Goodnotes Flashcards

1
Q

What are the 4 stages of pain?

A

Nociception
Transmission
Perception
Modulation

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2
Q

Which 2 conditions make up COPD?

A

Emphysema and Chronic Bronchtis

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3
Q

What happens to troponin levels in unstable angina?

A

Nothing they stay the same

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4
Q

What happens to troponin levels during an NSTEMI?

A

They rise due to damage to the myocardial cells

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5
Q

What happens to troponin levels during a STEMI?

A

They rise due to damage to the myocardial cells

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6
Q

What is pathophysiology?

A

The study of how disease processes affect the functioning of the body

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7
Q

What does the term ‘acute’ mean?

A

A sudden onset of illness

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8
Q

There are 3 types of cellular communication, What are they?

A

Nerve
Endocrine
Local

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9
Q

Describe the process of nerve signalling

A

Used exclusively by neurons
Uses neurotransmitters to send chemical signals through synapse to another neurone
It is fast and can travel long distances
Has specific routes of movement

Eg Parkinson’s disease

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10
Q

Describe the process of endocrine signalling

A

Sends chemicals called hormones into the blood stream
Received by a receptor cell to stimulate an action
Slow acting and diffuse around entire body

Eg Diabetes

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11
Q

Describe the process of local signalling

A

Occurs between cells that are close together
Cells will signal damage to other cells as part of body response to damage - inflammatory mediators

Eg Sprained ankle

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12
Q

Which cell change is described here? ‘Decrease in cell size, organ size may change if sufficient changes occur’

A

Atrophy

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13
Q

Describe atrophy

A

Decrease in cell size
Organ size may change if enough cells are affected

Eg Skeletal muscle atrophy in the elderly

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14
Q

What type of cell change is being described here? ‘Increase in cell size and volume, organ size may change if sufficient changes occur’

A

Hypertrophy

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15
Q

Describe hypertrophy

A

Increase in cell size and volume may cause enlargement of organ if sufficient changes occur

Eg Pyloric stenosis - increased muscle growth due to weight training

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16
Q

What cell changes are being described here? ‘Increase in number of cells. Occurs due to increased cell mitosis’

A

Hyperplasia

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17
Q

Describe hyperplasia

A

Increase in the number of cells occurs due to increased cell mitosis either for tissue or organ generation, compensatory reason or hormonal stimulation. Abnormal hyperplasia is an abnormal increase eg endometriosis

Eg Benign prostatic hyperplasia

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18
Q

What cell change is being described here? ‘A specific type of cell is replaced with another type that is less specific than the first’

A

Metaplasia

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19
Q

Describe metaplasia

A

This is where a cell of a specific type is replaced by another less specific cell. Commonly seen in smoking. Can turn dysplasia which can eventually turn into carcinoma.

Eg Barrats oesophagus

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20
Q

What cell change is being described? ‘Abnormal changes and variations in shape, size and organisation of cells’

A

Dysplasia

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21
Q

Describe dysplasia

A

Abnormal changes and variations in the shape, size and organisation of cells, can potentially turn to carcinoma

Eg Cervical dysplasia

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22
Q

What are the 2 types of cellular death?

A

Apoptosis and necrosis

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23
Q

What is being described here - ‘this is programmed cell death and is planned’

A

Apoptosis

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24
Q

What is being described here? ‘Unplanned or accidental cell death due to injury or damage to the cell’

A

Necrosis

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25
Q

Describe the process of necrosis ‘accidental cell death’

A

Happens due to injury, toxins, infections and trauma
May initially be reversible as part of the inflammatory process
Cell contents start to swell
Cell membrane becomes deform and loses integrity/ruptures
Cell contents and organ else leak out
Leakage stimulates inflammatory and immune responses when phagocytosed

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26
Q

Describe the process of apoptosis ‘programmed cell death’

A

Cell dies at the end of its life
Cell does not become damaged or rupture
Cell membrane forms blebs which contain cell contents and organelles
Blebs are removed by inflammatory cells such as macrophages.

