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Misc. Notes Year 1 > Rhodia > Flashcards

Rhodia Flashcards

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1
Q

Signs of pneumonia caused by strep. pneumoniae

A

High fever, rapid onset
Herpes Labialis
Rusty Sputum

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2
Q

Signs of pneumonia caused by Haem. Influenzae

A

Exacerbation of COPD or Bronchiectasis

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3
Q

Signs of pneumonia caused by Staph. Aureus

A

Recent influenza infection

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4
Q

Signs of pneumonia caused by Mycoplasma

A

Dry cough
Atypical chest signs
Haemolytic anaemia
epidemic every 4 years

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5
Q

Signs of pneumonia caused by Legionella

A

Foreign country in contact with cooling system or water stored below 60 degrees
Hyponatraemia
Lymphopenia (low levels of lymphocytes)

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6
Q

Signs of pneumonia caused by Klebsiella

A

Alcoholic
Homeless
Red jelly sputum

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7
Q

Signs of PCP (Pneumocystis jiroveci pneumonia)

A

HIV positive

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8
Q

Causes of Resp. Acidosis

A

COPD
Decompensation (asthma/oedema)
Sedative drugs
Pickwickian syndrome (obesity hypoventilation)
Basically not being able to clear out the CO2 in ur lungs

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9
Q

Causes of Resp. Alkalosis

A 
Anxiety Hyperventilation 
P.E
CNS disorders
Altitude
Pregnancy 
Basically when you blow off too much CO2
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10
Q

Cells involved in cell mediated response

A

Helper and Cytotoxic T Cells

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11
Q

Helper T cell - CD? - MHC?

A

CD4, MHCII

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12
Q

Cytotoxic T cell -CD? -MHC?

A

CD8, MHCI

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13
Q

Cells involved in chronic and acute organ rejection

A

Helper and Cytotoxic T Cells

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14
Q

Major humoral response cell?

A

B cells

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15
Q

Antigen presenting cells

A

B cells, Macrophages & Dendritic cells

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16
Q

Responsible for hyperacute organ rejection

A

B cells

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17
Q

Cell type differentiated from B cells

A

Plasma cells

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18
Q

Cell type which produces large amounts of antibody specific to antigen

A

Plasma cells

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19
Q

Cardiac arrest during an MI is usually due to what

A

ventricular tachycardias

VT or VF usually

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20
Q

What leads to cardiogenic shock during an MI

A

A decrease in ejection fraction

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21
Q

Bradyarrhythmia which can arise during MI and when more common

A

AV block

More common in inferior MI

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22
Q

Time frame after MI for acute pericarditis plus buzzword

A

48hours

“pain relieved on sitting up”

