Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3MB Buzzwords > Transition block > Flashcards

Transition block Flashcards

1
Q

Causes of pseudohyponatraemia include..

A

Hyperlipidaemia (increase in serum volume) or a taking blood from a drip arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hyponatraemia may be caused by..

A

Water excess or sodium depletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Lethargy, weakness, anorexia, nausea & vomiting, weight loss, ‘salt-craving’
Hyperpigmentation

A

Addison’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ix for addison’s disease

A

ACTH stimulation test (short Synacthen test)

Plasma cortisol is measured before and 30 minutes after giving Synacthen 250ug IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In addison’s disease, if an ACTH stimulation test is not readily available (e.g. in primary care) then..

A

9am serum cortisol

<100 nmol/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hyperkalaemia
Hyponatraemia
Hypoglycaemia
Metabolic acidosis

A

Addison’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Mx of addisonian crises

A

Hydrocortisone or IV normal saline infused over 30-60 mins or with dextrose if hypoglycaemic

Continue hydrocortisone 6 hourly until the patient is stable

Oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mx of addison’s disease

A

Hydrocortisone - first half of the day
Fludrocortisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Mx of intercurrent illness in addison’s disease

A

Glucocorticoid dose should be doubled, with the Fludrocortisone dose staying the same

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ABG in Cushing’s disease

A

Hypokalaemic metabolic alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In cushing’s disease, ectopic ACTH secretion (e.g. secondary to ___________) is characteristically associated with very low potassium levels

A

Small cell lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tests to confirm Cushing’s syndrome

A

Overnight (low-dose) dexamethasone suppression test
24 hr urinary free cortisol
Bedtime salivary cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cortisol not suppressed
ACTH suppressed

A

Cushing’s syndrome due to other causes (e.g. adrenal adenomas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cortisol suppressed
ACTH suppressed

A

Cushing’s disease (i.e. pituitary adenoma → ACTH secretion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cortisol not suppressed
ACTH not suppressed

A

Ectopic ACTH syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

An _________ test is used to differentiate between true Cushing’s and pseudo-Cushing’s.

A

Insulin stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

__________ sampling of ACTH may be needed to differentiate between pituitary and ectopic ACTH secretion

A

Petrosal sinus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Mx of Cushing’s disease

A

First-line = trans-sphenoidal removal of pituitary tumour (hypophysectomy)
Second-line = repeat trans-sphenoidal surgery, pituitary radiotherapy
Third-line = bilateral adrenalectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Source of prolactin

A

Anterior pituitary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Function of prolactin

A

Stimulates breast development (both initially and further hyperplasia during pregnancy)
Stimulates milk production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Prolactin secretion is under constant inhibition by…

A

Dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What decreases prolactin secretion

A

Dopamine
Dopaminergic agonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What increases prolactin secretion

A

Thyrotropin releasing hormone
Pregnancy
Oestrogen
Breastfeeding
Sleep
Stress
Drugs e.g. metoclopramide, antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

The syndrome of inappropriate ADH secretion (SIADH) is characterised by..

A

Hyponatraemia secondary to the dilutional effects of excessive water retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

SIADH involves an excessive release of..

A

ADH/ vasopressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Cause of SIADH

A

Small cell lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Urine osmolality high (>100 mOsm/kg)
Urine sodium concentration high (>40 mmol/L)

A

SIADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Mx of SIADH

A

Correction must be done slowly to avoid precipitating central pontine myelinolysis
Fluid restriction
Demeclocycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Decreased secretion of ADH from the pituitary (_________ DI) or an insensitivity to ADH (_________ DI)

A

Decreased secretion of ADH from the pituitary (cranial DI) or an insensitivity to ADH (nephrogenic DI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Causes of cranial DI

A

Idiopathic
Post head injury
Pituitary surgery
Craniopharyngiomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Causes of nephrogenic DI

A

Genetic
Hypercalcaemia/hypokalaemia
Lithium
Sickle-cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Polyuria + polydipsia

A

DI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

High plasma osmolality, low urine osmolality

A

DI

+ water deprivation test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

A urine osmolality of _____ mOsm/kg excludes diabetes insipidus

A

> 700

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Mx of DI

A

Nephrogenic: thiazides, low salt/protein diet
Central: desmopressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

High T4, High T3, Low TSH and presence of TSH-R antibodies

A

Grave’s disease (hyperthyroidism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Decrease in water permeability in late distal tubules and collecting duct

A

Nephrogenic Diabetes Insipidus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Does the following show hypo or hyperthyroidsm?

A

Hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Does the following show hyper or hypothyroidsm?

A

Hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Carbonic anhydrase inhibitors, e.g. acetazolamide, exert their action predominantly in the…

A

Proximal convoluted tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Anti-diuretic hormone (ADH) acts on vasopressin 2 receptors in the __________ causing upregulation of aquaporin water channel 2 and increased water reabsorption

A

Collecting duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What does the layers of the adrenal cortex produce?

A

GFR:

Zona Glomerulosa: mineralocorticoids like aldosterone
Zona Fasciculata: glucocorticoids like cortisol
Zona Reticularis: precursor androgens such as DHEA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

The thyroid gland is responsible for producing which hormones?

A

Triiodothyronine (T3), thyroxine (T4) and calcitonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Urine osmolality does not increase with fluid deprivation testing but upon administration of DDAVP urine osmolality increases

A

Central Diabetes Insipidus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Urine increases with fluid deprivation

A

Psychogenic polydipsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Increased plasma fluid leading to decreased plasma osmolality and intracellular fluid shift

A

SIADH, overhydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Plasma electrolyte loss leading to decreased plasma osmolality and intracellular fluid shift

A

Addison’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Hypovolaemic hyponatraemia

A

Burns
Sweating
Diarrhoea
Vomiting
Fistulae
Addison’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Euvolaemic hyponatraemia

A

Syndrome of inappropriate ADH release (SIADH)
Hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Hypervolaemic hyponatraemia

A

Renal/Heart/Liver failure
Nephrotic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the predominant stimulus for anti-diuretic hormone (ADH) release?

A

Increased plasma osmolarity

Low BP as well but that’s indirectly via ACE2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Unable to differentiate the sex of the baby at birth

A

21-hydroxylase deficiency - Congenital Adrenal Hyperplasia or CAH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Dilutional hyponatraemia
Low plasma osmolality

A

SIADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Thyrotoxicosis can cause hypo/hypernatraemia

A

Hypernatraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Enzyme responsible for the catalysis of the conversion of T4 (thyroxine) into T3 (thyronine)

A

Iodothyronine 5’deiodinase - prevented by propylthiouracil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Where is ACTH secreted from?

