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Things To Remember Flashcards

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0
Q

Effect of atrial natriuretic factor

A
  • from stretched cardiac atrial cells
  • dilates afferent and constricts efferent
  • increases GFR
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1
Q

RAAS stimulated by

A
  • decrease in afferent press
  • decrease in macula densa Na
  • decrease in blood vol
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2
Q

Criteria for substance to measure GFR

A
  • metabolically inert
  • filtered by kidney
  • not secreted, not reabsorbed
  • no interference with renal function
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3
Q

Anion gap calculation

A

(Na + K) - (Cl + HCO3)

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4
Q

3 types of resp VQ mismatches

A
  • diffusion barrier
  • intrapulm shunt (no vent)
  • alveolar deadspace (no perfusion)
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5
Q

Factors that decrease oxygen binding affinity to Hb

A
  • increased H
  • increased pCO2
  • increased temp
  • increased 2,3 DPG
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6
Q

Define type 1 hypoxemia

A
  • hypoxia without hypercapnia
  • VQ mismatch
  • failure of oxygenation
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7
Q

Define type 2 hypoxemia

A
  • hypoxia and hypercapnia

- inadequate ventilation

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8
Q

Causes of oedema

A
  • increased hydrostatic press
  • decreased oncotic press
  • increased permeability
  • medications
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9
Q

4 markers of Mi

A
  • myoglobin
  • troponin T
  • creatine kinase
  • lactate dehydrogenase
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10
Q

Cause of acute phase response

A

Any acute stress involving tissue necrosis

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11
Q

Effects of acute phase response

A
  • pyrexia
  • leucocytosis
  • iron sequestration in reticulo-endothelial system
  • hormonal changes
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12
Q

Positive acute phase reactants

A
  • CRP
  • a1-antitrypsin
  • fibrinogen
  • haptoglobin
  • complement
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13
Q

Negative acute phase reactants

A
  • albumin
  • transferrin
  • HDL
  • LDL
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14
Q

Why urgent to decide between pre and renal failure

A
  • pre can progress rapidly to more serious intra

- in pre one needs to replace fluids but in intra, one needs to restrict them

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15
Q

When to dialyse

A
  • patient is vol overloaded and at risk of oedema or cardiac failure
  • blood urea > 50 mmol/L
  • K > 7 mmol/L
  • bicarbonate < 10mmol/L
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16
Q

Physiological sources of H

A
  • metabolism produces non-volatile acids (excreted by kidney)
  • aerobic metabolism produces CO2 (excreted by lungs)
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17
Q

Why bicarbonate buffer system is powerful

A
  • open-ended

- regenerate (HCO3 retained and regenerated by kidney)

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18
Q

Causes of resp acidosis

A
  • depression of resp centre
  • physical inability to ventilate
  • airway obstruction
  • pulm disease causing decreased exchange
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19
Q

Causes of resp alkalosis

A
  • direct stim of resp centre
  • mechanical over ventilation
  • hypoxia
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20
Q

Causes of metabolic acidosis

A
  • gain of H
  • loss of bicarb
  • GIT loss
  • renal loss
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21
Q

Causes of metabolic alkalosis

A
  • gain of bicarb
  • loss of H
  • GIT loss
  • renal loss
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22
Q

