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Esa2 Clinical > MOD clinical > Flashcards

MOD clinical Flashcards

1
Q

Definition of hypoxia and the 4 different types.

A

Deficiency in oxygen levels to the tissues. Main cause of cell injury/cell death.

  1. Hypoxaemic hypoxia: oxygen content in blood is low (lung disase, high altitude)
  2. Anaemic hypoxia: decreased ability of Hb to carry oxygen (anaemia, CO poisoning)
  3. Ischaemic hypoxia: interruption in blood supply, oxygen isnt reaching the cells
  4. Histiocytic hypoxia: inability to utilise oxygen (cyanide poisoning)
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2
Q

Ischaemic reperfusion injury

A

Blood flow returned to tissue which is ischaemic but not yet necrotic -> makes it worse because of increased production of oxygen free radicals, increased number of neutrophils, and delivery of complement pathway

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3
Q

Excessive alcohol intake on the liver

A

Steatosis(fatty change) & acute alcohol hepatitis (inflammation of hepatocytes) are early stages of alcoholic liver disease. Fibrosis then occurs, causing alcoholic cirrhosis

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4
Q

Hereditary haemochromatosis

A

Hepcidin deficiency (Fe2+ storage molecule). Fe2+ deposited around body. Problems with pancreas, heart, etc. Treat with phlebotomy (remove some blood)

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5
Q

Carbon monoxide poisoning

A

Causes anaemic hypoxia -> Hb cant carry oxygen as it is bound to CO

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6
Q

Paracetamol poisoning

A

Production of NAPQI (strong oxidant) + depletion of glutathion (antioxidant) cause hepatocyte death/liver failure.

Treat with acetylcysteine within 8 hours to replenish GSH levels

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7
Q

Coal workers pneumoconiosis

A

Pulmonary fibrosis -> damaged lung. Reduced air entry -> cough/breathlessness/faint.
Due to accumulation of microscopic coal dust in lungs (high conc)

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8
Q

Alpha1 antitrypsin deficiency

A

Autosomal recessive. Lack of antitrypsin -> increased elastase -> breakdown of elastin in lung/liver tissue (destroys alveoli-> emphysema)

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9
Q

Bacterial meningitis

A 
Acute inflammation of meninges of brain -> rise in intracranial pressure -> occludes blood vessels supplying blood to brain -> brain damage.
Causes:
Neonates- streptococcus B
Children- neisseria meningitides
Adults- enterovirus (VIRUS)
Elderly- streptococcus pneumonae
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10
Q

Hereditary angio-oedema

A

Autosomal dominant. C1esterase inhibitor usually inhibits bradykinin and C1 (so inhibits C3 production).
Hereditary angio-oedema= c1 esterase inhibitor deficiency-> c3 and bradykinin no longer inhibited -> increased endothelial permeability -> oedema
Treat with fresh frozen plasma or c1 inhibitor

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11
Q

Chronic granulomatous disease

A

Neutrophils unable to form superoxide radicals -> no respiratory burst -> cant kill some bacteria. Forms granulomas in attempt to store the bacteria

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12
Q

Inflammatory bowel disease

A

Ulcerative colitis: chronic autoimmune inflammation of colon. Crypt abscesses, destruction of mucosa, attacks submucosa. Increases risk of colon cancer.
Crohns disease: chronic inflammation of any part of GI tract (mouth to anus). Many granulomas and a cobblestone bowel appearance. Anal lesions and bowel fistulae. Treat with steroids.

Difference between UC and crohns: crohns isnt limited to the colon and doesnt show crypt abscesses, and it doesnt increase the r isk of colon cancer.
Both cause abdominal pain, diarrhoea (may be bloody) and unexplained weightloss

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13
Q

Tuberculosis

A

Chronic infection in lungs (myobacterium tuberculosis). Spread by droplet infection. Macrophages phagocytose but cant destroy -> granulomas form -> bacteria multiply within the granulomas. Can lead to pulmonary fibrosis and death (and systemic infection) if not treated with antibiotics.