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23
Q

Time frame after MI for Dressler’s plus what is it

A

4-6weeks

Autoimmune phenomenon- pericarditis

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24
Q

Sign of an LV aneurysm following an MI

A

Persistent ST elevation with no chest pain

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25
Time frame for an LV rupture and signs
1-2weeks post-MI | Acute heart failure secondary to cardiac tamponade (raised JVP and muffled heart sounds)
26
Time frame for a ventricular septal rupture and signs
Within a week | Acute heart failure and pan-systolic murmur
27
Cardiac murmur which can arise after MI (more common in infero-posterior MI) and causes
Acute mitral regurge. can be down to ischaemia or rupture of the papillary muscle
28
List the immunoglobulins in order of serum abundance
IgG, IgA, IgM, IgD, IgE | remember GAMDE
29
Which of the immunoglobulins are monomers when secreted
IgG, IgD, IgE
30
Which of the immunoglobulins are dimers when secreted
IgA only
31
Which of the immunoglobulins are pentamers when secreted
IgM | remember what ben said 'M' has 5 lines
32
What is the role of IgG
Enhances phagocytosis Fixes complement passes on to fetal circulation
33
What is the role of IgA
Most commonly produced immunoglobulin Provides localised protection on mucous membranes Found in breast milk
34
What is the role of IgM
First Immunoglobulin produced during infection Fixes complement DOESN'T pass on to fetal circulation (think of it as being too big since it's a pentamer)
35
What is the role of IgD
Role in immune system largely unknown | no one knows how to really use the D
36
What is the role of IgE
Binds to Fc receptors on basophils and mast cells | Provides immunity to parasites such as helminths
37
What is a neutrophil
The main cell involved in acute inflammation | Most common WBC
38
What do neutrophil granules contain
lysozyme and myeloperoxidase | probably don't need to know
39
What is special about the neutrophil nucleus
Multi-lobed
40
What do basophil granules contain
Histamine and Heparin
41
What is special about the basophil nucleus
Bi-lobed
42
Which cell type are mast cells similar to and what dot heir granules contain
Similar to basophils | and yeh u guessed it their granules also contain histamine and heparin
43
What is special about the mast cell nucleus
nothing
44
What is special about the eosinophil nucleus
Bi-lobed
45
What is special about the monocyte nucleus
Kidney shaped
46
What is special about the macrophage nucleus
nothing
47
What is special about the NK cell nucleus
nothing
48
What is special about the dendritic cell nucleus
nothing lol | that got old quick
49
What sort of infections do eosinophils protect against
protozoan and helminthic
50
What cell do monocytes differentiate into
macrophages
51
What do NK cells do
Induce apoptosis in infected/tumour cells
52
What cell releases IL-1 and what is the function
Macrophages | acute inflammation and fever
53
What cell releases IL-2 and what is the function
Th1 cells | Growth and differentiation of T cell response
54
What cell releases IL-3 and what is the function
Activated T cells Differentiation and proliferation of myeloid progenitor cells (NOT GONNA COME UP)
55
What cell releases IL-4 and what is the function
Th2 cells | Stimulates differentiation and proliferation of B cells
56
What cell releases IL-5 and what is the function
Th2 cells | Stimulates production of eosinophils
57
What cell releases IL-6 and what is the function
Macrophages and Th2 cells Stimulates differentiation and proliferation of B cells + fever
58
What cell releases IL-7 and what is the function
U fool | There is no IL-7
59
What cell releases IL-8 and what is the function
Macrophages | Neutrophil chemotaxis
60
What cell releases IL-9 and what is the function
Fs | There is no IL-9
61
What cell releases IL-10 and what is the function
Th2 | Anti-inflammatory and inhibits Th1 cytokines
62
What cell releases IL-11 and what is the function
No | There is no IL-11
63
Is there an IL-12
Yes Released by dendritic + B cells & macrophages It activates NK cells + differentiation of T cells into Th1
64
What cell releases TNF-a and what is the function
Tumour-necrosis-factor alpha is released by macrophages Causes fever Neutrophil chemotaxis
65
What cell releases Interferon γ and what is the function
Th1 cells | Activates macrophages
66
In general, what is the rule of thumb for things that cause the oxygen dissociation curve shift to the left give examples
``` Less of something causes left shift Low [H+] (alkalosis) Low Temp Low 2,3-DPG Low pCO2 (carboxyhaemoglobin) ```
67
In general, what is the rule of thumb for things that cause the oxygen dissociation curve shift to the right give examples
``` More of something causes left shift Raised [H+] (acidosis) Raised Temp Raised pCO2 Raised 2,3-DPG ```
68
Define the tidal volume and give its average value
Volume of air entering or leaving lungs during a single breath 500mls
69
Define the inspiratory reserve volume (IRV) and give its average value
Extra volume of air that can be maximally inspired over and above the typical resting tidal volume 3000mls
70
Define the inspiratory capacity (IC) and give its average value
Maximum volume of air that can be inspired at the end of a normal quiet expiration (IC =IRV + TV) 3500ml obvs
71
Define the expiratory reserve volume (ERV) and give its average value
Extra volume of air that can be actively expired by maximal contraction beyond the normal volume of air after a resting tidal volume 1000mls
72
Define the residual volume (RV) and give its average value
Minimum volume of air remaining in the lungs even after a maximal expiration 1200mls (increases with age)
73
What is the vital capacity and how do you work it out
Maximum volume of air that can be moved out during a single breath following a maximal inspiration (VC = IRV + TV + ERV) 4500mls
74
