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Case 1-3 Flashcards

1
Q

What are the stages of wound healing?

A

Hemostasis, inflammation, proliferation, maturation

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2
Q

What is healing by primary intention ?

A

Wound comes together through self or manufactured needs.

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3
Q

What are the signs of inflammation ?

A

Redness, heat, swelling, pain, loss of function

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4
Q

What are the types of scar (5)

A

Hypertrophic (bigger than normal) , hypotrophic, keloid (granulomas) , atrophic , contracture

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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

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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

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7
Q

What cells are involved in acute and chronic inflammation (4 , 3)

A

Acute; NEUTROPHILS, mast, platelets, basophils

Chronic; MACROPHAGES, lymphocytes, antibodies

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8
Q

What are the stages of nociception;

A

Transduction, transmission, perception, modulation

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9
Q

When is emotion input seen during nociception?

A

During transmission in the substantia nigra of the dorsal horn

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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

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11
Q

Which nerve and muscles are effected during Tredelburg step ?

A

Superior gluteal nerve

Gluteus medius and minimus

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12
Q

How would damage to the common fibular nerve present in a px ?

A

‘Foot drop’ , unable to dorsiflex the foot

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13
Q

What is the difference between aspirin and Ibuprofen ?

A

Aspirin is irreversible , Ibuprofen is reversible. Both act on COX to decrease PGE2

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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

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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

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16
Q

What are osteoclasts derived from ?

A

Macrophages and monocytes

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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

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18
Q

Where is elastic cartilage found ?

A

External ear and epiglottis

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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
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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.

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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

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22
Q

List the structure of a nerve (3)

A

Epineurium , perineurium (fascicles) , endoneurium (fibres)

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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.

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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)

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25
Q

Which nodes are seen in OA and where are they located ?

A

Heberden’s (edge of finger at DIP joint)

Bouchardd’s (middle of finger at MIP)

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26
Q

In a hx what are the common differences between OA/RA ? (3,2)

A

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

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27
Q

What activates the extrinsic pathway, how does it compare to intrinsic ?

A

Tissue factor, it’s faster (fewer steps) but less robust response

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28
Q

Which pathways to APTT and INR assess?

A

APTT = intrinsic , INR = extrinsic

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29
Q

What is removed before APTT and what is the normal range ?

A

Tissue factor (so that it’s just intrinsic) . normally between 30-50 seconds

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30
Q

Which clotting fx are deficient in Haemophilia A, B and C ? which one is autosomal recessive (as opposed to sex linked)

A

8, 9, 11. Haemophilia C

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31
Q

What is Von Williebrand disease ?

A

decrease Fx VII and platelet adhesion -> prolonged bleeds. VWF normally binds to Fx VII and protects from proteolytic enzymes.

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32
Q

What is the ADR of paracetamol and how would you tx ?

A

Dose released toxicity of NAPBQI domain. Give N-acetly Cystiene as antidote.

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33
Q

What are the ADRs of ibuprofen?

A

IV, neonatal haemorrhage due to thrombocytopenia

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34
Q

What are the ADRs and CI of Codeine ?

A

ADRs; constipation, drowsy, dizzy, dependance

CI; acute respiratory depression, coma

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35
Q

What stimuli do the 3 fibres respond to ?

A

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

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36
Q

What is the most common site of fertilisation and what epithelium is it made of ?

A

Ampulla of uterine tube. Simple cubodial epithelium

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37
Q

What is the difference between secretory and Cilated cells ?

A

Secretory produce fluid rich in nutrients for sperm

Ciliated ^ Oestrogen activity

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38
Q

Name the ligaments of the uterus and their connections (4)

A

Broad (uterus to pelvic wall)
Round (uterine horn -> inguinal canal -> mons pubis)
Suspensory (ovaries)
Ovarian (ovary to lat uterus)

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39
Q

What is the function of the uterine wall endometrium ?

A

Can undergo hyperplasia under hormonal influence. Spiral arteries contract to induce menstruation.

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40
Q

What are the two layers of the uterine wall ?

A

Stratum functinoalis (proliferation phase) and stratum basalis (doesn’t change)

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41
Q

What are the 3 layers of the uterine myometrium ?