Definition of lipoprotein

A

Particle of lipid and apoprotein in association

- found in plasma and interstitial fluid

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23
Q

In shell of lipoprotein

A
  • phospholipid
  • cholesterol
  • apoproteins
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24
In core of lipoprotein
- cholesterol ester - TAGs - parts of apoB
25
Tests for lipoproteins
- ultracentrifuge - agarose electrophoresis - acrylamide electrophoresis - immunoaffinity assays
26
Requirements before fasted lipid profile
- stable diet for more than 2 weeks - alcohol abstinence for 48hrs - fast over night for more than 10 hrs - seated for 5 mins before venesection with min tourniquet time
27
Treatment of dyslipoproteinaemia
- diet - less cholesterol uptake - decrease cholesterol sysnthesis (statins) - PPARa activation - HSL inhibitors - Lp assembly
28
Requirements for reliable blood gas analysis
- arterial blood - anticoagulated with heparin - taken and kept anaerobic - on ice - analysed asap
29
Reasons for raised anion gap
- alcohol - uraemia - diabetic ketoacidosis - drugs - lactate
30
Causes of elevated plasma cardiac troponin levels
- MI - pulm embolus - chronic kidney disease - sepsis - burns - HT
31
Definition of proteinuria
Daily urine protein > 150 mg
32
Acquired causes of hypercholsterolaemia
- hypothyroidism - nephrotic syndrome - DM
33
5 components of normal haemostasis
- blood vessels - platelets - coag factors - coag inhibitors - fibrinolysis
34
Stages of haemostasis
- vessel injury - vasoconstriction - platelets adhere and aggregate - coag systems activates fibrin - clot dissolution via fibronolysis - endothelial repair
35
Platelet agonists
- collagen - adrenalin - ADP - thrombin
36
Steps of platelet activation
- shape change - release of granule contents - synthesis of secondary agonists (thromboxane A2) - exposure of procoagulant phospholipids - cross linking with fibrin through Gp2b3a
37
Natural inhibitors of platelets
- NO - prostacyclin - ecto-ADPase
38
Anti platelet drugs
- asprin - clopidogrel - abciximab - dipyridamole
39
Phases of cell based model of coag
- initiation phase - amplification phase - propagation phase
40
Natural anticoagulants
- anti thrombin 3 | - protein C + S
41
Thrombolytics
- streptokinase | - tissue plasminogen activator
42
New anticoag drugs
FXa inhibitors - fondaparinux - rivaroxaban - dabigatran
43
Test for extrinsic pathway
Prothrombin time
44
Test for intrinsic pathway
Activated partial thromboplastin time
45
Role of vWF
- binds to collagen in subendo | - has binding sites for platelets which then adhere to subendo
46
6 examples of URTIs
- rhinitis - pharyngitis - sinusitis - tonsillitis - otitis media - epiglottitis
47
5 classic resp viruses
- othomyxovirus - paramyxovirus - rhinovirus - adenovirus - coronavirus
48
Why people keep getting infected with viruses
- many different viruses and serotypes - poor immunity - viruses evolve
49
When do normal flora bacteria invade
- viral epi damage - mucus clearance by cilia is affected - obstruction of drainage (stasis)
50
Causes of common cold
- rhinovirus | - corona virus
51
Causes of sinusitis and otitis media
- influenza - parainfluenza - adenovirus - rhinovirus
52
Causes of laryngitis and croup
- mainly parainfluenza and RSV | - also mycoplasma pneumoniae
53
Cause of epiglottitis
- h. Influenzae
54
What URTIs to treat with antibiotics
- sinusitis - epiglotitis - bronchitis - pneumonia
55
URTIs not to treat with antibiotics
- colds - Larygitis - acute bronchitis - bronchiolitis
56
Who gets serious viral disease?
- very young - elderly - pre existing heart and lung disease
57
What does Haemagglutinin bind to?
Scialic acids linked to galactose on host cell surface
58
Drift
Gradual accumulation of point mutations | - RNA so no polymerase proof reading functions
59
Shift
Input of new genes
60
Complications of influenza
- influenza pneumonia - secondary bacterial pneumonia - exacerbation asthma - COPD - Reye's syndrome
61
Who should get flu vaccine
- pregnant - have risk factors - health care workers - children on long term asprin therapies - living in old age homes - over 65 yrs - family contacts of high risk cases
62
Risk factors for influenza
- chronic pulm/ cardiac disease - DM - immunosup - morbidly obese
63
Contraindication for flu vaccine
- allergic to egg | - have acute febrile illness
64
2 M2 inhibitors
- rimantadine - amantadine Inhibit uncoating of virus
65
2 neuraminidase inhibitors
