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Medicine - Year 2 > Block 9 - Disease Processes (2) > Flashcards

Block 9 - Disease Processes (2) Flashcards

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1
Q

Define parasite

A

Protozoa (unicellular)
Helminth (multicellular)
Arthropods (ectoparasites)

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2
Q

Define concomidant immunity

A

Develop immunity against new infections but cannot get rid of the pathogen that you already have

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3
Q

What do anti-protozoal agents target?

A

Fast growing and young organisms

via their metabolic pathways

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4
Q

What do anti-helminth agenets target?

A

Non-growing and adult organisms

via their metabolic pathways

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5
Q

What are the 4 main malaria parasites?

How are they diatinguished?

A

Plasmodium falciparum, vivax, ovale and malariae

PCR

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6
Q

What is the definite and intermediate malaria host?

A

Definite: Mosquito (sexual reproduction)
Intermediate: Human (no sexual reproduction)

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7
Q

Explain, in detail, the malaria lifecycle

A

1) Mosquito injects SPOROZITES
2) Exo-erythrocytic cycle: Sporozites infect the liver cell which ruptures and releases SCIZONTS that rupture to release MEROZOITES
3) Erythrocytic cycle: Merozoites infect cells forming TROPHOZITES then more schizonts which then rupture and infect more cells
4) Trophozites also form GAMETOCYTES which enter the mosqito (macro = F) (micro = M)
5) The gametocytes form an OOKINETE in the stomach, OOCYST in the midgut which released SPOROZITES which go to the salivary glands

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8
Q

What mosquito carries malaria?

A

The female anapheles mosquito

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9
Q

What are the 3 complications of malaria?

A 
Acodosis (respiratory distress)
Severe anaemia
Cerebral malaria (unarousable coma related to meningitis, convulsions and hypoglycaemia)
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10
Q

What organism causes African Tyranosomiasis?
What is another name for the disease?
How does the organism cause disease?

A

Tyranosoma brucei
Sleeping sickness

  1. Parasite in circulation = no symptoms
  2. Parasite crosses BBB –> CNS infection and death
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11
Q

What organism causes South American Tyranosomiasis?
What is another name for this disease?
How does the organism enter the body?
How does the organism cause disease?

A

Tyranosoma cruzi
Chagas disease

Insect bites and faeces enter through a lesion (also congnital, food, blood transfusion)
Acute = no symptoms
Chronic = heart, GI and neurological problems

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12
Q

What transmits Leishmaniasis?
Where does it reside in the body?
What disease does it cause?

A

Female sandfly
Resides intracellularly often in macrophages
Asymptomatic in the beginning but causes disruption to mucus membranes

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13
Q

What organism causes Toxoplasmosis?

What disease is often caused?

A

Toxoplasma gondii

Mild lymphadenopathy

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14
Q

Give 2 examples of intestinal protozoans
What disease do they cause?

What do they normally cause?

A

Entameba histolytica –> Amoebiasis (intestinal and extra retinal infections)
Giardia Lambila –> Giaraiasis (diarrhoea)

Usually non-pathogenic

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15
Q

WHAT ARE THE 6 EXAMPLES OF PROTOZOANS

A 
Malaria 
African Tyranosomiasis
South American Tyranosomiasis
Leishmaniasis
Toxoplasmosis
Intestinal protozoans
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16
Q

How do helminths cause infection?

What causes the problems in a helminth infection?

A

Infection by larvae/eggs causes problems

Adults are large but do not replicate and do not cause many problems

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17
Q

Give 3 examples of soil transmitted helminths

A

Ascarls (eggs secreted in faeces and human digest)
Hookworm
Whipworm

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18
Q

What causes Taeniasis infection?

How is it transmitted?

A

Larval cysts

Contaminated meat

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19
Q

What is another name for Schistomiasis
How is it transmitted?
Where do the helminths reside and when are symptoms caused?

A

Bilharzia
Spread by water contaminated with urine
Adult worms in blood vessels
Eggs in the bladder and intestine causing symptoms

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20
Q

What is another name for Lymphatic Filriasis
What helminth causes it?
How is it transmitted?
What is the disease mechanism?

