120 days Blood Erythropoiesis

What is the usual interval for a P-R interval

120-200 ms normal (3-5 small squares) Angina ECG

What is defined as pre-hypertension?

130-139 systolic<br />80-89 diastolic Hypertension

What is the normal platlet range?

140-400/450 x10^9/L Blood Haemostasis Pathophysiology

What is grade1 hypertension

140/90 Hypertension

What is the desired amount of iron in the diet a day?

15 mg Anaemia Blood

What is class 2 haemorrhage? Clinical symptoms?

15-30% loss of blood, compensation will happen with time<div>Tachycardia, tahcypnea, clammy skin, delayed capillary refill</div> Shock

Requirements of folate acid per day

150 ug/d Anaemia Blood

What is grade 2 hypertension?

160/100 Hypertension

What is Grade 3 Hypertension?

180/110 Hypertension

What is the normal difference in arterial and alveolar pressure?

2 kPa&nbsp; Breathlessness

What coronary arteries supply the interventriclar septum?

2/3 LAD<br />1/3 Posterior descending from the RCA Anatomy Anatomy-of-the-heart

How long does multi-drug resistant TB take to treat?

24 months&nbsp; Respiratory-Infections

What conc. of coagulation factors is seen in mild haemophilia? What are the clinical features?

25-50 is mild, with bleeding after major trauma<br />5-25 also mild, with bleeding after minor trauma Blood Haemostasis Pathophysiology

What is alpha thalassamia minima?

3 Normal genes, 1 defective gene: suffiecient for normal haemoglobin, silent carriers with no clinical features Haemoglobinpathies

How long can it take an intrinsic factor defieincy to become noticed?

3 years due to a large store of B12 in the body Anaemia Blood

What are three complications of pneumonia? What % of people get these?

3-5% Pleural effusion<div>1% Empyema thoracic</div><div>Lung abscess</div> Respiratory-Infections

What percentage of shunting is usually present in the lungs?

3-5%<div><br /></div> Breathlessness

How long does it take for adult haemoglobin to replace foetal haemoglobin?

3-6 months Haemoglobinpathies

How long are isoniazid and rifampicin given for TB?

4 months or more Respiratory-Infections

Each hemoglobin molecule has ? heme groups and ? globin molecule

4,4 Blood Erythropoiesis

What proportion of people age 45 with diabetes have hypertension?

40% Hypertension

How many patients go on to have a thrombosis stroke after a TIA?

40% Stroke

What is the maximum conc. of bicarbonate that the kidneys can supply in metabolic acidosis compensation

45 mmol/L Respiratory-Acidosis/Alkalosis

What is the FEVC1/FVC ratio in a moderative obstruction?

45-60% of predicted Lung-Disorders

What is the vapour pressure of water at 37 degrees?

47 mmg Breathlessness

How many genes in total code for the alpha subunit of haemoglobin?

4: 2 from each parent<div><br /></div> Haemoglobinpathies

What are the signs of an MI

4th heart sound<div>Low grade fever</div><div>ST-elevation</div><div>Leucocytosis &amp; raised inflammtory markers</div> Myocardial-Infarct

What is the normal cardiac output?

5 l/min Shock

How many readings are required for a diagonsis of hypertension

5 reading several days apart Hypertension

<div>Arrange the following five events in the order they occur as erythrocytes are broken down:</div><div>1. bilirubin is conjugated to glucuronic acid</div><div>2. bilirubin is excreted in bile</div><div>3. biliverdin is produced</div><div>4. free bilirubin is produced</div><div>5. hemoglobin is broken down to heme groups and globin molecules</div>

5,3,4,1,2 Blood Erythropoiesis

What is the normal stroke volume?

50-100 ml Shock

What is the normal concentration of a coagulation factor?

50-100 u/dL Blood Haemostasis Pathophysiology

What is the Hb range in Sickle cell?

6-8 g/dL Haemoglobinpathies

What proportion of people age 75 with diabetes have hypertension?

60% Hypertension

What is the FEV1/FVC ratio in mild obstructive disease?

61-69% of predicted Lung-Disorders

What is a normal tidal volume?

7 ml/kg Lung-Disorders

What is the normal diameter of erythrocytes?

7.8 um Blood Erythropoiesis

What is the lifespan of platlets?

8-14 days Blood Haemostasis Pathophysiology

What is the normal volume of erythrocytes?

