Learnt in past papers Flashcards

Question

Side effects azothyoprine

Answer 1

nausea, vomiting anaemia

Answer 2

side effects include convulsions, pancreatitis, kidney and liver dysfunction

Answer 3

Amplification of gene Point mutation Insertion Creation of fusion gene

Answer 4

Cyclin D C-myc Ras/raf EGFR

Answer 5

Even with 1 the other can still function

Answer 6

Superficial bleeding into skin, mucusoal membranes, spontaneous bleeding, epistaxis, easy bruising, petechiae

Answer 7

Granulation of megakaryocytes

Answer 8

Irreversible COX 1 inhibitor - prevents thromboxane from being produced by platelets as platelets don’t have nuclei so can’t make more enzyme.

Answer 9

Use as antithrombotic in arterial thrombosis, acute coronary syndrome -STEMI and NSTEMI, atrial fibrillation

Answer 10

1) Avoid fluid overload (potential heart failure) 2) More efficient - less is wasted because patients may not need all the components 3) Some components degenerate quickly if stored as whole blood ● Putting blood in the fridge is NOT good for the coagulation factors ● The fridge is also not good for preserving platelets

Answer 11

Preserve them | Reduced infection

Answer 12

Cause hospital acquired infections

Answer 13

Food Insect bite Medicine

Answer 14

Filamentous | Soluble chain of G actin monomers

Answer 15

Allergens stimulate anaphylaxis via IgE antibodies. Type 1: Immediate hypersensitivity ○ IgE antibody produced ○ Antigen cross-links IgE on the mast cells and basophils ○ This leads to degranulation of IgE sensitised mast cells and release of inflammatory mediators Cardiovascular collapse, vomiting, diahorrea. Respiratory effects are bronchospasm and laryngeal oedema - contraction of bronchial smooth muscle and constriction of the muscles around the throat and endothelial cells within the membranes of the blood vessels move apart so you get a lot of fluid moving into the tissues Skin effects are vasodilation, erythema, urticaria and angioedema

Answer 16

Inhibits glycolysis preventing glucose uptake

Answer 17

Abnormal growth pattern Loss of uniformity Deeply staining nuclei Variation in shape/size

Answer 18

Site of tumour Size of tumour Sites of metastases Lymph node involvement

Answer 19

There is damage or random mutation in the cells that affect cell proliferation pathways. They become permanently switched on (oncogenes)and lose the ability to apoptose (tumour suppressor genes). They proliferate uncontrollably, even without external stimulation, and often remain poorly differentiated. They can also gain the ability to become invasive via loss of anchorage-dependence and can spread away from the primary cancer site.

Answer 20

``` Mycobaterium tuberculosis (Gram +ve) streptococcus pneumoniae (Gram +ve) Haemophilus influenzae (Gram -ve) Legionella pneumophila (Gram -ve) ```

Answer 21

Squamous cell carcinoma | Adenocarcinoma

Answer 22

``` Enterococcus faecium (+) Staphyloccocus aeureus (+) C. Difficile (+) Clostridium Difficile Acinetobacter baumannii (-) Pseudamonas aeruginosa (-) E. coli (-) Escherichia ```

