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Clinical sciences Flashcards

1
Q

How is left ventricular ejection fraction calculated?

A

Stroke Volume / End Diastolic Volume) × 100%

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2
Q

What is a Wilcoxon signed-rank test?

A

compares two sets of observations on a single sample, e.g. a ‘before’ and ‘after’ test on the same population following an intervention

Non parametric

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3
Q

What is a Mann Whitney U test?

A

compares ordinal, interval, or ratio scales of unpaired data

non parametric test

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4
Q

What is a chi-squared test?

A

used to compare proportions or percentages e.g. compares the percentage of patients who improved following two different interventions

non parametric test

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5
Q

What is a Spearman, Kendall rank test?

A

Used to assess correlation
Non parametric

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6
Q

Which phase of the cell cycle determines cycle length?

A

G1 phase

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7
Q

What occurs within G0 of the cell cycle?

A

‘resting’ phase
quiescent cells such as hepatocytes and more permanently resting cells such as neurons

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8
Q

What occurs within G1 phase of cell cycle?

A
  • Gap 1, cells increase in size
  • determines length of cell cycle
  • under influence of p53
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9
Q

What occurs within G2 phase of cell cycle?

A

Gap 2, cells continue to increase in size

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10
Q

What occurs within S phase of cell cycle?

A

Synthesis of DNA, RNA and histone
centrosome duplication

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11
Q

What occurs within the M phase of the cell cycle?

A

Mitosis - cell division
the shortest phase of the cell cycle

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12
Q

What type of receptor is an atrial natriuretic factor?

A

guanylate cyclase receptor

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13
Q

Goodpasture’s syndrome is caused by autoantibodies against which substance?

A

type IV collagen

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14
Q

What are the features and EEG findings of Non REM stage 1 sleep?

A
  • Light sleep
  • Transition to this stage be associated with hypnic jerks
  • Theta waves on EEG
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15
Q

What are the features and EEG findings of Non REM stage 2 sleep?

A
  • Deeper sleep
  • Represents around 50% of total sleep
  • Sleep spindles + K-complexes on EEG
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16
Q

What are the features and EGG findings of Non REM stage 3 sleep?

A
  • Deep sleep
  • Parasomnias such as night terrors, nocturnal enuresis, sleepwalking
  • Delta waves on EEG
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17
Q

What are the features and EEG findings of REM sleep?

A
  • Dreaming occurs
  • Loss of muscle tone, erections
  • Beta waves on EEG
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18
Q

What is the usual outcome in a cohort study?

A

Relative risk

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19
Q

What are the features of randomised control trial?

A

Participants randomly allocated to intervention or control group (e.g. standard treatment or placebo)

Practical or ethical problems may limit use

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20
Q

What are the features of a cohort study?

A

Observational and prospective. Two (or more) are selected according to their exposure to a particular agent (e.g. medicine, toxin) and followed up to see how many develop a disease or other outcome.

The usual outcome measure is the relative risk.

Examples include Framingham Heart Study

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21
Q

What are the features of a case control study?

A

Observational and retrospective. Patients with a particular condition (cases) are identified and matched with controls. Data is then collected on past exposure to a possible causal agent for the condition.

The usual outcome measure is the odds ratio.

Inexpensive, produce quick results
Useful for studying rare conditions
Prone to confounding

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22
Q

What are the features of a cross sectional survey?

A

Provide a ‘snapshot’, sometimes called prevalence studies

Provide weak evidence of cause and effect

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23
Q

What is the gold standard test for cerebral metastases?

A

MRI with contrast

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24
Q

What are foam cells?

