last minute Flashcards
stroke volume
stroke volume = EDV- ESV
end diastolic volume
end systolic volume
ejection fraction =
EJ= stroke volume ( end diastolic volume- end systolic volume) /end distolic volume
stroke volume= end diastolic volume- end systolic volume
e.g.
120- 80/120= 33%
Naloxone is a
competitive antagonist, non-selective for all opioid receptors.
4) A 69 year female with atrial fibrillation reports no episodes of palpitations and does not have any other cardiovascular disease. Which antiarrhythmic agent would you prescribe to control rate for this patient?
A. Flecainide
B. Bisoprolol
C. Amiodarone
D. Digoxin
E. Ivabradine
Answer is B. Bisoprolol beta blocker for rate control. Flecainide would be appropriate for rhythm control as would amiodarone (possible for rate if beta blocker and CCB contraindicated).
10) A 36 year female has been admitted to a general ward with a severe infection. She has been prescribed i.v. antibiotics. A steady state plasma concentration is reached in 5 hours. What would be the predicted half-life of the antibiotic?
A. 10 hours B. 25 hours C. 1 hour
D. 15 hours E. 7.5 hours
The answer is C. 1 hour. Css should be reached in approximately 5 half-lives. 5/5=1.
ADR reactions
11) A junior doctor is reviewing the medications of an elderly patient. The patient reports that they have stopped taking one of their medications because it was causing side effects they describe as shaking or tremor. The doctor ascertains that it is a type B adverse drug reaction and goes about reporting it to the Medicines and Healthcare products Regulatory Agency through the online yellow card system. Which of the below does not describe a type B ADR?
A. Dose-related
B. Uncommon
C. Unpredictable
D. Serious/irreversible
E. Associated with high mortality
A. Dose-related
In patients with resistant hypertension, who have been prescribed drugs in accordance with guidelines up to and including step three, additional add on drugs can be prescribed. Name ONE class of drug (excluding a diuretic) that may be considered. Provide an example from this class and briefly describe how it lowers blood pressure.
Alpha blocker (1 mark), doxazosin (1 mark) cause vasodilation reducing the PVR (1 mark)
OR
Beta blocker – beta adrenergic receptor antagonist (1 mark), labetalol, bisoprolol, metoprolol (1 mark) lower renin levels, negative chronotropic and inotropic effects, decreased cardiac output
What clinical marker will the doctor measure to access how well her diabetes is being controlled and what target (%) would they be hoping for?
HbA1c (1 mark) 6.5% in first two treatment steps (1 mark)
DM diagnosis parameters
Fasting glucose >6.9 mml/L
Random plasma glucose >11 mmol/L
HbA1C >48 mmol/mol
A single raised plasma glucose without symptoms not sufficient for diagnosis ( would need several blood tests in the absence of symptoms)
Plasma or urine ketones
She is currently taking metformin TDS. How does metformin help control her diabetes?
Decrease insulin resistance (sensitivity of own insulin), (1 mark) increasing glucose uptake and utilisation in target tissues (skeletal muscle) (1 mark). Reduces hepatic glucose production. (Limits weight gain) (1 mark).
One of the participants in the phase 0 trial, develops breast cancer aged 55 (unrelated to the trial). Name the type of hormone replacement therapy (HRT) that increases the risk of breast cancer when used in the short term. Provide an example drug from this class.
Opposed oestrogen therapy (1 mark)
- oestrogen needs to be opposed by progesterone to prevent breast cancer
Estradiol with medroxyprogesterone, .
Specific dose combinations and trade names do not need to be learnt. (1 mark)
(Longer term unopposed HRT can increase risk of breast cancer and is suggested to be associated with increased age and other risk factors.)
Tamoxifen is discussed as an appropriate chemotherapeutic agent. What does this information suggest about the breast cancer diagnosis and to what class of chemotherapies does it belong?
Oestrogen receptor positive (1 mark) SERM (1 mark)
stages of kidney
pronephros (cervical region)
mesonephros (embryonic kidney)
Metanephros- true/definitive kidney
Ureteric bud (sprouts of the mesonephric duct) induces development of
the definitive kidney
Ureteric bud induces the development of the true kidney–> from the metanephros tissue
what happens to the metanephric kidney after it appears in the pelvic region
it ascends!!!