A

Elephantitis
Roundworms
Mosquito
Larvae block the lymphatic system

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21
Q

What is another name for Echinoccocosis?

Where is the adult, egg and larvae?

A

Hydarid disease
Adult in definite host (animal)
Eggs in faeces
Larval cysts form in the organs

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22
Q

What is the disease process in Dracunculiasis?

What is the treatment?

A

The worm moves over joints causing pain

Treatment is removal

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23
Q

WHAT ARE THE 6 EXAMPLES OF HELMINTHS?

A 
Soil transmitted
Taeniasis
Schistomiasis
Lymphatic Filriasis
Echinoccocosis
Dracunculiasis
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24
Q

What mite causes scabies?

A

The human itch mite

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25
What is another name for: Tapeworms Flukes Roundworms
Tapeworms: Cestodes Flukes: Trematodes Roundworms: Nematodes
26
What is a wood's lamp used for?
Looks for pigments and bacteria by using UVA light | Fluoresces
27
What do you look for in the skin? (SCAM)
Size, Shape, Symptoms Colour Associated seconday changes Morphology, Margin
28
5 things you palpate for in the skin?
Surface, Consistency, Mobility, Tenderness, Temperature
29
3 clinical features of Lichen Planus
Small bites on the wrist Nail problems White scarring on mucus membranes
30
What is the difference between erythema and purpura?
Erythema: Redness due to inflammation/vasodilation which disappears on pressure Purpura: Red/purple bleeding into the skin/mucus membranes which doesn't disappear on pressure
31
Define auritis
Itching
32
Define naevus
Localised malformation of tissue
33
Define ecchymoses
Large patches on the skin
34
3 causes of hyper-pigmentation | 1 cause of de-pigmentation
Pill, pregnancy, drugs | Vitiligo (decreased melanocytes)
35
What is the treatment of acne?
Antibiotics
36
Give 4 clinical features of acne
Seborrhoea: increased oil due to androgens turning on sebaceous glands Comedomes: non-inflammatory Papules and pustules: inflammatory Scarring
37
What are the 3 types of comedomes and their characteristics?
Open: blackhead (large; filled with melanin) Closed: whitehead (small) Early-mid-facial (severe)
38
Give 3 examples of superficial inflamed lesions
Macule: Flat Papule: Raised and red Pustule: Raised, red and pus
39
Give 2 examples of deep inflamed lesions
Nodule: Solid lesion, not always visible Cyst: Nodule with fluid
40
Where do you find eczema in INFANTS?
Face and extensors | flexors in children
41
Give 2 examples of skin findings with atopic eczema
Vesicles and bulla
42
What causes psoriasis
Hyperproliferation of keratinocytes and inflammatory cell infiltration
43
5 clinical signs of psoriasis
``` Plaque: Palpable raised lesion Urticaria: Wheals due to histamine Koebner effect Nail changes Joint problems ```
44
8 causes of psoriasis
Genetic, immune, environment | Trauma, infection, drugs, alcohol, stress
45
2 complications of psoriasis
Erythroderma: A lot of skin affected causing secondary infection, fluid, loss, electroylte imbalance, hypothermia, capillary leak, renal and heart failure Inflamatory dermatosis: 90% of body affected
46
Define abscess
Accumulation of pus in the dermis
47
2 benign skin tumours
Warts | Seborrheic keratoses
48
3 examples of fungi which infect the skin
Candida, Tinea, Yeast
49
3 examples of viruses which infect the skin
Herpes zoster, HPV, Herpes simplex
50
What is the difference in presentation of a BCC and SCC
BCC: Pearly rolled edge with spider veins and a necrotic centre SCC: Pink and scaly
51
Where is the most common site for a menaloma in a male and female?
Male: Trunk Female: Legs
52
What are the 4 types of melanoma? Where are they found? What age do they occur in? What type of UV exposure causes them?
Superficial spreading: Legs, young, intermittent high intensity UV Nodular: Trunk, young, intermittent high intensity UV Lentigo maligna: Face, elderly, long term cumulative UV Acral lentiginous: palms soles and nail beds, elderly, not related to UV