- oseltamivir - zanamivir Inhibit release of virus from infected cell
66
Viruses that cause lower resp tract infection
- RSV | - adenovirus
67
What is contained in influenza vaccine
Inactivated vaccine with partially purified envelope proteins of currently circulating influenza strains
68
Analytic cohort study
- group of people free of disease - classified into subgroups according to exposure - followed up - see how development of disease differs between groups
69
Strengths of cohort studies
- good causal relationship - risk can be directly measured - can assess if single exposure has multiple outcomes - efficient for studying rare outcomes
70
Limitations of cohort studies
- expensive - time consuming - loss to follow up - prone to info bias - inefficient to study rare disease
71
Case control studies
- researcher begins with cases - selects appropriate control group - collects info on exposure - compares - calculates measures of association
72
Strengths of case control
- quick and inexpensive - can evaluate diseases with long latent periods - can asses multiple risk factors for a single disease - efficient for studying rare diseases
73
Limitations of case control
- ineff for studying rare exposures - prone to bias - cant directly calculate incidence rates - more difficult to establish temporal relationship
74
Confounding
3rd variable results in apparent association between exposure and outcome
75
Strengths of ecological study
- simple to conduct (already have data) - some variables can only be measured at group level - useful if little variation in pop in exposure of interest
76
Limitations of ecological study
- findings difficult to interpret
77
What makes a notifiable disease?
- epidemic prone - preventable/ priority - environmental/ zoonosis
78
Why do surveillance?
- detect epidemics - help eradicate disease - estimate magnitude of problem - detect new health problems - facilitate epidemiological research - evaluate prevention/ control - planning and resource allocation
79
Types of surveillance
- passive - active - sentinel
80
Limitations of surveillance
- must know normal - under reporting - poor collation - poor analysis - delayed distribution
81
Exogenous pathway
Chylomicrons transport ingested fats to adipose or liver
82
Reverse cholesterol pathway
- HDL transports cholesterol from peripheral tissues to liver to be excreted as bile
83
Lack of ABCA1 (ATP binding cassette transporter A1)
Tangiers disease
84
Effect of oversupply of cholesterol
- inhibits HMG CoA reductase - activates ACAT - inhibits LDL receptor synthesis
85
Gout
- increased levels of Uric acid in plasma - Uric acid is poorly soluble at physiologic pH - crystallizes in synovial joints
86
Action of allopurinol
- inhibits xanthine oxidase | - binds xanthine irreversibly
87
Endocrine functions of kidney
- RAAS - erythropoietin - activates 1,25 hydroxycholecalciferol
88
Renal lobule
Medullary rays and surrounding cortical labyrinth
89
What does medullary ray contain?
- descending proximal straight tubule - ascending thick limb of Henlery - collecting duct
90
2 types of nephrons
- cortical | - juxtamedullary
91
Components of glom filtration barrier
- podocytes - BM - fenestrated endothelium
92
Alports syndrome
- thinning and splitting of BM | - collagen mutations
93
5 functions of mesangial cells
- structural support - phagocytic - contractile (regulate intra glom flow) - secretory (endothelin, prostaglandins, cytokines) - proliferative
94
Cell types of resp epithelium
- ciliated columnar cells - goblet cells - basal cells - small granule cells - brush cells - serous cells
95
Cells in olfactory epi
- basal cells - olfactory cells - olfactory serous glands - supporting cells
96
Innate pulm defences
- trapping - phagocytosis (alveolar macs) - phagocytosis and lysis (neuts) - complement activation - migration to local lymph nodes
97
Adaptive pulm defenses
- IgA secretion (bind bacteria) - IgG and IgM in fluid lining - T cells accumulate
98
Steps of the immune response
- activation of the immune response - antigen destruction - termination of immune response - immunological memory
99
Waldeyer's ring
- palatine - lingual - pharyngeal - tubal
100
Autoimmunity definition
- influx of auto reactive immune cells and antibodies in body tissues - initiates inflam - represents failure of tolerance induction
101
Types of peripheral tolerance mechanisms
- immune privileged sites - anergy/ clonal deletion - regulatory T-cells
102
4 mechanisms of loss of self tolerance
