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ESA 5 > Integrative > Flashcards

Integrative Flashcards

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1
Q

pH range

A

7.35-7.45

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2
Q

Describe HCO3 reabsorption?

A 
Baso = HCO3 Na sym
Apical = NHX

Intercalated has pump and HCO3 Na sym
From Glutamine/ a ketoglutarate and from CO2 carbonic anydrase.
Ammonia creasted rom glutamine and moves freely into lumen to trap H+

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3
Q

Anion gap calculation?

A

NAK- ClHCO3

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4
Q

Causes of metabolic acidosis with a normal anion gap?

A

REnal tubular necrosis

Diarrhoea (as HCO3 replaced by Cl-)

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5
Q

Body fluids and volumes in each

A

1/4 of ECF = plasma
ECF = 1/3
ICP = 2/3
so 12L dextrose to replace 1 L of blood

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6
Q

Stimulates thirst

A

AngioII
Hyothalamus-osmoreceptors
low saliva from tonicity

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7
Q

How can Diabetes lead to shock?

A

DKA = urinary loss of fluid

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8
Q

Describe types of clinical incident

A

Patient saftey Incident (PSI)
Near miss
Serious untoward incident (SUI)
Never event = preventaple PSI

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9
Q

How to report a clinical incident

A

Datix reporting

Inform key line managers

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10
Q

Describe the sites of haemopoesis in the fetus

A 
0-2 months = yolk sac
2-5 months = liver and spleen
5-9 months = bone marrow
Infants this is most bones
Adults in vertebrae, ribs, sternum, sacrum, pelvis and ends of femur
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11
Q

What is bone marrow? Colours?

A

Stem cells supported by stroma
Red marrow (haemopoetic) vs yellow marrow (fatty)
All red at birth

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12
Q

Myeoloid progenitor vs myeloblast?

A

Myeoloid progenitor also produces Magakaryocyte, eythrocyte and mast cells

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13
Q

Describe myeloblast to neutrophul

A 
Myeloblat
Promyelocyte
Myelocyte
Metamyeolcyte
Band cell (c shae)
Neutrophil

Nucleus starts large and cytoplasm grows so it shrinks

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14
Q

Describe myeloid progenitor to RBC

A

Proerythro
Normoblast
Reticulocyte
Red cell

Haemoglobinisation of cytoplasma
Nuclear maturation and nuclear extrusion

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15
Q

Platelet production controlled by?

A

Thrombopoietin (TPO)

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16
Q

Structure of the spleen?

A

Red pulp - sinuses lined by endothelial macrophages and cords
White pulp - like lymph follicles (white cells and plasma preferentialy pass here and red through red pulp)

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17
Q

Descrie the functions of the sleen

A

Phagocytosis
Blood pooling- activation of platelets and RBCs if bleeding
Haemopoiesis (from pluripotent) Extramedullary
Immunologicao - T and B cells

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18
Q

Causes of splenomegaly

A

Massive - keukaemia, malaria, myelofibrosis
Moderate - Liver cirrhosis, portal hypertension and above
Mild- as above also infections e.h. hep and glandular fever, hepatits, endocarditis, sarcoidosis
Pancytopeia from enlarged spleen possibke

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19
Q

Causes of hyposplenism

A

Caeliac and Sickle cell

Risk of sepsis

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20
Q

Define aplastic anaemia

A

Pancytopenia with hypocellular bone marrow with no infiltration or fibrosis
Can be idiopathic

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21
Q

COngenital deficit in B cells?

A 
X linked hypogammablobulinaemia
Low IgA,M
No tonsils
Recessive
Early
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22
Q

What is ataxia talangiectasia

A

Thymic hypoplasma, low B cells

BMTransplant

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23
Q

Neutrophil congenital deficiency

A

Chronic granulomatous disease
X linked recessive
Persistent infections of mucous membrane
BMT