A

Anterior pituitary gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Target cell of ACTH

A

Cells in the zona fasciculata and zona reticularis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Most pituitary adenomas are non-functioning and therefore..

A

Will not cause hormone abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Oxytocin and vasopressin have the opposite effects on water homeostasis. How?

A

Vasopressin: promote water reabsorption in the collecting ducts of the kidney so expands plasma volume

Oxytocin: breast milk secretion and uterine contractions in pregnancy. Also works on the kidneys to stimulate excretion of water and sodium in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

A glycoprotein hormone made up of an alpha and beta subunit

A

TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Can occur as a paraneoplastic syndrome in small-cell lung carcinoma

A

SIADH secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Hyponatraemia, low serum osmolality and a high or normal urine osmolality

A

SIADH secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Prolongation of PR interval and ST depression with T wave flattening/inversion

A

Hypokalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Prolongation of PR interval, widening of QRS complex, tall T waves

A

Hyperkalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Function of thyroid gland

A

Basal Metabolic Rate
Gluconeogenesis
Glycogenolysis
Protein synthesis
Lipogenesis
Thermogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What needs to be increased for the thyroid gland to achieve its function?

A

Size and number of mitochondria within cells
Na-K pump activity
Presence of β-adrenergic receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Coupling of MIT and DIT gives _______ hormone and coupling of DIT and DIT gives _______

A

Coupling of MIT and DIT gives the triiodothyronine (T3) hormone and coupling of DIT and DIT gives the tetraiodothyronine (T4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

T3 and T4 are the active thyroid hormones. They are fat soluble and mostly carried by…

A

Plasma proteins – thyronine binding globulin (TBG) and albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Why is T4 used instead of T3 in the treatment of hypothyroidism?

A

Longer half-life
Plasma concentrations are easier to manage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

The hypothalamus detects a low plasma concentration of thyroid hormone and releases thyrotropin-releasing hormone (TRH) into the..

A

Hypophyseal portal system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

TRH binds to receptors found on thyrotrophic cells of the _________ gland, causing them to release thyroid stimulating hormone (TSH) into the systemic circulation.

A

Anterior pituitary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Actions of cortisol

A

Gluconeogenesis
Lipolysis
Immunosuppression
Anti-inflammation
Protein, fat, bone metabolism
Regulate calcium absorption from the GI tract
Regulate behaviour, mood, and cognition through activity on the CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Cortisol has a negative feedback effect by..

A

Inhibiting the production of CRH in the hypothalamus
Reducing the sensitivity of the anterior pituitary to CRH, which reduces ACTH release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Cushing’s disease is due to an excess of ______, Addison’s disease is due to a lack of ______, commonly due to autoimmune destruction of the ___________

A

Cushing’s disease is due to an excess of cortisol, Addison’s disease is due to a lack of cortisol, commonly due to autoimmune destruction of the adrenal cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Hormones in the anterior pituitary

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Hormones in the posterior pituitary

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What provides a rich supply to the pituitary endocrine cells?

A

Hypophyseal portal system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Hypothalamic-anterior pituitary-endocrine axis

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Give an example of a primary endocrine disease

A

Addison’s disease - disease that affects hormone secretion in the organ that produces the hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Give an example of a secondary endocrine disease

A

Cushing’s disease - affects the endocrine organ that releases tropic hormones, which indirectly affects peripheral hormone secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Give an example of a tertiary endocrine disease

A

Tertiary adrenal insufficiency caused by a dysfunctional hypothalamus and decreased CRH production - disease of the hypothalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Four-Five key signs of inflammation

A

Calor or heat
Dolor or pain
Rubor or redness
Tumor or swelling
Functio laesa or temporary loss of function due to pain or swelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Two main microbial factors that trigger inflammation are…

A

Virulence factors and pathogen associated molecular patterns (PAMPS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

________ are intracellular proteins that get released when a cell’s plasma membrane is injured or when a cell dies

A

DAMPs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

PAMPs and DAMPs are recognized by ________

A

Pattern Recognition Receptors or PRRs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

The inflammatory process usually begins with which cells?

A

Macrophages or mast cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Function of inflammatory mediators released by mast cells?

A

Act on the endothelial cells surrounding the capillaries nearby, causing them to separate from each other

Cytokines causes capillaries to get larger, and increase vascular permeability, allowing plasma proteins and fluids to leave the circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Endothelial cells help spur the process of vascular permeability by releasing ________, which helps vasodilate the capillaries and make them more permeable

A

Nitric oxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

_________ get attracted to the site of infection by the chemokines and microbial products

A

Neutrophils

Then squeeze through gaps between 2 endothelial cells, until it reaches the other side - extravasation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

_________ are the first leukocytes recruited during the acute inflammatory process

A

Neutrophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Function of complement proteins in acute inflammation

A

Opsonisation
Direct bacterial killing via large pore-forming complexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

________ cells phagocytose pathogens and present bits of them to T lymphocytes

A

Dendritic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

__________ are recruited to eat up dead and dying cells, so that the tissue can make room for new cells

A

Macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

The inflammatory response ends with..

A

Angiogenesis (temporary)

Triggered by growth factors released by macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

If there’s only mild damage, then the tissue regenerates back to its normal healthy state, but if there’s severe damage, then the damaged cells get replaced by…

A

Non-functional fibrous scar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What is primary intention?

A

When the wound edges come together - stem cells in the epidermis, or uppermost layer of skin are brought close together and can regenerate the damaged tissue near the surface of skin, leaving a minimal scar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What is secondary intention?

A

When the wound edges are too far from one another - tooth extraction sockets or severe burn injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is tertiary intention?

A

Wound is cleaned and purposefully left open due to a high likelihood of being contaminated by bacteria - dog bite injury. Then closed by primary intention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What are the wound healing stages?

A

Hemostasis - blood clot

Inflammation

Epithelialisation/migration - basal cells, or the stem cells in the epidermis start to proliferate in order to replace the lost or damaged cells

Fibroplasia

Maturation - collagen cross linking/remodeling

Repigmentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Factors that prevent proper healing and lead to chronic wounds

A

Decreased blood flow - diabetes, atherosclerosis, and prolonged compression
Infections
Uncontrolled swelling or edema around the wound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is atrophy?

