LO Related (Part 1) Flashcards
Disadvantages the screening
Longer morbidity when prognosis is unaltered
Potential over treatment of abnormalities
Resource cost
False reassurance from false negatives
Anxiety from false positives
Hazard of the sreening test
Term in pregnancy
37-42 weeks
40 weeks on average
What anti epilieptic durg should be stopped during pregnancy
What if it isnt suitable to stop this drug?
Valproate
If cant then increase the dose of folic acid
Why are pregnant mothers usually given magnesium sulphate
Evidence that it aids neurological development
White blood cell with a kidney shaped nucleus
Monocytes
What is the exon-intron boundary AKA
Consensus sequence
White blood cell identification
- Second most common
- Large circular nucelus
- Some granuels
Lymphocytes
White blood cell identification
- Distinctive 3-5 lobed nucleus
Neutrophil
How many lobes of nuclei do eosoinophils have
Two
What does the APGAR score look at
What is is scored out of
What is a normal score
Tone/activity Colour Breathing HR Reflexes
Out of 10 (rare to get a 10)
Get worried if less than 5
Why are basophils so names
Describe their appreance
They are basophilic (stain blue) with a bilobed nucleus
Also contain granules (likely to contain histamine)
How should you describe the risk of a baby having downs syndrome
SHould really say that CHANCE
How is the chance of a baby having DS calculated
Screening results plus the age of the mother
How many babies born with DS
1 in 800
Most common downs syndrome screening
Nuchal translucency and blood tests (combinesd)
These are offered to ALL eligible mothers between 10-20 weeks **usually at week 11-13
When are the TRIPLE and QUADRUPLE tests
When are they used?
How do they compare to the nuchal transluency and combined test
TRIPLE - 14 wks
QUADRUPLE - 20 weeks
Have lower detection rates
NICE guidance regarding who gets which DS screen
IN FIRST TRIMESTER
Combined test
IN SECOND TRIMESER
Triple or quadruple test
Two diagnostic tests for DS
When are they performed
What are the rates of miscarriage
CHORIONIC VILLUS SAMPLING
(10-13 weeks)
(1-2% miscarriage risk)
AMNIOCENTESIS 15 weeks (0.5-1% miscarriage risk) If done at 14 weeks risk doubles
What is NIPT
What are the controversies around this
Non invasive prenatal testing
Testing the blood for cell free foetal DNA
High detection rate
BUT NEED TO HAVE AMNIOCENTESIS BEFORE A TERMINATION IS ABLE TO OCCUR
When is pregancy termination legal?
1) life of mother in danger
2) foetus have severe abnormalities
3) mental/physical health of mother will be harmed
4) other children will be harmed
MUST BE BEFORE 24 WEEKS (2 doctors required)
This is not the case if 1) or 3) apply (mothers life in danger, or mental/phys health may be harmed)
What is CHRONIC GRANULOMATOUSE DISEASE
X-linked mutation affecting NADPH OXIDASE
Defect in neutrophils and oxidative burst
Patients get severe bacterial infections and usually require life-long antibitoics
Complement regulatior proteins
Factor H and I (break down C3b)
C1INH
CFHR-1 (inhibits C5 converatase)
membrane cofactors which breakdwon C3b and C4b
Effects of genetic defects in C1-C4
Recurrent infection with pygenic bacteira
Effects of genetic defects in C5-C9
Failure to form MACs
Increases the suseptibility to N.Meningitiis
Common assocaited condiitons with downsyndrome
Hearing problems (80-90%) Eye problems (60%) Cardiac defects (40-50%) Higher prevalence of autism, leukaemia and thyroid issues
What is the medical model of disability
How does this compare the the social model of disability
MEDICAL MODEL - Disabillity is the problem the person has - and focusses on trying to improve this
SOCIAL MODEL - Frames the disability as a problem with society which contains environmental, social and organisational barries to those with disabilities
Example where drug absorption may be directly affected by GI contents
Tetracylines (MOA - inhibit tRNA binding) bind to milk and to antacids
3 enteral routes that AVOID first pass metabolism
Buccal
Sublingual
Rectal
For a 70kg man what do the following mean????