Answer 23

``` Naked eye examination Culture for bacteria on agar Microscopy to look for cysts Parasite staining Toxin detection Antigen detection (EIA) PCR Test for Salmonella: XLD (xylosine lysine deoxycholate) agar goes bright pink or red colour and bacteria produces hydrogen sulfide so forms black colonies on agar. Campylobacter: incubate sample at 42 degrees ```

Answer 24

Any abnormalities - Appearance, culture results, any sensitivity test results Tests carried out and findings of each test If there was an infection and if so the type of bacteria How much infection there was (number of bacteria).

Answer 25

Immunosuppression

Answer 26

Anticipatory vomitting

Answer 27

1j of energy per kg of tissue

Answer 28

Cisplatin – adds a platinum group to guanine, causing DNA interlinks and intralinks. The DNA is unable to uncoil at replication and therefore undergoes apoptosis. Bevazizumab - VEGF-R

Answer 29

Cdc42 promotes filopodia – polarised activity and actin polymerisation Rac promotes lamellipodia – actin polymerisation and branching. Rho promotes stress fibres – tension and contraction Lammellipodia are thin like sheets of polymerised actin that are used to project the front of the cell forward. Filopodia are finger like projections that also move forward and are used in combination of lamellopodia to extend the cell. Stress fibres are contracted and are used to drag the cell forwards. They are anchored on focal points (ie points of anchorage at the front of the cell).

Answer 30

Tumour cells lose their anchorage dependent and cell-cell adhesion and are consequently able to migrate and invade uncontrollably.

Answer 31

To check for primary liver cancer To investigate for cirrhosis To check for liver infection To detect presence of metastasis

Answer 32

Whole blood may cause fluid overload Only need RBCs There’s a shortage of blood, so why give clotting factors when they’re not needed.

Answer 33

A universal donor has blood type O-. This means they have no A or B antigens or Rh-D antigens so it can be given to any blood type as there are no antigens in the blood so it will not cause a haemolytic reaction in the recipient that may contain antibodies (anti-A or anti-B or anti-D) Potential problems with this - there are hundreds of red cell antigens on membranes (C, c, E, e etc) and 12-15% of them are clinically significant but are not matched for when giving transfusions. Therefore, a patient on a prior transfusion may have developed an antibody to one or more of these antigens. This can lead to a delayed haemolytic reaction

Answer 34

Allergen presentation via dendritic cell to Th 2 cells. These then cause degranulation of eosinophils by releasing IL-5 Th2 cells also release IL-4 and IL-13, which stimulate the production of IgE by plasma cells The IgE then becomes mobilised onto the surface of mast cells The antigens then cross-link with the IgE on the surface of the mast cells and cause degranulation Degranulation causes histamine, cytokines, toxic proteins, leokotrienes and prostaglandins to be released. These cause vascular leakage → airway oedema, mucus secretion and smooth muscle contraction arounf bronchi → bronchoconstriction

Answer 35

SOB Mucous production leading to cough Wheezing Chest tightness

Answer 36

Spontaneous bleeding Nosebleeds Prolonged bleeding

Answer 37

1) Molecular mimicry of other molecules 2) induction of co-stimulatory molecule or inappropriate MHC class II expression -> proinflammatory environment, 3) failure in regulation -> effects on regulatory T cells, 4) immune deviation -> shift in type of immune response eg Th1 to Th2

Answer 38

Many other flora bacteria in faeces

Answer 39

``` Macrocytosis Hyper-segmented Neutrophils Anisocytosis and poikilocytosis Low Hb, platelets and WCC Giant Metamyelocytes Howell Jolly bodies ```

Answer 40

Haemophilia | Type 1 vWb disease

Answer 41

Breast, Prostate, Lung

Answer 42

Degree of differentiation, number of mitotic bodies, pleomorphism, integrity of cells, necrosis

Answer 43

Lung cancer - can secrete ACTH -> cushing's | Thyroid cancer - secrete thyroxine -> thyrotoxicosis

Answer 44

Bilirubin | Albumin

Answer 45

A lower pH, as in metabolically active tissues, lowers the oxygen affinity of Hb and facilitates the downloading of O2 to tissues. HbA can carry up to 4 oxygen molecules. This is referred to as different liganded states. The main function of Hb is the carriage of oxygen from the lungs to metabolically active tissues. To facilitate this, the Hb can exist in two spatial configurations. Deoxy haemoglobin exists in a tight configuration and has a relatively low affinity for oxygen. Oxygen molecules are taken up sequentially by the 4 haem groups. At some point the partially liganded Hb molecule switches to a relaxed configuration which has a markedly higher affinity for oxygen.

Answer 46

O neg, no A, B or D antigens on RBC surface

Answer 47

Infertility | Gynaecomastia

Answer 48

PSA is normal part of seminal fluid, only released into serum upon damage to prostate, such as in prostate cancer, thus causing elevated levels PSA

Answer 49

Mutation allows the prostate to respond to anti-androgens and oestrogen. Upregulation of androgen receptors in response to low levels of circulating androgen and other weak androgens or by co-stimulatory molecules. Also decreased levels of co-repressors of the prostate.