A

Reduction in size of cell/organ/tissue due to apoptosis (weight loss) or decreased cell number (polyubiquitination)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Give an example of a severe , pathological form of atrophy

A

Cachexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Give an example of a physiological form of atrophy

A

Thymus involution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What is aplasia/hypoplasia?

A

Growth goes wrong in embryogenesis

Aplasia: Precursor cells absent so organ never forms (DiGeorge syndrome)

Hypoplasia: More common. Precursor cells present but not enough (Optic nerve hypoplasia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Differentiate between hyperplasia and hypertrophy

A

Hyperplasia - cell increase in number
Hypertrophy - cell increase in size

Hyperplasia, bigger pack
Hypertrophy, tough lumberjack!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What type of pathological process is shown in hypertension?

A

Hypertrophy - heart has to pump blood against a high resistance and cardiac myocytes once again adapt by increasing the synthesis of myofilaments causing individual cells to get bigger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Give an example of a physiological hyperplasia

A

Organs with stem cells that can undergo cellular differentiation to become a mature cell in that organ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Compensatory hyperplasia occurs in organs that regenerate, like the..

A

Skin, lining of the intestines, the liver, and bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Hormonal hyperplasia occurs in organs that are regulated by hormones like organs in the..

A

Endocrine and reproductive system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Enlargement of the female breast during pregnancy

What pathological process is shown here?

A

Physiologic hyperplasia - prolactin, progesterone, and human placental lactogen stimulate the growth of glandular tissue in the breast causing them to enlarge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Overproduction of estrogen by an ovarian tumor, it can lead to excessive endometrial growth

What pathological process is shown here?

A

Endometrial hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Hyperplasia can slip into…

A

Dysplasia

Abnormal growth/development of cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Hyperplasia and hypertrophy usually occur together when there’s increased stress. An example of this is seen in..

A

In pregnancy, the uterus gets stimulated by estrogen, which lead to hypertrophy and hyperplasia of the smooth muscle cells in the uterine wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Define metaplasia

A

Mature, differentiated cell type is replaced by another mature, differentiated cell type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What causes metaplasia?

A

Environmental stressor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Pathological process occurring in gastroesophageal reflux disease/Barrett’s esophagus

A

Metaplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Four major pathological microscopic changes

A

Cellular pleomorphism
Nuclear pleomorphism - hyperchromatism
Mitosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Infection of the cervix of the HPV causes the cells to become..

A

Dysplastic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

_________ is considered a precancerous state

A

Dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

_________ is generally benign, while dysplasia is considered a precancerous state, that can develop into carcinoma

A

Metaplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

__________ are actually mutated versions of proto-oncogenes, which are normal genes in charge of positive regulation of the cell-cycle

A

Oncogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Tumor suppressor genes are involved in…

A

DNA repair mechanisms and inhibiting transcription factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What are the two phases of the cell cycle?

A

Interphase and mitosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

What does the interphase consist of?

A

G1 - cell grows and performs its cell functions
S - DNA is replicated
G2 - cell grows again before entering mitosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

G1 and G2, there are cell cycle control points called the..

A

G1 and G2 checkpoints, where the cell checks to see if there’s any DNA damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

The main control point is the ____ checkpoint

A

G1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

If it turns out that there is DNA damage, then the cell can either _________ or _______

A

Enter a non-dividing state (G0) where the DNA repair mechanisms try to fix the problem

Apoptosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Now, if the cell does get the go-ahead at the G1 checkpoint, it enters the ____ phase

A

S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

If the cell gets past the G2 checkpoint, it enters ______

A

Mitosis - divides in two identical daughter cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Cells tend to stay in that ___ phase, like neurons

A

G0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Give examples of proto-oncogenes that code for growth factors or growth factor receptors

A

RTK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Give examples of proto-oncogenes that code for signal transduction proteins

A

Ras

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Give examples of proto-oncogenes that code for transcription factor that increases expression of cyclins and cyclin dependent kinases

A

Myc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Give examples of proto-oncogenes that code for transcription factor that code for proteins that inhibit apoptosis

A

Bcl-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Give an example of a translocation mutation that causes oncogene to get overexpressed

A

B cell lymphoma called Burkitt lymphoma - myc (from chromsome 8 to 14)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Give examples of tumour suppressor genes

A

Rb and p53

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Granulomas are associated with..

A

Exogenous foreign material

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Columnar mucinous epithelium of the endocervix of postpubertal women is gradually replaced by squamous epithelium through a normal physiologic process known as..

A

Squamous metaplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

What is the T zone?

A

Endocervical epithelium (columnar mucinous epithelium) is being actively replaced by squamous epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Which genes increase the risk of breast and ovarian cancer?

A

BRCA1 & 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Which genes increase the risk of colorectal and endometrial cancer?

A

Hereditary nonpolyposis colorectal cancer (Lynch II Syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

RMI

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

Give examples of functional non-neolpastic cells

A

Follicular cysts
Corpus luteal cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Give examples of pathological non-neolpastic cells

A

Endometrioma
Polycystic ovaries
Theca lutein cyst - molar pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Give examples of epithelial benign neolpastic tumours

A

Serous cystadenoma
Mucinous cystadenoma
Brenner tumour - solid grey or yellow appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Give examples of benign germ cell tumours

A

Mature cystic teratoma (Dermoid cysts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Give examples of sex-cord stromal tumours

A

Fibroma - present with Meig’s syndrome which is the association between these tumours and ascites/pleural effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

______, _______ and _______ should be measured in all women under 40 due to the possibility of germ cell tumours

A

Lactate dehydrogenase, alphafetoprotein and hCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

In premenopausal women, rescan a cyst in 6 weeks. If it is persistent then monitor with..

A

Ultrasound, an CA125 3-6 monthly and calculate RMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

Low RMI (less than 25) moa

A

Follow up for 1 year with ultrasound and CA125 if less than 5cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Moderate RMI (25-250) moa

A

Bilateral oophorectomy and if malignancy found then staging is required (with completion surgery of hysterectomy, omentectomy +/- lymphadenectomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

High RMI (over 250) moa

A

Referral for staging laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

_________ characterised by Psammoma bodies

A

Serous cystadenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

___________ characterised by mucin vacuoles

A

Mucinous cystadenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

Most common form of endometrial cancer is..

A

Adenocarcinoma - a neoplasia of epithelial tissue that has glandular origin and/or glandular characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

How does obesity predispose endometrial cancer?

