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pop endi Flashcards

1
Q

a) What is the safe range of BMI (1)?

A

18.5 > BMI > 25

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2
Q

b) A man is 98 kg and 175 cm tall. What is his BMI? (2 marks, remember units)

A

98/1.75^2 units are kg/m^2

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3
Q

c) In the obese, what is the main energy storage chemical? (1)

A

Fat/Lipids/Adipose tissue

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4
Q

d) What effect does insulin have on:
i) Adipose tissue lipolysis?

ii) Hepatic glucose management? (2)
iii) Production of ketones? (1)
iv) Muscle glucose intake (name receptor)? (2)

A

i) Decrease lipolysis
ii) Decreases hepatic glucose output (Decrease hepatic gluconeogenesis / decrease hepatic glycogenolysis / increase glycogenesis
iii) Decrease ketogenesis (No need to synthesis ketones to use as energy when there is already plenty of glucose available)
iv) GLUT-4, Increase muscle uptake

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5
Q

What is the receptor for oxytocin and what are its target tissues?

A

OXTR

Myometrial cells of the uterus
Myoepithelial cells of the mammary gland

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6
Q

What is the receptors for vasopressin and what are its target tissues?

A

V1a: Arterial/arteriolar smooth muscle
Hepatocytes (glycogenolysis)
CNS neurones

V1b: Adenohypophysial corticotrophs

V2:
Kidney collecting duct cells
Endothelial cells??
Factor VIII and Von Willbrandt factor??

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7
Q

a) Draw a diagram indicating all the different parts of the adrenal glands and what hormones each part secretes (4)

A

Adrenal Cortex:

Zona Glomerulosa – Aldosterone

Zona Fasciculata – Cortisol

Zona Reticularis – Sex hormones - androgens, oestrogen

Adrenal Medulla: – Adrenaline, noradrenaline, dopamine

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8
Q

List 3 hormonal components of the hypothalamo-adenohypophysial-adrenal axis (3 marks)

A

Somatotrophin, prolactin, TSH, LH, FSH, Corticotrophin

CRH (and VP for cortisol) -corticotrophin/ACTH - cortisol

FROM ANOTHER: Hypothalamus - Corticotrophin releasing hormone

Adenohypophysis - ACTH

Adrenal Glands - Cortisol

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9
Q

What is failure of the adrenal glands known as? Give two reasons why it occurs (3 marks)

A

Addison’s disease

Adrenal TB and autoimmune disease of the adrenals

Worlds biggest cause of TB

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10
Q

a) Name 2 tissues that produce androgens (1)

A

Leydig cells – mainly testosterone and some androgens

Theca cells - androgens

Tissues = adrenal glands and gonads (testes and ovaries)

(Also skin, brain, liver, prostate, seminal vesicles)

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11
Q

b) Describe the effects of testosterone in i) virilisation; ii) anabolism (2x2 marks)

A

The biological development of sex differences, changes that make a male body different from a female body.

i) Increases virilisation by stimulating growth and development of male genitalia, deeper voice, growth of pubic hair.
ii) Causes protein anabolism; decrease fat anabolism.

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12
Q

c) How do excess androgens cause infertility in males?

A

Prolactinoma – a benign tumour in the pituitary gland, causes excess prolactin to be produced by pituitary gland.

Prolactin inhibits Gonadotropin releasing hormone, thereby inhibiting spermatogenesis.

NB: Androgens produced by the Leydig cells (ie testosterone) exert negative feedback effects at the pituitary (LH, FSH) and hypothalamus level (GnRH). Too much androgens would inhibit the release of GnRH and therefore LH and FSH. This means that the Leydig cells stop producing androgens (testosterone) which is crucial for spermatogenesis.

No spermatogenesis = no spermatozoa (mature sperm) and therefore the male cannot conceive as only mature sperm can fertilise the egg. (Sertoli + FSH system also needed for germ cell dev).

