7.7 - 7.12

Question 1

___ in work hierarchy -> ___ probability of death (two answers)

Answer 1

Lower in work -> higher chance of death.

Higher in work -> lower chance of death.

Question 2

Acute effects of stress:

Answer 2

Increase alertness, decrease perception of pain, increase immunity, increase cardiovascular parameters (HR, constriction to increase O2 supply to muscle) and non-important functions are downregulated (e.g. reproduction).

Question 3

Chronic effects of stress:

Answer 3

Poor memory, increased risk of depression, immune function compromised, higher risk of hypertension and cardiovascular disease, women – higher level of infertility and spontaneous abortion.

Question 4

Factors in development of chronic stress:

Answer 4

Lack of control or EMPOWERMENT over home and work life, poverty, racism, unemployment, gendered violence, substance abuse, barriers to mental health care (cultural, financial, class, gender).

Question 5

The trachea begins in the neck at the level of ___

Answer 5

C6

Question 6

At the ___ plane, the trachea birfucates into ___

Answer 6

T4/5 plane

Into right and left main bronchus

Question 7

The right main bronchus is ___, ___ and more ___ than left main bronchus

Answer 7

Shorter, wider and more vertical

Most likely site for foreign object to enter

Question 8

The trachea is a series of U-shaped ___ rings, closed posteriorly by the ___ muscles

Answer 8

Cartilage rings

Posterior - trachealis muscle, so flattened posterior side.

Question 9

Main bronchi divide into ___ bronchi for each lobe, which then divide into ___ bronchi

Answer 9

Lobar bronchi for each lobe

Segmental bronchi

Question 10

Each segmental bronchus supplies a ___ segment

Answer 10

Bronchopulmonary

Question 11

Each bronchopulmonary segment is supplied by a segmental ___, ___ and ___

Answer 11

Bronchus
Artery
Vein

Question 12

Each bronchopulmonary segment is supplied by a segmental ___, ___ and ___

Answer 12

Bronchus
Artery
Vein

Question 13

If a patient had pooling of secretions e.g. due to pneumonia or aspiration of vomitus, is it most likely to settle in the ___ segment of ___ lobe esp. on ___ side

Answer 13

Apical segment of lower lobe esp. on right side due to anatomy of RMB

Question 14

Right lung normally has ___ lobes

Answer 14

3

Question 15

The left lung usually only has an ___ fissure

Answer 15

Oblique

Question 16

On the right side, the RMB divides ___ the hilum

Answer 16

Before!
So two bronchi (right upper lobe bronchus and bronchus intermedius) and 2 branches of pulmonary arteries that accompany the bronchi

Question 17

Pulmonary veins from each hilum are ALWAYS most ___ and ___ structures at hilum of lung.

Answer 17

Anterior and inferior (a pair on either side so 4 in total)

Question 18

On he LHS, the pulmonary artery is ___ the bronchus

Answer 18

Above

Question 19

On the RHS, the pulmonary artery is ___ to the bronchus

Answer 19

Anterior

Question 20

Bronchial arteries (approx. 3-5 branches) from the anterior surface of ___ thoracic aorta

Answer 20

Descending - to supply tracheobronchial tree

Question 21

Bronchial veins drain lung parenchyma drain into the ___ system

Answer 21

Azygous

Question 22

SNS of thorax from ganglia of ___ ___ in posterior mediastinum, adjacent to vertebral column on either side

Answer 22

Sympathetic trunk

Question 23

PNS of thorax from ___ nerve

Answer 23

Vagus

Question 24

PNS of thorax from ___ nerve

Answer 24

Vagus

Question 25

Number of X-rays that pass though an object depend on the ___-___ of the object

Answer 25

Electron density

Question 26

Electron density is dependent on ___ number, and ___ of atoms

Answer 26

Atomic number | Concentration of atoms

Question 27

In CXR, tissues can only be separated if they are of ___ e-densities

Answer 27

Differing

Question 28

An adequate PA CXR depends on ___ inspiration, ___ direction, ___ away from chest wall and ___ position

Answer 28

Full inspiration PA direction Scapulae Erect (if possible)

Question 29

Why is CXR done in PA direction?

Answer 29

Heart is closer to detector, less magnification and less blurring

Question 30

How to check if full inspiration?

Answer 30

Count 7 ribs anteriorly above level of hemidiaphragm, or 11 ribs posteriorly.

Question 31

How to check if full inspiration?

Answer 31

Count 7 ribs anteriorly above level of hemidiaphragm, or 11 ribs posteriorly.

Question 32

Is the patient standing straight?

Answer 32

Align edge of clavicular heads with spinous process of vertebrae - should be equidistant on either side.

Question 33

If heart is greater than 50% of maximum ___ diameter of thoracic cavity from inner aspect of ribs, then big heart

Answer 33

Transverse | Called the cardiothoracic ratio

Question 34

Chest is divided into different zone

Answer 34

Upper, middle and lower zones | Upper and lower zone is divided into upper and lower halves

Question 35

You cannot see contents of the mediastinum, but can see angle of ___, to divide ___ and ___ mediastinum

Answer 35

Angle of Louis - plane from manubiosternal junction to T4/5 disc Divides superior form inferior mediastinum

Question 36

Fluid drops to lung ___, and air rises to lung ___

Answer 36

Bases | Apices

Question 37

If hydrothorax (fluid only/effusion) then see a ___, but if hydropneumothorax (air and fluid), then fluid level is ___

Answer 37

Meniscus If air and fluid - it is flat!