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14
Q

Sarcoidosis

A

Idiopathic granulomatous disease of the lungs. Granuloma formation with no caseous necrosis. Steroids.

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15
Q

Rheumatoid arthritis

A

Autoimmune attack of synovial membrane in joints -> granuloma formation -> erodes the articular surface of bone -> painful joints. Treat with steroids. Rheumatoid nodes- clumps of granulomas across the body

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16
Q

Wegener’s granulomatosis

A

Autoimmune chronic inflammation of epithelia in ear/nose/throat/lungs/kidney -> granuloma formation and fibrosis -> renal failure if untreated. Treat with steroids.

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17
Q

Leucocytosis

A

Increased number of leucocytes in blood

Macrophages and endothelia produce colony stimulating factors -> bone marrow produces more neutrohpils

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18
Q

Acute phase response

A

Change in protein synthesis in the livr (decreased albumin, increased fibrinogen). Caused by cytokines (released by macrophages). Causes sleepiness and lack of appetite

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19
Q

Collagen synthesis defects

A

Scurvy: vit c deficiency -> cant hydroxylate proline -> weakened collagen -> unable to heal wounds adequately (seen with bleeding gums)
Ehlers-Danlos syndrome: decreased tensile strength. Hypermobility of joints,stretchy skin, susceptible to dislocations.
Osteogenesis imperfecta: type 1 collagen deformity/deficiency -> less bone tissue -> prone to fractures. Blue sclera.
Alport syndrome: x linked dominant. Type 4 collagen defect
Keloid scars: overgrown scar that spreads outside he original area of skin damage. (Made of collagen)

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20
Q

Deep vein thrombosis

A

Formation of thrombus within a deep vein. Caused by inactivity, obesity, oral contraceptives, heart conditions.
Fragt can break off and migrate to lung causing a PE
Prevented with SC heparin and stockings to reduce likelihood of thrombus formation.
Treat with IV heparin/oral warfarin.

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21
Q

Embolism

A

Blockage of a blood vessel by a solid/liquid/gas at a site distant from the origin.
Most arise from thrombus (thromboembolism)
Types: gas, nitrogen, cerebral, air, amniotic, fat, paradoxical

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22
Q

Pulmonary embolism

A

Embolism that migrates to the pulmonary arteries, occluding the vessels and leading to respiratory problems. >60% reduction in lung function is fatal.
Can cause right sided heart failure due to severe pulmonary hypertension, mechanical shock due to severely decreased preload of the left heart, or critical ischaemic hypoxia to a huge part of the lung

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23
Q

Atheroma

A

Accumulation of intracellular and extracellular lipids in the tunica intima and tunica media of medium/large arteries

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24
Q

Atherosclerosis

A

Thickening and hardening of arterial walls due to atheroma

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25
Q

Artiosclerosis

A

Thickening of arterial/arteriolar walls due to hypertension/ diabetes

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26
Q

Consequences of Ischaemic heart disease

A

Death, MI, angina, cardiac failure, arrhythmias

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27
Q

Consequences of cerebral ischaemia

A

Transient ischaemic attack (TIA), stroke, multi-infarct dementia

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28
Q

Consequences of mesenteric ischaemia

A

Malabsorption, intestinal infarction, ischaemic colitis

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29
Q

Consequences of peripheral vascular disease

A

Intermittent claudication (intermittent leg cramps due to arterial obstruction), Leriche syndrome (aortoiliac occlusive disease), critical limb ischaemia (ischaemic rest pain and gangrene)

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30
Q

Examples of pathological hyperplasia

A

Hyperplasia: increased organ/tissue size due to increased cell numbers.
Psoriasis: extreme proliferation of skin cells-> deposition of keratinocytes at stratum corneum -> scaling
Thyroid goitre: hyperplasia of thyroid gland to compensate for inefficiency

