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People and illness > Week 2 > Flashcards

Week 2 Flashcards

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People You Should Know flashcards
1
Q

What is a psychiatrist?

A

a doctor who assesses, diagnoses and manages mental illness

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2
Q

Describe the psychotic sieve

A 
psychotic
mood
anxiety
organic
substance misuse
personality 
no mental illness
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3
Q

What are the three main psychotic symptoms?

A

hallucinations
delusions
thought disorder

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4
Q

What is a delusion?

A

a false, unshakeable idea or belief which is out keeping with the person’s educational, cultural and social background; it is held with extraordinary conviction and subjective certainty

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5
Q

What are the three core symptoms of depression?

A

low mood
anhedonia
low energy

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6
Q

What are the cognitive features of depression

A 
slowed speed of thought
reduced concentration
reduced self esteem
ideas of guilt and unworthiness
bleak and pessimistic views of the future
hoplessness
ideas or acts of self-harm or suicide
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7
Q

What are the biological symptoms of depression?

A 
disturbed sleep
diminished appetite
weight loss
loss of libido
low energy
constipation
amenorrhoea
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8
Q

what are the cognitive disorders associated with depression?

A 
arbitary inference
selective abstraction
magnification
minimisation
over-generalization
personalisation
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9
Q

Give examples of SSRIs

A

sertaline, fluoxetine

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10
Q

WHat are the side effects of SSRIs?

A

nausea, vomiting, agitation, sexual dysfunction, hyponatraemia, sweating

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11
Q

Give examples of tricyclic antidepressants

A

amitryptaline

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12
Q

give examples of SNRIs

A

venlafaxine

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13
Q

Give examples of NASSAs

A

mirtazepine

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14
Q

Give examples of NARIs

A

Reboxetine

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15
Q

What are the 5 stages of adjustment?

A 
denial
anger
bargaining
depression
acceptance
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16
Q

What are the types of abnormal grief

A

unexpected
ambivalent
chronic
delayed

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17
Q

What are the factors associated with abnormal grief reactions?

A 
loss of child
loss of parent during childhood
sudden unexpected death
multiple deaths
attachment of blame to survivor
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18
Q

What is invasion?

A

growth by infiltration and destruction of surrounding tissues

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19
Q

WHat is metastasis?

A

spread of tumour to and growth at ectopic sites via blood, lymphatics, intraepithelial route or transcoelomic

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20
Q

What is a carcinoma?

A

malignant tumour derived from epithelial cells

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21
Q

What is a sarcoma?

A

malignant tumour derived from mesenchymal cells

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22
Q

What is melanoma?

A

malignant tumour derived from neural crest cells

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23
Q

What is leukaemia?

A

malignant tumour derived from circulating white blood cells

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24
Q

What is lymphoma?

A

malignant tumour derived from the lymphatic system

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25
Q

What is the metastatic cascade?

A 
local invasion
angiogenesis
detachment 
intravasation 
transport
lodgement / arrest
extravasation
growth at ectopic site
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26
Q

What are the properties of a metastatic tumour?

A 
reduced cell -cell adhesion
altered cell-substratum adhesion
increased motility
increased proteolytic ability
angiogenic ability
ability to intravasate and extravasate
ability to proliferate
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27
Q

How do carcinomas acquire the ability to escape the “glue” that binds them together?

A

via mutations in E-cadherin or in the molecules that regulate or interact with it

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28
Q

What are the names for the transcription factors that regulate E-cadherin?

A

snail, slug, twist

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29
Q

Describe the action of HGF

A

mitogen, mitogen and morphogen
Produced by stromal cells of the tumour
binds to c-met on tumour epithelial cells
increased phosphorylation of beta-catenin in tumour epithelial cells which leads to disrupted ECD-mediated adhesion

30
Q

What is the stromal component of Cmet?

A

HGF

31
Q

Where are chemokines produced in relation to cancer?

A

stromal cells

32
Q

How are MMPs normally regulated?

A

transcriptional
synthesis of zymogen
activated by serine proteases
negative regulation by tissue inhibitors of metalloprteinases

33
Q

What are the stages of extravasation?

A

rolling
activation
adhesion
diapedesis

34
Q

Where do skin melanoma tumours usually spread to?

A

lungs, brain, skin, liver

35
Q

What are possible mechanisms for organ tropism?

A

selective adhesion to endothelium to target organs
selective response to GFs at ectopic site
selective migration to CK source
Factors released by tumour cause changes in prospective TMW at secondary sites
balance of local and systemic angiogenic factors

36
Q

WHat is the name of the chromosome mutation in chronic myeloid leukaemia?