Kidney and gonad undergo apposing changes
- Gonad descends
- Kidney ascends–> moves up through embryonic body due to expansion of the cavity
Renal agenesis (no kidney)
Ureteric bud fails to interact with intermediate mesoderm
Structural anomalies related to migration
pelvic kidney- doesnt ascend properly
horseshoe kidney- 2 developing true kidneys move up through the abdominal cavity together due to the caudal poles fusing –> limits migration e.g. first unpaired branch of the abdominal aorta–> doesn’t cause too many symptom
Symptomatic consequence is ectopic ureteral opening
- Openings can be anywhere from the bladder, the vagina
- Into the urethra (no muscular or sphinctal control of bladder)
- Symptoms- incontinence –> doesn’t pass through bladder for storage phase
*
urorectal septum divides
the cloacal membrane into two membranes: the urogenital membrane (ventrally) and the anal membrane (dorsally).
development in the urinary tracts in females
(XX)
- Mesonephric ducts (MD) reach urogenital sinus (UGS)
- Ureteric bud sprouts from MD
- Urogenital sinus begins to expand
- Mesonephric duct regresses à no testosterone (XX)
- Ureteric buds open into the urogenital sinus
development of the urinary tract in males
- Mesonephric ducts (MD) reach urogenital sinus (USG)
- Ureteric bud sprouts from MD
- Smooth musculature begins to appear and UGS begins to expand
- Ureteric bud and Mesonephric Ducts make independent openings in UGS
- Due to presence of androgen (testosterone)
- MD become converted into the vas deferens
- Then the prostate and prostatic urethra forms
male urethra divided into 4 parts
Pre-prostatic
Prostatic
Membranous- through the perineum
Spongy – external genitalia under influence of androgens
development of male urethra
In the male the Genital tubercle elongates and genital folds fuse to form spongy urethra
Nephrotic syndrome
e.g. diabetic nephropathy’s, minimal change disease and membranous glomerulonephritis, focal segmental glomerosclerosis (FSGS)
- Proteinuria (typically >3g/d) sufficient to cause
- Hypalbuminaemia
- Sufficient to cause:
- Oedema
treatment- blood pressure control
diabetic nephropathy treatment
- Hypertension
- Good glycaemic control
- ACE inhibitors
- Angiotensin receptors blockers
nephritic syndrome
e.g. IgA nephropathy (Berger Disease), rapidly progressive glomerulonephritis, post-streptococcal glomerulonephritis, good pastures syndrome
- Oliguria- no urine output
- Hypertension
- Hematuria – microscopic or macroscopic
pathology of nephritic syndrome
- Inflammation that disturbs basement membrane
- Bigger gaps in basement membrane
- RBC can pass through into the urine
- Haematuria – coke coloured urine
pathology of nephrotic
- Damage to podocytes–> large amounts of protein being lost in urine e.g. albumin
- O of nephrotic links to oedema
- Reduction of albumin in the body – lost in urine
- Less oncotic pressure
voiding is a
parasympathetic process
- pelvic nerve (M3) stimulated–> detrusor muscle contraction
- pudendal nerve inhibited (nicotinic ACh)–> relaxation of EUS
storage is a
sympathetic process
- hypogastric nerveprevents contraction of the detrusor (B3) whilst causing contraction of the IES (alpha1)
mesoderm made up of
Paraxial mesoderm turns into somites
- Skeletal muscle
- Vertebra
- Cartilage
Intermediate mesoderm
- Kidneys and gonads
Lateral plate mesoderm
- Somatic – body walls
- Splanchnic – visceral
Ectoderm
- Epidermis (nails, skin etc)
- Nerve tissue
……….mesoderm on both side of the embryo condenses into 2
intermediateurogenital ridges
- runs parallel to the the future vertebral column
- organises into a cylinder of mesoderm called the nephrogenic cord
indifferent stage: a pair of duct
- Mesonephric ducts develop in both male and female embryos
- Paramesonephric ducts develop in both male and female embryos
- Both the mesonephric and paramesonephric ducts end at the urogenital sinus part of the cloaca
- Mesonephric ducts is also known as Wolffian duct
- Paramesonephric duct is also know as the Mullerian duct
mesonephric duct
wolffian duct- male
paramesonephric duct
mullerian duct- female
male reproductive system
sex determining gene carried on Y chromosome
- testosterone produced which maintains the mesonephric duct (wolffian duct)
- mullerian inhibiting factor produced- paramesonpheric duct regresses
female reproductive system
no testosteorne produced- mesonephric ducts disintegrate
no MIH produced - paramesonephric (mullerian) ducts maintained
testosterone treated women
- Exogenous androgen
- Supports wolffian duct
