Introductory Clinical Sciences Flashcards
1
Q
What is the name of the main effector cell in acute inflammation?
A
Neutrophil Polymorph
2
Q
Describe the function of neutrophil polymorphs
A
First on the scene of acute inflammation
- Cytoplasmic granules full of enzymes that kill bacteria
- Release chemicals that attract other inflammatory cells such as macrophages
3
Q
Describe the role of endothelial cells in inflammation
A
- Become sticky in areas of inflammation so inflammatory cells adhere to them
- Become porous to allow inflammatory cells to pass into tissues
- Grow into areas of damage to form new capillary vessels
4
Q
Function of fibroblasts in inflammation
A
Form collagen in areas of chronic inflammation and repair
5
Q
Which of the following is an example of acute inflammation?
a. Glandular fever
b. Leprosy
c. Appendicitis
d. Tuberculosis
A
Appendicitis
(glandular fever is an acute illness, but cells are lymphocytes & macrophages NOT neutrophils)
6
Q
In which of the following does granulomatous inflammation occur?
a. Crohn’s disease
b. Acute appendicitis
c. Infectious mononucleosis
d. Lobar pneumonia
A
Crohn’s disease
7
Q
What is another name for infectious mononucleosis?
A
Glandular fever
8
Q
What is the specific name of calcification in diseased (as opposed to normal) tissues?
A
Dystrophic calcification
9
Q
Which one of the following is a chronic inflammatory process from its start?
a. Appendicitis
b. Cholecystitis
c. Infectious mononucleosis
d. Lobar pneumonia
A
Infectious mononucleosis
10
Q
What is the name of the cells which produce antibodies?
A
Plasma cells
11
Q
What 4 questions is the coroner trying to answer?
A
- Who was the deceased?
- When did they die?
- Where did they die?
- How did they come about their death?
12
Q
Who performs autopsies?
A
Doctors:
- Histopathologists
- Forensic pathologists
13
Q
What is pus made up of?
A
Dead neutrophils
14
Q
Why can an abrasion of the skin heal quickly?
A
Bottom layer of squamous cells is still present
15
Q
What is the main difference between skin wounds healed by 1st vs 2nd intention?
A
In 1st intention, the edges are brought together immediately.
When a wound has to be healed by 2nd intention, there has been skin loss so the edges of the wound cannot be brought together straight away.
16
Q
What cell produces collagen?
A
Fibroblasts
17
Q
Where does gliosis occur?
A
The brain
18
Q
What is the difference between fibrosis & gliosis?
A
Gliosis is more delicate
19
Q
3 points on Virchow’s triangle?
A
20
Q
What does Virchow’s triad show?
A
The 3 factors that can individually or combined contribute to thrombosis
21
Q
How does aspirin reduce risk of thrombus formation?
A
Inhibits platelet aggregation
For a similar amount of endothelial cell injury, there won’t be a full thrombus formation
22
Q
How is atherosclerotic plaque thought to form?
A
Any endothelial cell damage leads to a small amount of thrombus formation → plaques
Endothelial cells grow over thrombus formation → more endothelial cell damage → another thrombus etc etc
So the vessel becomes occluded more
23
Q
Give an example of useful apoptosis in development
A
At some stage in development, we have webbed fingers
The cells in between our fingers must be killed
24
Q
Define congenital
A
Present at birth
(doesn’t have to be genetic, can be acquired)
25
Give an example of a congenital disease & how it occurs
Club foot - thought to be due to a lack of amniotic fluid during development
26
Define acquired, in terms of disease
Caused by non-genetic environmental factors
27
Give an example of an acquired, congenital disease
Fetal alcohol syndrome (mother has drunk excess alcohol whilst pregnant)
28
What is adjuvant therapy?
Therapy given after primary or initial treatment to maximise effectiveness
29
Name the 3 layers in a normal arterial wall from innermost to outermost
Tunica intima
Tunica media
Tunica adventitia
30
Main structural differences between arteries & veins
Arteries have:
- smaller, rounder lumen
- thicker elastic layer
- thicker muscle layer
- no valves
31
Summarise the 5 main stages in the formation of an atherosclerotic plaque.
1. Endothelial dysfunction
2. Formation of lipid layer or fatty streak within the intima
3. Migration of leukocytes and smooth muscle cells into the vessel wall
4. Foam cell formation
5. Degradation of extracellular matrix
32
What is a foam cell?
