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Semester 1 > Acute Confusional State > Flashcards

Acute Confusional State Flashcards

1
Q

Process of the formation of fibril

A

Collagen:

  • translation glycosylation
  • procollagen transported to Golgi
  • excreted by exocytosis
  • trimmed to tropocollagen
  • cross-linked to form fibril
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2
Q

Where is elastin made and why does it recoil?

A

Made in fibroblasts as well as smooth muscle cells and chondroblasts

Hydrophobic effect is main driving force for recoil

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3
Q

What is GAG?

A

Glycosamino glycans

  • long chain of repeating disaccharide units
  • highly charged negative and highly hydrated
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4
Q

What adheres actin filaments to the membrane?

A

Plaque

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5
Q

Which cadherins provide cell adhesion in different tissues?

A

E Calderon - Epithelia
N cadherin - neurones and heart muscle
P cadherin - plasma and epidermis
VE cadherin - endothelial cells

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6
Q

What are focal adhesions?

A

Link the ECM through transmembrane proteins (integrins) with cytoskeleton (actin filaments)
Also act as signalling platforms
Link to fibronectin

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7
Q

What are hemidesmosomes?

A

Link the ECM through integrins with cytoskeleton (intermediate filaments)
More stable e.g linking epithelial cells to basement membrane

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8
Q

What are integrins?

A

Large family of proteins that bridges between cytosol and ECM

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9
Q

Stages of ECM in cancer

A
  1. Cell adhesion in cancer stages
    - tumour cells accumulate
    - cells haven’t breached the basement membrane
    - carcinoma in situ
    - cells undergo epithelial to mesenchymal transition
  2. Microinvasion
    - cells convert to mesenchymal cells and expression of cadherins reduced
    - microinvasion starts aided by actin based protrusions called invadapodia
    - secretion of metalloproteases
    - basement membrane breached
    - invading Tumour leading cells express integrins promoting interaction with ECM and non epithelial cells during movement
  3. Progression to metastasis
    - increased motility of tumour cells and decreases e cadherin
    - angiogenesis factors (promote vascularisation)
    - entry into and through lymphatic and blood vessels
    - dissemination - metastasis
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10
Q

Complement cascade

A

Diagram

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11
Q

Which are APC?

A

Macrophages, monocytes and dentritic cells

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12
Q

Action of antibodies

A

IgG1, IgG3 and IgM: activate complement by classical pathway

IgG1 and IgG3: cross the placenta

IgE coats granulocytes (mast cells, eosinophils and basophils)

IgA: secreted across gut mucosal membranes to protect the GI tract

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13
Q

Treatment for delirium

A
  • identify and treat underlying cause
  • Reduce or remove culprit medications
  • Maintain hydration and nutrition
  • Reorientation strategies
  • Maintain mobility
  • Normalise sleep wake cycle

Haloperidol and benodiazepines

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14
Q

Function of myofibroblasts

A

during injury, fibroblasts differentiate into myofibroblasts and they:

  • proliferate
  • secret collagen
  • consolidate damaged area
  • contract to reduce size of damaged area
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15
Q

Functions of tight junctions

A
  • define polarity
  • control passage of substances between cells
  • can link to actin cytoskeleton
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16
Q

What are desmosomes?

A

link between strong intermediate filaments in adjacent cells

17
Q

What are the features of the innate immunity?

A
  • uses constitutent physical barriers
  • recognition is through non-antigen specific activation receptors on cells
  • complement system
18
Q

Functions of the complement cascade proteins

A
  • induce inflammation
  • opsonise pathogens
  • lyse bacteria
  • mediate immune complex clearance
19
Q

Complement cascade activation

A

Classical pathway:

  • antigen:antibody complexes
  • C1q, C1r, C1s, C4, C2

MB-Lectin pathway:

  • MB-lectin binds to mannose on pathogen surfaces
  • MBL, MASP-1, MASP-2, C4, C2

Alternative pathway:

  • pathogen surfaces
  • C3, B, D

All pathways make C3 convertase

20
Q

What does C3 convertase do?

A

C3a, C5a
- inflammatory mediators

C3b:
- opsonisation of pathogens

C5b, C6, C7, C8, C9:
- membrane attack complex, lysis of certain pathogens and cells

21
Q

what are the innate immune cells?

