CR2 OVERVIEW Flashcards Preview

Year 2 CR > CR2 OVERVIEW > Flashcards

Flashcards in CR2 OVERVIEW Deck (130):
1

Cardioinhibitory centre

Parasympathetic innervation to the heart - synapsing with the vagus nerve

Release of ACh

2

Cardioacceleratory centre

Sympathetic innervation of the heart - synapsing with sympathetic trunk and general visceral afferents in lateral horn of grey matter

3

Autonomic region of the grey matter within the spinal cord

Lateral horn - T1 to T4

4

Vagus nerve nuclei

Nucleus ambiguus
Dorsal motor nucleus
Solitary nucleus

5

Mechanism of action of ischaemia of the heart - angina

Nociceptors on the ends of the general visceral afferents are activated via the build up of lactate

6

Nerve roots of general visceral afferents

T1-T4

7

Where is angina referred to?

T1-T4 - inferior medial aspect of the arm and under the jaw

Also referred to the epigastrium - T5-T9

8

Surfaces of the heart

Anterior (top)
Right pulmonary
Left pulmonary
Diaphragmatic (bottom)

9

Blood supply to the interventricular septum

Posterior descending artery and the LAD

10

Define afterload

The end load against which the heart contracts to eject blood

11

Consequence of left ventricular hypertrophy

Reduced size of the ventricle chamber - reduced cardiac output and reduced compliance of the wall of the left ventricle

12

In which valvular disease will the atrium large?

Mitral valve stenosis

13

What is the consequence of left atrial enlargement?

Atrial fibrillation - stroke
Loss of atrial kick
Decreased filling of the left ventricle - reduced cardiac output
Can result in emboli entering the circulation

14

Pulmonary oedema vs plural effusion

PO - collection of excess fluid at the base of the lungs
PE - collection of excess fluid in the plural cavity

15

Isoforms of NOS

1 - bNOS - calcium dependent
2 - iNOS - not calcium dependent - inflammatory cytokines
3 - eNOS - vascular endothelium - calcium dependent

16

How does exercise activate the sympathetic nervous system?

Exercise causes activation of the sympathetic nervous system via activation of the alpha-1 receptors

17

Receptors causing vasoconstriction

Alpha-1 receptors

18

Receptors causing vasodilation

Beta-2 receptors

19

Chemicals causing vasodilation of exercising muscles

NO
Adenosine

20

Reduced cerebral blood flow - when does this result in reversible and in permanent brain damage?

Reduced by half - reversible brain damage
Reduced by 3/4 - irreversible brain damage

21

Formula to calculate BP

BP = CO x SVR

22

Hypotension

BP less than 90/60

23

Hypertension

BP greater than 140/90

24

Prehypertension

BP in the range of 135-139/85-89

25

Define cardiac output

The volume of blood pumped out of the heart per minute

26

Concentric hypertrophy

The wall of the left ventricle increases in size - hypertrophy of the muscle wall and the size of the chamber decreases - must increase HR to maintain CO

27

Eccentric hypertrophy

The size of the whole of the left ventricle increases - leads to heart failure

28

Hyponatremia? Exact value

Low sodium levels in the blood - below 135mm/L

29

RAAS pathway

Angiotensinogen to angiotensin 1 via renin
Angiotensin 1 to angiotensin 2 via ACE
Angiotensin 2 - release of aldosterone, increased production of ADH and activation of sympathetic NS

30

Location of baroreceptors

Mechanoreceptors in the carotid sinus and in the aortic arch

31

Mechanism of thiazide diuretic

Inhibits reabsorption of sodium chloride from the distal convoluted tubule

32

'Myeloid tissue'

Bone marrow

33

Production site of EPO

Fibroblasts in the proximal convoluted tubule of the kidney

34

Function of haemoxygenase enzyme

Conversion of haem to biliverdin

35

Enzymes involved in haem to bilirubin conversion

Biliverdin reductase

36

What are the three stages of atheroma formation?

Endothelial damage - activation
Uptake of modified LDLs and adhesion and infiltration of macrophages
Smooth muscle proliferation and formation of a fibrous cap

37

What is meant by glycation?

Bonding of sugars to a lipid/protein

38

What are monocytes transformed into?