What is the Functional residual capacity (FRC) and how do you work it out
Volume of air in lungs at end of normal passive expiration (FRC = ERV + RV) 2200mls
75
What is the total lung capacity and how do you work it out
Total lung capacity is the maximum volume of air that the lungs can hold Total lung capacity = Vital Capacity + Residual Volume Roughly 5700mls
76
What is the only lung volume you cannot measure with spirometry and what does this mean
Residual Volume | It means you cannot accurately calculate someone's total lung capacity
77
Give examples of ejection systolic murmurs
Aortic Stenosis (the most obvious one) Pulmonary Stenosis HOCM Atrial septal defect
78
Give examples of pan systolic murmurs
Mitral regurgitation Tricuspid regurgitation Ventricular septal defect
79
Give examples of early diastolic murmurs
Aortic regurgitation | Pulmonary regurgitation
80
Give examples of mid/late diastolic murmurs
Mitral stenosis
81
What does it mean if you hear a continuous machinery murmur below the left clavicle
Patient has a patent ductus arteriosus
82
What perforates the diaphragm at T8
IVC
83
What perforates the diaphragm at T10
Oesophagus | Vagus
84
What perforates the diaphragm at T12
Aorta Azygous vein Thoracic Duct
85
What will be the heart rate for regular sinus rhythm
60-100bpm
86
What is the duration of a normal PR interval
0.12-0.2 seconds
87
What is the duration of a normal QRS complex
0.06-0.12 seconds
88
What is the atrial rate in atrial fibrillation
>300bpm
89
What is the ventricular rate in atrial fibrillation
can be slow, normal or fast | doesn't really matter the atria are still spazzing out
90
What are the P waves like on an ECG of atrial fibrillation
The P waves are absent
91
What is the PR interval like on an ECG of Atrial Fibrillation
Well the P wave is absent so obviously, there isn't a PR interval u idiot
92
What is the QRS complex like on an ECG of Atrial Fibrillation
Normal | Problem is with atria why would that affect ventricular depolarization
93
Describe the atrial rate in atrial flutter
pretty damn fast
94
How would you differentiate between an atrial flutter ECG and an atrial fibrillation ECG
There is no P wave in atrial fibrillation There is saw tooth P waves in atrial flutter (BUZZWORD)
95
What is the ventricular rate in atrial flutter
slow af compared to the atrial rate | but yeh slow compared to normal as well
96
What is the PR interval like in atrial flutter
Non-Measurable
97
What is the QRS complex like in atrial flutter
Normal | Again, the problem is with atria why would that affect ventricular depolarization
98
What is absent on an ECG of someone in asystole
P wave, PR interval (obvs), QRS complex | Basically everything patient is pretty much dead
99
What is the QRS complex like in a bundle branch block ECG
Wide | No idea why wtf even is a bundle branch block
100
What is the rate like in ventricular fibrillation
Non-measurable
101
What is the P wave like in ventricular fibrillation
It's not there - Absent
102
What is the QRS complex like in ventricular fibrillation
There is no QRS complex
103
What is the PR interval like in Ventricular Fibrillation
Lol u fool there's no P wave and no QRS complex How tf are u gonna get a PR interval
104
How can you tell the difference between a ventricular tachycardia and a supraventricular tachycardia on an ECG
SVT has a narrow QRS complex | VT has a wide QRS complex
105
What are two names for Type 1 hypersensitivity
IgE mediated | Immediate
106
Which exposure to the antigen is usually more severe in type 1 hypersensitivity
2nd exposure 1st exposure acts as a sensitisation, priming t cells 2nd exposure involves anaphylaxis
107
Which immunoglobulin is involved in type 1 hypersensitivity
IgE | That's why it's called IgE mediated
108
How is a type 1 hypersensitivity reaction treated
Anti Histamine Corticosteroid Adrenaline
109
What are the immune components involved in a Type 1 Hypersensitivity
Mast cells IgE B lymphocytes T lymphocytes
110
What are 2 names for Type 2 hypersensitivity
Direct Cell killing | Cytotoxic
111
Give 2 examples of type 2 hypersensitivity reactions
Autoimmune Haemolytic Anaemia | Blood transfusion reaction
112
What immune components are involved in Type 2 hypersensitivity
Antibody to cell surface protein B lymphocytes T lymphocytes
113
What is another name for a Type 3 hypersensitivity
Immune complex mediated
114
Give 2 examples of type 3 hypersensitivity reactions
SLE (systemic lupus erythematosus) | Farmer's Lung (hypersensitivity pneumonitis/ EAA)
115
What immune components are involved in Type 3 hypersensitivity
Antigen-antibody complexes B lymphocytes T lymphocytes
116
What are 2 names for Type 4 hypersensitivity
Delayed | T cell mediated
117
Give 3 examples of type 4 hypersensitivity reactions
Sarcoidosis (NON-CASEATING granuloma) Tb (CASEATING granuloma) Type 1 Diabetes
118
What immune components are involved in Type 4 hypersensitivity
Activated T cells and macrophages | persistently activated to form a granuloma
119
What does hyperplasia mean
An increase in cell number
120
What does hypertrophy mean
An increase in cell size
121
What does atrophy
A decrease in cell size & number in a normal sized organ or tissue
122
What is hypoplasia
Reduced size in an organ or tissue which was never normal sized
123
What is metaplasia
An acquired form of altered differentiation | NOT NEOPLASTIC
124
What is neoplasia
An abnormal tissue mass with uncoordinated growth | All cancers are neoplastic but not all neoplasms are cancer
125
What is a benign neoplasm
Resemble normal tissue | no necrosis or metastases
126
What are the characteristics of a malignant neoplasm
``` invasive rapid growth not encapsulated common necrosis may metastasise ```
127
What are the 4 types of necrosis | hahah yeh huge tb to principles
Caseous Coagulative Colliquative Fibrinoid
128
What is the PPE pneumonic
AGGA | apron, gloves, gloves, apron
129
Where would you put household waste
Black bag
130
