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Science to Clinical Practice 1 > Inflammation > Flashcards

Inflammation Flashcards

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1
Q

What is viral load in HIV?

A

Number of viral RNA genomes /ml blood

Determined by RT-PCR - reverse transcription-linked polymerase chain reaction

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2
Q

How can you diagnose HIV?

A

Presence anti-p24 (Capsid) antibodies via ELISA
Only detects individual seroconverted, 3 months after infection
Positive samples re tested mit diff ELISA/Western Blot

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3
Q

What test can detect HIV before the individual has seroconverted?

A

RT-PCR

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4
Q

What is the common treatment for HIV?

A

Highly Active Anti-Retroviral Therapy (HAART)
2 x Nucleoside Reverse Transcriptase Inhibitor (NRTI)
PLUS
1 x Non Nucleoside Reverse Transcriptase Inhibitor (NNRTI)
OR
1 x Protease Inhibitor

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5
Q

What joints are affected first in osteoarthritis?

A

Weight-bearing joints e.g. knees and hips

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6
Q

What defines a retrovirus?

A

Reverse transcription, copying RNA template (viral genome) ==> double-stranded DNA copy
Integration: covalent insertion of viral cDNA into genome of infected cell, forms provirus

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7
Q

What 3 types of polyproteins do retroviruses synthesise?

A

Gag: group specific antigen
Pol: polymerase
Env: envelope glycoprotein

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8
Q

What are some examples of the polyproteins retroviruses synthesise?

A

Gag: viral core proteins, MA (matrix), CA (capsid), NC (nucleocapsid)
Pol: PR (protease), RT (reverse transcriptase), IN (integrase)
Env: SU (surface), TM (transmembrane)

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9
Q

What are the 2 ways a retrovirus can enter a cell?

A

Receptor mediated endocytosis

Direct fusion of lipid bilayers (e.g. HIV)

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10
Q

How long does retrovirus life cycle take under permissive conditions?

A

24 hours

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11
Q

What is the negative effect of HIV reverse transcriptase having no proofreading activity?

A

Contributes to immune escape + drug resistance

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12
Q

What are some example of drugs to treat HIV that are entry inhibitors?

A

CCR5 inhibitor

Fusion inhibitor

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13
Q

What are the 2 classes of reverse transcriptase inhibitors for treatment of HIV?

A

Nucleoside-analogue reverse transcriptase inhibitors (NRTI) - incorporate ==> elongating DNA chain, X 3’OH leads to chain termination
Non-nucleotide Reverse transcriptase inhibitors (NNRTI). Allosteric RT inhibitors, X bind active site
Block initiation of RT

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14
Q

What drug affects integrase in the treatment of HIV?

A

Raltegravir, binds active site of Integrase, blocks strand transfer reaction

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15
Q

How do protease inhibitors work to treat HIV?

A

Inhibit HIV protease specifically, prevent cleavage of Gag + Gag-Pol to mature proteins
New virus particle non-infectious

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16
Q

What genetic predispositions can an individual have to get rheumatoid arthritis?

A

Human Leukocyte Antigen - HLA-DR1 + HLA-DR4

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17
Q

What is citrullination? How is it a part of rheumatoid arthritis?

A

Type II collagen + Vimentin modified
Arginine ==> Citrulline
Susceptibility genes (HLAs) mean immune system no longer recognises proteins as self and attacks

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18
Q

What is Charcot’s triad? What condition does it represent?

A

Jaundice, pain in URQ, rigors

Ascending cholangitis

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19
Q

What is Courvoisier’s law in regards to jaundice?

A

In presence of jaundice, if gall bladder palpable and non tender, jaundice unlikely due to stones
consider malignancy - pancreatic/gallbladder cancer

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20
Q

What illnesses are common in these countries?

a) Africa
b) Asia
c) SE Asia

A

a) Malaria
b) Typhoid
c) Dengue virus

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21
Q

What are key parts of the patients travel history should you keep in mind?

A

When travelled - incubation periods (time from exposure to symptoms)
What they did - business/posh hotels less risk compared to backpacking

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22
Q

What are the features of severe falciparum malaria?

A 
confusion/fits
acute renal failure
respiratory failure
hypoglycaemia
acidosis
hyperparasitaemia
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23
Q

What would you use to treat falciparum malaria?

A

IV artesunate (or quinine if artesunate x available)

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24
Q

How would you treat viral pharyngitis?