Cell can be coerced into its own death by the immune system

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27
Q

Which of the following is NOT a common cause of Type 1 respiratory failure?
COPD
PULMONARY EMBOLISM
MUSCLE DISORDERS
ASTHMA

A

MUSCLE DISORDERS

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28
Q

Asthma is a chronic disorder of the airways that causes?

A

Episodes of airway obstruction, bronchial hyper responsiveness, airway inflammation

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29
Q

Bronchiolitis normally occurs in which age group?

A

Under 2 years

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30
Q

What are congenital heart defects?

A

Defects occurring during foetal development

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31
Q

Which of the following is NOT a cardiac arrest rhythm?
SUPERVENTRICULAR TACHYCARDIA
VENTRICULAR FIBRILLATION
ASYSTOLE
PULSELESSNESS VENTRICULAR TACHYCARDIA

A

SUPERVENTRICULAR TACHYCARDIA

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32
Q

Name 4 potential causes of atherosclerosis

A

From childhood
Hypercholesterolemia
Smoking
Hypertension
Diabetes

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33
Q

What interventions can be used in ischaemic heart disease?

A

Lifestyle modifications
Control of hypertension
Control high cholesterol
Thrombosis development control
Glycaemic control
Symptom management

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34
Q

Describe some interventions used to treat acute coronary syndromes

A

Analgesia, GTN, opiates
Aspirin
Oxygen
Continuous monitoring - ECG
Cardiac monitor - NEWS2
Troponin T levels
CABG or PCI

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35
Q

Describe the physiology of emphysema

A

Destruction of the alveoli
Loss of surface area which reduces gas exchange
Loss of muscular surface prevents movement of air in alveoli
Causes inflammatory and immune responses causing alveolar walls to break down.

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36
Q

Describe the pathophysiology of chronic bronchitis

A

Damage to bronchus and bronchioles
Cellular damage - inflammation
Exudate
Bronchoconstriction
Bronchospasm
Hypertrophy of goblet cells

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37
Q

Explain how the body responds to hypotension to increase blood pressure

A

Renin released from kidneys in response to low perfusion in the glomerulus.
Renin diffuses into the bloodstream and converts angiotensinogen from the liver into angiotensin 1.
Angiotensin converting enzyme is released from the lungs.
ACE converts angiotensin 1 to angiotensin 2.
Angiotensin 2 causes vasoconstriction.

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38
Q

Suggest possible causes with examples for an acute kidney injury

A

Pre-renal: lack of or reduced perfusion, failure of auto regulation, perfusion needed to maintain glomerular filtration

Intra-renal: damage to kidney tissue, may be referred to by location, nephrotoxicity

Post-renal: obstruction below the kidney/lower urinary tract, full or partial blockage, likely to cause reduction in urine output, increase pressure prevents glomerular filtration

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39
Q

Name some causes of pre-renal AKI

A

Trauma
Post operative bleeding
Hypotension
Dehydration
Medication
D&V
Burns
Cardiac failure
Sepsis

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40
Q

Name some causes of intra-renal AKI

A

Ischaemia
Nephrotoxic injury
Immunity
Vascular disease

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41
Q

Name some causes of post-renal AKI

A

Tumour
Kidney stones
Urtheral blood clot
Enlarged prostate
Retention
Blocked catheter

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42
Q

What does renin convert angiosinogen into?

A

Angiotensin I

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43
Q

Where is angiotensin converting enzyme produced?

A

In the lungs

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44
Q

Which blood test is used to assess the functioning of the kidney?

A

Estimated Glomerular Filtration Rate (eGFR)

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45
Q

Will all patients with an acute kidney injury have a drop in urine output? YES or NO

A

NO

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46
Q

Which test is used to aid the diagnosis of COPD?

A

Spirometry

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47
Q

At which point does bronchiolitis peak in its symptoms?

A

3-5 days

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48
Q

The most common cause of bronchiolitis is?

A

Respiratory syncytial virus

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49
Q

Asthma is regarded as an allergic inflammatory response. Which type of inflammatory mediator cell releases histamine in asthma?

A

Mast cells

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50
Q

What immunoglobulin attaches to mast cells causing them to release histamine which produces the symptoms of asthma?

