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CardioResp Flashcards

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1
Q

Preload measurement

A

End diastolic volume
End diastolic pressure
Right atrial pressure

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2
Q

Afterload measurement

A

Diastolic bp

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3
Q

Heart sounds

A

S1: closure of mitral valve
S2: closure of aortic valve
S3(just after S2): congestive HF
S4(just before S1): hypertension etc

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4
Q

Alveolar cells

A 
Type 1(95%): thin, gas exchange
Type 2(5%): secrete antiprotease and surfactant, replicate to replace type 1
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5
Q

Function of nasal conchae

A

Warm and humidify air

Filter large particles

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6
Q

Lung capacities

A 
Tidal volume
Inspiratory capacity
Functional residual capacity
Vital capacity
Total lung capacity
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7
Q

Positive and negative pressure breathing

A

Negative is normal

Positive is CPAP or mechanical ventilation

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8
Q

Shifts in HbO2 sat and PO2 graph

A

Right shift: high temp, CO2, 2,3DPG, acidosis
Left shift: low temp, CO2, 2,3DPG, alkalosis, HbF
Down shift: anaemia
Up shift: polycythaemia
Down and left: HbCO
Severe left shift: myoglobin

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9
Q

Endogenous regulation of heart

A

SA node controls pulse
Phase 0: upstroke from Ca influx
Phase 3: repolarisation from K efflux
Phase 4: pre potential from Na influx

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10
Q

Cardiac muscle action potential

A 
Phase 0: Na influx(depolarisation)
Phase 1: K efflux(early repolarisation)
Phase 2: Ca influx(plateau)
Phase 3: K efflux(repolarisation)
Phase 4: RMP
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11
Q

Exogenous regulation of heart(brain)

A

Vasomotor centre(VMC) in medulla
Sympathetic/paraympathetic on SA node
M2 receptor(ACh)
Beta-1 receptor(NA)

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12
Q

Exogenous regulation of heart(kidney)

A

BP detected by baroreceptors
Sympathetic->renin->AT2-> vasoconstriction and raise bp
AT2->aldosterone->Na reabsorption-> blood volume rise

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13
Q

Exogenous regulation of heart(blood vessels)

A

Low filling/pressure->low baroreceptor firing->sympathetic activity
Vasoconstrictors: thromboxane A2, adrenaline
Vasodilators: NO, ANP

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14
Q

Control of lung function

A

4 nuclei in medulla
Dorsal respiratory group: inspiration
Ventral respiratory group: expiration and inhibits apneustic centre
Apneustic centre: stimulates DRG
Pneumotaxic centre: regulates depth and frequency, inspiratory off switch

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15
Q

Afferent lung receptors

A

Irritant: induces cough
Stretch: excessive inflation->DRG & VRG
J: detects oedema->breathing frequency

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16
Q

Type of vessel with highest resistance

A

Arteriole

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17
Q

Variation of perfusion and ventilation in lung

A

Highest at base, lowest at apex

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18
Q

Arteriole vasodilation

A

Active hyperaemia e.g. skeletal muscle

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19
Q

Arteriole vasoconstriction

A

Myogenic autoregulation e.g. GI arterioles

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20
Q

What is heart failure(causes, symptoms, tests, treatment)

A

Preserved(<50%) or reduced(<40%) ejection fraction
Causes: hypertension, cardiac damage, valve disease
Symptoms: exertional dyspnoea
Tests: elevated BNP and cardiomegaly
Treat with drugs that reduce heart exertion

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21
Q

Atrial arrhythmias

A 
AF: disorganised electrical activity
WPW: tachycardia and abnormal electrical conductance
Symptoms: palpitations and chest pain
ECG: 
Absent p wave and irregular rhythm(AF)
QRS delta wave(WPW)
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22
Q

Conduction block

A

1: prolonged P-R interval
2: Mobitz 1(increasing) and 2, missing QRS
3: no relationship between P and QRS
Treatment: discontinue AV blocking drugs and implant pacemaker if severe

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23
Q

Acute coronary syndrome types, cause, symptoms, biomarker and treatment

A

Angina, NSTEMI, STEMI
Caused by atherosclerosis

Angina: chest pain on exertion
NSTEMI: chest pain, sweating, nausea
STEMI: radiating chest pain, sweating, nausea

High troponin in NSTEMI & STEMI

Treat with vasodilators, coronary stent, CABG, anti platelets, pain relief

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24
Q

COPD comprises of

A

Emphysema: alveolar destruction
Chronic bronchitis: mucus hypersecretion
Small airway disease: small airway fibrosis

