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BONUS:
other questions:
| Question | Answer |
|---|---|
| morula | 16 cells in a solid ball of cells (blackberry) made at day 4 after zygote divides |
| early blastocyst | morula with a big hole in the middle |
| late blastocyst | blastocyst but it begins to make differentiated layers eg trophoblast and embryoblast |
| LHF | problem emptying blood into the aorta (LVF/systolic) or filling properly (diastolic). Leads to blood backing up into lungs, causing pulmonary edema (symptoms dyspnea, crackles, pink frothy sputum, paroxysmal nocturnal dyspnea). Most common type. |
| RHF | problem pumping blood into lungs leading to blood backing in systemic venous system causing prominence of internal jugular veins (JVD) and dependent pitting oedema in legs ankles etc |
| systolic heart failure | heart cannot pump properly characterised by a low ejection fraction (EF <40%/ 50%) |
| diastolic heart failure | heart cannot fill properly characterised by a normal or preserved ejection fraction (EF > 60%) at rest often due to a stiff ventricle |
| most common cause of diastolic HF | concentric LV hypertrophy due to essential hypertension |
| EF = | SV / EDV |
| normal EF range | 55-80% |
| BNP | B-type natriuretic peptide (cardiac neurohormone secreted from ventricles in response to volume overload and SNS activation causing VASODILATION via natriuresis/ diuresis |
| key diagnostic tests for heart failure | N-terminal pro BNP, 12-lead ECG (shows LV hypertrophy, electrical issues) Transthoracic Echocardiogram (TTE) - shows if it's systolic or diastolic failure, and assesses EF. CXR - for visualizing pulmonary edema. |
| S3 heart sound | normal in young people BUT in young adults it often indicates volume overload eg in systolic heart failure |
| S4 heart sound | ALWAYS PATHOLOGICAL indicating stiff ventricle eg in diastolic HF |
| MCMV means | tells average volume (size) of RBC |
| MCV formula | haematocrit / RBC count |
| pre-embryo stage/ germinal period | first 2 weeks (where zygote undergoes cleavage, morulation, and blastulation) |
| embryo stage | weeks 3-8 (gastrulation and formation of germ layers and major organ systems) |
| foetus stage | week 9 onwards (organs mature and fetus grown significantly beginning to look more human like) |
| inner cell mass of blastocyst | embryoblast (makes embryo proper) |
| outer cell layer of blastocyst | trophoblast (gives rise to placenta) |
| basophils | blueberries (purple and in anaphylaxis releasing heparin and histamine) |
| eosinophils | raspberries (pink and in allergic inflammation) |
| difference between ionotropic and chronotropic | ionotropic is contractions and chronotropic is heart rate |
| BP formula | CO X total peripheral resistance |
| where is the needle injected in thorax for samples | close to upper border of lower rib in intercostal space 9 in midaxillary line |
| triangle of safety for chest tube insertion formed of (3) | lateral border of pectoralis major anteriorly, lateral border of latissimus dorsi posteriorly, and inferior horizontal line from nipple (5th intercostal space) |
| typical thoracic vertebrae | 2-8 |
| atypical thoracic vertebrae | 1st and 9-12 |
| where does the pectoralis major insert into | intertubercular (or bicipital) groove of the humerus |
| which nerve innervates the pectoralis minor muscle | medial pectoral nerve (C8, T1) |
| which nerve innervates the pectoralis major muscle | medial and lateral pectoral nerve |
| sternocostal head of the pectoralis major attaches to the | sternum and upper 6 costal cartilages |
| clavicular head of the pectoralis major attaches to the | medial half of the clavicle |
| attachments of the pectoralis minor muscle | Coracoid process of scapula to ribs 3-5 near cartilage |
| pectoralis major movement at shoulder joint | adduction and medial rotation |
| costochondral joint type of joint | synchondrosis joint |
| origin of the intercostal muscles | lower border of the rib above. This allows them to act on the rib below. |
| What makes up the manubriosternal joint | symphysis - secondary cartilaginous joint. |
| Flail chest means | 3 or more adjacent ribs are fractured in multiple places, leading to a segment of the chest wall that moves paradoxically (inward on inhalation, outward on exhalation) |
| most effective way for detecting IgE-mediated type I allergic reactions. | skin prick test |
| when you get a positive skin prick test, what two things would you typically observe at the site where the allergen was applied | wheal (a raised bump) and a flare (redness around the bump) |
| IgM-mediated Type II HSR works by | causing lysis via the membrane attack complex (C5-C9) |
| nasolacrimal duct opens into | inferior meatus |
| when choanae is narrowed or blocked at birth what is this called | atresia |
| choanae open into | nasopharynx |
| arterial supply of inside of nose | little's area aka Kiesselbach's plexus |
| lobes in right lung | 3 |
| lobes in left lung | 2 |
| hilar shadows on CXR | made of pulmonary vessels |
| position of phrenic and vagus nerve | phrenic passes anterior to lung root and vagus passes posterior of lung root |
| causes of shortness of breath (respiratory) | upper airway (eg croup as a paediatric example) asthma emphysema/ pneumonia pleural problem eg pleuritic chest pain chest wall problem eg trauma respiratory/ cardiac interaction eg pulmonary embolism |
| causes of SOB (cardiac) | cardiac failure (heart muscle problem, heart valve problem, heart rhythm problem, obstructive heart problem) |
| causes of SOB (apart form cardiac and respiratory) | metabolic (diabetic ketoacidosis), haematological (anaemia), neuromuscular, psychological (anxiety), physiological (pregnancy), and drugs (eg aspirin or overdose) |
| questions to ask (HPCx) asthna | when did it start when does it happen any triggers any relieving factors any associated symptoms does it restrict activity |
| questions to ask (PMHx) asthma | signification/ previous/ongoing conditions atopic history immunisation history |
| explain the PEF results (variability of readings and what is considered positive) | value of more than 20% variability after monitoring at least twice daily for 2 weeks is regarded as a positive result (NICE) |
| positive results on FeNO | level of >50ppb and indicates eosinophilic airway inflammation |
| asthma definition | chronic respiratory condition associated with airway inflammation and hyper-responsiveness |
| budesonide | synthetic inhaled corticosteroid causing anti-inflammatory action via cellular binding and modulating gene expression |
| serial (anatomical) dead space | volume of conducting airways (0.15l) |
| distributive dead space | not airways and dont support gas exchange eg damaged alveoli (0.02l) |
| physiological dead space | serial dead space + distributive dead space (0.17l) |
| pulmonary ventilation rate (PVR)= | respiration rate x tidal volume |
| dead space ventilation rate = | physiological dead space x respiration rate |
| alveolar respiration rate (AVR) = | PVR - dead space ventilation rate |
| central chemoreceptors (CCR) | found on medulla and are sensitive to changes in H+ and pCO2 |
| peripheral chemoreceptors (PCRs) | found within aortic arch and carotid arteries and are sensitive to changes in arterial pO2 and pH |
| permeability of BBB to substances | impermeable to H+ and HCO3- but permeable to CO2 (CO2 travel into brain react with water making products detected by CCR leading to hyperventilation -> decreases PCO2) |
| for PCRs when does hyperventilation get stimulated | when arterial pO2 falls below 13.3mmHg |
| increased pCO2 and response from receptors | most important in CCR than PCR |
| fall in pH and response from receptors | detected by carotid but not aortic bodies |
| hypoventilation leads to | respiratory acidosis |
| hyperventilation leads to | respiratory alkalosis |
| uncontrolled diabetes leads to | metabolic acidosis |
| vomiting leads to | metabolic alkalosis |
| priority of responses in ventilation | PCO2 -> pH -> PO2 |
| cheyne strokes | occurs in people with CNS diseases, head trauma, intracranial pressure and heart failure where rapid breathing -> apnoea (due to delayed message relay) -> rapid breathing |
| respiratory depression | rate/depth respiration is insufficient to maintain adequate exchange in lungs and can be reversed by analeptics eg doxapram hydrochloride |
| DRG (dorsal respiratory group) | innervate diaphragm and external intercostal muscles having a role in inspiration- switch on for 2s and off for 3) |
| VRG (ventral respiratory group) | innervate abdominal muscles and internal intercostal muscles for forced expiration |
| pneumotaxic centre in pons | transmits inhibitory signals to DRG to limit inspiration and prevent over inflation of lungs |
| apneustic center in pons | responsible for prolonged insiratory gasps (apneusis) to prolong DRG stimulation |
| vagus nerve | sends afferent information from lungs to DRG to prevent overinflation of lungs bu switching off inspiration |
| cerebral cortex in ventilation | bypasses medullary centers (mind over body) to an extent (will need to breath when O2 conc reaches critical levels) |
| hypothalamus in ventilation | alters resp rate based on strong emotions, pain, temperature eg will experience apnoea when angry or tachypnoea when excited |
