MEQ 2004 Flashcards
State the two key histological features of a granuloma.
Epithelioid histiocytes (2 marks), Cuff of lymphocytes, giant cells
State three non-specific (innate) mechanisms that prevent micro-organisms from reaching the lungs.
Nasal hair, muco-ciliary escalator, mucus, coughing, sneezing, warming of inspired air by nose, humidification of inspired air by nose
State two socioeconomic factors that are associated with an increased prevalence of tuberculosis
Two from: Poverty, overcrowding, poor nutrition, low socio-economic class, migrants
If BP = blood pressure, PVR = peripheral vascular resistance, and CO = cardiac output, write an equation that indicates the interrelationship between these parameters.
BP = CO X PVR
Total Peripheral Resistance = (Mean Arterial Pressure - Mean Venous Pressure) / Cardiac Output
Blood pressure (BP) is a measure of the force being exerted on the walls of arteries as blood is pumped out of the heart.
Mean arterial pressure = 2/3 diastolic + 1/3 systolic *at rest
MAP = also perfusion pressure
- Cardiac output (as we have already discussed)
- Blood viscosity (the thickness of the blood)
- Total peripheral resistance ‘TPR’ (the resistance the blood encounters on its voyage within the blood vessels)
Which type of blood vessel is the major site of peripheral vascular resistance?
Arteriole
State three metabolic or physiological factors that reduce peripheral vascular resistance.
Nitric oxide/metabolic breakdown products, hypoxia, hypercapnia, reduced sympathetic stimulation, parasympathetic stimulation
List two anatomical sites where arterial baroreceptors are locat
Aortic arch, carotid sinus
State two effects that stimulating arterial baroreceptors has on systemic blood pressure.
Two from: Decreased sympathetic nervous system stimulation, decreased arteriolar vasoconstriction, decreased blood pressure
What is the normal systolic and diastolic blood pressure for an adult male aged 30?
120/80 (range of 100/70 to 144/94)
Describe three characteristics of the pain caused by an acute myocardial infarction.
Crushing, central, pain in jaw or neck, pain in arm, lasts over 30 mins, severe
Ischaemia
Reversible damage to tissues (1 mark) as a result of impaired vascular perfusion
depriving tissues of vital nutrients and oxygen. (No marks for just ‘hypoxia’)
Infarction
Irreversible death/necrosis of tissue due to ischaemia
State four features describing the structure and components of an atheromatous fibrolipid plaque.
Four from: Fibrous cap, lipid core, smooth muscle cells, macrophages, lymphocytes, calcium, cholesterol crystals
List two possible complications that she may suffer as a result of her infarct.
Two from: Death, arrhythmias, mural thrombus, embolic phenomena, rupture of valve/heart, heart failure, infarct extension/expansion, papillary muscle damage, pericarditis, pericardial effusion, etc.
Q1. The normal oesophagus is lined by what type of epithelium?
Strat Squamous NK
Q2. List three structures that lie anterior to the oesophagus in the thorax.
Heart/left atrium, trachea, left main bronchus, diaphragm
Q1. State two likely pathophysiological reasons why her ankles are swollen.
Raised systemic venous pressure or raised venous pressure, salt and water retention
R-heart failure = raised systemic venous pressure = odema due to salt and water retention
Q2. What is the most likely cause of her tiredness?
decreased CO
Q3. Why does this patient have a fast pulse rate?
Stimulation of the sympathetic system
She mentions that over the last three weeks she has lost her appetite and that her abdomen has become swollen.
Q5. State two abnormalities that you might expect to find on examination of abdomen.
Two from: enlarged liver, pulsatile liver, ascites, oedema of skin(1 mark)
Q7. Why does she suddenly become breathless whilst in bed at night?
Pulmonary oedema or acute heart failure or alveolar oedema
State three clinical features of shock.
From: Low blood pressure, low urine output, sweating, pallor, rapid pulse
Q2. Your patient has been passing black tarry stools for 2 weeks prior to this admission. What is this explanation of this?
Loss of blood from the stomach
Q4. You suspect your patient has a gastric ulcer. State three possible causes of such ulcers.
From: Hyperacidity, alterations in mucin, duodeno-gastric reflux, H. pylori
Q5. What hormone is responsible for the production of gastric juice, and which 2 organs secrete it?
Gastrin; Stomach, Pancreas
Q5. On examining your patient, you note a mass in the abdomen. Name two features that would lead you to conclude that it is the spleen.
From:Left upper quadrant; can’t feel an upper border on palpation; or get above it; notch felt.
Define median survival
The median survival is the time at the end of which 50% of index cases are still alive.
Q6. The usual way to determine “how many people die from” a disease is with five year survival rates. How is a five year survival rate determined?
The proportion of diagnosed patients still living five years after diagnosis of the disease.
Q1. How much absolute alcohol is there in a unit of alcohol? Give one example of a standard drink typically containing one unit of alcohol.
8 grammes of absolute alcohol. Half a pint of beer, 1 small glass of wine, 1 glass of sherry, 1 pub measure of spirits.
Q2. State two pathological changes that occur in the liver with continued consumption of excessive amounts of alcohol.
Fatty liver, alcoholic hepatitis, cirrhosis
Q3. Assume that this patient’s oedema is caused solely by his liver disease. State one possible pathophysiological mechanism for the oedema.
From: Hypoalbuminaemia, Fluid retention secondary to hyperaldosteronism.
Types of stress
Distress and Eustress
From: Biochemical, Behavioural, Cognitive, Emotional
Biochemical: endorphin levels altered
Behavioural: increased alcohol, poor sleep, absenteeism
Cognitive: negative thoughts, poor concentration
Emotional: feeling tearful, mood swings, irritability
Physiological =
Q2. State three functions of the cell membrane of bronchial epithelial cells.
From: Separating the intracellular contents from the extracellular environment; Regulating access to the cell; Acting as a semi-permeable membrane; Regulating molecular transport into and out of the cell; Intercellular signalling/hosting membrane receptors; Maintaining cell shape; Allowing movement of the cell
What are amphipathic substances
Amphipathic substances are both hydrophilic and hydrophobic.
Q1. What are the three key surface markings of the oblique fissure?
Back:T2; Mid-axillary line: 4th rib; Anteriorally: end of 6th rib.
Q2. State one reason why the patient is centrally cyanosed.
Excess reduced haemoglobin
Why do small changes in the diameter of a blood vessel have a very great effect on the resistance to flow of a fluid through that vessel?
Pouiselle’s law
What part of the heart is the apex beat?
LV
Feature of malabsorption and why
Pale and smelly = fats
Bruising = vit K
Swollen ankles = protein
What are the two key stages of fat digestion in the gut?
Emulsification
Triglyceride hydrolysis
Triggers of asthma, which vessels
Bronchioles
-Exercise, allergens, infection, temp change
What causes wheezy cough + clear sputum
Three from: Muscle spasm, narrowed airway (1 mark), swelling of wall, excess mucus
State two non-pulmonary conditions of which this patient may give a past medical history.
Hey fever, eczema
Anaphylaxis is caused by the cross-linking of an immunoglobulin on the surface of an inflammatory cell, resulting in the release of a potent chemical mediator. Q4. State the class of the immunoglobulin, the name of the cell and the name of the chemical mediator.
immunoglobin - igE
cell - mast cell
chemical mediator - histamine