53
Define tumour
Swelling
54
Define neoplasm
Abnormal mass of cells due to poorly regulated proliferation
55
Define cancer
Malignant tumour/neoplasm
56
3 characteristcs of the mutations in a cancer cell
They must happen in the genes controlling cell proliferation (tumour suppressor or oncogenes) Affect a proliferating cell Accumulate over time
57
What are the 8 hallmarks of cancer
1) Self sufficiency in growth signals (oncogenes) 2) Insensitivity to antigrowth signals (tumour supressor) 3) Evasion of apoptosis 4) Replicative immortality (telomerase) 5) Sustained angiogenesis 6) Tissue evasion and metastasis 7) Reprogramming of energy metabolism 8) Evasion of host immune defences
58
What happens in each of the 5 stages of the cell cycle?
``` G0: Not dividing G1: Replication of cell contents and machinery S: DNA replication G2: Prepare to divide M: Division ```
59
What regulates the cell cycle?
cyclin-CDK complexes
60
What are the 4 cell cycle checkpoints?
G0-G1: Growth factors ensure more cells are needed G1-S: DNA damage checkpoint, replication machinery triggered and environment and cell checked for readiness G2-M: DNA replication checkpoint (has it all been replicated), DNA damage checkpoint, mitosis machinergy triggered and environment checked M-G1: Mitotic spindle assembly checkpoint and chromosomes checked for alignment
61
Give 4 examples of external signalling mechanisms
Growth factors (activate transcription factors) Receptors Signal transduction pathway
62
What does DNA damage activate
DNA damage activates ATM which can activate BRACA --> DNA repair P53 which inhibit CDK complexes CDK complexes can no longer phosphorylate Rb so DNA synthesis is stopped
63
Which gene causes cancer- oncogenes or proto-oncogenes? | What do the normal genes do? (2)
Oncogenes cause cancer | Proto-oncogenes code for normal cell regulatory factors e.g. growth factors, transcription factors
64
How many mutations do you need in oncogenes?
1 mutation
65
How can gene amplification cause cancer?
The gene coding for oncogenes is amplified
66
How many mutations do you need in tumour suppressor genes? | Why?
2 mutations One in each allele (one inherited and one acquired)
67
Define the role of a gatekeeper genes | 2 examples
Loss of the gene leads to increased proliferation | P53 and Rb
68
Define the role of a caretaker gene | 1 example
Maintain genetic stability e.g. DNA repair | BRACA
69
Explain how p53 works
DNA damage checkpoint P53 is degraded if the DNA is normal ATM phosphorylates P53 if the DNA is damaged --> inhibition of CDK and prevention of Rb synthesising DNA If the DNA cannot be repaired, P53 --> puma and apoptosis
70
What instructs Rb to release the transcription factor?
CDK phosphorylates Rb when the cell is instructed to proliferate
71
What are the 2 viral oncogenes which the HPV virus produces? | What do they do?
E6: Removes p53 E7: Captures Rb
72
What is the process of cell structure change?
Metaplasia - Dysplasia - Neoplasia
73
Define parenchyma
Proliferating cells
74
How does H.pylori cause a reduction in the stomach pH
Produces urease --> CO2 --> ammonia --> decreased pH
75
Benign and malignant tumour of the surface epithelia
Benign: Papilloma Malignant: Carcinoma
76
Benign and malignant tumour of the glandular epithelia
Benign: Adenoma Malignant: Adenocarcinoma
77
Benign and malignant tumour of the adipose tissue
Benign: Lipoma Malignant: Liposarcoma
78
Benign and malignant tumour of the smooth muscle
Benign: Leiomyoma Malignant: Leiomyosarcoma
79
Benign and malignant tumour of the skeletal muscle
Benign: Rhabdomyoma Malignant: Rhabdomyosarcoma
80
What are lymphoid malignancies?
Malignancies of the lymphoid lineage of the blood cells
81
Define choristoma
A tumour arising from a germ layer foreign to the site of the tumour
82
Define hamartoma
A benign tumour which resembles a neoplasm in its tissue of origin
83
What can tumours form in veins?
Embolisms
84
Define anaplasia | What 3 things do cells experience?
Malignant neoplasm made from undifferentiated cells Pleomorphism (variation in size and shape) Abnormal nuclear morphology Atypical mitosis
