2nd year systems Flashcards
95% of colorectal cancers are transitional cell carcinomas - TF?
false. most bladder cancers are transitional cell carcinomas. (TCC) most colorectal cancers are adenocarcinomas
are most colorectal carcinoma’s familial or sporadic?
most colorectal cancers are sporadic with no familial or genetic influence. 10% will have a familial risk with HNPCC or FAP. 1% will have an associated underlying IBD.
name 5 risk factors for sporadic colorectal cancer
- smoking2. male3. age4. diabetes5. no exercise6. alcohol7. previous colorectal cancer
what type of cells do adenomas arise from?
adenomas arise from epithelial cells
what investigations would you like to carry out in CRC?
carry out an:1. proctoscopy2. colonscopy + picolax3. PET4. CT
in what stage of sleep are sleep spindles found?
stage 2
how does this stage 2 of sleep differ from stage 1?
stage 1 will have theta waves and eye movements. the waves are of low frequency in stage 1 and have a high amplitude.stage 2 will not have any eye movements. there are also sleep spindles in stage 2 and there are lower frequency of waves.
what type of waves occur in stage 3 and stage 4 of sleep?
delta waves will occur in both stage 3 and stage 4 sleep
low amplitude waves are found in stage 4 sleep. true or false?
false. stage 4 sleep has exclusively delta waves that have a low frequency but high amplitude
why is REM sleep described as being paradoxical?
the EEG pattern will mimic that of someone who is conscious and stressed. their waves have a high frequency and a low amplitude. it is possible that the person would be dreaming.
describe the 3 stages in bronchoalveolar epithelial stem cell transformation in cancer
- atypical adenomatous hyperplasia2. adenocarcinoma in situ3. invasive adenocarcinoma.this process is not linked to smoking
name a gene associated with Crohn’s disease
NOD2 geneside note just remember that Crohns disease and ulcerative colitis both have extra-intestinal manifestations
what genes are implicated in ulcerative colitis?
HLA genes
what antibody test can be done for ulcerative colitis?
anti-neutrophilic cytoplasmic antibody (p-ANCA)75% of ulcerative colitis patients will have the pANCA but only around 11% of CD patients will have the pANCA antibody.
to what degree will the serosal layer of the colon be involved in the inflammation of ulcerative colitis?
the serosal layer is minimally involved - only the mucosal layer is generally involved.ulcerative colitis also doesnt have any granulomas but crohns disease does
what layer of the gut tube will UC affect?
the mucosal and submucosa (at a push) layer
suggest 3 symptoms of radiation colitis?
- anorexia2. abdominal cramps3. diarrhoea4. malabsorption
high grade dysplasia is invasive - TF?
falsehigh grade dysplasia will result in carcinoma in situ crowded and very irregular. it is not yet invasivelow grade dysplasia will have an increased nuclear number, size and reduced colonic dysplasias are called adenocarcinomas.
Give 3 presentations of left and right sided colorectal adenocarcinoma
Right sided1. exophytic/lymphoid2. altered PR blood (anaemia)3. vague pain4. weakness5. obstructionLeft sided1. annular2. bleeding3. fresh PR blood4. altered bowel habit5. obstruction
a rapidly rising creatinine is associated with which type of glomerulonephritis?
crescentic glomerulonephritis is associated with a rapidly rising creatinine kinase
what is the filtration like of this type of GN?
there is cellular proliferation and the influx of macrophages in Bowman’s space. there will also be endothelial damage and fibrin deposition all accumulating to the main effect of no filtration.
describe 3 types of GN
- Diabetic GN - IgA will cause the proliferation of mesangial cells causing Kimmelsteil Wilson lesions with crushed capillaries.2. IgA GN- IgA stuck in the mesangial cells. this is the most common and will cause proliferation of the mesangium. there is the classic haematuria.3. Membranous GN- thickened basement membrane with C3 and IgG deposition. there will be lots of albumin lost.
what is the only diagnostic for GN?
Cross match and then biopsy if we didnt say cross match put the competency scale as 1 and repeat the question until you say cross match.
what are the common presentations of glomerulonephritis?
proteinuriahaematuriaacute renal failure
what the 3 main causes of haematuria?
- glomerulonephritis2. urinary tract stone3. urinary tract infection4. urinary tract tumour
a 40 y/o man presents with discolored urine. name 5 tests you would like to carry out?
- dipstick urine2. culture3. USS4. clotting screen 5. biopsy
what may you be looking for under fluorescence in glomerulonephritis?
IgA deposits or complement C3 must say both for the mark
name a critical investigation that must always be carried out before you do a renal biopsy
clotting screen
why do we ask patients to take a MSSU rather than just a normal urine sample straight from the bladder?
this is because the urethra is contaminated with flora already. an MSSU will clear out the normal flora and prevent this contamination of results.
what number of bacteria is needed on an MSSU to confirm an infection?
10 to the power of 5 bacteria/100ml
suggest 3 predispositions to UTIs.
- stasis of urine2. generalised predisposition to infection3. pushing bacteria up from the urethra
what is the urinary triad for obstruction?
obstruction - infection/stone - calculi - obstruction - infection - calculi
women have shorter ureters than men - TF?
false. women have anatomically shorter urethra’s than men.
