SAQ 2011 Flashcards
Describe the symbols in a pedigree
Circle = female square = male
coloured = diseased shaded or half/half = carrier blank = normal
line through = deceased
Define laws of mendelian inheritance
- Law of segregation = During gamete formation, the alleles for each gene segregate from each other so that each gamete carries only one allele for each gene.
- Law of independent assortment = Genes for different traits can segregate independently during the formation of gametes. (during metaphase of meiosis)
- Law of dominance = Some alleles are dominant while others are recessive; an organism with at least one dominant allele will display the effect of the dominant allele.
Name the cells of the stomach, what they secrete and where they are found
G cells - antrum
Parietal – BODY AND FUNDUS
Chief cells – body, FUNDUS AND PYLORUS - secrete pepsinogen (HCl activates to pepsin - protein digestion)
(Enterchromaffin-like = release histamine gastric glands in vicinity of parietal cells)
Where is somatostatin released from?
- Delta cells in the pyloric antrum, the duodenum and the pancreatic islets
- Acts on parietal cells in the stomach to reduce HCl secretion, can also act of G cells and ECM-like cells
What 3 processes would you advise someone to go through to quit?
Ready – plan, find out info from GP, stead-set a date and throw out lighters, cigerettes etc, go- make a plan for the plan and try to avoid triggers, reward yourself
Ethics – 14 year old girl having sex without a condom, has contracted STI and refuses to use condoms even though she’s on the contraceptive pill
o What are 2 ethical considerations in this case?
Autonomy – respecting her decision to make her own decisions,
Utilitarianism– if she doesn’t start using condoms she is likely to spread STI and hurt other people
What is a disadvantage of virtue ethics
- what is ‘right’ can be culture specific
- too broad?
- individual understanding can ignore social and communal dimensions
- which are the most important virtues when they contradict each other?
What is a limitation of deontology?
What document by the GMC advocates the use of deontology?
Can duties conflict?
1- It does not take into consideration the complexity of life situations and sometimes the results of the decisions taken by deontologists can be very drastic (it might reach the death of an innocent person like case study 1).
2- It faces big dilemma when 2 principles are involved and usually applying it would not be effective.
-Duties of a doctor - deontology/virtue ethics
What type of theory is used to maximize greater good
Utilitarianism = max good for max people
Consquentialism
Describe the main ethical theories
Ethical Theory - philosophical attempts to create ethical theories:
i virtue ii categorical iii imperative iv utilitarianism v 4 principles (autonomy, beneficence, non-maleficence, justice)
What utilitarian/consequentialism (teleological)
- An act is evaluated solely in term of its consequences
* Maximising good and minimizing harm
What is KANTIANISM (Deontological)?
KANTIANISM (Deontological)
• Features of the act themselves determine worthiness (goodness) of that act
• Following natural laws and rights
• Categorical imperatives - a set of universal moral premises from which the duties are
derived (do not lie; do not kill; …)
• A person is an end itself, never a means to an end
• deon = duty (from the Greek)
• Know the criticisms
What is virtue ethics? What are the five focal virtues?
VIRTUE ETHICS (Deontological)
• Focus is on the kind of person who is acting, deemphasizes rules
• Is the person in action expressing good character or not?
• We become virtuous only by practicing virtuous actions
• Integration of reason and emotion
• The Five Focal Virtues: (CDTIC) i Compassion ii Discernment iii Trustworthiness iv Integrity v Conscientiousness • Know the criticisms!
What are the 4 principles
THE FOUR PRINCIPLES (Prima Facie)
- Autonomy (self-rule, the obligation to respect the decisions of our patients)
The decision is intentional
The decision is done with understanding
There are no major controlling influences over the decision - Benevolence (providing benefits, balancing the benefits against risks)
- Non-maleficence (do no harm, reduce or prevent harm)
- Justice (Utility/QUALY, need vs. benefit, fairness in the distribution of benefits and risks)
What are the GMC duties of a doctor?
- Protect and promote the health of patients and the public
- Provide good standard of practice and care
- Recognise and work within the limits of your competence
- Work with colleagues in the ways that best serve patients’ interests
- Treat patients as individuals and respect their dignity
What are the 4 principles?
Autonomy
Beneficence
Non-maleficence
Justice
What are the challenges of utilitarianism?
Should minorities suffer for the sake of the majority?
Should ethically questionable experiments be conducted for the greater good of the population?
How can you define ‘good’ or ‘better’?
What are the fraser guidelines for?
Contraception advice to under 16s
- that the girl (although under the age of 16 years of age) will understand his advice;
- that he cannot persuade her to inform her parents or to allow him to inform the parents that she is seeking contraceptive advice;
- that she is very likely to continue having sexual intercourse with or without contraceptive treatment;
- that unless she receives contraceptive advice or treatment her physical or mental health or both are likely to suffer;
- that her best interests require him to give her contraceptive advice, treatment or both without the parental consent.”(Gillick v West Norfolk, 1985)
(Gillick in general)
What is mean arterial pressure?