90 fL Blood Erythropoiesis

5 Different Drugs used to treat Angina

<b>Aspirin</b>: Antiplatlet/antiinflammatory activity, reducing formation of a clot&nbsp;<div><b>GTN</b>: nitrate that is a vasodilator</div><div><b>Beta-blockers</b>: Decrease the work of the heart: negative ionotropic effects &amp; chronotropic effects</div><div><b>Calcium channel blockers</b>: increases O2 delivery by vasodilation</div><div><b>Statins</b>: Reduces the formation of atherosclerosis in the arteries</div><div><br /></div><div><br /></div> Angina

Name as many causes of breathlessness as possible

<div>- Hypoxia</div><div>- Metabolic acidosis</div><div>- Hypotension/reduced cardiac output</div><div>- Exercise</div><div>- Pregnancy</div><div>- Anxiety</div><div>- Pulmonary oedema</div><div>- Anaemia</div> Breathlessness

Indications for surgery in mitral regurgitation<div><br /></div>

<div>-Symptoms with no response to treatment</div><div>-Worsening CV complications - pulmonary hypertension and left ventricular dilatation</div><div><br /></div> Disease Heart Valvular

Five different methods for diagonsising TB

<div>1. PCR (polymerase chain reaction) (from sputum)</div><div>2. Skin test (Mantoux/Pirquet)&nbsp;</div><div>3. Chest X-ray - 1st</div><div>4. Histological examination of biopsy (microscopy)</div><div>5. Microbiological culture (sputum</div> Respiratory-Infections

Five treatment steps of asthma

<div>1.Salbutamol</div><div>2. Inhaled steroids as well&nbsp;</div><div>3. Long acting bronchodilators/increased inhaled steroid/consider leukotriene antagonist&nbsp;</div><div>4. Theophyllines/anything else you haven't used&nbsp;</div><div>5. Oral steroids</div> asthma

What is heart failure?

<div>A cardiac disorder that prohibits delivery of sufficient output to meet the perfusion requirements of metabolizing tissues&nbsp;</div><div><br /></div> Failure Heart

What will you be able to see on a CXR of a heart in heart failure?

<div>A: alveolar oedema</div><div>B: Kerley-B-lines</div><div>C: cardiomegaly (cannot comment if AP)</div><div>D: Diversion (upper lobe)</div><div>E: Effusion (pulmonary)</div><div><br /></div> Failure Heart

How does secondary/post-primary TB occur?

<div>Bacteria may remain alive with the Ghon complex and later in life if the person becomes immunocompromised or malnourished the bacteria may escape and symptoms of TB recur - reactivation&nbsp;</div> Respiratory-Infections

Where are RBC formed children 5-20/25 years?

Bone marrow of the long bones Blood Erythropoiesis

What two viruses normally cause a cold?

Rhinoviruses &amp; Coronaviruses Respiratory-Infections

How does FEV1 and FVC and therefore the ratio change in a restrictive disease?

Both decrease, therefore the ratio remains the same Lung-Disorders

Another name for eccentric hypertrophy?

Dilated heart Anatomy Anatomy-of-the-heart

What are the pathological consequences of DIC?

All of the coagulation factors are used up<div>Thrombosis formation due to uncontrolled fibrin formation</div> Blood Haemostasis Pathophysiology

What is the pathogenesis of asthma?

Allergens activate Th2 Cells --&gt; IL4 --&gt; B cells differentiate into IgE --&gt; IgE activates mast cells --&gt; mast cells release PDG3 and histamine amongst other inflammatory mediators asthma

What is a charateretic apperance of systolic heart failure?

Dilated heart Failure Heart

What is the first line treatment for diabetes with hypertension?

ACE inhibitors or Angiotensin receptor blockers (ARBs) Hypertension

How to treat systolic heart failure (5)

ACE-I&nbsp;<div>ARBs&nbsp;</div><div>Beta-blockers</div><div>Spironolacetone (keeps body from absorbing too much salt)</div><div>Angiotensin receptor neprilysin inhibitor&nbsp;</div> Failure Heart

How is vWF diagonsied via a blood test<div><br /></div>

APTT prolonged<br />PT, TT normal<br />vWF activity low<br />vWF:Ag low (vWF antigen)<br />fVIII low Blood Haemostasis Pathophysiology

How would haemophilia be identified when measuring APTT, PT and TT?&nbsp;

APTT would be prolonged<br />PT and TT would be normal Blood Haemostasis Pathophysiology

How will DIC be detected via a blood test?

