LO Related (Part 2)

Question 1

Cardiac arrest would present with which acid-base abnormality

Answer 1

Cardiac arrest

Question 2

Pink puffer

Are they likely to be in type I or type II resp failure

Answer 2

Type 1

Question 3

Where should an ET tube sit normally?

Answer 3

Just above the carina

Question 4

Where is the centre that controls the RESPIRATORY DRIVE found?

Answer 4

In the medulla

Question 5

Max oxygen that can be given with nasal canulae

RATE

PERCENTAGE

Answer 5

4l/min

34%

Question 6

What is the treatment for type 2 respiratory failure

Answer 6

Controlled O2 therapy

Treat the underlying cause

Question 7

What is the DEFINITION of respiratory failure

Answer 7

Failure of the lungs to oxygenate the arterieal blood and/or failure to eliminate CO2

Question 8

TWO roles of Tregs

Answer 8

Peripheral tolerance

Dampening down of immune responses

Question 9

What is a thymocyte

Answer 9

Immature T cell found in the thymus

Question 10

Mutations in FOXP3 (Treg marker) can lead to which syndrome

Answer 10

IPEX

Condition in which Treg function is lost - thus individuals will mount inappropriate immune responses and the body will not be able to supress these

Question 11

Cancer is only MALIGNANT when

Answer 11

The basement membrane has NOT been breached

Question 12

Describe the stigma associated with lung cancer

Why is this an issue

Answer 12

Often seen as a disease brought on by smoking “brought on themselves by smoking”

This stigma can delay people seeking help

Question 13

What is the single cause of preventable illness

Answer 13

Smoking - lung cancer

Question 14

Example of a benign tumour that despite being benign can have SERIOUS COMPLICATIONS

Answer 14

Meningioma

Benign slow growing tumour in the arachnoid mater

Can lead to increased intercranial pressure

Question 15

Describe the 5 steps of CENTRAL TOLERANCE

Answer 15

T cell progenitors enter the cortex of thymus

TCR a and B chains generated

Thymocytes exp TCR WEAKLY recongising SELF MHC allowed to survive (FIRST SELECTION IS POSITIVE)

Thymocytes exp a TCR STRONGLY binding SELFMHC with a SELF PEPTIDE are KILLED (SECOND SELECTION IS NEGATIVE)

REMAINING CELLS WEAKLY BIND TO SELF MHC IS THE PRESENCE OR ABSENCE OF SELF PEPTIDES

Question 16

Markers of Treg cells

Answer 16

CD4 and CD25

ALSO FOXP3 (this is the key transcription factor in Treg development)

Question 17

Cytokine produced by Th cells to activate B cells and CT cells

Answer 17

IL-2

Question 18

What are the three different types of stigma

Answer 18

Physical

Moral

Tribal

Question 19

What is a LEIOMYOSARCOMA

Answer 19

Malignant tumour of the smooth muscle

Question 20

Symptoms of Horners syndrome

Answer 20

Miosis - constriction of the pupil

Ptosis - drooping of the upper eyelid

Anhidrosis - lack of sweating

Question 21

What is nuclear pleomorphism

Answer 21

Abnormalities in the size/shape of the nucleus

Question 22

What are the FIVE As of PATIENT CENTRED COUNSELLING

Answer 22

Ask

Assess

Advise

Agree

Assist/arrange

Question 23

SCLC arise from which cells

Answer 23

NEuroendocrine

Question 24

What is a leimyoma

Answer 24

Benign tumour of the smooth muscle

Question 25

What does release of IFN-gamma from Th cells promote

Answer 25

The activation of MACROPHAGES and NK cells

Question 26

Describe how DENDRITIC cells are SUPER ANTIGEN PRESENTING CELLS

Answer 26

Exogenous antigen can be presented on MHC1 by dendritic cells

Question 27

What is the theory of SELF-AFFIRMATION

Answer 27

People respons to situations in a certain way to protect their self-identity

Question 28

What is the gap between the FIRST and SECOND heart sound

Answer 28

SYSTOLE

Question 29

Vircows triad for blood clot formation

Answer 29

Stasis Hypercoagulation Endothelial damage

Question 30

Secondary pacemaker of the heart and its rate

Answer 30

Av node - 50 bpm

Question 31

ST depression is the reuslt of

Answer 31

Myocardial ischaemia

Question 32

What is a PHAEOCHROMOCYTOMA

Answer 32

Tumour of the adrenal medulla - catecholamine secreting

Question 33

Define postural hypertension

Answer 33

Sudden decrease in blood pressure upon standing Systolic BP drops by OVER 20mmHG

Question 34

What is the primary pacemaker of the heart What is its INHERENT ryhthm Why is the actual HR usually less

