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Random Revision Flashcards

1
Q

What ECG change would you expect to see in hypertrophy of the left ventricle

A

Larger QRS complex (ie the QRS complex in lead 2 is greater than 2 large squares)
This is heart failure with preserved ejection fraction (>/= 50%) so there is decreased diastolic function

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2
Q

Which cardiac ECG parameter changes with heart rate

A

RR interval

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3
Q

Major disadvantages of spirometery lung function test

A

Heavy reliance in technique

May be uncomfortable for the patient, reduces their motivation to apply maximum effort

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4
Q

How to calculate peak expiratory flow rate from a time(secs) volume (Litres) graph

A

Read up from x = 0.2 seconds to see where it crosses the y axis
And multiply the value by 300 for L/min

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5
Q

How to obtain FVC value from flow volume loops

A

Highest observed x value on expiratory curve (which is top one)

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6
Q

How to obtain PEFR from flow volume curves

A

Read off peak value of curve in y axis and multiple by 60 for answers in L/min

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7
Q

Where do the left and right adrenal veins drain into

A

Right adrenal vein Into inferior vena cava

Left adrenal vein into renal vein which then drains into inferior vena cava

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8
Q

3 types of corticosteroids and where are they each produced

A

Mineralocorticoids (aldosterone) - zona glomerulosa of adrenal cortex
Glucocorticoids (cortisol) and Sex Steroids (androgens/oestrogen) - both produced in zona fasciculata and zona reticularis

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9
Q

Effect of PTH on the bone

A

Binds to receptor on osteoblast
Causes the release of osteoclast activating factors
These factors cause the osteoblast to change into an osteoclast
This increases bone resorption

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10
Q

Where is PTH released from and what is it released as

A

Released from chief cells of parathyroid gland as pre-pro-PTH

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11
Q

Where is calcitonin released from

A

Parafollicular cells of thyroid gland

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12
Q

How is PTH secreted

A

From chief cells of parathyroid gland as pre pro PTH then cleaved into PTH
(protein coupled receptors sense calcium levels as calcium in blood binds to them - this determines how much PTH they secrete)

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13
Q

Causes of hypercalcaemia

A

Excess PTH - parathyroid adenoma
Excess vitamin D
Malignancy - bony metastases produce local factors which activate osteoclasts which release calcium

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14
Q

Causes of vitamin D deficiency

A

Less sunlight exposure - less UVB to convert 7 dehydrocholesterol into vit D3
Less dietary intake/ malabsorption - less ergocalciferol (vit D2)
Liver disease - less 25 hydroxylase
Renal disease - less 1 alpha hydroxylase
Less vitamin D 3 receptors

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15
Q

Symptoms of hypocalcaemia

A 
CATs go numb 
Convulsions 
Arrhythmias 
Tetany 
Parasthesia
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16
Q

Causes of hypoparathyroidism

A

Surgery - neck surgery
Auto immune
Magnesium deficiency
Congenital

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17
Q

Where is calcitonin released from

A

Parafollicular cells of thryoid gland

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18
Q

PTH effects in kidney

A

Increase calcium reabsorption
Increase phosphate excretion
Increase 1 alpha hydroxylase activity

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19
Q

How does FGF23 regulate serum phosphate

A

Inhibits the sodium phosphate co transporter so less phosphate is absorbed from the urine
Inhibits calcitriol so less phosphate is absorbed from the gut

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20
Q

Which layer of the uterus is shed during menses and why

A

The endometrium due to vasoconstriction of arteriole causing necrosis and ischaemia. This leads to the shedding and haemorrhage of menstruation

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21
Q

Why are males continuously fertile

A

Spermatogonia undergo differentiation and self renewal, maintains the pool for subsequent spermatogenic cycles throughout life

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22
Q

What is the tunica propria

A

Lines the seminiferous tubules

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23
Q

What is adrenarche

A

Onset of adrenal androgen production

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24
Q

What are the first signs of gonadarche

A

Boys - testicular enlargement (below 4 mls prepubertal, above 15mls for adult size)
Girls - thelarche

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25
Q

What age is premature menopause

A

Below 40

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26
Q

Average age for menopause

A

45-55

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27
Q

Treatment for menopause

A

Menopause hormone therapy:
Oestrogen to stimulate growth of endometrium
Add progesterone if the endometrium is intact to prevent endometrial hyperplasia or cancer

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28
Q

What is an ovarian reserve marker

A

Anti Mullerian hormone

Levels of AMH peak in early adult life then gradually decrease until the6 are very low at menopause

