Polishing

Question 1

Describe the coronary venous drainage

Answer 1

Great cardiac vein: arises at apex, runs in AV sulcus and around to the coronary sinus. Drains territory supplied by LCA
Middle cardiac vein: runs in posterior interventricular septum
Small cardiac vein: starts on right marginal side, runs in AV sulcus to drain into coronary sinus

Question 2

How can CKD cause hTn?

Answer 2

• Kidneys cannot filter blood as effectively
• Less sodium detected by macula densa
• Renin release
• Plus: increase in blood volume because less is filtered out

Question 3

What is phaeochromocytoma?

Answer 3

• Tumour of chromaffin cells in adrenal gland
• Overproduction of catecholamines

Question 4

How can diabetes cause hypertension (two mechanisms)

Answer 4

Mech 1: Hyperglycaemia damages kidneys, leading to renin release and hypertension
Mech 2: Glucose stays in blood, creating an osmotic gradient that causes hypertension

Question 5

List three causes of secondary hypertension

Answer 5

• Phaeochromocytoma
• Chronic Kidney Disease
• Diabetes

Question 6

How can hypertension damage the brain

Answer 6

• Vascular damage
• Increased arterial clot formation

Question 7

Which muscle does the long thoracic nerve supply?

Answer 7

Serratus anterior

Question 8

Why is the long thoracic nerve vulnerable to damage?

Answer 8

• Long, superficial course

Question 9

What property of a pressure-volume loops tells us its compliance?

Answer 9

Its slope (change in volume per change in pressure)

Question 10

Describe the gradient of lung ventilation from the apical to the basilar regions

Answer 10

Ventilation is lowest at the lung apices, and highest at the lung bases.

Question 11

How does the V/Q ratio change from lung base to lung apex?

Answer 11

It increases

Question 12

Describe the four different kinds of mechanoreceptors in the lung (and, briefly, their roles)

Answer 12

• Stretch receptors (Hering-Breuer reflex)
• Muscle receptors (increase respiration in response to activity)
• Juxtacapillary receptors (respond to capillary engorgement and chemicals)
• Irritant receptors (cough reflex)

Question 13

What receptors are on the end of bronchopulmonary C-fibres?

Answer 13

Juxtacapillary receptors

Question 14

Effect of obstructive/restrictive lung disease on lung volumes

Answer 14

Obstructive: increased reserve volume
Restrictive: all lung volumes (including TLC) decreased

Question 15

Are the symptoms of a STEMI and NSTEMI different?

Answer 15

• No
• They are the same

Question 16

Recap ECG lead placement

Answer 16

• Leads V1-V6:
  Fourth ICS parasternal right side (V1)
  Fourth ICS parasternal left side (V2)
  Fifth ICS mid-clav left side (V4)
  Between V2 and V4 (V3)
  Anterior axilla fifth ICS (V5)
  Middle axilla fifth ICS (V6)
• Limb leads (traffic light):
  Right Arm: Red
  Left Arm: Yellow
  Left Foot: Green
  Right foot: Black

Question 17

List two non-atherosclerotic causes of myocardial infarction

Answer 17

• Coronary artery dissection
• Vasospasm

Question 18

List some causes of Type 2 MI

Answer 18

• Anaemia
• Hypotension
• Sepsis

Question 19

Describe conservative treatment of peripheral vascular disease

Answer 19

• Risk factor reduction (weight loss, smoking cessation, exercise)
• Medication (aspirin, hTn meds, diabetes medication, statin)

Question 20

Describe more invasive methods of treating peripheral vascular disease

Answer 20

• PCI (stent placement)
• Surgical bypass

Question 21

Recall some inherited and acquired causes of hypercoagulability

Answer 21

Inherited:
- Factor V Leiden Mutation
- Protein C/S deficiency
Acquired:
- Pregnancy
- Malignancy
- Birth control pills
- HRT

Question 22

How does oestrogen increase coagulation in pregnancy, HRT, and oral contraceptive use?

Answer 22

• Increased factors VII, X, XII, and XIII
• Decrease protein S

Question 23

What is added to plasma in aPTT testing?

Answer 23

• Calcium
• Phospholipids

Question 24

Describe the innervation of the visceral and parietal pleura (basic overview)

Answer 24

Parietal:
- Mediastinal surface: phrenic nerve
- Lateral surface: intercostal nerves

Visceral:
- Autonomic

Question 25

How does pneumothorax cause chest pain?

Answer 25

It triggers sensory fibres in the visceral (autonomic) and parietal (phrenic/intercostal) nerves

Question 26

Thoracentesis vs thoracostomy

Answer 26

Thoracentesis: needle drainage Thoracostomy: insertion of chest tube (continuous drainage)

Question 27

Primary spontaneous pneumothorax management

Answer 27

In HD stable: observation and monitoring In HD unstable: thoracostomy

Question 28

How is recurrent spontaneous pneumothorax treated?

Answer 28

Definitive management (pleurodesis) should also occur

Question 29

How is tension pneumothorax treated?

Answer 29

- Needle decompression - Tube thoracostomy

Question 30

How can pulmonary embolism cause transudative AND exudative effusions?

Answer 30

Transudative: increase hydrostatic pressure proximal to blockage Exudative: release of vasoactive cytokines in response to blockage

Question 31

What are the three types of infective pleural effusion?

