Case 1-3 Flashcards
1
Q
What are the stages of wound healing?
A
Hemostasis, inflammation, proliferation, maturation
2
Q
What is healing by primary intention ?
A
Wound comes together through self or manufactured needs.
3
Q
What are the signs of inflammation ?
A
Redness, heat, swelling, pain, loss of function
4
Q
What are the types of scar (5)
A
Hypertrophic (bigger than normal) , hypotrophic, keloid (granulomas) , atrophic , contracture
5
Q
Name the unhappy triad, what is the most common site of damage in the knee ?
A
Medial collateral ligament , ACL and medial meniscus
MCL from lateral blow to knee when foot on ground
6
Q
What is the function of the bursa , name the pathology ?
A
Secrete fluid to keep the joint moist/mobile
Bursitis; friction between skin and patella (Maids) –> inflammation
7
Q
What cells are involved in acute and chronic inflammation (4 , 3)
A
Acute; NEUTROPHILS, mast, platelets, basophils
Chronic; MACROPHAGES, lymphocytes, antibodies
8
Q
What are the stages of nociception;
A
Transduction, transmission, perception, modulation
9
Q
When is emotion input seen during nociception?
A
During transmission in the substantia nigra of the dorsal horn
10
Q
Which fibres are involved in the ‘closing of the gate’ in gate theory ? What effect does this have ?
A
A beta fibres. Inhibitory cells in dorsal horn block the substantia nigra sending impulses to the brain
11
Q
Which nerve and muscles are effected during Tredelburg step ?
A
Superior gluteal nerve
Gluteus medius and minimus
12
Q
How would damage to the common fibular nerve present in a px ?
A
‘Foot drop’ , unable to dorsiflex the foot
13
Q
What is the difference between aspirin and Ibuprofen ?
A
Aspirin is irreversible , Ibuprofen is reversible. Both act on COX to decrease PGE2
14
Q
What is the difference between osteoprogenitor cells and osteoblasts ?
A
Osteoprogenitor - stem cells of the bone marrow that produce osteoblasts
Osteoblasts - in the bone lining secrete collagen and osteoid for calcification
15
Q
How are osteocytes formed and what is their function ?
A
Trapped osteoblasts in matrix in lucanae (small spaces). Maintain tissue and form gap junctions
16
Q
What are osteoclasts derived from ?
A
Macrophages and monocytes
17
Q
What is fibrocartilage, where is it found and how is it arranged ?
A
strongest type of cartilage in tendons and IV disc. Hylaine matrix and bundle of collagen fibres arranged in direction of stressor
18
Q
Where is elastic cartilage found ?
A
External ear and epiglottis
19
Q
What is the difference between skeletal and cardiac muscle ? (3, 3)
A
Skeletal = voluntary, multinucleate, striated Cardiac = involuntary, single nucleus, branched cells connected by specialist junctions
20
Q
What structures allow for cardiac myocytes to be electrically coupled and contract in synchrony ?
A
Intercalated discs, connect the ends of cells. Made up of adheren junctions, gap junctions and desmosomes.
21
Q
How would you differentiate between skeletal and SM on histology ? (3)
A
SM has a single central nucleus in the cell, non striated (no sarcomere repeats) with random action/myosin arrangement, spindle shaped cells
22
Q
List the structure of a nerve (3)
A
Epineurium , perineurium (fascicles) , endoneurium (fibres)
23
Q
What are the key features of RA and what is the deformity often seen ?
A
Proximal joints, symmetry, soft tissue swelling, osteoporosis, joint space narrows
Boutonniere’s deformity, the little finger curls inward.
24
Q
What are the 3 hallmarks of OA?
A
Sclerosis (hardening of bones/joints) , subchondral cysts (erosion of fluid space inside joint) and osteophytes (bony projections)
25
Which nodes are seen in OA and where are they located ?
Heberden's (edge of finger at DIP joint)
| Bouchardd's (middle of finger at MIP)
26
In a hx what are the common differences between OA/RA ? (3,2)
RA; more common in women , morning stiffness gets better throughout the day
OA; more common in elderly, stiffness upon work relieved with rest, weight bearing joints
27
What activates the extrinsic pathway, how does it compare to intrinsic ?
Tissue factor, it's faster (fewer steps) but less robust response
28
Which pathways to APTT and INR assess?
APTT = intrinsic , INR = extrinsic
29
What is removed before APTT and what is the normal range ?
Tissue factor (so that it's just intrinsic) . normally between 30-50 seconds
30
Which clotting fx are deficient in Haemophilia A, B and C ? which one is autosomal recessive (as opposed to sex linked)
8, 9, 11. Haemophilia C
31
What is Von Williebrand disease ?
decrease Fx VII and platelet adhesion -> prolonged bleeds. VWF normally binds to Fx VII and protects from proteolytic enzymes.