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29
Q

Structure of myosin

A

2 globular heads

Tail is formed from 2 alpha helices

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30
Q

Changes to muscle fibres as a result of training

A

Type IIB to IIA

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31
Q

Changes to muscle fibres as a result of deconditioning or spinal cord injury

A

Type I to II

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32
Q

Changes to muscle fibres as a result of ageing

A

Loss of both type I and II but more loss of type II

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33
Q

What does cross innervation of fast and slow twitch muscle fibres do

A

Fast becomes slow

Slow becomes fast

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34
Q

Where are upper and lower motor units found

A

Upper in brain

Lower in brain stem or spinal cord

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35
Q

Myoglobin content of different muscle fibres

A

I : high
IIA : high
IIB : low

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36
Q

Aerobic and anaerobic capacity of different muscle fibres

A

I: high, low
IIA : moderate, high
IIB : low, high

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37
Q

2 mechanisms by which brain regulates the force a single muscle can produce

A

Recruitment

And Rate coding

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38
Q

What opens the ryanodine receptor

A

DHP (dihydropyridine) senses change in velocity and changes the shape of the protein linked to the ryanodine receptor
This opens the receptor allowing Ca2+ to flow out of sarcoplasmic reticulum

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39
Q

Covers of muscle, fascicle and myofibre

A

Epimysium
Perimysium
Endomysium

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40
Q

2 functions of neurotrophic factors

A

Prevent neuronal death

Promote growth after injury

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41
Q

What effect does aspirin poisoning have in urine

A

Ketones in urine

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42
Q

Features to look for for diabetic nephropathy

A

Microalbuminuria (albumin:creatinine ratio > 2.5)

Proteinuria

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43
Q

What would a Kidney biopsy for nephritic syndrome cause

A

IgA nephropathy

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44
Q

Difference in urine between nephrotic and nephritic syndrome

A

Nephrotic: foamy urine due to severe proteinuria

Nephritic : haematouria

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45
Q

Investigations for kidney stones

A

X ray
Ultrasound
CT scan

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46
Q

What condition causes colicky loin to groin pain, haemtouria and tenderness of loin and lower abdomen

A

Kidney stones

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47
Q

3 treatments for kidney stones

A

Shockwave lithotripsy
Uteroscopy
Percutaneous nephrolithotomy

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48
Q

Treatment for polycystic kidney disease

A

Tolvaptan - slows cyst formation
Treatment for hypertension and infection
Pain control
Dialysis or transplantation

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49
Q

Horseshoe kidney and consequences

A

Kidneys fuse together during development

Increases risk of obstruction stones and infection

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50
Q

3 examination tests for ACL injury

A

Lachmann’s test
Anterior drawer test
Pivot shift tets

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51
Q

Complications from surgery to fix a tendon

A

Tendon rupture
Neurovascular damage
Local infection
Joint stiffness

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52
Q

Which bones contains yellow bone marrow

A

Cortical bone s

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53
Q

What is the role of red bone marrow

A

Haematopoiesis

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54
Q

Compare and contrast the role of tendons and ligaments (3 marks)

A

1) Tendons joint muscle to bone
Ligaments connect bone to bone
2) both are important in maintains joint stability
3) tendons transfer force from muscles to bone, and resist compressive forces
Ligaments contain proprioceptors so also have a proprioceptive role

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55
Q

Someone recently had a fracture but also Is found to have calcium deficiency. Explain how they could be related

A

Low calcium can cause increases PTH secretion due to negative feedback
The PTH binds to receptors on the osteoblast, releasing osteoclast activating factors to turn the osteoblasts into osteoclasts
This is so that the osteoclasts break down bone to release calcium into the blood
But this osteoclastic activity also weakens the bone, leading to osteoporosis (decreased bone density) and increasing risk of fractures

56
Q

List some treatments for osteoporosis

A

Vitamin D and calcium
PTH
menopausal hormone therapy

57
Q

How does myelin prevent AP spreading

A

It has a high resistance and a low capacitance

58
Q

For the SAN in the heart what are the receptors for sympathetic and parasympathetic innervation

A

Parasympathetic: M2 receptors
Sympathetic: beta 1 receptors

59
Q

What can cause reduced axon diameter

A

Regrowth after injury

60
Q

What can cause reduction in myelination

A

Multiple sclerosis

Diphtheria

61
Q

What reduces Action potential transmission

A 
Reduced axon diameter 
Reduced myelination
Cold
Anoxia
Compression
Some drugs eg anaesthetics
62
Q

What are the 3 main factors that influence ion movement across the membrane

A

Concentration gradient of ions
Voltage difference across membrane
Charge of ions

63
Q

Why is the K+ potential negative (-90mV) but the Na+ potential positive (+72mV) if they’re both positive ions