Question 38

CT has ___ spatial resolution but ___ contrast resolution

Answer 38

Lower spatial resolution c.f. CXR | But higher contrast resolution - can different between tissues of more similar e-densities

Question 39

For CT, patient is ___

Answer 39

Supine

Question 40

CT - look from __ up when reading

Answer 40

Feet up!

Question 41

CT - look from __ up when reading

Answer 41

Feet up!

Question 42

Incomplete dominance is also called ___

Answer 42

Penetrance, not true dominant | Intermediate trait of dominant and recessive traits e.g. wavy hair between straight and curly).

Question 43

Mendel's first law

Answer 43

Parents have 2 copies of a gene for a character and only pass 1 copy

Question 44

Mendel's second law

Answer 44

Different characters are inherited independently (except for characters on same chromosome i.e. linked character)

Question 45

PKU is an ___ ___ genetic disease

Answer 45

Autosomal recessive

Question 46

PKU is a lack of ___ ___

Answer 46

Phenylalanine hydroxylase

Question 47

In PKU, there is an elevation of ___ that cannot be converted to ___ because of the lack of phenylalanine hydroxylase

Answer 47

Phe to Tyr

Question 48

In PKU, phenylalanine accumulates and is converted to ___ by aminotransferase.

Answer 48

Phenylpyruvate

Question 49

Phenylpyruvate causes damage to ___, and inhibits ___ which makes melanin

Answer 49

Brain Inhibits tyrosinase which makes melanin! Darked haired parents with blond haired child example.

Question 50

Cystic fibrosis is an ___, ___ disease

Answer 50

Autosomal recessive

Question 51

In CF, there is a mutation in the ___ gene

Answer 51

CFTR Cystic fibrosis transmembrane conductance regulator – a chloride channel protein active in membranes of lungs, liver, pancreas, intestines, reproductive tract and skin.

Question 52

The most common mutation in CF is a ___ base deletion

Answer 52

3 base deletion -> Delta F508

Question 53

In CF, Cl- cannot move ___ of cells, and mucus accumulates in ___

Answer 53

Out of cells, Cl- is stuck inside | Mucus accumulates outside cells in airways

Question 54

The sequence of most collagens is repeats of ___, ___, ___

Answer 54

Gly-Pro-Ala | Glycine is stacked in the centre

Question 55

In Ehlers Danlos sundrome, mutations in family of ___ genes

Answer 55

Collagen genes

Question 56

Ehlers Danlos syndrome is mostly inherited as an ___ ___ disease

Answer 56

Autosomal dominant

Question 57

Marfan syndrome involves a mutation of the ___ gene

Answer 57

Fibrillin 1 gene

Question 58

In albinism, there is a defect or lack of the ___ enzyme

Answer 58

Tyrosinase which makes melanin pigment!

Question 59

In HbS. there is a single base change of ___ glutamic acid to ___ valine.

Answer 59

Hydrophilic to hydrophobic

Question 60

The base change in HbS causes the hydrophobic valine to bind to a normal hydrophobic pocket in ___ Hb

Answer 60

Deoxy - this leads to sickle shape.

Question 61

Disorders of Hb are mainly inherited as ___ ___ conditions

Answer 61

Autosomal recessive

Question 62

Disorders of Hb are mainly inherited as ___ ___ conditions

Answer 62

Autosomal recessive

Question 63

HbA is a tetramer of __ and __ globin chains

Answer 63

2 alpha and 2 beta chains

Question 64

During the first three months of gestation - 3 embyronic forms of Hb are produced

Answer 64

Zeta and epsilon Zeta and gamma Alpha and epsilon

Question 65

Embryonic forms switch off and fetal forms switch on during first 3 months of gestation

Answer 65

Fetal Hb is alpha2gamma2

Question 66

In alpha and beta thalassaemias

Answer 66

Decreased synthesis of one more globin chains

Question 67

Alpha thalassaemia is due to a deficiency of ___ globin chains

Answer 67

Alpha | And beta thal - due to deficiency of beta globin chains.

Question 68

Alpha thalassaemia is more likely to manifest during ___ because the fetus expresses alpha in HbF

Answer 68

Development | Beta is more likely to manifest after birth

Question 69

Outcomes of untreated beta thal

Answer 69

Reduced beta globin production - excess of alpha globins - precipitate in RBCs Anaemia Hepatosplenomegaly to attempt to increase RBC production (because RBCs are ineffective) Iron overload - increased uptake from diet, but no way to excrete extra diet uptake Marrow expansion - leading to bone deformity e.g. bossing, etc.

Question 70

Primary treatment for beta thal

Answer 70

Anaemia with chelation therapy for iron overload

Question 71

For alpha, there are ___ copies of alpha gene on each chromosome, therefore ___ total copies

Answer 71

2 on each, so 4 copies in total! 3 functional = silent carrier (thal minor) 2 functional = alpha thal trait - mild anaemia 1 functional = HbH disease - mild to moderate/severe anaemia 0 functional = HbBart - hydrops fetalis, fatal!