Keeping people healthy Flashcards
In the thyamus what is often found in the medulla and what is it?
Thymic/ Hasel’s corpuscles
Dead clumped epitheioreticular cells
What are the two processes of filtration in the lymph nodes?
Mechanical filtration
Biological filtration
What’s the disease called when someone has no thyamus and what’s the outcomes of this?
Di George’s syndrome
No T cell formation
What type of connections do E-Cadherins have?
Homotypic connection
What do epithelial cells become when they lose their E-cadherins?
Epithelial mesenchymal transitional tissue
To diagnose depression what core symptoms must a person have?
Low mood and:
- Anhedonia - loss of happiness in things
- fatigue
Everyday for 2 weeks +
What is the clinical term for someone who starts to believe they are dead? or have parts of them that are dead?
Cotard’s syndrome
What type of drug is amitriptyline?
tri-cyclic anti-depressant
A form of monoamine oxidase enzymes are found in the G.I and break down what substance? and if this substance is blocked from being broken down what can it cause?
Tyramine
Hypertensive crisis
What is checklist criteria for assessing one’s mental health?
Appearance
Behaviour
Speech
Mood and Affect
Thought form
Perception
Cognition
Insight
What are the types of Delusions?
Persecutory - perceived threat from others
Grandiose - Overestimation of self - believing they have powers
Nihilistic - believing they are dead or part of them is dead
Delusions of reference - believing external things are talking to them
Thought interference - insertion, withdrawal or contrast
What’s the difference between hallucination and illusion?
Hallucination is based on NO stimuli
Illusion is based on a stimuli that is miss - interrupted
What is mood and how can it be broken down?
Mood is the generalised emotional state - over weeks and months.
Subjective - what patients says the feel
Objective - what the clinician observes
What is affect and what can it be broken down to?
The affect is the moment by moment monitoring of the mood of someone.
reactive? - appropriate to discussion Expansive? - exaggerated effects Flattened? - limited reaction Blunted? - no reaction Labile? - excessive emotions
What are differential diagnosises for depression?
Dysthymia - not bad enough to be depression
Clyclothymia - not enough to be bipolar
Atypical depression - SAD
Adjustment reaction - grief usually 1 month afterwards and lasts 6 months
What are the core features of depression?
Low mood with:
- Anhedonia
- Fatigue
What enzyme is checks the protein has folded correctly within the R.E.R? and what is it checking?
Glucosyltransferase
Checking for stretches of hydrophobicity. If large amoutn present it is re-folded or destroyed
What is internal locus of control?
People see that they have agency and control over their illness.
- more likely to comply
- can lead to feelings of guilt
What is external locus of control?
Where they do not believe they have control but instead is due to external agency
What are some barriers to adjustment?
Characteristic of the illness - pain? fatigue? uncertainty?
Treatment - burdensome? long?
Societal - stigma? rejection? does society see you as ill?
Co-moralities
Personality - locus of control
Social circumstances - fiances? support?
What is secondary gain of illness?
where there is subconscious increase in the person illness.
Their wife won’t leave them as long as their ill
What are 2nd auditory halluciations? and how does this compare to 3rd auditory halluciations?
2nd auditory - is to you “you are useless”
3rd auditory - is hearing voices talking about you “He’s useless”
What is the gene defect in Chronic Myloid Leukemia
Abl (chromosome 9) Bcr (chromosome 22)
What is the Abl Bcr?
It is a Tyrosine Kinase protein - only found in cancer cells from the mutation of chromosome 9 and 22
What is a x-linked recessive genetic condition that can cause haemolysis? and why does this affect the african population more?
glucose - 6 - phosphate dehydrogenase
It is useful against malaria - which is prevalent in africa
What properties are needed for metastasis?
Reduced Cellular adhesion - loss of E-cadherins becoming mesenchymal epithelial transitional tissue
Cell Substratum - intergrin mutations
Increased motility - Hepatocyte growth factor - scatter factor
Increased proteolytic enzymes - MMPs & serine proteases
Angiogenesis - VEGF, PDGF
Ability to extravasate and intravasate - selectins up regulation like leukocytes
Ability to proliferate at ectopic site - seed and soil hypothesis, mechanical hypothesis
Whats the most common BRAF mutation in melanoma?
V600
What is the deficiencies seen in alcohol abuse that increase the liver disease? and what the mechanism by which they do?
Folic Acid
Vitamin B6
Vitamin B12
disrupts methionine pathway causing:
- increased: S-Adenosyl Homocysteine - increase pro-apoptic genes
Decreases: S- Adenosyl Methionine - decrease in normal gene expression
Decreases: glutathione - lack of anti- oxidant
What is binge drinking?
This is where more than 6 Units of alcohol are consumed in one sitting.
- essentially drinking to get drunk.
*note this recently changed from 8 Units.
Name 4 mental state examinations:
Mini Mental state examination: 30 q’s. Cut off 24.
Abbreviated Mental test: 10 q’s. Cut off 7-8
Addenbrookes Cognitive assessment: 100 q’s. Cut off 82
6 item cognitive impairment
What test can be done to evaluate the pre-frontal cortex?