A

The K+ has a tendency to leave the cell as there’s more in cell than out, so it needs a negative potential in order to attract it and keep it in the cell
The Na+ has a tendency to enter the cell as there’s more out of cell than in, so it needs a positive potential to repel it and keep it out of the cell

64
Q

Difference between depolarisation and overshoot

A

Depolarisation is increasing the membrane potential to 0, overshoot is increasing it to over 0 - making it positive

65
Q

Difference between Passive propagation and active propagation of an Action potential

A

Passive propagation: only resting K+ channels are open, outward flow of K+ propagates the potential along the membrane from the site of depolarisation
Active propagation: local current flow depolarises adjacent areas of membrane towards the threshold

66
Q

What does GABA stand for

A

Gamma amino butyric acid

67
Q

3 neurotransmitters that look similar

A

Dopamine
Noradrenaline
Serotonin

68
Q

What is an adverse effect

A

Side effect with negative health consequences

69
Q

Receptor for heroin and different areas the receptor is for heroines different effects

A

Opioid receptors

Analgesia: Peri aqueductal grey region
Euphoria: ventral tegmental area
Cough suppression: solitary nucleus

70
Q

What is pramipexole

A

A dopamine receptor agonist

71
Q

Safest drugs

A

Large difference in dose required to produce side effect and dose that produces adverse/side effects
(As u increase dose, side effects increase as selectivity decreases - off target effects or on target effects but in the wrong tissue)

72
Q

How much CSF is produced per day

A

500 ml

73
Q

Where is CSF produced,where does it occupy (and how much CSF occupied these areas), and how is it reabsorbed

A

Produced by choroid plexus of lateral 3rd and 4th ventricles
~125 ml occupies subarachnoid space and ventricular system
Reabsorbed via arachnoid villi into superior sagittal sinus

74
Q

Difference between CSF and plasma

A

CSF has lower pH and less proteins, potassium, glucose

75
Q

Where are the primary motor cortex and somatosensory cortex

A

Primary motor cortex: pre central gyrus

Somatosensory cortex: post central gyrus

76
Q

What is special about the six elf somatotropin areas in the somatosensory cortex

A

Size of somatotropin areas is proportional to the density of sensory receptors in that region (somatosensory homonculus)

77
Q

Where in spinal cord are the corticobulbar and corticospinal stracts

A

Corticobulbar: genu of internal capsule
Corticobulbar: posterior limb of internal capsule

78
Q

What is somatotopy

A

Point to pint correspondence if an area on body to an specific point on CNS

79
Q

Location of infarct that causes stroke resulting in loss of sensation in left arm and hand

A

Right parietal cortex in somatosensory cortex

80
Q

Risk factors for septic arthritis

A

Immunosuppressed
Pre existing joint damage
Intravenous drug use

81
Q

How many joints are usually affected in septic arthritis and what is the exception

A

1 joint

Gonococcal septic arthritis - multiple joints at once (poly arthritis)

82
Q

Which bacteria are commonly responsible for septic arthritis

A

Staphylococcus aureus
Streptococci
Gonococcus

83
Q

Does PNS or CNS have long pre ganglionic neurons

A

PNS

84
Q

What neurotransmitters does PNS and CNS use

A

PNS: only Ach
CNS: Ach in pre ganglion neuron and NA in post ganglionic neuron

85
Q

Is adrenal gland innervated by PNS or SNS

A

Sympathetic nervous system

86
Q

What is diagnosis for low TSH and low T4

A

SECONDARY hypothyroidism

Ie not a problem with the thyroid gland but rather with the anterior pituitary

87
Q

Most common cartilage which cushions end of long bones

A

Hyaline (aka articular)

88
Q

How does most T4 travel in blood

A

Bound to thyroid binding globulin

89
Q

Measures of preload

A

End-diastolic volume
End-diastolic pressure
Right atrial pressure

90
Q

Measures of after load

A

Diastolic blood pressure

91
Q

Why does aortic pressure fall slowly whereas ventricular pressure falls rapidly once the aortic valve closes

A

The aorta has more elasticity - the recoil of the elastic arteries causes pressure to fall slowly and creates diastolic flow in the downstream circulation

92
Q

Which is more stable, elbow or hip joint and why

A

Elbow - as there is a relationship trade off between stability and motility
Hip joint has more motility than elbow as it can move in more than one plane (ball and socket joint) whereas elbow can only move in one plane)
So hip joint is therefore also less stable

93
Q

What are delusions

A

Fixed false beliefs which are not held by other people in the same culture. They are firmly held even when there’s evidence to the contrary
Often held by people with schizophrenia

94
Q

How does airway conductivity change with increasing lung volume

A

It increases linearly

95
Q

Standard volume of CSF in body

A

125 ml

96
Q

What arterial system is most of the cerebral hemisphere supplies by, and what about for the brain stem