- loss of immune privileged status (infection) - viral - reg T-cell dysfunction - molecular mimicry
103
Grave's disease
Anti-TSH receptor antibodies stimulate the production of thyroid hormones
104
Myasthenia gravis
Anti-ACh prevent muscles from responding to neuronal impulses - block ACh receptors - no Na influx
105
Atopy
A familial tendency to develop allergen specific IgE on exposure to environmental allergens and to suffer symptoms
106
Molecules in innate system which can kill mycobacteria in macs
- NO - hydrogen peroxide - cathelicidin
107
Investigations to diagnose latent TB
- chest X-ray - pos Mantoux test - IGRA assay
108
Contraindications of immunotherapy
- unreliable social circumstances - year round symptoms - uncontrolled asthma
109
Reasons for failure of BCG vaccine in adults
- over-attenuated virus - environmental mycobacteria mask protective effects - exposure to environmental worms (induces type 2 HS)
110
Effects of histamine
- vasodilation - bronchospasm - increased vascular perm
111
Effect of leukotrienes
- prolonged bronchospasm | - increased vascular perm
112
Effect of ECP (eosinophilic cationic protein)
- recruitment of eosinophils to airways
113
Effect of PAF (platelet activating factor)
- activation of platelets
114
Effect of NCF (neutrophil chemotactic factor)
- recruitment of neutrophils to airways
115
Process of desensitization in immunotherapy
- IgE rises then falls - specific IgG to antigen rises - specific T reg cells are induced - reduction of antigen-induced histamine release from basophils - reduction of wheal and flare reaction to antigen - IL 10 levels rise
116
How mycobacteria survive in macs
- inhibit phagolysosomal fusion - secrete anti-oxidants to neutralize ROS - ESAT-6 and CFP-10 induce membrane rupture
117
Cathelicidin anti-mycobacterial activity mediated by
- direct killing of MTB - production of ROS - autophagy (overcoming inhibition of phagolysosomal fusion)
118
3 mol in macs that can kill mycobacteria
- NO - granulysin - cathelicidin
119
Causes of neg Mantoux test
- early stage TB infection - never exposed - anergy due to systemic disease/ immunosup - anergy due to severe TB
120
When to use antimicrobial prophylaxis
- infection is common and predictable | - re infection would be very detrimental
121
Disadvantages of antimicrobial prophylaxis
- cost - adverse effects - antibiotic resistance - insuff attention to other preventative measures
122
What antibiotic to use for PCP
Cotrimoxazole
123
What antibiotic to use for cryptococcal infections
Fluconazole
124
Choice of antibiotic to use for surgical prophylaxis
Cefazolin
125
Host defences against LRTIs
- cough reflex - mucociliary clearance (IgA can penetrate mucus) - alveoli protected by phagocytes
126
Risk factors for LRTI
- impaired cough reflex - impaired mucociliary function (CF, smoking) - damaged alveolar macs/ alveoli (asbestosis)
127
Types of organism detection
- microscopy - culture - serology - nucleic acid amplification
128
Diagnosis of pleural infections
- clinical - X- ray - pleural tap
129
S pyogenes enzymes
- streptokinase | - DNAses
130
Haemolysins and toxins in S pyogenes
- streptolysin O | - erythrogenic toxin
131
S pyogenes clinical manifestations
- pharyngitis/ tonsillitis - impetigo - erisipelas - cellulitis - necrotising fasciitis - scarlet fever
132
Enzymes of S aureus
- coagulase - penicillinase - lipase and hyaluronidase
133
Haemolysins and toxins in S aureus
- enterotoxins - exfoliatin - TSST 1
134
Predisposing factors for S aureus infection
- foreign bodies - previous viral infection - DM - break in skin defences
135
Nerve roots of parasympathetic nervous system
- S 2,3,4 | - CN 3,7,9,10
136
Dilemmas of chronic illnesses
- cause - prevalence - symptoms - diagnosis - management - education - adherence - stigma - relapse - hospitalization - prognosis - death
137
contextual factors for chronic illness
- religion - culture - social circumstances - pre-morbid functioning - doctor patient relationship
138
Consequences of IPV
- pschological health - mental health - physical health - social well being
139
Role of doctor in IPV
- manage physical and psychological injuries - screen for IPV - document and photograph injuries - share info with patient and refer - safety assessment and plan
140
Forms of IPV abuse
- physical abuse and violence - sexual abuse and rape - economic abuse and control - emotional, verbal and pschological abuse - intimidation
141
Benefits of traditional medicine
- convenient, accessible and usually cheaper - connect to culture - placebo - social support - feel more comfortable - believe more natural
