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Biol131 - Biomedical Science In Practice > Biol131 > Flashcards

Biol131 Flashcards

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1
Q

When making a diagnosis , what is checked in the blood?

A

Biochemical markers, cell abnormality

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2
Q

When making a diagnosis, what is checked in urine/faeces?

A

Clinical chemistry, cytology

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3
Q

When making a diagnosis, what is used for biopsy tissue?

A

Direct histological examination

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4
Q

An ultrasound/ sonogram uses….. to produce an image?

A

High frequency sound waves, at a low resolution

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5
Q

What does a CT scan use? Fast or slow? Is it detailed?

A

X-rays to quickly produce an image with less detail

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6
Q

What does an MRI scan use to produce images? Faster or slower than CT? More or less detailed?

A

Radio waves and strong magnetic fields, slower than CT, more detailed than CT

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7
Q

What is histology?

A

The study of the structure of animal and plant tissues as visualised

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8
Q

What is cytology?

A

The microscopic appearance of cells under the microscope

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9
Q

What is a neoplasm?

A

New growth of cells

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10
Q

Which cells do not respond to regulatory signals?

A

Cancer cells

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11
Q

Briefly describe neoplastic transformation? Are tumour cell growths that are well differentiated or less differentiated more aggressive?

A

Cells becoming less differentiated, more like precursor cells. Less differentiated = more aggressive as they are less like normal cells

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12
Q

What are features of the atypical cytology of neoplastic cells?

A

1) pleomorphism (change in shape or size) of cells and nuclei
2) increase in hyperchromatism (increased nuclear staining)
3) increase in size of nucleus

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13
Q

What is metastasis?

A

Invasion of the tissue away from the original tumour growth via the lymph/ blood

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14
Q

Above 2mm = ……….. environment, so the tumour produces its own blood supply

A

Hypoxic

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15
Q

Dysplasia

A

Abnormal growth or development

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16
Q

What are the techniques for obtaining a tissue sample?

A

Needle biopsy, endoscopic biopsy, incisional biopsy, excisional biopsy, resection

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17
Q

What is a needle biopsy? what is it used for?

A

Uses cutting needle to take a 1-2 mm wide 2cm long bit of tissue from anywhere even brain lesions

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18
Q

What is an endoscopic biopsy?

A

Uses small forceps to take a 2-3 mm sample from the GI , respiratory, urinary and genital tracts

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19
Q

What does an incisional biopsy use?

A

A scalpel

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20
Q

What is removed in an excisional biopsy?

A

The whole lesion

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21
Q

What is a resection?

A

A large tissue sample

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22
Q

What are the techniques to obtain cell samples?

A

Shed naturally into bodily fluids, aspiration with a needle, exfoliation using a brush

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23
Q

How is a smear test done?

A

1) scrape cells from ectocervix and lower cervical canal with a spatula/brush
2) fix onto a slide and stain
3) looking for CIN ( cervical intraepithelial neoplasia)

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24
Q

What has helped to decrease the risk of cervical cancer?

A

HPV vaccination

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25
Q

Adenoma

A

A tumour of epithelial origin, that is not cancer.

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26
Q

Anaplasia

A

Reversion of cell to primitive/undifferentiated state

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27
Q

Angiogenesis

A

New blood vessel growth.

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28
Q

Apoptosis

A

A type of cell death in which a series of molecular steps in a cell lead to its death.

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29
Q

Benign

A

Neoplastic growth (tumour) that is not cancer.

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30
Q

Carcinogen

A
  • a substance, organism or agent capable of causing cancer.
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31
Q

Carcinoma

A

Cancer that originates in epithelial (lining) cells.

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32
Q

Dysplasia

A

Abnormal growth or development

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33
Q

Hyperchromatism

A

increased staining, usually due to more dense structure.

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34
Q

Hyperplasia

A

increase in number of tissue cells due to increased cell division

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35
Q

Hyperproliferation

A

increased rate of cell proliferation

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36
Q

Hypertrophy

A

increase in size of existing cells, matched by increase in functional capacity

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37
Q

Malignant neoplasm

A

Tumour that invades surrounding tissue/Tendency to metastasize

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38
Q

Neoplasia

A

Uncontrolled abnormal growth ( benign or cancerous)

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39
Q

What causes squamous metaplasia in the transformation zone of the cervix?

A

The columnar epithelium is exposed to a hostile environment causing more growth of stratified squamous epithelium

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40
Q

What is needed on the slide when using a magnification of more than x40

A

Oil immersion

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41
Q

What is the magnification and resolution of a light microscope?

A

X1000 magnification, 200nm

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42
Q

What is the magnification and resolution of an electron microscope?

A

X1x106
0.2nm

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43
Q

What is a disadvantage of staining specimen?

A

Requires fixing , cells usually have to be dead

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44
Q

How does Phase-contrast and Nomarski microscopy allow for examination of living , unpigmented cells?