A

Symptomatic management e.g. analgesia

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25
How would you treat pneumocystis jirovecii (PCP)?
Co-trimoxazole Corticosteroids (prednisolone) Oxygen therapy
26
Definition of healthcare associated infection?
Occurring cos of healthcare activity, not incubating at time of initial healthcare exposure Cut off usually 48-72 hours
27
What different shapes can bacteria be identified by?
Coccus - round Bacillus - rod shaped Coccobacilli - oval shaped
28
What colour are these types of bacteria when stained? a) Gram +ve b) Gram -ve
a) Purple-blue | b) Red
29
What type of toxins do these bacteria produce? a) Gram +ve b) Gram -ve
a) Exotoxins, have teichoic acid in cell wall | b) Endotoxins in cell wall
30
What type of bacteria survives well on drying?
Gram +ve
31
What type of bacteria produces spores?
Gram +ve - some of them, not all
32
``` What are the class one antibiotics? What are the class 2 antibiotics? ```
Beta lactams, Aminoglycosides, Macrolides | Tetracyclines, Fluoroquinolones, Glycopeptides
33
What is the common gram positive cocci in clusters?
Staphylococcus aureus
34
What organism is the most common cause of septic arthritis?
Staphylococcus aureus
35
What is the common gram positive cocci in pairs and chains?
Streptococci
36
What are the two common gram -ve cocci?
Neisseria meningitidis | Neisseria gonorrhoeae
37
What is the eclipse phase in viral infections?
Period from virus entry until new infectious virons released
38
Definition of prodrome in viral infections
Non-specific symptoms appearing before more specific features (usually rash)
39
Definition of Reproductive Number (R0) in viral infections
Average no of secondary cases arising from a single index case in a totally susceptible population
40
When would you use an oral glucose tolerance test?
During pregnancy for gestational diabetes | Diabetes hasn't been around long enough to affect Hb1aC
41
What are some microvascular complications of diabetes?
Retinopathy Nephropathy Neuropathy
42
What are some macrovascular complications of diabetes?
Cerebro-vascular disease Ischaemic heart disease Peripheral Vascular Diabetic foot
43
What type of diabetes is ketosis prone?
Type 1
44
How is diabetes diagnosed?
Symptoms of hyperglycaemia ↑ blood glc conc/HbA1c Venous plasma glucose ≥ 11.1 mmol/l HbA1c ≥ 48 mmol/mol
45
How is diabetes diagnosed in asymptomatic patients?
On 2 separate occasions any of: HbA1c ≥ 48 mmol/mol (≥6.5%) Fasting venous plasma glucose ≥7 mmol/l Random or 2h post 75 g glucose load ≥11.1 mmol/l
46
How is prediabetes diagnosed?
HbA1c 43 – 47 mmol/mol (6.1-6.4%) | fasting venous plasma glc - 6.1 - 6.9 mmol/l
47
Why would you not use a glucometer (capillary) to diagnose diabetes?
Venous plasma more accurate | Need to make sure of diagnosis
48
What ketones produced lead to metabolic acidosis on DKA?
acetoacetate 3 hydroxy-butyrate Organic acids
49
Why are potassium levels affected in DKA?
Insulin causes K+ to move into cells Without it, high extracellular K+, hyperkalaemia Renal K+ loss, whole body K+ depletion
50
What antibody complexes are formed in RA?
IgG and IgM
51
Difference between osteoclast and osteoblast?
Osteoclast - breakdown of bone | Osteoblast - formation of bone
52
What do the pro-inflammatory mediators in RA do?
Promote tissue remodelling + damage | Stimulate macrophages, fibroblasts, osteoclasts, neutrophils
53
What genetic predisposition can make you more susceptible to develop RA?
HLA-DR1 HLA-DR4 QKRAA
54
What would you see on imaging in osteoarthritis (mnemonic)?
L - loss of joint space O - osteophytes S - subchondral sclerosis S - subchondral cysts
55
What would you see on imaging in RA (mnemonic)?
L - loss of joint space E - erosions S - soft bone (osteopenia) S - soft tissue swelling
56
What condition does smoking actually reduce the risk of?
Ulcerative colitis
57
What are the different classifications of ulcerative colitis depending on what parts of the colon are affected?
Proctitis - only rectum Left-sided colitis - rectum + descending colon Pancolitis - all of colon
58
What antigens are the primary target of the immune system on a transplanted organ?
HLA antigens
59
What type of organ donors are there?
Donation after brain death Donation after circulatory death Living donor Expanded Criteria (EC) donor
60
When can anti-HLA antibodies develop?
After exposure to blood products, pregnancies, prior transplants
61
Where are the different classes of HLA antigens presented?
Class I - all nucleated cells | Class II - on APC (B cell, monocytes, dendritic cells), activated endothelial cells
62
What are the 3 types of HLA antibodies?
A, B, DR
63
When may a patient have pre-formed anti-HLA antibodies?
Pregnancy, Blood transfusions, Previous transplant