32
What is the ADR of paracetamol and how would you tx ?
Dose released toxicity of NAPBQI domain. Give N-acetly Cystiene as antidote.
33
What are the ADRs of ibuprofen?
IV, neonatal haemorrhage due to thrombocytopenia
34
What are the ADRs and CI of Codeine ?
ADRs; constipation, drowsy, dizzy, dependance
| CI; acute respiratory depression, coma
35
What stimuli do the 3 fibres respond to ?
A delta ; fast myelinated noxious stimuli , heat and pressure
A beta ; non noxious stimuli , light touch , vibration
C fibres ; throb/burn pain , heat and chemical eg. Capsaicin in chillies
36
What is the most common site of fertilisation and what epithelium is it made of ?
Ampulla of uterine tube. Simple cubodial epithelium
37
What is the difference between secretory and Cilated cells ?
Secretory produce fluid rich in nutrients for sperm
| Ciliated ^ Oestrogen activity
38
Name the ligaments of the uterus and their connections (4)
Broad (uterus to pelvic wall)
Round (uterine horn -> inguinal canal -> mons pubis)
Suspensory (ovaries)
Ovarian (ovary to lat uterus)
39
What is the function of the uterine wall endometrium ?
Can undergo hyperplasia under hormonal influence. Spiral arteries contract to induce menstruation.
40
What are the two layers of the uterine wall ?
Stratum functinoalis (proliferation phase) and stratum basalis (doesn't change)
41
What are the 3 layers of the uterine myometrium ?
SM interwoven with CT
| Outer longitudinal, middle crisscrossing and inner circular
42
How does the epithelium change between endo and ectocervix and what is the significance ?
Endocervix is simple columnar epithelium (mucous secreting)
Ectopic is NK strat squamous
Transformation zone is the site of dysplasia so used for smears
43
What are the 3 components of the penis ?
2 corpus cavernousa and 1 corpus spongiosum.
44
What are the 4 sections of the male urethra and how does the epithelium change throughout?
1+2 = transitional epithelium
3 and half 4 = pseudo stratified columnar epithelium
4 = stratified columnar epithelium
45
What are the 3 prostate gland zones and which has the ^risk of cancer ?
Peripheral (largest next to rectum so increased risk) , central and transitional
46
What type of cells do the seminiferous tubules contain ?
Spermatogenic, divide by mitosis then meiosis to form gametes.
Sertoli, protect sperm from autoimmune and nourish them under FSH control
47
What are Leydig cells and what controls them ?
Cells adjacent to tubules. Produce testosterone in presence of LH
48
How long is the ureter and what is its function ?
25-30 cm. Takes urine from kidney to bladder
49
What is the blood supply to the ureter ?
Split into abdominal (renal and testicular artery) and pelvic (superior/inferior vesicle arteries)
50
What is the significance of the vas deferens for the path of the ureter ?
Ureter passes under vas deferens, 'water under the bridge'.
51
What is the specialised SM of the bladder and what is its' function ?
Detrusor muscle, can remain strong when stretched.
52
What is the function of the external urethral sphincter in males ?
Prevents seminal regurgitation
53
How do granulosa cells of the ovary fluctuate ?
Surround oocyte ^in response to gonadotropic and decrease in response to testosterone
54
What does the Graafian follicle produce originally and what effect does this have ?
^oestrogen, inhibits growth of other follicles then thickens endometrium and thins cervical mucous to ^sperm entry.
55
How does LH change with O?
Initially ^O inhibits LH but once mature O reaches threshold so LH spikes at day 12
56
What hormones does the corpus luteum secrete and what effect does this have ?
^P and some ^O which inhibits LH/FSH causing corpus luteum to degenerate.
57
If fertilisation occurs how is the corpus luteum maintained ?
Blastocyst produces hCG (similar action to LH)
58
How are gamete production and growth rate ^ initially stimulated during puberty ?
Hypothalamus ^GnRh -> endocrine cells in APG have ^sensitivity so ^LH/FSH which act on gametes.
59
What is menarche ?
First period for a girl, between 10-16 normally
60
What is hypogonadotropic hypogonadism ?
2ndry hypothalamic pituitary disorder. less FSH/LH so hypogonads and testosterone down. CNS disorders/tumours, anorexia, ^exercise.
61
What is hypergonadotropic hypogonadism ?
primary testicular disease, gonads don't respond to FSH/LH so ^production as compensation. Tx - replace testosterone and O.