A

Amplifies variations in density within specimens

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45
Q

What is fluorescence used for in light microscopy? Do teh fluorescent molecules usually exist naturally?

A

Shows the locations of specific molecules in the cell. The fluorescent substances absorb short wavelength radiation, UV, and wemit longer wavelength radiation ( visible light). They are usually added by tagging.

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46
Q

What is the most common stain used in hospital pathology labs?

A

H and E ( Haemotoxylin and Eosin

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47
Q

What are the problems with processing and histology ?

A

1) processing alters structures and can introduce artefacts
2) only gives a snapshot of dead cells
3) 2D image of 3D structure

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48
Q

Describe histology start to finish?

A

1) Specimen dissected
2) Fixation
3) Dehydration
4) Embedding
5) Sectioning
6) Staining

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49
Q

What is a common fixative ? What does it do?

A

Formaldehyde
Arrests biological activity, prevents tissue degradation (autolytic degradation, bacteria)

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50
Q

What process is required prior to embedding?
How do we embed?

A

Dehydration to prevent issue damage
Support the tissue by embedding in a hard medium such as paraffin wax, freezing or a plastic resin

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51
Q

What are the 3 methods for tissue sectioning ?

A

Cryostat, microtome, vibratome

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52
Q

With a cryostat method of sectioning , how are tissues preserved? What is the thickness?

A

Frozen
10-40 micrometers

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53
Q

With a microtome, what are tissues embedded into? What thickness?

A

Wax
5-40 micrometers

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54
Q

With a vibratome how are samples attached? What thickness?

A

They are glued to the holder, 40-400 micrometers

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55
Q

Haematoxylin stain , stains acidic structures what colour?

A

Purplish blue

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56
Q

with Eosin staining what colour are basic structures shown?

A

Red/pink

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57
Q

Massons trichome stains …….. tissue ?
Nuclei stains ….
Connective tissue stains ….
Cytoplasm stains …..

A

Connective tissue
Nuclei goes purple/pink
Connective stains blue
Pink/red

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58
Q

Periodic acid-Schiff rxn stains complex carbs what colour ?
E.g Mucin in the …….cells in the intestine

A

Purple /magenta
Mucin in the goblet cells

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59
Q

What describes the use of antibodies to label a specific protein or cell?

A

Immunohistochemistry

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60
Q

What is the function of simple columnar epithelium?

A

Absorptive / secretory surfaces

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61
Q

What is the function of stratified epithelia?

A

Protective function

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62
Q

What is the purpose of elongated cells in smooth muscle tissue?

A

To maximise contractile properties

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63
Q

Which type of cells migrate up the crypt in the colon?

A

Stem cells

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64
Q

What are some of the features of dysplasic colon?

A

Villiform change of epithelium
Crypt budding, branching, and crowding
Irregularity of crypt contour
Increased angiogenesis

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65
Q

In a normal prostate, what proportion of the cells are luminal cells and what proportion are basal cells?

A

60% luminal , 40% basal

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66
Q

What are some of the features of prostate cancer, regarding the histology?

A

Luminal hyperproliferation, loss of the basal layer, breakdown of the basal membrane , immune cell infiltration and stromal reactivity

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67
Q

Give a type of cell that does not regenerate?

A

Cardiomyocytes

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68
Q

What changes can cause cellular stresses?

A

Osmotic stress( water and electrolyte concentrations) , temperature stress, oxygen deprivation, infection, pH changes

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69
Q

What are some examples of adaptive responses during cellular stress?

A

Metabolism :
During fasting fatty acids are mobilised from adipose tissue
Calcium can be sourced from bone matrix
Liver enzymes can metabolise drugs
Metaplasia
Genes:
Housekeeping gene expression decreases
Cell stress gene expression increases e.g heat-shock proteins

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70
Q

What is the function of heat-shock proteins?

A

“ chaperones” for protection, assist in refolding, and preventing protein aggregation ( clumping)

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71
Q

What is Ubiquitin useful in?

A

Targeting proteins for destruction

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72
Q

During cellular stress: increased functional demand may result in………
Give an example for each

A

Hyperplasia , hypertrophy
Endometrial lining during menstrual cycle
Skeletal muscle fibres of athletes

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73
Q

How can transient epithelial hyperplasia be a benefit when infected with a pathogen?

A

It can help to expel intestinal pathogens

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74
Q

Is BPH (benign prostatic hyperplasia) a risk factor for prostatic carcinoma?

A

No

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75
Q

In which method of cell death is membrane integrity NOT maintained?

A

Necrosis

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76
Q

What are the phases of Apoptosis?

A

1) Induction/signalling + cell shrinkage/ chromatin condensation
2) Effector- mitochondrial permeability - no return point
3) Degradation - membrane blebbing , organelles disintegrating due to proteases - forms apoptotic bodies
4) Phagocytosis- cell fragments are engulfed and removed

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77
Q

Give 2 examples of beneficial apoptosis

A

Removal of autoreactive immune cells
Intestinal cell turnover

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78
Q

What are the triggers of necrosis ?

