Pathology/ immunology/ pharmacology Flashcards
1
Q
Why are clots rare?
A
- laminar flow
- endothelial cells arent sticky when healthy
2
Q
positive feedback loops in clot formation?
A
- platelet release chemicals when they aggregate
3
Q
thrombosis definition
A
is the formation of a solid mass from blood constituents in
an intact vessel in a living person.
4
Q
3 things to cause thrombosis?
A
- change in laminar flow
- change in blood constituents (too many platelets)
- change in vessel wall
5
Q
What can damage endothelial cells?
A
- nicotine
damages vessel wall and ruins blood flow because of damaged wall
6
Q
embolism def?
A
solid mass in the blood being carried
through the circulation to a place where it gets stuck and
blocks the vessel.
7
Q
virchows triad?
A
3 factors creating a thrombosis
- change in laminar flow
- change in blood constituents (too many platelets)
- change in vessel wall
8
Q
commonest cause of embolus?
A
deep vein thrombosis
9
Q
example of common sites of an embolus?
A
mural thrombus overlying a myocardial infarct
in the left ventricle can go anywhere is the systemic
circulation
cholesterol crystals from an atheromatous plaque
in the descending aorta
10
Q
emboli travels in venous system where does it travel ?
A
right side of heart via vena cava into the pulmonary arteries - cant go further because lungs go down to capillary size
11
Q
emboli travels in arterial system where does it travel ?
A
can travel anywhere downstream
12
Q
why do get redness/heat during inflammation?
A
vasodilation/ increased blood flow
13
Q
why do you get swelling during inflammation?
A
oedma
physical cell mass
14
Q
how long do neutrophils live?
A
short life span
15
Q
how long do macrophages live?
A
long life span of weeks to months
16
Q
how does histamine increase blood flow ?
A
open pre capillary sphinctors
17
Q
what prevents endothelial cells from sticking?
A
release of NO
18
Q
what produces prostaglandin?
A
prostaglandin synthase
19
Q
how long to lymphocytes live?
A
years
20
Q
how does oedma occur in acute inflammation?
A
excess fluid leaks out of capillaries into tissues along with plasma proteins
21
Q
roles of fibroblasts?
A
produce collagen in areas of chronic inflammation and repair
22
Q
what is TB ?
A
mycobacteria ingested by macrophages however can not kill the mycobacteria
fibrosis occurs
23
Q
what is a granuloma ?
A
A granuloma is a collection of immune cells and a type of chronic inflammation. Granulomas are made up of specialized immune cells including lymphocytes, histiocytes, and multi-nucleated giant cells
feature of some chronic inflammation conditions
24
Q
conditions where granuloma is found?
A
TB, leprosy, chrons disease
25
second intention healing?
loss of tissue and repairs involve granulation tissue
white scar with collagen left over
26
main lipid in atheroscolsis?
cholesterol
27
preventing platelet aggregation?
low dose aspirin a day
28
How does atherosclerosis form?
fatty streak
accumulated endothelial damage - LDL
primary platelet plug
fibrous cap
thrombosis forms and then heals on top
Thrombosis keeps forming on top of atherosclerosis clots
29
complications of atherosclerosis?
aortic aneurysm
30
Why do cells apoptosis?
DNA damage
31
Cancer and apoptosis?
lack of apoptosis in cancer
32
what happens during pancreatitis?
Pancreas become inflamed and eats its self
form of necrosis
33
what do intrinsic apoptotic factors respond to?
growth factor deprivation and biochemical stress such as DNA damage from UV rays
34
BCL 2 role in apoptosis?
inhibits factors that induce apoptosis - part of intrinsic apoptosis
35
BAX role in apoptosis?
factors enhancing apoptosis - Part of the intrinsic apoptosis
36
Extrinsic apoptosis?
receptors ?
The specific mechanism for the activation of apoptosis characterised by
ligand-binding at death receptors on the cell surface
TNFR 1
FAS
37
results of extrinsic and intrinsic apoptosis?
cascade the activation of caspases
38
inhibitors of apoptosis?
growth factors
extracellular cell matrix
sex steroids
39
the neurotransmitter of chloergeneric pharmacology?
acetylcholine
40
tissue in hypertrophy example
occurs in organs where cells cannot divide
* examples - skeletal muscle in athletes/bodybuilders
41
tissue in hyperplasia example
occurs in organs where cells can divide
* examples - benign prostatic hyperplasia, endometrial
hyperplasia
42
tissue in mixed hyperplasia/ hypertrophy example
occurs in organs where cells can divide
* example - smooth muscle cells of the uterus during
pregnancy
43
atrophy examples
Alzheimer’s dementia, quadriceps muscle
following knee injuries
44
dysplasia examples
bronchial epithelium in cigarette smokers:
metaplasia from ciliated to squamous epithelium, then
development of dysplasia in the squamous epithelium
45
causes of dysplasia
longstanding irritation, chronic inflammation, or certain carcinogenic substances
46
polygenic diseases example?