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25
COPD cells and mediators
``` Neutrophils secrete proteases (neutrophil elastase and MMP) Macrophages T lymphocytes TNF alpha IL8 ```
26
Tetralogy of Fallot
Pulmonary stenosis Right ventricle hypertrophy Interventricular septal defect Widening of aorta
27
Aortic stenosis causes
Rheumatic heart disease | Calcium build up
28
Aortic stenosis pathogenesis
Endocardial injury Inflammation Leaflet fibrosis and calcium deposition on valve Low aortic leaflet mobility High afterload->left ventricle hypertrophy
29
Aortic stenosis presentation
Ejection systolic murmur High LDL Chest pain Exertional dyspnoea
30
Aortic stenosis management
Aortic valve replacement Balloon aortic valvuloplasty Antihypertensive Statins
31
Aortic regurgitation causes
Acute: infective endocarditis, trauma Chronic: rheumatic fever
32
Aortic regurgitation pathogenesis
Acute: Infective endocarditis->rupture of leaflets Chronic: Rheumatic fever->fibrotic changes-> thickening and retraction of leaflets
33
Aortic regurgitation presentation
Acute: Tachycardia Cyanosis Pulmonary oedema Chronic: Wide pulse pressure
34
Aortic regurgitation management
Treat underlying cause first Acute: vasodilators and valve replacement/repair Chronic asymptomatic: drugs if LV function normal Chronic symptomatic: valve replacement and adjunct vasodilator therapy
35
Mitral stenosis causes
Rheumatic fever SLE Carcinoid syndrome
36
Mitral stenosis pathogenesis
``` Acute cause Formation of multiple foci Infiltrate endo and myocardium Valve thickens, calcifies and contracts High left atrial pressure Pulmonary oedema&hypertension Low left ventricle filling Low cardiac output ```
37
Mitral stenosis presentation
Dyspnoea Orthopnoea Diastolic murmur Hepatojugular reflux
38
Mitral stenosis management
Progressive asymptomatic: no therapy Severe asymptomatic: adjuvant balloon valvotomy Severe symptomatic: diuretic, valve repair/replacement, beta blockers
39
Mitral regurgitation causes
``` Acute: Infective endocarditis Chronic: Rheumatic heart disease SLE ```
40
Mitral regurgitation pathogenesis
``` Infective endocarditis Abscess formation Rupture of chordae tendinae Leaflet perforation Eccentric hypertrophy ```
41
Mitral regurgitation presentation
``` Dyspnoea Pan systolic murmur Fatigue Orthopnoea Chest pain Atrial fibrillation ```
42
Mitral regurgitation management
Acute: Emergency surgery, diuretics, intra aortic balloon counterpulsation Chronic asymptomatic: ACEi, beta blockers, surgery if EF<60% Chronic symotomatic: surgery, intra aortic balloon counterpulsation if EF<30%
43
Dilated cardiomyopathy type of dysfunction
Systolic
44
Most common valve disease
Mitral regurgitation
45
Dilated cardiomyopathy presentation
``` Dyspnoea Displaced apex beat Systolic murmur Pulmonary congestion Low cardiac output High natriuretic peptides ```
46
Dilated cardiomyopathy management
Fluid and Na restrict Treat underlying cause Antihypertensive
47
Hypertrohpic cardiomyopathy type of dysfunction
Thick left ventricular wall | Diastolic
48
Hypertrophic cardiomyopathy presentation
``` S3 gallop Syncope Dizziness Palpitations Double carotid artery impulse ```
49
Hypertrophic cardiomyopathy management
Check Hb, BNP, troponin levels Beta blockers Calcium channel blocker Pacemaker Disopyramide
50
Restrictive cardiomyopathy type of dysfunction
Normal wall thickness but stiff muscle | Diastolic
51
Restrictive cardiomyopathy presentation
Ventricular pressure rises quickly but ventricular volume rises slowly Low filling Low cardiac output Hepatomegaly with pain Peripheral oedema Hepatojugular reflux
52
Restrictive cardiomyopathy management
Amyloidosis check ``` Antihypertensive Antiarrhythmic Immunosuppression Pacemaker Cardiac transplant ```
53
Broad QRS complex
LBBB or RBBB
54
High take off on ST segment
Benign early repolarisation
55
Tall T wave
Hyperkalaemia
56
