Introduction to clinical medicine Flashcards
To recap on topics covered in the first module
1
Q
Define Autopsy
A
examination of a corpse to identify cause of death
2
Q
Name 2 types of autopsies
A
Hospital and Medico-Legal (such as Coronial and Forensic autopsies)
3
Q
which type of autopsy is most common
A
Medico-Legal (> 90%)
4
Q
what is a coronoer
A
Orders examination of a corpse in the case of a legal event (sudden death/crime)
5
Q
What types of deaths are referred to a coroner
A
- Presumed natural (cause unknown)
- Presumed unnatural (accident, killing)
- Presumed iatrogenic (during treatment or examination)
6
Q
what are the 4 things a coroner is looking for
A
who was deceased when did they die where did they die how did they come about their death (they are not looking for any other present illnesses!)
7
Q
what are the stages of an autopsy
A
History/Scene External examination Evisceration Internal examination Reconstruction
8
Q
what is external examination
A
SURFACE OF THE BODY
identification of the corpse (who)
disease or treatment (why)
injuries (identify the right person to carry out the autopsy)
9
Q
what is Evisceration
A
Removal of the organs
10
Q
what is internal examination
A
dissection of the body
11
Q
Define inflammation
A
reaction to injury and infection
12
Q
features of acute inflammation
A
sudden onset
short duration
usually resolves
13
Q
features of Chronic inflammation
A
Slow onset/ after acute
may never resolve
long duration
14
Q
name the white blood cells involved in inflammation
A
Neutrophils Polymorphs
Macrophages
Lymphocytes
15
Q
give an example of acute inflammation
A
Acute appendicitis
16
Q
give an example of chronic inflammation
A
Tuberculosis
17
Q
whats the main medication used to treat inflammation
A
Aspirin - inhibits prostaglandin
Ibuprofen
Corticosteriods - binds to DNA to regulate inhibitors of inflammation
18
Q
Explain features of acute appendicitis
A
inflammation of the appendix (which may be caused by blockage of the opening or lining)
19
Q
Explain features of tuberculosis
A
usually caused by mycobacterium mainly affects the lungs treated by a course of antibiotics body responds by inflammation that can damage the lungs fibrosis occurs
20
Q
when is inflammation good
A
It is essential in fighting infection (white blood cells during infection)
it is important when healing injuries
21
Q
when is inflammation bad
A
when it is constantly triggered - this is seen in autoimmune disease rheumatoid arthritis
22
Q
Explain features of Rheumatoid arthritis
A
inflammation around joints - causing damage
23
Q
what is pus made of
A
neutrophils
24
Q
function of neutrophils
A
Bags of enzymes that kill bacteria (predominantly)
First on onset of acute inflammation
Die at the scene
Makes up puss
Not mediated by antibodies (no LTM) work on recognition
25
function of macrophages
Long lived (don’t die on action)
Take antigens to lymphocytes for memory
Involved in immune reaction
26
function of lymphocytes
Long lived
Produce antibodies (plasma cells specialised type of)
T lymphocytes make chemical mediators
27
function of endothelial cells ( in terms of inflammation)
non stick layer
| blood has a central laminar movement - moves in middle of vessel so plain lamina is at the sides to prevent sticking.
28
function of endothelial cells (in terms of inflammation)
non stick layer
| blood has a central laminar movement - moves in middle of vessel so plain lamina is at the sides to prevent sticking.
29
function of fibroblast
Essential role in scarring
30
what is Granuloma
Particular form of inflammation the body does to particular material - frequently found in the lung
Mass of granulation tissues formed
31
what is granulation tissue
new reddish tissue that forms on the surface of a wound when the wound is healing
32
what is resolution
ideal result - occurs during minor injury
initiating factor removed and tissue is undamaged - able to regenerate
removal of necrotic cellular debris
33
what is regeneration
Any necrotic parenchymal cells may be replaced by new parenchymal cells of the same type
34
what happens when resolution and regeneration do not occur
repair
35
what is repair
initiating factor is still present
tissue damaged and unable to regenerate
collagen replaces the dead cells - leaving permanent scarring
36
what factors determine the healing
type of inflammation
| extent of tissue neurosis
37
what happens during abrasion of the skin
only the top layer of skin is taken off, so main layers are still present for regeneration
(goes back to extent of necrotic tissue)
epidermal layer still present
38
what is healing by 1st intention?