Frontal assessment battery
What is dysphasia? and how does it compare to aphasia?
Able to produce language but it is nonsensical. `it is fluent (able to express easily) but is incorrect in its produce.
- receptive dysphasia
Aphasia is the inability to produce language
What does the Frontal Assessment Battery consist of?
- Similarities - orange and banana (3correct - 0 correct)
- Lexical Fluency - name as many words beginning with M (>9 words = 3, <3 = 0)
- Motor serious planning - hitting leg with fist closed and then get them to repeat
- conflicting instructions - “tap twice when I tap once”
- Inhibitory control- “do not tap when I tap twice”
- Prehension behaviour - telling them not to grap hands when you put them out
What is odynophagia?
Painful swallowing
What is Strangury?
Desire to pass urine every couple of minutes
What are some general clinical features seen in someone with alcohol miss use?
Spider naevi - above SVC area
Telangiectasia
Facial mooning - due to enlargement of parotid gland
Dupuytren’s contractures
What is the guidelines for alcohol consumption? and what does this equate to in wines and beers?
14 units
Six 175ml of wine at 13%
Six pints of beer at 4%
What is the drink drive limit in Scotland?
22micrograms per 100ml of breath
50mgl/100ml of blood
What is the sign, that if a person has a palpable mass, with painless jaundice it is unlikely to be gallstones. furthermore, what is it likely to be?
Courvoisier’s sign
Pancreatic cancer
What is the lymph node called that cancer first reaches?
Sentinel lymph node
What is the daily requirement of thiamine?
1-2mg
What are the symptoms of Weirnkes Korsakoff syndrome?
Confusion with recent memory loss
Ngstagmus
Gaze paralysis
Ataxia
What is the hyperacut reaction to organ donors?
Where a person has Anti HLA antobodies towards the donors particular HLA.
antibodies bind this triggers an immediate compliment cascade with neutophil involvement destroying blood supply to tissue.
Chronic allography nephropahty, what are the two ways it degrades?
Immunological - due to immune damage
Non - immunological - due to state of organ prior to donation
What is the term for an organ donation between the same species?
Allograft
What is a transplant which involves the tissue of the same person onto the same individual?
Autograft
What is a transplant between species?
Exongraft
What are the core features of ADHD?
Poor concentration - moving from 1 task to another without completion
Excessive activity - disorganised/ restless
Impulsive
- poor awareness of danger or consquence
- lack if inhibition
- poor peer relationships
- emotionally unstable
*symptoms must be before age 7 and present in more than 1 environment with them usually being worse in evening
What are associated disorders with ADHD?
Sleep disorders - 50%
Behaviour difficulties - 25%
Learning difficulties - 25%
Social Communication difficulties - 25%
Diagnosis of ADHD includes?
NO set diagnostic test. it involves:
Direct observation 1:1
Pyschoeducational assessment
Questionnaires to parents and teachers - SNAP-IV
Developmental history
- alcohol use by parents
- feeding patterns/ sleeping patterns
- drug use
- birth weight
- milestones
Family setting?
What medical problems should be considered when assessing for ADHD?
head injury
past or current illnesses
Tics
Hearing disturbance
Outline some behavioural training programmes for ADHD?
Encouragement of consistency
Not personalising behaviour
Postiviely reinforce behaviour
assist parents in maintaining routines and quiet times
Have childs attention before giving instructions
What affect does alpha 2 agonist have in pre-frontal cortex?
Strengthen synaptic connections.
Reduce noradrenaline release
What does phychosis mean?
Altered mind - wrapped sense of reality
Outline some biological etiologies of depression:
Genetic - 60%
co-moralities - hypothyroidism
Drugs - steroids
Neurochemical - 5HT reduction - monoamine hypothesis
Name some socio-economic causes of depression:
Poor quality of living
poor social support
northern hemisphere
Give reference to the severity of depression:
Mild: core symptoms +2>associated symptoms
Moderate: core symptoms +4> associated symptoms
Severe: core symptoms +6> associated symtoms + psychosis
What is a major risk of an ERCP?
Acute pancreatitis
What are the stages to giving up addiction?
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Relapse
when assessing someones thoughts - during the discussion they rapidly move from one topic to the next which seem to have connections - but it is just very fast. What is this suggestive off?
Mania
During the assessment of thought, the person makes lots of different jumps in their topics when talking. these seem to have no discernible connections, what is this called and what is it suggestive off?
Knights move
Schizophrenia
How does liver disease lead to gynecomastia?
reduced breakdown of oestrogens and reduced sex-hormone binding proteins, leading to more accessible amount in the blood.
What are acute psychological effects of alcohol intoxication?
Insomina
Depression
anxiety
Amnesia
Suicidal
Define dependence
Compulsion
controlling
withdrawal effects
Persistence
Neglect
What is treatment for alcoholism?
Assistance withdrawal home detox
Individual cognitive models to help with motivation
Groups = AA
Pharmacology
treatment of co-morbilites
