clinical stuff

Question 1

1-complement cascade creates MAC

Answer 1

-causes cell lysis

Question 2

2-complement binds to FC receptor

Answer 2

• chemotaxic chemicals released
• attracts neutrophils
• neutrophils destroy the cells

Question 3

3-opsonisation and phagocytosis

Answer 3

-happens in the spleen

Question 4

4-antibody mediated

Answer 4

• natural killer cells
• binds to antibodies in the AD-AB complex
• causes cell death

Question 5

5-causes antibody antigen complex to interrupt normal cell processes -not cell death

Answer 5

-AB bound to the antigen causes changed receptor response

Question 6

Alzheimer’s disease

Answer 6

caused by a build up of aberrant protein in the brain

• cells cannot communicate effectively-treated with acetylcholinesterase inhibitors
• causes of acetylcholinesterase to be unable to break down acetylcholine in the brain-increased communication between cells-alleviating symptoms

Question 7

mad cow disease

Answer 7

• build up of prions in the brain that fold up into an almost indestructible aggregate
• also causes other prion proteins to fold up swell

Question 8

cystic fibrosis -6 different classifications

Answer 8

class 1-MRNA is not produced correctly or at all so no protein channels are created 
class 2-the proteins are made but do not fold correctly 
class 3-the proteins are made and put into the membrane, but the channels are blocked 
class 4-the channel is made but isn't as effective so only some ions can diffuse out 
class 5-there is not enough of the proteins made so they cannot allow a big enough total volume of ions to diffuse out of the cells 
class 6-the half life of the proteins is too short so there isn't enough in the cell membrane at one time

Question 9

Asthma

Answer 9

can be allergic(extrinsic)

or non-allergic(intrinsic)

Question 10

asthma -first exposure

Answer 10

-on first exposure to the allergen=sensitisation occurs

Question 11

asthma-second exposure

Answer 11

-mast cells release histamines and spasmogens which cause the bronchioles to go into spasm and restrict the airways

Question 12

asthma-late phase attack

Answer 12

t helper 2 cells are recruited and activate inflammatory cells.this can cause excessive mucous production and bronchoconstriction hours after exposure

Question 13

asthma-peak flow meter

Answer 13

-will show a LOW FEV1 due to its nature as an obstructive disease

Question 14

asthma-spirometer

Answer 14

vitalograph with a shallower curve, but reaching the same max volume-an obstructive pattern

Question 15

COPD

Answer 15

• collapse of the alveolar walls and build up of fluid in the lungs means that air can be retained in the alveoli and no extra air can be taken in
• this causes hyperinflation of the lungs
• spirometry shows a higher volume and reduced expiration rate
• x-ray shows longer lungs -more than 10 ribs can be counted on each side
• if infection suspected-co-amoxiclav

Question 16

COPD-acute exacerbation

Answer 16

• increase in dyspnoea, cough, wheeze, increase in sputum

- hypoxic-oral prednisolone 30mg for 5 days

Question 17

end stage COPD treatment

Answer 17

opioid or benzodiazepine medications for symptomatic relief of breathlessness

Question 18

emphysema

Answer 18

break down of alveoli walls decreasing surface area

Question 19

chronic bronchitis

Answer 19

swelling of bronchioles causing obstructive disease

Question 20

acute bronchitis

Answer 20

usually self limiting
odemous large airways and sputum due to inflammation of trachea and bronchi
disease usually resolves in 3 weeks
management-analgesia,fluids consider antibiotics if systemically very unwell or co-morbidities
doxycycline first line

Question 21

severe pulmonary fibrosis

Answer 21

visible on an X-ray as much more coarse or fine white streaks
every type of volume is reduced due to restrictive disease

Question 22

sarcoidosis

Answer 22

• inflammatory deposits in various parts of the body
• creates a restrictive issue in the lungs
• presents similar to fibrosis
• enlarged lymph nodes

Question 23

erythema nodosum

Answer 23

• red patches on the skin

- associated with many types of autoimmune disease

Question 24

wheeze

Answer 24

• lower airways, heard during expiration
• airway obstruction at the level of bronchioles,increasing airway resistance
• polyphonic wheeze-each bronchiole is restricted a different amount

Question 25

stridor

Answer 25

• occurs at the level of the larynx
• infection and swelling or vocal cord palsies
• airway obstruction outside the thoracic cavity
• heard during inspiration

Question 26

pharyngeal pouch

Answer 26

• outpouching of the hypo pharynx just superior to upper oesophageal sphincter
• between 2 parts of inferior constrictor
• can trap food and cause bad breath, cough,aspiration or infection

Question 27

tension pneumothorax

Answer 27

• trauma causing the pleural membranes to rupture
• air gets into the pleural cavity and allows the lungs to deflate
• trachea is palpably shifted to the opposite side
• chest drain is needed to be placed into second intercostal space on the side of the trauma

Question 28

Virchow’s node

Answer 28

• supraclavicular cervical lymph node in the left subclavian triangle
• close proximity to the thoracic duct
• enlargement suggests abdominal malignancy
• especially gastric

Question 29

haemoptysis

Answer 29

blood in sputum

Question 30

rhino sinusitis

Answer 30

-upper respiratory
usually viral and clears in a week
if longer than 10 days there could be a secondary bacterial infection
periorbital oedema creates visual changes, cranial nerve palsies are possible
-papillodema=swelling of the brain pressing on the optic disk

Question 31

common cold

Answer 31

upper ri
50% rhinovirus
25% coronavirus
15% influenza

Question 32

acute pharyngitis

Answer 32

upper ri

• viral tonsilitis will resolve by self
• bacterial needs antibiotics, usually streptococcus

Question 33

bronchiolitis

Answer 33

-lower ri 
leading cause of admission for under 5 year olds 
-respiratory syncytial virus 
-swelling of the bronchioles 
-90% will resolve within 3 weeks

Question 34

pneumonia

Answer 34

• lower ri
• pleuritic chest pain -also common with pulmonary embolism
• high temperature, breathing rate, heart rate
• CURB65 score is used to assess the severity -confusion,urea ,heart rate ,breathing rate

Question 35

complications of pneumonia

Answer 35

pleural effusion-build up of pleural fluid in the pleural space
empyema-pus in the pleura
ARDS-acute respiratory distress syndrome
abscesses
cavitating disease