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13
Q

d) Identify other symptoms of excess androgens

A

Women with high levels of testosterone have polycystic ovary syndrome, characterised by amenorrhoea or oligomenorrhoea, infertility, blood sugar disorders, sometimes acne and excess hair growth.
• Aggression, competitiveness, mood swings, depression, low sperm count
• Deeper voice, increase in body hair, muscle mass

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14
Q

b) Name a stress hormone and 2 discrete physiological responses to it. (3)

A 
Cortisol
•	Peripheral protein catabolism
•	Hepatic gluconeogenesis
•	Increased blood [glucose]
•	Fat metabolism (lipolysis in adipose tissue)
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15
Q

c) Name the condition related to adrenal failure and two common causes? (2)

A

Addison’s disease – adrenal TB, autoimmune disease of the adrenals

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16
Q

d) Immediate Treatment for acute adrenal failure. (1)

A

Injection of hydrocortisone (synthetic cortisol) in a vein

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17
Q

f) What hormone is released when blood glucose is high? How should it be delivered to patients?

A

Insulin
Injection into fatty tissue underskin (subcutaneous fat) in fatty area – thigh, abdomen.
NB: When blood glucose low: intramuscular injection of glucagon.

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18
Q

Two different types of cells that are developing in the ovarian follicle

A

Theca and granulosa cells

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19
Q
  1. What hormones do follicular and luteal synthesise?
A

Follicular: LH stimulates the thecal cells to produce androgens. The androgens diffuse into the granulosa cells. Under the influence of FSH, the granulosa cells produce aromatase, which converts androgens into oestrogen.

Luteal: LH and FSH cause the corpus luteum (produced by granulosa cells) to produce progesterone and oestrogens (less so).

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20
Q

Describe the cells of the testes and its functions of each.

A

Sertoli cells:
• Form seminiferous tubules
• Synthesise FSH and androgen receptors
• In response to FSH, molecules such as inhibin are produced

Leydig cells:
• Produce testosterone
• Synthesise LH receptors
• In response to LH they produce androgens

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21
Q

b) Name the hormone which stimulates aldosterone secretion (1)

A

Angiotensin II

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22
Q

c) Describe each part of the adrenal cortex and indicate what each part secretes (3)

A

Zona Glomerulosa – Aldosterone
Zona Fasciculata – Cortisol
Zona Reticularis – Sex hormones

(Last two are glucocorticoids)

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23
Q

d) Name two uses of pharmacological doses of cortisol (2)

A

Anti-inflammatory action
Immunosuppressive action
Anti-allergic action

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24
Q

a) Identify four hormones that elevate the plasma glucose concentration.

A

Cortisol
Glucagon
Catecholamines (adrenaline)
Somatotrophin

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25
Q

b) List the major physiological stimulant to insulin secretion and two other stimulants.

A

b) Increased plasma Glucose concentration (1mark) (Not FFA)

Others, positive: amino acid concentration, glucagon, some gut hormones, parasympathetic, sympathetic b receptors (any two = 2 marks)

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26
Q

c) What is the main stimulus to glucagon secretion?

A

c) Low plasma glucose (1 mark)

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27
Q

d) A high plasma glucose concentration and osmotic symptoms (glycosuria and polydipsia) are found in types 1 and 2 diabetes mellitus. State what common sign and simple biochemical test suggest the absolute insulin deficiency of type 1 diabetes mellitus?

A

d) Weight loss, Ketones (in urine) (2 marks)

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28
Q

Describe a test for primary hyperthyroidism and state what you would find (2)

A

A thyroid-stimulating hormone (TSH) test, which is a blood test that measures your levels of TSH.
High thyroxine level and 0 TSH.

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29
Q

i) Describe a test for primary hypothyroidism and state what you would find (2)

A

TSH test – take a sample of blood and measure level of TSH (measuring TSH – thyroid stimulating hormone, thyrotropin)
Low thyroxine level and high TSH level.

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30
Q

How is primary hypothyroidism treated? (1)

A

Replace thyroxine via tablets

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31
Q

Why is there increased pigmentation in those with adrenal failure? (3)

A
  • Adrenal glands are failing. ACTH levels will rise in order to try and make the adrenal glands produce more cortisol.
  • POMC is a precursor to ACTH as well as MSH (Melanin Stimulating Hormone). If ACTH levels high then so too are MSH which means that skin will darken.
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32
Q

What is the immediate treatment for someone suffering from an Addissonian crisis? (3)

A
  • Rehydrate with normal saline
  • Give dextrose to prevent hypoglycaemia
  • Give hydrocortisone
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33
Q

a) Name the endocrine tissue of the pancreas. (1)

A

Islets of Langerhans

34
Q

c) Explain why polyuria occurs in Diabetes Mellitus. (3)

A

The most common cause of polyuria in both adults and children is uncontrolled diabetes mellitus, which causes osmotic diuresis, when glucose levels are so high that glucose is excreted in the urine. Water follows the glucose concentration passively, leading to abnormally high urine output.