2 edges of wound brought together and closed
| usually occurs where theres little tissue damage
39
what is healing by 2nd intention
2 edges to not close, due to the damage of a lot of tissue.
| other measures must be taken to protect wound - such as tying it up
40
what are the 3 main differences between 1st and 2nd intention
longer repair time
greater chance of infection
greater scarring
41
name 2 features of the body that prevents clotting in vessels
1) endothelial cell lining the vessel
| 2) blood cells flow at central lamina flow
42
define thrombosis
clotting within a vessel
43
what 3 features can increase chances of thrombosis
1) change in vessel wall
2) change in blood constituents
3) change in blood flow
44
how does endothelial cell injury lead to thrombus formation
injury causes platelet aggregation
blood flow is no to the injury and not central lamina
some red blood cells therefore move to site and stick to it
sticking is mainly due to fibrous cells also coming
THROMBUS FORMATION
45
How does smoking increase chances of thrombosis
cigarettes damage the blood vessel lining
this causes a change in blood flow through the vessel
also inhaling a lot of carbon monoxide - changing blood constituents
all 3 factors are affected
46
which direction does thrombi grow in
direction of blood flow (as the blood sticks to clump as moving past?)
47
why does atheroma not occur in veins
lower blood pressure, so flow is more passive.
| the high pressure of arteries affect the inner lining of the vessel (endothelial cells are delicate and can be damaged)
48
what is most likely to cause venous thrombus
Valves
49
define atheroma
build up of fatty deposits in vessels, causing clotting and eventually thrombus.
50
what is the endothelial damage theory
the belief that damage to the endothelial cell leads the platelet aggregation, which eventually builds up to form a thrombus
51
What increase risk of damage to the endothelial cells
Smoking
Hypertension
Hyperlipidaemia
Diabetes
52
how does Hyperlipideamia affect the endothelium
- high levels of LDL = deposit on intima (under endothelial cell) and become oxidised
- oxidised lipids activate endothelial cells
53
define apoptosis
programmed cell death
| - INTENDED
54
define necrosis
multiple cell death by external source
| - unintended cell death due to cellular injury
55
whats the difference between apoptosis and necrosis
whether the cell death is external or internal (programmed by cell itself)
56
do stem cells apoptose
no - cells that still have the potential to divide are able to regenerate and therefore cannot apoptose
57
name one feature that might affect apoptosis
DNA DAMAGDE
| - if there is DNA damage in a resting cell, it can no longer divide, this is to prevent the spread of cancerous cells
58
which gene is important in detecting the extent of DNA damage
p35- vital in preventing cancer,
59
name 3 things apoptosis is important in
- development
- normal functioning
- disease
60
what can a lack of p35 lead to?
prevalence of cancerous cells - CANCER -proteins are unable to detect where apoptosis.
61
which disease is a result of too much apoptosis
HIV - lymphocytes are killed, reducing the efficiency of an individuals immune system
62
Name some examples of necrosis
Frostbite - too cold no blood goes round and so dies- cerebral infarction
toxic spider venom
avascular necrosis of bone
pancreatitis
63
Name 3 types of necrosis
Coagulative
Liquefactive
Caseous
64
what is a homeobox gene
a group of 180 base pairs important in the development of a baby and its bone structures
65
name the classifications of disease
Genetic/inherited
Congenital
Acquired
multifactorial
66
what classification of disease is spina bifida
Multifactorial
67
what is the non-environmental factor that may cause spin bifida
folate deficiency
68
Define hypertrophy, give an example
the increase in tissue size due to increase in cell size
| - muscle hypertrophy
69
Define Hyperplasia, give an example
the increase in tissue due to increase in number of cells
| - benign prostate enlargement
70
Define Atrophy, give an example
Loss in tissue size due to size/number
| - dementia, alzheimers
71
Define Metaplasia,
change In differentiation of a cell from one cell type to another
this refers to its structure (squamous, cuboidal ect)
72
Give an example of where Metaplasia occurs
in the Bronchi of smokers= cigarettes kill the ciliated columnar epithelium and only squamous can grow back
this is why dirt and other particle get stuck in the trachea, and this reduced efficiency of breathing and gaseous exchange - causing coughing
73
define Dysplasia
Imprecise term for the morphological changes seen in cells in the progression to becoming cancer
74
give an example of where both hypertrophy and hyperplasia occur
In the uterus during pregnancy
75
what causes the limit to cell division
Telomeres
76
what is the process of telomeric shortening
telomeres are found at the ends of chromosomes as protection
at dna synthesis, only part of telomere is replicated
single strand left on one chromosome is excised out
once the telomere is too short for the dna polymerase to engage with, replication stops.
77
what are telomeres?
non-coding randomly repetitive DNA sequence
78
is telomeric length inherited from father or mother
father
79
where is telomeres replaced by enzymes telomerase
embryo and germ cells
80
what are the affects of aging?
| 7 days till heaven
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Deafness
Osteoporosis
Dermal elastosis
Impaired immunity
Cataracts
Senile dementia
Sarcopenia
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81
name 5 causes of acute inflammation
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Microbial infection
Hypersensitivity reactions
physical agents
Chemicals
Bacterial toxins
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