KCP Flashcards
Where and what is pain from myocardial ischaemia felt?
Centre on the chest.
It may radiate to the neck, jaw, upper or lower arms
Occasionally, in the back
Dull, constricting, choking and is described as burning, aching or squeezing
takes several minutes to develop.
Accompanied by sweating, nausea, breathlessness or vomiting
Where and what is the pain of myocarditis or pericarditis felt?
To the left of the sternum, or in the left or right shoulder
Felt as sharp, and may ‘catch’ during coughing
Where is the pain of aortic dissection felt?
central, with radiation to the back.
severe, and ‘tearing, usually sudden onset
What is pleurisy?
a condition in which the pleura — two large, thin layers of tissue that separate your lungs from your chest wall — becomes inflamed
a sharp or catching chest pain aggravated by deep breathing,
What is angina caused by?
Occurs during exercise and is relieved by rest. Can be exacerbated by emotion, a large meal or cold wind.
What is pain caused by gastro-oesophageal reflux like?
central, dull and burning
can elicit a history relating chest pain to eating drinking or oesophageal reflex.
How can you tell the difference between ischaemic cardiac and non-cardiac chest pain?
What should clinicains investiagte if a patient presents with chest pain?
- 12 lead electrocardiogram (ECG)
-
What does chest pain accompanied by clinical evidence of increased intracardiac pressure indiacte?
Myocarial ischaemia or massive pulmonary embolism.
Legs should be examined for clinical evidence of deep vein thrombosis.
What is coronary heart disease usually caused by?
atherosclerosis (buildup of fats, cholesterol and other substances in and on your artery walls)
rarely, aortitis (inflammation of the aortia)
What are the risk factors for coronary heart disease?
Age
Genetics
Smoking
Hypertension
type 2 diabtetes
physical activity levels
obesity
Alcohol
social deprivation
What are risk factors for myocardial infarct?
Age, gender, obesity, lack of exercise, bad diet, smoking, blood pressure, family history, diabetes,
What is myocardial ischemia?
Myocardial ischemia occurs when blood flow to the heart muscle is obstructed by a partial or complete blockage of a coronary artery. A sudden, severe blockage of one of the heart’s artery can lead to a heart attack. Myocardial ischemia may also lead to abnormal heart rhythms (atrial fibrillation).
Why is troponin released into the blood during a myocardial infarction?
When the cell does not get enough oxygen, aerobic pathways cannot continue and ATP cannot be made. Anaerobic respiration takes place and lactic acid is produced. This leads to components of the cell being released, called troponins.
What are the steps of an ECG?
What happens when a trauma patient arrives at the hospital?
- hospital get a warning call- includes vital signs, injury, age and time of injury
- role allocation occurs, organise equipement and a room for the patient
- Once patient arrives, check for life threatening injuries
- May need to remove head blocks, stretcher, pelvic scoop and clothes.
- Aim to get a CT scan 20 mins after arriving in the hospital.
What initiative should emergency doctors follow?
ATLS (advanced trauma life support) which involves a primary and secondary check and the ABCDE checklist
What is the airway section of managing trauma patients?
If uncounscious, patients airway should be checked and cleared.
If the patient is vomiting, either log roll them or if chance of a spinal injury, head tipped bacl and vomit sucked away
Once airway checked, very patient should receive 100% oxygen at a flow rate of 15 L/min, and neck and cervical spine must be checked for injuries.
What does the breathing section of trauma patient managment include?
Check for tension pneumothorax, cardiac tamponade, open chest wound, massive haemoxthroax or flail chest
Respiratory rate must be measured
Chest x-ray crucial
Chest should be visually examined and listened to as well
What does the circulation and haemorrhage control section of managing trauma patients involve?
Look for clinical signs of shock, such as fast HR and poor capillary refill
Control any external haemorrage by pressure- torniquets only used when limb is unsalvagable
Blood should be taken to determine blood type, electrolyte concentrations, pH and blood gas analysis
The type of fluid given to patients differs in each region. To reduce the chance of hyperthermia, fluids must be warmed before use. If the vital signs do not improve at all, the patient has lost >40% of blood.
Whata are the D and E sections of managing a trauma patient?
D= disability, spinal cord and brain function tested by reflexes. The glasgow coma scale should be used
E=exposure and environment control- keep patient warm, continue to measure vital signs. Only after the main problems have been solved can move onto secondary survery.
What is hypovolaemic shock?
- Hypovolaemic shock is a clinical state in which loss of blood, extracellular fluid, or plasma causes inadequate tissue perfusion.*
- Hemorrhagic shock is hypovolemic shock from blood loss*
How much blood needs to be lost until a healthy adult’s systolic blood pressure decreases?
30-40% of blood volume
What happens in haemorrhagic shock?
Haemorrhagic shock causes a significant lactic acidosis; pyruvate is unable to enter the Krebs cycle. Instead, pyruvate undergoes anaerobic metabolism in the cytoplasm, a process that is relatively inefficient for adenosine triphosphate (ATP) generation. ATP depletion causes cell membrane pump failure and cell death. The aim of resuscitation is to deliver oxygen rapidly to stop death.
What are signs of hypovolaemic shock?
- Skin pallor
- hypotension
- confusion, agression, drowsiness
- weakness
- thirst
What are the 3 different classes of hypovolaemic shock?