Answer 34

SA node 100 bpm PSNS tonic inhibiton via CNX

Question 35

6Ps of CIRITICAl LIMB ISCHAMEIA

Answer 35

``` Pallor Pain Pulseless Paresthesia Paralysis Perishingly cold ```

Question 36

What is a FUSIFORM aneurysm

Answer 36

Dilation of the ENTIRE CIRCUMFERENCE of the artery

Question 37

Gp1b/Ix binds

Answer 37

vWF

Question 38

What are the VITAMIN K DEPENDENT CLOTTING factors

Answer 38

7 10 and prothrombin

Question 39

What are GARTANS

Answer 39

Direct thrombin inhibitors

Question 40

What are XABANS

Answer 40

Direct factor X inhibitors

Question 41

GpIIb/IIIa binds

Answer 41

Fibrinogen and vWF inducing platelet aggregation`

Question 42

What type of clots would anti-platelets be most useufl against

Answer 42

Arterial

Question 43

MOA abciximab and tirofiban

Answer 43

Inhibition of gpIIb/IIIa

Question 44

When post infarct would you see yellow discolouration and neutrophil infiltrate

Answer 44

24-72 hours

Question 45

When post infarct will you see HYPERAEMIA around yellow dead muscle (macroscopic) and visible granulation tissue (micro)

Answer 45

3-10 days

Question 46

How is the extrisnic pathway of the coagulation cascade activated

Answer 46

TISSUE INJURY Causing the release of tissue factor or phospholipid exposure

Question 47

What is the most common HEPARIN used now and why

Answer 47

LMWH COmpared to unfractionated LONGER DURATION with a MORE PREDICTABLE EFFECT

Question 48

What is a saccular aneurysm

Answer 48

Aneurysm with a sac-like bulge on the one side

Question 49

At what time after an infarct will white fibrotic scar tissue appear

Answer 49

Weeks to months

Question 50

GpIa/IIa binds...

Answer 50

Collagen

Question 51

At what time after an infarct will you see pale discolouration and intracellular oedema

Answer 51

12-24 hours

Question 52

When do troponins rise post-MI

Answer 52

Within 3 hours

Question 53

Function of type II pneumocytes

Answer 53

Production of surfactant

Question 54

Side effects of GTN sprays

Answer 54

Reflex tachy Postural hypotension Headache

Question 55

Describe UNSTABLE ANGINA

Answer 55

Plaque that has a THIN FIBROUS cap so ruptures unpredictably causing CP that resolves in 20mins as the thrombus resolves THERE IS NO LASTING DAMAGE

Question 56

What type of Ca channel do CCBS block

Answer 56

L-type

Question 57

Describe the acute (WITHIN HOURS) changes as a reuslt of MI

Answer 57

ST elevation Abnormal Q wave T wave inversion Tachycardia

Question 58

What is KARYOREXXIS

Answer 58

Nuclear fragmentation

Question 59

Risk calculatory for CVD

Answer 59

QRISK3

Question 60

Where in the body to dihyrdropyrdines work

Answer 60

They work on the ARTERIOLAR SMOOTH MUSCLE They DO NOT work on the heart

Question 61

How do Na, Adre and Ang II contribute to cardiac remodelling

Answer 61

Increased production of TGF-B

Question 62

How does the NYHA classify the stages of heart failure

Answer 62

Symptoms are graded dependent on their ability to carry out physical activity 1 = no limitations 4 = inability to carry out activities of daily life

Question 63

Normal level of what peptide excludes HF

Answer 63

BNP

Question 64

Causes of ACUTE heart failure

Answer 64

MI PE Valve rupture

Question 65

How does aldosterone lead to cardiac remodelling

Answer 65

Increased levels of EGF

Question 66

Treatment for chronic HF

Answer 66

``` Diuretic ACEi/ARB Beta blockers Digoxin Pacemaker if arrhythmia ```

Question 67

2 potential causes of right heart failure

Answer 67

Shunt (left to right) Cor pulmonale

Question 68

Why do K sparing diuretics INCREASE PROGNOSIS of HF

Answer 68

Inhibtiion of aldosterone - thus also inhibits the effects aldosterone has on cardiac remodelling

Question 69

3 main causes of HF

Answer 69

Ischaemic heart disease Dilated cardiomyopathy Long standing HTN

Question 70

Which drugs releive symptoms in HF

Answer 70

Loop and thiazide diuretics Inotropic drugs (e.g. digoxin)

Question 71

RSR in V1 =

Answer 71

RBBB

Question 72

M shaped QRS in lead 5/6 ==>

Answer 72

LBBB

Question 73

Limits of an RCt

Answer 73

Sometimes unethical Expensive Poor design is common Can take time MUST BE CRITICALLY APPRAISED

Question 74

Treatment of ACUTE HF

Answer 74

``` Sit up High flow O2 IV loop diuretic Morphine Nitrate CPAP ```

Question 75

What are three threats to the reliability of evidence

Answer 75

BIAS CHANCE CONFOUNDERS