Vd 5L
Vd 10-15L
Vd 40-42L
Vd 5L (drug is confied to the plasma) e.g. insluin
Vd 10-15L (drug is confied to the interstitial fluid) e.g. mannitol
Vd 40-42L (drug is also in the intracellular fluid) e.g. ethanol
Why might you have an impossibly high Vd
if the drug is not evenly distributed in body compartments
I.e. it is being sequestered like FLUORIDE in BONE
What is ECTOPIA
The presence of differentiated cells in an abnormal location
E.g. ectopic pancrease in the wall of the small intestine
Two examples of metaplasia
CIGARETTE SMOKERS
Resp epithelium –> stratified squamous
GORD (BARRETS)
Oesoph (strat squamous) –> columnar glandular
% of DNA as INTRONS and EXONS
1.5% is exons
25% is introns
Small arm of chr =
Long arm of chr =
P = small arm
Q = long arm
Four breast cancer risk factoros
Early menache, late menopause
Medication containing oestrogen (OCP)
Environmental factors
Genetics
Also typical cancer RFs - obesity, diet, alochol, immunosuppp
What is the nottingham prognostic index
Assesses the chance of 15 year survival
BASED ON
TUMOUR SIZE, NODAL INVOLVEMENT AND GRADe
What should every women with suspected breast cancer be offered
TRIPLE ASSESSMENT
Breast exam
Mammography
Biposy
How many pairs of chromosos
23
Sarcoma is
Cancer arrising from connective tissue
What is SPIIKES
Method for BREAKING BAD NEWS
Setting Perception Invitation Knowlege Emotions Strategy and summary
What are the first set of nodes draining the breast (and thus the nodes that are most likely to be affected by breast cancer)
Sentinel nodes
What types of neurones are usually UNmyelinated
Autonomic
What might cause an increase in disease PREVALENCE
True increase in risk
Change in demogrpahic
Longer duration of living with disease
Artefacts
What is the metabolic syndrome
Combination of DIABETES, HYPERTENSION and OBESTIY this puts an indiv at hi risk of CVS disease
Main neuropeptide STIMULATING FEEDING
AGrP
Descirbe a low and VERY low calorie diet in terms of
CALORIES/DAY
EXPECTED WEIGHT LOSS IN 6 MONTHS
1000-1500 calories/day
Roughly 8% weight loss in 6 months
300-800 calories/day
Roughly 13% in 6 months
MOA ORLISTAT
Intestinal lipase inhibitor
What are the indications for bariatric surgery
BMI >40 or >35
Associated with severe health consequences and have not had sucess by other means
Aged 18-60
What are the (4) tiers of obesity management/referral
TIER 1 - health promotion to prevent future weight gain
TIER 2 - Lifestyle change for those who are overweight/obese
TIER 3 - Specialist services for obesity
TIER 4 - Surgery for morbid obesity
Define the clearance of a drug
Volume of blood from which the drug is cleared per unit time by a particular organ
What is the elimination rate of a drug
Ammount of drug cleared per unit time
Clearance x plasma concentration
Disadvantages to subcutaneous insulin injection
Injection
Systemic circ (liver exposed to less insluin)
Loss of negative feedback between glucose concentration and insluin secretion
MOA and effects
DOBUTAMINE
B1 agonist
Mimics Nadr and the SNS to inc HR and inc contract
Example of where the PSNS and SNS are complementary
Salivary glands - both cause saliva prodcution
PSNS - watery
SNS - thick
First line treatment for T2DM
Lifestyle changes
Metformin
Effects of metformin
LOWERS BLOOD GLUCOSE BY
- Increasing uptake and storage
- Reducing absorption in the SI
- Suppressing hepatic gluconeogenesis
SITAGLIPTIN
DPP4-i
LIRAGLUTIDE
GLP-1
What is the commonest form of blindness in working age people
Diabetic retinopathy
Why is the incidence of T2Dm increasing
Population growth
Ageing population
Longer survival
Western diets
When is metformin CId
What are common side effects
CI;d in people with reduced renal function who cant clear lactate or biguandies
Common S/E = GI upset and decreased absorption of B12
Rare SE = lactic acidosis
MOA pilocarpine
Muscarinic agonist
So reduces occular pressure and can be used to treat glaucoma
Adherence =
Extent to which a patients behaviour corresponds with the doctors reccomendation
MOA Atropine
MAChr antagonist
Reduces secretion before surgery ALSO decreases HR
Catabolism is
Breaking of large –> small
CN III
Occulomotor
Why are sulfonylureas not commonly used
Risk of hypo
Describe how lipids can be metabolised to ACoA for use in the Krebs cycle
Lipases break up into glycerol and FAs
