Clinical Science Flashcards by Scott Griffiths

Symptoms and Mx of hereditary angioedema

Painful macular rash followed by painless subcutaneous/submucosal swelling. May have abdo pain from visceral swelling
Mx: IV C1-inh concentrate or FFP if not available
Steroids may help prophylaxis

How well did you know this?

Not at all

Perfectly

Action of alpha-1 adrenoceptor

Vasoconstriction
GI sm relaxation
Salivary secretion

How well did you know this?

Not at all

Perfectly

Action of beta1 and beta2 adrenoceptors

Beta-1: in the heart, positively chronotropic and ionotropic

Beta-2: vasodilatation, bronchodilation, relax GI sm

How well did you know this?

Not at all

Perfectly

Causes of hyperuricaemia

Associations with hyperuricaemia

Increased production: high purine diet, increased cell turnover, cytotoxics, psoriasis, exercise, myeloproliferative disease
Decreased excretion: renal failure, lead, alcohol, aspirin, diuretics, pre-eclampsia
Associations: HTN, hyperlipidaemia, metabolic syn

How well did you know this?

Not at all

Perfectly

Genetic abnormality and symptoms of kleinfelters

47 XXY

Tall, infertile, gynaecomastia, small hard testes, lack secondary sexual characteristics, increased gonadotropin levels

How well did you know this?

Not at all

Perfectly

name the gram positive rods

what’s the mneumonic

A - actinomyces
B - bacillus anthracis
C - clostridium
D - diphtheria (corynebacterium diphththeriae)
L - listeria monocytogenes

How well did you know this?

Not at all

Perfectly

which antibiotic is active against both MRSA and VRE (vanc resistant enterococci)?
how does it work?
SEs

linezolid
inhibits bacterial protein synthesis therefore bacteriostatic
also effective against GISA (Glycopeptide Intermediate Staphylococcus aureus)
thrombocytopenia, monoamine oxidase inhibitor

How well did you know this?

Not at all

Perfectly

Hereditary angioedema: inheritance, what’s the problem, investigations during attacks and between them

Auto dom
Low C1 inhibitor
During attacks: low C1-inh
Between attacks: low C4 (and C2)

How well did you know this?

Not at all

Perfectly

What is the role of the p53 gene?

What is the effect of its mutation?

Tumour suppressor gene
Mutation seen in breast, colon and sarcomas
Mutation seen in Li-Fraumeni syndrome (lots of cancers)

How well did you know this?

Not at all

Perfectly

type 1 hypersensitivity

pathology, example

Anaphylaxis
antigen reacts to IgE on mast cells
anaphylaxis, atopy

How well did you know this?

Not at all

Perfectly

type 2 hypersensitivity

pathology, example

Cell Bound
IgG or IgM binds to antigen
Goodpasture’s, pernicious anaemia, acute haemolytic transfusion reaction

How well did you know this?

Not at all

Perfectly

Type 3 hypersensitivity

pathology, example

Immune complex
free antigen and antibody (IgA, IgG) form complex
SLE, EAA, post strep glomerulonephritis

How well did you know this?

Not at all

Perfectly

Type 4 hypersensitivity

pathology, example

Delayed hypersensitivity
T cell mediated
Graft vs host, allergic contact dermatitis, MS, Guillian-Barre syn

How well did you know this?

Not at all

Perfectly

Type 5 hypersensitivity

pathology, example

Autoimmune
Antibodies recognise and stimulate or block cell receptors
Graves, myasthenia gravis

How well did you know this?

Not at all

Perfectly

Give examples of live attenuated viruses (7)

BCG
MMR
influenza (intranasal)
rotavirus
polio
yellow fever
typhoid

How well did you know this?

Not at all

Perfectly

Mx of eclampsia

IV magnesium sulphate

should be given once decision to deliver has been made

How well did you know this?

Not at all

Perfectly

what is rheumatoid factor?

IgM antibody against IgG

How well did you know this?

Not at all

Perfectly

Action of antiemetics:
Ondansetron
Metoclopramide
Cyclizine

Ondansetron - 5HT3 r antagonist
Metoclopramide - D2 r antagonist
Cyclizine - H1 r antagonist

HLA associations:
A3
B5
B27

A3 - haemochromatosis
B5 - Bechet’s
B27 - ank spond, reiter’s syn, acute ant uveitis

HLA associations
DQ2/DQ8
DR 2
DR 3 
DR 4

DQ2/DQ8 - coeliacs
DR 2 - narcolepsy, goodpastures
DR 3 - dermatitis herpetiformis, Sjögren’s syndrome, primary biliary cirrhosis
DR 4 - T1DM, RA

what are the LH and FSH levels in Kleinfelters and Kallman’s?