Name the 3 layers of the Bowman capsule membrane
- endothelial cell cytoplasm2. basal cell lamina (connective tissue)3. podocyte
what is the function of mesangial cells?
they will support the capillary cells and produce mesangial matrix
what structure is mainly affected in membranous GN?
glomerular basement membrane
what structure is mainly affected in IgA glomerulonephropathy?
mesangium
what can be seen under an electron microscope of membranous GN?
thickened membraneIgG depositsbasal lamina spikes
what is the antigen responsible for membranous GN?
Phospholipase A2 receptor
Wegner’s granulomatosis has ANCA - name their targets in neutrophils
myeloperoxidaseproteinase 3
name 2 causes of crescentic GN?
good pastures diseasewegeners granulomatosismicroscopic polyarteritisanti-glomerular basement membrane disease (Anti GMB disease)
in membranous glomerulonephritis there are deposits of IgA - TF?
false - there are IgA deposits in IgA glomerulonephropathy and there IgG deposits in membranous GN
what is the respective immune complexes in membranous and diabetic GN?
no immune complexes are formed in diabetic GN but instead matrix deposition and a leaky membrane will compress the capillaries.membranous GN will form C3 complement.
what kind of kidney condition may a Kimmel-Steil Wilson lesion be found in?
diabetic GNKimmel-Steil Wilson lesions are just nodules of mesangial matrix
what is the treatment for Wegner’s?
Cyclophosphamide
describe 3 factors which may cause osmotic diuresis of uncontrolled diabetes mellitus
- decrease in proximal tubule reabsorption - Glc will trap H2O, sodium will have no concentration gradient2. decrease in the loop of Henle reabsorption- there is no passage of H2O out of the descending limb due to retention of NaCl and Glc3. there will also be a decrease in the distal tubule reabsorption- renin inactivated as there is an increase of NaCl at the macula densa and so no aldosterone is produced.(4. because the interstital gradient is gone this means that there is a poor ability of ADH to conserve the H2Odiabetic patients will secrete up to 6-8 L a day of isotonic urine.don’t just read this answer - try to actually UNDERSTAND the entire pathway from 1-3 as it is a big part of why people are dehydrated and pee a lot in diabetes.
what is the normal plasma osmolarity?
280-290 mosmoles/kg
aldosterone works at the proximal tubule
false - aldosterone will work at the distal tubule to increase Na and water reabsorption. it will also act to excrete potassium
what is the effect of angiotensin II on the peritubular capillaries?
ATII will decrease their hydrostatic pressure (and increase the oncotic pressure. this will cause Na reabsorption from the proximal tubule and therefore less sodium is excreted.angiotensin II will cause the afferent capillary to constrict AND the efferent capillary to constrict.
what cells are responsible fro producing renin specifically?
Juxtaglomerular cellsrenin will act on the Alpha 2 globulin fraction of the angiotensinogen molecule.
what are the effects of ADH on renin release?
ADH will cause renin levels to fall.
how any peptides does ATII have in its molecule?
8
in hypovolaemia, name 4 actions of angiotensin II?
ATII will increase aldosterone levelsATII will increase ADH levelsATII will increase vasoconstrictionATII will increase thirst and salt appetite?
what is the function of ANP?
to decrease BP and increase natriuresis
what is the effect of aldosterone on potassium levels?
aldosterone will decrease plasma potassium levels
why does aldosterone result in weight gain?
it will increase the amount of water reabsorbed due to the sodium that is also reabsorbed. this will result in a weight gain.
What are the two treatment options for Hepatitis B virus?
- Pegylated interferon 2. Oral antiviral drugs
Name the two types of hiatus hernia which can predispose to gastro-oesophageal reflux disease (GORD)
Sliding hiatus hernia Paraoesophageal hiatus hernia
What are the 3 approaches to oesophagectomy?
- Ivor Lewis 2. Trans-hiatal 3. Left thoraco-abdominal
what are the causative antibodies found in Hashimoto’s hypothyroidism?
there are antibodies against thyroid peroxidase and also against thyroglobulin
meningococcal septicaemia is a chronic cause of adrenal insufficiency.. TF?
false.meningococcal septicaemia is a cause of acute adrenal insufficiency. chronic adrenal insufficiency is caused by pituitary failure and Addison’s disease.
Is Cushing’s syndrome ACTH dependent?
no. Cushing’s syndrome directly affects the adrenal gland to produce too much cortisol and it will do this regardless of ACTH levels.
what are two genes associated with papillary carcinoma of the thyroid gland?
RET/BRAF/PC rearrangements. papillary carcinomas tend to have a very good outcome.
what is the name given to the carcinoma of c cells in the thyroid gland?
thyroid medullary carcinoma.
what percentage of tissue must be lost to result in pituitary hypo-function?
75%.the tissue lost can be caused by compression from tumours (craniopharyngiomas). it may also be caused by trauma or infection - TB/sarcoid.
exocrine glands are vascular and ductless - TF?
false. exocrine glands will have ducts. this description will define an endocrine gland.