A

the philadelphia gene

37
Q

How does imatinib work?

A

binds to ATP binding region on Abl kinase and therefore prevent it from functioning properly

38
Q

What drugs are VEGF inhibits?

A

sunitinib
pazopanib
axitinib

39
Q

What are common mutations in melanoma?

A

Raf kinase

MAP kinase

40
Q

What can be used to chemically castrate a man?

A

GnRH agonist
GnRH antagonist
oestrogens
AR antagonist

41
Q

WHat are the advantages of targeted treatments for cancer?

A 
more selective for cancer cells
less selective for normal cells
less side effects
higher doses
more anti-cancer effects
42
Q

Describe drug resistance in targeted therapy

A

kinase mutations emerge which are no longer sensitive to drug
cancers eventually begin to grow again

43
Q

Describe predictive markers

A

predict which patients will benefit from a specific treatment
what drug to use

44
Q

WHat are prognostic markers?

A

inform about outcome regardless of treatment

may help choose which patients to treat but not which drugs

45
Q

Describe the innate immune system mediated tumour control

A

innate IR recognises tumour cell establishment
NK cells and other effectors recruited to site by chemokines, which also target tumour growth directly
tumour specific T-cells home to tumour site, along with macrophages and other effectors to eliminate tumour cells

46
Q

What are the three Es of immunoediting?

A

elimination
equilibrium
escape

47
Q

Describe IFN a/b treatment

A 
affects MHC class I expression and cell division
prolongs survival and stabilises disease in cancers such as RCC
48
Q

Describe IL-2 treatment

A

therapy for RCC and metastatic melanoma
expansion of tumour specific T cells
high dose only
must be in hospital

49
Q

WHat is the problem with single peptide vaccines against cancer?

A

tumour escape through selection of non-antigen variants

50
Q

How can preformed antibodies work?

A

directly target cancer cells and mediate tumour destruction

51
Q

How can monoclonal antibodies destroy a tumour?

A

apoptosis induction
complement mediated cytotoxicity
ADCC
conjugated to toxin

52
Q

What is the target of ipilimumab?

A

CTLa4

53
Q

what does biTEs stand for?

A

bi-specific T cell engager

54
Q

Give examples of cell therapy

A 
haematopoetic stem cells
tumour infiltrating T cells
dendritic cell vaccines 
NK cells
gamma-delta T cells
virus specific T cells
genetically engineered T cells
55
Q

What are the stages of stem cell therapy?

A 
mobilise patient or donor cells
condition patient with radio / chemo
manipulate graft
re-infuse cells to "clean system"
innate immune system reconstitutes 
adaptive system reconstitutes
56
Q

Describe receptor engineering in T cell therapy

A

tumour antigen-specific artificial receptor generated, containing signalling functions
transferred into patient T cells to attack cancer cells

57
Q

Describe a MSE

A

an assessment of current state of mind
snapshot during interaction
carried out with psychiatric history
observations and specific questions

58
Q

What is the format of a MSE?

A 
appearance and behaviour
speech
mood and affect
though form and content
perception
cognition
insight
59
Q

Describe appearance in MSE

A 
how person looks
ethnicity. build, hair colour, clothing
biological vs chronological age
well kemp?
self neglect?
unwell or intoxicated?
60
Q

Describe behaviour in MSE

A 
how they act
motor activity
eye contact
rapport and engagement
body language 
unusual or socially unacceptable behaviour
61
Q

Describe speech in MSE

A 
how they talk
rate and quantity 
rhythm 
volume 
tone
spontaeity
62
Q

What is mood

A

a person’s emotional state overall

63
Q

What is affect?

A

changes in the person’s emotions that you observe moment to moment during the interview

64
Q

What types of mood are there?

A

subjective and objective

65
Q

What types of affect are there?

A

reactive
flattened
blunted
labile

66
Q

Give examples of thought disorders

A

flight of ideas

loosing of associations / knight’s move thinking

67
Q

What types of delusion are there?

A 
paranoid
grandiose
nihilistic
delusions of reference
thought interference
68
Q

What are over -valued ideas?

A

a false belief, not totally fixed but causing great disability

69
Q

What are obsessions?

A

recurrent, intrusive, distressing ideas, impulses or images that the patient recognises as their own

70
Q

How is cognition assessed?

A

alertness
orientation
attention / concentration
memory

71
Q

WHat is insight?

A

the patient’s understanding of their presentation and their need of treatment

People and illness (5 decks)

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