A

Greater the amount of subcutaneous fat, the faster the rate of peripheral aromatisation of androgens to oestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Genetic conditions that predispose to cancer, such as __________________, are a risk factor for developing endometrial cancer

A

Hereditary non-polyposis colorectal cancer (Lynch syndrome)

158
Q

Leiomyomas are _____________ tumours of the uterus

A

Benign smooth muscle

159
Q

Cervical polyps develop as a result of focal _________ of the columnar epithelium of the endocervix

A

Hyperplasia

160
Q

Cervical polyps have a small risk of __________ transformation

A

Malignant

161
Q

Cervical ectropion occurs when there is..

A

Eversion of the endocervix, exposing the columnar epithelium to the vaginal milieu

162
Q

T or F: Cervical ectropion is an example of metaplasia

A

False

163
Q

T or F: CIN is an example of metaplasia

A

True

164
Q

The majority (70%) of cervical cancers are ___________. Of the remainder, 15% are ___________ and 15% are ___________ in type

A

The majority (70%) of cervical cancers are squamous cell carcinomas. Of the remainder, 15% are adenocarcinoma and 15% are mixed in type

165
Q

Lichen sclerosus characteristically causes _______; producing a thin stratified squamous epithelium

A

Atrophy

166
Q

Approximately 90% of vulval cancers are…

A

Squamous cell carcinomas

167
Q

Squamous _____________ in the respiratory tract occurs in cigarette smokers where the respiratory pseudostratified columnar epithelium is replaced by stratified squamous epithelium

A

Metaplasia

168
Q

Squamous _________ of the transformation zone of the uterine cervix is where a simple columnar epithelium is changed to be a stratified squamous epithelium

A

Metaplasia

169
Q

Sequence of vaccular changes occurring during inflammation

A

Vasoconstriction - thromboxane A2 and reflex from pain receptors
Vasodilatation - histamine from mast cells and nitric oxide from endothelial cells
Increased permeability of vessels - oedema
Stasis of RBC - allows white blood cells to line up on the peripheral edge of the vessel

170
Q

Epstein-Barr virus is an oncovirus for which cancers?

A

Burkitt’s lymphoma
Hodgkin’s lymphoma
Post transplant lymphoma
Nasopharyngeal carcinoma

171
Q

Human papillomavirus 16/18

A

Cervical cancer
Anal cancer
Penile cancer
Vulval cancer
Oropharyngeal cancer

172
Q

Breast implants often become surrounded by a pseudocapsule and this may secondarily subjected to a process of…

A

Dystrophic calcification

173
Q

___________ polymorphs are the cell type most commonly encountered in acute inflammation

A

Neutrophil

174
Q

Which cells are involved in the haemostasis phase of wound healing?

A

Erythrocytes and platelets - seconds/minutes

175
Q

Which cells are involved in the inflammation phase of wound healing?

A

Neutrophils, fibroblasts and macrophages - days

176
Q

Which cells are involved in the regeneration phase of wound healing?

A

Fibroblasts, endothelial cells, macrophages - weeks

177
Q

Which cells are involved in the remodelling phase of wound healing?

A

Myofibroblasts - 6 weeks to 1 year

178
Q

What is anaplasia?

A

Loss of structural differentiation and is seen in malignant change

179
Q

What is dysplasia?

A

Loss of maturity of epithelium type, and is the result of incomplete cellular differentiation

180
Q

What is metaplasia?

A

Change from one cell type to another cell type

181
Q

Potent mediators of vascular dilatation include..

A

Histamine, prostaglandins, nitric oxide, platelet activating factor, complement C5a (and C3a) and lysosomal compounds

182
Q

Vasoconstrictors in acute inflammation..

A

Serotonin

183
Q

Neutrophil polymorphs = Acute inflammation
__________ = Chronic inflammation

A

Granuloma

184
Q

Leucocyte extravasation consists of..

A

Chemoattraction, rolling, tight adhesion and transmigration

185
Q

Which cells are responsible for chemoattraction in leucocyte extravasation?

A

Macrophages in the affected tissue release cytokines such as IL-1, TNF-α

186
Q

Which cells are responsible for tight adhesion in leucocyte extravasation?

A

Leucocytes express integrins in response to the cytokines. These bind to ICAM proteins on endothelial cells

187
Q

Which cells are responsible for transmigration in leucocyte extravasation?

A

PECAM proteins on both endothelial cells and leucocytes

188
Q

Cellular changes that occur after vascular changes

A

Leukocyte extravasation (leakage of fluid)
Margination, rolling and adhesion of neutrophils due to selectins and adhesion proteins
Transmigration across the endothelium into the tissues
Migration towards chemotactic stimulus (bacterial products or endogenous chemoattractants)

189
Q

After cellular changes, leukocyte activation occurs, which is induced by..

A

Microbes, products of necrotic cells, antigen-antibody complexes
Production of prostaglandins
Degranulation and secretion of lysosomal enzymes
Cytokine secretion
Modulation of leukocyte adhesion molecules

190
Q

_______ causes secretion of water and electrolytes

A

Secretin

191
Q

_________ comprise 50% of the cells of the anterior pituitary gland

A

Somatotrophs

192
Q

Mechanism of the body’s response to a decrease in blood pressure?

A

Antidiuretic hormone promotes water reabsorption by the insertion of aquaporin-2 channels

193
Q

Folate/Vit B12 absorption is dependent on pancreas

A

Vit B12

194
Q

Give examples of surface epithelial cell tumours

A

Serous/mucinous
Endometriod
Cystadenocarcinoma

195
Q

Give examples of germ tumours

A

Teratoma
Dysgerminoma

196
Q

Give examples of sex cord stromal cells

A

Fibroma
Granulosa theca cell tumour
Sertoli Leydig cell

197
Q

Metastasis to ovaries usually occur from..

A

Breast
Lung
Colon

198
Q

What is the action of LH in males?

A

Stimulates the Leydig cells in the testes to produce testosterone

199
Q

What is the action of FSH in males?

A

Sperm production in the Sertoli cells of the testes (spermatogenesis)

Synthesis of proteins important for the production and action of steroid hormones

200
Q

What is the function of LH and FSHin females?

A

Stimulate the ovary to produce mature gametes, as well as synthesise and secrete oestrogens and progestins

201
Q

LH binds to ______ and ______ cells on developing follicles

After ovulation, LH binds to cells of the ______. It acts on theca cells to produce progestins and androgens.