62
What are the different causes for central and peripheral precocious puberty ?
Central, ^GnRh; brain (CNS tumour, hydrocephalus, trauma) McCume Albright syndrome (hormone imbalance) , hypothyroidism
Peripheral, Ovarian/testicular ^ of O/P; tumour of adrenal/pituitary gland, external exposition of O/P
63
What is the tx for precocious puberty ?
Aromatase inhibitors, GnRh analogues and tx underlying causes.
64
What are the ADRs for COCP ?
most stroke/heart/vascular problems, overweight, >35+smoke
65
What is the POP and when should it be taken ?
P only (when O contraindicated) taken every day no break same time to ^efficacy.
66
What are the different injection contraceptions ?
Depo Provera for 13 wks
| Noristerat for 8 wks
67
What is the difference between IUD and IUS?
Device; plastic/copper device that releases Copper lasts for 5-10 yrs
System; 3-5 yrs releases P not Cu. Periods light/shorter so can be used if heavy
68
When is the patch contra ?
Oestrogen intolerance (it's same as COCP) , ^BP (headache) , smoking, >35, >90 Kg
69
What colour do GRAM +ve/-ve stain ?
```
+ve = purple
-ve = red/pink
```
70
What are the difficult targets for abx and what antibiotic can be used to penetrate the CSF?
intracellular bacteria, eye, prostate, CSF
| Chloranphenicol
71
What does Nisseria meningitidis cause and what is the tx ?
Bacterial meningitis. inflammation breaks down bbb so you can use amoxicillin and cephalosporins.
72
E coli is most common UTI cause. what are the common manifestations ? (5)
Bowel flora, sex, catheter colonisation, DM, constipation
73
How is UTI indicated on a dipstick and what other tests could be used ?
Nitrates = bacterial cause , Leukocytes = WBCs ^
| MSU, blood tests, imaging is severe
74
What is the tx for uncomplicated and complicated UTIs ?
Uncomplicated; trimethoprim and Nitrofurantoin
| Complicated; Co-amoxiclav (clauvonic acid + amoxicillin)
75
What is the most common bacterial STI and how is it dx and tx ?
Chlamydia, NAAT (nucleic acid amplification test) or vulvovaginal swab.
Tx; azithromycin or doxycyline
76
What are the sx and tx of Gonorrhea ?
Sx; discharge, dysuria, infection
| Mx; Azithromycin and ceftriaxone
77
What are the two types of genital herpes, where is it latent and what is the tx ?
type 1 = oral , 2 = genital
Latent in the sensory ganglia
Tx is aciclovir but no cure.
78
What strains are the causes of genital warts and HPV ?
warts = 6+11 , cervical cancer = 16+18. HPV vaccine prevention
79
What structure converts testosterone to DHT (male sex development before growth) and shows def that results in female genital with male genital growth at puberty ?
5-alpha reductase
80
What muscles make up the pelvic diaphragm ?
Levator ani (puborectalis, pubococcygeus and iliococcygeus) and coccygeus.
81
When are macrolides used ?
Type of abx inhibits protein synthesis by binding to the ribosomal 50s subunit.
azithromycin in Chlarmydia/Gonorrhea and Clarithromycin in H pylori
82
Which cancer strains are protected in the new HPV vaccine for boys ? (5)
31, 33, 45, 52, 58
83
What are ethanyl estradiol and Levonorgestral ?
Oestrogen and progesterone analogues used in contraception
84
What is Mifepristone ?
P antagonist causes endothelium degneration -> abortificant
85
What drug can be used to treat MRSA and Staphylococcus when R to penicillin ?
Vancomycin
86
What drug is 1st line for TB ?
Rifampicin, mRNA synthesis inhibitor.
87
What happens during 3rd stage of Taner puberty ?
Boys; ^penis length>thick and testes ^
Girls; ^breast/areolar
Hair; darker, coarser, curls, spread sparse from pubic region
incidence of depression doubles in girls
88
How does the epithelium change through the oesophagus ?
From stratified squamous to simple columnar
89
What are secreted by the stomach cells; chief, parietal and Goblet ?
Chief = Pepsinogen , Parietal = HCl, gastrin , Goblet = mucous
90
What makes up the portal triad ?
Portal vein, hepatic artery and common bile duct
91
What is the function of the pancreatic duct ?
Connects to CBD and releases pepsinogens to ^fat breakdown in 2nd duo
92
What is the entrance of the common bile duct into the duodenum ?
Sphincter of oddi at the ampulla of Vater
93
What is the difference between primary and secondary secretion of saliva ?