Kleinfelters (47 XXY) - raised LH and FSH

Kallman’s (hypogonadotrophic hypogonadism) - inappropriately low-normal LH and FSH

What is the pathology of Kallman’s syndrome?

features?

x-linked recessive
failure of GnRH secreting neurones to migrate down into hypothalamus
anosmia
‘delayed puberty’
hypogonadism
low sex hormones and inappropriately low LH and FSH

What is premature ovarian failure?

onset of menopausal features before 40

elevated FSH and LH

Complement deficiencies; what is the effect
C1 inhibitor deficiency
C3 def
C5 def
C5-9 def

C1 inh deficiency - hereditary angiodema
C3 deficiency - recurrent bacterial infections
C5 deficiency - Leiner disease (severe seborrheic dermatitis, diarrhoea, infections)
C5-9 def - encodes the membrane attack complex (MAC) prone to N.meningitidis infection

Which immunoglobulin has the highest and lowest concentration in the blood? what are the roles of IgA, D,E,G,M?

IgG - most (75%). Monomer, enhances phagocytosis IgA - monomer/dimer. found in secretions. IgM - anti A and B antibodies. pentamer IgD - activates B cells. monomer IgE - least. involved in allergic reactions.

what is endothelin? | in which diseases are the levels raised?

potent vasoconstrictor and bronchoconstrictor | MI, primary pulmonary hypertension, HF, raynauds, ARF, asthma

What promotes and inhibits endothelin release

endothelin (a potent vaso- and broncho-constrictor) promotes: angiotensin II, vasopressin (ADH), hypoxia, mechanical sheering forces inhibits: nitric oxide, prostacyclin

What does the cyanide-nitroprusside test identify? features treatment

To identify cystine in the urine (cystinuria) - autosomal recessive, leads to renal stones. Rx by hydration, D-penacillamine, urine alkalisation

what is the enzyme deficiency in homocystinuria? | what is the amino acid affected?

cystathionine beta synthase (CBS) deficiency | methionine

features of homocystinuria | treatment

cystathionine beta synthase (CBS) enzyme deficiency marfanoid appearance, learning difficulties, downwards dislocation of the lens, increased arterial and venous thomboembolism Rx with pyridoxine (B6)

normal distribution how many values lie in 1SD? 2SD? 3SD? how do you calculate SD?

1SD - 68.3% 2SD - 95.4% 3SD - 99.7% SD = square root (variance)

what is the amount of sodium and chloride in normal saline? | how much salt do we need per day?

150mmol/l of Na and Cl | need 6g of salt/day

how much Na Cl K and bicarb is there in hartmann's solution?

Na 131 Cl 111 K 5 HCO3 29

what are the features of pseudoxanthoma elasticum?

auto rec abnormality in elastin fibres plucked chicken skin appearance - small yellow papules on neck and axillae retinal angoid streaks cardiac: mitral valve prolapse, increased risk of IHD GI haemorrhage

What are T-helper 1 cells involved in and what do they secrete?

Th1 - involved with cell mediated response (type 4 hypersensitivity) secrete IFN-gamma, IL-2, IL-3

What are T-helper 2 cells involved in and what do they secrete?

Th2 - involved with humoral (antibody) immunity | secrete IL 4/5/6/10/13

What is the main action of atrial natriuretic peptide

powerful vasodilator | also promotes sodium excretion and antagonises angiotensin II and aldosterone.

what would you test for to establish an anaphylaxis reaction?

serum tryptase

how do you calculate standard error?

SD/ square root (number of subjects) | standard error gets smaller as the sample size increases.

Mechanism of clopidogrel

inhibits ADP binding to platelet receptors, inhibiting platelet activation concurrent use of PPIs makes clopidogrel less effective

Dx and Mx of Wilson's disease

Dx: low caeruloplasmin, raised urinary copper excretion Mx: penacillamine or trientine (chelates copper)

In statistics what is a type 1 error?

null hypothesis is rejected when it is true (false positive) | found if the study has too many end points

In statistics what is a type 2 error?

accepting null hypothesis when it is false (false negative) | found if the sample is too small