DVTs & PEs & Sleep Physiology

Question 1

What are 3 major cardiovascular causes of death?

Answer 1

Ischaemic heart disease
stroke
DVT

Question 2

more chance of DVT if you’re older or younger?

Answer 2

older

Question 3

Risk factors for Venous Thrombosis?

Answer 3

Slowing of flow

endothelial dysfunction/injury

Question 4

Hypercoagulability causes?8 things

Answer 4

severe burns
post-MI
malignancy/chemo
high oestrogen 
autoimmune
nephrotic syndrome
obesity
inflammatory diseases

Question 5

Genetic Hypercoagulability causes?

Answer 5

Factor V Leiden mutation (most common)

Question 6

What happens in Factor V Leiden mutation?

Answer 6

Activated protein C(anticoagulant) can no longer bind to Factor V cause it’s mutated

Question 7

Heterozygotes of Factor V Leiden mutation have how many fold increase? what’s the prevalence in pop?

Answer 7

4% of pop, 50% in DVT pop

5 fold increase

Question 8

Homozygotes of Factor V Leiden mutation have how many fold increase of DVT?

Answer 8

100-fold increase

Question 9

Prothrombin mutation does what for hyper coagulability?

Answer 9

increase circulating plasma level

Question 10

Thrombophilia happens more arterial? or venous

Answer 10

venous

Question 11

Thrombophilia would suspected if 3 things happen:

Answer 11

young age
recurrent
unusual site

Question 12

Is post-surgical state considered Thrombophilia?

Answer 12

Nope, it’s transient. Thrombophilia is more long term/chronic

Question 13

deep and superficial veins, they connect, which way do they flow?

Answer 13

superficial>deep

Question 14

proximal or distal DVTs likely to embolize?

Answer 14

proximal

Question 15

common site of DVTs?

Answer 15

calves

Question 16

symptoms of DVT?

Answer 16

subtle: swelling, redness, warmth, pain, tenderness

Question 17

Do most people with DVT have symptoms?

Answer 17

50% asymptomatic

Question 18

Pulmonary thrombo-embolism, how many people die within first hour? how many from subsequent recurrent embolism?

Answer 18

10%

30%

Question 19

Pleuritic pain in Pulmonary thrombi-embolism could indicate what?

Answer 19

pulmonary infarct

Question 20

Pulmonary thrombo-embolism symptoms

Answer 20

variable dyspnoea

haemoptysis, cough, syncope

Question 21

What happens once a Pulmonary thrombi-embolism gets into a local pulmonary artery?

Answer 21

hypoxaemia
reflex vasoconstriction
V/Q mismatch

Question 22

If a large one of 60% of vascular bed occluded in Pulmonary thrombi-embolism, what happens?

Answer 22

sudden death and collapse

Question 23

medium sized Pulmonary thrombo-embolism, what happens?

Answer 23

dyspnoea
cough
acute for pulmonale

Question 24

Are pulmonary infarcts common?

Answer 24

nope, only if has CVD or preexisting lung condition

Question 25

Small Pulmonary thrombi-embolism features?

Answer 25

clinically silent | multiple small emboli = chronic cor pulmonale

Question 26

What is saddle Pulmonary thrombi-embolism?

Answer 26

near beginning of pulmonary artery near heart

Question 27

fate of Pulmonary thrombi-embolism?

Answer 27

dissolution | organization

Question 28

What happens in Pulmonary thrombi-embolism organization?

Answer 28

recanalization, complete or partial

Question 29

What could happen to valves in DVT?

Answer 29

damaged | varicose veins

Question 30

long term DVT consequences?