Androgens enter granulosa cells and are then converted to ______

A

LH binds to theca and granulosa cells on developing follicles

After ovulation, LH binds to cells of the corpus luteum. It acts on theca cells to produce progestins and androgens.

Androgens enter granulosa cells and are then converted to oestrogens

202
Q

GnRH is released in a ________ fashion from neurons in the hypothalamus

A

Pulsatile

203
Q

In prostate cancer, _________ are administered to suppress LH and FSH release, thereby reducing testosterone production

A

Long-acting GnRH analogue

204
Q

What are the direct effects of GH?

A

Increased lipolysis
Glycogenolysis
Stimulation of stem cell division and differentiation of daughter cells in epithelia and connective tissues

205
Q

What are the indirect effects of GH?

A

via IGF-1:

Increased protein synthesis and cell growth
Increased carbohydrate oxidation

206
Q

Whilst GHRH promotes GH release, the hypothalamus also produces ____________ which inhibits GH

A

Growth hormone inhibiting hormone (somatostatin)

207
Q

Growth hormone axis

A
208
Q

Depression
Reduced muscle mass and strength
Reduced bone mass
Reduced energy
Possible cardiac dysfunction

A

Growth Hormone Deficiency

209
Q

Large extremities with growth of hands, feet and jaw
Paraesthesia in the extremities
Amenorrhoea
Coarse facial features, wide nose and rounded face
Hypertension
Cardiomegaly (enlarged heart)

A

Growth Hormone Excess - acromegaly

210
Q

Several factors including stress, exercise, nutrition, hormones such as _________ (synthesised by the stomach) and sleep modulate the production of growth hormone

A

Ghrelin

211
Q

Within the hypothalamus, neurons from the ________ and _________ nuclei extend into the posterior pituitary

A

Paraventricular and supraoptic

212
Q

Activation of oxytocin receptor (GPCR) results in a significant influx of _________ ions into the cell

A

Calcium

213
Q

___________ release further oxytocin, forming a positive feedback loop

A

Contractions

214
Q

Oxytocin reaches the _________ cells lining the alveoli in the breast, causing these cells to contract

A

Myoepithelial

215
Q

Which hormone is responsible for milk ejection reflex or milk let-down reflex?

A

Oxytocin

216
Q

__________ released during ejaculation stimulates contraction of the vas deferens and prostate gland for the emission of sperm and prostatic secretions

A

Oxytocin

217
Q

_____ increases the number of oxytocin receptors present in the myometrium and decidua during this time.

A

Oestrogen

218
Q

SIADH can come from..

A

Small cell lung carcinoma

219
Q

Mutations in vasopressin gene

A

Cranial diabetes insipidus

220
Q

Mutations in ADH receptor gene or aquaporin-2 gene

A

Nephrogenic diabetes insipidus

221
Q

Most common cause of neck swellings

A

Reactive lymphadenopathy

222
Q

Rubbery, painless lymphadenopathy
Pain whilst drinking alcohol is very uncommon
There may be associated night sweats and splenomegaly

A

Lymphoma

223
Q

Hypo-, eu- or hyperthyroid symptomatically
Moves upwards on swallowing

A

Thyroid swelling

224
Q

< 20 years old
Usually midline, between the isthmus of the thyroid and the hyoid bone
Moves upwards with protrusion of the tongue
May be painful if infected

A

Thyroglossal cyst

225
Q

Older men
Posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Usually not seen but if large then a midline lump in the neck that gurgles on palpation
Dysphagia, regurgitation, aspiration and chronic cough

A

Pharyngeal pouch

226
Q

A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth (<2 years)

A

Cystic hygroma

227
Q

An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Failure of obliteration of the second branchial cleft in embryonic development
Early adulthood

A

Branchial cyst

228
Q

More common in adult females
Around 10% develop thoracic outlet syndrome

A

Cervical rib

229
Q

Pulsatile lateral neck mass which doesn’t move on swallowing

A

Carotid aneurysm

230
Q

Metabolic _______ is associated with hyperkalaemia

A

Acidosis

231
Q

Causes of Hyperkalaemia

A

ACE inhibitors
Addison’s disease
Acute kidney injury - haemodialysis

232
Q

Causes of Hypokalaemia

A

Bendroflumethiazide
Furosemide
Primary hyperaldosteronism
Pyloric stenosis
Cushing’s disease
Hypokalaemic periodic paralysis

233
Q

Hypertension
Hypokalaemia
Metabolic alkalosis

A

Primary hyperaldosteronism

234
Q

Ix for Primary hyperaldosteronism/conn’s syndrome

A

Plasma aldosterone/renin ratio
High-resolution CT abdomen
Adrenal vein sampling to differentiate whether if it’s unilateral or bilateral

235
Q

Mx of Primary hyperaldosteronism/conn’s syndrome

A

Adrenal adenoma: surgery (laparoscopic adrenalectomy)
Bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone

236
Q

Causes of hyponatraemia

A

Thiazides
Loop
SSRI
Lung cancer
Addison’s
Carbamazepine
Sulfonylureas
Acute intermittent porphyria

237
Q

Cause of hypernatraemia

A

Hyperosmolar hyperglycaemic state
Diabetes insipidus

238
Q

Hypovolaemia
Hyperglycaemia (>30 mmol/L) without significant ketonaemia or acidosis
Raised serum osmolarity (> 320 mosmol/kg)

A

Hyperosmolar hyperglycaemic state

239
Q

Mx of HHS

A

IV 0.9% sodium chloride solution - 0.5 - 1 L/hour
Insulin if blood glucose stops falling while giving fluids
Venous thromboembolism prophylaxis

240
Q

Mode of inheritance in FH

A

Autosomal dominant - high levels of LDL-cholesterol

241
Q

We should suspect FH as a possible diagnosis in adults with..

A

A total cholesterol level greater than 7.5 mmol/l and/or
A personal or family history of premature coronary heart disease (an event before 60 years in an index individual or first-degree relative)

242
Q

If one parent is affected by familial hypercholesterolaemia, arrange testing in children by..

A

Age 10

243
Q

If both parents are affected by familial hypercholesterolaemia, arrange testing in children by..

A

Age 5

244
Q

Mx of FH

A

Referral to a specialist lipid clinic
High-dose statins (discontinued in women 3 months before conception)

245
Q

What type of inheritance is shown here?

A

Mitochondrial

Affected females transmit the disease to all their children
Affected males don’t

246
Q

Which genetic condition is detected via deletion using fluorescence in-situ hybridisation?