Breast cancer risk is an example There are some genes, such as BRCA1 and BRCA2, which do have a large individual effect but most of breast cancer risk is composed of incremental rises in risks by tens to hundreds of apparently unrelated genes even when there is strong family histor
47
congenital disease?
disease someone is born with
may be genetic or acquired in the development
48
Atherogenesis steps?
1. endothelial cell wall damage
2. LDL accumulates in the arterial wall
3. macrophages accumulate at the site of damage and cause inflammation
4. formation of fatty streak
5. smooth muscles increases around ldl core and fibrous cap forms
49
role of monocytes in acute inflammation?
migrate to tissues and become macrophages and secrete chemical mediators for chemotaxis
50
most common tumour spread?
tumours that grow locally and then naturally move around the body. eg: breast cancer and colorectal cancer
51
spread of basal cell carcinoma?
only spread locally and do not spread (metastasise) to other parts of the body
52
spread of leukaemia?
arise from cells that naturally move around the body
53
sarcoma?
tumour growing in connective tissue
54
oncogenesis?
formation of benign and malignant tumours from normal tissue
55
tumour ?
abnormal swelling
56
why can neoplasm not arise in erythrocytes?
erythrocytes don't have nuclei
57
HPV linked to which cancer
cervical cancer
58
extravasation?
increased leukocyte transendothelial migration is also known diapedesis
59
where do all leukocytes originate from?
hematopoietic stem cells in red blood marrow
60
lymphocytes?
B cell, T cell and large granular lymphocyte
61
role of basophils?
release IL-4 (promotes IgE production) and histamine
62
presence of eosinophils and granulomas?
parasitic infection
63
role of eosinophils?
cause production of prostaglandins and cytokines and releases granular proteins
64
What is the name of the main effector cell in
acute inflammation?
neutrophil polymorphs
65
What is the name of the cells that produce
collagen in fibrous scarring?
fibroblasts
66
where are most of the cancer risks from?
85% environmental - latent internal may be decades
67
oesophageal cancer risks?
Japan, Chine - diet
turkey, Iran - scalding hot drinks burns the throat
68
Asbestos cancer risks?
bladder cancer and mesothelioma
69
chemical carcinogens how do they do this?
must be metabolised from pro-carcinogens to ultimate carcinogens
70
classifications of viral carcinogens?
DNA virus or RNA virus
71
UV rays or suncream which according to evidence could cause skin cancer?
UV rays
72
Which one of the following does
granulomatous inflammation occur?
A. Crohn’s disease
B. Acute appendicitis
C. Infectious
mononucleosis
D. Lobar pneumonia
A chrons disease
73
inherited predispositions for developing cancer examples?
colonic polyps
ulcerative colitis
cervical dysplasia
74
Which one of the following is chronic inflammation from the start:
appendicitis
cholecystitis
infectious mononucleosis
infectious mononucleosis
"mono" "gladular fever"
enlargement of spleen
75
why fever during inflammation?
macrophages and polymorphs release endogenous pyrogens (IL-6, IL- 1, TNF) acting on the hypothalamus to set thermoregulatory mechanisms at a higher temp
76
what endogenous pyrogens respond to?
exogenous pyrogen (virus, bacteria)
chemical agents
77
what is the differentiation pattern of metaplastic cells lining cigarette smokers' bronchi?
ciliated with mucociliary escalator to squamous epithelium
78
Gram positive patterns?
thick cell wall, no outer envelope
79
gram negative patterns?
thinner cell with outer envelope
80
what does TLR 1/2 DETECT?
GRAM positive bacteria
lipoproteins
81
what does tlr 4 detect?
lipopolysaccharides of gram-positive bacteria
82
which tlr detects flagella ?
TLR 5
82
which tlr detects flagella ?