A

IgE

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51
Q

Which of the following assessment findings demonstrate severe asthma?
A) Increased respiratory rate
B) Normal oxygen saturation
C) Silent chest on auscultation
D) Wheeze

A

C) Silent chest on auscultation

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52
Q

What is the initial management for an AKI?

A

Monitor patient
Maintain circulation
Minimise further kidney insults
Manage acute illness

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53
Q

Define Chronic Kidney Injury

A

Irreversible, long term condition
Characterised by decline in kidney function over many years
Failure of homeostasis as disease progresses
Increased risk of other conditions such as CVD
Major cause of morbidity and mortality

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54
Q

What are the symptoms of chronic kidney disease?

A

Normally asymptomatic until late stages
Then: swollen ankles, hands or feet
Shortness of breath
Fatigue
Blood in urine
Urinary frequency
Insomnia
Itchy skin, muscle cramps, headache
Erectile dysfunction

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55
Q

Which of the following is a non-pharmacological treatment of depression?
A) Supporting the person to get over it
B) Monoamine oxidase inhibitors
C) Cognitive behavioural therapy
D) SSRIs

A

C) Cognitive behavioural therapy

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56
Q

Which neurotransmitter might be involved in an inflammatory response model of depression?

A

Cytokines reducing levels of serotonin

57
Q

Which model of depression is explained using the ‘stress bucket’?

A

Stress vulnerability model

58
Q

Which theory of depression links stress and the release of cortisol as the pathophysiological stimulus for depression?

A

Neuroendocrine dysregulation

59
Q

Name and describe risk factors for depression

A

Gender - women are twice as likely to experience depression
Adverse childhood experience - physical/sexual abuse, parental divorce
Personality type - neuroticism, lowered ability to deal with stressful events, major life changes
Health/medication - diabetes, thyroid disorders

60
Q

Where is the vomiting centre located in the brain?

A

Medulla oblongata

61
Q

Describe the process of vomiting

A
  1. Noxious stimuli to the vomiting centre
  2. Vomiting centre coordinates reflex through cranial nerves
  3. Hypersalivation, pallor, sweat, tachycardia
  4. Glottis closes; soft palate rises to close of airway
  5. Deep inspiration, diaphragm contracts
  6. Gastroesophageal sprinter and fundus of stomach relax
  7. Abdominal muscles contract forcefully
62
Q

Name some receptors of the CTZ (Chemoceptor trigger zone) that stimulate nausea and vomiting

A

Opioid Mu2
Histamine
Acetylcholine
Dopamine type 2
Substance P
Serotonin type 3

63
Q

Name some possible causes of nausea and vomiting in newborns and infants

A

Overfeeding
Gastroesophageal reflux
Pyloric stenosis
Whooping cough
Small bowel obstruction
Constipation
Systemic infection

64
Q

Name some causes of nausea and vomiting in older children and adolescents

A

Gastroenteritis
Migraine
Raised intercranial pressure
Toxic ingestion of medication
Pregnancy
Stress

65
Q

Name some causes of nausea and vomiting from across the lifespan

A

Sensory input
Haemorrhage
Meningitis
Motion sickness
Opioids
Electrolyte imbalance
Toxins
Chemotherapy
Antibiotics
Obstruction, constipation

66
Q

What are the 4 stages of vomiting?

A
  1. Noxious stimuli
  2. Vomiting centre initiates
  3. Nervous system pathways
  4. Pre ejection, ejection
67
Q

What are the consequences of prolonged nausea and vomiting?

A

Dehydration
Avoidance of treatment associate with symptoms
Electrolyte disturbance
Malnutrition
Tissue damage
Metabolic alkalosis
Transmission of infection

68
Q

Define ‘constipation’

A

Bowel movements that are infrequent, hard to pass, often associated with being hard and dry

69
Q

Define ‘diarrhoea’

A

3 or more loose or liquid stools per day. Or more frequently than is normal for the individual

70
Q

What are the 3 types of diarrhoea?