Answer 50

Assesses chromosome stability ext environment cell size

Answer 51

cell size ext environment correct and complete DNA replication

Answer 52

``` Hemophilus influenzae (Gram -) Neisseria meningitidis (Gram -) Streptococcus pneumoniae (Gram +) clostridium tetani corynebacterium diphtheriaea ←is this not clostridium diptheriae? Salmonella typhi Bacillus anthracis Bordetella pertussis ```

Answer 53

Polycythaemia

Answer 54

Penicillin ● Should be started at 3 months of age to reduce the risk of life-threatening pneumococal infection Vaccination ● Against the organisms that individuals with hyposplenism are susceptible to Monitor Spleen Size ● Splenic sequestration is a potential cause of death in young people (repetitive vaso-occlusive damage from infarction from early life) ● Parents can be taught how to monitor spleen size Prophylaxis against pneumococcal infection ● Risk of recurrent stroke in children with sickle cell anaemia is very high so they should keep having regular transfusions Induction of HbF HYDROXYUREA (Hydroxycarbamide) ● This is cytotoxic - it is a ribonucleotide reductase inhibitor ● It induces the production of red cells in the bone marrow that mainly contain HbF ● This means that, over time, there will be an increase in the number of red cells that are UNABLE to sickle ● It will also have other effects such as reducing the adhesion to the vascular endothelium

Answer 55

Low affinity for oxygen so releases it to tissues meaning less EPO released Free Hb from intravascular haemolysis

Answer 56

Hyperuricaemia esult of the release of cellular contents of dying cells into the bloodstream from breakdown of cells after cytotoxic therapy or from cancers with high cell turnover and tumor proliferation rates result in nausea and vomiting, acute kidney failure, seizures, cardiac arrhythmia, death

Answer 57

Increased pressure in bone marrow

Answer 58

Reduced production of other cells

Answer 59

PSA not only released by prostate cancer, elevated levels can be due to other reasons so this may cause undue anxiety while they wait for further, invasive, investigations A raised PSA will cause further invasive tests to occur, and cause acute anxiety for patient. If cancer is detected will undergo treatment - has unpleasant side effects - decrease quality of life. However if leason was left alone may not have affected man in his lifetime.

Answer 60

T cell hodgkins lymphoma

Answer 61

Parasites | Autoimmune

Answer 62

TCR gene recombination

Answer 63

Schilling | Romberg

Answer 64

Rhinovirus

Answer 65

Haemolysis of RBCs

Answer 66

Plasma contains clotting proteins, serum does not contain clotting proteins

Answer 67

1. Cell culture 2. Electron microscopy 3. Immunofluorescence (IF) 4. Enzyme immuno assays (EIA) 5. Viral genome detection and quantification – PCR

Answer 68

Bedside examination with the naked eye: is the specimen clear, cloudy, haemorrhagic etc. ● Microscopy: the cell types that may be present include white blood cells (high concentrations indicate infection), red blood cells, epithelial cells etc. Crystals and casts may also be present. ● Culture on agar: urine should be sterile so any growth may suggest infection. ● Quantitative colony count: for significant bacteruria of >105 bacteria/mL. ● Antibiotic sensitivity testing: for any bacterial growth.

Answer 69

1. To determine the cause of death of a patient. 2. To explain why treatment for the patient was unsuccessful. 3. To show the spread of disease. 4. To educate doctors regarding disease processes.

Answer 70

1. Antisera from immunised animals. 2. Monoclonal antibodies. 3. Genetically engineered antibodies.

Answer 71

Detects abnormalities in the fibrinogen to fibrin conversion

Answer 72

1. Immunophenotyping – test for light chain restriction. | 2. Test for gene rearrangement using Southern Blot analysis.

Answer 73

1 Folic acid 5mg / day To compensate for the short RBC lifespan, RBC turnover may be increased, depleting stores of folic acid. 2 Vaccination To protect against pneumococcal infection (normally dealt with by the spleen; hyposplenism is a feature of sickle cell anaemia). 3 Penicillin prophylaxis To prevent some of the infections caused by hyposplenism 4 Monitoring spleen size To check for future splenic sequestration

Answer 74

● Capsule - S.pneumoniae ● Endospores - clostridium, bacillus ● Biofilms - pseudomonas aeruginosa, staphylococcus epidermis ● Neurotoxins - tetanus, botulinum ● Enterotoxins - infectious diarrhoea (V. cholera, E. coli, C. Jejuni, etc ...), food poisoning (S. aureus, B. cereus) ● Pyrogenic exotoxins - S. Aureus, S. pyogenes ● Tissue invasive exotoxins - S. Aureus, S. pyogenes, C. perfringens ● Endotoxins - any gram negative bacteria

Answer 75