A phagocytic macrophage that has absorbed lipoproteins
33
What problems can the formation of atherosclerotic plaque cause?
Causes ischaemia as it narrows blood vessels
When the plaque ruptures, a bit may break off and lead to infarction
34
Modifiable risk factors for atherosclerosis
- Smoking
- Obesity
- Hypertension
- Hyperlipidaemia
35
Non-modifiable risk factors for atherosclerosis
- Age
- Family history
- Gender
- Ethnicity
36
Primary preventative measures to take against atherosclerosis
- Stop smoking
- Become more active/weight loss
- Reduce stress levels
- Balanced diet with fewer saturated fats
37
Secondary preventative measures to take against atherosclerosis
- Control diabetes
- Aspirin
- Statins
- Calcium channel blockers
- Regular checkups
38
Meaning of the term 'co-benefits' in relation to health and climate change. Give an example
The positive effects that a policy or measure aimed at one objective (climate change) might have on other objectives (health)
Increased walking & cycling rather than driving short distances = less fossil fuel emission & increase in activity for our patient.
39
Which of the following tumour never metastasises:
* malignant melanoma
* small cell carcinoma of the lung
* basal cell carcinoma of skin
* breast cancer
Basal cell carcinoma of skin
40
What is the name of a malignant tumour of striated muscle?
Rhabdomyosarcoma
41
Which of the follow tumours does **not** commonly metastasise to bone
* Breast cancer
* Lung cancer
* Prostate cancer
* Liposarcoma
Liposarcoma
42
As well as breast, lung and prostate cancer, name two cancers which commonly metastasise to bone
Renal cell & thyroid cancers
43
What term describes a cancer that has not invaded through the basement membrane?
Carcinoma in situ
44
What is the name of a benign tumour of glandular epithelium?
Adenoma
45
Which one of these tumours does not have a screening programme in the UK: breast, colorectal, cervical, lung?
Lung
46
Which one of the following is not known to be a carcinogen in humans:
* Hep C virus
* Ionising radiation
* Aromatic amines
* Aspergillus niger
Aspergillus niger (a fungus)
47
What is the name of a benign tumour of fat cells?
Lipoma
48
What is the name of a malignant tumour of glandular epithelium
Adenocarcinoma
49
Which one of the following is not a feature of malignant tumours:
* vascular invasion
* metastasis
* increased cell division
* growth related to overall body growth
Growth related to overall body growth
50
T or F: a transitional cell carcinoma of the bladder is a malignant tumour?
True
51
T or F: a leiomyoma is a benign tumour of smooth muscle?
True
52
T or F: radon gas is a cause of lung cancer
True
it is a radioactive gas
53
T or F: asbestos is a human carcinogen
True
54
T or F: ovarian cancer commonly spreads in the peritoneum
True
55
Where do all immune cells originate?
The bone marrow
56
Where do T cells mature?
The thymus
57
Where is a common place for B & T cells to accumulate?
Lymph nodes
58
What innate cell is involved in allergic reactions?
Basophils
59
What innate cell is involved in parasitic infections?
Eosinophils
60
What are the two types of immune response in humans?
Innate & Acquired
61
What cell type is described below?
## Footnote
*'These are the most abundant white blood cell in humans and are characterised by the multi-lobed shape of their nucleus'*
Neutrophil
62
Which antigen presenting cell is considered a professional at activating lymphocytes?
Dendritic cell
63
Which of the following is not a component of innate immune mechanisms?
* Antimicrobial peptides
* Mucosa
* Inflammatory mechanisms
* Antibody production
* Skin
Antibody production
64
Antigen presenting cells process and present antigens for recognition by
* Neutrophils
* Red blood cells
* Eosinophils
* T cells
T cells
65
Which of the following are features of the adaptive immune response
* Does not require prior contact with the pathogen
* It works with B and T lymphocytes
* Lacks specificity
* Distinguishes "self" from "non-self"
* Enhanced by complement
It works with B and T lymphocytes
66
Complements are the proteins that are involved in the clearance of antigen/bacteria.
Which of the following is not part of the Elimination phase of complement activation?
* Opsonisation
* Production of interferons
* Target cell lysis
* Chemoattraction of leukocytes
* Phagocytosis
Production of interferon
67
Which of the following are administered as a live attenuated vaccine in the UK:
* Hep A
* Tetanus
* MMR
* Flu
* BCG (TB)
MMR & BCG (TB)
68
Polysaccharide vaccines are composed of long chains of sugar molecules that make up the surface capsule of certain bacteria. These vaccines are available for the treatment of which of the following diseases?