APTT, TT, PT will all be prolonged<br />Low platlets<br />Low fibrinogen<br />Raised D-Dimer Blood Haemostasis Pathophysiology

How would a haemostasis issue from renal issues be detected on a blood test?

APTT, TT, PT would be normal<br />Platlet aggregation/count would be low&nbsp;<br />Prolonged bleeding time&nbsp; Blood Haemostasis Pathophysiology

What is haemoglobin E?

Abnormal haemoglobin with a single point mutation in B chain Haemoglobinpathies

Are most haemostatic issues acquired or inherited?

Acquired Blood Haemostasis Pathophysiology

What is antiphospholipid syndrome (APS)?

Acquired form of thrombophilia Venous-Thrombosis

What is the role of protein C in anti-coagulation?

Activated by thrombin, inactivates Va and VIIIa Blood Haemostasis Pathophysiology

What is APTT and what is normal?

Activated partial thrombin time, 30-50 seconds Blood Haemostasis Pathophysiology

What is the role of vWF?

Acts as a glue between platlets and endothelium, and between platlets<br />Also a carrier protein for factor VIII Blood Haemostasis Pathophysiology

"What does this angiogram show?<div><img src=""paste-3728031613189.jpg"" /></div>"

Acute MI<div>Occuded coronary artery</div><div><br /></div> Myocardial-Infarct

How does cardiogenic shock present?

Acute cardiac ischemia symptoms&nbsp; Shock

What is clinical shock?

Acute circulatory failure with inadequate or inappropriately distributed tissue perfusion; cellular hypoxia Shock

What can lead to quinsy and scarlet fever?

Acute pharyngitis Respiratory-Infections

What is the neurohumoral response in heart failure?

Acute: sympathoadrenal activation: increase HR &amp; inotrophy<div>RAA activation: Retention to improve filling of the heart</div><div>Payback for compensatory methods limitted as will cause hypertrophy</div><div><br /></div> Failure Heart

What is another local vasodilator apart from NO?

Adenosine Vascular-Motor-Control

When do symptoms of Haemoglobin E present?

After 3-6 months when HbE replaces foetal haemoglobin Haemoglobinpathies

What are irreversible risk factors for angina?

Age, male, family Hx, diabetes mellitus Angina

Name as many risk factors as possible for DVT and PE

Age<div>Pregnancy</div><div>Synthetic oestrogen (birth control)</div><div>Trauma</div><div>Surgery</div><div>Past DVT</div><div>Obesity</div><div>Immobility</div><div>Thrombophilia</div><div>Malignancy</div> Venous-Thrombosis

What are the triggers of asthma?

Air pollutants, dust, smoke, mists, pollen, mediciations, food Lung-Disorders

Progonsis of asthma if poorly controlled?

Airway remodelling and progression to COPD asthma

Are all hosptial acquired pneumonia atypical or typical?

All HAP pneumonia are typical pathogens Respiratory-Infections

Where are RBC formed children under 5 years of age?

All bone marrow Blood Erythropoiesis

What defiency can lead to irreversible neurological defects, B12 or Folate?

B12 Anaemia Blood

How is pernicious anaemia classified?

B12 defiency caused by the absense of an intrinsic factor Anaemia Blood

What is the name of the abnormal chain produced in sickle cell disease? Hence what are the subunits of the haemoglobin?

B^Sproduces A₂B^s₂: HbS Haemoglobinpathies

Clinical Manifestations of Anaphylactic shock?

BP drops due to fluid leaking into interstital space due to leaking of the great veins<br />Peripheries will often be warm due to loss of fluid in tissues<div>Red itchy rash</div><div>Sore red itchy eyes</div><div>Angioedema in face, lips, hands, feet, pharynx &amp; larynx</div><div>Bronchoconstrictoin</div> Anaphylactic-Shock

What response occurs via baroreceptors when you stand up with respect to blood pressure?

Baroreceptors cause a neuronal response that constricts vessels in legs to maintain blood to the head when you stand up Hypertension

What are the four possible cell types a myeloblast can differentiate into?

Basophil, Eosinophil, Monocyte (--&gt;Macrophage), Neutrophil Blood Erythropoiesis

What does a lack of GpIb cause?