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24
Q

Aquired B cell deficiency

A

Hypogammaglobulinaemia

Chronic lymphatic leukaemia and other lymphoproliferativevm nephrotic

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25
Aquired T Cell immunodeficiency
HIV, Chemo, Hodgkins, immunosuppression
26
What is myelodysplasia
Non-functioning neutrophils
27
Describe cytomegalovirus
In immunocompromised patients Pneumonitis, oesophagitis, colitis, hepatitis Black spots?
28
What do Stellate cells in the liver do?
Secrete ECM so more in disease
29
NYHA Functional calssification of HF
Class I no syptoms/ limitations II - slight limit and symptoms in physical III - Marked limitation and symptoms in physical act IV - At rest, discomfort with any phys
30
Heart diagram in systolic and dialstolic
Hypertrophy in dia | Dilated in systolic
31
Describe diastolic heart failure
``` Elderly and female Hypertension, DM, obesity Reduced LV compliance and relaxation Unable to compensate by increasing EDP Low cardiac output results ```
32
Normal result in clonus
2 is still normal
33
What is Hoffman's sign?
Monosynaptic reflex (indicate an UMNL)
34
Illicit drugs RF stroke
Cocaine
35
What is the valsalva maneouvre?
aneuver or Valsalva manoeuvre is performed by moderately forceful attempted exhalation against a closed airway, usually done by closing one's mouth, pinching one's nose shut while pressing out as if blowing up a balloon
36
Causes of haemorrhagic stroke
``` Hypertension Anti coagulation Vascular abnormalit Amyloid deposition Tumour ```
37
Describe TACs and PACs
Hemianopia, hemiparesis, hemisensory loss and higher cortical dysfunction PACS: 2 of these or higher cortical dysfunction only
38
Name of removal system in spleen
Reticuloendothelial system
39
TYpes of abnormal red cells
Spherocytes Elloptocytes Acanthocytes Target cells e.g. alcohol, liver, thalassemia
40
Symptoms and signs of anaemia
``` Tierdness DIzziness Palpatations Headaches SOB Weakness Angina, claudication, confusion, HF ``` Palor Tachycardoa Sstolic flo murmur HF
41
Causes of microcytic anaemia
``` Iron Anaemia of chronic disease Thalassemia Lead SIderoblastic anaemia (ring sideroblasts produced) ```
42
Causes of macrocytic anaemia
B12 deficiency, folate deficiency | Pernicous anaemia - autoantibody to intrinsic factor required to absorb B12
43
Normocytic normochromic (NORMAL SIZE)ANAEMIA CAUSES?
aNAEMIA OF CHRONIC DISEASE mIXED DEFICIency of Fe and V12/folate BM failure
44
Causes of neutrophillia
``` Infection Acute inflam Smoking Drugs Acute haemorrhage Myeloproliferative disease Metabolic/ endocrine disorders Malignant disease Cytokines ```
45
Causes of monocytosis
Chronic inflammatory conditions chronic infection eg..g. TB Carcinoma Myeloproliferative disaeases/ leukaemias
46
Causes of eosinophila
Drug hypersensitivity e.g. penicillin Allergic disease e.g. asthma, eczema, urticaria, hay fever, aspergillus Parasitic infection
47
Causes of basophilia
Hypersensitivity reactions UC RA MYeloproliferative
48
Lymphocytosis causes
Reactive e.. viral infections, bacterial, stress e.g. MI, splenectomy Lymphoproliferative e.g. chronic lymphocytic leukaemia Lymphoma
49
What is a Leucoerythroblastic film and what are the causes
Granulocyte precursors and nucleated RBC on film Bone marrow infiltration carcinoma or haem malignancy Sepsis/ shock Severe megaloblastic anamia Storage disease
50
What is VOn Willebrands factor (vWF)
Essential for platelet adhesion and for factor VIII | Activated by collagen and tissue factor
51
Describe the main platelet functions
activation - Coauglation factor activation Secretion - encourage furthur aggregation e.g. ADP thromboxane Aggregation - Platelet plug Adhesion- vessel wall
52
How do we measure intrinsic and extrinsic pathways of clotting
Extrinsic - INR | Intrinsci - APTT
53
SOme problems with vessels
``` Hereditary haemorrhagic telangiectasia (HH) Connective tissue e.g. ehlers Danlos Senile purpura Steroids Infection e.g. measles Scurvy ```
54
Problems with vessels signs
Easy bruiding | Spontaneous bleed from small vessels skin and mucous membranes
55
Causes of platelet function decrease
Rare heriditary NSAIDs clopidogred Uraemia Hypergammaglobulinamiia Leads to bleeding
56
PRoblem with coag factors?
A = 8 B = 9 Liver disease Vit k def
57
Postictal symptoms
headche confusion myalgia
58
Causes of non-epileptic seizure
Trauma Hypoglycaemia Hypoxia
59
Define hypersensitivity
The antigen specific immune response that are either inappropriate or excessive and result in harm to host All have a sensitisation phase and an effector phase (re exposure)
60
Infections driving hypersensitivity against self
Rheumatic heart disease Guillain Barre syndrome Type 1 diabetes - Coxsakie
61
Examples of type I
``` Anaphylaxis Asthma Acute urticaria Food allergy Lts of symptoms ```
62
Pathology in Type 2
Antibody mediated complemet, cytotoxicity and modulation of cellular function
63
examples of type 2 immunosesnitivity reactions
``` Graves disease Myasthenia gravis Pernicious anaemia Goodpastures Haemalogical disease e.g. rhesus and second bby Tissue damage vs change in function ```
64
Type 3 exmamples
Deposition and tissue damage non specifically RA Glomerulonephritis (infectious) SLE
65
Symptoms in SLE
Cardiac (pericarditis), resp, renal, joint (arthrirtis), pleura inflam, fatigue, appetitie, fever, photosensitive, butterfly rash, myalgia
66
Criteria for SLE
Most women Skin Sstemic Laboratory - anti nuclea antibody (ANA)
67
Type IV examples
``` Tuberculin and Mantoux test Granulomatous hypersensitivity e.g. TB Leprosy Schistosomiasis Sarcoidosis Hashimotos RA Coeliac disease - lead to hyposlenism and lymphoma ```
68
Examples of nitrates
Isosorbide Mononitrate
69
SABA expamples
Salbutamol | Terbutaline
70
Nystatin use
Treat mould and yeast infections | Binds to fungal cell membrane and forms pores (K+ leakage)
71
Nystatin ADRS
Diarrhoea, abdo pain, hypersensitivity
72
Clotrimazole moa and adrs
Increases membrane permeability | Itching nausea cvomiting LFTs
73
Amphotericin moa and use
Systemic fungal infections Same as nystatin Fever chills headaches hypotension
74
Metronidazole ADRs
Nausea Metallic Loss of appeatite Headache
75
Drugs to treat anaemia
Ferrous sulphate/ fumerate Hydroxocobalamin- b12 Folic acid
76
MSK anticholiesterases
Neostigmine | Pyridostigmine
77
Isoflurant and sevoflurane MoA
GABA and glycine sesnitisation
78
NM blocking agents
Pancuronium | Suxamethonium chloride

ESA 5 (4 decks)

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