A

Cri du chat syndrome

247
Q

Which genetic condition is detected via duplication using fluorescence in-situ hybridisation?

A

Chacot marie tooth disease

248
Q

Which genetic condition is detected via translocation using fluorescence in-situ hybridisation?

A

Philadelphia chromosome - CML

249
Q

Karyotype 47XY + 21

A

Down Syndrome

Robertsonian Translocation

250
Q

22.q11.2 Deletion

A

DiGeorge Syndrome

251
Q

47, XXY

A

Klinefelter syndrome

252
Q

45, X

A

Turner syndrome

253
Q

Turner Syndrome is diagnosed by…

A

Karyotyping

254
Q

Mode of inheritance seen in turner’s syndrome

A

Sporadic - monosomy of the X chromosome

255
Q

46 XY/46 XX

A

Noonan’s syndrome

256
Q

Androgen sensitivity syndrome mode of inheritance

A

X-linked recessive

257
Q

Mode of inheritance seen in Klinefelter

A

Sporadic - non-disjunction during meiosis

X inactivation - Barr body

258
Q

Mode of inheritance seen in Fragile X syndrome

A

X-linked inheritance - CGG trinucleotide repeat

259
Q

Robertsonian/Reciprocal translocation is seen in down syndrome

A

Robertsonian

260
Q

___________ non-disjunction is the most common mechanism underpinning the development of Down syndrome

A

Chromosomal

261
Q

Trisomy 18

A

Edward’s

262
Q

Trisomy 13

A

Patau

263
Q

If a mutation develops in the mismatch repair genes, the cell can no longer correct (insertions/deletions) errors, increasing the overall mutation rate in the cell. This is termed…

A

Microsatellite instability.

264
Q

An example of a condition with a mutated mismatch repair gene is..

A

Hereditary non-polyposis colorectal cancer (HNPCC)

265
Q

Antithrombin III deficiency mode of inheritance

A

Autosomal dominant

266
Q

Hypotonia, small hands and feet and undescended testes

A

Prader–Willi syndrome

267
Q

Expansion of cytosine–guanine–adenine (CAG) repeats

A

Huntington’s disease

268
Q

Microcephaly with a prominent occiput, low-set ears and an abnormally small jaw. She also has clenched fists with overlapping fingers on both hands

A

Edwards syndrome - Trisomy 18

269
Q

Amniocentesis: _____ weeks
CVS: _____ weeks

A

Amniocentesis: 16-20 weeks
CVS: 11-14 weeks

270
Q

With autosomal-dominant conditions, for the child to develop the disease, the mother or father must be _________ of the dominant allele

A

Carriers

271
Q

True hyponatraemia with a markedly low urine osmolality (< 100 mOsmo/kg) narrows the differential diagnosis to either ___________________ or _______________

A

Psychogenic polydipsia
Low solute intake (solely beer or tea and toast diet)

272
Q

_______ can decrease the absorption of tetracycline antibiotics (e.g. doxycycline)

A

Oral iron (e.g. ferrous sulfate)

Give iron at least 3 hours before or 3 hours after tetracycline

273
Q

_____________ can prolong bleeding times and cause gastrointestinal toxicity. These effects are aggravated when given with anticoagulants (e.g. warfarin)

A

Naproxen, and other NSAIDs

Alter warfarin dose to ensure ref range

Monitor INR + bleeding signs

274
Q

Drug metabolism commonly occurs in the liver through__________ or ___________

A

Phase I reactions (oxidation, reduction, or hydrolysis)

Or

Phase II reactions (e.g. glucuronidation)

275
Q

Most drug metabolism is carried out by phase I reactions involving…

A

Isoenzyme cytochrome P450 (CYP450)

276
Q

T or F:

Enzyme induction: takes approximately two-three weeks to develop and wear off

Enzyme inhibition: takes only days to develop

A

True

277
Q

Enzyme inducers

A

GP RAPS:

Griseofulvin
Phenytoin
Rifampicin
Alcohol (chronic)
Phenobarbital
Sulfonylureas (e.g. gliclazide)

278
Q

Phenytoin is a potent CYP3A4 inducer which induces the metabolism of ____________ contraceptives (e.g. ________), allowing ovulation to occur

A

Progesterone-only contraceptives (e.g. desogestrel)

IUD, depots, barrier for less than two months use of phenytoin

Consider additional consistent use of condoms during and for at least 28 days after stopping phenytoin

279
Q

Enzyme inhibitors

A

COKE, Alcohol and Grapfruit juice with your PIs

Cimetidine
Omeprazole
Ketoconazole
Erythromycin
Portease inhibitors
Sodium Valproate

280
Q

Clarithromycin inhibits the CYP3A4 enzyme responsible for metabolising ____________, subsequently increasing the plasma concentration

A

Simvastatin

Withhold simvastatin while administering clarithromycin

281
Q

Methotrexate is a substrate for OAT1 and/or OAT3 so can compete with __________ which are involved in the active renal secretion of drug

A

NSAIDs

Avoid NSAIDs with methotrexate and use alternative analgesia

282
Q

Example of a beneficial additive/synergistic interaction

A

Ramipril inhibits the ACE enzyme from converting angiotensin I to angiotensin II, causing increased vasodilation due to inhibition of bradykinin breakdown

Amlodipine causes the direct relaxation of the vascular smooth muscles

No action is required unless hypotension occurs

283
Q

Example of a harmful additive/synergistic interaction

A

Enoxaparin with apixaban

Additive anti-Xa activity. This increases the risk of bleeding

284
Q

Example of an antagonism interaction

A

Propranolol (blocks b2 which can make asthma worse) with salbutamol

285
Q

Cardioselective Beta Blockers Are MEAN

A

Celiprolol
Bisoprolol
Betaxolol
Acebutolol
Metoprolol
Esmolol
Atenolol
Nebivolol

286
Q

Omeprazole with clopidogrel interaction

A

Omeprazole can decrease the antiplatelet effects of clopidogrel (give cimetidine instead)

287
Q

SSRIs with NSAIDs interaction

A

Can increase GI bleading

288
Q

Methotrexate with trimethoprim interaction

A

Risk of severe bone marrow suppression & subsequent pancytopenia (monitor FBC and give folinic acid as an antidote)

289
Q

Verapamil with beta-blockers interaction

A

Additive cardiac depression effects (leading to bradycardia, asystole, sinus arrest) so never give verapamil in IV

290
Q

ACE inhibitors with potassium-sparing diuretics (e.g. spironolactone/eplerenone) interaction

A

Increases the risk of hyperkalaemia and acute kidney injury

291
Q

Which drug causes unexplained rhabdomyolysis?

