EoY2 Formatives Flashcards
How does GTN spray help angina?
Ventilation increases blood flow to heart so more oxygen gets to cardiac muscle
3 signs of hypercholesterolaemia?
Xanthelasma, Corneal arcus, tendon xanthoma
What is the pathophysiology between high LDL and atherosclerosis?
- LDL is susceptible to oxidative damage due to short half life
- Oxidised LDL is taken up by macrophages
- Macrophages are now foam cells which lie in tunica intimacy
- This forms a fatty streak which can evolve into a plaque
What are the potential medical complications of hypercholesterolaemia?
Srtoke
Acute coronary syndromes
Peripheral arterial disease
State some chemical mediators in acute inflammation?
Histamines
prostaglandins
leukotrienes
coagulation proteins
Describe the fibrous repair process
- Phagocytosis of necrotic tissue debris
- Proliferation of endothelial cells and angiogenesis of new capillaries
- Proliferation of fibroblasts and myofibroblasts to synthesise collagen and cause wound contraction
- Granulation tissue becomes less vascular and matures into a fibrous scar
- The scar shrinks due to contraction of fibrils
What pattern of inheritance does haemophilia A follow?
X linked recessive (factor VIII deficiency)
What causes a subdural haematoma?
Significant trauma or minor injury in elderly due to cenile atrophy
What is the first line treatment for a subdural haematoma?
Craniotomy
What is the venous drainage in the brain?
superior sagittal sinus
confluence of sinuses
transverse sinus
sigmoid sinus
internal jugular vein
Which bones form the foramen that the IJV flows through?
Petrous part of temporal bone
Occipital bone
What are some examples of nephrotic syndrome?
Minimal change disease
Focal segmental glomerulosclerosis
Membranous glomerulonephritis
Diabetes
Define emotional abuse
The persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development.
What is the toxic trio?
Domestic violence
Adult mental health issues
Substance abuse
How can you diagnose active TB?
TB culture using a sputum smear and nucleic acid amplification test using sputum sample
What should be done before initiating a patient on medications to treat depression?
Ensure they don’t have bipolar as antidepressants will destabilise there mood
What herniation can occur in a extradural haemorrhage and what CN is at risk?
Transtentorial herniation
CN 3 palsy
What are some changes to the respiratory system in the elderly?
Reduced compliance due to reduced elastic recoil
TLC reduced
Which respiratory postoperative complications are common in the elderly?
Atelectasis
PE
Pneumonia
What is the physiological definition of frailty?
Increased vulnerability due to ageing-associated decline in reserve and function
Across multiple physiologic systems
Affects everyday activities/ability to cope with stressors
What term is used to describe a medical treatment that could be harmful?
Doctrine of double effect
What defines a good death?
Choosing where to die
Option for pain relief
Knowing what to expect
Dignity & Privacy
Where is the most common location of breast cancer?
Upper outer quadrant
What are the resp and CVS symptoms of an allergic reaction?
Wheeze
Stridor
Cough
Struggling to breathe
Pallor
Hypotension
Tachycardia
What medications would you give for allergy in addition to epinephrine?
Chlorphenamine (anti-histamine)
Hydrocortisone
Define atopy
A tendency to produce IgE antibodies in response to ordinary exposure to potential allergens
Give an example of a sedating and non-sedating antihistamine?
Cetirizine (non-sedating)
Chlorphenamine (sedating)
ADR- Drowsiness, dry mouth
Which cell type would be raised in the blood in an allergy?
Eosinophils
What would be a positive response in a skin test?
Wheal - raised white bump surrounded by a small circle of itchy red skin
(has low sensitivity so use with other tests)
What are the 2 phases of allergy?
Sensitization phase- First encounter with the antigen. Activation of APCs and memory effector cells.
Effector phase - Pathologic reaction upon re-exposure to the same antigen and activation of the memory cells of the adaptive immunity
Why is baked milk more tolerated?
conformational (folded) epitopes are destroyed
sequential epitopes preserved
What are the differences between IgE and non IgE mediated?
IgE: presents any age, immediate response (mins)
Non IgE: resents at infancy, delayed response (hours)
What’s the pathophysiology behind RA?
immune complexes are deposited in the tissue which cause complement activation
Attracts neutrophils by chemotaxis, which adheres to the cells and degranulates causing cell membrane breakdown.
How can we diagnose autoimmune disease?
Presence of autoantibodies/autoreactive T Cells
Levels of autoantibodies correlate with disease severity
Autoantibodies/autoreactive T cells found at site of tissue damage
What is the mechanism behind type 1 hypersensitivity?
On 1st exposure - antigen specific IgE antibodies are made by plasma cells, the IgE antibodies attach to mast cells.
On Second exposure - the IgE antibodies cross-link with the antigen, this causes mast cell degranulation.
Activated mast cells release histamine and chemokines
causes increased vascular permeability, vasodilation and bronchoconstriction (IgE mediated response)
Define sensitisation
Production of IgE antibodies or IgE mediated response after repeated exposure to an allergen
Stages of asthma exacerbations?
Oxygen therapy
Nebulised Salbutamol
Oral prednisolone or IV hydrocortisone
Nebulised ipratropium bromide
IV aminophylline/theophylline
What are the clinical features of congestive heart failure?
Leg swelling/pitting oedema
Bibasal crackles on auscultation of lungs
Dry cough
Dyspnoea
What are common side effects of aspirin?
Dyspepsia (NSAID)
Haemorrhage
Why can’t NSAIDs and ACE inhibitors be co-prescribed?
NSAIDs affect the afferent arteriole
ACEi affect the efferent arteriole
Both together increases the risk of AKI
How does aspirin work as an anti-pyretic?
Inhibition of hypothalamic COX-2
Which abx can you use in penicillin allergy?
Clarithromycin
Define allergy
A type 1 hypersensitivity reaction that is IgE mediated
What inheritance does Huntington’s follow?
Autosomal dominant
What are some features of Huntington’s?
Dystonia
loss of coordination
cognitive decline
chorea
What makes up Cushing’s triad?
Hypertension
Bradycardia
Irregular breathing
What is secondary ammenorhoea and give some causes?
Absent periods for at least 6 months in a woman that has had regular periods.
Pregnancy
Menopause
PCOS (associated with hirsutism)
Thyroid disease
Stress
Weight loss
High prolactin
What is the likely diagnosis with fishy discharge?
Bacterial vaginosis
[Gardnerella vaginalis]
Treated with Metronidazole