Where would you put recycled household waste
Green bag
131
Where would you put confidential waste
Blue bag | Yeh still never seen one
132
Where would you put low-risk special waste
Orange bag
133
What would you put in a yellow bucket
depends on the top
134
Where would you put ethical, possible infectious waste
in a yellow bucket with a red top
135
Where would you put medicinal waste such as drug bottles
yellow bucket with a blue top
136
What parts of the hand are frequently missed when washing them
THUMB THUMB THUMB
137
What are the 5 I's of infection spread
``` Inhalation Ingestion Inoculation Infant (from mother) Intercourse (giggity) ```
138
Give the average asthma spirometry result
FEV1 decreased FVC normal Ratio decreased CLASSIC OBSTRUCTIVE PATTERN
139
Give the average COPD spirometry pattern
FEV1 decreased FVC decreased (due to emphysema) Ratio DECREASED COPD GIVES A MIXED PATTERN YEH ITS WEIRD
140
How would you class an FEV1/FVC ratio
>75% is normal | <75% is reduced
141
What is the most common lung cancer in smokers
Squamous
142
What hormone does squamous cancer secrete
PTH (Parathyroid hormone)
143
What does PTH secreted by squamous cancer cause
Hypercalcaemia
144
Where do squamous cancers tend to occur in the lungs
Centrally, close to hilum
145
Which lung cancer is most often cavitating
Squamous
146
What is the most common lung cancer in non smokers
Adenocarcinoma | unlucky ppl
147
What cells is adenocarcinoma derived from
Gram cells | ??
148
Which lung cancer has the worst prognosis
Small cell
149
Which cancer is most chemosensitive and why
small cell | has a rapid growth rate and chemotherapy targets rapidly dividing cells
150
What hormones does small cell cancer secrete
ACTH | ADH
151
What is Horner's Syndrome, what causes it and what are the symptoms
Pancoast Tumour (apical tumour) invades the sympathetic chain, causing unilateral drooping of eyelid and loss of sweating
152
What is the pneumonic to remember how hypercalcaemia can present
MOANS - constipation + abdominal pain STONES - kidney stones + frequent urination BONES - bone aches + arching of spine GROANS - confusion, memory loss, depression
153
Define communitarianism
Is the act good for everyone who will be affected by it? | p.s ethics can fuck off
154
Define deontology
Is the act wrong or right in itself? | p.s ethics can fuck off
155
Define consequentialism/utalitarianism
Is the act right or wrong depending on its consequences | p.s ethics can fuck off
156
Define religious theory
Does the act respect the sanctity of human life | what does that even mean fuck off ethics
157
Define virtue ethics
Am I being honest and consistent in my acts | I'm being honest when I say ethics is shit
158
Define the 4 ethical principles
Autonomy: respecting the decision-making capacities of autonomous persons Beneficence: the healthcare professional should act in a way that benefits the patient Non-maleficence: avoiding the causation of harm Justice: distributing benefits, risks and costs fairly These are all obvious if ur not a retard but learn the definitions
159
What is epidemiology
Study of determinants, frequency and distribution of a disease in a population
160
What is the incidence
Number of new cases in a population over a given time period
161
What is the prevalence
Number of cases of disease in the population currently
162
What is sensitivity
Proportion of those who have the disease who have a +'ve test
163
What is specificity
Proportion of those who don't have the disease and have a -'ve test
164
What does stimulation of the alpha 1 receptor do
Vasoconstriction of SM in vasculature | Sphincters in GI tract and urinary bladder contract
165
What does stimulation of the alpha 2 receptor do
Inhibits insulin secretion | Induces glucagon secretion
166
What does stimulation of the beta 1 receptor do
Increases heart rate and force
167
What does stimulation of the beta 2 receptor do
SM relaxation in airways Increases mucociliary clearance in airways Reduced motility in GI tract
168
What does stimulation of the Muscarinic 1 receptor do
Increase in stomach and salivary secretions
169
What does stimulation of the Muscarinic 2 receptor do
Slows down heart rate | no effect on force remember very little parasympathetic innervation of myocardium
170
What does stimulation of the Muscarinic 3 receptor do
Airway SM contraction Increased airway mucous secretion from goblet cells Vasodilation of SM in vasculature Increases motility of GI tract
171
When can M3 stimulation cause bronchial SM relaxation
Via non-cholinergic synapse | regulated by NO and VIP
172
What type of study is observational and prospective and what is the usual outcome
Cohort study | usual outcome is relative risk
173
What type of study is observational and retrospective and what is the usual outcome
Case-control study | Usual outcome is odds ratio
174
What should you consider doing for a primary pneumothorax that is under 2cm
Consider discharge and review in 2-4weeks
175
What should you consider doing for a secondary pneumothorax that is under 2cm
Admit patient High flow oxygen monitor for 24hrs
176
What should you do simple pneumothorax that is over 2cm
Aspirate using a 16-18G cannula
177
What is the safe triangle for chest drain insertion for a pneumothorax
anterior border of latissimus dorsi posterior border of pectoralis major axial line superior to nipple
178
Where would a large guage cannula be inserted to treat a pneumothorax
2nd or 3rd intercostal space | Mid clavicular line
179
What is Henry's Law
The amount of a given gas dissolved in a given type and volume of liquid at a constant temperature is proportional to the partial pressure of the gas in equilibrium with the liquid (Horrid Henry and his partial pressure)
180
What is Boyle's Law
As the volume of a gas increases the pressure exerted by the gas decreases (treating a boyle)
181
What is the Law of LaPlace