Primary is isotonic as Cl has drawn out water
| Secondary is hypotonic as HCO3 ^ during modification but tube is impermeable to water
94
How is a swallow initiated during the oral digestion phase ?
Tongue contracts rolls bolus back to oropharynx, its mechanoreceptors then stimulates CN IX to initiate swallow
95
What is deglutination apnoea ?
Respiration inhibited for 6-8 seconds. Larynx goes up allowing the epiglottis to cover the tracheal opening during digestion preventing aspiration
96
What is the alkaline tide ?
During gastric acid secretion HCO3 exchanged with Cl from blood causing high pH in venous blood around the stomach.
97
What are the risk fx for GORD ? (6)
Preg/ obesity ^intra abdo P , spicy food, alcohol , hiatus hernia, NSAIDs, smoking
98
How often should you screen for Barret's Oesophagus ?
Dx through biopsy and endoscopy
| Screen every 5 yrs for <3cm and every 3 for >3cm.
99
How would you tx Barret's oesophagus ?
PPIs 1st line, radio frequency ablation, endoscopic mucosal/surgical resection
100
What difference sx will arise for gastric and duodenal ulcers ?
Gastric is worse after food , duodenal is worse before. Breaks in stomach mucosal lining HCl destroys mucous
101
What is the triple medication therapy for H pylori ?
Omeprazole, Clarithromycin, amoxicillin
102
What change does H pylori cause ?
95% duo and 75% gastric ulcers. urea +H2O -> NH3 (urease catalyst) . Produces CAGA toxins which ^IL8 recruits neutrophils. Histamines ^HCl.
103
What is ZES and how would you dx ?
Gastrinomas of pancreas/duodenum. ^HCl and doesn't respond to tx. Dx; fasting gastrin
104
What is Achalasia and what is the indication on a Barium swallow ?
Failure of the GOJ to relax, dysphagia to solid food/liquids. Gives bird beak.
105
Give an example of enzyme induction ?
A decreases B. St John's wort ^CYP3A4 which decreases COCP.
106
What can be used to give a short term soothing effect for gastric upset ?
Ma/Ca carbonates (Rennies) strong alkaline neutralise HCl but can't be used chronically as body ^acid secretions in response
107
Give two examples of H2RAs, what are their ADRs ?
Competitive histamine receptors. ADR; impotence, gynaecomastia (anti androgens)
108
What are the CIs of PPIs ?
Nausea, dizziness, headaches
109
What are the acute and chronic hepatitis forms ?
```
Acute = A and E
Chronic = B, C, D
```
110
What are the sx of Hep A ?
After two weeks ^AST/ALT jaundice 70% of the time. Dark urine, pale stools and hepatomegaly.
111
How is Hep C transmitted and what are the sx ?
Early on is mild fever/often asx
85% silent chronic infection
25% cirrhosis
Leads to hepatocellular cancer
112
Once bilirubin has been conjugated what can it then be converted to ?
Into blood stream Urobilinogen -> Urobilin
| Or poo stercobilinogen -> stercobillin
113
What is prehepatic jaundice and give two examples ?
Bilirubin > hepatic conjugation. Liver function normal.
| Sickle cells anaemia, G6PD deficiency.
114
Give two causes of unconjugated hyperbilirubineamia and give the signs ?
No enzyme function eg. Gilbert's , Crigle Najjor syndrome
| Normal LFTs, pale stool, dark urine
115
What are the signs of cirrhosis or hepatitis ?
Conjugated hyperbillirubanaemia.
| ^AST, ALT, GGT normal stools and dark urine
116
What are the signs of post hepatic jaundice ?
Pale stool, dark urine, ^ALP and GGT (biliary damage and bile outflow obstruction respectively)
117
What is the significance if urobilin is found in the urine ?
Can't be obstructive because it's been converted from urobilinogen
118
What is the toxic and lethal dose of paracetamol ?
Toxic = 4-6 g , lethal >12
119
What are the enzymes involved in paracetamol metabolism ?
Normal is UGT to glucoronidate the drug making is H2O soluble/inactive
Patho is CYP2E1 and CYP1A2 which produces NAPBQI
120
What is the action of ACh in regulation of acid secretion ?
Stimulated by PSNS at cholinergic synapses to act on M3 receptors of parietal cells to ^HCl
121
CCK; stimulus, location, MOA ?
Fat and chyme in duodenum
Secreted by I cells
Competitive inhibitor of gastrin at CCK-B
122
What regulator acts to decrease gastrin release, responding to HCl in the duodenum ?
Secretin , from S cells in duodenum
123
What regulators are secreted by enteric nerves and what is their function ?
VIP - distension of stomach ^somatostatin release
| GIP - fat in the duodenum decreases gastrin release