A

Osmotic
Motility
Secretory

71
Q

Describe osmotic diarrhoea

A

Hyper-osmotic, non-absorbable substances and excess water are drawn into the bowel which increases weight and volume of the stool.

Causes: decreased transit time, excessive use of antacids, overuse of osmotic laxatives, lactose intolerance

72
Q

Describe secretory diarrhoea

A

Increased mucosal secretions of fluid and electrolytes.

Causes: infection, excess bile, inflammation of the colon, overgrowth of micro biome

73
Q

Describe motility diarrhoea

A

Decreased transit time, fluid absorption in the bowel is decreased.

Causes: short bowel, fistula formation, IBS, overuse of laxatives

74
Q

Describe normal transit constipation

A

Known as functional constipation, involves regular passing of stools but evacuation is difficult

Associated with sedentary lifestyle, low fibre diet and low fluid intake

74
Q

Name the 3 types of constipation

A

Normal transit constipation
Slow transit constipation
Pelvic floor dysfunction

75
Q

Describe slow transit constipation

A

Infrequent bowel movement, straining to pass stool and mild abdominal distension by impaired colon activity

76
Q

Describe pelvic floor dysfunction (constipation)

A

Poor action of the pelvic floor muscles or anal sphincter leading to difficulty or inability to defaecate

77
Q

What are the hall marks of cancer?

A

Unlimited proliferation
Evading growth suppressors
Resistance to cell death
Replication immortality
Angiogenesis
Invasion and metastasis

78
Q

What is a neoplasm?

A

A new growth of cells which is abnormal
Abnormal mass of tissues
Defined as excessive, uncoordinated and persistent

79
Q

Cell death to myocardial cells following a myocardial infarction is an example of what?

A

Necrosis

80
Q

Endocrine signalling involves the release of what?

A

Hormones

81
Q

An increase in the severity of a pre existing disease is known as?

A

Exacerbation

82
Q

What is the difference between ENDEMIC, EPIDEMIC and PANDEMIC?

A

ENDEMIC - disease constantly present in population or region, low spread
EPIDEMIC - sudden increase in cases spreading through large population
PANDEMIC - sudden increase in cases across several countries, continents or the world

83
Q

The process in which a cell ingests a solid particle to form an internal vesicle is called?

A

Phagocytosis

84
Q

Explain the term ‘acute on chronic’ and give an example

A

A sudden, severe and rapid deterioration of a pre existing, long term medical problem E.g Exacerbation of COPD with pneumonia

85
Q

In the inflammatory process, which type of cell signalling is used by inflammatory mediators?

A

Local signalling

86
Q

What can b cells do when they encounter a foreign antigen?

A

B cells clone and become plasma cells. Plasma cells release antibodies as an early attempt to neutralise the foreign antigen

87
Q

What are the 3 ways that antibodies work to neutralise and destroy pathogens and toxins?

A

NEUTRALISATION - coat pathogen and prevent it from interacting with the host cell surface
OPSONISATION - coat pathogen to attract and encourage phagocytic cells
COMPLIMENT FIXATON - coat pathogen to activate blood proteins to kill the pathogen

88
Q

What 2 processes occur in the vascular response to inflammation?

A

Vasodilation and increased vascular permeability

89
Q

What is one of the processes that neutrophils perform in the inflammatory response?

A

Phagocytosis

90
Q

Which circulating inflammatory mediators cause vasodilation in sepsis?

A

Histamine, nitric oxide and bradykinin

91
Q

What would a drop in urine output indicate in sepsis?

A

Renal blood flow is related to cardiac output. As cardiac output falls, due to reduces SVR and hypotension so does renal blood flow and therefore so does urine output.

92
Q

Which of the following is not a barrier in innate immune response?
A) Mucous membrane
B) Stomach acid
C) Nasal hair
D) Macrophages

A

D) Macrophages

93
Q

What blood test is used to specifically monitor the presence of inflammation?

A

C reactive protein

94
Q

What are the cardinal signs of inflammation?

