week 4-6 info

Question 1

pneumonia

Answer 1

streptococcus pneumonia accounts for majority of the bacterial pneumonia

Question 2

what can cause hospital acquired pneumonia?

Answer 2

Moraxella catarrhalis

Question 3

RSV

Answer 3

Respiratory syncytial virus (RSV) is the most common cause of viral pneumonia in young children

Question 4

MOA of penicillin ?

Answer 4

Penicillin kills bacteria through binding of the beta-lactam ring to DD-transpeptidase, inhibiting its cross-linking activity and preventing new cell wall formation.

Question 5

what drug can eb sued as an alternative to penicillin?

Answer 5

Macrolides

for community acquired pneumonia - azithromycin would be used

Question 6

First line for pneumonia?

Answer 6

First line is amoxocillin

If allergic to penicillin then doxycycline

Question 7

Antibiotic stewardship?

Answer 7

Antibiotic stewardship- The effort to measure and improve how antibiotics are prescribed by clinicians and used by patients.

Question 8

curb 65 score:

Answer 8

Assess severity using CURB-65
• Confusion.
• Urea >7 mmol/L.
• Respiratory rate >30/min.
• BP <90/<60 mmHg.
• >65 years old.

Each section of the CURB-65 is worth 1 point:
1 = Outpatient care.
2 = Admission.
>3 = Requires ICU admission.

Question 9

pneumonia : what immunoglobulin is inhibitied ?

Answer 9

Inhibition of igA

Question 10

mechanics of breathing:

inspiration?

Answer 10

diaphragm flattens

external intercostal muscles elevate the ribs and the sternum

Question 11

the 3 bacterial species

Question 12

aortic stenosis

Answer 12

associated with ejection systolic murmur

described as crescendo-decrescendo quality

Question 13

clinical features of aortic stenosis

Answer 13

Ejection systolic murmur heard loudest over the aortic area​

Radiates to the carotid arteries​

Loudest on expiration and when the patient is sitting forwards​

Slow rising pulse with narrow pulse pressure​

Non-displaced, heaving apex beat​

Reduced or absent S2​

Reverse splitting of S2 – aortic valve closes after pulmonary valve due to the longer time required for blood to leave left ventricle.​

​

Question 14

mitral regurgitation

Answer 14

backflow of blood from left ventricle to left atria
pansystolic murmur heard loudest over mitral area and radiates to axilla

radiation of the murmur to axilla

heard loudest using bell

Question 15

First line to help reduce cholestrol?

Answer 15

Statins
Can reduce LDL cholesterol by around 30%
works by slowing down LDL cholesterol production by blocking an enzyme called HMG-CoA-Reductase

E.G:
Atorvastatin
Simvastatin

Question 16

difference between ezetimibe and statin?

Answer 16

statin inhibit cholesterol production in the liver

Ezetimibe inhibits cholesterol absorption

Question 17

what is the alternative for people that cant have statins?

Answer 17

Fibrates

Question 18

nitrates:

Answer 18

Prevent heart pain (angina, chest pain etc)

Question 19

CCB : Dihydropyridine: vs Non-dihydropyridine

Answer 19

Dihydropyridine: has more of an effect on vasodilation. Dilates arterioles. Reduces afterload.​

Non-dihydropyridine: has more of an effect on heart function. Reduces heart rate and reduces oxygen demand.​

Question 20

NSAIDs

Answer 20

NSAIDs normally work by blocking the body’s production of prostaglandins by inhibiting COX-1 and COX-2 enzymes, subsequently stopping inflammation.

Question 21

herat sounds:

Answer 21

1st heart sound - closing of mitral valve

Jugular venous a wave: atrial systole

P-R interval on the ECG- electrical conduction from AV node to ventricle

Question 22

DVT: well score

Answer 22

Active cancer 
immbolisation of legs
bedridden >3 days 
locaslised tenderness
entire leg swollen 
>3cm calf circumference 
Pitting oedema 
Collateral superficial veins

Question 23

Non small cell cancer:

Answer 23

Split into 3 subtypes:

Adenocarcinoma (most common- usually begins in the outer regions of the lungs)

Squamous cell carcinoma- usually begins in the bronchial tubes

Large cell carcinoma- usually begins in the outer edges of the lungs

Question 24

Asthma:

Answer 24

Moderate: Peak flow 50-75% best

Severe: 
Peak flow 33-50% best
Respiratory rate >25/min
Heart rate >110bpm
In ability to complete sentences in one breath

Life threatening:
Peak flow <33% best
SpO2 <92%
<8 kPa
Cyanosis
Arrythmia 
Hypotension
Poor respiratory effort
Altered conscious level

Question 25

asthma

Answer 25

regular preventer - low dose ICS initial add on therapy - LABA Then consider increasing ICS to medium dose or adding LTRA Refer to specialist

Question 26

what drug should not be used in heart failure?

Answer 26

Calcium channel blockers, with the exception of amlodipine, should be avoided in heart failure as they can further depress cardiac function and exacerbate symptoms

Question 27

liver function:

Answer 27

Production of bile ​ Production of certain proteins for blood plasma​ Production of cholesterol and proteins that help carry fats through the body ​ Conversion of excess glucose into glycogen ​ Regulation of blood levels of amino acids ​ Processing haemoglobin for use of its iron content ​ Conversion of poisonous ammonia to urea (urea is an end product of protein metabolism and is excreted in the urine)​ Clearing the blood of drugs and other poisonous substances​ Regulating blood clottin

Question 28

Pancreas

Answer 28

Alpha cells: produces glucagon beta- produce amylin and insulin Delta cells - somatostatin - Gamma- pancreatic polypeptide

Question 29

cholelithiasis:

Answer 29

Gall stones made from componenets of bile