High blood glucose - more glucose in tubules - cannot absorb all glucose due to transport maximum, so glucose is excreted - urine follows via osmosis - increases medullary interstitial space osmolality so water will follow - therefore increase water excretion and more urine.

35
Q

d) Explain why there is an increase of ketone bodies in Type 1 Diabetes Mellitus. (3)

A

This happens when a severe lack of insulin means the body cannot use glucose for energy, and the body starts to break down other body tissue as an alternative energy source. Ketones are the by-product of this process. Ketones are poisonous chemicals which build up and, if left unchecked, will cause the body to become acidic – hence the name ‘acidosis’.

36
Q

Which ribs are known as the ‘false ribs’ and why?

A

Ribs 8-10

Do not attach to the sternum directly but are connected to the 7th ribs by cartilage

37
Q

Name the 4 constrictions of the oesophagus

A

Junction with the pharynx

Where it was crossed by the aortic arch

Compressed by the left main bronchus

Oesophageal hiatus (T10 - where it pierces the diaphragm)

38
Q

Explain how you could locate the apex beat using landmarks

A

Count down to left 5th space from sternal angle or nipple. Palpate this space in the mid-clavicular line

39
Q

How would you locate the apex of the heat if the patient were a woman?

A

Lower border of breast on 6th space - lift breast and palpate above rib

40
Q

During forced inspiration additional muscles may act to further increase the chest volume. Give an example of one such muscle and how it works. (1 mark)

A

The sternocleidomasteoid contracts to elevate the sternum, thus increasing the space superiorly
The scalenes lift the upper ribs
The external intercostal lifts the ribs upwards and outwards.

41
Q

What is the name of the artery which gives rise to the 1st and 2nd intercostal arteries?

A

Supreme intercostal artery

42
Q

What is found at vertebral level L2?

A

Cisterna chyli

43
Q

What drains lymph from the abdomen, pelvis, perineum and lower limbs?

A

Cisterna chyli

44
Q

What starts at vertebral C7?

A

Oesophagus

45
Q

Most of the blood supply to the breast comes from branches of which of the arteries?

A

Internal thoracic artery

46
Q

What is a A component of the upper limb girdle?

A

Clavicle

47
Q

What is the name of the branch of the intercostal nerve which emerges parasternally?

A

Anterior cutaneous branch

48
Q

What is a name of a pectoral muscle?

A

Subclavius

49
Q

What is one of the muscles underlying the breast?

A

Serratus anterior

50
Q

What is the name of Excessive development of male breasts?

A

Gynaecomastia

51
Q

An obliterated costodiaphragmatic recess on a CXR is indicative of which condition?

A

Pleural effusion

52
Q

What is an accessory muscle of strenuous inspiration?

A

Pectoralis minor

53
Q

What is a main muscle in forced expiration ?

A

Rectus abdominis

54
Q

a) During inspiration, what is the muscular mechanism for increasing the volume for lung expansion in the vertical direction? (2 marks)

A

contraction of diaphragm

lung expands into costo-diaphragmatic recess

55
Q

a) During inspiration, what is the muscular mechanism for increasing the volume for lung expansion in the transverse direction? (2 marks)

A

contraction of intercostal (and scalenus anterior)
articulation of ribs at vertebrate and sternum plus rib shape means increased transverse diameter (‘bucket handle’, ‘pump handle’)

56
Q

Carcinoma of the breast can be in situ or invasive.

a) Which of these two types would metastasise? And what is the most common site of metastasis for breast cancer?

A

Invasive carcinoma would metastasise. Commonest site of metastasis is axillary lymph nodes.

57
Q

a) Describe the microscopic similarities and differences between the two types.
(in situ or invasive breast cancer)

A

Similarities: Both lesions consist of malignant cells, which are larger than the normal cells and have larger and more darkly stained nuclei and may show prominent mitotic activity.

