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Key ALS facts > Block 13 > Flashcards

Block 13 Flashcards

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1
Q

Briefly explain concept of Cor pulmonae

A

pulmonary vessels constrict to shunt blood away from damaged alveoli to healther alveoli to maintsain gas exchange

increases pulmonary vascular resistance -> pulmonary hypertension -> increases backflow of blood to R side of heart, R side of heart enlarges overtime to compensate => R sided HF

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2
Q

Type of HF where ventricles can’t pump hard enough during systole

A

Systolic HF or HF w reduced ejection fraction

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3
Q

Type of HF where not enough blood fills ventricles during diastole

A

Diastolic HF or HF w preserved EF

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4
Q

Adverse effects of HF

A
  • increased preload and afterload
  • reduced coronary + renal perfusion due to decreases CO
  • fluid accumulation — pulmonary oedema
  • increased K+ excretion
  • cardiomyocyte necrosis + arrhythmias
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5
Q

Impact of HF on kidneys

A

decreases CO → decreases renal blood flow → decreased GFR → RAAS activated → increased Na+ and water reabsorption

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6
Q

Age-related changes to heart

A
  • Interstitial collagen within the myocardium increases
  • myocardium stiffens
  • myocardial relaxation is prolonged
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7
Q

Symptoms of HF

A
  • dyspnoea
  • orthopnoea — SOB that’s worse when lying down
  • SOB that wakes patient up at night
  • pedal oedema
  • fatigue
  • tachycardia
  • tachypnoea
  • elevated JVP
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8
Q

2 key complications of COPD

A

Cor pulmonae

Type II respiratory failure

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9
Q

Type II respiratory failure

A

alveolar ventilation is insufficient to excrete the carbon dioxide being produced:

low oxygen

high CO2

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10
Q

Cardinal symptoms of CVD

A

Chest pain

Breathlessness

Palpitations

Syncope

Haemoptysis

Oedema

Cough

Fatigue

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11
Q

Key symptoms of angina

A

substernal pain

exacerbated by emotional stress + exertion

relieved by rest

*worse in cold, lasts 2-10mins

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12
Q

Subjective sign of disease

A

Symptom

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13
Q

Objective sign of disease discoverable on examination

A

Sign

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14
Q

Key symptoms of MI

A
  • pain at rest
  • builds up over a few mins
  • no relief w GTN or rest
  • 30mins plus
  • SOB
  • sweats
  • nausea
  • fear
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15
Q

Aortic dissection symptoms

A

tearing intense chest pain

sudden onset

pain radiates to back as well as other sites e.g. arms/legs/neck/head

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16
Q

Cardiac symptoms of Pericarditis

A
  • retrosternal pain
  • relieved by sitting forward
  • may radiate to neck + shldr
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17
Q

Orthopnea

A

type of dyspnea only occurs when a person is lying down

*caused by increased pressure in BVs of lungs

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18
Q

Paroxysmal nocturnal dyspnea

A

SOB that wakes patient at night

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19
Q

Site of ANP release

A

myocytes of RA + RV mainly

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20
Q

Action of ANP

A
  • natriuresis - sodium excretion
  • lowers BP
  • antagonises actions of angiotensin II, aldosterone
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21
Q

