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BM4 Year 1 - Quizlet Cards > LO Related (Part 3) > Flashcards

LO Related (Part 3) Flashcards

1
Q

What is ECOLOGICAL FALLACY

A

Error that arises when information about groups of people is used to make inferences about individuals

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2
Q

Causes of a raised anion gap metabolic acidosis

A

Severe kidney dysfunction

Ketoacidosis

Ingestion of acid

Lactic acidosis

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3
Q

Describe the two theories that allow AUTOREGULATION of GFR

A

MYOGENIC - contraction and relaxation of the afferent arteriole that results from the the ammount of strech caused by systemic BP

TUBULOGLOMERULAR - Macula densa cells in contact with the JGA monitor Na content can can relase vasoactive mediators

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4
Q

What drugs can IMPAIR RENAL FUNCTION

A

NSAIDS
ACEi/ARBS
Cyclosporin
Aminoglycoside antibitiotcis (e.g. gentamycine)

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5
Q

What is BIAS

A

Systematic DEVATION from the TRUTH

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6
Q

What is a CONFOUDNING VARIABLE

A

A factor other than the independent variable that may produce detectable results

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7
Q

FOUR phases of a CLINICAL TRIAL

A

Phase 1 - safety - small numbers of health patients

Phase 2 - large numbers of disease individuals

Phase 3 - full scale evaluation compared to the standard treatment

Phase 4 - post marketing surveillance

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8
Q

What is the creatinine clearance rate

What is it useful for?

A

Volume of blood plasma that is cleared of creatinine per unit time

This is a useful measure for approximating GFR

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9
Q

Creatinie clearance provides OVER/UNDER estimate of GFR

A

Over

There is some Cr secretion into the filtrate

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10
Q

Causes of pre-renal AKI

A

Hypovolaemia

Decreased renal perfusion

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11
Q

Causes of intra-renal AKI

A

Direct damage to the kidneys via inflammation, drugs and infections

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12
Q

Cloudy and lumpy urine can be a sign of

A

UTI

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13
Q

Acute complications of AKI

A

Fluid retention

Hypercalaemia

Increased urea and creatinine

Metabolic acidosis

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14
Q

Criteria for RRT (renal replacement therapy)

A

Worsening hyperkalaemia

Worsening acidosis

Fluid overload

Symptomatic uraemia

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15
Q

Strenghts and weaknesses of a CROSS SECTIONAL STUDY

A

+ fast, inexpensive, no loss to follow up, good for looking at prevalence

  • cant est causation, difficult with rare diseases
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16
Q

Strengths and weaknesses of a CASE CONTROL study

A

+ fast, inexpensive, good for rare disease

  • recall bias
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17
Q

Stengths and weaknesses of a COHORT study

A

+ assess multiple outcomes/exposures, demonstrate causality

  • time consuming, expensive, not good for rare diseases
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18
Q

What is the role of the 3 consitiutent parts of the FILTRATION BARRIER

A

CAP ENDOTHELIUM - stops blood cells

BASEMENT MEMBRANE - stop large proteins moving across, also repels -ve molecules

PODOCYTES - allow small ions through but not PROTEINS

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19
Q

Define AKI

A

Failure of renal function over hour days characteristed by a rise in serum urea and creatinine

Reversible

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20
Q

What is the creatinine clearance rate

What is it useful for?

A

Volume of blood plasma that is cleared of creatinine per unit time

This is a useful measure for approximating GFR

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21
Q

Creatinie clearance provides OVER/UNDER estimate of GFR

A

Over

There is some Cr secretion into the filtrate

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22
Q

Causes of pre-renal AKI

A

Hypovolaemia

Decreased renal perfusion

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23
Q

Causes of intra-renal AKI

A

Direct damage to the kidneys via inflammation, drugs and infections

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24
Q

Cloudy and lumpy urine can be a sign of

A

UTI

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25
Q

Acute complications of AKI

A

Fluid retention

Hypercalaemia

Increased urea and creatinine

Metabolic acidosis

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26
Q

Criteria for RRT (renal replacement therapy)

A

Worsening hyperkalaemia

Worsening acidosis

Fluid overload

Symptomatic uraemia

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27
Q

Nephrotic diseases

Main symptoms

How do they come about

A

Generally due to DAMAGE to the BASEMENT MEMBRANE or to the PODOCYTES

Proteinuria

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28
Q

Strengths and weaknesses of a CASE CONTROL study

A

+ fast, inexpensive, good for rare disease

  • recall bias
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29
Q

Stengths and weaknesses of a COHORT study

A

+ assess multiple outcomes/exposures, demonstrate causality

  • time consuming, expensive, not good for rare diseases
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30
Q

