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Flashcards in Integrative Deck (78):
1

pH range

7.35-7.45

2

Describe HCO3 reabsorption?

Baso = HCO3 Na sym
Apical = NHX

Intercalated has pump and HCO3 Na sym
From Glutamine/ a ketoglutarate and from CO2 carbonic anydrase.
Ammonia creasted rom glutamine and moves freely into lumen to trap H+

3

Anion gap calculation?

NAK- ClHCO3

4

Causes of metabolic acidosis with a normal anion gap?

REnal tubular necrosis
Diarrhoea (as HCO3 replaced by Cl-)

5

Body fluids and volumes in each

1/4 of ECF = plasma
ECF = 1/3
ICP = 2/3
so 12L dextrose to replace 1 L of blood

6

Stimulates thirst

AngioII
Hyothalamus-osmoreceptors
low saliva from tonicity

7

How can Diabetes lead to shock?

DKA = urinary loss of fluid

8

Describe types of clinical incident

Patient saftey Incident (PSI)
Near miss
Serious untoward incident (SUI)
Never event = preventaple PSI

9

How to report a clinical incident

Datix reporting
Inform key line managers

10

Describe the sites of haemopoesis in the fetus

0-2 months = yolk sac
2-5 months = liver and spleen
5-9 months = bone marrow
Infants this is most bones
Adults in vertebrae, ribs, sternum, sacrum, pelvis and ends of femur

11

What is bone marrow? Colours?

Stem cells supported by stroma
Red marrow (haemopoetic) vs yellow marrow (fatty)
All red at birth

12

Myeoloid progenitor vs myeloblast?

Myeoloid progenitor also produces Magakaryocyte, eythrocyte and mast cells

13

Describe myeloblast to neutrophul

Myeloblat
Promyelocyte
Myelocyte
Metamyeolcyte
Band cell (c shae)
Neutrophil

Nucleus starts large and cytoplasm grows so it shrinks

14

Describe myeloid progenitor to RBC

Proerythro
Normoblast
Reticulocyte
Red cell

Haemoglobinisation of cytoplasma
Nuclear maturation and nuclear extrusion

15

Platelet production controlled by?

Thrombopoietin (TPO)

16

Structure of the spleen?

Red pulp - sinuses lined by endothelial macrophages and cords
White pulp - like lymph follicles (white cells and plasma preferentialy pass here and red through red pulp)

17

Descrie the functions of the sleen

Phagocytosis
Blood pooling- activation of platelets and RBCs if bleeding
Haemopoiesis (from pluripotent) Extramedullary
Immunologicao - T and B cells

18

Causes of splenomegaly

Massive - keukaemia, malaria, myelofibrosis
Moderate - Liver cirrhosis, portal hypertension and above
Mild- as above also infections e.h. hep and glandular fever, hepatits, endocarditis, sarcoidosis
Pancytopeia from enlarged spleen possibke

19

Causes of hyposplenism

Caeliac and Sickle cell
Risk of sepsis

20

Define aplastic anaemia

Pancytopenia with hypocellular bone marrow with no infiltration or fibrosis
Can be idiopathic

21

COngenital deficit in B cells?

X linked hypogammablobulinaemia
Low IgA,M
No tonsils
Recessive
Early

22

What is ataxia talangiectasia

Thymic hypoplasma, low B cells
BMTransplant

23

Neutrophil congenital deficiency

Chronic granulomatous disease
X linked recessive
Persistent infections of mucous membrane
BMT

24

Aquired B cell deficiency

Hypogammaglobulinaemia
Chronic lymphatic leukaemia and other lymphoproliferativevm nephrotic

25

Aquired T Cell immunodeficiency

HIV, Chemo, Hodgkins, immunosuppression

26

What is myelodysplasia

Non-functioning neutrophils

27

Describe cytomegalovirus

In immunocompromised patients
Pneumonitis, oesophagitis, colitis, hepatitis
Black spots?

28

What do Stellate cells in the liver do?

Secrete ECM so more in disease

29

NYHA Functional calssification of HF

Class I no syptoms/ limitations
II - slight limit and symptoms in physical
III - Marked limitation and symptoms in physical act
IV - At rest, discomfort with any phys

30

Heart diagram in systolic and dialstolic

Hypertrophy in dia
Dilated in systolic

31

Describe diastolic heart failure

Elderly and female
Hypertension, DM, obesity
Reduced LV compliance and relaxation
Unable to compensate by increasing EDP
Low cardiac output results

32

Normal result in clonus

2 is still normal

33

What is Hoffman's sign?

Monosynaptic reflex (indicate an UMNL)

34

Illicit drugs RF stroke

Cocaine

35

What is the valsalva maneouvre?

aneuver or Valsalva manoeuvre is performed by moderately forceful attempted exhalation against a closed airway, usually done by closing one's mouth, pinching one's nose shut while pressing out as if blowing up a balloon

36

Causes of haemorrhagic stroke

Hypertension
Anti coagulation
Vascular abnormalit
Amyloid deposition
Tumour

37

Describe TACs and PACs

Hemianopia, hemiparesis, hemisensory loss and higher cortical dysfunction

PACS: 2 of these or higher cortical dysfunction only

38

Name of removal system in spleen

Reticuloendothelial system

39

TYpes of abnormal red cells

Spherocytes
Elloptocytes
Acanthocytes
Target cells e.g. alcohol, liver, thalassemia