A

Statins

292
Q

Absorption of levothyroxine is reduced by…

A

Food and caffeine
Antacids
Calcium and iron supplements

293
Q

Long-term side effects of taking omeprazole

A

Osteoporosis, Clostridium difficile infection, hypomagnesaemia and vitamin B12 deficiency

294
Q

Omeprazole drug interactions

A

SSRI
Clopidogrel
Methotrexate

295
Q

Key counselling point of taking amlodipine?

A

Dizzy so blood pressure monitoring will be required during treatment

296
Q

Amlodipine drug interactions

A

Simvastatin - rhabdomyolysis
Diltiazem and verapamil - arrythmias
Ramipril - hypotension

297
Q

Joint pain (arthralgia), muscle discomfort (myalgia), nausea & vomiting, flatulence, constipation and gastrointestinal discomfort

A

Atorvastatin

298
Q

Excess dosing causes symptoms of hyperthyroidism

A

Levothyroxine

299
Q

Dizziness, flushing, palpitations, headaches, peripheral oedema (usually leg swelling) and headaches

A

Amlodipine

300
Q

Dry cough
Hyperkalaemia
Angioedema

A

Ramipril

301
Q

Rampiril drug interactions

A

NSAIDs - hyperkalaemia
Lithium

302
Q

Bisoprolol interactions

A

Verapamil, diltiazem and amiodarone - heart block

303
Q

Gastrointestinal and taste disturbances
Weight loss

A

Metformin

304
Q

Don’t mix _____ or _____ with ciprofloxacin or doxycyclin

A

Calcium or ferrous sulphate

305
Q

Causes of decreased compliance

A

Pulmonary oedema
Pulmonary fibrosis
Pneumonectomy
Kyphosis

306
Q

Causes of resp alkalosis

A

Anxiety leading to hyperventilation
PE
Salicylate poisoning
CNS disorders: stroke, subarachnoid haemorrhage, encephalitis
Altitude
Pregnancy

307
Q

ABG in overdose

A

Mixed respiratory alkalosis and metabolic acidosis

Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis

308
Q

What would be the expected ABG of a normal pregnant woman?

A

Compensated respiratory alkalosis

309
Q

ABG seen in Hyperemesis gravidarum

A

Metabolic alkalosis

310
Q

What is anticipation?

A

Increased severity or earlier onset of disease in succeeding generations

311
Q

What is mosaicism?

A

Genetically distinct cell lines in the same individual

312
Q

What is codominance?

A

Both alleles contribute to the phenotype of a heterozygote - ABO blood groups

313
Q

Heteroplasmy vs Homoplasmy

A

Pesence of more than one type of organellar genome (mitochondrial DNA or plasmid DNA) within a cell or individual and explains why there is a varying expression of disease in this patient’s family

Homoplasmy is the opposite to heteroplasmy

314
Q

What is Penetrance?

A

Proportion of a population of individuals who carry a disease-causing allele who express the related disease phenotype

315
Q

What is Expressivity?

A

Degree of variation in expression of a non-binary phenotype

316
Q

Example of trinucleotide repeat disorders

A

Fragile X (CGG)
Huntington’s (CAG)
Myotonic dystrophy (CTG)
Friedreich’s ataxia (GAA)
Spinocerebellar ataxia
Spinobulbar muscular atrophy
Dentatorubral pallidoluysian atrophy

317
Q

What is Aneuploidy?

A

Presence of an abnormal number of chromosomes in the cell, for example, an extra chromosome in Down syndrome

318
Q

Which genetic test is used to selectively amplify and detect short genomic sequences?

A

PCR

Denaturation, annealing and elongation

319
Q

Which genetic test is used to measure proteins?

A

ELISA

320
Q

Which test is used to detect genomic sequence on a chromosome?

A

Fluorescence in situ hybridisation - labelled probe

321
Q

Which genetic technique is used to measure gene expression levels by hybridising them with a sample containing DNA or RNA?

A

Microarray

322
Q

___________ is used in rheumatoid arthritis and Crohn’s

A

Infliximab (anti-TNF)

323
Q

__________ is used in non-Hodgkin’s lymphoma and rheumatoid arthritis

A

Rituximab (anti-CD20)

324
Q

__________ is used in metastatic colorectal cancer and head and neck cancer

A

Cetuximab (epidermal growth factor receptor antagonist)

325
Q

_____________ is used in metastatic breast cancer

A

Trastuzumab (HER2/neu receptor antagonist)

326
Q

_______________ is used in chronic lymphocytic leukaemia

A

Alemtuzumab (anti-CD52)

327
Q

________ is used in prevention of ischaemic events in patients undergoing percutaneous coronary interventions

A

Abciximab (glycoprotein IIb/IIIa receptor antagonist)

328
Q

___________ is used to prevent organ rejection

A

OKT3 (anti-CD3)

329
Q

What is the function of Azathioprine?

A

Immunosuppressant that inhibits purine synthesis

330
Q

__________ test can be used to assess azathioprine toxicity

A

A thiopurine methyltransferase (TPMT)

331
Q

Azathioprine can cause a significant interaction with…

A

Allopurinol

332
Q

What is the function of Ciclosporin?

A

Immunosuppressant widely used to prevent transplant rejection

333
Q

Explain the pharmacology of Ciclosporin

A

Decreases clonal proliferation of T cells by reducing IL-2 release. It acts by binding to cyclophilin forming a complex which inhibits calcineurin, a phosphatase that activates various transcription factors in T cells

334
Q

Anti-CCP

A

RA

335
Q

Anti-mitochondrial

A

Primary biliary cholangitis

336
Q

ANA antibodies

A

Systemic lupus erythematosus
Sjogren’s syndrome

337
Q

Anti-RNP antibody

A

Mixed connective tissue disease

338
Q

Anti-thyroid peroxidase antibody

A

Hashimoto’s disease

339
Q

Anti-tissue transglutaminase antibody

A

Coeliac

340
Q

Rheumatoid factor

A

Rheumatoid arthritis
Sjogren’s syndrome

341
Q

Smooth muscle autoantibodies

A

Autoimmune hepatitis

342
Q

TSH receptor antibody

A

Grave’s

343
Q

cANCA

A

Granulomatosis with polyangiitis/ Wegener’s granulomatosis

344
Q

pANCA

A

Eosinophilic granulomatosis with polyangiitis
Microscopic polyangiitis

UC, PSC, Anti-GBM, Crohn’s

345
Q

Examples of live attenuated vaccines

A

BCG
MMR
Influenza (intranasal)
Oral rotavirus
Oral polio
Oral typhoid
Yellow fever