A

SM interwoven with CT

Outer longitudinal, middle crisscrossing and inner circular

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42
Q

How does the epithelium change between endo and ectocervix and what is the significance ?

A

Endocervix is simple columnar epithelium (mucous secreting)
Ectopic is NK strat squamous
Transformation zone is the site of dysplasia so used for smears

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43
Q

What are the 3 components of the penis ?

A

2 corpus cavernousa and 1 corpus spongiosum.

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44
Q

What are the 4 sections of the male urethra and how does the epithelium change throughout?

A

1+2 = transitional epithelium
3 and half 4 = pseudo stratified columnar epithelium
4 = stratified columnar epithelium

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45
Q

What are the 3 prostate gland zones and which has the ^risk of cancer ?

A

Peripheral (largest next to rectum so increased risk) , central and transitional

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46
Q

What type of cells do the seminiferous tubules contain ?

A

Spermatogenic, divide by mitosis then meiosis to form gametes.
Sertoli, protect sperm from autoimmune and nourish them under FSH control

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47
Q

What are Leydig cells and what controls them ?

A

Cells adjacent to tubules. Produce testosterone in presence of LH

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48
Q

How long is the ureter and what is its function ?

A

25-30 cm. Takes urine from kidney to bladder

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49
Q

What is the blood supply to the ureter ?

A

Split into abdominal (renal and testicular artery) and pelvic (superior/inferior vesicle arteries)

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50
Q

What is the significance of the vas deferens for the path of the ureter ?

A

Ureter passes under vas deferens, ‘water under the bridge’.

51
Q

What is the specialised SM of the bladder and what is its’ function ?

A

Detrusor muscle, can remain strong when stretched.

52
Q

What is the function of the external urethral sphincter in males ?

A

Prevents seminal regurgitation

53
Q

How do granulosa cells of the ovary fluctuate ?

A

Surround oocyte ^in response to gonadotropic and decrease in response to testosterone

54
Q

What does the Graafian follicle produce originally and what effect does this have ?

A

^oestrogen, inhibits growth of other follicles then thickens endometrium and thins cervical mucous to ^sperm entry.

55
Q

How does LH change with O?

A

Initially ^O inhibits LH but once mature O reaches threshold so LH spikes at day 12

56
Q

What hormones does the corpus luteum secrete and what effect does this have ?

A

^P and some ^O which inhibits LH/FSH causing corpus luteum to degenerate.

57
Q

If fertilisation occurs how is the corpus luteum maintained ?

A

Blastocyst produces hCG (similar action to LH)

58
Q

How are gamete production and growth rate ^ initially stimulated during puberty ?

A

Hypothalamus ^GnRh -> endocrine cells in APG have ^sensitivity so ^LH/FSH which act on gametes.

59
Q

What is menarche ?

A

First period for a girl, between 10-16 normally

60
Q

What is hypogonadotropic hypogonadism ?

A

2ndry hypothalamic pituitary disorder. less FSH/LH so hypogonads and testosterone down. CNS disorders/tumours, anorexia, ^exercise.

61
Q

What is hypergonadotropic hypogonadism ?

A

primary testicular disease, gonads don’t respond to FSH/LH so ^production as compensation. Tx - replace testosterone and O.

62
Q

What are the different causes for central and peripheral precocious puberty ?

A

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
Q

What is the tx for precocious puberty ?

A

Aromatase inhibitors, GnRh analogues and tx underlying causes.

64
Q

What are the ADRs for COCP ?

A

most stroke/heart/vascular problems, overweight, >35+smoke

65
Q

What is the POP and when should it be taken ?

A

P only (when O contraindicated) taken every day no break same time to ^efficacy.

66
Q

What are the different injection contraceptions ?

A

Depo Provera for 13 wks

Noristerat for 8 wks

67
Q

What is the difference between IUD and IUS?

A

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
Q

When is the patch contra ?

A

Oestrogen intolerance (it’s same as COCP) , ^BP (headache) , smoking, >35, >90 Kg

69
Q

What colour do GRAM +ve/-ve stain ?

A 
\+ve = purple 
-ve = red/pink
70
Q

What are the difficult targets for abx and what antibiotic can be used to penetrate the CSF?