40

Symptoms and signs of anaemia

Tierdness
DIzziness
Palpatations
Headaches
SOB
Weakness
Angina, claudication, confusion, HF

Palor
Tachycardoa
Sstolic flo murmur
HF

41

Causes of microcytic anaemia

Iron
Anaemia of chronic disease
Thalassemia
Lead
SIderoblastic anaemia (ring sideroblasts produced)

42

Causes of macrocytic anaemia

B12 deficiency, folate deficiency
Pernicous anaemia - autoantibody to intrinsic factor required to absorb B12

43

Normocytic normochromic (NORMAL SIZE)ANAEMIA CAUSES?

aNAEMIA OF CHRONIC DISEASE
mIXED DEFICIency of Fe and V12/folate
BM failure

44

Causes of neutrophillia

Infection
Acute inflam
Smoking
Drugs
Acute haemorrhage
Myeloproliferative disease
Metabolic/ endocrine disorders
Malignant disease
Cytokines

45

Causes of monocytosis

Chronic inflammatory conditions
chronic infection eg..g. TB
Carcinoma
Myeloproliferative disaeases/ leukaemias

46

Causes of eosinophila

Drug hypersensitivity e.g. penicillin
Allergic disease e.g. asthma, eczema, urticaria, hay fever, aspergillus
Parasitic infection

47

Causes of basophilia

Hypersensitivity reactions
UC RA
MYeloproliferative

48

Lymphocytosis causes

Reactive e.. viral infections, bacterial, stress e.g. MI, splenectomy
Lymphoproliferative e.g. chronic lymphocytic leukaemia
Lymphoma

49

What is a Leucoerythroblastic film and what are the causes

Granulocyte precursors and nucleated RBC on film
Bone marrow infiltration carcinoma or haem malignancy
Sepsis/ shock
Severe megaloblastic anamia
Storage disease

50

What is VOn Willebrands factor (vWF)

Essential for platelet adhesion and for factor VIII
Activated by collagen and tissue factor

51

Describe the main platelet functions

activation - Coauglation factor activation
Secretion - encourage furthur aggregation e.g. ADP thromboxane
Aggregation - Platelet plug
Adhesion- vessel wall

52

How do we measure intrinsic and extrinsic pathways of clotting

Extrinsic - INR
Intrinsci - APTT

53

SOme problems with vessels

Hereditary haemorrhagic telangiectasia (HH)
Connective tissue e.g. ehlers Danlos
Senile purpura
Steroids
Infection e.g. measles
Scurvy

54

Problems with vessels signs

Easy bruiding
Spontaneous bleed from small vessels skin and mucous membranes

55

Causes of platelet function decrease

Rare heriditary
NSAIDs clopidogred
Uraemia
Hypergammaglobulinamiia

Leads to bleeding

56

PRoblem with coag factors?

A = 8
B = 9
Liver disease
Vit k def

57

Postictal symptoms

headche
confusion
myalgia

58

Causes of non-epileptic seizure

Trauma
Hypoglycaemia
Hypoxia

59

Define hypersensitivity

The antigen specific immune response that are either inappropriate or excessive and result in harm to host

All have a sensitisation phase and an effector phase (re exposure)

60

Infections driving hypersensitivity against self

Rheumatic heart disease
Guillain Barre syndrome
Type 1 diabetes - Coxsakie

61

Examples of type I

Anaphylaxis
Asthma
Acute urticaria
Food allergy
Lts of symptoms

62

Pathology in Type 2

Antibody mediated complemet, cytotoxicity and modulation of cellular function

63

examples of type 2 immunosesnitivity reactions

Graves disease
Myasthenia gravis
Pernicious anaemia
Goodpastures
Haemalogical disease e.g. rhesus and second bby
Tissue damage vs change in function

64

Type 3 exmamples

Deposition and tissue damage non specifically
RA
Glomerulonephritis (infectious)
SLE

65

Symptoms in SLE

Cardiac (pericarditis), resp, renal, joint (arthrirtis), pleura inflam, fatigue, appetitie, fever, photosensitive, butterfly rash, myalgia

66

Criteria for SLE

Most women
Skin
Sstemic
Laboratory - anti nuclea antibody (ANA)

67

Type IV examples

Tuberculin and Mantoux test
Granulomatous hypersensitivity e.g. TB
Leprosy
Schistosomiasis
Sarcoidosis
Hashimotos
RA
Coeliac disease - lead to hyposlenism and lymphoma

68

Examples of nitrates

Isosorbide Mononitrate

69

SABA expamples

Salbutamol
Terbutaline

70

Nystatin use

Treat mould and yeast infections
Binds to fungal cell membrane and forms pores (K+ leakage)

71

Nystatin ADRS

Diarrhoea, abdo pain, hypersensitivity

72

Clotrimazole moa and adrs

Increases membrane permeability
Itching nausea cvomiting LFTs

73

Amphotericin moa and use

Systemic fungal infections
Same as nystatin
Fever chills headaches hypotension

74

Metronidazole ADRs

Nausea
Metallic
Loss of appeatite
Headache

75

Drugs to treat anaemia

Ferrous sulphate/ fumerate
Hydroxocobalamin- b12
Folic acid

76

MSK anticholiesterases

Neostigmine
Pyridostigmine

77

Isoflurant and sevoflurane MoA

GABA and glycine sesnitisation

78

NM blocking agents

Pancuronium
Suxamethonium chloride