* Pneumococcal disease
* Influenza type b
* Rabies
* Salmonella Typhi
* Meningococcal disease
Pneumococcal disease, Salmonella Typhi, Meningococcal disease
69
Influenza vaccine is targeted towards 'at risk' groups in the UK.
Which of the following are classified as 'at risk'?
* Asthmatics
* 16 years old
* Diabetics
* The obese of any age
* 6 months of age and over
6 months of age and over
70
Which of the following is not an organ-specific auto-immune disease?
* Type 1 diabetes mellitus
* Graves disease
* Ulcerative colitis
* Hashimoto’s thyroiditis
* Sjogren's syndrome
Ulcerative colitis
71
Which of the following are classical PAMPs?
* Flagellin, a protein found in bacterial flagella
* Lipopolysaccharide (LPS) from the outer membrane of gram-negative bacteria
* Peptidoglycan, found in bacterial cell walls
* Lipoarabinomannan of mycobacteria
* Interleukin 12
* Flagellin, a protein found in bacterial flagella
* Lipopolysaccharide (LPS) from the outer membrane of gram-negative bacteria
* Peptidoglycan, found in bacterial cell walls
* Lipoarabinomannan of mycobacteria
72
What is transudate?
Transudate is an ultrafiltrate of plasma that contains few, if any, cells and does not contain large plasma proteins, such as fibrinogen.
73
When does transudate build up?
“Transudate” is fluid buildup caused by systemic conditions that alter the pressure in blood vessels, causing fluid to leave the vascular system.
74
What is hypercoagulability?
Hypercoagulability can be defined as the tendency to have thrombosis as a result of certain inherited and/or acquired molecular defects.
75
What is stasis?
Phenomena of interrupted blood flow
76
What is the function of NOD2?
Activates inflammatory signalling pathways
77
What is NOD2?
It is an NLR
78
4 aims of a perfect vaccine
- Achieve long term protection (from a small number of immunisations)
- Stimulate both B & T cells
- To induce memory B & T cells
- To stimulate protective high affinity IgG production
79
4 categories of different types of vaccine
- Whole organism
- Subunit
- DNA vaccines
- Engineered virus
80
2 types of whole organism vaccine
- Live attenuated pathogen
- Killed, inactivated pathogen
81
4 advantages of live attenuated pathogen
- Sets up a transient infection
- Activates a full natural immune response
- Stimulation of a memory response in T & B cell compartments
- Often only a single immunisation required
82
3 disadvantages of a live attenuated pathogen
- Immunocompromised patients may become infected as a result of immunisation
- In live measles vaccine, attenuated organism can revert to its virulent form
- Typically needs refrigeration for stable storage
83
Advantages of a killed, inactivated pathogen in a vaccine
- No risk of infection
- Storage is less critical
84
Disadvantages of a killed, inactivated pathogen as a vaccine
- Tends to just activate humoral response (not cell mediated)
- Lack of T cell involvement
- Immune response can be weak
- Repeated booster vaccines required
85
3 major types of subunit vaccines
Inactivated exotoxins (toxoids)
Antigenic extracts
Recombinant proteins
86
What is an exotoxin?
A toxin secreted by bacteria
87
Advantages of a subunit vaccine
- Theoretically safer than handling live or inactivated pathogens
- No risk of infection
- Easier to store and preserve
88
Disadvantages of a subunit vaccine
- Immune response is less powerful than live attenuated vaccines
- Repeat vaccines required & adjuvants
89
Advantages of DNA vaccines
- Do not require complex storage
- Delivery can be simple & adaptable to widespread programs
90
Disadvantages of DNA vaccines
- As with 'killed' and subunit vaccines, no transient infection
- DNA vaccination is likely to produce a mild immune response
- Subsequent boosting required
91
Advantages of recombinant vector vaccines?
- Produce immunological memory
- Safe - relative to live attenuated pathogen
92
Disadvantages of recombinant vector vaccines?
- Requires refrigeration for transport
- Immune response to virus in subject can negate effectiveness
93
3 main protein ports in cell membranes?