Bernard Soulier syndrome Blood Haemostasis Pathophysiology

What drugs are a common trigger of anaphylaxis shock?

Beta lactams, aspirin, NSAIDS,&nbsp; Anaphylactic-Shock

A blood test for a child has come back showing no HbA, and increased HbA₂&nbsp;and HbF- what would the diagonosis be?

Beta thalassemia major Haemoglobinpathies

What are the clinical features of heterozygous thalassaemia?

Beta thalassemia minor<div>MCV &amp; MCH will decrease a lot</div><div>Hb will decrease a little&nbsp;</div><div>Hb_A2production increases</div> Haemoglobinpathies

What receptors do the sympathetic nervous system act upon to cause relaxation of the smooth bronchiole muscle?

Beta-2 receptors Vascular-Motor-Control

Drugs for secondary prevention after an MI

Beta-blockers<div>Statins</div><div>Aspirin</div><div>Ticagrelor (for a year)</div><div>ACE-I</div> Myocardial-Infarct

Where are common sites for atherioscleorsis formation?

Bifurcation of arteries atherosclerosis

What to look for in a CXR in TB diagnosis?

Bilateral opacities<div>Cavitations</div><div>Calcification</div><div>Hilar Shadowing&nbsp;</div> Respiratory-Infections

What is needed for vitamin K absorption?

Bile Salts Blood Haemostasis Pathophysiology

What can cause a vitamin K defiency?

Biliary obstruction: malabsorption of vitamin K (as needs bile salts to be absorbed) Blood Haemostasis Pathophysiology marked

What converts biliverdin to bilirubin?

Biliverdin reductase Blood Erythropoiesis

What is the prophyrin ring without an iron atom called? Colour?

Bilverdin- Green Blood Erythropoiesis

How do innate immune cells bind with antibodies?

Bind via their Fc receptor, which binds the Fc proportion of the antibody&nbsp; Anaphylactic-Shock

What two receptors can endothelin act on, with what resulting affects?

Binds with ET_a&nbsp;causes vasoconstriction<div>Binds with ET_b&nbsp;causes vasodilation</div> Shock

How is lithium used in strokes?

Blocks apopotosis pathways after excitotoxcity Stroke

What is Haematuria?

Blood in urine Blood Haemostasis Pathophysiology

Pathologies that would cause anaemia with a normal mean corpuslar volume

Blood loss, chronic disease, cancer (marrow infiltatation)<div><br /></div> Anaemia Blood

What is the B in CURB65?

Blood pressure &lt; 90 mmHg Respiratory-Infections

Where do B cells mature?

Bone marrow Anaphylactic-Shock

What is type 1 hypersensitivity?

Damage done by IgE-Mast Cell Axis, via B cells stimulating CD4+ Th2 cells to release IgE Anaphylactic-Shock

How does smooth muscle proliferation occur in the formatoin of atherioscherosis formation?

Damaged endothelial cells and macrophages release growth factors causing migratoin and proliferation of smooth muscle cells&nbsp; atherosclerosis

What do most iron chelating compounds start in?

De- or Des- Haemoglobinpathies

How would a B12 defiency affect RBCs?

Decrease production Anaemia Blood

How would a folate defiency affect RBCs?

Decrease production Anaemia Blood

How would a iron defiency affect RBCs?

Decrease the production Anaemia Blood

What does digoxin do

Decreases HR and increases contractility Disease Heart Valvular

How does a low pH affect brain blow flow?

Decreases it Respiratory-Acidosis/Alkalosis

How does chronic disease cause normocytic anaemia?

Decreases lifespan of RBC, depresses erythropoiesis, body becomes less responsive to erythropoitein<div><br /></div> Anaemia Blood

How does the FEV1/FVC ratio change in an obstructive disorder?

Decreases, as FEV1 decreases Lung-Disorders

Pathophys of Herediatry Spherocytosis

Defect in proteins in the RBC cytoskeleton, resulting in cell contracting to most surface tension effecitent structure- a sphere<div><br /><br /></div> Anaemia Blood

What is haemophilia A?

Deficiency in VIII&nbsp; Blood Haemostasis Pathophysiology

What is haemophilia b?

Defiency of XI Blood Haemostasis Pathophysiology

What sort of mutation is present in Alpha Thalassemia?

Deletion of a gene on chromosome 16 Haemoglobinpathies

What do the myointimal cells do in the atherosclerosis?