A 
Cerebral hemisphere (anterior part of CNS):  internal carotid system 
Brain stem (posterior part of CNS): vertebrobasilar system
97
Q

Difference between Meissner and pacinian corpuscles

A

Meissner: fine touch and slow vibration
Pacinian: deep pressure and high frequency vibrations

98
Q

What is intrapleural bleeding called

A

Haemothorax

99
Q

What do NA and adrenaline circulate bound to

A

Albumin

100
Q

What are adrenaline and noradrenaline degraded by

A

2 hepatic enzymes: monoamine oxidase and catechol-O-methyl transferase

101
Q

Precursor for adrenaline and noradrenaline synthesis

A

Tyrosine

102
Q

Name given to cycles of smooth muscle contractions sweeping though the gut

A

Migrating motor complex

103
Q

What is incretin effect

A

A lot more insulin is produced when glucose is taken orally rather than intravenously

104
Q

How does MS affect conduction velocity and why

A

Reduces conduction velocity
Because the lack of myelin sheath means the impulse cannot travel by saltatory conduction, instead it has to depolarise the hole membrane so travels more slowly

105
Q

Describe ventilation and perfusion across the lung whilst standing

A

Both are greater at the base

106
Q

What compound makes bile green

A

Biliverdin

107
Q

Is ACTH involved in aldosterone regulation

A

No, only cortisol regulation

108
Q

How is pepsinogen converted to pepsin

A

Activated by HCl

109
Q

Which cranial nerves arise form midbrain pons and medulla

A

Midbrain: 2, 4
Pons: 5,6,7,8
Medulla: 9,10,12

110
Q

What is gastrin and explain it’s function

A

Found in the pyloric antrum of the stomach
Stimulates release of histamine from chromaffin cells of the lamina propria
Stimulated by distension, small peptides and amino acids, and vagus nerve stimulation

111
Q

What is the enterogastric reflex

A

Stretching of duodenum inhibits gastric motility and slows rate of emoting of stomach

112
Q

Name 2 medications for acid reflux and how they work

A

Omeprazole: inhibits K+/H+ ATPase
Ranitidine: inhibits H2 receptor for histamine

113
Q

How does vitamin D increase calcium absorption in duodenum/ileum

A

Stimulates the transcription of TRPV6 (calcium moves in via this) and PMCA (calcium moves out via this)

114
Q

Most common bacteria in gut flora

A

Bacteriodes

115
Q

Which conditions are bacteriodes implicated in the initiation of

A

Colitis and colon cancer

116
Q

What regulates the depth and frequency of breathing

A

Pneumotaxic centre

117
Q

Causes of secondary osteoporosis

A

Hypogonadism
Glucocorticoid excess
Alcoholism

118
Q

Which channel does glucose enter cell through in intracellular pathway to insulin release

A

GLUT2

119
Q

What do serous cells secrete in airway

A

Antibacterial enzymes

120
Q

What is the most common type of joint in body

A

Synovial

121
Q

What type of jaundice may arise from large blood transfusion

A

Pre hepatic jaundice

122
Q

4 stages of fracture healing

A

Bleeding
Inflammation
Callus formation (soft then hard)
Remodelling

123
Q

Which epidermal layer has an active division cells

A

Stratum basale

124
Q

What is blood flow with constant velocity called

A

Laminar flow

125
Q

Role of parasympathetic and sympathetic NS in micturition reflex

A

Parasympathetic contracts the detrusor muscle

Sympathetic relaxes internal sphincter

126
Q

What is law of la place

A

T = PxR or (/h)

127
Q

What h cells are responsible for sperm development

A

Sertoli

128
Q

What term is given to condition where person experiences a 20mmHg drop in systolic bp when changing from supine to upright position

A

Postural hypotension

129
Q

Serum marker for acute pancreatitis

A

Elevated pancreatic enzymes/amylase/lipase

130
Q

Most common cause of cushings

A

Prolonged glucocorticoid therapy

131
Q

Scan for confirming pituitary tumour

A

MRI

132
Q

Why can a stroke lead to sudden twitching movements

A

Tissue damage due to the stroke can result in propagation of discharge to adjacent areas in primary motor cortex

133
Q

Mechanism of action of diazepam

A

Indirect GABA agonist

134
Q

Selectivity

A

Degree to which a drug acts in a specific site reactive to other sites

135
Q

What is diurnal variation of mood a sign of

A

Depression

136
Q

What is splanchnic vasoconstriction and what disorder is it felt in

A

Butterflies in tummy feeling

Anxiety

BRS (8 decks)

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