Answer 31

- Parapneumonic - Empyema - Complex parapneumonic

Question 32

Sliding vs rolling hiatus hernia

Answer 32

Sliding: gastrooesophageal junction Rolling: fundus of stomach

Question 33

Where is haem predominantly synthesised?

Answer 33

Erythrocyte precursors in bone marrow (before organelles are dissolved)

Question 34

Microcytic anaemia acronym

Answer 34

TAILS: - Thalassaemia - Anaemia of chronic disease - Iron deficiency - Lead poisoning - Sideroblastic anaemia

Question 35

Normocytic anaemia acronym

Answer 35

3 As, 2 Hs: - Acute blood loss - Anaemia of chronic disease - Aplastic anaemia - Haemolysis - Hypothyroidism

Question 36

Macrocytic anaemia acronym

Answer 36

FATRBC: - Foetal pregnancy - Alcohol - Hypothyroidism - Renal failure - B12 and folate deficiency - Cirrhosis/liver disease

Question 37

Vulnerable stages of life to iron deficiency

Answer 37

- Pregnancy - Pre-menopausal women - Growing adolescents

Question 38

Neutrophil lifespan

Answer 38

~2.5 days

Question 39

What is the lifespan of lymphocytes (memory/non-memory)

Answer 39

Non-memory: weeks/months Memory: years

Question 40

Lifespan of eosinophils

Answer 40

2-5 days

Question 41

Macrophage/monocyte lifespan

Answer 41

Monocyte: 1-6 day Macrophage: months/years

Question 42

Basophil lifespan

Answer 42

12-15 days

Question 43

List the three functions of macrophages/neutrophils

Answer 43

- Phagocytosis - Chemotaxis - Killing foreign bodies

Question 44

What do CD4 and CD8 bind to?

Answer 44

Corresponding MHC molecule (product is always 8)

Question 45

What disease does Binet staging relate to?

Answer 45

CLL

Question 46

Outline stages A, B, and C of binet staging

Answer 46

A: <3 lymphoid areas of involvement, no anaemia/thrombocytopaenia B: =>3 lymphoid areas of involvement, no anaemia/thrombocytopaenia C: Anaemia and/or thromboytopaenia

Question 47

Describe the three phases of chemotherapy for haematological malignancies

Answer 47

Induction: Aim is to induce remission Consolidation: Aim is to kill all remaining cancer cells once remission has been achieved Maintenance: Given to prolong remission/stop recurrence of cancer

Question 48

Name and describe the mutation that causes chronic myeloid leukaemia

Answer 48

- ABL gene is moved from chromosome 9 to chromosome 22 - Joins next to BCR gene from 22 - New BCR-ABL gene allows unregulated cell proliferation

Question 49

Briefly describe the mechanism of anaphylaxis

Answer 49

Allergic reaction (usually IgE mediated) that results in release of inflammatory substances into the bloodstream, causing multi-organ involvement.

Question 50

How is anaphylaxis treated

Answer 50

- Intramuscular adrenaline - Antihistamines - Airway monitoring (supplemental O2, airway management, IV fluids)

Question 51

Four criteria of informed consent

Answer 51

- Capacity - Voluntary - Specific to procedure - Must understand alternatives, risks

Question 52

List some organs other than the lungs that TB can infect

Answer 52

- Kidneys - Brain - Bones

Question 53

Symptoms of bronchiectasis

Answer 53

Transient: - Wheezing - Dyspnoea - Foul-smelling mucous - Coughing - Clubbing

Question 54

What causes S3 and S4?

Answer 54

S3: Ventricular filling S4: Atrial systole

Question 55

Which valvulopathy radiates to the left axilla?

Answer 55

Mitral regurgitation

Question 56

Common features of IV-drug related endocarditis

Answer 56

Right-sided valve involvement

Question 57

Common organism of acute native valve endocarditis

Answer 57

Staph aureus

Question 58

Common organisms of subacute endocarditis

Answer 58

Enterococcus/ alpha haemolytic strep

Question 59

Four levels of alpha thalassaemia

Answer 59

One mutated alpha globin: silent Two: Trait Three: HbH disease Four: Incompatible with life

Question 60

Genetic inheritance of beta thalassaemia

Answer 60

Autosomal recessive

Question 61

Haemophilia inheritance pattern

Answer 61

X-linked recessive

Question 62

Does ferroportin reduce iron ions?

Answer 62

No; that is done by an enzyme

Question 63

Which family of organisms are most commonly responsible for community acquired pleural infections?

Answer 63

Streptococcus

Question 64

What describes a positive bronchodilator response in an adult?

Answer 64

Increase in FEV1 (or FVC) of ≥12% and an absolute increase in FEV1 (or FVC) of ≥200 mL

Question 65

True or false: obesity is a risk factor for PE

Answer 65

True

Question 66

Does COPD cause clubbing?

Answer 66

No

Question 67

At what level does an airway obstruction cause a stridor?

Answer 67

Extrathoracic (i.e. trachea, glottis etc.)

Question 68

Is connective tissue disorder more likely to cause regurgitant or stenotic valvulopathies?

Answer 68

Regurgitant

Question 69

What causes a JVP "wave"

Answer 69

Atrial contraction

Question 70

What is more specific to myocardium: Troponin or creatine kinase MB?

Answer 70

Troponin

Question 71

What is the most common modification of the left ventricle in mitral stenosis

Answer 71

Dilation