| juxtapulmonary receptors (J.C fibres) | lie in alveolar wall between epithelium and endothelium (close to pulmonary capillaries) and are stimulated by congestion, oedema and histamine where activation leads to apnoea/ rapid shallow breathing, bronchoconstriction and mucus secretion |
| irritant receptors | between epithelial cells and are sensitive to irritant gases, smoke and dust and activation results in rapid shallow breathing, cough, bronchoconstriction, mucus secretion and gasps |
| who should be tested for alpha-1 antitrypsin deficiency (AATD) | all patients with COPD should be tested once for AATD |
| effect of low/ absent AATD | EMPHYSEMA/COPD because theres not enough to inhibit neutrophil elastase |
| questions to ask when COPD suspected | weight loss reduced exercise tolerance waking at night with breathlessness ankle swelling fatigue occupational hazards chest pain haemoptysis |
| which drug can cause ankle swelling | amlodipine |
| Vd= | dose/ To conc |
| formula for first order kinetic rate of elimination | Ct= Coe^-kt (e= 2.718) |
| k= | CL/ Vd |
| CL = | K x Vd |
| t1/2 = | 0.693/k |
| infusion rate = | clearance x Css |
| F = | AUC oral/ AUC IV |
| how many half lives does it take to reach steady state | 5 |
| dose = (for oral regimen) | (CL X Css X t )/ F |
| dose given = | amount needed / F |
| factors affecting design of dosage regimen (3) | TW, urgency of onset of effect, and elimination half life |
| large TW uses what strategy | maximal dose |
| small TW uses what strategy | target level |
| loading dose (LD) = | target level x (V/F) |
| maintenance dose (MD) = | target level x (CL/ F) |
| short elimination half life | <1 hour. If it has large TW then intervals of 6 or 8 but if it has small TW given by infusion +/- loading dose |
| moderate elimination half life | 4-24 hours given initial dose, then half that every half life |
| long elimination half life | >24 hours - set a 24 hour dosage interval to ensure best patient compliance |
| gentamicin | antibiotic (aminoglycosides) which manages septicaemia, endocarditis and is given as IV/ IV infusion and IM in 3 divided doses or single daily dose with side effects of ototoxicity and nephrotoxicity |
| post antibiotic effect | time needed to show regrowth following removal of antibiotic (to prevent toxicity we aim for tough <2mg/L) |
| gentamicin half life (t1/2) | 2-3 hours in normal renal function but 30-60 hours in anephric patients |
| which patients should receive single daily dose of gentamicin | those on cisplatin chemotherapy, those with CLcr <20mL/min, children, and those with endocarditis |
| single daily dose gentamicin - how much given and when | give 7mg/kg in 100mL over 30-60 min and sample 6-14 hours after start of infusion |
| pneumonia | inflammatory reaction of alveoli and interstitium caused by infection and characterised by inflammatory exudate in alveolar space that consolidates, inflammation of alveolar septa, and features of acute inflammation |
| how is pneumonia different to bronchitis | bronchitis affects bronchi and pneumonia affects alveoli |
| red hepatization appearance | when neutrophils and fluid in alveoli congested in capillaries |
| routes of infection for pneumonia | aspiration, inhalation of pathogen, and contamination from systemic circulation |
| how can pneumonia be classified | by pathogen, setting, anatomically |
| anatomical pneumonia classification types | lobar pneumonia and bronchopneumonia |
| lobar pneumonia | alveoli-alveoli (organism access alveoli and spread rapidly via alveolar pores to others seen in poor adults or alcoholics) |
| bronchopneumonia | bronchi-alveoli (organisms colonise bronchi and spread to alveoli with affected areas consolidating seen in young/elderly/immobile) |
| community acquired: acute/typical pneumonia cause | S pneumoniae (most common cause of 90% lobar- is gram positive diplococi) |
| causative organisms for pneumonia | bacteria )gram +/-), viruses, mycoplasma, fungi, and inorganic agents (inhaled dusts or gases) |
| aspiration pneumonia | caused by abnormal gag/swallow reflexes (from stroke/unconsciousness/repeated vomiting/ underlying disease MS) causing irritation of gastric contents and bacteria leading to often necrotising abscess formation in survivors |
| symptoms of acute bacterial pneumonia | fever, dyspnoea, cough with purulent sputum, crackles on auscultation, consolidation in radiograph |
| when can pneumonia be diagnosed using what | sputum (bacterial/virus is gram stained or bacterial cultured with suitable antibiotic), xray, and FBC (wbc counted) |