FATTY ACIDS - go through B-oxidation in Mt matric to form ACoA
GLYCEROL - forms glycolysis intermediate
COMPLIANCE =
Degree to which patients obeys the recommendations of a doctor
S/Es of glicasides
Weight gain
Fluid retention (oedema)
Also heart failure and anaemia
MOA Prazosin
Alpha 1 antag
Blocks NADr
used in resitant hypertension
Where are a2 adrenoreceptors found
Presynaptic memebrane
To inhibit any further neurotransmitter release
Tamulosin MOA
A1 blocker
Relaxes smooth muscle in the bladder - used in prostate enlargement to control urination
What is an adenocarcinoma
Cancerous tissue of glandular tissue
What are two types of opsonins
Immunoglobulin and C3b
5 clinical features of inflammation
Red Pain Heat Swelling Loss of function
What are the main cell types involved in chronic inflammation
Lymphocytes and macrophages
What is PIGEON FANCIERS DISEASE
A type of HYPERSENSITIVITY PNEUMONITIS caused by bird droppings
The luungs become inflammaed with granuloma formation
How many anterior ribs should be seen on a CXR
5-7
Omalizumab MOA
Binds and sequesters IgE
this REDUCES mast cell DEGRANULATION
What chemokines can cause vascular dilation and increased vascular permeability
Histamine
Prostaglandins
What in an FBC could indicate asthma
Increased eosinophils
When is a LABA only taken
When ALREADY taking INHALED CORTICOSTEROIDS
When is the intrapulmonary pressure negative
Inspiration
Why do COPD sufferers used PURSED LIP breathing
They have lost elastic recoil in the lungs
They are trying to INCREASE THE PRESSURE in TERMINAL BRONCHIOLES
What is the triad for the diagnosis of pneumonia
EVIDENCE OF INFECTION
SIGNS AND SYMPTOMS LOCALISED TO RESP TRACT
NEW OR CHANGED INFILTRATE ON CXR
What gram class are NITRIMIDAZOLES most effective against
Gram +ve
Trachea will deviate AWAY from what?
Tension pneumothorax or a pleural effusion
First line treatment for sinusitis
Amoxicillin
What is Vc
FOR VACCINATIONS
Percentage of the population that need to be vaccinated to eradicate a disease
1- 1/R0
What is the first line PNEUMONIA antibiotic that should be given WITHIN 4 HOURS of admission
Penicillin and a macrolide
What is an epitope
Small defined region of an antigen to which the antibody binds
What are the THREE methods of BACTERIAL GENE TRANSFER
Transference (plasmids)
Transduction (phage)
Conjugation (sexpillus)
What vaccine type confers a strong humoural and strong cell mediated response?
Live attenuated
What cell type is required for CLASS SWITCHING
Th cells
Give an example of a macrolide
ErythroMYCIN
What types of VACCINE confer STRONG HUMORAL but WEAK CELL MEDIATED responses?
Sub unit vaccine
Inactivated
Why is T cell INDEPENDENT B cell activation less good
No class switching Less memory cells
What is an exotoxin
Proteins that are SECRETED by gram +ve or -ve bacteria
In T cell DEPENDENT B cell activation
What are the two signals
1) Bidning of an antigen to B cell receptor
2) Presence of activated Th cell which has recognised the same antigen
MAX O2 with a venturi mask
What is the advantage of a venturi mask
60% O2
More precise
What can a diffusion limitation result from?
Low inhaled O2
Impared alveolar interface
What is the HALDANE effect?
Deoxygenation of the blood increases its ability to carry CO2
What would cause an increase V/Q
PE
Area of the lung that is ventilated but not perfused
(As Q tends to 0, V/Q will tend to infinity)
Location of a chest drain
5th intercostal space in the mid axillary line
IN THE TRIANGLE OF SAFETY
How is CO2 transported in the blood
Most as bicarbonate
Some as carbamino compounds
A little as dissolved CO2
How much O2 can be given using a NON RE-BREATHER mask
Up to 90%
There is also a one way valve - THIS MEANS THE PATIENT IS NOT REBREATHING THE CO2
What forms when H+ react with Hb
Why is this useful?
HHb - this is less acidic and is a BETTER PROTON ACCEPTOR
This FACILITATES THE LOADING of CO2
What causes a rise in the hemidiaphragm
Volume loss in the lung above
Adverse effects of oxygen
IT IS MOSTLY SAFE
Fire
Toxic in large ammounts
In CO2 retainers it can cause a reduced respiraotry drive
With a simple face mask how much O2 can be given
5-15L/min (this is around 30-50%)
What does a RAISED ANION GAP show
Presence of non-volatile acids e.g. lactic acid and ketoacids
Treatment for type 2 respiratory failure
Controlled O2 therpay
Need to treat the underlying cause