A

Metabolic stress, hypoxia ( lack of oxygen) , absence of nutrients, trauma

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79
Q

What molecular mechanisms can result in necrosis ?

A
  • reduction in ATP , internal membranes can swell, dec biosynthesis
  • cytosolic calcium increases activating protein kinases and phospholipases
  • reduction in ability to scavenge reactive oxygen species ( ROS)
  • plasma membrane integrity and cytoskeleton compromised
  • cell swelling , lysis or bursting as this can cause inflammation
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80
Q

What chemical agents are examples of chemicals that can cause necrosis?

A

CCl4 , paracetamol

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81
Q

Describe how ischemia ( restriction in blood supply ) leads to necrosis. Where does this become irreversible?

A
  • Anaerobic metabolism
  • Failure of ionic pumps leading to cellular swelling
  • accumulation of metabolic intermediates leading to cell damage . Till now is reversible
  • Necrosis
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82
Q

Reintroduction of oxygen ( reperfusion) can cause further damage , how?

A

-Inflammatory response
-Oxidative stress
- Further ionised calcium influx
- more cell damage

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83
Q

Which cell death process requires ATP and which is passive? Which involves cytoplasm shrinkage and which involves swelling?

A

Apoptosis is active , necrosis is passive. Apoptosis- shrinkage. Necrosis- swelling

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84
Q

After gel electrophoresis what is the difference between teh DNA after apoptosis and necrosis?

A

Apoptosis- non-random degradation ———ladder
Necrosis - random DNA digestion ———— smear

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85
Q

What are the 2 outcomes after cell death following tissue damage ?

A

Restitution- if cells can regenerate
Fibrous repair and scar tissue formation

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86
Q

Which type of inflammation is a normal healthy temporary process designed to eliminate damaging stimuli and heal damage?

A

Acute

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87
Q

When does chronic inflammation occur?

A

When the stimulus cannot be removed and in inflammatory process persists becoming damaging to the host tissues

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88
Q

What are the 4 cardinal effects of acute inflammation

A

Rubor( redness), Calor( heat), Dolor(pain), Tumor (swelling)

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89
Q

What do chemical mediators stimulate the production of ?

A

Acute inflammatory exudate

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90
Q

What happens to the damaged tissue after the exudate has reached the damaged area?

A

The damaged tissue is broken down, partly liquefied and the debris is removed from the site of damage

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91
Q

What are the components of acute inflammatory exudate ?

A

-salt containing fluids and proteins
-fibrin (insoluble protein)
-neutrophils (phagocytic cells)
-macrophages ( produce cytokines)
-dendritic cells (present antigen to T cells)
- Lymphocytes ( T cells)

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92
Q

Why does the blood flow become slower and the blood vessels dilate?

A

To increase blood at injury site

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93
Q

What word describes how water, salts and proteins leave vessels?

A

Exudation

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94
Q

What word describes the way in which Neutrophils ( then monocytes) squeeze between the endothelial cells?

A

Transmigration

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95
Q

What are the stages of transmigration of leukocytes during inflammation?

A

1) tethering and rolling
2) Activation
3)Firm Adhesion
4)Transmigration

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96
Q

What are leukocytes attracted by during transmigration ?
What is a synonym for transmigration ?

A

Chemokines and cytokines released by tissue macrophages
Diapedesis

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97
Q

What do leukocytes do to help themselves to move between the endothelial cells of veins and migrate into the tissue?

A

Form pseudopodia and produce proteases to help move between endothelial cells of veins and migrate into the tissue

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98
Q

Monocytes become ……. In tissue

A

Macrophages

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99
Q

Neutrophils are the main effector cells of which response?

A

The acute response

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100
Q

What part of the cellular response is conducted within minutes?

A

Monocytes and macrophages secrete cytokines

101
Q

What do cytokines do ( immune response)?

A

Trigger the adaptive immune response , they activate B and T cells

102
Q

How does acute exudate leave the tissue?

A
  • lymphatic system , stimulate adaptive immune response in lymph nodes
103
Q

Which type of white blood cell does not recirculate?

A

Neutrophils , stay at site as pus build up

104
Q

What are the histological features of chronic inflammation?

A
  • necrotic cell debris
  • acute inflammatory exudate
  • vascular and fibrous granulation tissue
  • lymphoid cells and macrophages
  • collagenous scar
105
Q

What is the main effector cell of chronic inflammation?

A

Macrophages

106
Q

What is the name for the discrete clusters formed from macrophages?

A

Granulomas

107
Q

How does TB evade the acute immune response?

A

It invades, and replicates within macrophages

108
Q

What are the given examples of receptors that trigger the innate immune response?

A

PAMPs (Pathogen-associated molecular patterns)
DAMPs (Damage-associated molecular patterns)

109
Q

Is immunodeficiency inherited or acquired?