Macrophages

39

What is the role of macrophages in ateriosclerosis development?

Monocytes bind to receptors that are sticking out into the lumen from the endothelium and then enter the blood vessel - transformed into macrophages - these release of proinflamamtory cytokines e.g. PDGF
Pick up excess levels of LDL via scavenger receptor - formation of foam cells

40

What is a foam cell?

LDL laden macrophage/fat laden macrophage

41

How is a foam cell formed?

Macrophage normally picks up LDL due to apolipoprotein B100 receptor - modified LDL not recognised by this receptor and is picked up by scavenger receptor - excess levels picked up --> foam cell

42

Summarise formation of atheromatous plaque

Activated endothelium
Uptake of modified LDL and infiltration of macrophages - formation of foam cells
Release of growth factors - migration of smooth muscle cells which lay down collagen
Formation of fibrous cap
Rupturing of fibrous cap - exposure of underlying collagen and platelets can stick here to form thrombus

43

What are the different levels of an artery?

Tunia adventia
Tunica media
Tunica intima

44

What is contained within the polypill?

Aspirin
ACE inhibitor/Beta blocker
Diuretic
Statin

45

Through what artery is a stent usually inserted for atherosclerosis?

Radial artery (rather than femoral artery)

46

Arteriosclerosis vs. atherosclersosis

Ateriosclerosis - stiffening/hardening of arterial wall
Atherosclerosis - narrowing of an artery due to plaque build up

47

How does LDL modification occur?

Oxidation from ROS
Glycation

48

Common sites of atheroma formation

Aortic bifurcation
Carotid bifurcation
Common iliac artery - lateral wall
Coronary arteries

49

Ferric reductase

Ferrous 2+ to ferric 3+

50

Chemical presentation of ferrous iron

Fe2+

51

Chemical presentation of ferric iron

Fe3+

52

What are the normal levels of haemoglobin in males and females? (NEED TO KNOW)

Males - 13.5
Females - 11.5

53

Define hypochromic

Paler than normal in colour (less colour)

54

MCV of microcytic anaemia

<76

55

MCV of macrocytic anaemia

>96

56

What is a pencil cell?

Cell that has shrunk down into a tube
Indicative of microcytic anaemia

57

What are plasma ferritin levels indicative of?

Indicative of the level of iron that is stored in the body (diagnostic marker)

58

Factors to increase iron absorption

Increased haem consumption
Pregnancy
Iron deficiency
Ferrous (Fe2+) salts
Acid pH

59

Factors to impair iron absorption

Alkali pH
Consumption of non-heam iron (veg)
Ferric salts
Iron overload
Inflammatory disorders
Drugs use e.g. PPIs

60

Cause of macrocytic anaemia

B12/Folate deficiency

61

Where is B12 and where is folate absorbed in the body

B12 - absorbed in the ileum
Folate - absorbed in the duodenum and the jejunum

62

Cells that produce intrinsic factor

Parietal cells in the gastric mucosa

63

Cause of spherocytic anaemia

Haemoloysis - lack of proteins to hold the cell in bioconcave shape

64

Splenomegaly occurs in what type of anaemia and why

Spherocytosis because there is increased premature haemolysis occurring

65

Glucose-6-phosphate dehydrogenase

G6PD - enzyme that prevents/reverses the oxidation of RBCs

66

Significance of G6PD deficiency

Deficiency results in premature oxidation of RBCs - premature haemolysis

67

Inheritance of G6PD deficiency

X-linked

68

Clinical tests to test for the presence of antibodies to red blood cells (haemolytic anaemia)

Direct coombs test
Direct antiglobulin test

69

RR interval represents?

Heart rate

70

PR interval represents?

Action potential from the atria to the Bundle of His

71

P wave represents?