142
Risks of traditional medicine
- prep not always safe - no standard prep - healers not registered or controlled - may delay western treatment - no scientific proof of efficacy
143
Purpose of DSM 4
Structure and documents the diagnosis of mental illness for treatment and research purposes
144
Axes of DSM
``` 1 - clinical disorders 2- underlying personality disorders 3- acute medical conditions and physical disorders 4- psychosocial and environ factors 5- global assessment of functioning ```
145
Types of relievers in asthma control
- short acting B2 agonists | - anticholinergics
146
Types of controllers in asthma management
- inhaled corticosteroids - oral corticosteroids - leukotriene receptor agonists - long acting B2 agonists
147
Advantages of using IGRA for TB diagnosis
- no cross reaction with BCG or MOTTs - may be more sensitive than Mantoux - only need 1 visit
148
Disadvantages of using IGRA to diagnose TB
- limited data on use with HIV and children - limited data on use in high prevalence setting - lab infrastructure required - need more local data
149
3 levels of TB control
- administrative - environmental - respiratory protection
150
Differences between common cold and flu
- clinical spectrum - speed of onset - fever - presentation - fatigue - course - complications - occurrence
151
6 preformed mast cell mediators
- histamine - neutral proteases - acid hydrolases - oxidative enzymes - chemotactic factors - proteoglycans
152
Prerequisites for choosing immunetherapy
- IgE mediated allergen sensitivity has major relevance to symptoms - allergen is unavoidable - only a single allergen responsible
153
Grades of bee sting allergy
1- localized 2- spreads 3- bronchospasm and angioedema 4- systemic reaction with BP drop
154
Contraindications for immunotherapy
- extracts of unproven efficacy - infancy or old age - pregnancy - severe eczema - contraindications for use of epinephrine - uncontrolled asthma
155
Clara cell functions
- prod surfactant - reg Cl transport - secrete enzymes - secrete anti proteases - stem cells
156
Blood air barrier
- type 1 pneumocyte - BM - cap endo cell
157
Functions of alveolar macrophages
- phagocytose debris and bacteria - carbon uptake - hemosiderin uptake - degrades surfactant - stim chemotactic factors
158
Role of lung surfactant
- mono layer lining internal alveolar surface - acts as a detergent - prevents collapse and facilitates expansion - bactericidal effect
159
Functions of thymus gland
- maturation of T cells - proliferation of mature T cells - development of immune self tolerance - hormone secretion - haematopoiesis
160
Determinants of vent preload
- diastolic filling time - venous return - atrial press - vent compliance
161
Factors affecting afterload
- arterial elastic rebound - vascular tone - quality of flow
162
Stages of Valsalva maneuver
- pulm squeeze - decreased venous return (bvs constrict-compensatory tachycardia) - pulm decompression (press on chest released) - overshoot (dammed blood released)
163
Classes of branch blocks
1- prolonged RR 2 - prolonged RR and dropped beat 3- dissociation
164
How to measure Renal blood flow
- clearance methods - electromagnetically - laser Doppler flowmetry
165
H secretion induced by
- increased pH - increased pCO2 - decreased HCO3
166
3 types of alveolar dead space
- anatomical (trachea) - alveolar - physiological (anatomical and alveolar)
167
How smoking affects O2 transport
- carbon monoxide toxicity (CO binds to Hb) - impaired vent (mucus, cilia damage) - impaired diffusion (thickening of resp membranes) - impaired perfusion (pulm vasoconstriction)
168
Local pressures in pulm oedema
- pulm cap hydrostatic(towards) - pulm cap oncotic (away) - pulm interstitial fluid (towards) - alveolar gas (away) - lymphatic (away)
169
ECG abnormalities after MI
- ST elevation - T wave inversion - tall T wave - significant Q wave
170
Evidence based practice
- assess patient - ask right questions - assess evidence - appraise evidence - apply evidence - audit clinical practice
171
Stages of lung development
- embryonic - pseudo glandular - canalicular - terminal sac - saccular stage - alveolar stage
172
Mechanism of warfarin
- inhibits action of vit K in the synthesis of factors 2,7,9,10 and anticoag factors proteins C and S
173
Clara cell Functions
- surfactant - reg Cl transport - secrete enzymes - secrete anti proteases - act as stem cells

IHS (2 decks)

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