CR EOYS4 Flashcards by patrick ellis

What pathology should you investigate after an ECG after a TIA? [1]

arrhythmias

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keratin pearls are associated which of the following?

small cell cancer
squamous cell cancer
adenocarcinoma cancer
non-small cell lung cancer

keratin pearls are associated which of the following?

small cell cancer
squamous cell cancer: HALLMARK FEATURE !
adenocarcinoma cancer
non-small cell lung cance

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What type of cancer is depicted?

small cell lung cancer
squamous cell lung cancer
adenocarcinoma lung cancer
non-small cell lung lung cancer

What type of cancer is depicted?

small cell lung cancer
squamous cell lung cancer; keratin pearl !!
adenocarcinoma lung cancer
non-small cell lung lung cancer

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Malignant squamous cell carcinoma can lead to

Hypercalcemia
Hyperkalemia
Hyponatremia
Hypophosphatemia

Malignant squamous cell carcinoma can lead to

Hypercalcemia Squamous cell carcinoma can cause hypercalcemia, as the tumor secretes parathyroid-hormone-related peptide, which can cause hypercalcemia.

Hyperkalemia
Hyponatremia
Hypophosphatemia

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Which of the following would be caused by pneumonia induced hypoventilation

Increased resistance as a result of airway obstruction

Reduced compliance of the lung tissue/chest wall

Reduced strength of the respiratory muscles

Drugs

Which of the following would be caused by pneumonia induced hypoventilation

Increased resistance as a result of airway obstruction

Reduced compliance of the lung tissue/chest wall

Reduced strength of the respiratory muscles (

Drugs

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Name two disease that would cause reduced strength of the respiratory muscles and this hypoventilation [2]

Guillain-Barré; motor neurone disease

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Name two clinical signs of CO2 retention [2]

Flap (asterixis): ask a patient to extend arms out, close eyes, should be able to hold for 30 secs
Bounding pulse

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The usual Alveolar-arterial O2 difference is not normally greater than:

1.0 kPa
1.3 kPa
2.4 kPa
2.8 kPa
3.0 kPA

The usual Alveolar-arterial O2 difference is not normally greater than:

1.0 kPa
1.3 kPa
2.4 kPa
2.8 kPa
3.0 kPA

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Which of th following would be caused by obesity induced hypoventilation

Increased resistance as a result of airway obstruction

Reduced compliance of the lung tissue/chest wall

Reduced strength of the respiratory muscles

Drugs

Which of th following would be caused by obesity induced hypoventilation

Increased resistance as a result of airway obstruction

Reduced compliance of the lung tissue/chest wall

Reduced strength of the respiratory muscles

Drugs

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A patient suffering from an asthma attack would use which of the following

Simple face mask
Nasal cannulae
Venturi mask
Face mask with reservoir bag

A patient suffering from an asthma attack would use which of the following

Simple face mask
Nasal cannulae
Venturi mask
Face mask with reservoir bag

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A patient suffering from an sepsis attack would use which of the following

Simple face mask
Nasal cannulae
Venturi mask
Face mask with reservoir bag

A patient suffering from an sepsis attack would use which of the following

Simple face mask
Nasal cannulae
Venturi mask
Face mask with reservoir bag

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A patient suffering from an acute exacerbation of COPD would use which of the following

Simple face mask
Nasal cannulae
Venturi mask
Face mask with reservoir bag

A patient suffering from an acute exacerbation of COPD would use which of the following

Simple face mask
Nasal cannulae
Venturi mask
Face mask with reservoir bag

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Which part of the lung has the greatest airway resistance? [1]

Which part of the lung has the least airway resistance? [1]

The above can be determined according to which law? [1]

Medium-sized bronchi collectively have the smallest radius: greatest airway resistance.

Terminal bronchioles have the lowest resistance since, collectively, it has the largest radius

Poiseuille law

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What determines the alveolar to arterial PO2 difference? [1]

What is usual Alveolar-arterial O2 difference not normally greater than? [1]

Shunting determines the alveolar to arterial PO2 difference

The normal A-a O2 difference is not normally greater than 1.3 kPa

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How do you calculate normal aterial PaO2? [1]

Normal PaO2 = 13.6 – (0.044 x age in yrs) kPa

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What is shunting (of the lungs)? [1]

What can shunting be caused by [1]

]

When an area of the lung is perfused but not ventilated. Blood is transported through the lungs without taking part in gas exchange

Can be caused by Arteriovenous malformations (AVMs)

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Label A & B [2]

A: Lung failure
B: Pump failure

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Type 2 Respiratory Failure is an imbalance between which three factors? [3]

Imbalance between:
- Neural respiratory drive
- Load of resp. muscles
- Capacity of the resp. muscles

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LEARN ! Name 4 reasons that could cause hypoventilation

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Increased resistance as a result of airway obstruction (e.g.COPD)

Reduced compliance of the lung tissue/chest wall (e.g. pneumonia, rib fractures, obesity).

Reduced strength of the respiratory muscles (diaphragm) (e.g. Guillain-Barré, motor neurone disease)

Drugs acting on the respiratory centre reducing overall ventilation (e.g. opiates)

Name three consequences of CO2 retention [3]

State for each their clinical signs [3[

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End-organ hypoxia
- Altered mental status
- Bradycardia and hypotension (late)

Haemoglobin desaturation
- Cyanosis

CO2 Retention
- Flap (asterixis): ask a patient to extend arms out, close eyes, should be able to hold for 30 secs
- Bounding pulse

If the SpO2 is >94% the the PaO2 should be >[]kPa

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If the SpO2 is >94% the the PaO2 should be >10kPa

First line of treatment for respiratory failure? [1]

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Oxygen

Which type of patients would require the following?