| TB is a form of what | chronic pneumonia |
| what bacteria causes TB | mycobacterium tuberculosis |
| symptoms of TB | gradual onset anorexia, weight loss, fever (low grade remitting), night sweats, chest pain, prolonged coughing with sputum production |
| diagnosis of TB involves (2) | sputum analysis (2- finding slender role aerobes, high content of complex lipid identified with acid fast stains, cultures to check for drug susceptibility ) and xray |
| pathogenesis of TB | Inhale → macrophage engulfs → change pH so no phagolysosome formed -> survives in macrophage w flu symptoms/asymptomatic → lymph node cell mediated response → Th1 activation → IFN-γ → macrophage activation → granuloma → latent or active TB |
| types of emphysema (anatomical location) | centriacinar/ centrilobar (most common in upper lobes, smoking related, dilated respiratory BRONCHIOLES) and pan acinar/ pan lobar (dilated alveoli, more common in lower lobes, is hereditary) |
| causes of emphysema | smoking and inherited (AATD deficiency) |
| presentation/ symptoms of emphysema | SOB and prolonged expiration, barrel chest due to use of accessory muscles, prolonged onset >40 years, congenital AATD deficiency presents earlier, often copresents with chronic bronchitis (cough + excess mucus), and pursed lips to maintain airway |
| bronchiectasis | permanent dilation of main bronchi + bronchioles, seconfary to pulmonary inflammation and scarring causing airway to dilate as surrounding scar tissue (fibrosis) contracts |
| bronchiectasis symptoms | chronic cough, dyspnoea, production of copious amount of FOUL SMELLING sputum, and clubbing, haemoptysis (due to damage to epithelium causes bleeding) |
| pathogenesis of bronchiecstasis | infection (recurrent and persistent infection weakens bronchial walls), obstruction (inters with drainage of bronchial secretions), and congenital/ hereditary (CF-> infection, immunodeficiency -> infection etc) |
| bronchiectasis morphology | lower lobes on both sides, vertical air passages, 4x expanded, affected lobes surgically removed |
| acute restrictive lung disease | ARDS |
| chronic restrictive lung disease | pulmonary fibrosis and pneumoconioses |
| type I pneumocyte | squamous and extremely thin, cover 95% alveolar space, involved in gas exchange |
| type II pneumocyte | granular and cuboidal, cover 5% alveolar space and secrete pulmonary surfactant |
| fibrosis | Excessive formation of scar tissue due to chronic injury or inflammation (inflammation of alveolar walls attract macrophages + fibroblasts -> fibroblasts lay down collagen decrasing lung compliance) |
| obstructive disease overview | limited airflow due to obstruction caused by increased airway resistance |
| restrictive disease overview | restrict normal lung movement due to reduced expansion of lung tissue and decreased total lung capacity |
| pneumoconioses | from workplace, develop over a long time even after exposure stops which increases risk of cancer |
| pleural effusion causes (2) | exudate from cancer of pneumonia and congestive heart failure/ kidney or liver disease (transudate) |
| symptoms of pleural effusion | SOB, chest pain on breathing in deeply, fever, cough |
| treatment of pleural effusion | drain or treat cause with antibiotics |
| majority of epithelium from nasal cavity to bronchi | pseudostratified columnar ciliated epithelium |
| lining of bronchioles | simple columnar to cuboidal epithelium |
| lining of alveoli | thin squamous epithelium |
| conducting segment of airway | nostrils to terminal bronchiole |
| respiratory segment of airway | respiratory bronchioles to alveoli |
| lining of nasal vestibule | keratinised stratified squamous epithelium |
| oropharynx and laryngopharynx lining | non keratinised stratified squamous epithelium |
| function of turbinate bones in nasal cavity | create turbulence driving air in and out sinuses |
| how many lobar bronchis on the right | 3 |
| how many lobar bronchis on the left | 2 |
| histological sites in respiratory system (4) | mucosa (respiratory epithelium and lamina propria), submucosa, cartilage and o muscular layer, and adventitia |
| lamina propria in respiratory system contains | CT, blood, and lymph |
| cartilage in trachea | c shaped hyaline cartilage |
| club cells | found in terminal bronchioles only to repair airway after injury, secrete antiinflammatory and immunodulatory proteins etc MAKE SURFACTANT TOO |
| cilia features | membrane bound, centriole derived projections + microtubule cytoskeleton, 9+2 ciliary axoneme, dynein arms for motility |
Created by:
kablooey
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