Answer 30

chronic venous insufficiency chronic oedema, pigmentation/haemosiderin ulceration

Question 31

prevention of DVTs: 5 things:

Answer 31

``` drugs mobilization exercise compression stockings lifestyle ```

Question 32

When do you thrombosis of upper limbs?

Answer 32

catheritizations or thrombophilia

Question 33

When would you be likely to get thrombosi in cerebral venous sinus mesenteric veins portal veins hepatic veins?

Answer 33

thrombophilia/genetics

Question 34

Defining characteristic of sleep?

Answer 34

capability of returning rapidly to wakefulness. Accumulation of debt

Question 35

sleep for energy preservation?

Answer 35

eh, not really, only 10% less than fully awake

Question 36

sleep to keep out of trouble

Answer 36

nah. more older theory.

Question 37

What seems to be the ideal amount of sleep vs. mortality?

Answer 37

7-ish hours

Question 38

Kids who are sleep deprived are tired? or hyper?

Answer 38

ADHD hyper

Question 39

83% increase in risk of complications with sleep deprivation in what professionals?

Answer 39

surgeon

Question 40

Does nap help with degradation of cognitive performance?

Answer 40

yes, sleep is sensitive to beef amount of sleep

Question 41

what will get you over 0.05 for sleep?

Answer 41

awake for 18-24 hours 5 hours of sleep for 4-5 nights sleep apnoea return trans-atlantic flight

Question 42

What's the objective vs. subjective reports of people with sleep deprivation?

Answer 42

objective: performance worsens consistently subjective: ppl get used to it

Question 43

What are the 3 most common sleep problems in Aus?

Answer 43

4.7 sleep apnoea 3% primary insomnia 1.2% restless legs syndrome

Question 44

What increased breathing when you exercise before chemoreceptors?

Answer 44

muscle/joint receptors

Question 45

What 3 drives to breath are stopped completely during sleep?

Answer 45

higher brain centers emotion stim wakefulness drive to breath

Question 46

What 3 drives to breath are partially stopped completely during sleep?

Answer 46

lung stretch receptors touch/temp/pain receptors muscle/joint receptors

Question 47

upper airway resistance increases with inspiration or expiration?

Answer 47

inspiration

Question 48

What happens to minute ventilation as soon as you fall asleep?

Answer 48

sharp decreases minute ventilation

Question 49

What is the major regulator of breathing during sleep?

Answer 49

chemical control

Question 50

What sleep phase is worst for OSA?

Answer 50

REM sleep

Question 51

What is normal pCO2 during sleep?

Answer 51

35-45mmHg

Question 52

How is movement during REM sleep?

Answer 52

commanded but inhibited

Question 53

Which muscles are not paralyzed during REM?

Answer 53

breathing and eyes

Question 54

How many sleep cycles per night? How long do each cycle last for?

Answer 54

4-6 cycles | each between 90-120min

Question 55

what happens to slow wave/deep refreshing sleep as you get older?

Answer 55

decreases in time and frequency

Question 56

Circadian rhythms cues include?

Answer 56

Light | endogenous

Question 57

body temp Warmer at night or day?

Answer 57

during day, cooler at night varies ~1 degree

Question 58

Where is the suprachiasmatic nucleus? what does it do?

Answer 58

in hypothalamus governs some circadian rhythms

Question 59

How does suprachiasmatic nucleus work?

Answer 59

receives light from retina (esp. blue light) projects to paraventricular nucleus>pineal gland and secretes melatonin

Question 60

What happens to a rat drinking water after suprachiasmatic nucleus lesion?

Answer 60

drinks randomly through day instead of at night when it's awake (nocturnal animal)

Question 61

2 times of day where there's the most MVAs?

Answer 61

morning | late afternoon

Question 62

If you take away light, what is the biological clock set to?

Answer 62

25.3 hours

Question 63

What is advanced sleep phase type sleep disorder?

Answer 63

bed at 6 | up at 3am

Question 64

2 ways sleep is generated:

Answer 64

1. cholinergic | 2. His, NA, Ache affecting thalamus/cortex

Question 65

VLPO does what to sleep system?

Answer 65

inhibits all other activating systems

Question 66

What causes disinhibition of VLPO in sleep?

Answer 66

ATP depletion/accumulation of adenosine in basal forebrain

Question 67

What's the role of Orexin in sleep?

Answer 67

stabilizes the on/off switch in sleeping when VLPO is disinhibited