Practise questions Flashcards
Define MUS
Medically unexplained symptoms are defined as physical symptoms persisting for more than several weeks and for which adequate medical examination has not revealed a condition that explains the symptoms
List 2 impacts of mood and anxiety disorders on society?
1) School/work- reduced attendance and performance
2) Healthcare costs
3) Unemployment, difficult to return to work
Define empathy
Empathy is the capacity to understand the patient’s situation, perspective and feelings, and to communicate that understanding back to the patient
Explain the differences between empathy and sympathy
Empathy is understanding another persons suffering from with their frame of reference. Sympathy is a feeling of pity from an external perspective
Describe Cognitive Behavioural Therapy
A treatment that addresses the patient’s life events, thoughts, feelings, physical symptoms and behaviours
The enzyme involved in the phase 1 metabolism of ethanol?
Alcohol dehydrogenase
What biochemical marker is used to test for hepatocellular damage?
Alanine transaminase
What cell type plays a key role in fibrosis
Stellate cells
Where do caput medusae arise
In the Paraumbilical region
What triggers contractions of the gallbladder
Cholecystokinin (CCK)
The 6 data protection principles
1: that processing be lawful, fair and transparent.
2: that the purposes of processing be specified, explicit and legitimate.
3: that personal data be adequate, relevant and not excessive.
4: that personal data be accurate and kept up to date.
5: that personal data be kept for no longer than is necessary.
6: that personal data be processed in a secure manner
What enzyme activates trypsin
Enteropeptidase
Anterior borders of the oral cavity
1) Oral fissure
2) Lips
3) Oral vestibules
Posterior border of the oral cavity
1) Oropharyngeal isthmus
2) Oropharynx
Lateral borders of the oral cavity
1) Buccinator muscle
2) Mucous muscle
Superior border of the oral cavity
1) Hard palate
2) Soft palate
Inferior border of the oral cavity
1) Mylohyoid muscle
2) Geniohyoid muscle
3) Tongue
4) Salivary gland
Why do we give adrenaline in anaphylaxis
Adrenaline is adrenergic receptor agonist and so opens airways to breathing (beta2), Cardiac stimulant (beta1), Peripheral vasoconstrictor maintaining blood pressure (alpha1)
How do corticosteroids work?
Corticosteroid enhance transcription when bound to Glucocorticoid receptors, the receptor then moves to the nucleus
What cytokine increases the function of Macrophages?
Interferon-gamma is produced by NK cells and T cells and its main function is activation of macrophages
Where do the classical, lectin and alternative complement pathways converge in the complement cascade.
Creation of C3b
What is the most characteristic feature of granulation tissue?
Proliferating capillaries and fibroblasts
What leukotriene receptor antagonist is used in the treatment of asthma
Montelukast
What lymphocyte is involved in the innate immune responce
Natural killer cells
How does hyperglycaemia influence wound healing
Reduces endothelial retraction
Which zone of the liver is most prone to damage
Zone 3 (inner zone)- less oxygenated so more prone to ischaemia
Phase 1 of drug metabolism
1) Make molecules more polar
2) Oxidation, reduction, hydrolysis
3) Results in more toxic substances
Phase 2 of drug metabolism
1) Usually makes molecules more inactive
2) Most common reaction is production of glucuronides
3) Increases negative charge, makes molecules more hydrophilic
Phase 3 of drug metabolism
Secretion
1) Products are transported out of the hepatocytes into canaliculi by ATP binding cassette (ABC) transporter
Blood results for hepatocellular insult
ALT- greater than 10 fold increase
ALP- less than 3 fold increase
Blood results for cholestasis
ALT- less than 10 fold increase
ALP- greater than 3 fold increase
Structural change of cirrhosis
1) Bridging fibrous septa between portal triads
2) Parenchymal nodules
3) Diffuse whole level architectural changes
Consequences of cirrhosis
1) Hepatorenal syndrome
2) Hepatocellular carcinoma
3) Encephalopathy
4) Reduced synthetic function- clotting factors, albumin
5) Portal hypertension- ascites, varices