A

Can be either or can be from damaging stimuli e.g radiation and chemotherapy

110
Q

What can sustained irregularities in white blood cell counts indicate?

A

Inc- leukaemia
Dec- immunodeficiency

111
Q

What is immunophenotyping used for ? What are the 2 ways that expression can be detected?

A

To study protein expression on cells
Microscopy , flow cytometry

112
Q

Which method ( microscopy or flow cytometry ) allows you to examine multiple cell types at the same time? Which allows tissue to be preserved during processing?

A

Flow cytometry
Microscopy

113
Q

What are the 3 levels of fungal ( mycoses) infection ?

A

Superficial ( skin, hair) , cutaneous and subcutaneous (nails and deeper skin) or deep mycoses (internal organs)

114
Q

Where are protist diseases most prevalent?
How are they transmitted?
Parasites can be ……….. or …………..
What is the usual type of reproduction ?

A

-Tropical and subtropical regions
-Bites of blood sucking insects or accidental ingestion of infective stages
- Intracellular or extra cellular
- Asexual reproduction

115
Q

How do we classify viruses?

A
  • type of nucleic acid
  • mode of replication
  • symmetry of virus particle - icosahedral , helical or complex
  • presence or absence of an external envelope
  • identification using antibodies to certain features (epitopes) , serologic reactivity or PCR amplification of viral DnA
116
Q

Why are histological fixatives not used for medical microbiology?

A

It kills the microbes

117
Q

Give some example of body sites which are usually sterile?

A

Blood and bone marrow , cerebrospinal fluid, serous fluids, tissues, lower respiratory tract , bladder

118
Q

Which body sites have a normal commensal flora?

A
  • mouth and nose
    -upper respiratory tract
  • skin
  • gastrointestinal tract
  • female genital area
  • urethra
119
Q

What are some examples of acute lower respiratory tract infections?

A

Bronchitis , pneumonia and influenza

120
Q

What are some examples of chronic lower respiratory tract infections?

A

Tuberculosis, aspergillosis , lung abscesses , infections in cystic fibrosis

121
Q

How does pneumonia infection occur?

A
  • inhalation of aerosols
  • aspiration of normal flora
  • via the blood
122
Q

Tubercles may heal spontaneously , become …….. or calcified and persist (dormant) in otherwise healthy people
In the immunocompromised the mycobacteria invade the bloodstream leading to often fatal “……….” TB

A

Fibrotic
Military

123
Q

What is epidemiology ?

A
  • the study of factors ,implicated in disease progression , that determine its frequency , distribution and severity in cohorts of individuals
124
Q

What is the epidemiological triangle of causal factors?

A
  • external agent
  • a susceptible host
  • an environment that brings the host and agent together
125
Q

Epidemiological triangle
Give 3 examples of agents ?

A

Bacteria , viruses , pesticides

126
Q

Define endemic , given an example
Define epidemic

A

Diseases that occur at a constant rate within a given population like chicken pox
Incidence of disease above the endemic rate e.g measles outbreak

127
Q

What is the biggest risk factor for cancer? What % of cancer related deaths can be avoided? In terms of no. deaths what is the deadliest event in history ?

A

-Age
- 30%
- AIDS

128
Q

What is the difference between antigenic drift and shift?

A

Antigenic shift is where 2 viruses enter and both genes and antigens from both viral types are incorporated into new proteins so the change is more severe, the new virus is very different .
Antigenic drift is where mutations occur so the new virus is slightly different

129
Q

Causal pies are a good way of studying non-communicable diseases like cancer, when does disease occur in this model?

A
  • Once all the pieces of the pie are present
130
Q

Sickle cell anaemia is more common in people of what origin? What about Tay-Sachs disease?

A
  • African or Mediterranean
  • Ashkenazi ( eastern and Central European) Jewish or French Canadian ancestry
131
Q

Sickle cell anaemia is more common in people of what origin? What about Tay-Sachs disease?

A
  • African or Mediterranean
  • Ashkenazi ( eastern and Central European) Jewish or French Canadian ancestry
132
Q

Sickle cell anaemia is more common in people of what origin? What about Tay-Sachs disease?

A
  • African or Mediterranean
  • Ashkenazi ( eastern and Central European) Jewish or French Canadian ancestry
133
Q

Why does migration have an effect on cancer rate?

A
  • carcinogens of dietary or environmental origin play the most significant role in cancer causation rather than genetic background ( Japan / Hawaii migration study)
134
Q

Why are tests needed ( clinical biochem)? To see if a tumour has been successfully removed what can we check for?

A
  • diagnosis
    -monitoring of treatment
    -disease screening
  • prognosis
  • tumour markers in blood
135
Q

What are the most common sample types in clinical biochem?

when no anti-coagulant is added and the sample is centrifuged , what is the top layer? What if it is added?