Inverted T wave
V1-3: RBBB V4-6: LBBB V5-6: left ventricular hypertrophy Widespread: HCM
57
Biphasic T wave
Hypokalaemia
58
Asthma cells and mediators
Eosinophils Mast cells Type 2 lymphocytes IL4,5,13
59
Asthma allergic sensitisation test
Skin test: wheel and flare reaction | Blood test: specific IgE
60
Asthma diagnosis
Spirometry FEV1/FVC<0.7 Bronchodilator reversibility >12% Exhaled nitric oxide(FeNO)>35ppb(child) or 40ppb(adult)
61
Asthma management
``` Inhaled corticosteroids Leukotriene receptor antagonist Beta 2 agonist Anticholinergic therapy Anti IgE antibody (mepolizumab) Anti IL-5 Anti IL-5 receptor ```
62
Most common and most deadly resp infections and most commonly infected age group
Common: rhinovirus Deadly: tuberculosis Age: 0-10
63
Pneumonia grading
CURB65 ``` Confusion Urea >7mmol/L Resp rate >30 breaths/min BP <90systolic or <60diastolic Age >65 ```
64
Bacterial pneumonia management
Supportive: oxygen, fluids, analgesia Penicillin (amoxicillin) Macrolides (clarithromycin)
65
Viral bronchiolitis management
Supportive: fluids, oxygen, analgesia Antiinflammatory: steroids, anti IL6, anti IL6R Vaccine Antivirals: remdesivir, paxlovid, casirivimab
66
Types of resp failure
Type 1: hypoxaemic Type 2: hypercapnic Type 3: perioperative Type 4: intubated and ventilated during shock
67
ARDS symptoms
Dyspnoea Tachypnoea Cyanosis
68
ARDS pathophysiology
Fluid accumulation in lungs not from heart failure Alveolar injury and surfactant dysfunction Inflammation: TNF, DAMPs, cytokines Compliance is reduced
69
ARDS diagnosis
Acute onset Bilateral opacities on imaging Respiratory failure not caused by heart failure Decreased PaO2/FiO2 ratio
70
ARDS treatment
Mechanical ventilation Prone position Fluid management(diuresis) ECMO
71
Lung cancer epidemiology
Age >75 M>F Smoking history Genetics
72
Types of lung cancer
Squamous cell carcinoma: bronchial Adenocarcinoma(common): peripheral Large cell lung cancer Small cell lung cancer: highly malignant
73
Lung cancer oncogenes
BRAF ALK ROS1 EGFR Tyrosine kinase inhibitor for systemic treatment
74
Lung cancer symptoms
``` Weight loss Haemoptysis Cough Breathlessness Chest pain ```
75
Lung cancer biopsies
Bronchoscopy for central airway Endobronchial ultrasound and transbronchial needle aspiration of lymph nodes: stage mediastinum CT guided biopsy: peripheral tumours
76
Lung cancer management
Surgery: lobectomy and lymphadenectomy Radical radiotherapy: SABR Oncogene systemic Immunotherapy systemic: block PDL1 but PDL1 must be >50% Cytotoxic chemotherapy: platinum based regime, good with pembrolizumab(immuno) Palliative and supportive care
77
Primary haemostasis failure causes
Thrombocytopenia(leukaemia, B12 deficiency, ITP, DIC) Impaired platelet function(aspirin, clopidogrel, NSAIDs) Von willebrand factor disease(hereditary) Vessel wall(ageing, vasculitis, scurvy)
78
Primary haemostasis failure symptoms
Prolonged bleeding Petechiae(blanches with pressure):thrombocytopenia Purpura(doesnt blanch):platelet/vascular disorders Easy bruising
79
Primary haemostasis failure treatment
Replace missing factor/platelets Stop drugs Immunosuppression if autoimmune(ITP) Splenectomy for ITP
80
Secondary haemostasis failure causes
Low factor production(haemophilia A/B, drugs, liver disease) Dilution(blood transfusion) High consumption(DIC)
81
Secondary haemostasis failure features
Haemarthrosis(haemophilia) Superficial cuts dont bleed Bleeding into deep tissue, muscle, joints
82
Raised PT, normal APTT
Factor VII
83
Normal PT, raised APTT
Factors VIII, IX, XI, XII
84
Raised PT and APTT
Liver disease, anticoagulants, DIC, transfusion dilution
85
Secondary haemostasis failure treatment
FFP: contains all factors Cryoprecipitate: mainly fibrinogen Factor concentrates: except factor V
86
Haemophilia treatment
Gene therapy Bispecific antibodies(A):mimics factor VIII RNA silencing: targets antithrombin Desmopressin: raises VWF and factor VIII Tranexamic acid: antifibrinolytic
