Week 9

Question 1

what is ketamine?

Answer 1

dissociative antagonist

NMDA receptor antagonist

Question 2

harms of hallucinogens?

Answer 2

OD, bad trips and hams from hallucinating

Question 3

administration of inhalants and volatile substances?

Answer 3

sniffing
huffing
bagging

Question 4

harms with volatile substances?

Answer 4

volatile substances are lipid soluble and damage cell membranes in the CNS:
white matter damage
optic damage, hearing loss
cortical atrophy
cerebellar damage
peripheral neuropathy

Question 5

acute management of volatile substances?

Answer 5

recognition
be aware
be alert
monitor sats/ ECG
O2 when needed 
decontamination - get substance away
wait it out

Question 6

chronic management of volatile substances?

Answer 6

address underlying issue
physical assessment and needs
harm minimization
psychosocial needs (psychotherapy / life skills)

Question 7

recommended screening tool 1 for gambling?

bief biosocial gambling screen:

Answer 7

withdrawal: during the past 12 months, have you been restless, irritable or anxious when trying to stop/ cut down on gambling
deceive: during the past 12 months, have you tried to keep your family and friends from knowing how much you gamble?

bailout/ need money? during the past 12 months have you had financial trouble that you had to get help with living expenses from family, friends, welfare?

Question 8

recommended screening tool 1 for gambling?

NODS-CLIP:

Answer 8

loss of control: have you ever tried to stop, cut down ir control your gambling?
lying: have you ever lied to family member or friends about how much you gamble or how much money you’ve lost gambling?
pre-occupation: have their been periods lasting > 2 weeks or longer when you spent a lot of time thinking about your gambling experiences or planning out future gambling ventures/ bets?

Question 9

recommended screening tool 1 for gambling?

Lie-Bet screening instrument:

Answer 9

have you ever felt the need to bet more and more money?

have you ever had to lie to people important to you about how much you gamble?

Question 10

what are the components of innate immunity in viruses?

Answer 10

complement (forms MAC complex)

interferons (activate NKC)

Question 11

3 functions of interferon 1?

Answer 11

induce viral replication in all cells
increase expression of ligands for receptors on NKC
activate NKC to kill infected cells

Question 12

what are the components of Ab adaptive immunity in viruses?

Answer 12

neutralize EC virus (Ab may block virus to bind to arrestor, aggregation of virus so its easier to phagocytose, block endocytosis)

enhancing complement cell mediated killing of virus directly or cell containing virus

promoting cytotoxicity and opsonization

Question 13

evasion of immune response by viruses?

Answer 13

antigenic variation
encode proteins that bind complement, cytokines and cytokine receptors
interfere with Ag processing and presentation
produce molecules that sequester AB
interfere with CTL and NKC functions

Question 14

evasion of host immunity from viruses?

Answer 14

DNA viruses have low mutation rates but large genomes meaning that they have large number of viral genes encoding immune subversion proteins

Question 15

what is the extracellular immune response to protozoa?

Answer 15

innate: phagocytosis, complement
Ab: phagocytose, complement, ADCC
T cell: Th2 cytokines for Ab response ADCC and activation of eosinophils and mast cells

Question 16

what is the intracellular immune response to protozoa?

Answer 16

Ab: neutralization to block entry to host cells

T cell: TH1 cells activate macrophages, CTLs kill infected cells

Question 17

immune evasion by protzoa?

Answer 17

antigenic variation
antigenic drift
molecular mimicry
sequestration in immune privileged sites

Question 18

immune evasion by helminths?

Answer 18

shedding of surface Ag
protease production to neutralize anti-parasite immune components
absorbing host Ag and making parasite Ag

Question 19

what are the 6 basic stages essential for viral replication?

Answer 19

attachment 
penetration
uncoating
replication 
assembly 
viral release

Question 20

how does HIV enter the cell?

Answer 20

HIV GP120 receptor attached to CD4 receptor and undergoes conformational change to avoid detection by neutralizing Abs
binds co receptors:
CCR5 - macrophages
CXCR4 - T cells

Question 21

innate immune response in HIV?

Answer 21

Macs, DC, NKC

Question 22

adaptive immune response in HIV?

Answer 22

CTLs lyse HIV cells and release cytokines

inhibit virus replication and block its entry into the cell

Question 23

humoural immune response in HIV?