A
  • neutrophils
  • macrophages
  • innate lymphoid cells (ILC1, ILC2, ILC3 and natural killer cells)
  • dentritic cells
22
Q

What is the antigen binding site for B cell receptors?

A

Vh + Vl = antigen binding site

23
Q

What is the process of B lymphocyte development?

A

stem cell –> lymphoid progenitory –> pre-b cell –> early pre-b cell –> late pre-b cell –> immature b cell –> mature b-cell –> (plasma cell) + (memory b-cell)

draw diagram

24
Q

T lymphocyte development process

A

stem cell (bone marrow) –>

thymocyte –> mature t-lymphocyte (thymus) –>

(b cell help) + (cytolysis) + (activation of inflammation) (periphery

25
Q

MHC class I and MHC class II recognition

A

MHC class I:

  • recognised by cytotoxic T cells CD8+
  • infected host cells

MHC class II:

  • recognised by T helper CD4+
  • don’t kill but drive immune responses
26
Q

which tissues/cells express MHC molecules?

A

MHC class I:

  • macrophages/dentritic cells
  • B cells
  • T cells
  • Neutrophils
  • All cells that are at risk of viral infection

MHC class II:

  • macrophages/dentritic cells
  • B cells
27
Q

The different types of immune responses

A

Type 1:

  • ILC 1 and NK cells
  • Cytotoxic T cells and helper T cells

Type 2:

  • ILC 2
  • t helper cells
  • expulsion of extracellular parasites

Type 3:

  • ILC 3
  • t helper cells
  • immunity to extracellular bacteria and fungi
28
Q

What are the four criteria for valid consent?

A
  1. patient must have capacity
  2. patient must give consent voluntarily
  3. patient must be informed
  4. consent must be continuing
29
Q

What are the types of consent?

A
  1. implied
  2. express
  3. oral
  4. written
30
Q

Why might someone lack capacity?

A

Impairment of, disturbance in the functioning of, the mind or the brain:
– Can be permanent
– Can be temporary

31
Q

What is the criteria for capacity?

A
  1. Understand the information
  2. Retain the information
  3. Use or weigh the information
  4. Communicate their decision
  5. Hold decision consistently
32
Q

What defines incapacity?

A

Incapacity is when a person is incapable of:

  1. Acting or
  2. Making decisions or
  3. Communicating decisions or
  4. Understanding decisions or
  5. Retaining the memory of decisions
33
Q

What is hyperactive delirium?

A
  • Hyperactive delirium causes the person to experience agitation, restlessness, aggression, loss of concentration, confusion
  • May have hallucinations/delusions
  • Can be difficult for carers to manage
34
Q

What is hypoactive delirium?

A
  • Hypoactive delirium causes a slowing down, sleepiness/lethargy, reduction of consciousness and reduced speech or interaction
  • Easily missed – depression or fatigue
  • Poor oral intake -> dehydration
  • Higher mortality/poor prognosis
35
Q

Who develops delirium?

A
  • Anyone with a severe enough insult
  • Very common in ITU
  • Vulnerable and frail people develop delirium with a much smaller insult
  • Common in people with dementia
36
Q

What are the risk factors for delirium?

A
  • Age > 65
  • Background cognitive impairment or dementia
  • Surgery esp Hip fracture
  • Comorbidities
  • Polypharmacy
  • Sensory impairment
  • Functional impairment
  • Sleep disturbance
  • Hospital admission
37
Q

Identifying delirium?

A

Use a screening tool

SQiD:
– Do you think your relative has been more
confused recently?
- Sensitivity 80%, specificity 71%

CAM
– confusion assessment method.
- Sensitivity 94%, specificity 89%

  • 4AT
    – recommended by Scottish Delirium Association and used across Tayside and Fife.
  • Sensitivity 87%, specificity 70%
38
Q

Assessment for delirium

A
  • Full history – obtain collateral history
  • Key factors are acute onset, fluctuation, decreased
    attention
  • Review medication
  • Vital signs (EWS)
  • Physical and neurological examination for signs infection, dehydration, neurological changes
  • Consider capacity
39
Q

What are the trigger medications for delirium?

A

 Opiates (morphine, codeine, tramadol)
Anticholinergics eg for bladder symptoms, painkillers
 Benzodiazepines eg diazepam, nitrazepam
 Drugs used in Parkinson’s
 Antipsychotics
 Antiepileptics
 Antihistamines
 Antihypertensives (if BP too low or low Na)

Semester 1 (13 decks)

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