A

Pain
Swelling
Redness
Heat
Loss of function

95
Q

Explain the 4 events of respiration

A

Pulmonary ventilation - moving air in and out of the lungs
External respiration - gas exchange between pulmonary blood and alveoli
Gas transport of o2 and Co2 via blood stream
Internal respiration - gas exchange between blood and tissue cells

96
Q

Which chemoreceptors detect decreased oxygen levels in the arterial blood and where are they located?

A

Peripheral chemoreceptors
Found in arch of aorta and carotid bodies

97
Q

Name the 3 physiological characteristics of asthma

A

Airflow limitation - reversible with treatment
Airway hyper responsiveness
Chronic inflammation of the bronchi

98
Q

Chronic inflammation in asthma is characterised by the presence of which white blood cell?

A

Eosinophils - release harmful proteins and reactive oxygen species which damage the lining of the airway causing remodelling

99
Q

In atopic asthma IgE antibodies bind to which cells in the lining of the airways?

A

Mast Cells

100
Q

Why do blood carbon dioxide levels rise in obstructive airway disease?

A

Reduced airflow through obstructed airway leads to reduced volume of air reaching the alveoli causing accumulation of Co2 in the distal airways and alveoli, and reduction of the pressure gradient between air in the alveoli and in the bloodstream. As pressure gradient reduces, diffusion also reduces and less Co2 passes into bloodstream for excretion.

101
Q

Increased stimulation of sympathetic fibres to the airways causes?

A

Bronchodilation (to allow more airflow through the lungs)

102
Q

Describe type 1 respiratory failure

A

Hypoxaemic respiratory failure. It is the failure of gas exchange function of lung leading to hypoxaemia with normal or low c2 levels

103
Q

Describe type 2 respiratory failure

A

Hypercapnic/hypoxaemic respiratory failure
Failure of ventilation

104
Q

Which 3 variables affect stroke volume?

A

Pre load
Contractility
After load

105
Q

Which one is a non-modifiable risk factor for cardiovascular disease?
A) Diabetes
B) Hypertension
C) Genetic factors
D) Hypercholesterolemia

A

C) Genetic factors

106
Q

Atherosclerosis is a chronic inflammatory response due to damage to the endothelium base layer caused by exposure to certain sources, name 3 of them?

A

Toxins from smoking
Low density lipoproteins
LDL
Hyperglycaemia in diabetes
Shear stress from hypertension

107
Q

In atherosclerosis LDL particles activate the inflammatory response. Which white blood cells engulf LDLs and what are they called afterwards?

A

Macrophages
Foam cells

108
Q

In which congenital heart defect does blood pass from the left to the right side of the heart causing o2 rich blood to be pumped back to the lungs instead of the body?

A

Ventricular septal defect - hole in the heart.
Defect occurs in the septum that separates the ventricles and allows blood to pass from the left side back to the right.

109
Q

What condition is the leading cause of acquired heart disease in children?

A

Kawasaki disease

110
Q

What are the signs and symptoms of ISCHAEMIC heart disease?

A

Fatigue
Dyspnoea
Chest pain on exercise - stable angina
ECG changes only present during exercise or with pain

111
Q

Acute coronary syndrome encompasses a spectrum of conditions which result from the formation of a thrombus on an atherosclerotic plaque in a coronary artery. What are these conditions?

A

NSTEMI - myocardial infarction without ST elevation
STEMI - ST elevation myocardial infarction
UNSTABLE ANGINA

112
Q

Which of the following is NOT a cardiac arrest rhythm?
A) Ventricular fibrillation
B) Superventricular tachycardia
C) Asystole
D) Pulseless ventricular tachycardia

A

B) Superventricular tachycardia

113
Q

Hypertension of no known cause is known as?

A

Essential hypertension

114
Q

Discuss the immediate management required for caring for an adult or child experiencing a seizure (4)

A

Remove danger if safe to do so
Protect airway as best as possible - put person on side and support in this position
Time the seizure
Provide head protection and limbs if possible
Commence high flow o2

115
Q

Describe 2 possible psychosocial implications of seizures

A

Feelings of isolation
Loss of self esteem
Psychological distress
Embarrassment
Depression and anxiety

116
Q

How many episodes of loose stool are required in one day to meet the definition of diarrhoea?