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31
Q

Examples of physiological hyperplasia

A

Hyperplasia: increased tissue/organ size due to increased cell numbers.
Endometrial proliferation due to oestrogen during menstruation
Increased bone marrow production of erythrocytes during low oxygen levels

32
Q

Examples of physiological hypertrophy

A

Hypertrophy: increased tissue/organ size due to increased cell size.
Skeletal muscle in bodybuilders, smooth muscle of uterus during pregnancy

33
Q

Examples of pathological hypertrophy

A

Hypertrophy: increased tissue/organ size due to increased cell size
Ventricular cardiac muscle due to hypertension/valvular disease/etc.
Bladder smooth muscle due to obstruction

34
Q

Compensatory hypertrophy

A

Occurs in paired organs. If a kidney is removed, the other kidney undergoes hypertrophy to compensate

35
Q

Physiological examples of atrophy

A

Atrophy: oran shrinkage due to decrease in cell number or size
Ovarian atrophy post menopause

36
Q

Pathological examples of atrophy

A

Atrophy: decrease in organ size due to decrease in cell numbers or size
Muscle atrophy due to denervation
Cerebral atrophy due to Alzheimers

37
Q

Metaplasia

A

Reversible change of one differentiated cell type to another, to suit its new environment.
Occurs within epithelia and CT
Preludes to dysplasia/cancer
Smoking causes pseudostratified ciliated -> stratified squamous. No longer secretes mucus.

38
Q

Aplasia

A

Embryonic failure of an organ/tissue to develop

39
Q

Involution

A

Normal programmed organ shrinkage

40
Q

Hypoplasia

A

Congenital underdevelopment of tissue/organ

41
Q

Atresia

A

No orifice (eg. No opening between right ventricle and pulmonary artery = pulmonary atresia

42
Q

Dysplasia

A

Preneoplastic alteration of cells. Disordered tissue organisation, reversible so not neoplastic.

43
Q

Paradoxical embolism

A

Passage of a thrombus from systemic veins (from body into heart) to systemic arteries (from heart to body). Passage of thrombus through a hole in the septum of the heart (ASD, VSD) causes the clot to cross from the right to the left side of the heart and pass into systemic arteries instead of entering the lungs. May enter brain and cause a stroke.

44
Q

Neoplasm and malignant neoplasm definitions

A

Neoplasm: abnormal growth of cells that persists after initial stimulus is removed
Malignant neoplasm: abnormal growth of cells that persists after initial stimulus is removed, and invades surrounding tissue with the potential to spread to distant sites.

45
Q

Definition of a tumour

A

Clinically detectable lump/swelling

46
Q

Cancer

A

Malignant neoplasm (abnormal growth of cells that persists after the initial stimulus is removed, and invades surrounding tissue with the potential to spread to distant sites)

47
Q

Papilloma

A

Tumour with finger-like projections

48
Q

Polyp

A

Small growth, with a stalk, protruding from mucous membrane

49
Q

Malaise

A

Feeling of general discomfort or uneasiness

50
Q

Pyrexia

A

Fever

51
Q

Xeroderma pigmentosum

A

Hereditary defect in the enzyme system that causes nucleotide excision repair (repairs DNA damage from UV rays)

  • > extreme sensitivity to sunlight
  • > tendency to develop skin cancer
52
Q

Human papilloma virus (HPV)

A

Strongly linked to cervical carcinoma. Direct carcinogen because it expresses E6 proteins (inhibits p53) and E7 proteins (inhibits pRB protein function) -both important in control of cell proliferation

53
Q

Hepatitis B and C

A

Indirect carcinogens -> cause chronic liver cell injury and regeneration -> increased risk of mutations

54
Q

Helicobacter pylori

A

Causes chronic gastric inflammation -> increased risk of gastric carcinoma

55
Q

HIV (human immunodeficiency virus)

in terms of neoplasia

A

Acts indirectly to cause neoplasia by lowering immunity and allowing other potential carcinogenic infections to occur

56
Q

Retinoblastoma

A

Rare, malignant tumour of the retina in young children.
Familial retinoblastoma: first hit delivered through germline and affects all cells in body. Second hit is somatic- child only needs one mutation in any cell.
Sporadic retinoblastoma: no germline mutation so requires both hits to be somatic mutations and to occur in same cell.