``` P= 2T/r where: P = inward directed collapsing pressure T = surface tension r = radius of the alveoli The smaller alveoli (with smaller radius - r) have a higher tendency to collapse ```
182
What is the Bohr effect
Facilitates the shifting of the oxyhaemoglobin dissociation curve to the right (oxygen is Bohring)
183
What is the Haldane effect
Removing O2 from Hb increases the ability of Hb to pick-up CO2 and CO2 generated H+
184
What is the Frank-Starling curve
Describes the relationship between venous return, EDV and SV | The more filled the ventricle becomes during diastole, the greater the volume of ejected blood
185
What is Dalton's Law
The total pressure exerted by a gaseous mixture = the sum of the partial pressures of each individual component in the gas mixture
186
What is Fick's Law
The amount of gas that moves across a sheet of tissue in unit time is proportional to the area of the sheet but inversely proportionate to its thickness
187
Name the two mechanisms via which oxygen travels in the blood
Bound to haemoglobin | Dissolved in plasma
188
What are the 2 most commonly measured saturations of oxygen
SaO2 - arterial saturation - ABG machine | SpO2 - percutaneous - pulse oximeter
189
What are the target O2 saturations
94-98% in most patients | 88-92% in COPD patients
190
What type of lung disease can cause CO2 retention
``` Both Severe Obstructive (COPD)-most common Severe Restrictive (obesity) ```
191
What is respiratory drive normally driven by
Driven by blood CO2 levels, recognised by chemoreceptors
192
What occurs in chronic hypercapnia and what does this mean for respiratory drive
Chemoreceptors become desensitised to the high levels of CO2 so hypoxia is the main driver of respiration
193
What is the aim of O2 therapy on a patient who retains CO2
To increase their oxygen saturation without decreasing their respiratory drive
194
How do you treat an acutely hypoxic CO2 retainer
Start them on oxygen through a venturi mask, blue or white (24 or 28%) Monitor their ABG's every 30mins
195
What can kill a patient quicker, hypoxia or hypercapnia
Hypoxia obviously | so if a CO2 retainer dangerously hypoxic, don't be afraid to give high flow oxygen
196
What is the pneumonic for clinical features of an immunodeficiency
SPUR | Serious, Persistent, Unusal, Recurrent
197
Define the components of SPUR
Serious - unresponsive to oral antibiotics Persistent - early structural damage Unusual - unusual sites or unusual organisms Recurrent - 2 major or 1 major and many infections in 1 year
198
What network is activated when a granuloma is formed
IL-12 gIFN network | Wow such a catchy name
199
Which cytokine, produced by macrophages, is essential for the formation of a functional granuloma
TNF-alpha (Tumour Necrosis Factor alpha)
200
What actually is a granuloma
An organised collection of activated macrophages and lymphocytes
201
Name 2 diseases which involve functional granulomas and the difference between them
Sarcoidosis (non-caseating granuloma) | Tb (caseating granuloma)
202
How do NK cells work
Kill cells that lack MHC molecules on their surface
203
What type of cells are generated during primary immune response
Long-lived memory B cells
204
What happens when memory B cells have a second encounter with the antigen
They rapidly activate, undergo clonal expansion and differentiate into plasma cells to release specific antibodies
205
During primary infection, which immunoglobulin is produced first
IgM
206
Name the two types of vaccines
Inactivated | Live attenuated
207
What are the pro's of a live vaccine
All relevant effector mechanisms are stimulated Localised strong response Usually, single dose required
208
What are the cons of a live attenuated vaccine
Safety - may revert to virulence | Must be stored and handled carefully
209
What are the pro's of a killed vaccine
Can be made quickly Easy to store Safe
210
What are the cons of a killed vaccine
Doesn't stimulate clonal expansion of B and T cells Many killed organisms don't stimulate a good immune response More than one dose may be needed
211
What does stimulation via Gq protein do
Stimulation of phospholipase C
212
What does stimulation via Gi protein do
Inhibition of adenylyl cyclase
213
What does stimulation via Gs protein do
Stimulation of adenylyl cyclase
214
What does stimulation of adenylyl cyclase do
Increased levels of cAMP
215
What G protein is the M1 receptor coupled to
Gq
216
What G protein is the M2 receptor coupled to
Gi
217
What G protein is the M3 receptor coupled to
Gq
218
What G protein is the B1 receptor coupled to
Gs
219
What G protein is the B2 receptor coupled to
Gs
220
What G protein is the a1 receptor coupled to
Gq
221
What G protein is the a2 receptor coupled to
Gi
222
What is the first step of the atherosclerosis pathogenesis ladder
Uptake of LDL from the blood into the tunica intima
223
What happens to the LDL which is taken into the tunica intima (atherosclerosis pathogenesis)
It is oxidised to oxLDL
224
Which white blood cells migrate into the tunica intima and which cell do they turn into (atherosclerosis pathogenesis)
Monocytes -> turn into macrophages
225
What do the macrophages do the oxLDL in the tunica intima and how do they do this (atherosclerosis pathogenesis)
The macrophages take up the oxLDL using scavenger receptors | Uptake of oxLDL turns them into foam cells
226
What occurs after the foam cells form a fatty streak in the tunica intima (atherosclerosis pathogenesis)
Release of inflammatory cytokines which causes division of SM cells in the tunica intima
227
What does an atheromatous plaque consist of (atherosclerosis pathogenesis)
A lipid core (consisting of dead foam cells) | A fibrous cap covering the lipid core (consisting of smooth muscle cells and connective tissue)
228
Which enzyme does aspirin block
COX-1
229
Which binding reaction does clopidogrel block
ADP binding to GPCRPY12
230
Which factors does warfarin block the activation of
``` Factor 10 (X) and factor 2 (prothrombin) By blocking Vitamin K reductase ```