Uniporters
Symporters
Antiporters
94
Define pharmacology
The study of the effects of drugs
95
Define pharmacokinetics
How the body affects the drug (**ADME**)
* **A**bsorption
* **D**istribution
* **M**etabolism
* **E**xcretion
96
Define pharmacodynamics
How the drug affects the body
97
Define potency
Measure of how well a drug works
98
Define agonist
A compound that binds to a receptor & activates it
99
Define antagonist
A compound that reduces the effect of an agonist
100
Define affinity
Describes how well a ligand binds to the receptor
101
Define efficacy
Describes how well a ligand activates the receptor
102
Define bioavailability
Amount of drug taken up as a proportion of the amount administered
103
Define partial agonist
Binds to and activates the receptor, but only has partial efficacy when compared to a full agonist
104
Define pro-drug
A drug that must be activated in the liver before it can work
105
In terms of using opioids, what is the benefit of using a partial agonist instead of a full agonist?
With a partial agonist, there is a lower risk of the patient going into respiratory arrest
106
What is the difference between dose of oral morphine compared with s/c (subcutaenous), IM, IV
50% of oral morphine is metabolised by first pass metabolism.
So double the dose is given compared to other routes
107
Define tolerance in terms of pharmacology
Down regulation of receptors with prolonged use of a drug
So you need a higher dose to achieve the same effect
108
What is the goal of opioids?
Block pain
109
How do opioids work?
Inhibit the release of pain transmitters at the spinal cord and midbrain
Modulate pain perception in higher centres - changes the emotional perception of pain
110
Side effects of opioids given systemically
- Respiratory depression
- Sedation
- Nausea & vomiting
- Constipation
- Itching
- Immune suppression
- Endocrine effects
111
If a patient goes into opioid induced respiratory depression, what steps should you take?
1. Call for help
2. ABC
3. Naloxone
1. IV is fastest route
2. Titrate to effect
112
Define adrenergic
Relating to adrenaline, noradrenaline & their receptors
113
Define cholinergic
Relating to ACh and its receptor
114
3 main differences between somatic and autonomic divisions of the efferent NS
Somatic:
* Single neuron between CNS & skeletal muscle
* Innervates skeletal muscle
* Leads to muscle excitation (not inhibition)
Autonomic
* 2 neuron chain
* Smooth muscle, cardiac muscle, glands (GI neurones)
* Leads to excitation or inhibition
115
2 major neurotransmitters involved in the autonomic division of the efferent NS
ACh & noradrenaline (NAd)
116
In the autonomic NS, what neurotransmitter acts on the preganglionic neurone?
ACh
117
In the autonomic NS, what type of receptor is found on the preganglionic neurone?
Nicotinic
118
In the autonomic NS, what neurotransmitter acts on the postganglionic neurone?
Parasympathetic: Muscarinic
Sympathetic: α & ß receptors
119
In the autonomic NS, what neurotransmitter acts on the postganglionic neurone?
Parasympathetic: ACh acts on muscarinic receptors
Sympathetic: noradrenaline acts on α & ß receptors
120
What activates muscarinic receptors?
Muscarine
121
How many types of muscarinic (M) receptors are there?
5 (M1-M5)
122
Where is each type of M receptor present?
M1: brain
M2: heart
M3: all organs with parasympathetic innervation
M4: mainly CNS
M5: mainly CNS
123
When the M2 receptor at the SAN is activated, what happens?
HR decreases
124
When the M2 receptor at the AVN is activated, what happens?
Decreases conduction velocity
Increases AV node block (increases PR interval)
125
When the M3 receptor in the resp system is activated, what happens?
Produces mucus
Increased smooth muscle contraction
126
When the M3 receptor in the GI tract is activated, what happens?
Increased saliva production
Increased gut motility
Stimulates biliary secretion
127
When the M3 receptor in the skin is activated, what happens?
(only place where sympathetic releases ACh)
Causes sweating
128
When the M3 receptor in the urinary system is activated, what happens?
Contracts detrusor muscle
Relaxation of internal urethral sphincter
(allows urine to pass out of the bladder into the urethra)
129
When the M3 receptor in the eye is activated, what happens?
Causes myosis
Increases drainage of aqueous humour
Secretion of tears
130
2 muscarinic antagonists
Atropine - M2 antagonist
Hyoscine - M3 antagonist
131
In terms of receptors, what happens in myasethenia gravis
Blockage of nicotinic ACh receptors
leads to skeletal muscle weakness, particularly on repeated attempts at movement
132
What can myaesthenia gravis be treated with?
Anti-cholinesterase to increase ACh availability at a neuromuscular junction
133
Effect of agonist binding to α1 receptor?