A
  • serum from venous blood or urine
  • serum
    -plasma
136
Q

What is the red blood sample tube ?
Yellow?
Purple?
Green?
Heparinized Syringe

A
  • no anticoagulant, clot, general
  • SST gel to separate serum, general
  • EDTA anticoagulent, whole blood analysis , red cell analysis , lipids and lipoproteins
    -lithium heparin anticoagulent
  • fluoride oxalate, glucose and lactate testing
  • arterial blood sampling
137
Q

What other specimens can be used in clinical biochem other than venous blood and urine?

A
  • arterial blood
  • faeces
  • CSF ( cerebrospinal fluid)
  • sweat ( used in cystic fibrosis diagnosis )
  • saliva (can test cortisol)
138
Q

What is Pheochromocytoma?

A

Excessive adrenaline production

139
Q

What are the stages in the biochemistry process?

A
  • request form with clinical data
  • patient sampled
    -transit to lab
  • reception and ID
    -analysis
    -quality control
  • collation
  • interpretation
    -reporting
    -answer
140
Q

What is sensitivity?

A
  • how little of the analyte can be detected by the assay
141
Q

What is specificity?

A

-how good is the assay at discriminating between the requested analyte and other interfering substances?

142
Q

What does infarction mean?

A

Death of tissue following lack of blood supply

143
Q

What does morbidity mean?

A

The condition of suffering from a disease or medical condition

144
Q

Coronary circulation:

In the left coronary artery what are the 2 branches and where do they deliver blood to?

In the right coronary artery what are the 2 branches?

A

-Circumflex branch - left ventricle and left atrium
- anterior interventricular branch - both ventricles

  • posterior interventricular branch - both ventricles
  • marginal branch- right ventricle
145
Q

What are the 3 levels of structure in an artery?

A

Tunica Intima
Tunica media
Tunica externa

146
Q

What causes a myocardial infarction ?

A

Supply of blood to coronary muscle reduced by a critical value usually due to atheromatous plaque rupture with overlying thrombosis

147
Q

What is perfusion ?

A

Passage of fluid through circulatory or lymphatic system to organs

148
Q

What are the risk factors for atheroma development ?

A
  • toxins
  • viruses
  • hypertension
    -smoking
  • immune reactions
149
Q

Describe the development of atheroma in coronary arteries

A
  • initial damage to endothelium
  • LDLs ( low density lipoproteins) enter the intima and taken up by macrophages
  • fatty streak forms due to macrophages under endothelial cells
  • macrophages release lipids into the Intima
  • collagen released
  • lipid plaque forms
    -fibrolipid cap forms
    -endothelium is fragile and ulcerates
    -platelet aggregation which leads to thrombus formation
150
Q

What are the consequences of atheroma ?

A
  • artery narrowing
  • thrombus formation
  • bleeding into the plaque
  • aneurysm
151
Q

What is arteriosclerosis? Atherosclerosis?

A
  • thickening and hardening of artery wall
  • thickening and hardening of high pressure artery wall due to atheroma
152
Q

How can an ECG show a diagnosis of MI? What is issue?

A
  • an elevated ST region
  • can take up to 24 hours to develop
153
Q

What are some examples of enzyme cardiac biomarkers?

A

Creatine kinase (CKMB) - muscle damage, specificity issue
Lactate dehydrogenase -not used since 2000
Aspartate amino transferase (AST) - not since 2000

154
Q

What are some muscle protein cardiac biomarkers for detecting MI?

A
  • myoglobin ( issue as also in skeletal muscle)
  • Troponin I (cTnI) -cardiac specific.
  • Troponin T (CTnT) -cardiac specific
155
Q

What are the 3 forms of Troponin ?

A

Troponin C - binds calcium and regulates the action of the filaments during contraction
Troponin I - Prevents contraction in absence of calcium and Troponin T - binds the complex to tropomyosin

156
Q

What 2 types of cardiac Troponin when measured can indicate infarction?

A

CTnT and CTnI

157
Q

What are the treatments of Myocardial Infarctions ?

A
  • thrombolytic agents such as Streptokinase and Tissue plasminogen activase
    -coronary angioplasty to remove obstruction and enable blood flow
    -anticoagulants such as heparin
158
Q

Give some core biochemical tests ?

A

-Us and Es (urea and creatinine and electrolytes )
-LFTs - liver function test (e.g bilirubin , albumin)
-Thyroxine and thyroid stimulating hormone
-H+, pCO2, pO2 ( blood gases)
-glucose

159
Q

What components are checked as a U an Es test?

A

-sodium, potassium, urea, creatinine, chloride ,bicarbonate

160
Q

When do serum urea and creatinine increase?

A

When the glomerular filtration rate is reduced

161
Q

What is vasopressin another term for? What does it do?
What does aldosterone?

A
  • ADH
  • Causes reabsorption of water in collecting ducts
    -Causes reabsorption of sodium in nephron and hence water
162
Q

What is the normal sodium range? Where is the major site of sodium loss in non-renal associated disease?

A

-135-145 mmol/l
-GI tract

163
Q

What is hypernatraemia? Causes? Clinical signs? How to treat?