TLR 5
83
which tlr are within the endosome?
tlr 3, tlr 7, tlr 9 , tlr 8
84
tlr 7 detects ?
single stranded ran
85
complement system activation pathways?
classical - antibody antigen
alternative - bacteria endotoxins
lectin - Manose binding protein
86
describe opsonisation.
caused by c3 b activation and triggers phagocytosis
87
In situ carcinoma?
carcinoma within collagen basement membrane not spreading
88
invasive carcinoma?
carcinoma through the collagen basement membrane and arrives into the extracellular matrix could reach blood vessels or lymphatic
89
where are tlr found?
macrophages, dendritic cells and neutrophils
90
which important surface receptors do dendritic cells have?
tlr and mhc 2
91
describe the process of active immunity.
vaccine
- engage innate immune system (dendritic cells, neutrophils
- danger signals (PAMPs, TLR release of cytokines and proinflammatory)
- activate antigen-presenting cells (Langerhans cells)
- engage the adaptive immune system and memory in t cells and b cells
92
5 immunoglobulins classes?
GAMED
IgG
IgM
IgA
IgE
IgD
93
HOW DO THE iG classes differ?
different heavy chain structure
94
Ig involved in parasitic infections?
IgE
95
effect of fab in antibodies role?
- neutralize toxins
- prevent binding
- form complexes
- immobilizes motile microbes
96
role of fc receptors in antibdies ?
- trigers phagocytes
- nk cells - enhanced killed of infected cells
- mast cells - releases inflammatory mediators (tnf alpha + histamine)
97
role of cytokines?
control behaviour of leukocytes (nuetrophil, monocytes - macrophages, basophils)
98
what antigens do t cells recognize?
cell-associated not free soluble antigens
99
role of mhc?
initate t cell response
100
which t cell does mhc1 present too?
CD8+ (CYTOTOXIC)
101
WHICH t cell does mhc 2 present too?
cd4+ helper
102
role of TH2?
TRIGGER B CELLS to release ige and promote release of inflammatory mediators
103
role of afferent lymphatic vessels?
carries dendritic cells with bacterium from the site of infection to naive t cells
dendritic cells activate t cells
- trigger plasma cells to release antibodies
- create effector t cells
104
cells from common myeloid progenitor ?
- eosinophil
nutrophil
basophils
mast cells
monocyte - macrophage
dendritic cells
megakryocyte
105
cells from common lymphoid progenitor?
t cells
b cells
natural killer cell
106
THC 1 triggers which ig release?
b cells to relase IGg (main class in serum and tissues)
107
THC 2 triggers which ig release?
b cells to release ige to release inflammatory mediators such as histamine and tnf alpha
108
mechanism of statins?
stops the liver from producing cholesterol
109
4 a FOR TREATING cardiovascular disease
aspirin
statin
beta blockers
ace inhibitors
110
2 types of cholinergic receptors?
muscaneric (parasympathetic) and nicotinic
111
types of muscarinic receptors? and what do they effect?
M1 - Mainly in the brain
M2- mainly in the heart slows down
M3- Glandular and smooth muscle
bronchoconstriction
sweating
salivary gland secretion
M4 + M5 - CNS
112
M2 on SA and AV node?
SA - decreases HR
AV - induce av node block increases PR interval
113
pre ganglionic receptors? and neurotransmitter?
receptor - nicotinic
neurotransmitter - ACh
both para and sympathetic
114
post ganglionic
receptors?
neurotransmitters?
parasympathetic
muscarinic + ACh
sympathetic
alpha/ beta receptors + noradrenaline
115
skeletal muscle (voluntary) uses which receptors to contract?
nicotinic receptors
116
cholinergic crisis?
excessive stimulation of ACh on nicotinic receptors
parasympathetic nervous system in overdrive
117
cholinergic crisis sludge?
symptoms of crisis:
S - salivation
L - LACRIMATION tears
U - URINATION
D - DEFEACATION
G- gi UPSET CRAMPING VOMITING
E - vomiting
118
receptor in the somatic nervous system? neurotransmitters?
nicotinic receptors (n1)
ACh
119
how do LDL and HDL increase plaque formation?
increases the number of foam cells to build plaque
120
what are foam cells?
These are macrophages that have phagocytosed oxidised lipoproteins -
they have large amounts of cytoplasm with a foamy appearance
121
structural differences in the somatic and autonomic nervous systems?
somatic - single nurone from CNS to muscle
autonomic - there are two nerves in series,
the pre- and post-ganglionic fibres.