What is the role of the 3 consitiutent parts of the FILTRATION BARRIER

A

CAP ENDOTHELIUM - stops blood cells

BASEMENT MEMBRANE - stop large proteins moving across, also repels -ve molecules

PODOCYTES - allow small ions through but not PROTEINS

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31
Q

Define AKI

A

Failure of renal function over hour days characteristed by a rise in serum urea and creatinine

Reversible

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32
Q

How can NSAIDS lead to AKI

A

NSAIDS inhibition production of PROSTAGLANDINS

Local prostaglandins relax the afferent arteriole

So NSAIDS lead to constriction of the afferent arteriole and decreased perfusion

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33
Q

Most common (3) causes of CKD

A

Diabetes

Hypertension

Glomerulonephrtisi

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34
Q

3 major functions of the kidney in ACID BASE BALANCE

A

1) Reabsorption of filtered bicarbonate
2) Excretes excess acid - as phosphoric acid and ammonium
3) Forms new bicarbonate through breakdwon of carbonic acid and glutamine

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35
Q

What is Anti-GBM disease?

What it also caused

A

ANTI-GBM = GOODPASTURES

Pulmonary and renal disease caused by anti-GBM antibodies

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36
Q

Anti-GBM nephrotic or nephritic

A

Nephritic

37
Q

Give an example (and the MOA) of an antibody that promotes immune system activation

A

ANTI-CLTLA-4 (ipilimumab)

38
Q

Minimal change disease is an example of which kind of disease

A

Nephrotic

39
Q

What is the inner layer of the spleen

What is its function

A

White pulp

WBC action (removal of antibody coated microbes) and synthesis of antibodies

Reservoir of monocytes

40
Q

MOA Corticosteroids

A

Lipid soluble

Binds steroid receptor - DIMERISATION

Steroid receptor complex activates/inhibits pro/anti inflammatory genes in the nucleus

41
Q

Describe how INDIRECT ALLORECOGNITION is able to occur

A

Peptides from donor MHC and minor HLA antigens presented to recipient T cells on MHCII on APCs

Activation of recipitent T cells

Production of chornic inflammaotry cycle

42
Q

Non-immune causes of glomerular disease

A

Diabetes

Amyloidosis

43
Q

What occurs in IgA nephropathy

Is Iga nephropathy nephrotic or nephritic

A

IgA depsition in the mesangium - the most common form of primary glomeruluonephrtisi

This is a NEPHRITIC disease

44
Q

Describe how DIRECT ALLORECOGNITION occurs

A

Intact foreign MHC presented directly to T cells

Recipient T cells activated

Recipient T cells attack foreign tissue

45
Q

Main HLA loci to avoid mismatches

A

A B DR

46
Q

What is SLE

What sort of disease does it cause?

A

Systemic lupus erythematosus

Causes immune mediated glomerular disease

47
Q

What happens in MEMBRANOUS NEPHROPATHY

A

Subepithelial immune deposits often due to autoantibodies

Chancges in the basement membrane

48
Q

What is the worst HLA mismatch that you can have

A

HLA-B7-positive to HLA-A1-positive

49
Q

Minimal change disease is an example of which kind of disease

A

Nephrotic

50
Q

How does diabetes cause CKD

A

Hyperglycaemia causes non enzymatic glycation of the efferent arteriole - this makes it STIFF AND NARROW

Leads to an increased pressure in the kidney leading to hyper-filtration and glomerulosclerosis

51
Q

Describe why CORTICOSTEROIDS are good for PREVENTING transplant REJECTION

A
  • Decrease cellular response to pro-inflammatory cytokines
  • Suppressed chemotactic and inflammatory mediators
  • Reduced activation and expression of MHCII on macrophages
  • Reduced recruitment of white blood cells
52
Q

Symptoms of NEPHRTIC SYNDROME

What is usually the underlying cause

Give one example

A

Haematuria with hyperalbuminaemia and hyperlipidaemia

Usually due to GLOMERULAR INFLAMMATION

E.g. IgA nephropathy

53
Q

Pros of HAEMODIALYSIS

A

Predictable

Can be monitored by healthcare professional

Only 3/4 times per week

54
Q

What are the potential issues associated with the use of CORTICOSTEROIDS

A

Suppress pre-existing innate and adaptive immunity

Long term can lead to Cushings syndrome

Also long team - patients need to be WEANED off since the steroids will suppress production of corticotrophin releasing hormone by the hypothalamus