A

intracellular bacteria, eye, prostate, CSF

Chloranphenicol

71
Q

What does Nisseria meningitidis cause and what is the tx ?

A

Bacterial meningitis. inflammation breaks down bbb so you can use amoxicillin and cephalosporins.

72
Q

E coli is most common UTI cause. what are the common manifestations ? (5)

A

Bowel flora, sex, catheter colonisation, DM, constipation

73
Q

How is UTI indicated on a dipstick and what other tests could be used ?

A

Nitrates = bacterial cause , Leukocytes = WBCs ^

MSU, blood tests, imaging is severe

74
Q

What is the tx for uncomplicated and complicated UTIs ?

A

Uncomplicated; trimethoprim and Nitrofurantoin

Complicated; Co-amoxiclav (clauvonic acid + amoxicillin)

75
Q

What is the most common bacterial STI and how is it dx and tx ?

A

Chlamydia, NAAT (nucleic acid amplification test) or vulvovaginal swab.
Tx; azithromycin or doxycyline

76
Q

What are the sx and tx of Gonorrhea ?

A

Sx; discharge, dysuria, infection

Mx; Azithromycin and ceftriaxone

77
Q

What are the two types of genital herpes, where is it latent and what is the tx ?

A

type 1 = oral , 2 = genital
Latent in the sensory ganglia
Tx is aciclovir but no cure.

78
Q

What strains are the causes of genital warts and HPV ?

A

warts = 6+11 , cervical cancer = 16+18. HPV vaccine prevention

79
Q

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 ?

A

5-alpha reductase

80
Q

What muscles make up the pelvic diaphragm ?

A

Levator ani (puborectalis, pubococcygeus and iliococcygeus) and coccygeus.

81
Q

When are macrolides used ?

A

Type of abx inhibits protein synthesis by binding to the ribosomal 50s subunit.
azithromycin in Chlarmydia/Gonorrhea and Clarithromycin in H pylori

82
Q

Which cancer strains are protected in the new HPV vaccine for boys ? (5)

A

31, 33, 45, 52, 58

83
Q

What are ethanyl estradiol and Levonorgestral ?

A

Oestrogen and progesterone analogues used in contraception

84
Q

What is Mifepristone ?

A

P antagonist causes endothelium degneration -> abortificant

85
Q

What drug can be used to treat MRSA and Staphylococcus when R to penicillin ?

A

Vancomycin

86
Q

What drug is 1st line for TB ?

A

Rifampicin, mRNA synthesis inhibitor.

87
Q

What happens during 3rd stage of Taner puberty ?

A

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
Q

How does the epithelium change through the oesophagus ?

A

From stratified squamous to simple columnar

89
Q

What are secreted by the stomach cells; chief, parietal and Goblet ?

A

Chief = Pepsinogen , Parietal = HCl, gastrin , Goblet = mucous

90
Q

What makes up the portal triad ?

A

Portal vein, hepatic artery and common bile duct

91
Q

What is the function of the pancreatic duct ?

A

Connects to CBD and releases pepsinogens to ^fat breakdown in 2nd duo

92
Q

What is the entrance of the common bile duct into the duodenum ?

A

Sphincter of oddi at the ampulla of Vater

93
Q

What is the difference between primary and secondary secretion of saliva ?

A

Primary is isotonic as Cl has drawn out water

Secondary is hypotonic as HCO3 ^ during modification but tube is impermeable to water

94
Q

How is a swallow initiated during the oral digestion phase ?

A

Tongue contracts rolls bolus back to oropharynx, its mechanoreceptors then stimulates CN IX to initiate swallow

95
Q

What is deglutination apnoea ?

A

Respiration inhibited for 6-8 seconds. Larynx goes up allowing the epiglottis to cover the tracheal opening during digestion preventing aspiration

96
Q

What is the alkaline tide ?

A

During gastric acid secretion HCO3 exchanged with Cl from blood causing high pH in venous blood around the stomach.

97
Q

What are the risk fx for GORD ? (6)

A

Preg/ obesity ^intra abdo P , spicy food, alcohol , hiatus hernia, NSAIDs, smoking

98
Q

How often should you screen for Barret’s Oesophagus ?