Why should no fluid be given prehospital if theres a pulse/ little fluid given if theres no pulse?
if the wounds are still open as extra fluid could dislodge clots and further cause bleeding
What fluid ratios should be given to patients?
Platelets : Fresh frozen plasma : blood
1:1:1
Where are the most common places patients bleed?
chest, abdomen, pelvis and femur
What are the 5 shapes of bone?
Long- cyndrical shape such as femur
Short- cube or box shaped such as carpals
Flat- broad and thin, such as scapulae
Irregular bones- clustered in groups, facial bones
Sesamoid bones- irregular bones that appear by themsleves such as patella
What is the medullary cavity?
Marrow cavity- filled with connective tissue rich in fat (yellow marrow). Lined by the endosteum
What is articular cartilage and periosteum?
Articular cartilage is the thin layer of hyaline cartilage that covers the articular or joint surfaces of epiphyses. The resiliency of this material cushions jolts and blows. Periosteum is dense, white fibrous membrane that covers bone except at joint surfaces. Many of the periosteum fibres penetrate the underlying bone and weld these two structures to each other. In addition, muscle tendon fibres interlace with periosteal fibres, thereby anchoring muscles firmly to bone.
What are the layers of flat bones?
Outer and inner walls of compact bone- called external and internal table.
Between them is a region called diploe, made of cancellous bone. Red marrow fills the spaces of the cancellous bone inside many flat bones.
Why is bone hard?
Results from the deposition of rocklike crystals of calcium and phosphate. Known as hydroxyapatite- make up 85% of organic mix
What structure does compact bone have?
Osteons or haversian systems, surrounding central canal. Made up of individual lamellae cyclinders.
What is cancellous or spongey bone made of?
No osteons, instead crisscross branches known as trabeculae. Nutrients are delivered to the cells and waste products are removed by diffusion through tiny canaliculi that extend to the surface of the very thin bony branches
What are the different bone cells?
- Osteoblasts mall cells that synthesize and secrete an organic matrix called osteoid. Collagen strands in the osteoid serve as a framework for the formation of hydroxyapatite crystals, which mineralizes the bone tissue.
- Osteogenic stem cells, found in the endosteum and lining the central canals, undergo cell division to form osteoblasts
- Osteoclasts are giant multinucleate cells that are responsible for the active erosion of bone minerals.Osteoclasts erode bone by releasing hydrochloric acid (HCl) that dissolves the hard mineral crystals and collagenase , which is an enzyme that breaks the peptide bonds in collagen proteins.
- Osteocytes are mature, nondividing osteoblasts that have become surrounded by matrix and now lie within lacunae. Maintain bone tissue
What is osteoporosis?
The defining feature of osteoporosis is reduced bone density, which causes micro-architectural deterioration of bone tissue and leads to an increased risk of fracture, in response to minor trauma.
What are the risk factors for Osteoporosis?
Exercise and Calcium intake during growth effect peak bone mass
Smoking
Alcohol
Age
Drugs such as glucocorticoid
Post-menopause
Ethnicity
What are the two types of osteoporosis?
Idiopathic OP- no specific underlying cause, usually old age
Secondary- caused by diseases and drug treatments such as glucocorticoid-induced OP
What is a DEXA scan?
Dual-energy X-ray absorptiometry is a means of measuring bone mineral density using spectral imaging. Two X-ray beams, with different energy levels, are aimed at the patient’s bones. When soft tissue absorption is subtracted out, the bone mineral density can be determined from the absorption of each beam by bone.
What main treatment is given for OP?
Bisphosphonates, target bone surfaces and are ingested by osteoclasts during the process of bone resorption. Impairs bone resorption. Increases bone density.
Given orally for upto 10 years. Have to be taken on an empty stomach.
What treatments other than Bisphosphates are given for OP?
Denosumab= a monoclonal antibody that inhibits bone resorption by neutralising the effects of RANKL. One potential adverse effect is hypocalcaemia but this can be mitigated by calcium and vitamin D supplements.
Calcium and vitamin D= Combined calcium and vitamin D supplements have limited efficacy in the prevention of osteoporotic fractures when given alone but are widely used as an adjunct to other treatments.
Surgery= Orthopaedic surgery with internal fixation is frequently required to reduce and stabilise osteoporotic fractures. Patients with intracapsular fracture of the femoral neck generally need hemi-arthroplasty or total hip replacement.
What are the 4 stages of bone remodelling?
What is the difference in spirometry levels of a COPD patient?
•COPD diagnosed with an FEV1/FVC ratio <0.7
How does sitting contribute to back pain?
Sitting shortens the psoas muscle, which pulls slightly on the spine
(Lumbar lordosis is the inward curve of the lumbar, or lower, spine in the lower back)
What causes lumbar radiculopathy?
Most commonly due to:
Disc herniation (slipped disk)
Spondylosis (pain in the spine) due to degenerative osteoarthritis
What is the arterial blood supply to brain like?
What is the circle of Willis and why is it important?
The Circle of Willis is the joining area of several arteries at the bottom (inferior) side of the brain.
Circle of Willis is important in circulation as there are connections so if one path gets slowly blocked, the blood can go the other way.
What do each of the arrows point to and what is the diagnosis?
Diagnosis- OA
What do each of the arrows point to and what is the diagnosis?
Diagnosis- OA
What leads to hyperuicemia (high uric acid concentrations)?