Differences: The tumour cells in carcinoma in situ are still surrounded by the basement membrane. In invasive carcinoma the malignant cells have penetrated the basement membrane and infiltrated the breast stroma. They can also penetrate lymphatics and blood vessels.

58
Q

a) Describe the mechanisms involved in tumour metastasis in general, and their principal pathways.

A

Mechanisms involved in metastasis:
Changes in tumour cells genotype which enable them to penetrate lymphatics or blood vessels and to exit from them.
Ability to colonise and grow in their new sites, overcoming any local resistance.

Principal pathways of metastasis:
Lymphatics, to lymph nodes
Blood vessels, to organs
Transcoelomic, across body cavities

59
Q

a) Give two major areas the common carotid artery supplies. (2)

A

Head and Neck (think this enough – need to say specifically brain, face etc…?)

60
Q

a) Explain how you would palpate the common carotid artery.

A

Palpate in the neck, between the lateral side of the thyroid cartilage and medial border of the sternocleidomastoid muscle (from 13th floor).
Note: don’t press too hard as just behind common carotid is the vagus and is possible to make the patient faint if too much pressure’s applied.

61
Q

a) What is the venous drainage of the part of the heart that was labelled (it was the apex). (1)

A

The great cardiac vein, which then drains into the coronary sinus.

62
Q

a) Under a light microscope, how would you distinguish between a cross-section of human trachea and reparatory bronchioles? (4)

A
  • C-shaped rings of cartilage.
  • Trachealis muscle at the back whilst respiratory bronchioles has more smooth muscle.
  • Trachea epithelium would have lots of cilia and goblet cells, which wouldn’t be present in respiratory bronchioles.
  • Bronchioles would contain more Clara cells (fewer cilia and no goblet cells).
  • Trachea would have a larger diameter than respiratory bronchioles.
63
Q

With regards to the pulmonary vein, describe its oxygen content (including values)

A

High O2 -

Pa02 = 13.3kPa

64
Q

The muscular rim of the oval fossa is a distinctive feature of which chamber of the heart?

A

Right Atrium

65
Q

Name the three most common sites where arterial clots are formed

A

Coronary, cerebral and femoral arteries

66
Q

a) With regard to heart sounds, where would you place your stethoscope to listen to the following (3 marks)
a. Pulmonary valve

b. Mitral valve
c. Apex beat

A

a.
Over the medial end of the right second intercostals space

b.
Left 5th intercostals space in the midclavicular line, over the apex of the heart

c.
Same as the mitral valve

67
Q

a) The pectinate muscles are most numerous in which chamber of the heart? (1 mark)

A

Right atrium

68
Q

a) The trabeculae carnae (trabeculations) are coarser/rougher in which chamber or the heart? (1 mark)

A

Right ventricle

69
Q

a) What is meant by a stenotic valve? (1 mark)

A

Orifice is narrowing (or words to that effect e.g. the valve cannot open fully)

70
Q

a) What is meant by a left-dominant coronary circulation? (1 mark)

A

The circumflex artery continues into the posterior descending/interventricular coronary artery

71
Q

a) Which vessel is the main tributary of the coronary sinus? (1 mark)

A

Great cardiac vein OR left coronary vein

72
Q

a) Most of the areas supplied by the right coronary artery are drained by which two cardiac veins? (2 mark)

A 
Middle cardiac vein
Small cardiac (right coronary) vein
73
Q

What is the vessel draining the posterior wall of the thorax and abdomen, arching over the right lung root and draining into the SVC

A

Azygous vein

74
Q

What is the structure formed by the asymmetric union of right and left brachiocephalic veins?

A

SVC

75
Q

What is the superior mediastinal structure almost non-existent in the elderly due to atrophy?

A

Thymus

76
Q

What are the nerves motor to the diaphragm originating in the neck?

A

Phrenic

77
Q

What are the lymph nodes associated with the internal thoracic arteries?

A

Parasternal nodes

78
Q

What is the most superficial pectoral muscle

A

Pectoralis major

79
Q

There are 7 of which vertebrae?

A

Cervical

80
Q

What separates the superior lobe from the middle lobe of the right lung?

A

Horizontal fissure

81
Q

Extra: What are androgens?

A

Male Sex hormone - ie. testosterone

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