Effect of Beta blockers on renin

A

inhibit renin release from kidneys

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22
Q

Most common pathogen causing lower respiratory tract infections

A

Streptococcus pneumoniae

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23
Q

Type of breath sounds caused by consolidation in lobar pneumonia

A

Bronchial breathing

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24
Q

MoA of Class IV antiarrhythmic drugs

A
  • block voltage-sensitive calcium channels
  • slow conduction in the SA and AV nodes
  • shorten the plateau phase of the action potential
  • reduce force of contraction
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25
MoA of Digoxin
- increases vagal outflow to reduce conduction rate at AV node - inhibits Na+/K+ ATPase pump which increases intracellular Ca2+ => positive inotropic effect - increased intracellular Na+ slows extrusion of Ca2+ via the Na+/ Ca2+ exchanger decreasing Ca2+ extrusion and thus increased Ca2+ is stored in the SR and available on release
26
MoA of Class II antiarrhythmic β1-selective-Adrenoceptor antagonist
e.g. Atenolol diminishes the Phase 4 depolarisation which: - suppresses automaticity - prolongs AV conduction - decreases HR + contractility
27
MoA of Dobutamine
β1 adrenoceptor agonist and α1 selective activity with some weak β2 activity - increases contractility + CO
28
Why is Verapamil contraindicated in HF?
because it blocks calcium channels and has negative inotropic effect
29
Site of Spironolactone action
collecting ducts
30
How does spironolactone help reduce pulmonary oedema in HF?
Blocks aldosterone action in CD which: increases Na+ and water excretion so decreased fluid volume = decreased pulmonary oedema
31
Canon ball lesions in all lung fields indicate
Metastatic cancer
32
Important side effect of ACE inhibitors:
first-dose hypotension
33
Therapy for NSTEMI
Antiplatelet therapy, LMWH, statins and anti-ischaemics
34
D-dimers are
biomarkers for ongoing thrombosis
35
1st Degree heartblock on ECG
- regular QRS complexes | - p waves present BUT delay at AV node, P-R interval prolonged => 1st degree heart block
36
Slow or blocked conduction through AV node is
HEART BLOCK
37
Effect of adenosine on AV node
BLOCKS AVN
38
Effect of atropine on AV node
STIMULATES AV node
39
Common presentation of atrial flutter on ECG
- 150bpm | - narrow QRS complex
40
Common causes of tachycardia
- Hyperthyroidism - Anxiety - Heart failure - Hypovolaemia - Septicaemia
41
Commonest pathogen causing lower respiratory tract infections in ALL age groups
Streptococcus pneumoniae
42
Patchy shadowing in lung fields on X-ray
BRONCHO-PNEUMONIA
43
Antiarrhythmic drugs that: slow conduction in the SA + AV noded shorten the plateau phase of the AP decrease force of contraction
CLASS IV anti-arrhythmic drugs
44
Beta 1 selective receptor agonist used to treat acute but reversible HF e.g. cardiogenic or septic shock
DOBUTAMINE -> increases cardiac output + contractility
45
Type of calcium channel receptors that Verapamil acts on
L-type Ca2+ channels
46
The pathogen that generally causes pneumonia after a preceding viral illness
Staphylococcus aureus
47
Mechanism of Action of Theophylline
competitively inhibits type III + type IV phosphodiesterase WHICH prevents cAMP breakdown LEADING TO: bronchial SM relaxation; bronchodilation
48
What clinical finding distinguishes L. pneumophilia from other pneumonias?
HYPONATREMIA!
49
In what pathologies are hyper-inflated lungs normally seen?
COPD - as air gets trapped within the lungs
50
Typical therapy for NSTEMI
LMWH - inactivates thrombin + activated factor X prevent further thrombin activation and fibrin formation Statins - maintain plaque stability Anti-ischaemic medications - maintain perfusion and prevent ischaemia Anti-platelet therapy - prevent further platelet recruitment to the thrombus
51
Briefly explain atrial flutter
ATRIA contract v fast BUT, AV node is refractory so only conducts a proportion of impulses
52
Torsades de Pointes
specific type of polymorphic ventricular tachycardia: common cause: decreased K+ AND decreased Mg2+
53
How to calculate HR in bpm from an ECG?
300 / no. of lrg squares
54
What is heart block?
slow/blocked conduction through AV node
55
Sinus Arrest
failure of sinus node discharge ==> no atrial/ventricular depolarisation
56
3 classes of class I anti-arrhythmic drugs
MODERATE - Quindine - Procainamide WEAK - Lidocaine - Phenytoin STRONG - Propafenome - Flecainide
57
Non-selective beta blockers
Propanolol Timolol Nadolol
58
Cardioselective beta blockers
Atenolol Carvedilol Bisoprolol Metoprolol
59
MoA of Ca2+ channel blockers
inhibit Ca2+ influx during membrane depolarisation EFFECTS: - reduces LV contraction - dilates BVs - reduces myocardial oxygen demand
60
Main aetiological agents of acute bronchitis
``` VIRUSES: Rhinoviruses Adenoviruses Parainfluenza Influenza A+B ```
61
Exacerbation of COPD is usually:
acute bronchitis!!!
62
Which groups of ppl are more susceptible to bronchopneumonia?
infants AND elderly
63
Which organisms commonly cause cavitating pneumonia?
S. aureus Klebsiella Mycobacteria TB
64
Majority of community acquired pneumonia is caused by
BACTERIA 70% - 90% caused by Streptococcus pneumoniae
65
Which class of antibiotic should be used to treat Legionnaire's?
Macrolides or Quinolones (penicillins don't work!!!)
66
Pneumonia occurring 48hrs after hospital admission or discharge
Hospital acquired pneumonia
67
Where are ACE inhibitors activated in the body?
phase 1 metabolism in liver
68
Where are baroreceptors located?
Carotid sinus AND aortic arch

Key ALS facts (6 decks)

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