A

-Na > 145mmol/l
-water depletion
-excessive sodium intake
-renal failure

-blood pressure decreased (or inc salt)
-dry mucous membranes

-oral water
IV 5% dextrose

164
Q

What is hyponatraemia ? Causes for oedematous hyponatraemia? Treatment ?

A

-Na < 135mmol/l

-Heart failure
-dec in effective blood volume
-aldosterone and adh secreted
-salt and water retained

-diuretic and restrict fluid + treat condition

165
Q

What are the causes of non-oedematous hyponatraemia? Treatment

A

-ADH released all the time (infection and malignancy )
-Syndrome of inappropriate antidiuresis (SIAD)
-Too much water absorbed by kidney

  • Restrict fluid
166
Q

What are the causes of hyponatraemia via sodium loss?
What are the clinical signs?
Treatment?

A
  • vomiting , diarrhoea
    -lack of Na intake
    -lack of aldosterone

-Tachycardia
-Hypotension

-oral correction of sodium loss

167
Q

What is the normal level of potassium in the blood?
What is the function of K+?
What can rapid changes in K+ cause?

A

-3.4-4.9 mmol/l
-Excitable cells (nerves and muscles) behave differently if K conc alters
-dangerous cardiac arrhythmias that can result in death

168
Q

What are the example causes of hyperkalaemia ( >4.9mmol/l) ?
What are some example treatments ?

A

-Renal failure, adrenal failure, K+ released from damaged cells
-calcium gluconate
Insulin + glucose
Dialysis

169
Q

Acute renal failure :
-What is Anuric and what is oliguric?
What are the biochemical findings?
What are some of the causes?

A

-Anuric ( no urine ) or oliguric (<400ml/day )
-Conc urine, serum urea and creatinine inc
-hyperkalaemia

-pre-renal - blood supply to kidney failure
-renal- damage to kidney tissue
-post-renal- obstruction blocks urinary disease

170
Q

What are the biochemical findings of chronic renal failure?
What management is used?

A

-Hyperkalaemia - nephron can’t excrete K
-Serum urea and creatinine high

-sodium restriction
-diuretics
-dietary restriction of protein
-oral ion exchange resin (K removal)
-potentially dialysis or transplant

171
Q

What mnemonic can help to remember symptoms of hypernatremia?

A

FRIED
F-fever, flushed skin
R-restless
I-Increeased fluid retention and BP
E-Edema
D-decreased urinary output , dry mouth

172
Q

What mnemonic can help you remember symptoms of hyperkalaemia ?

A

MURDER

M-muscle weakness
U-Urine, oliguric, anuria
R-respiratory distress
D-Decreased cardiac contractability
E-ECG changes
R-reflexes , hyperreflexia or areflexia

173
Q

What mnemonic can be used for causes of hyperkalemia?

A

MACHINE
M-medications, ACE inhibitors
A-Acidosis
C-Cellular destruction - Burns , traumatic injury,
H-hypoaldosteronism /hemolysis
I-Intake excessive
N-Nephrons , renal failure
E- Excretion - Impaired

174
Q

What is the tunica Intima composed of in arteries?

A

Endothelium
Basement membrane
Internal elastic laminate

175
Q

What is the tunica media composed of?

A

Smooth muscle
External elastic lamina

176
Q

What is the tunica external composed of?

A

Elastic and collagen

177
Q

What type of filament are cardiac biomarkers Troponin I and T present in?

A

Thin filament (actin)

178
Q

What is coronary artery bypass grafting?

A

Grafing an artery or vein to the coronary artery to bypass any obstruction

179
Q

What does a coronary angioplasty involve ?

A

A procedure used to widen blocked or narrowed coronary arteries by inserting a stent

180
Q

What is the normal value for blood glucose ?

A

4.0 - 6.0 mmol/l

181
Q

1 out of ……. People have Diabetes mellitus

A

11

182
Q

What is MODY with respect to the young ?

A

Maturity onset diabetes of the young

183
Q

What percentage :
Adults with type 1 DM
Adults with type 2
Children with DM
Children with type 1
Children with type 2
Children with mody

A

10
90
95
2
3

184
Q

What can cause hypoglycaemia?

A

Hyperinsulinism
Glycogen storage diseases

185
Q

What happens when blood sugar levels are low?

Too high?

A

-glucagon released from alpha cells
-Hepatocytes release glucose

-insulin released from beta cells
-glucose enters cells

186
Q

How does the beta cell know when to release insulin? (Stimulus-secretion coupling)

A

-Glucose enters the beta cell
-Phosphorylation of the glucose
-Glycolysis
-Pyruvate formed
-ATP is produced
-The K channel closes
-K+ rises in cell
-membrane depolarisation
Calcium channels open, calcium rises in cell
-insulin granule exocytosis

187
Q

What happens when insulin binds to its receptors

A

-Insulin binds to receptor ( tyrosine kinase) which is embedded into the membrane. It has 2a and 2b subunits
-Binding of insulin to the a subunits causes phosphorylation of the b-subunits thus activating the kinase activity.
-Results in glucose utilisation and further glucose uptake via a range of signal transduction pathways that increase the number of glucose transporters

188
Q

What are the causes and onset age for type 1 and 2 diabetes mellitus?