122
what is the name of a maligant tumour of straiated muscle? ?
rhabdo myo sarcoma
sarcoma - tumour in connective tissue
123
cancer of epithlium ?
carcinoma
124
adenoma?
a benign tumour in glandular tissue - very common
125
screening for breast cancer screening?
mammogram
126
screenign for coloractal cancer?
FIT test - testing for blood in faeces
127
cervical cancer screening?
smear test
128
how to detect lung cancer?
ct scans
129
name some carcinogens?
hepatitis c
aromatic amines
ionising radiation
aflatoxin - hepatocellular carcinoma
130
adenocarcinoma?
malignant tumour in glandular tissue
131
what is a receptor?
compenent of a cell that interact with a ligand and intiates and a biochemical change
132
exmaple of irreversible antagonist ?
BAAM
133
two types of inhibitors ?
irreversible inhibitors
reversible inhibitors bind non covalently
134
active transporters examples?
ATPase required
moves aginst ions gradient
135
types of protein ports?
uniport
symporters
co transporters
136
where are ions channels found?
most tissues
epithial sodium channel
voltage gated (calcium, sodium)
metabolic (potassium)
receptor activated (chloride)
137
Where are epithelial sodium channels sound?
found in kindeys and GI
reabsoprtoion of na+ at collecting ducts
138
ROLE AMLODIPINE ?
angioselective
on smooth muscle cell by inhibiting
vasodilation - lowers bp
inhibits Ca influx across cell membranes
139
3 states of voltage-gated sodium and potassium channels
closed
open
inactive
140
role of voltage gated potassium channels ?
regulates insulin secretion from pancreas
increased glucose leads to block of ATP dependant K+ channels
reptitice firing of action potentials increases Ca+ influx and triggers insulin secretion
141
do receptor mediated chloride channels have mulitble binding sites?
yes
142
antiporter activity
moves ions against their conc gradients
143
sodium (na/k atapase ) pump how much pumped in and out?
3 Na - to extracellular (out)
2 k - intracellular (in)
144
type of inhibition in omeprazole?
irreversible inhibitors
inhibits h/k ATPase (ppi)
145
Pharmacokietics
study of drug metabolism
146
pharmacokinetics ADME?
Absorption - how will it get in?
metabolism - how is it broken down? liver?
distribution - where will it go?
excretion - how does it leave?
147
where are human CYPS located?
role
inner membrane of mitochondria
the endoplasmic reticulum of cells
75% of total metabolism - deactivates or activates drugs
148
What are the two types of immune response in humans?
innate and acquired
149
Which of the following are features of the adaptive immune response?
Does not require prior contact with the pathogen
It works with B and T lymphocytes
Lacks specificity
Lectin type molecules
Unmethylated CpG sequences
unmethylated cpg sequences
lectin type molecules
150
which immune response are PRR molecules part of?
innate
151
role of MBL (mannose binding lectin) ?
is a PRR of innate immune system
recognises PAMPs
activates the complement system
152
Polysaccharide vaccines are composed of long chains of sugar molecules that make up the surface capsule of certain bacteria. These vaccines are available for the treatment of which of the following diseases?
Pneumococcal disease
Influenza type b
Rabies
Salmonella Typhi
Meningococcal diseas
pnuemococcal
salmonella
meningococcal
153
chemoattraction of leukocytes and phagocytosis are...
forms of PRR
154
what is catalase test?
155
what causes endocarditis ?
156
mycobactiera stian? examples
TB
zhiel neelsen stain
157
come in and stain?
158
MRSA ?
RESITTED STRAIN OF staphycocci aureus
159
why of infectioin of s epidermidis?
infections are opportunisitc
- attacks immune comprised patienst
160
how does antigenic sero grouping work?
161
role of streptokinase ?
spreading streptokinase
breaks down clots
C5a peptidase
- reduces chemotaxis
162
For which group of bacteria should you do an optochin test?
A: identifies staph aureus
B: identifies staph from non-staph
C: identifies mycobacterium
D: identifies fungi
staph from non staph
163
role of c tentani?
tetanus is gram anaerobic positive bacilli
inhibits GABA and causes muscle contractions
164
rash during anaphylaxis ?
direct response to histamines
fluid leaking out of dermis - angioedema
165
type 1 hypersensitivity sensation stage?
initial exposure to allergen
antigen brought to lymph nodes
In allergy: antigen-presenting cells also present costimulating molecules
The body releases IgE and attach to mast cells
no further response
166
second exposure type 1 hypersensitivity stage?