Increases intracellular Ca2+
Contracts smooth muscle (pupil, blood vessels)
134
Which agonist is favoured at an α1 receptor?
NAd\>Ad
135
Effect of agonist binding to α2 receptor?
Gi signalling, inhibition of cAMP generation
Mixed effects on smooth muscle
136
Which agonist is favoured at an α2 receptor?
NAd = Ad (no preference)
137
Agonism of ß1 receptors leads to...
Tachycardia
Increased SV
Renin release → increased vascular tone
Lipolysis & hyperglycaemia
138
Beta 1 blockers will...
Reduce HR
Reduce SV
Reduce myocardial O2 demand & help remodelling the heart in heart failure & post MI
139
Example of an agonist drug to ß2 receptor
Salbutamol
140
Effect of an agonist binding to a ß2 receptor?
Bronchi → Bronchodilation
Bladder wall → Inhibits micturation
Uterus → Initiation of labour
Skeletal muscle → Increased contraction speed
Pancreas → Insulin & glucagon secretion
141
A patient with COPD becomes progressively breathless.
He has heard about some medicines which may help
Which drugs do these use & which receptors do they affect?
Salbutamol.
Beta 2 receptors: role in bronchi is bronchodilation
142
A patient complains of dry mouth on days when he uses his inhaler too much & he gets palpitations
Why is this?
Which drugs are responsible?
His inhaler contains salbutamol which is is a beta 2 agonist. Side effects of this include tacchyarrythmia
Dry mouth - due to the antimuscarinic. When M3 receptors are stimulated in resp system, saliva production is increased. (so when this is blocked saliva production will decrease)
143
Upon which receptor does the muscle relaxant suxamethonium work?
Works by mimicing ACh at the neuromuscular junction - muscarinic receptors
144
A patient suffers a heart attack following an operation & develops atrial fibrillation. He is commenced on bisoprolol.
Upon which receptor does bisprolol predominantly work? What positive effects will it have?
Acts on beta 1 receptor as an antagonist
This will:
- Slow HR
- Reduce myocardial O2 demand
- Help cardiac remodelling post MI
145
Define anaphylaxis
Anaphylaxis is an acute, potentially life-threatening hypersensitivity reaction, involving the release of mediators from mast cells, basophils and recruited inflammatory cells
146
Possible anaphylaxis trigger agents that may be encountered in a hospital environment?
Penicillin
Latex gloves
Antibiotics
NSAIDs
General anaesthetic
IV contrast used in some imaging
147
Why may a second dose of adrenaline be required following anaphylactic shock?
Adrenaline has a short half-life (in plasma about 2-3 minutes)
148
Effect of adrenaline following anaphylaxis?
Stimulates ß1 adrenoreceptors
Positive ionotropic effect = increases heart contraction
Positive chronotropic effect = increases HR
Increases vasodilation
149
What blood test can be done to confirm anaphylaxis?
A timed blood test for mast cell tryptase
Histamine is released from mast cells during anaphylaxis.
Mast cell tryptase breaks down mast cells. If levels of this are increased this shows an increase in the number of mast cells (shown in anaphylaxis)
150
Symptoms & signs of anaphylaxis?
Respiratory distress
Abdominal issues/pain
Skin redness/urticaria
Hypotension
151
How do protein kinase inhibitors work?
Targeted to specific mutations
Modifies specific parts of a pathway by recognising specific mutations that occur
152
What is the goal of gene therapy?
To use genes to treat or prevent disease
153
3 ways gene therapy can work?
- Replace mutated gene with healthy copy
- Inactivating a mutated gene that is functioning improperly
- Introducing a new gene into the body to help fight a disease
154
Give an example of a disease that can be treated with gene therapy
Spinal muscular atrophy
(a rare genetic disease that affects motor nerve cells in the spinal cord)
155
What is drug repurposing?
A technique whereby existing drugs are used to treat emerging and challenging diseases
156
Define 'adverse drug reaction'
Unwanted or harmful reaction following administration of a drug or combination of drugs under normal conditions of use and is suspected to be related to the drug
- Has to be noxious (unpleasant) & unintended
157
Define 'side effect'
An unintended effect of a drug related to its pharmacological properties and can include unexpected benefits of treatment
158
Define 'idiosyncrasy'
An inherent abnormal response to a drug
159
Which disease are covered in a 6-in-1 vaccine given to 8 week old babies?
* Diptheria
* Hep B
* Haemophilus influenza type B (Hib)
* Polio
* Tetanus
* Whooping cough