A

Type 1:

-autoimmune mediated destruction of pancreatic beta cells which result in absolute insulin deficiency
-weak family trait (except 40% in identical twins)
- at 9-13 usually

Type 2:
- insulin resistance
-overeating, obsesity and lack of exercise
-strong family trait
-over 40 years old

189
Q

What are the treatments for type 1 and 2 diabetes mellitus?

A

Type 1:
-insulin injection subcutaneously ( just under skin in fatty tissue)
-Pancreas transplant

Type 2:
-reduce calories
-sulphonylureas - beta cells secrete more insulin
-Bariatric surgery ( weight loss)

190
Q

How can diabetes mellitus be diagnosed?

A

-urine glucose test ——> 10mmol/I glucose, overspill ( glycosuria)
-HbA1c
-Blood glucose
1) fasting blood glucose
2) random blood glucose (RBG)
3) oral glucose tolerance test (OGTT)

191
Q

In the oral glucose tolerance test what happens?

A

Baseline fasting blood glucose levels are taken
A glucose drink is consumed
Measure the glucose in plasma every 30 mins for 2h

192
Q

What does HAI stand for?
What does exogenous mean?
What does endogenous mean?

A

-Healthcare associated infection
-From another person or the environment
-From another site in the patient

193
Q

What HAI used to come from physicians hands?
What are the most common HAIs in England?

A

Puerperal fever - uterine tissue infection
Pneumonia
UTI
Surgical site infection
Clinical sepsis
Gastrointestinal infections
Bacteraemia (bacteria in blood)

194
Q

What HAI used to come from physicians hands?
What are the most common HAIs in England?

A

Puerperal fever - uterine tissue infection
Pneumonia
UTI
Surgical site infection
Clinical sepsis
Gastrointestinal infections
Bacteraemia (bacteria in blood)

195
Q

What are the most important causes of HAI in England?

A

-E.coli (gram - )
-S.aureus (gram + )

196
Q

What are the most important causes of HAI in England?

A

-E.coli (gram - )
-S.aureus (gram + )

197
Q

Why is making sure antibiotic conc is high enough important /

A

-a low conc can stimulate bacterial mutation

198
Q

What does MRSA stand for?

A

Methicillin-resistant Staphylococcus aureus

199
Q

If c.difficile is a bacterium in normal gut flora why can taking antibiotics cause it to infect and have a high morbidity and mortality ?

A

-antibiotics kill other bacteria , so C.difficile inc, produces toxins, diarrhoea and pseudomembranous colitis

200
Q

What does VRE stand for in terms of Hospital acquired infection?

A

-Vancomycin-resistant Enterococci
-it is in normal gut flora

201
Q

What are the principles of the of the health care act 2006?

A

-patients must be cared for in a clean environment
-keep HAI risk as low as possible

202
Q

How can we eliminate the source of infection to reduce HIAs?

A

-cleanliness
-sterile equipment
Dressings
IV fluid
Blood product screening
Bacterailly-effective handwashing
Immunisation
‘Bare below elbows’ policy

203
Q

What are the environmental sources of infection for HAIs?

A

Food
Air
Dust
IV fluid catheters
Wash bowls and bed pans
Endoscopes
Ventilators and respiratory equipment
Water and disinfectants

204
Q

What is the difference between sterilisation and disinfection ?

A

-Disinfection removes most but not all viable organisms but sterilisation removes all viable microorganisms including viruses and spores

205
Q

What is the difference between sterilisation and disinfection ?

A

-Disinfection removes most but not all viable organisms but sterilisation removes all viable microorganisms including viruses and spores

206
Q

How can we sterilise? Vs disinfectant

A

-heat 160-180 glassware
Autoclaves equipment and dressings
Irradiation - gamma for needles, gloves and vaccines
Filtration - fluids
Chemicals e.g glutaraldehyde for endoscopes

Chemical, boiling, low pressure steam

207
Q

How can we interrupt transmission of infection (HAIs)?

A

Airborne :
Check air conditioning for legionella
Hospital operating theatre ultra clean air
Isolation nursing
Contact:
Aseptic behaviour
Handwashing +
Alcohol based Hand gels

208
Q

Which people are at high-risk /susceptibility to infection ?

A

Very young and elderly
Lack of vaccination or previous exposure e.g chickenpox in adult
Immune defects such as diabetes or HIV
Immunosuppressive drugs
Lung, skin or urinary system disease (portals of entry for microbes)
Trauma e.g burns , surgery , IV access, urinary catheters

209
Q

What measures can be taken to reduce risk factors for HAIs?