Deposit collagen around the lipid pool so the plaque grows in size atherosclerosis

"What is seen on this ECG?<br /><img src=""paste-29055453757593.jpg"" />"

Depressed ST segement Angina ECG

Name three iron chelating compounds

Desferrioxamine<div>Deriprone</div><div>Deferasirox</div> Haemoglobinpathies

How is folate affected by cooking?

Destroyed Anaemia Blood

What does serine elastase do in empheysema?

Destroys lung tissue Lung-Disorders

What is a thrombosis stroke?

Development of a clot in a cerebral artery, from a atherosclerotic plaque.<div>In a period of low BP, lumen may close due to a compromised diameter and distal circulation ceases</div> Stroke

If the QRS complex for lead I is positive but QRS complex for aVF is negative- what has happened to the electical axis of the heart?

Deviated to the left Angina ECG

If the QRS complex in lead I and in aVF are both negative- what has happened to the electrical axis of the heart?

Deviated to the right Angina ECG

Why are diabetics prone to hypertension

Diabetes damages the kidneys, leading to excess renin release Hypertension

What is the transportation method called by which RBC pass from the bone marrow to the capillaries?

Diapedesis Blood Erythropoiesis

When is a mitral valve stenosis heard?

Diastolic murmur as left atrium must work harder to generate a pressure Anatomy Anatomy-of-the-heart

What part of the antibody changes to give different classes?

Different Fc regions of antibodies dictate what happens to them once they bind an antigen, giving different classes Anaphylactic-Shock

What is an early erythroblast?

Differentiates from a proerythroblast<div>Nuclear material starts to condense</div><div>Where ribosome synthesis begins</div> Blood Erythropoiesis

What is the action of eNO once synthesised?

Diffuses into smooth muscle, activating guanylate cyclase converting GTP --&gt; cGMP, which causes vascular smooth muscle relaxation Vascular-Motor-Control

What is telangectasia?

Dilated capillaries that are &nbsp;visible on the skin Blood Haemostasis Pathophysiology

Mechanism of pyrazinamine and what does it treat?

First line treatment in TB<div>Inhibits fatty acid synthase&nbsp;</div> Respiratory-Infections

How many genes encode for the beta subunit? What chromosome are these on?

Five genes on chromosome 11 encode for the beta subunit Haemoglobinpathies

What is a bullae?

Fluid filled sac Lung-Disorders

How to treat atypical legionella pneumonia?

Fluoroquinolone Respiratory-Infections

What is a reticulocyte?

Formed once the normoblast has ejected its nucleus, it is an immature RBC. Has ribosomal RNA which give them dark markings Blood Erythropoiesis

What is a TOLL receptor? How many are there

Found on innate immune cells, antigen like receptor. Each cell has a multiple of different receptors, 20-30 in total Anaphylactic-Shock

Diagonsis for a still born with only Haemoglobin Barts present?

Four alpha defects: Fatal Alpha thalassemia Haemoglobinpathies

If a baby is delivered with hydrops fetalis, what may the pathogensis explanation be?

Four defective alphasubunit haemoglobin Haemoglobinpathies

What is&nbsp;Hb Barts

Four gamma subunits<div><br /></div> Haemoglobinpathies

Chemical makeup of NO

Free radical as it has an unpaired electron in its outershell&nbsp; Vascular-Motor-Control

What causes calcium channels in endothelial cells to open? And what does this increase in intracellular activate in terms of NO production?

Friction- increase in Ca²⁺&nbsp;activates calmodulin, activating eNOS Vascular-Motor-Control

What is the role of G6PD deficiency in RBCs?

G6PD prevents/reverses oxidation of Hb, membrane etc; prolongs lifetime of RBC. Anaemia Blood

What does a lack of GpIIb/IIa cause?

Glanzmann's<div><br /></div> Blood Haemostasis Pathophysiology

What attatches to unconjugated biliburbin and where? What does this do to its solubility?

Glucuronic acid attached by hepatocytes to make it more soluble Blood Erythropoiesis

What is the main excitatory transmitter in the brain?

Glutamate Stroke

How is LDL modified in atherscleorosis formation?

Glycated or oxidised atherosclerosis

What are the most abdundant glycoproteins on the platlet surface

GpIIb/IIa heterodimer and GpIb Blood Haemostasis Pathophysiology

What is the role of the GpIIb/IIa glycoprotein?