231
How does rivaroxaban work
By directly inhibiting factor 10a (Xa)
232
What two factors does heparin inactivate
10a (Xa) and 2a (thrombin)
233
What is the inhibitor of coagulation through which heparin acts
AT3 (Antithrombin III)
234
What is the difference in the way which heparin inactivates factors Xa and IIa(thrombin)
Heparin only needs to bind to AT3 to inactivate factor Xa | Heparin must bind to both AT3 and IIa (thrombin) in order to inactivate IIa (thrombin)
235
What are the 3 embryological layers
Ectoderm, Mesoderm & Endoderm
236
What are the three parts of the ectoderm
Surface ectoderm Neural tube Neural crest
237
When are the embryological layers formed
Gastrulation | Came up twice in the CAP no excuses
238
What is the central dogma
DNA undergoes transcription and splicing to become RNA | RNA undergoes translation to become protein
239
What are the three main differences between RNA and DNA
RNA has the sugar ribose - DNA has deoxyribose RNA is single stranded - DNA is double RNA has Uracil instead of Thymine like DNA
240
What occurs during splicing and what are the start and end products
Pre-mRNA has its introns removed | The exons remaining are the mature mRNA transcript and these leave the nucleus
241
How many bases is a codon
3 bases
242
What does each codon correspond to
Each codon corresponds to an amino acid
243
What are the 4 stages of the cell cycle and what occurs in each stage
G1 - Growth S - DNA synthesis G2 - growth + preparation for mitosis M - Mitosis
244
What 'mode' does a cell spend most of it's life in
G0
245
Which enzymes 'unzips' the DNA strand
DNA helicase
246
Which enzymes make a copy DNA strand and a copy RNA strand
DNA- DNA polymerase | RNA- RNA polymerase
247
What direction is DNA copied
5' -> 3'
248
What is the structure of the DNA strands and what does this mean when it comes to DNA replication
Antiparallel (the strands run in opposite directions) | There will be a leading strand and a lagging strand
249
Which enzyme creates a copy of the lagging strand | 3' -> 5' strand
Still DNA polymerase u mong
250
What are the short DNA fragments copied on the lagging strand called
Okazaki Fragments (Davie Loh what)
251
Which enzyme joins the Okazaki fragments together on the lagging DNA strand
DNA ligase
252
What are the differences between mitosis and meiosis
Mitosis produces 2 genetically identical daughter cells | Meiosis produces 4 genetically variable daughter cells
253
Define a polymorphism
A DNA variant which has a population frequency of more than 1%
254
Define a mutation
A DNA variation which causes or predisposes to a specific disease
255
What gender does an autosomal dominant disease affect
Both obviously | sorry all 63*
256
What is the risk of having an affected child in the case of an autosomal dominant disease
50%
257
What is the risk of having an affected child in the case of an autosomal recessive disease
25%
258
Define expression
The process by which information from a gene is used in the synthesis of a functional gene product
259
Define penetrance
The extent to which a particular gene is expressed in the phenotype of the individual carrying it
260
What are the indications of a severe asthma attack
HR >110bpm PEFR <50% Can't complete sentences Resp Rate ≥25/min
261
What the indications of a life-threatening asthma attack
``` HR <60bpm Confusion Lack of breath sounds PEFR <33% Cyanosis PaO2 <8kPa ```
262
What is the QRISk 2 score
A score which calculates the risk of a cardiovascular event in the next 10 years
263
What is the CHA2 DS2 - VASc score
Used to determine the need to anti-coagulate a patient with AF
264
What is the normal cardiac axis
-30 to +90 degrees
265
What indicates right axis deviation
An axis greater than +90 degrees
266
What indicates left axis deviation
An axis less than -30 degrees
267
What does an irregularly irregular pulse indicate
Atrial fibrillation | yeh pretty obvious
268
What does a slow-rising pulse indicate
Aortic stenosis | no shit
269
What does a collapsing pulse indicate
Aortic regurgitation
270
What does a bounding pulse indicate
Acute Co2 retention Hepatic failure Sepsis
271
What does radio-femoral delay indicate
coarctation of the aorta
272
What is the buzzword sign on a CXR for coarctation of the aorta
Notching of the inferior border of the ribs
273
What does a jerky pulse indicate
Mitral regurgitation | HOCM
274
What does pulsus bisferiens mean
A pulse with 2 peaks
275
What does pulsus bisferiens indicate
Mixed aortic valve disease | HOCM
276
What does pulsus paradoxus indicate
Constrictive pericarditis | Cardiac tamponade
277
What is pulsus paradoxus
an abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mmHg
278
What does a raised, fixed JVP indicate
SVC obstruction
279
What does a JVP rising on inspiration indicate
Cardiac tamponade | Constrictive pericarditis
280
What do large V waves in the JVP indicate
Tricuspid regurgitation
281
What do absent A waves in the JVP indicate
Atrial Fibrillation
282
What do cannon A waves in the JVP indicate
Complete heart block AV dissociation Ventricular arrhythmias
283
What does malar flush indicate
Mitral stenosis
284
What does pulsatile hepatomegaly indicate
Tricuspid regurgitation
285
What is Corrigan's sign and what does it indicate
Carotid pulsation | Indicates Aortic regurgitation
286
What is De Musset's sign and what does it indicate
Head bobbing | Indicates Aortic regurgitation
287
What is Quincke's sign and what does it indicate
Capillary pulsations | Indicates Aortic regurgitation
288
What is Traube's sign and what does it indicate
Pistol shot femoral pulse Indicates Aortic regurgitation This one has literally come up once
289
What are Roth's spots and what do they indicate
retinal hemorrhages | They indicate infective endocarditis
290
What are Janeway lesions and what do they indicate
Small, nodular, painless lesions on the palms or soles | Indicate infective endocarditis