A

-prophylactic antibiotics ( preventative )
-care of invasive devices
-short pre-operative time
-minimum duration for operations

210
Q

How is a surgical wound characterised?

A

Inflammation, pus, discharge

211
Q

How can catheter infection be prevented ?

A

Cover insertion site , wash hands , wear gloves, single use disinfection wipes

212
Q

How can HAIs be surveilled?

A

-microbiology reports
-ward rounds
-staff health records
-patient surveys after discharge

213
Q

What is a complication of diabetes mellitus due to defective blood supply to neurons in feet ?

A

Diabetic tropic ulcers due to ischaemia in feet, poor healing

214
Q

What is hyaline arteriosclerosis ?
What happens due to this glomerular damage ( diabetes) ?

A

-Thickening of glomerular capillary basement membrane due to a glycation of proteins
-Inc in permeability
-proteinuria - renal failure

215
Q

What effects can diabetes have on the eyes?

A

Hyaline arteriosclerosis ; basement membrane thickening in retinal blood vessels
Retinal haemorrhage
Cataracts - glucose attaches to lens proteins causing cloudiness

216
Q

What is arrhythmias ?

A

Abnormal / irregular heart beat

217
Q

What is another name for ADH?

A

Vasopressin

218
Q

Where is ADH released from ? And what does it do?

A

Pituitary gland
Causes reabsorption of water in collecting ducts

219
Q

Where is aldosterone released rom? And what does it do?

A

Adrenal glands
Reabsorption of sodium in nephron and hence water

220
Q

What is SIAD?

A

Syndrome of inappropriate antidiuresis

221
Q

What is tachycardia?

A

Heart rate above 100 beats per minute

222
Q

In non-renal associated diasease where is a common place for sodium loss?

A

GI tract

223
Q

When you centrifuge a blood sample what 3 layers form?

A

Plasma 55%
RBC 45%
Buffs coat (wbc and platelets)

224
Q

What are the components of blood plasma ?

A

Water
Electrolytes
Plasma proteins

225
Q

What does blood transport?

A

Gases
Nutrients
Metabolic waste
Hormones
Antibodies

226
Q

What term means development of blood cells?

A

Haemopoiesis

227
Q

Where is red Bone marrow found?

A

Pelvis
Vertebrae
Sternum
Proximal ends of humerus and femur

228
Q

What are 3 examples of granular leukocytes?

A

Eosinophil
Basophil
Neutrophil

229
Q

What are the agranular lymphocytes?

A

Monocytes
T cells
B cells

230
Q

What does a high neutrophil count mean? Low?

A

-potential bacterial infection
-drug toxicity

231
Q

What does a high count of lymphocytes mean ? Low?

A

CLL (chronic lymphocytic leukaemia )
HIV

232
Q

What does a high and low count of monocytes indicate ?

A

Viral/fungal
Bone marrow suppression

233
Q

What does a high count of eosinophils mean? Low?

A

Allergic reaction , parasitic infections
Drug toxicity , stress

234
Q

What does a high count of basophils?

A

Allergic reaction, leukaemia
Stress

235
Q

What are haemoglobinopathies?

A

Abnormal Hb production

236
Q

Why are sickle cells sickle shaped ?

A

GAG to GTG
Mutation from adenine to thymine causes a change in tertiary structure. R group goes to hydrophobic (valine) from negatively charged (glutamic acid has an extra COOH group )

237
Q

What are the types of thalassemia?
There is a reduced synthesis of what ?
How do the erthrocytes stain?

A

Alpha / beta
Alpha or beta globin chains
Weakly with eosin (hypohromic)

238
Q

What are the complications of wrong blood transfusion ?

A

-chest pain , vomiting
Iron overload
Infection

239
Q

Type A blood has …..
Antigens
Antibodies in plasma can receive

A

A antigens
B antibodies
Receive type A or type O

240
Q

Type B blood has …….. antigens
……antibodies
Can receive

A

B
anti-A
Receive B or O

241
Q

What antigens does type O blood have ?
Anti-….. antigens ?
Can receive

A

none
Anti-A and Anti-B antigens
Recieve O blood

242
Q

What does AB blood have ?
Receive ?

A

A and B antigens
No antibodies
AB, O, A, B

243
Q

What is rhabdomyolysis

A

a condition that causes your muscles to break down (disintegrate), which leads to muscle death

244
Q

Hypovolemic shock

A

severe blood or other fluid loss makes the heart unable to pump enough blood to the body

245
Q

Hypovolemic shock

A

severe blood or other fluid loss makes the heart unable to pump enough blood to the body

246
Q

What % of deaths worldwide can be accredited to cancer?

A

13%

247
Q

What % of deaths worldwide can be accredited to cancer?

A

13%

248
Q

What causes retinal haemorrhage in Diabetic patients ?

A

Hyaline arteriosclerosis
Thickening of basement membrane in retinal blood vessels

Biol131 - Biomedical Science In Practice (1 decks)

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