Answer 23

occurs later in the infection
first we get non-neutralizing Abs to structural proteins eg, p24
then we get neutralizing Ab to specific proteins involved in the entry of the virus in the cell

Question 24

what is the route of transmission for hep A and E

Answer 24

ingestion of contaminated foods and drink

Question 25

what is the route of transmission for hep B C D

Answer 25

parenteral contact with infected body fluids

hep B may be transmitted from mother to baby or sexual contact

Question 26

what chemo drugs can cause secondary malignancies?

Answer 26

anthracyclines and alkylating agents

Question 27

prognostic factors for early cancer?

Answer 27

size of primary
level of differentiation
node involvement
receptor status
age 
molecular markers

Question 28

steps in staging?

Answer 28

to assess extent of disease

hx
examination
tumour markers (a-fetoprotein, hCG, PSA, CA125, CEA)
FBC, LFT, BM
histology
x-ray, CT, MRI, bone scan, PET scan

Question 29

indications for pet scan?

Answer 29

when we’re treating patient for curative intent and aggressive tx may offer prolonged surival
also decreases need for unnecessary/ intensive procedures if cancer is deemed incurable

Question 30

what are some curative cancers with chemo?

Answer 30

lymphoma, leukemia, germ cell tumours, osteosarcoma

Question 31

tumours curable with adjuvant therapy?

Answer 31

breast cancer, ovarian cancer and sarcoma

Question 32

some features of telehealth?

Answer 32

improve patient access to health care
reduce travel/ inconvenience to patient, families, carers and health professionals
provide health professionals with access to peer support/ education

Question 33

how does interferon 1 response work in innate immunity against viruses?

Answer 33

IFN alpha and IFN beta =

• induce resistance to viral replication in all cells
• increase expression of ligands for NKC receptors
• induce NKC killing of virus infected cells

Question 34

where do NKC develop?

Answer 34

BM and circulate in the blood

Question 35

how does hepatitis adhere to the host cells?

Answer 35

hepatitis virus gains entry into hepatocytes via interaction with receptor on hepatocytes

Ab can neutralize EC virus to stop it from entering the cell (adaptive viral immunity)

Question 36

role of AB in adaptive immunity for viruses?

Answer 36

neutralize EC virus (block virus binding to a receptor, block endocytosis, form viral aggregates easier to phagcytose)
enhance complement mediated killing (directly - virolysis or cells containing virus - cytolysis)
promoting cytotoxicity and phagocytosis by NKC and phagocytes

Question 37

how does CTL differentiate with the help of CD4 T cells?

Answer 37

APC stimulates CD4T cells to increase expression of B7 and CD40L

APC stimulation through CD4 increases B7 and 4-1BBLL which both co-stimulate naive CD8 T cell

Question 38

what does AIDS stand for?

Answer 38

acquired immune deficiency syndrome

Question 39

rough time course of HIV infection?

Answer 39

first few days HIV is starting to replicate and their are no signs of disease

6 days later we can detect virus in blood - look for nucleic acid via qPCR

few days later we can see Ab appearing in blood

12 days later we see specific Ab (non-neutralizing) p24
then neutralizing ABs appear specific for proteins, involved in the entry of virus into cell

Question 40

2 types of eukaryotes?

Answer 40

trophozoite = reproducing/ feeding form
cyst = dormant and infective form

Question 41

examples of intracellular and extracellular protozoa?

Answer 41

extraceullular: amoebiasis
intracellular: malaria

Question 42

malaria life cycle summary?

Answer 42

mosquito bites and injects sporozoites into the infected cell which travels to the liver and infects hepatocytes = hepatocyte shizont

shizont rupture in the liver releases merozoites which infect the RBCs

once in the RBC it is called a trophozoite

now it can either mature into a gametocyte which will be taken up by another mosquito and continue the spread of disease OR
develop into latent trophozoite and into a blood stage schizont which will burst and release more merozoites to continue cell cycle of infection

Question 43

role of eosinophils in helminth infection?

Answer 43

produce MBP which kills parasite
can undergo ADCC
contains toxic granules - with toxic enzymes and free radicals which degrade wall of cuticle of from = interferes with worms ability to replicate

Question 44

how is malaria parasite detected?

Answer 44

thick blood smear = detects parasite
thin blood smear = differentiates parasite type
dipstick = rapid Ag detection

Question 45

evasion of host immunity in viruses?

Answer 45

dna viruses have low mutation rates but large viral genomes = large number of genes encoding immune subversion genes

Question 46

how come neutralizing Abs don’t stop HIV from entering the cell?

Answer 46

their is a bit of lag time because HIV is a new virus so don’t have time for the production of enough Ab to prevent HIV entry into cell

Question 47

which forms of Hepatitis are the cause of hepatic cirrhosis and liver cancer

Answer 47

hep B and C