64
What 4 key principles aid in donor-recipient matching in kidney transplantations?
ABO compatibility Best HLA match (DR>B>A) No pre-formed anti-donor HLA antibodies Minimise cold ischaemia time
65
When may A2 kidney donors be transplanted into O or B recipients?
If anti-A antibody titres are low (<1:8)
66
What test result is an absolute contraindication for renal transplantation?
Positive CDC T-cell crossmatch
67
When is risk of acute rejection and graft loss highest during kidney transplantation?
1st 3 months
68
How do NSAIDs increase the risk of peptic ulcers?
Inhibit COX-1, reducing prostaglandin production - cytoprotective
69
How does the Helicobacter pylori bacteria cause peptic ulcers?
Burrow into mucosa, allowing acid to reach other layers
70
Why may amylase levels be normal if taken 24-48 hours later in a patient with pancreatitis?
Excreted by kidneys
71
What obstructions can cause appendicitis?
``` Inflamm of vermiform appendix Faecolith Stool Infective agents Lymphoid hyperplasia ```
72
What is the common bacteria in appendicitis?
Bacteroides fragilis + E coli
73
What type of T helper response is prominent in: a) U.C? b) Crohn's?
a) Th2 | b) Th1
74
What does a stool MC&S test in U.C and Crohn's exclude?
Campylobacter, C.diff, Salmonella, Shigella, E.Coli, Amoeba
75
What are the 3 features of renal bone disease/CKD -MBD?
Osteomalacia - softening of bones Osteoporosis - brittle bones Osteosclerosis - hardening of bones
76
What is the most common cause of nephrotic syndrome in: a) Children? b) Adults?
a) Minimal Change disease | b) Focal Segmental glomerulosclerosis
77
What is the most common cause of primary glomerulonephritis?
IgA nephropathy AKA Berger's disease
78
What is an: a) Uncomplicated UTI? b) Complicated UTI?
a) Female, first presentation, not pregnant, immunocompetent | b) male, recurrent UTIs, elderly, catheter related, children, pyelonephritis
79
What is pyuria?
Presence of WBC in urine, >10 per HPF x400
80
What part of the urinary tract is involved in: a) Upper UTIs? b) Lower UTIs?
a) Kidneys and ureters | b) Bladder, Urethra, Prostate (male)
81
What are some examples of: a) Upper UTIs? b) Lower UTIs?
a) Pyelonephritis, Intrarenal/perinephric abscess | b) Cystitis, Urethritis, Prostatitis
82
What bacteria is the most common cause of UTIs? | Acronym for most common ones?
E. Coli | SEEEK PP - Saprophyticus, E.Coli, Enterococcus. Enterobacter, Klebsiella, Proteus, Pseudomonas
83
What is an ascending infection in UTIs?
Bact move from rectal area → urethra → bladder → kidney
84
What is a descending infection in UTIs?
Bact starts in blood/lymph → kidney → bladder → urethra
85
Why is antibiotic Nitrofurantoin avoided in 3rd trimester of pregnancy in treatment of UTIs?
Linked with haemolytic anemia in new-born
86
What arteries and veins are used to make a arteriovenous fistula?
Radiocephalic, Brachiocephalic, Brachiobasilic
87
What enzyme converts unconjugated bilirubin to conjugated bilirubin?
Glucuronyl transferase enzyme
88
Definition of: a) Jaundice b) Icterus
a) yellow discoloration of skin, mucous membranes and sclera due to hyperbilirubinemia b) specific yellow discolouration of sclera due to hyperbilirubinemia, usu visible before jaundice develops elsewhere
89
Why would you get gynaecomastia in alcoholic liver disease?
Liver breaks down oestrogen, so when it's ill, cannot break down
90
What is the difference between compensated and decompensated liver cirrhosis?
Compensated - liver is coping, no symptoms | Decompensated - liver x cope, symptoms
91
What can be given to help patients with diabetes insipidous?
Desmopressin - synthetic ADH
92
What 2 things increase calcium levels in body?
``` PTH Vit D (Calcitonin) ```
93
What is the role of PTH?
Increase: osteoclast activity in bones (reabsorbing Ca from bones) Ca absorption from the gut Ca absorption from the kidneys (LoH + distal tubules) Vit D activity - turn to active form
94
What is primary hyperparathyroidism? | How treat?
Tumor (adenoma commonly) in parathyroid gland Hypercalcaemia, low phosphate, Surgically remove tumour
95
What is secondary hyperparathyroidism? | How treat?
Low Vit D intake/chronic renal failure, low Ca resorbed (hypocalcaemia) so high levels PTH Correct Vit D insufficiency/renal transplant
96
What is tertiary hyperparathyroidism? | How treat?
After prolonged secondary hyperparathyroidism, hyperplasia of glands When secondary treated. PTH still high so hypercalcaemia Surgically remove PT gland so PTH normal
97
What is primary hypoparathyroidism? | How treat?
decreased PTH gland failure/parathyroid surgery low Ca, high phosphate Ca supplement (alfacalcidol)

Science to Clinical Practice 1 (5 decks)

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