55
Q

ANP inhibits what channel

What does this promote

A

ENaC

Naturesis

56
Q

How can amyloidosis lead to CKD

What type of syndrome does it cause

A

Abnormal deposition of amyloid proteins

Leads to a NEPHRITIC disease

57
Q

Define (in words) specificity

A

The proportion of people without the disease who test negative

58
Q

What happens in MEMBRANOUS NEPHROPATHY

A

Subepithelial immune deposits often due to autoantibodies

Chancges in the basement membrane

59
Q

Symptoms of acute pyelonephrtisi

A

Fever

Loin pain

Tenderness

60
Q

What does NEGATIVE LIKELIHOOD RATIO show

Give the formula

A

How much more likely a negative test is in a person without the disease than in a person with the disease

(1 - Sensitivity) / Specificity

61
Q

What is KOILONYCHIA

What is it a sign of

A

Spooning of the nails

Seen in iron deficient anaemia

62
Q

In what form is iron most easily absorbed

A

Fe2+ or as haem

63
Q

Example of an INTRAVASCULAR RBC defect that causes HAEMOLYSIS

A

Transfusion reaction

Infection

Prosthetic heart valves

Snake/spider bites

64
Q

Example of an INTRINSIC RBC DEFECT that causes HAMEOLYSIS

A

Enzyme deficiency or membrane defect

65
Q

What does a likelihood ratio of LESS THAN 1 mean

A

Test result is associated with absnecne of disease

Further from 1 = stronger associaion

66
Q

Causes of microcytic anaemia

A

Iron deficient anaemia

Hamoglobinopathies - thalassaemia

Sideroblastic anaemia

Lead poisoning

67
Q

Define (in words) specificity

A

The prop

68
Q

Coombs test is a trst for

A

HAEMOLYTIC ANAEMIA

69
Q

Give some examples of drugs that can cause anaemia

A 
NSAIDS
Metformin 
High dose penicillins 
Ranitidine 
Furosemide 
Warfarin 
Glitazones
70
Q

Causes of a NORMOCYTIC anaemia

A

Anaemia of chronic disease

Acute blood loss

Mixed deficiency

Bone marrow failure

71
Q

Bruising under the skin is a sign of which anaemia

A

Haemolytic

72
Q

What is myelodysplasia

A

Family of bone marrow failure syndromes

73
Q

Example of an EXTRINSCI RBC defect that causes HAMEOLYSIS

A

Autoimmune haemolytic anaemia

Liver disease

Infections

Drugs

74
Q

Stimuli for the release of gastrin

What is the main effect of gastrin

Where is it released from?

A

Rising gastric pH
Neural (vagal) stimulation
Presence of partially digested food

INCREASES GASTRIC ACID SECRETION AND MOTILITY

Released from G cells

75
Q

What does a likelihood ratio of greater than 1 mean

A

Test result is associated with presence of disease

The further from 1 it is the greater the association

76
Q

Causes of microcytic anaemia

A

Iron deficient anaemia

Hamoglobinopathies - thalassaemia

Sideroblastic anaemia

Lead poisoning

77
Q

Structure and classification of H. Pylori

A

Gram -ve

Helical

Flaggella

78
Q

Transamination describes the conversion OF WHAT, TO WHAT

A

Amino acid –> Keto acid

79
Q

What is CORNEAL ARCUS

A

Lipid deposition in the cornea

Sign of hypercholesterolaemia

80
Q

Pancreas develops from a

A

DORSAL AND VENTRAL bud on the duodenum

81
Q

What is proctitis

A

Inflammation of the rectum - this is commonly seen in ULCERATIVE COLLITIS

82
Q

Symptoms of duodenal ulcers

A

Weight gain

Eating that reduces pain

83
Q

What are BRUNNERS GLANDS

What do they produce

A

Glands that are unique to the duodenum

Secrete bicarbonate to neutralise stomach acid

84
Q

Stimuli for the release of gastrin

What is the main effect of gastrin

Where is it released from?

A

Rising gastric pH
Neural (vagal) stimulation
Presence of partially digested food

INCREASES GASTRIC ACID SECRETION AND MOTILITY

Released from G cells

85
Q

Everyone with coeliac has which MHCs

A

DQ2 and DQ8

86
Q

What is APECED

A

Autoimmune condition arising from the last of expression of self antigens in the thymus

87
Q

Structure and classification of H. Pylori

A

Gram -ve

Helical

Flaggella

88
Q

Ways in which Tregs suppress activation of CD4

A

Contact dependent killing and suppression

High levels of CD25 (mop up IL-2)

Hi CTLA-4 (mops up CD80/86)

Bystander effect on nearby cytokines

Production of immunosuppressive cytokines - IL-10

89
Q

Defect in FOXP3 leads to

A

IPEX

BM4 Year 1 - Quizlet Cards (3 decks)

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