291
What are Osler's nodes and what do they indicate
Painful, tender lesions Indicate infective endocarditis They're called fkin Osler's nodes ofc they're painful
292
What would be the indications of an atrial septal defect
Wide, fixed 2nd heart sound | Ejection systolic murmur in the 2nd intercostal space
293
What would be the signs of a ventricular septal defect
Harsh, pan-systolic murmur over left sternal edge
294
Where would you hear a patent ductus arteriosus and what would it sound like
A continuous machinery murmur heard below the left clavicle
295
How would transposition of the great vessels present
Cyanosis on the 1st day of life | Egg shaped ventricles on CXR
296
How would Tetralogy of Fallot present
Cyanosis during 1st month of life | A boot-shaped heart on CXR
297
Name 7 respiratory causes of clubbing
``` Bronchial carcinoma Bronchiectasis Lung Abscess Empyema Cystic Fibrosis Idiopathic Pulmonary fibrosis Mesothelioma Tb ```
298
Which two common respiratory diseases do not cause clubbing
Asthma | COPD
299
What are the indications to diagnose stage 1 hypertension
Clinic Bp > 140/90 | ABPM/HBPM > 135/85
300
What are the indications to diagnose stage 2 hypertension
Clinic Bp > 160/100 | ABPM/HBPM > 150/95
301
What are the indications of severe/malignant hypertension
Bp > 180/110
302
What is white coat hypertension
When the patients Bp appears higher than it is because they are in clinic "in front of a white coat"
303
What is masked hypertension
When the patients Bp appears lower than it is because they are in clinic i.e freaks who are relaxed when seeing doctors
304
What are the requirement for ABPM
At least 2 measurements per hour during waking hours
305
What are the requirements for HBPM
2 consecutive seated measurements, 1minute apart, twice a day for 4-7 days (ideally 14) Discard first day results because patient will be shitting it a bit
306
What provides immediate symptomatic relief for anginal pain
GTN spray
307
What is the long-Mterm therapy for Angina
Isosorbide mononitrate
308
What do you have to be careful of with nitrates
Leave 8 hours a day nitrate free to avoid tolerance build-up
309
-What is the drug therapy ladder for Angina
Aspirin | Beta blocker or CCB (not both)
310
What other drugs can you offer to someone with Angina
Statins | Ivabradine or nicorandil
311
What are the total cholesterol level targets
< 5mmol/L for healthy adults | < 4mmol/L for those at risk
312
What are the LDL cholesterol level targets
< 3mmol/L for healthy adults | < 2mmol/L for those at risk
313
What are the HDL cholesterol level targets
> 1mmol/L for healthy adults
314
What is the HDL cholesterol level target for those at risk
same as healthy adults - > 1mmol/L | u judgemental bastard
315
What is the triglyceride level target for everyone
< 1.7mmol/L
316
What is the first step in treating Acute Atrial fibrillation
Treat the underlying cause | e.g. MI, HF, PE
317
What is the drug treatment to treat ventricular rate in acute atrial fibrillation
Beta blocker or CCb (first line) | Add digoxin or amiodarone (second line)
318
What do you do after controlling the patient's ventricular rate in acute atrial fibrillation
Anti-coagulate with heparin | Consider cardioversion
319
What is the treatment ladder for Chronic Atrial fibrillation
Control ventricular rate same as Acute AF (say it in ur head) Anti-coagulate with warfarin (more long term than heparin)
320
What is the treatment ladder for paroxysmal Atrial fibrillation
``` BAD-A Beta blocker for older patients or verapamil in younger patients (because of it's -'ve inotropic effect) - 1st line Amiodarone - 2nd line Digoxin - 3rd line Antocoagulate ```
321
What three things could cause supraventricular tachycardia
Av nodal re-entry Accessory pathway tachycardia (e.g WPW syndrome) Ectopic atrial tachycardia
322
What is the management of acute SVT | Pneumonic
VAV Vagal manoeuvres (Valsalva/carotid massage) Adenosine (IV) Verapamil (IV)
323
What is the treatment for chronic SVT
Avoid stimulants | Ablation
324
What is the management for sinus tachycardia
Rate control using beta bloicker
325
What is the treatment for stable VT
Amiodarone
326
What is the treatment for unstable VT
Cardioversion | Amiodarone
327
What is the treatment for Acute VT
High Flow O2 Adenosine or CCb or Beta blocker Amiodarone or cardioversion
328
What is the treatment for Torsades De Points
Magnesium Sulphate | Basically a buzzword
329
How would you describe Torsades De Points
VT with varying amplitude
330
What are the two types of pacemakers
Single and Dual chamber
331
Where are single chamber pacemakers located
Either in the RA or the RV
332
Single chamber pacemakers in the RA are used to treat what
SA nodal disease
333
Single chamber pacemakers in the RV are used to treat what
Atrial fibrillation
334
Which chambers does a dual chamber pacemaker manage
RA and RV
335
What condition are Dual chamber pacemakers used to treat
AV nodal disease
336
What is the pneumonic for remembering what channels the anti-arrhythmic drugs act on
Seumas Barker Pulls Cammy Class I, II, III, IV Sodium, Beta, Potassium, Calcium
337
Which of the classes of anti-arrhythmic drugs are rhythm control and which ones are rate control
Class I, II, III, IV | Rhythm, Rate, Rhythm, Rate
338
What is sotalol and how does it work
Class III anti-arrhythmic drug BLOCKS K+ CHANNELs NOT A BETA BLOCKER
339
What is infective endocarditis
Infection of the endothelium of heart valves
340
What is the pathogenesis of infective endocarditis
Heart valve damaged or abnormal - turbulent blood flow Bacteria settle in damaged area and vegetate Bacteria break off and lodge in the next capillary bed Normally mitral and aortic valves involved
341
Which heart valve tends to be involved in IV drug users
Tricuspid | Think about it, you moron, they inject into their veins and the bacteria will hit the tricuspid valve first
342
How do you diagnose infective endocarditis