A

Fat-laden macrophages

25
Which clotting factors are inhibited by heparin?
Factors 2,9,10,11
26
Which clotting factors synthesis are affected by warfarin?
Factors 2,7,9,10
27
Which clotting factors are affected in DIC?
Factors 1,2,5,8,11
28
Which clotting factors are affected in liver disease?
Factors 1,2,5,7,9,10,11
29
What are the key features of haemophilia A?
X- linked recessive Factor VIII Intrinsic pathway affected PT Normal APTT prolonged (raised) Deep tissue/joint bleeding Severity correlates with factor level Ix - APTT and factor VIII assay Rx - Recombinant FVIII
30
What are the key features of haemophilia B?
X-linked recessive Factor IX Intrinsic pathway affected PT Normal APTT prolonged (raised) Deep tissue/joint bleeding Severity correlates with factor level Ix - APTT, factor IX assay Rx - Recombinant FIX
31
What are the key features of Von Willebrand disease?
Autosomal dominant vWF ± Factor VIII Platelet adhesion & intrinsic pathway affected PT normal APTT normal or prolonged Prolonged bleeding time Mucocutaneous (e.g. epistaxis, menorrhagia) bleeding Variable severity Ix - vWF antigen/activity + factor VIII assay Rx - Desmopressin (Type 1), vWF concentrates
32
What are the key features of Factor XI deficiency?
Autosomal recessive (mainly Ashkenazi Jews) Factor XI Intrinsic pathway affected PT normal APTT prolonged Variable bleeding (often post op) Variable severity (often mild) Ix - Isolated ↑ aPTT + factor XI assay Rx - Antifibrinolytics ± FXI concentrate or FFP
33
What are the key features of Factor VII deficiency?
Autosomal recessive Factor VII Extrinsic pathway PT prolonged APTT normal Mucocutaneous ± deep tissue bleeding Variable severity (doesn't always correlate with factor levels) Ix - isolated prolonged PT + factor VII assay Rx - Recombinant FVIIa, plasma-derived FVII
34
What is achondroplasia?
Autosomal dominant disorder associated with short stature. It is caused by a mutation in the fibroblast growth factor receptor 3 (FGFR-3) gene. This leads to abnormal cartilage which results in: - short limbs (rhizomelia) with shortened fingers (brachydactyly) - large head with frontal bossing and narrow foramen magnum - midface hypoplasia with a flattened nasal bridge - 'trident' hands - lumbar lordosis
35
What is the main risk factor for developing achondroplasia?
Advancing parental age at time of conception
36
What are the histopathological findings for acute tubular necrosis?
- tubular epithelium necrosis: loss of nuclei and detachment of tubular cells from the basement membrane - dilatation of the tubules may occur - necrotic cells obstruct the tubule lumen
37
What are the phases of acute tubular necrosis?
oliguric phase polyuric phase recovery phase
38
What is alkaptonuria?
Rare autosomal recessive disorder of phenylalanine and tyrosine metabolism caused by a lack of the enzyme homogentisic dioxygenase (HGD) which results in a build-up of toxic homogentisic acid. Eventually it accumulates in cartilage and other tissues.
39
What are the features of Alkaptonuria?
Generally a benign and often asymptomatic condition. Features include: - pigmented sclera - urine turns black if left exposed to the air - intervertebral disc calcification may result in back pain - renal stones
40
What is the treatment for Alkaptonuria?
- high-dose vitamin C - dietary restriction of phenylalanine and tyrosine
41
What is the function of anti-diuretic hormone?
Promotes water reabsorption in the collecting ducts of the kidneys by the insertion of aquaporin-2 channels.
42
What causes an increase in ADH secretion?
- extracellular fluid osmolality increase - volume decrease - pressure decrease - angiotensin II
43
What causes a decrease in ADH secretion?
- extracellular fluid osmolality decrease - volume increase - temperature decrease
44
Where is ADH synthesised and released?
Synthesized in the supraoptic nuclei of the hypothalamus Released by the posterior pituitary
45
What is meant by the term non-penetrance?
lack of clinical signs and symptoms (normal phenotype) despite abnormal gene. E.g. 40% otosclerosis
46
Which tumours most commonly spread to the brain?
lung (most common) breast bowel skin (namely melanoma) kidney
47
What is phase 0 of the cardiac cycle?
Rapid depolarisation - rapid influx of sodium
48
What is phase 1 of the cardiac cycle?
Early repolarisation - efflux of potassium
49
What is phase 2 of the cardiac cycle?
Plateau - slow influx of calcium
50
What is phase 3 of the cardiac cycle?
Final repolarisation - efflux of potassium
51
What is phase 4 of the cardiac cycle?
Restoration of ionic concentrations - Resting potential is restored by Na+/K+ ATPase There is slow entry of Na+ into the cell decreasing the potential difference until the threshold potential is reached, triggering a new action potential
52
What is stroke volume?
end diastolic LV volume - end systolic LV volume
53
What cardiac output?
Stroke volume x heart rate Amount of blood pumped by heart in 1 minute
54
What is pulse pressure?
Systolic Pressure - Diastolic Pressure
55
What is systemic vascular resistance?
mean arterial pressure / cardiac output
56
What are the key features of mitosis?
- Occurs in somatic cells - Results in 2 diploid daughter cells - Daughter cells are genetically identical to parent cell.
57
What are the key features of meiosis?
- Occurs in gametes - Results in 4 haploid daughter cells - Daughter cells contain one homologue of each chromosome pair and are therefore genetically different
58

MRCP (14 decks)

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