Atrial depolarisation

72

Normal range for heart rate

60-100pbm

73

Normal length for p wave

<80

74

Normal length for PR interval

120-200

75

Normal length for QRS interval

<120

76

Atrial fibrillation vs. atrial flutter

AFib: Many sites in the right atrium are firing action potentials to compete with the SAN
AFlut: One overexcited site of excitation in the left atrium competing with the SAN

77

Ventricle tachycardia vs. ventricle fibrillation

Tachy: Abnormal but regular QRS complex
Fib: Abnormal and irregular QRS complex - no sign of organisation at all and the ventricles only quiver

78

Junctional rhythm

Some form of damage to the SAN/the path through here and so the main pacemaker shifts to the AVN

79

Supraventricular tachycardia

Atrial tachycardia

80

Significance of right bundle branch block

Damage to the right hand side of the heart

81

Significance of left bundle branch block

Heart disease

82

Wolff-Parkinson White syndrome

Formation of a new (pathological) connection between the atria and the ventricles - known as the Bundle of Kent

83

Atrioventricular nodal reentrant tachycardia

There are two activations of the AVN - a fast cycle and a slower cycle SO inbetween each AVN depolarisation - there is another, pathological one

84

Why does a low grade fever occur when you have an MI?

MI - ischaemia - there is a leakage of proteins and this can stimulate an inflammatory response

85

Cardiogenic shock

Inadequate circulation of blood and insufficient perfusion of tissues to meet the O2 demand

86

Cardiac arrest

A sudden stop in effective blood flow due to a failure of the heart to contract effectively

87

Thromboembolytic drugs (name two main)

Streptokinase
Tissue plasminogen activator (tPA)

88

What is the main problem with thromboembolytic drugs?

Major risk of haemorrhage and bleed

89

Why can streptokinase only be used once?

Develop antibodies against it - risk of anaphylaxis and allergy

90

Define dyspnoea

Difficult or laboured breathing where the subject is short of breath
Undue awareness of breathing/difficulty breathing

91

What are J receptors?

Pulmonary c-fibre receptors (slow)
Sensory nerve endings in alveolar walls innervated to vagus nerve
Feedback - shortened expiration and increased respiratory frequency

92

Value for hypoxia

pO2 <8kPa

93

Value for hypercapnia

pCO2 >6.8

94

Type 1 vs type 2 respiratory failure

Type 1 - hypoxia and hypocapnia
Type 2 - hypoxia and hypercapnia

95

Different types of heart block

a

96

How can you recognise macrocytic anaemia from blood film?

a

97

Cause of macrocytic anaemia

a

98

Common causes of sinus bradycardia

a

99

Cause of type 1 respiratory failure

Ventilation/perfusion mismatch

100

Cause of type 2 respiratory failure

Inadequate alveolar ventilation

101

What is released from the blood vessel when it is damaged? Local effect of this?

Endothelin - vasoconstriction

102

Sepsis vs. septic shock

Sepsis - systemic response to the presence of pathogens in the blood
Septic shock - sepsis + hypotension

103

Stroke volume vs cardiac output

a

104

Obstructive vs. restrictive disease

a

105

Vitalograph and function

a

106

Define tidal volume

a

107

Define expiratory reserve volume

a

108

Define inspiratory reserve volume

a

109

Define vital capacity

a

110

Define functional residual volume

a

111

Define residual capacity

a

112

Define total lung capacity

a

113

Define peak flow rate

a

114

Vitalograph and function

a

115

Obstructive vs. restrictive disease

a

116

Peak flow rate morning vs. evening

a

117

Define asthma

a

118

Investigation to determine presence of obstructive vs. restrictive disease

a

119

Asthma - on which cells are the IgE receptors found?

a

120

Which mediator results in the immediate bronchoconstriction in asthma?

a

121

Pathophysiology of bronchoconstriction in asthmatics (immediate and delayed)

a

122

Main immunoglobulin (Ig) involved in asthma/allergies/atopic condtions

a

123

Four substances that can trigger asthma

a

124

Alpha-1-anti-tripsin and cause

a

125

Main cause of emphysema

a

126

Significance of virchow's node

Metastasis from the gut

127

Where is the lymphatic drainage to and which is most major?

Right - right lympatic duct
Left - thoracic duct - this is the major drainage

Right - only from the right arm, right side of head and the right thorax

128

Where are the superficial lymph nodes located?

Cervical - drain above the clavicle
Axillary - drain between clavicle and the umbilicus
Inguinal - drainage below the umbilicus

129

State the lymph nodes of the head adn neck

Think from osce

130

Two groups of inguinal lymph nodes

Horizontal - superficial to the inguinal ligament - drain from perineum and the external genitalia
Vertical - along great saphenous vein - drain from the leg