Mean Arterial Pressure– the average arterial pressure in the body
MAP can be used to approximate afterload (↑MAP leads to in ↑resistance and increase↑afterload)
Equation 1 MAP= CO x Total Peripheral Resistance
Equation 2 MAP = 2/3 diastolic + 1/3 systolic
What is ejection fraction?
Ejection Fraction– Stroke volume / End diastolic volume.
measurement of the percentage of blood leaving your heart each time it contracts
Where are the baroreceptors found?
Carotid sinus (just after where carotid bifurcates into internal and external, inside internal @ C4) and aortic arch
What are 2 effects of stimulating baroreceptors on peripheral BP
Increase in parasym, decrease in symp = this means that BP decreases as blood vessels dilate
- Bradykinin = peptide that causes dilation because it releases nitric oxide and endothelium-derived hyperpolarising factor
- Nitric oxide
- Prostacyclin
- ANP powerful vasodilation
What stimulates vasoconstriction?
Hormones = angiotensin II, vasopressin, adrenaline
local = endothelin and myogenic contraction
Name 3 types of cells found in an atheroma
Macrophages, lymphocytes, smooth muscle
Describe the anatomical relations of the BODY of the pancreas
Superiorly = Liver and coeliac plexus Anteriorly = Stomach - omenta bursa (pancreas lies behind the stomach) Posteriorly = Abdominal aorta, L kidney, L supra renal, L renal artery, splenic vein
Head of pancreas is in duodenum curve
Posteriorly = IVC, renal vessels, Bile duct
Describe blood supply of pancreas
- Splenic artery = tail (neck body and tail)
- Superior and inferior pancreaticduodenal arteries = head
The body and neck of the pancreas drain into the splenic vein; the head drains into the superior mesenteric and portal veins
o Why would pancreatic islet cells stain with haemotoxylin?
Large levels of ribosomes/RER RNA
Irregularly irregular pulse?
SAN node - Atrium contraction
o Definition of a respiratory acinus (3 structures within
respiratory bronchioles and alveoli duct, alveoli
Describe the stages in CAGE
o CAGE
• Have you ever felt you needed toCut down on your drinking?
• Have peopleAnnoyed you by criticizing your drinking?
• Have you ever feltGuilty about drinking?
• Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
3 consequences of drinking
– can causes fatty liver, hepatitis and cirrhosis of the liver, risk taking, over eating, social problems
Describe main lung volumes and average volume
- Tidal volume - normal expiration and after norma inspiration aproxx 500ml
- Vital capacity - max volume of exhalation approx. 4,800 (around 3 and 5 L)
- FEV1 = ratio to VC should be 80%, max air expired in 1 sec after max inspiration
3 physiological causes of high CO2
-Hypoventilation, extreme exercise, V/Q mismatch
3 causes of metabolic physiological vasodilatation
-Hypoxia = dilation in arterioles and constriction in venous
-more parasym
-less symp
-hypercapnic
-acidosis (low pH due to excess co2)
prostaglandins
NO
ANP
Describe process of inhalation
- Diaphragm and external intercostals contract (T1-T11)= decrease in pressure due to thorax expansion
- Pressure of intra pleural fluid becomes subatmospheric
- increase in transpulmonary pressure (pressure inside and outside lung)
- Air drawn into lungs
- Pressure in alveoli becomes subatmospheric
- Air drawn in via bulk flow :)
What are the impressions on the lung?
Right -SVC, Azygos vein
Left - Heart, Aortic arch
What is in the carotid sheath?
-internal jugular vein (lateral)
-common carotid and internal carotid artery (medial)
- vagus nerve (posterior)
- deep cervical lymph nodes
What can cause a V/Q mismatch?
Ventilation = dead space, alveoli doesnt function
Perfusion = shunt, blood doesnt flow to ventilatied alveoli
What occurs in expiration?
- Diaphragm and external intercoastals not contracted
- Thorax decreases in size
- Intrapleural fluid pressure increases
- Transpulmonary pressure decreases
- Lungs recoil to original size (pressure increases = becomes compressed, boyle’s law)
- P alv becomes greater than atmospheric pressure
- Air flows out via bulk flow
What is Dalton’s law?
When temp and volume are constant the total pressure of two gases is the sum of each individual partial pressure
Describe different types of immune response
- Allergic; IgE/histamine mediated (e.g. asthma, anaphylaxis,
hay fever) – Type I
Antigen binds to IgE→ Release of mediators (including
histamine) → acute inflammation
Histamine → bronchoconstriction and mucus hypersecretion
(e.g. in anaphylaxis)
- Cytotoxic antibody mediated (e.g. Goodpasture’s) – Type II
- Immune complex deposition mediated (e.g. SLE) – Type III
- Delayed; T cell mediated (e.g. TB) – Type IV