A

Dx through biopsy and endoscopy

Screen every 5 yrs for <3cm and every 3 for >3cm.

99
Q

How would you tx Barret’s oesophagus ?

A

PPIs 1st line, radio frequency ablation, endoscopic mucosal/surgical resection

100
Q

What difference sx will arise for gastric and duodenal ulcers ?

A

Gastric is worse after food , duodenal is worse before. Breaks in stomach mucosal lining HCl destroys mucous

101
Q

What is the triple medication therapy for H pylori ?

A

Omeprazole, Clarithromycin, amoxicillin

102
Q

What change does H pylori cause ?

A

95% duo and 75% gastric ulcers. urea +H2O -> NH3 (urease catalyst) . Produces CAGA toxins which ^IL8 recruits neutrophils. Histamines ^HCl.

103
Q

What is ZES and how would you dx ?

A

Gastrinomas of pancreas/duodenum. ^HCl and doesn’t respond to tx. Dx; fasting gastrin

104
Q

What is Achalasia and what is the indication on a Barium swallow ?

A

Failure of the GOJ to relax, dysphagia to solid food/liquids. Gives bird beak.

105
Q

Give an example of enzyme induction ?

A

A decreases B. St John’s wort ^CYP3A4 which decreases COCP.

106
Q

What can be used to give a short term soothing effect for gastric upset ?

A

Ma/Ca carbonates (Rennies) strong alkaline neutralise HCl but can’t be used chronically as body ^acid secretions in response

107
Q

Give two examples of H2RAs, what are their ADRs ?

A

Competitive histamine receptors. ADR; impotence, gynaecomastia (anti androgens)

108
Q

What are the CIs of PPIs ?

A

Nausea, dizziness, headaches

109
Q

What are the acute and chronic hepatitis forms ?

A 
Acute = A and E 
Chronic = B, C, D
110
Q

What are the sx of Hep A ?

A

After two weeks ^AST/ALT jaundice 70% of the time. Dark urine, pale stools and hepatomegaly.

111
Q

How is Hep C transmitted and what are the sx ?

A

Early on is mild fever/often asx
85% silent chronic infection
25% cirrhosis
Leads to hepatocellular cancer

112
Q

Once bilirubin has been conjugated what can it then be converted to ?

A

Into blood stream Urobilinogen -> Urobilin

Or poo stercobilinogen -> stercobillin

113
Q

What is prehepatic jaundice and give two examples ?

A

Bilirubin > hepatic conjugation. Liver function normal.

Sickle cells anaemia, G6PD deficiency.

114
Q

Give two causes of unconjugated hyperbilirubineamia and give the signs ?

A

No enzyme function eg. Gilbert’s , Crigle Najjor syndrome

Normal LFTs, pale stool, dark urine

115
Q

What are the signs of cirrhosis or hepatitis ?

A

Conjugated hyperbillirubanaemia.

^AST, ALT, GGT normal stools and dark urine

116
Q

What are the signs of post hepatic jaundice ?

A

Pale stool, dark urine, ^ALP and GGT (biliary damage and bile outflow obstruction respectively)

117
Q

What is the significance if urobilin is found in the urine ?

A

Can’t be obstructive because it’s been converted from urobilinogen

118
Q

What is the toxic and lethal dose of paracetamol ?

A

Toxic = 4-6 g , lethal >12

119
Q

What are the enzymes involved in paracetamol metabolism ?

A

Normal is UGT to glucoronidate the drug making is H2O soluble/inactive
Patho is CYP2E1 and CYP1A2 which produces NAPBQI

120
Q

What is the action of ACh in regulation of acid secretion ?

A

Stimulated by PSNS at cholinergic synapses to act on M3 receptors of parietal cells to ^HCl

121
Q

CCK; stimulus, location, MOA ?

A

Fat and chyme in duodenum
Secreted by I cells
Competitive inhibitor of gastrin at CCK-B

122
Q

What regulator acts to decrease gastrin release, responding to HCl in the duodenum ?

A

Secretin , from S cells in duodenum

123
Q

What regulators are secreted by enteric nerves and what is their function ?

A

VIP - distension of stomach ^somatostatin release

GIP - fat in the duodenum decreases gastrin release

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