Risk factors for Hepatocellular adenoma
1) Oestrogen containing contraception
2) Anabolic steroids
Risk factors for hepatocellular carcinoma
1) Hepatitis B and Hepatitis C
2) Anabolic steroids
3) Alcohol
4) Cirrhosis
5) Aflatoxins
What causes release of bile
1) Parasympathetic stimulation- Vagus nerve
2) Secretin
3) Cholecystokinin
Two types of bile
1) Secreted from duct cells (bile acid-independent) – composed of sodium, potassium, chloride and bicarb – composition altered by flow rate
2) Secreted from hepatocytes (bile acid-dependent) – bile salts, albumin, conjugated bilirubin, cholesterol
Risk factors for cholesterol gallstones
1) High cholesterol diet
2) Oestrogen containing oral contraception
3) Pregnancy
Why do cholesterol gallstones form
1) Too much cholesterol in the bile
2) Not enough bile salts to stop cholesterol from precipitating
3) Gall bladder stasis
How to treat gallstone obstruction
ERCP
Intrahepatic cholangiocarcinoma
Expansible, firm, white tumour. Vague and insidious presentation
Hilar cholangiocarcinoma
Infiltrating, ill-defined, fibrous tumour. Jaundice, itch, abdominal pain, weight loss and fever
Charcot’s triad
1) Fever
2) Jaundice
3) Abdominal pain
Seen in ascending cholangitis
Causes of Pancreatitis
I GET SMASHED Idiopathic Gallstones Ethanol Trauma Steroids Mumps/malignancy Autoimmune Scorpion sting High triglycerides/hypercalcaemia ERCP Drugs (hydrochlorothiazide, azathioprine etc.)
Describe the mechanism of action of Sulphonamide antibiotics
They interfere with folic acid metabolism
How is sweat secreted in eccrine sweat glands
Merocrine- the sweat is excreted via exocytosis from secretory cells into an epithelial-walled duct or ducts and then onto a bodily surface or into the lumen
What is the virulence factor of s.pyogenes which causes sepsis
Protein F
What is the growing phase of the hair cycle
Anagen
Main side effect of Carbimazole
Pruritic rash
Time period for a diagnosis of generalised anxiety disorder
Excessive anxiety for more days than not for at least a period of 6 months
Advantages of SSRI’s
Selective serotonin reuptake inhibitors are the best tolerated and are the least dangerous in overdose.
How long does Levothyroxine take to have its effect
Due to the genomic action of these drugs, they take longer than other drugs to have their effects as there is a transcriptional output. The maximum effect from specific dose can take several weeks to occur.
Neuromorphological change that occurs as a result of chronic depression.
Decrease in hippocampus size and connections causing memory problems
Function of centroacinar cells
They are within the pancreatic acinus and function to produce bicarbonate ions, which in turn produce an alkaline environment when secreted into the duodenum
Dyspepsia
Impaired digestion for 4 or more weeks, presents with upper abdominal pain, heartburn, acid reflux and nausea
Melaena
Black, tarry stools that contain blood
Three protective factors of the gastric mucosa
1) Mucus layer
2) Surface epithelia connected by tight junction
3) Bicarbonate
Damaging factors of the gastric mucosa
1) Excess gastric acid secretion
2) H.pylori
3) NSAID’s
4) Smoking
Peptic ulcer disease
A breach of the epithelium that penetrates the muscularis mucosa in the stomach or duodenum
Risk factors for peptic ulcer disease
1) H.pylori infection
2) Drugs- NSAID’s and aspirin
3) Smoking, alcohol and stress
Barretts’s Oesophagus
An oesophagus in which any portion of the normal distal squamous epithelial lining has been replaced by metaplastic columnar epithelium,
Main requirements for the clinical trial to be ethical
1) Value- enhancement of health
2) Scientific validity
3) Fair subject selection
4) Favourable risk-benefit ratio
5) Independent review
6) Informed consent
7) Respect for enrolled subjects
8) Transparent- aware of risks and funding
9) Demonstrate clinical equipoise- uncertain about which arm is more beneficial
Complications of peptic ulcer disease
1) Haemorrhage
2) Perforation
3) Gastric outlet obstruction
4) Gastric malignancy
Pernicious anaemia and gastritis
1) Pernicious anaemia is associated with autoimmune gastritis
2) Autoimmune gastritis is associated with increased risk of gastric carcinoma