A

3 episodes

117
Q

What are the key differences between anorexia and anorexia nervosa?

A

Anorexia - physiological stimulus that produce hunger remain intact but there is lack of desire to eat due to stress, drugs, other diseases

Anorexia nervosa - low body weight accompanied by persistent pattern of behaviour to prevent the restoration of normal weight

118
Q

When introducing nutrition after a period of starvation, which 3 electrolytes should be closely monitored?

A

Magnesium
Phosphate
Potassium

119
Q

Cancer is a disease of dividing cells. Describe what type of cancer is sarcoma?

A

Sarcoma is a cancer arising from cells found in supporting tissues: bones, cartilage, fat, muscle and connective tissues

120
Q

If cancer cells were described as poorly differentiated how would these look compared to well-differentiated cells?

A

Cancer looks very abnormal and not arranged in a normal way
More spaces between cells
Irregular and not similar structure or shape to original cell
More likely to invade surrounding tissue

121
Q

In the hallmarks of cancer explain what happens to the cell that results in replicative immortality

A

Protective ends of DNA (telomeres) shorten after each round of DNA replication. In cancer mutations the telomeres do not shorten or there is constant lengthening which results in immortality of the cancer cells.

122
Q

List the six hallmarks of cancer

A

Evading growth suppressors
Inducing angiogenesis
Unlimited proliferation
Evading cell death
Invasion and metastasis
Replicative immortality

123
Q

Name the 2 types of nociceptors

A

A delta and C fibres

124
Q

Which 2 excitatory neurotransmitters are used in transmission across the dorsal horn?

A

Substance p and glutamate

125
Q

What do we call the conversion of noxious stimuli into nerve impulses?

A

Nociception

126
Q

Which part of the neuron is damaged by hyperglycaemia leading to diabetic neuropathy?

A

The Schwann cells

127
Q

Hba1c is a measurement of what and what is the normal range?

A

The amount of glycated haemoglobin and gives an overall picture of blood glucose levels over a period of 3 months.

Normal is below 42mmol/mol or 6%

128
Q

Hyperosmolar hyperglycaemic state (HHS) - why will there not be any serum ketones?

A

HHS is associated with type 2 diabetes where there is still beta cell function. Therefore some insulin still being secreted to prevent lipolysis and ketogenesis.

129
Q

In DKA, what is present in the urine?

A

Glucose and ketones

130
Q

Glomerular nephritis can be the cause of what type of acute kidney injury?

A

Intrinsic or intrarenal

131
Q

Angiotensin II causes vasoconstriction and also the release of aldosterone from the adrenal glands; how does aldosterone work to increase blood pressure?

A

Aldosterone acts on distal tubule and collecting duct.
It stimulates the reabsorption of sodium and promotes secretion of potassium.
The increase in sodium increases the volume of plasma and therefore blood pressure.

132
Q

In type 1 diabetes which cells in the pancreas stop producing the hormone insulin?

A

Beta cells

133
Q

Which excitatory neurotransmitter is linked to increased neuron activity and seizures?

A

Glutamate

134
Q

Describe the 2 stages of a tonic clonic seizure

A

Tonic stage - muscles become ridges and contracted
Clonic stage - rhythmic relaxation and contraction which looks like “classic” whole body seizure convulsions

135
Q

What’s the difference between a generalised and focal seizure and give an example of each one

A

Generalised - abnormal electrical activity in both brain hemisphere (tonic-clonic, myoclonic, atonic)

Focal - abnormal electrical activity in one area of the brain. Motor, sensory, autonomic depends on which are of the brain is affected. They can be simple (remain conscious) or complex (loss of consciousness)

136
Q

Febrile seizures are multi factorial but which inflammatory mediators is thought to have a causality effect?

A

Cytokines and interleukin

137
Q

In the monoamine theory of depression, which neurotransmitters are thought to be reduced?

A

Noradrenaline, dopamine and serotonin

138
Q

In the neuroendocrine dysregulation theory of depression, which hormone is found to be elevated?

A

Cortisol