Second exposure
Encounters allergen again and IgE are already made and primed with mast cells
Allergen binds to IgE-primed mast cells and mast cells degenerate and histamine is released with pro-inflammatory mediators
167
Adrenaline role in anaphylaixs ?
suppress histamine release
restores cardiac output
168
role of autonomic nervous system?
Conveys ALL outputs from CNS to the body except voluntary stuff
169
adrenergic ?
relating to (nor)adrenaline and their receptors
170
location of sympathetic preganglionic nerve?
lateral horn of the spinal cord (T1- L2)
171
Sacral location of parasympathetic nerves?
T12/L1 outflow in S2-S4
172
NORADRENLINE ACTS ON WHICH RECEPTORS ? which ganglion? which autonomic system?
beta and alpha receptors (smooth + cardiac muscle)
post ganglion
sympathetic
173
neurotransmitter for sweat glands?
sympathetic post-ganglionic fibres release
acetylcholine to stimulate muscarinic receptors
this is an exception
174
neurotransmitter for somatic nervous system?
ACh
175
where is noradrenline released?
released from sympathetic nerve fibre ends
176
where is adrenline rleeased?
adrenal glands
177
alpha 1 agonism? nuerotransmitter?
Alpha 1 agonism causes vasoconstriction, mainly in the skin and splanchic
(abdominal) beds
noradrenaline
178
alpha 1 antagonist ?
doxazosin (generally less frequently used
than modern antihypertensive)
lowers bp
179
where are beta 1 receptors found?
◦ Heart
◦ Kidney
◦ Fat cells
180
beta 1 agonism leads to ? neurotransmitters?
Tachycardia
◦ Increase in stroke volume
◦ Renin release (increase in vascular tone)
◦ Lipolysis and hyperglycaemia
Noradrenline + adrenline
181
beta 2 receptors location?
bronchi - bronchodilation
bl;adder wall - inhibits micturation
uterus - inhibition of labour
skeltal muslce - increase contraction speed
pancreas - insulin and glucagon secretion
182
beta 2 agonist drugs?
Agonist drugs (e.g. salbutamol) are very useful in asthma and
chronic obstructive pulmonary disease
Side effects include tremor hyperglycaemia (glucagon release) and
tachyarrythmia
183
how long does morphine last ?
3-4 hours
184
potency 0f diamorphine?
binding affinity
5mg
passes through blood brain barrier quicker
185
why do not all drugs make it into circulation?
first pass metabolism
gut and liver metabolise before getting into circulation
186
how much of the population is absent of cyp2d6?
10%
187
examples of drugs that require cyp2d6 to be metabolsied?
tramadol - needs to be metabolised by CYP2D6 to o-desmethyl
tramadol to be active
codine
188
levels of hypersensity represent what?
Type 1 and 2 are IG responses
Type 3 and type 4 are cell mediated
Further down is about how much the body responds
189
sensation phase in allergy?
T cell bring antigen to lympnodes
In allergy antigen-presenting cells also present costimulating molecules
Then body releases IgE and attach to mast cells
190
second exposure phase in allergy?
Encounters allergen again and IgE are already made and primed with mast cells
Allergen binds to ige primed mast cells and mast cells degenerate and histamine is released with proinflammatory mediators
191
late phase in allergy?
Proinflammatory mediates stimulates of basophils
192
blood test for anaphylaxis ?
tryptase levels which are elevated 3 hours after anaphylaxis
secreted by mast cells
193
prevalence?
probabilty of having disease at a given time point
194
incidence?
probabilty of getting disease during a specified time period
195
effects of adrenline on alpha 1 , beta 1 and beta 2 receptors?
Alpha 1- adrenoreceptors : increases BP + coronary perfusion
Beta 1 - adrenoreceptors: positive ionotrophic (heart rate contracts stronger) + positive chronotropic (increase HR)
Beta2 - adrenoreceptors: reduces oedma and bronchocontrcition
Reduces release of inflammatory mediators by increase cAMP in mast cells and basophils
196
risk factors for ADRS
F>M
elderly
neonates
polypharmacy
atopy
197
how does aspirin work?
LOW DOSES inhibits COX 1
HIGH DOSES INHIBITS cox 1 and 2
198
role of cox 1and 2?
cox 1 - produces thromboxane ]causes vasoconstriction and platelet agreggeation
cox 2 - produces prostaglandins and causes inflammation and pain
199
most common drugs to have ADRS?