Send 3 sets of blood cultures | Echocardiogram
343
What should you consider if all 3 sets of blood come back negative but you still suspect infective endocarditis
Consider serology for an atypical organism
344
Pneumonic for Native valve endocarditis treatment | native valve subacute
Aboriginal GENTleman | Amoxicillin(IV) + GENTamicin (IV)
345
Pneumonic for Prosthetic valve endocarditis treatment | or Staph Epidermidis
Very Good Replacement Vancomycin(IV) + Gentamicin(IV) + Rifampicin(PO) also consider valve replacement
346
Pneumonic for IV drug user endocarditis | or native valve severe sepsis
Fucktards | Flucloxacillin(IV)
347
Pneumonic for Strep Viridans endocarditis
Very Slutty Big Girls | Viridans strep - Benzylpenicillin(IV) + Gentamicin(IV)
348
Pneumonic for MRSA endocarditis
Van Rentals | Vancomycin(IV) + Rifampicin(PO)
349
What is the treatment for non-severe C.difficile infection
Metronidazole PO (10days)
350
What is the treatment for severe C.difficile infection
Vancomycin PO ± Metronidazole IV
351
Which gut pathogen can cause HUS (Haemolytic Uraemic Syndrome)
E. Coli O157
352
What is the most common hepatitis in developing countries and what is it's incubation period
Hep. A | 28days
353
Which leukotriene is released from airway eosinophils and mast cells
Leukotriene D4
354
Which nerve supplies somatic sensory nerve fibres to the face
Trigeminal
355
Name the layers of the heart from deep --> superficial
Endo-, Myo-, Epicardium
356
Which drug will give rapid relief of symptoms of hyperthyroidism
Beta Blockers
357
What is the only cranial foramen that is in the anterior aspect of the skull
Cribriform plate of the ethmoid bone
358
Name the parts of the mandible
``` Mental process Mental foramen Inferior border + body Angle Ramus Condylar process (posterior) Coronoid process (anterior) ```
359
Name the cranial foramina from POSTERIOR to ANTERIOR
``` Hypoglossal canal Jugular foramen Internal acoustic meatus Foramen ovale Foramen rotundum Superior orbital fissure Optic canal Cribriform plate of the ethmoid bone ```
360
What is the curative treatment for achalasia
Heller's Cardimyotomy
361
Describe the pathology of Barrett's Oesophagus
Metaplasia of squamous epithelium to columnar epithelium
362
Describe the pathology of a peptic ulcer
Gastric acid erosion of the gastric mucosa
363
What kind of cancer can arise from Barrett's oesophagus
Adenocarcinoma
364
Describe the pathology of an adenocarcinoma as a result of Barrett's Oesophagus
Uncontrolled proliferation of mucous gland cells in the lower 1/3 of the oesophagus
365
What is the chance that a man with an X-linked condition will pass it onto his daughter
100% u fool cos he only has the faulty X gene to pass on
366
Why is there decreased blood volume in sepsis
Due to endotoxins released which cause leakage from vasculature
367
During CPR what is the indication to check the patient's pulse
If they show purposeful movement
368
What is the rate of rescue breathing given to an adult in respiratory arrest
10/min
369
The venous angle is formed between which two vessels
Subclavian vein | Interal Jugular vein
370
What is the most common causative orgaism of bronchiolitis
RSV
371
In chronic asthma, sensitisation of airway smooth muscle to inflammatory mediators leads to what
Airway hyper-sensitivity
372
What are defensins
Anti-microbial proteins secreted by epithelial cells at mucosal surfaces
373
what are the treatment options for unstable angina
give oxygen fucking obviously GTN (if not -> B-blocker if not -> CCB) Also give aspirin, Tirofiban(anti-platelet) & Heparin
374
What is treatment for Chronic Heart Failure
ACE inhibitors + Beta Blockers 1st Line Spironolactone 2nd line Diuretics if fluid overloaded
375
What is the treatment for Acute Heart Failure
Sit them up (obviously) Give High flow oxygen IV Furosemide Once resus'd continue Beta blocker therapy
376
When can you discharge someone from hospital if they come in for Acute HF
Once they have been stable for 48hours
377
What treatments can you offer someone once they have been discharged following acute HF
Ace inhibitor & spironolactone
378
What diameter must an AAA reach to indicate surgery
>5.5cm | Yes, it is a bit random
379
What are the 6 steps to treating sepsis
Give high flow oxygen (spo2 between 94-98%) Fluid resuscitation (500ml saline) Take blood cultures (and other relevant cultures: urine, wounds, sputum) Give antibiotics Measure lactate and FBC (elevated lactate is an indicator of tissue death) Monitor hourly urine output (indicative of kidney function)
380
What drugs do you give to someone with sepsis | Pneumonic
AGM | Amoxicillin, Gentamicin, Metronidazole IV
381
Wtf is Fexofenadine
A competitive H1 receptor antagonist used to treat allergic rhinitis. fkin nerd
382
What is indicated by a positive p-ANCA
Churg-Strauss Syndrome | -Eosinophilic Granulomatosis with Polyangiitis (EGPA)
383
What does the presence of anti-CCP antibodies indicate
rheumatoid
384
What side effects can methotrexate cause
Lung fibrosis | Abnormal LFT's
385
What are the rules for diagnosing an STEMI
≥1mm elevation in 2 or more adjacent limb leads | ≥2mm elevation in 2 or more continuous precordial leads
386
Which of the clotting factors are glycoprotein precursors of the active factors
2, 7, 9, 10 | Require vitamin K to be activated
387
What can you give a patient to counteract a Warfarin overdose
Vitamin K | Think about the meme
388
What are the two types of chemoreceptors
Central (located near medulla) | Peripheral (Located in aortic and carotid bodies)
389
What do the central chemoreceptors monitor
H+ conc. of the CSF | Co2 in blood
390
What do the peripheral chemoreceptors monitor
Monitor O2 conc. of the blood
391
Which chemoreceptors are active in COPD patients and why
Peripheral (hypoxic drive) | The central chemoreceptors have become desensitized to chronic hypercapnia

Misc. Notes Year 1 (13 decks)

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