GpIIb/IIa mediates platlet-platlet crosslinking via vWF Blood Haemostasis Pathophysiology

What colour does the cytoplasma of an early erythroblast stain?

Grey or Brown Blood Erythropoiesis

What bacteria causes acute rheumatic fever I?

Group A Streptococcus Disease Heart Valvular

How to remember the common bacteria in HAP pneumonia?

HAP-PE (happy)<div>P: Pseudomonas</div><div>E: Enterobactr</div> Respiratory-Infections

What enzyme do statin inhibit?

HMG-CoA reductase atherosclerosis

How can a ECG stress test diagonsis angina?

HR increases with a potential ST planar/depressed slope Angina

What symptoms would give a low chance of a bleeding disorder?

Haemoptysis (coughing up blood)<br />Haemoatemesis (vomitting of blood)<br />Haematuria (urine in blood)<div>Melanea: Sticky feaces due to internal bleeding/swallowing blood</div><div>Telangiectasia- dilated capillaries</div> Blood Haemostasis Pathophysiology

What would the symptom of a severe headache in a stroke indicate about the origin of the stroke?

Haemorrhagic Stroke Stroke

What enzyme breaks down the haem group in RBCs?

Haemoxygenase enzyme Blood Erythropoiesis marked

What is arteriosclerosis

Hardening of the artery walls that typically occurs with old age atherosclerosis

What would an obstructive lung look like in a flow-volume loop?

Has a scooped out apperance in the expiration part, due to expiration ending early due to airway closure Lung-Disorders

What is the name for haemoglobin in the embryonic yolk?

Hb Gower-1 (ζ₂ε₂) Haemoglobinpathies

What is foetal haemoglobin known as? Subunits?

HbF- two alpha two gamma Haemoglobinpathies

What is the R in CURB-65

Respiratory rate &gt; 30 Respiratory-Infections

Signs and Symptoms of Pneumonia

Respiratory: Cough and one of the following, pleural pain (sharp pain when you breath in), dyspnoea, tachypnoea<div>Systemic: Sweating, fever, shivers, aches, pains AND/OR fever &gt; 38</div> Respiratory-Infections

"What are the cells with the dark markings?<img src=""paste-22905060589728.jpg"" />"

Reticulocytes<div><br /></div> Blood Erythropoiesis

What is the respiratory quotient?

RQ= Relationship between pCO2/pO2 = 0.8 Breathlessness

4 Factors that affect airflow through a tube

Radius of the tube⁴<div>Length of tube</div><div>Pressure difference</div><div>Viscocity of gas</div> asthma

What is tachypnoea?

Rapid breathing of &gt;16 bpm Angina

Main clinical features of&nbsp;epiglottitis?

Rapid onset of fever<div>Sore throat</div><div>Dysphagia</div> Respiratory-Infections

What is primary haemostasis?

Rapid platlet plug formation formed to stop bleeding initally after injury.wH Blood Haemostasis Pathophysiology

What would sinus brachycardia look like on an ECG?

Rate &lt; 60 bpm Angina ECG

How to identify Supraventricular Tachycardia on an ECG?

Rate 140-220 bpm<br />P wave absent or multiple<div>Rate regular</div><div><br /></div> Angina ECG

What is a venous thrombus?

Red clot: RBC in fibrin Venous-Thrombosis

How can brain swelling be reduced after a stroke?

Reduce the metabolic demands by cooling the brain<div><br /></div> Stroke

How to treat haemostasis issues from a renal issue?

Reduce uraemic retention via dialysis<br />Short term can give platlet transfusions Blood Haemostasis Pathophysiology

How is FEV1 and FVC affected in an obstructive disease?

Reduced FEV1<div>FVC normal</div> Lung-Disorders

Signs of pleural effusion on examination?

Reduced TVF (tactile vocal fremasis)<div>Expansion of lungs</div><div>Stony Dullness</div><div>Breath sounds</div> Respiratory-Infections

What is the most significant reduced value in an obstructive disorder?

Reduced peak flow rate Lung-Disorders

What is the most significant reduced value in a restrictive disorder?

Reduced vital capacity Lung-Disorders

How does atheomatous deposits affect eNOS activity&nbsp;

Reduces activity, damaged vessels cannot dilate can lead to angina/ischemia in exercise&nbsp; Vascular-Motor-Control

In vasoconstriction of arterioles, where is the noradrenaline released from and where is the receptor it binds to?