ANTIBITOICS
ANTINEOPLASTICS - cancer treatment
cardiovascular drugs
NSAIDS
cns DRUGS
200
tellow card scheme ?
voluntary ADR reporting scheme - reports to MHRA
ALL SUSPECTED REACTIONS - HERBAL MEDICINES OR DRUGS
201
type 2 reactions example?
methyl-dopa-induced haemolytic anaemia
drug induced haemolysis
202
type 3 reactions examples ?
glomerulonenephritis
203
type 4 reactions example?
contact dermatitis -eczema
steven johnson syndrome
204
how does paracetmol overdose cocur?
cure?
uses up glutathione stores (makes paracemol a stable metabolite) - builds up dangerous metabolise - cellular necorissi
activated charcoal - glutathione trasferase reverses reaction
205
role of enalalrpil ?
ace inhibitpr to treat hypertension and heart failure
no ace 2
and bradykinin remains as vasodilator
206
contraindication of enalapril in what condition?
most common side effect
not prescribed for patented with egfr of less than?
renal artery stenosis
dry cough
60
207
factors that influence the activity of an antagonist are?
affinity of antagonist for the receptor
208
what happens when B2 adrenoreceptors is stimulated?
bronchodilation
209
irreversibile enzyme inhibitor?
aspirin
210
5 catagories of protozoa ?
flagellates
Amoebae
Sporozoans
Ciliates
- Microsporidia:
211
tests for malaria?
blood film Plasmodium ovale trophozite! posotive
212
mycotoxins
toxins released by fungi
213
t cell deficiency (HIV) increases susceptibility to?
fungi - yeast (candida spp)
virus - herpes
MALIGENCIES (EPSTEIN BARR VIRUS)
autimmune viruses
214
what are catalase positive
gram neagtive bacteria - e coli
fungi
215
life-threatening fungi infections for immune compromised patients?
Candida line infections
*Pneumocystis
216
why is selective toxicity harder for fungi infections than bacteria?
fungi are eurkayotic and similar to human cells and there selective is harder to differentiate
217
how to treat candida (oral thrush) infections?
antifungal - oral fluconazole
218
how to treat Pneumocystis pneumonia?
fungal infection of lungs usually in HIV patients - co-trimoxazole (antibiotic combination)
219
when is Aspergilliosis dangerous
released by aspergillus flavus fungi
can cause hepatocellular carcinoma
dangerous to immune comprised people (cystic fibrosis)
220
chickenpox vs shingles?
varicella zesta virus - primary infection
herpes zoster - shingles - secondary infection
221
why does herpes stay within us ?
lipid envelop with spikes
double-stranded DNA - mimics our own DNA
222
WHEN IS VZV INFECTIOUS?
48 hours before spots and a couple of days (until blisters are crusted)
in nasal secretion before vesicle
in blister fluid
223
small pox vs chicken pox?
chicken pox likes warms bits - chest
small pox - likes cooler parts of body
224
signs of encephalitis?
seizures
confused
not able to walk properly
225
most common antiviral drug?
Acyclovir - treatment of herpes
226
serology test?
initial things detections ?
look for antibodies in response to virus
IgM within 1 week of onset, IgG - memory antibody appears later
227
why cant viruses be detected in light microscopy?
Not visible in light microscopy, can’t culture as only reproduce inside live cells
228
how wont pain killers work for pain of shingles?
need neurological treatment to treat the abnormal nerve responses in damaged nerve endings
amatryptalin
229
what causes hand foot and mouth?
how to test?
enterovirus
PCR to test
watch out for stool- can spread
230
what can enterovirus cause?
meningitis viral
encephalitis
endocarditis
231
characterisitcs of CMV, EBV?
atypical lympcytes
232
who is relapse of cmv dangerous for?
what does it do?
immuno comprismed patients
reactviation in retina - pizza
pneumonitis
233
3 classes of antibtiocs ?
- cell wall synthesis
- nucleia cid synthesis
- protein synthesis
234
examples of cell wall synthesis antibtiocs ?
beta lactams
- pencillin
- amoxicillin
- flucloxacillin
235
endogenous infections?
increases risk?
infections caused by patients own bacterial flora
PLASTIC - allows bacteria to form a biofilm and cause problems
related to catheter and canulla
236
Preventing endogenous infections?
good nutrioin and hydration
antisepsis prep
remove lines as clinically possible
hand hygiene
237
antibiotics for cellulitis? bacteria involved?
group a and group c and group g strep and s. Aureus ⇒ flucloxacillin
238
antibitoics that inhibits cell wall synthesis? subgroup? examples?
beta lactams - penicillin
glycopeptides - vancomysin
239
ratio male: female with hiv?