Weakened form of pathogen
NOT for immunocompromised/pregnant

346
Q

Examples of inactivated vaccines

A

Rabies
Hepatitis A
Influenza (intramuscular)

Pathogens have been killed by heat/chemicals to elicit immune response

347
Q

Examples of toxoid vaccines

A

Tetanus
Diphtheria
Pertussis

Immune system learns to combat the natural toxins the bacteria produce

348
Q

Examples of conjugate vaccines

A

Pneumococcus
Haemophilus
Meningococcus

Links poorly polysaccharide immunogenic bacterial outer coats to proteins - more immunogenic

349
Q

Examples of subunit vaccines

A

Hepatitis B
Human papillomavirus

Only part of the pathogen is used to generate an immunogenic response

350
Q

Examples of mRNA vaccines

A

COVID-19

Introduce a piece of mRNA into cells which then produce a protein to trigger an immune response

351
Q

Examples of vector vaccines

A

Ebola and COVID-19

Use a harmless virus (different from the target pathogen) to deliver critical parts of the target pathogen to stimulate an immune response

352
Q

Different types are available, including whole inactivated virus, split virion (virus particles disrupted by detergent treatment) and sub-unit (mainly haemagglutinin and neuraminidase)

A

Influenza

353
Q

Contains HBsAg adsorbed onto aluminium hydroxide adjuvant and is prepared from yeast cells using recombinant DNA technology

A

Hepatitis B

354
Q

Contains inactivated Inaba and Ogawa strains of Vibrio cholerae together with recombinant B-subunit of the cholera toxin

A

Cholera

355
Q

Example of monovalent vaccines

A

Measles

Singular antigenic component, conferring immunity against one strain or subtype of a pathogen

356
Q

Example of polyvalent vaccines

A

Quadrivalent influenza vaccine

Multiple antigenic components, safeguarding against various strains or subtypes of a pathogen or, occasionally, multiple pathogens

357
Q

Cavitating lesions, recent flu

A

Staphylococcus aureus

358
Q

Alcoholics and diabetics

A

Klebsiella pneumoniae

359
Q

Pneumonia in COPD

A

Haemophilius influenzae

360
Q

Hyponatraemia, headache, AC exposure, deranged LFTs

A

Legionella

361
Q

Associated with CF, green sputum

A

Pseudomonas aeruginosa

362
Q

Cold sores, most common type of pneumonia if no specific indications for other types of pneumonia

A

Streptococcus pneumoniae

363
Q

TB drugs side effects

A

Rifampicin - R for Red secretions
Isoniazid - Is for Ice, which would numb you, so neuropathy
Pyrazinamide - Pyra as in Pyramid-like-crystal, so gout
Ethambutol - E for Eyes, so visual problems

364
Q

Tender lymphadenopathy, usually unilateral, pyrexia and lower back pain (indicative of deep iliac node lymphadenopathy. Anorectal involvement and skin conditions like erythema nodosum are usually associated with it

A

Lymphogranuloma venereum

365
Q

Lumbar puncture should be avoided in which circumstances?

A

Signs of severe sepsis or a rapidly evolving rash
Severe respiratory/cardiac compromise
Significant bleeding risk

Signs of raised intracranial pressure:
Focal neurological signs
Papilloedema
Continuous or uncontrolled seizures
GCS ≤ 12

366
Q

Avoid dexamethasone in..

A

Septic shock,meningococcal septicaemia, or if immunocompromised, or in meningitis following surgery

367
Q

IV dexamethasone should be started no later than ____ hours

A

12 hours

368
Q

Tx for Pyelonephritis

A

Broad-spectrum cephalosporin or a quinolone (for non-pregnant women) for 7-10 days

369
Q

Tx for Urethritis

A

Either oral doxycycline for 7 days or single dose of oral azithromycin

370
Q

Posterior/cervical lymphadenopathy + longer duration of prodromal symptoms

A

EBV

371
Q

Isolated submandibular lymphadenopathy + 2-20 days of prodromal symptoms

A

HSV

372
Q

Mx of genital warts

A

Topical podophyllum or cryotherapy
Imiquimod

373
Q

Perform stool microbiological investigations if:

A

1) You suspect septicaemia
2) there is blood and/or mucus in the stool or
3) the child is immunocompromised

374
Q

Management of PCP

A

Co-trimoxazole
IV pentamidine in severe cases (aerosolized alt.)
Steroids if hypoxic (if pO2 < 9.3kPa then steroids reduce risk of respiratory failure by 50% and death by a third)

375
Q

Develops over weeks. meningeal enhancement or signs of cerebral oedema

A

Cryptococcal meningoencephalitis

376
Q

Develops over days, abnormalities in the temporal lobes and inferior frontal lobes

A

Herpes simplex encephalitis

377
Q

Calculation of safe dose medication

A
378
Q

Lung volumes

A
379
Q

MOA of antibiotics

A
380
Q

Side effects of ACE inhibitors

A

Cough
Hyperkalaemia

381
Q

Side effects of Bendroflumethiazide

A

Gout
Hypokalaemia
Hyponatraemia
Impaired glucose tolerance

382
Q

Side effects of CCB

A

Headache
Flushing
Ankle oedema

383
Q

Side effects of BB

A

Bronchospasm
Fatigue
Cold peripheries

384
Q

Side effects of Doxazosin

A

Postural hypotension

385
Q

NSAIDS (substrate) + Fluconazole (inhibitor) = ?

A

GI ulcers, renal injury

386
Q

Amitriptyline, clozapine (substrate) + Ciprofloxacin (Inhibitor) = ?

A
387
Q

Drugs that cause gynecomastia

A

DISCO

Digoxin
Isoniazid
Spironolactone (most common)
Cimetidine
Oestrogen

388
Q

Give examples of type 2 hypersensitivity

A

Autoimmune haemolytic anaemia
ITP
Pernicious anaemia
Acute haemolytic transfusion reactions

389
Q

Give examples of type 4 hypersensitivity

A

Multiple sclerosis
Guillain-Barre syndrome
Graft versus host disease

390
Q

Give examples of type 5 hypersensitivity

A

Graves’ disease
Myasthenia gravis

391
Q
A

3MB Buzzwords (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions