Learnt in past papers Flashcards
Role of BUB
Is dissociated from chromatid to commence anaphase
Role of CENPE
Senses tension in chromatid
Role of CHKE1 and 2
Anticancer therapy arresting cell at G2
How can carcinoma prognosis and invasive ability be assessed
Degree of cell-cell adhesion
When to give platelet concentrations
haematology patients with bone marrow failure (if platelets <10 x 109/L)
Massive bleeding or acute DIC
If very low platelets and patient needs surgery
If for cardiac bypass and patient on anti-platelet drugs
When to not give platelet concentrations
Autoimmune thrombocytopenia
2 examples of reduced survival of platelets
Autoimmune thrombocytopenia
DIC
Presentation of beta thalassaemia
○ Profound anaemia thalassaemia
○ Failure to thrive
○ Malaise
○ Splenomegaly
All in first year of life
Treatment for beta thalasaemia major
Lifelong transfusion
iron chelating agent
Risks of life long infection
Viral infection in particular Hep C
Causes of liver cancer
Hep C. Chronic Hep. B Alcoholism Aflatoxin B1 (aspergillus flavus) Haemochromatosis Diabetes Obesity Drugs & Medication Steroids Oestrogens
Liver cancer pathophysiology
Hepatitis infection > becomes chronic if untreated > inflammation > cirrhosis > dysplastic lesions >clonal selection > hepatocellular carcinoma
Example of initial signalling protein
Grb2
How do cells go from benign to malignant
Disassembly of the cell-cell contact
Loss of polarity
Increased motility
Release of MMP to break down the extracellular matrix
Problems with metastases
Worse prognosis
Hard to resect
5 steps for investigating outbreak
Preliminary Investigation Case definition and identification Descriptive study Analytic study Control
Drugs given with transplant
Tacrolimus - inhibit t lymphocyte signal transduction (CNI inhibitor)
Cyclosporin - inhibit t lymphocyte signal transduction (CNI inhibitor)
Rapamycin - inhibit t lymphocyte signal transduction (mTOR inhibitors
Azathioprine - antiproliferative agent - purine synthesis inhibitor
Corticosteroids
Risks of immunosuppression
1) Increase risk of getting infection both conventional infections and opportunistic
2) Activation of dormant pathogen such as TB due to immunosuppression
3) Cardiovascular morbidity and mortality
4) Azathioprine - side effects include nausea, vomiting anaemia and Cyclosporin - side effects include convulsions, pancreatitis, kidney and liver dysfunction
5) Increase risk of malignancy
Blood film iron deficiency anaemia
Anisocytosis, Poikilocytosis, Hypochromasia, Pencil Shaped RBC
Drugs that cause iron deficiency anaemia
NSAIDS
Fluoroquinalone
Advantages and disadvantages of PCR, electron microscope, cell culturing and immunofluorescence
PCR; advantage; able to work out viral load. Also highly sensitive method (low rate of false negatives) used to detect specific sequences of nucleic acids. Disadvantage; prone to contamination
Electron microscope; able to visualise the viral structure disadvantage; expensive? Not highly specific?
Cell culture; able to see viral susceptibility to drugs ( useful for phenotypic antiretroviral susceptibility testing) disadvantage;slow and time-consuming
Immunofluorescence - useful for direct detection of viral antigens in clinical setting. used for typing and cell culture confirmation, rapid and inexpensive. Disadvantage - subjective and dependant on skill of technician and quality of sample
Advantages and disadvantages of molecular techniques and culture
Culture: advantage; figure out which antibiotic to use (test for antimicrobial resistance). Disadvantage; it takes about 24 hrs to grow the bacteria and another 24 hrs to do the susceptibility testing.
Molecular techniques: advantage; rapid and sensitive (low level of false negatives). Disadvantage; myriad of resistance genes.
Tacrolimus side effects
side effects include cardiac damage, nephrotoxicity, lung damage, increased chance of malignancy
Side effects rapamycin
Lung toxicitiy
Diabetes M
Side effects azothyoprine
nausea, vomiting anaemia
Side effects corticosteroids
Cushings
Side effects cyclosporin
side effects include convulsions, pancreatitis, kidney and liver dysfunction
How can proto-oncogene become oncogene
Amplification of gene
Point mutation
Insertion
Creation of fusion gene
Classes of proto-oncogenes
Cyclin D
C-myc
Ras/raf
EGFR
Why do you need 2 mutations for TSG
Even with 1 the other can still function
Features of thrombocytopenia
Superficial bleeding into skin, mucusoal membranes, spontaneous bleeding, epistaxis, easy bruising, petechiae
How are platelets formed
Granulation of megakaryocytes
Aspirin MOA
Irreversible COX 1 inhibitor - prevents thromboxane from being produced by platelets as platelets don’t have nuclei so can’t make more enzyme.
Uses of aspirin
Use as antithrombotic in arterial thrombosis, acute coronary syndrome -STEMI and NSTEMI, atrial fibrillation
Why give red blood cells rather than full bood
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
Why are red blood cells stored at 4 degrees
Preserve them
Reduced infection
What are ESCAPE bacteria
Cause hospital acquired infections
3 things causing anaphylaxis
Food
Insect bite
Medicine
Describe f actin structure
Filamentous
Soluble chain of G actin monomers
What happens in anaphylaxis
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
How does fluoride oxalate work
Inhibits glycolysis preventing glucose uptake
Things looked for when grading a tumour
Abnormal growth pattern
Loss of uniformity
Deeply staining nuclei
Variation in shape/size
Things for when staging a tumour
Site of tumour
Size of tumour
Sites of metastases
Lymph node involvement
Sequence to carcinogenesis
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.
4 common resp infections
Mycobaterium tuberculosis (Gram +ve) streptococcus pneumoniae (Gram +ve) Haemophilus influenzae (Gram -ve) Legionella pneumophila (Gram -ve)
2 types of cervical cancer
Squamous cell carcinoma
Adenocarcinoma