3:1
240
CD4 count in HiV positive patients not on treatment ?
CD4 count < 200 cells/mm3
241
oppurtunis infections of HIV?
oral candida
oral hairy leucoplakia
recurrent herpes simplex
syphalis
pnuemococcal pneumonia - PCP
multi dermatomal shingles
242
Amphotericin B role?
antifungal
very broad spectrum and high barrier to resistance
Only IV infusion
Adverse effects - also very expensive
243
common complications from HIV?
Kaposi sarcoma
Pneumocystis jiroveci pneumonia - FUNGAL
Candidiasis
HSV
244
Lentivirus?
slow retrovirus family with long incubation period - HIV
245
4 types of anti HIV drugs? HAART?
integrase inhibitors - most effective
protease inhibitors
fusion/ entry inhibitors
reverse transcriptase inhibitors
246
Why is HIV highly mutative ?
REVERSE TRANSCRIPTASE - no error protection - error prone
Rapid replication
247
Symptoms of acute retroviral syndrome?
Glandular fever like illness
fever
sore throat
skin rash in upper trunk
248
CD4 count level of 50? risk of developing?
CNS lymphoma
malignant (cancer) cells form in the lymph tissue of the brain and/or spinal cord.
249
what cells with CD4+
HELPER T CELL
REGULATORY T CELLS
DENDRITIC CELLS
macrophages
250
what drives pathogenesis in HIV infection?
constant activation of immune system
damage to cd4 cells in gut so dangerous bacteria eneter system from gut
- antibiody response is weak and takes to months to develop the antibodies against HIV
251
WHY is antiobdy response weak to hiv?
- lack of protein spikes to create antibodies
- covered in sugar molecule which lessens attachment of antibodies
252
two most common bacterial causes of meningitis in adults?
- Neisseria meningitidis (cocci g. negative)
- Strep. Pneumoniae (cocci g. positive)
253
agar for haemophilus influenza?
chocolate agar
its coccobacilli!!
254
gram negative bacteria responsible for resp tract infections?
H influenzae
255
role of lipopolysaccharide (LPS) from gram negative bacteria
endotoxin production
256
specimens tested for with charcoal testing?
bacterial
257
why test for IgM?
IgM is an acute antibody response and when detected against a virus in serum may often confirm the diagnosis of an acute infection
258
hiv envelope contains?
RNA + capsid + RNA reverse transcriptase
259
Giardia toxoplasma and Falciparum malaria are what ?
flagellated protozoa
260
mycobacteria or bacteria Cell wall contains lipoarabinomannan?
mycobacteria
glycolipid that inactivate macrophages
261
Broad spectrum agents promote resistance in the gut microbiome, true or false?
true
262
staph aureus treatment?
flucloxacillin
263
what is clostridium difficile?
antibiotic induced diarhea
any antibitoci beginning with a C
carbapanems - meropenem
264
Co-amoxiclav role on beta lactamase?
beta lactamase inhibitor
265
target of macrolides? examples?
antibiotic that inhibits ribosomal activity and protein synthesis
- Clarithromycin
266
Staph infections respond to ?
penicillin
267
antibiotic for UTI?
Nitrofurantoin or Trimethoprim - inhibits folate synthesis
268
antibiotic for mrsa?
vancomysin
glycopeptide - distrupts cell wall synthesis
269
common SSRI?
FLOUxetine - 20 mg
270
List the main types of antidepressant medication and give an example of each
- Selective Serotonin Reuptake inhibitors (SSRI) eg fluoxetine Sertraline
- Tricyclic antidepressants (TCA) eg lofepramine or amitriptyline
- Monoamine Oxidase Inhibitors (MAOI) eg selegiline
271
which antidepressants are prescribed first?
SSRI
Tricyclic antidepressants tend not to be prescribed first line as they are more dangerous in overdose due to prolonging the QT interval of the cardiac cycle
MAOI have dangerous interactions with tyramine - found in aged cheeses, sauerkraut, cured meats, draft beer and fermented soy products
272
side effects of SSRIs?
SSRI medication may cause heartburn and other gastrointestinal side effects, and so it is best to take it with food. Patients may also notice vivid dreams or poor sleep - take in morning !
273
signs and symptoms of pneumonia?