- But no testis- therefore no MIH
- Therefore mullerian ducts develops
androgen insensitive male
Androgen Insensitivity Syndrome
Receptors for testosterone don’t work
Wolffian ducts don’t survive
But MIH present so Mullerian ducts degenerate
Development of the ductal systems- summary
- Mesonephric duct functions in both male and female embryos as duct of the embryonic kidney
- Paramesonephric (Mullerian) ducts appear in both
- Mesonephric duct ceases to be of use to the urinary system and will degenerate unless testis-derived testosterone is present- wolffian pathway
- Paramesonephric duct regresses in the present of testis-derived MIH
external indifferent stage
Genital tubercle (FT)
Genital folds
Genital swelling
External genitalia – male
In male the genital tubercle elongates and genital folds fuse to form the spongy urethra
GT develops into glans penis
Influence of testis- derived androgen hormones- dihydrotestosterone
External genitalia – female
No fusion occurs in the female
Development of labia majora and labia minora
Genital tubercles develops into clitoris
Urethra opens into the vestibule
colon should be on the …….. hand side
right
small intestine should be on the
left hand side
reversed rotation: midgut development problem
1 x 90 degrees rotation clockwise
Transverse colon behind the SI
omphalocele
- When the herniation fails to return to the abdominal cavity in week 10
- Herniated contents still remain within the umbilical cord
-
Midgut structures still covered with peroneal covering
- Not exposed to amniotic fluid
- Mortality is high due to other developmental abnormalities
gastroshisis
midgut development problem
- Failure of abdominal wall to form anteriorly due to incomplete lateral folding
- Defect in abdominal wall through which abdominal viscera can permeate
- Not covered in peritoneum
- Exposed to amniotic fluid
- Negatively effects gut development
- May not fit in abdominal cavity
- Fewer developmental defect than omphalocele so mortality rate lower
urorectal septum
- descends caudally, separates the cloaca into an anterior urogenital and a posterior anorectal space
- urogenital space is a wedge of mesoderm that continues to descend until we have completely separated urogenital and anorectal spaces
summarise Ph A1 cartilage
mechels cartilage
Maxillary cartilage (first bump)
- Gives rise to incus
Meckel’s cartilage (second bump)Mandible cartilage
- Gives rise to malleus
- trigmeninal nerve associated- muscles of mastication*
summarise Ph A2
Reichert’s
- Stapes
- top of hyoid
facial nerve- muscles of facial expression
summarise Ph A3
- remainder of the hyoid
- glossopharnagel*
- Stylopharangeus
- internal carotid*
summarise Ph A4
Cartilage of the larynx
Thyroid cartilage
- vagus*
- aorta*
- Pharyngeal constrictors
- Cricothyroid
summarise PhA6
Cartilage of the larynx
- vagus*
- pulmonary arch*
atorvostatin vs simvastin
atorvostatin –> first lines
simvastatin–> pushes towards DM but more effective
Simvastatin is a prodrug activated by first pass metabolism – t1/2 around 2h
- taken at night
Atorvastatin is active- first pass metabolism- also active derivatives- t1/2 around 24h
A 32 year old woman who has missed her last period has been feeling sick in the mornings, tired, and is needing to pass urine more often. The woman takes a pregnancy test which comes back positive.
Where does fertilisation of the ovum usually occur?
Ampulla region of a Fallopian Tube
Fertilisation of the ovum occurs within the fallopian tube.
Implantation of the fertilised ovum then occurs at the posterior uterine wall.
biochemist studying the function of the enzyme glucokinase fits a graph of experimental data using the Michaelis-Menten equation.
Which option represents this equation ?
C
Which term describes the distance between cells at the same stage of spermatogenesis down the length of the seminiferous tubule?
The spermatogenic wave.
Note: The Spermatogenic cycle is different from the spermatogenic wave and is defined as time taken for reappearance of the same stage within a given segment of tubule (~16 days in human).
fracture types
With respect to fatty acid catabolism, which enzyme facilitates the activation of fatty acids by linking coenzyme-A?
Fatty acyl CoA synthase.
An electrophysiologist studying the function of the CFTR protein characterises the functional consequences of a gene mutation which results in a negatively charged amino acid being mutated to a positively charged amino acid.
Which mutation did the electrophysiologist characterise?
Glutamic acid (D) to Lysine (K)