Released from nerve endings outside of the arteriole, and penetrates the tunica adventia binding wtih catecholamine alpha receptors in the tunica media Shock

In a healthy person, what happens to potassium in the extracellular space in the brain?

Removed by glial cells&nbsp; Stroke

What pathologies can lead to secondary hypertension?

Renal disease, coarctation of the aorta, latrogenic, endocrine disease Hypertension

What patients should not recieve Fondaparinux?

Renally impaired patients Venous-Thrombosis

What happens to elastin in the arteries with age?

Replaced by collagen Hypertension

What is RSV?

Respiratory Synctial Virus: Single major pathogen of respiratory infections in children Respiratory-Infections

"What is this?<br /><img src=""paste-28587302322367.jpg"" />"

Third Degree Heart Block<br /> Angina ECG

What are the long term compensatory responses to haemorrhage, and what stimulates these?

Thirst- stimulated by angiotensin II receptors in the brain.&nbsp;<div>Aldosterone release from adrenal cortex in response to angiotensin II</div><div>Peritubular cells that are sensetive to hypoxia release erythropoetin to stimulate RBC production</div><div><br /></div> Shock

What do anti-thrombins inhibit?

Thrombin and Xa, as well as factors vii, ix and xi Blood Haemostasis Pathophysiology marked

What is mechanism of dabigatran? What is it used in?

Thrombin inhibitor, used as an anticoagulant&nbsp; Venous-Thrombosis

What is TXA2?

Thromboxane A2, a mediator of platlet aggregation, causing further alpha granulation release Blood Haemostasis Pathophysiology

Mechanism of tPa in treating myocardial infarctions

Thromolytic therapy: Tissue plasmogen activation, it breaks down plasminogen to plasmin which lyses the fibrin Myocardial-Infarct

Where do T cells mature?

Thymus Anaphylactic-Shock

What does the PR interval indicate?

Time to cross the AV node and propagate via the bundle of His to the ventricles Angina ECG

Tissue factor is a receptor for which coagulation factors? Role of tissue factor?

Tissue factor forms a complex with VIIa to activate X -&gt; Xa. TF is a cell surface receptor for VIIa Blood Haemostasis Pathophysiology

If urobilinogen doesn't pass out of the body in the faeces where does it go?

To the spleen via the portal vein&nbsp; Blood Erythropoiesis

What is the anatomical clinical feature of a severe increase in intracranial pressure?

Tonsillar herniation<div>When the cerebellum extudes through the foramen magnum</div> Stroke

What does FVC measure?

Total amount you can exhale Lung-Disorders

Where is a mitral stenosis best heard?

Towards the axilla Anatomy Anatomy-of-the-heart

What molecule transfers iron

Transferrin Haemoglobinpathies

What molecule transports free iron throughout the body? How many iron molecules can each hold?

Transferrins- can hold 2 iron molecules Anaemia Blood

Treatment for type 4 shock?

Transfusion immediately&nbsp; Shock

What is a TIA?

Transient Ischemic Attack<div>Comes from a small emboli from a thrombus sticking to a vessel wall which subsequently dissolves</div><div><br /></div> Stroke

Mechanism of Ethambutol- What does it treat?

Treat TB via preventing the formation of the cell wall- bacteriostatic Respiratory-Infections

What is the mechnism of rifampicin- what does it treat?

Treats TB<div>Inhibits bacterial DNA-dependent RNA polymerase</div> Respiratory-Infections

What does isoniazid treat? Mechanism?

Treats TB<div>Inhibits synthesis of mycolic acid, component of cell wall&nbsp;</div> Respiratory-Infections

What is alpha thalassemia minor?

Two defective alpha genes, may present with mild microcytic hypochromic anaemia Haemoglobinpathies

How many genes are there that code for the light chain ascept of the antibody?

Two genes Anaphylactic-Shock

Causes of Type 2 respiratory failure<div><br /></div>

Type 1 with failure: muscles no longer can excrete CO₂<div>Hypoventilation</div><div>Brain stem injury</div><div>Neuropathy</div><div>Depressant drugs</div><div>Spinal cord injury</div><div><br /></div> Breathlessness

What type of hypersensitivity is TB?

Type 4 Respiratory-Infections

"What is this?<div><img src=""paste-28441273434327.jpg"" /></div>"

Type II Second Degree Heart Block Angina ECG