Fever, sweats, malaise, “rusty sputum”, SOB, pleuritic chest pain, weakness
274
pathogens in pneumonia?
Strep .pneumonia - gram + cocci
Coccidicides immitis (dimorphic fungi)
haemophilus influenzae - parasite causes pneumonia in HIV, CF pts
275
treatment and antibiotics for osteomyelitis?
Flucloxacillin - strep not resistant
joint wash out
276
pathogens in osteomyelitis?
Staph A (gram + cocci)
Strep A and B groups - s pyogenes (gram + cocci)
Enterobacter - salmonella - (gram - rod)
277
treatment of chlamydia
its a parasite
Azithromycin (macrolides) or Doxycycline
inhibt ribosomal transcription
278
4 classes acting of antibiotics acting on ribosomal inhibition?
MCAT
Macrolides such as erythro/clarithromycin
Chloramphenicol
Aminoglycosides like gentamicin and amikacin
Tetracyclines such as doxycycline
279
which antibitoic can work against ESBL? extended spectum bacteri lactamases
Carbapenems are very broad spectrum and can overcome ESBL
its a beta lactam
280
pathogens causing infectious endocarditis? and how do they enter?
Staph. aureus gains access to the blood from the skin
Strep. viridian's gains access to the blood from the oropharynx (tooth brushing) - (cocci gram +)
Enterococci gain access to bloodstream following instrumentation of bowel (gram + cocci) - groub D strep
coagulase neg staph - IV contamination - s. epidermidis
281
examples of alpha haemolytic strep ? what colour in blood agar?
strep. viridans
strep. pnuemonia
green!
282
effect of a2 adrenoreceptor activation with noradrenaline?
Inhibits the release of NAd into the cleft, and reduces insulin produced from pancreas
283
Effect of noradrenaline binding to B3 adrenoreceptors?
Increased lipolysis and relaxation of the bladder
284
when should a beta blocker not be prescribed?
asthma !
285
role of kidneys and liver with morphine?
Kidneys - excrete metabloites of morphine such as M6G
liver - create the metabolites of morphine with UGT (making them water soluble)
286
stages of inflammation?
1. vessel calibre - inflammatory cytokines mediate vasodilation - space between endothelial lining cells increases
2. fluid exudate - vessels become leaky - fluid of vessels into tissues
3. cellular exudate - cells leaves vessels
287
conditions with central necrosis?
TB
288
signs of parasite ?
granuloma and eosinophils
ACE as blood test marker
289
3 stages of thrombisis?
1 - vasospams caused by damage
2 - primary platelet plug - VWF binds to exposed collagen - platelets bind to this
- activates
agreggetation - binds to each other
3 - platelet clotting cascade!
290
formation of DVT? TREATMENT?
decreased blood laminar flow
warfarin
291
warfarin vs aspirin?
warfarin - targets synthesis of clotting factors
aspirin - decrease platelet aggregation
292
arterial thrombosis signs vs venous thrombosis signs?
aterial - cold, pale, clammy
venous - swollen tender red
293
cytotoxic apoptosis?
CD8 binding release perforin which activates caspases
294
why is apoptosis not mutagenic but necrosis is?
necrosis damages chromatin
295
sign of benign adenoma ?
optic chiasm - bitemporal hemianopia
296
histogenesis classifcaion?
- epithelium: non glandular benign - papilloma
non glandular malignant - carcinoma
- connective tissue: lipoma (benign) and liposarcoma (malignant)
- lypoid: leaukemia, lymphoma
297
which carcinoma never metasasise?
basal cell carcinmoa
298
tumor grading similarity to parent cell ?
differentiation
(well differentiated resemble parent cells by at least 75%)
- grade 2 slightly similar
299
example of ischemia?
TIA
300
EXAMPLE OF INFARCTION?
stroke
301
classification of tumours?
behaviour and histogenesis
302
example of behaviour of benign tumour?
slow growing
localised
exophytic - outward growth
close resemblance to normal tissue
303
example of behaviour of malignant tumour?
basement membrane invading
rapid division - hyperdense nuclei
endophytic - inward growth
poor differentiation - little similarity to normal tissue
304
characteristic of neoplastic cell?
autocrine growth factor
avoiding apoptosis
telemerase - prevents telemerase from shortening during each replication
own blood supply
305
pathway of metastasis?
detachment
invasion of other tissue
invasion of Blood vessel
evasion of host defense
extravastate to distant site
306
method of spread of metstatis
haematogenesis
lymphatic
transcolemic