57
Q

Hereditary non-polyposis colon cancer (HNPCC) syndrome

A 
Autosomal dominant (germline mutation)
Associated with colon carcinoma and the germline mutation affects one of several DNA mismatch repair genes.
58
Q

Familial breast carcinoma

A

Associated with either BRCA1 or BRCA2 genes (important in repairing double strand DNA breaks).

59
Q

6 hallmarks of cancer

A
  1. Self sufficient growth signals (HER2 gene amplification in breast cancer)
  2. Resistance to anti-growth signals
  3. Immortalisation (telomerase prevents telomere shortening)
  4. Angiogenesis (activation of VEGF expression)
  5. Resistance to apoptosis
  6. Invade and produce metastases
60
Q

Hodgkins lymphoma

A

Cancer of the lymphatic system

Cancerous b lymphocytes (called Reed Sternberg cells)

61
Q

Non hodgkins lymphoma

A

Cancer of the lymphatic system

62
Q

TNM staging system

A

T- size of primary tumour (T1-T4)
N- extent of regional node metastasis (N0-N3)
M- extent of distant metastatic spread (M0-M1)

TNM staging is then converted into a stage from I to IV

63
Q

Ann Arbor staging

A

Unique staging system for lymphoma
I- lymphoma in a single node region
II- two separate regions on one side of the diaphragm
III- spread to both sides of diaphragm
IV- spread to one or more extra lymphatic organs (eg. Bone marrow or lungs)

64
Q

Dukes staging

A

Used for colorectal carcinoma as a powerful predictor of survival.
Dukes A: invasion into but not through bowel (93% 5yr survival)
Dukes B: invasion through bowel wall
Dukes C: involvement of lymph nodes
Dukes D: distant metastases (6% 5yr survival)

65
Q

Bloom-richardson system

A

Grading system for breast carcinoma
Assesses tubule formation, nuclear variation and number of mitoses (eg, amount of proliferation and pleomorphism)

Increasing grade(g1-g3) -> worsening differentiation

66
Q

Familial adenomatous polyposis

A

Hereditary condition in which numerous adenomatous polyps form in the epithelium of the large intestine -start out benign but can transform into malignant if untreated (colon cancer)

67
Q

Burkitts lymphoma

A

A type of high grade non-hodgkin lymphoma
Develops from b lymphocytes
One of the fastest growing lymphomas

68
Q

Melanoma

A

Type of skin cancer, usually develops from moles

Abnormal proliferation of melanocytes (melanin forming cells)

69
Q

Basal cell carcinoma

A

Slow growing skin cancer, doesnt spread to other parts of body
Its a non-melanoma (doesnt affect melanocytes)

70
Q

Teratoma

A

Germ cell neoplasm, usually malignant in testes and benign in ovaries.
Benign teratoma of ovaries also called dermoid cyst.
Contain highly differentiated tissues- teeth, hair, eyes, bone, limbs

Struma ovarii: mature teratoma that contains mostly thyroid tissue. May cause hyperthyroidism

71
Q

Neoplasms ending in -oma are what type of neoplasm?

A

Benign

72
Q

Neoplasms ending in -carcinoma are what type of neoplasm?

A

Malignant neoplasm of the epithelia

73
Q

Neoplasms ending in -sarcoma are what type of neoplasm?

A

Stromal (CT) malignant neoplasm

74
Q

Myeloma

A

Malignant neoplasm of plasma cells

75
Q

Leiomyo- neoplasms are where? Ie. Leiomyosarcoma, leiomyoma

A

Smooth muscle

76
Q

Myositis ossificans

A

Calcification/ossification of muscle

77
Q

Barretts oesophagus

A

Metaplasia of the oesophagus due to persistent acid reflux

Esa2 Clinical (7 decks)

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