``` Cephalosporins Inhibit peptidoglycan synthesis by inhibiting the activity of penicillin binding proteins Extended spectrum beta lactamase cleaves cephalosporins Carbapenems Inhibit peptidoglycan synthesis by inhibiting the activity of penicillin binding proteins Carbapenemase enzyme encoded on a transposon which cleaves carbapenem Methicillin Inhibit peptidoglycan synthesis by inhibiting the activity of penicillin binding proteins Expression of additional penicillin binding proteins such as PBP2A 13 Vancomycin Inhibit peptidoglycan synthesis by binding to a peptidoglycan precursor Multiple proteins synthesised by genes carried on a plasmid or transposon resulting in the synthesis of different peptidoglycan precursors ```

Answer 76

1. Hide the PAMP to avoid detection 2. Interfere with host gene expression/protein synthesis no ISGs made 3. Blocking interferon induction cascades 4. Inhibiting interferon signalling 5. Block the action of individual interferon induced antiviral enzymes specifically 6. Activate SOCs genes 7. Replication strategy insensitive to IFN, i.e. too quickly for IFN to work

Answer 77

1) Vaccines: if we block the ability of viruses to control the interferon response they become attenuated, and thus can be used in vaccinations. 2) Influenza therapy: interferon lambda receptors are only present on epithelial surfaces. Since this is where influenza grows, interferon lambda could potentially be used as influenza therapy with lesser systemic side effects than type 1 interferons, which bind to many cell types. 3) Cancer therapy: cancer cells are deficient in interferon so viruses are able to grow well in them. Viruses could therefore be used to lyse cancer cells, without harming healthy cells.

Answer 78

Protozoa Metazoa Single-celled Multicellular Do not produce eosinophilia in the host Forms which invade the blood often cause eosinophilia

Answer 79

``` Acute ● Mast cell activation and degranulation ● Release of preformed histamine and newly formed prostaglandin and leukotriene ● Features: o Vascular leakage o Mucosal oedema, mucous secretion and smooth muscle contraction leads to acute, reversible airway narrowing Chronic ● Th2 lymphocyte and eosinophil activation ● Features: o Inflammatory cellular infiltration o Tissue damage o Epithelial cell shedding o Sub-epithelial fibrosis o Smooth muscle hypertrophy o Mucus pluggin ```

Answer 80

Failed organ / tissue Reason for failure 1. Cornea 2. Skin 3. Kidney 4. Liver 5. Heart 6. Lungs 7. Pancreas 8. Bone marrow 9. Small bowel 1. Degenerative disease, infections, trauma 2. Burns, trauma, infection 3. Diabetes, hypertension, glomerulonephritis, hereditary conditions 4. Cirrhosis, acute liver failure 5. Coronary artery/valve disease, cardiomyopathy, congenital defects 6. COPD, interstitial fibrosis, cystic fibrosis, pulmonary hypertension 7. Type I diabetes 8. Tumours, hereditary diseases 9. ‘Short gut’, Crohn’s, vascular disease etc

Answer 81

Acquired inability to respond with an immune reaction to an antigen to which the organism usually responds

Answer 82

1. Anergy: an absence of costimulation for naïve T cells results in a refractive state so that cell proliferation and factor production cannot proceed. 2. Ignorance of antigen: occurs in immunologically privileged sites where immune cells cannot normally penetrate, such as the eye. 3. Suppression by regulatory T cells: autoreactive T cells are present but controlled by ‘regulatory’ T cells to prevent them from responding to autoantigen.

Answer 83

1. Molecular mimicry of self molecules 2. Induction of co-stimulatory molecules 3. Induction of inappropriate MHC II expression 4. Failure of regulatory T cells 5. Shift in the immune response from Th1 to Th2 6. Tissue damage at immunologically privileged sites leading to ‘leakage’ of antigen

Answer 84

● A mutation in the coding sequence (point mutation or deletion) leading to an aberrantly active protein. ● Gene amplification leading to multiple gene copies and overproduction of the normal protein. ● Chromosomal translocation: an inappropriate piece of one chromosome is joined to another chromosome e.g. a ‘strong enhancer’. ● Insertional mutagenesis: a virus inserts its genome into the host, which fuses to actively transcribed gene leading to overproduction of a protein or the fusion protein itself is overactive.

Answer 85

``` Cancer ● Chronic inflammatory diseases ● Diabetic retinopathy ● Cardiovascular disease ● Psoriasis ● Vascular malformation ```

Answer 86

Wound healing Embryo Menstrual cycle