87
Virchow’s triad thrombosis
``` Blood(venous) Vessel wall(arterial) Blood flow(mixed) ```
88
Thrombophilia presentations
Thrombosis at young age Spontaneous thrombosis Thrombosis while on anticoagulants
89
Thrombophilia causes
Low antithrombin, protein C, protein S High factor VIII, II Factor V Leiden Myeloproliferative disorders
90
Vessel wall and blood flow thrombosis
Vessel wall: inflammation Blood flow: reduced flow increases risk(long haul flight)
91
Heparin
Enhances antithrombin: inactivates IIa and Xa Unfractionated: IV, short half life, greater effect Low molecular weight: subcutaneous
92
Warfarin
Blocks recycling of vit K Many drug interactions Side effects: bleeding, skin necrosis, purple toe syndrome, embryopathy Warfarin montoring using INR
93
DOAC
``` Rapid onset No food effect Few drug interactions No monitoring Some renal dependence Reversible with antidotes ```
94
Layers of vascular endothelium
Tunica adventitia Tunica media Tunica intima
95
Atherosclerosis risk factors and causes
``` Hypercholesterolaemia Diabetes mellitus Smoking Obesity Hypertension Sex hormone imbalance Ageing Oxidative stress Infectious agents Haemodynamic forces ```
96
Nitric oxide in different types of flow
Laminar: high NO production Turbulent: low NO production
97
Nitric oxide functions in vessel wall
``` Reduce LDL oxidation Vasodilation Reduce platelet activation Inhibit monocyte adhesion Reduce superoxide release ```
98
Where is LDL deposited in atherosclerosis
Subintimal space | Binds to matrix proteoglycans
99
Role of macrophages in atherosclerosis
Inflammation from LDL deposition LDL oxidised by free radicals Macrophage phagocytosis Foam cell formation, apoptosis after
100
Receptors on macrophage(atherosclerosis)
LDL receptors undergo -ve feeback when LDL in cell is high Scavenger receptors have no feedback so high influx of OxLDL
101
Atherosclerosis enzymes invloved
NADPH oxidase(O2-) Myeloperoxidase(bleach) Metalloproteinase(MMP): degrades collagen, causing bleeding
102
Atherosclerosis cytokines and chemokines, chemoattractant and growth factor
IL-1 Monocyte chemotactic protein(MCP-1) Platelet derived growth factor(PDGF) TGF beta
103
Transcription factor in atherosclerosis activated by __ and activates __
Nuclear factor kappa B gets activated by scavenger receptors and IL-1 Activates MMP and IL-1 secretion
104
Macrocytic anemia causes
B12 deficiency: diet, gastrectomy, pernicious anaemia, Crohn’s Folate deficiency: diet, proximal jejunum(coeliac disease), high demand Drugs that inhibit DNA synthesis Liver disease/ethanol toxicity
105
Haemolytic anaemia causes
Membrane integrity: hereditary spherocytosis, autoimmune haemolytic anaemia Structure and function: sickle cell anaemia Cellular metabolism: G6PD deficiency
106
Blood test for autoimmune haemolytic anaemia
Direct antiglobulin test (DAT)
107
Causes of microcytic anaemia and which chain is affected
Iron deficiency(haem) ACD(haem) Thalassaemia(globin)
108
Iron deficiency causes
Blood loss: menorrhagia, GI Insufficient intake: vegetarian, coeliac, H. Pylori gastritis Increased requirement: pregnancy
109
Iron deficiency blood test results
Low ferritin High transferrin Normal ESR
110
ACD blood test results
High ferritin Low transferrin High ESR
111
ACD pathology
Rheumatoid arthritis, autoimmune disorder, malignancy or TB/HIV IL-1, TNFa, IL-6 Low erythropoietin, high hepcidin
112
Hb electrophoresis thalassaemia
HbA2 is raised: beta thalassaemia
113
MI treatment
Anticoagulants Primary percutaneous coronary intervention Alternative: thrombolysis or CABG
114
Mild VWD treatment
Desmopressin: increases VWF and FVIII
115
Murray score ARDS
PaO2/FiO2(on 100% O2) CXR PEEP(positive end expiratory pressure) Compliance(ml/cmH2O) 3 or more->ECMO

Y2 (10 decks)

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