Oxygen masks / nasal cannulae
Face mask with reservoir bag
Venturi mask

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Oxygen masks, nasal cannulae
Patient with normal vital signs (post-op)

Face mask with reservoir bag
Higher O2 concentration needed (asthma attack, pneumonia, sepsis)

Venturi mask
Controlled treatment in long-term respiratory failure (COPD)

Explain MoA of how atherosclerosis causes ischaemic stroke

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Endothelial damage allows lipoproteins and monocytes to adhere to the vessel wall and enter the intima.

Monocytes differentiate into macrophages and engulf the lipoprotein and become known as foam cells.

Further accumulation of cholesterol and foam cells forms a fatty streak.

Foam cells release pro-inflammatory cytokines which leads to smooth muscle cell proliferation. and connective tissue to deposition in the fatty streak.

These changes form a fibrous cap over the lipid core.

A necrotic core can form due to the lack of capillaries.

Plaque rupture removes the endothelium which exposes the fibrous cap leading to thrombosis and occlusion of the artery

What is a watershed ischaemic stroke? [1]

Sudden **BP drop** by more than **40mmHg**, then there is **low cerebral blood flow** = **global ischaemia leading to ‘watershed infarcts**’ in vulnerable areas of cortex between **boundaries of different arterial territories** brain ischemia that is localized to the vulnerable border zones between the tissues supplied by the anterior, posterior and middle cerebral arteries

When is common to see watershed stroke?

Sepsis patients

Which drug classes would use for primary prevention of stroke? [3] Control of which disease would allow prevention of stroke? [1]

Primary prevention: * Cholesterol: statin * AF: anticoagulation * Good diabetic control * BP: antihypertensives

What are the 3 overlying causes of cellular death in stroke? [3]

Mechanical compression Cerebral Oedema Excitotoxicity

Excitotoxicity of stroke

How would you treat acute ischameic stroke: - if within 4.5 hrs of onset [1] - if outside 4.5 hrs of onset [1]

**Thromboylsis:** - using drug - **Alteplase** - Must occur within 4.5 hours of onset - haemorrhage has to be excluded **Mechanical thrombectomy** - endovascular removal of a thrombus from a large artery.

How would you manange an acute TIA?

**300mg Aspirin** Refer urgently to TIA clinic (to be seen within 24 hours). In clinic: work out if was stroke or not. Might do ECG to see if have AF

What are a common consequence of prolonged or recurrent inflammation, particularly allergic inflammation in respiratory system? [1]

**Nasal polyps** are oedematous protrusions of the respiratory mucosa and are a common consequence of prolonged or recurrent inflammation, particularly allergic inflammation.

Which part of the respiratory system is the main site of SABA action? [1]

Smaller airways in tracheal / bronchial tree: requires **smooth muscle** to be there (to relax)

Which secretory protein is associated with pathologies such as COPD and asthma? [1] Which cell secretes? [1]

**Secretory protein C16:** associated with pathologies such as COPD and asthma. **non-ciliated bronchiolar Clara cells** This protein increasingly appears to protect the respiratory tract against oxidative stress and inflammation

What are the histopatholigcal features of TB? [4]

**Langhan cells** immune cell infiltration granulomas; have central **necrosis and cavitation** **tissue destruction**

Histopathological features in pneumonia? [1]

aggregates of neutrophils (almost like an abscess) in the alveolar

Name a risk factor for squamous cell carcinoma [1] What are histological changes are induced by ^? [2]

Often centrally located close to hilum Smoking is a risk factor: - Leads initially to **metaplasia** (from **respiratory to squamous epithelium**) then **dysplasia**. - Smoke **procarcinogens** can be converted to **carcinogens** via **P450**

What may be indicative of paraneoplastic syndrome due to Squamous Cell Carcinoma? [1]

**Hypercalcemia** may be indicative of paraneoplastic syndrome due to SCC

Histopathological features of Cytological features of Squamous cell C? ? [5]

- Small, malignant cells often very large with **eonisophilic cytoplams** [1] and large vesicular nucleus [1] - High nuclear:cytoplasm ratio - **Intercellular bridges** - **Keratin pearls** [1]

Histopathological features of adenocarcinoma? [3]

irregular, closely packed glands effacing normal lung appearance with **atypical cells lining the gland lumen** **glandular hyperplasia** **desmoplastic (fibrotic) stroma around them.**

What type of T helper cells are found in granulomas? [1]

TH1 subtype

Describe that immune pathophysiology of granuloma formation

- Antigen taken up by macrophage & presented to CD4+ helper T cells - CD4+ helper T cell convert to **TH1 subtype** - TH1 cells screte **IL-2 and INy** - **T cell proliferation and macrophage activation** - **Macrophages** and T cells secrete **TNFa** - Causes increase in inflammatory cells - Causes repeat of TH1 cells screte IL-2 and INy etc

Label A-D of this granuloma

Name the type of lung cancer depicted

metastatic small cell carcinoma - blue cluster note: - orange myeloid precursors - fat cells - blue erythoid precursors - megakaryocytes

subacute combined degeneration of the cord causes degeneration of which columns of the spinal cord posterior and lateral posterior and medial anterior and lateral anterior and medial

subacute combined degeneration of the cord causes degeneration of which columns of the spinal cord **posterior and lateral** posterior and medial anterior and lateral anterior and medial

CR EOYS4 Flashcards

(45 cards)