85
Define paraneoplastic syndrome | What can it be mistaken for?
Symptoms due to local or distant spread of the tumour Includes hormone production by tissues Can be mistaken for metastasis
86
Define tumour grade
The degree of differentiation
87
Define menschymal malignancy
Soft tissue malignancy
88
How is tumour grade assessed?
Tubuleacinar/glandular formation Nuclear changes (atypical) and pleomorphism Frequency of mitosis Each component is graded from 1-3 to give an overall score Grade 1 = 3-5 Grade 2 = 6-7 Grade 3 = 8-9
89
Define tumour stage
The extent of spread
90
How is tumour stage assessed?
T0-T4 N0-N3 M0-M1
91
Give 5 examples of DNA damage
``` Pyrimidine dimers (UV) DNA cross-links Base oxidation, hydrolysis and free radicals Single/double strand breaks Replication errors ```
92
Explain how biotransformation can cause DNA damage
Biotransformation is the enzymatic process which transforms chemicals to excretory products which can cause DNA damage e.g. CP450 enzymes add aflatoxin --> damage
93
What happens in spontaneous deamination?
One base is changed for another
94
Give 4 methods of DNA repair
Direct reversal Base/nucleotide excision repair Mismatch repair Double strand break repair
95
What does the direct reversal repair system repair? | How?
Alkylation damage O-6 methylguanine-DNA methyltransferase (MGMT) 'picks up' the alkyl group from the DNA
96
What does the base excision repair system repair? | How?
Removes damaged bases DNA glycoslyases remove damaged bases and AP endonuclease repair the gap
97
What does the double strand break repair system repair? | How?
Ionising radiation damage End binding, processing and ligation
98
What cancers can be treated with alkylating agents?
Cancers with decreased MGMT expression
99
What does the nucleotide excision (mismatch) repair system repair? How?
DNA damage not recognised by the base excision repair system (bulky lesions) XP DNA damage complex binds to the DNA XP helicases separate the DNA XP endonueleases cut the damage and remove an oligonucleotide fragment along with the damaged base DNA polymerases repair the fragment
100
What mutation means that you have a high sensitivity to sunlight?
Defect in the XP proteins
101
``` What gene is involved in Familial Adenomatous Polyposis? What class of gene is it? How does it cause cancer? ```
APC gene Tumour suppressor - Gatekeeper APC gene blocks beta catenin (a transcription factor) APC gene mutated = beta catenin released = proliferation
102
``` What gene is involved in Hereditary non polyposis colon cancer? What class of gene is it? ```
hMSH1 and 2 Tumour suppressor - Caretaker Genes normally repair replication errors and DNA damage Mutations cause mutations, expansion of mutated sequences, DNA instability
103
Which colon cancer affects the right colon? | What is the usual age of onset?
HNPCC | Early
104
Which colon cancer has an increased cancer risk?
HNPCC
105
What are the two methods of damaging DNA in radiotherapy?
Indirect action: Photon produces a free radical which attacks the DNA Direct action: Radiation attacks the DNA
106
Give an advantage and disadvantage of bradytherapy
Continuous low dose rate --> higher overall rate | Cannot be used if at risk of metastasis
107
How is external beam radiation given?
Linear accelerator
108
What does the timing of acute tissue reactions in chemotherapy depend upon? 2 examples
The timing depends on the stage of the cell cycle Epithelial reactions - heals after treatment Mucositis - mucosal membrane disruption
109
What limits the maximum dose of radiotherapy? How long does it take to develop and how long does it last? What cells are impacted?
Late tissue reactions Takes months - years to develop and is permanent Cells with low turnover rates are affected
110
Give 6 examples of late tissue reactions
> Xerostomia: dry mouth - dental decay > Skin fibrosis > Soft tissue necrosis: mucus ulcers, vessel and bone damage > Ocular: cataracts, neuropathy > Otolotic: otis media > Nerve tissue damage: spinal cord damage (paraplegia), transverse myelitis, brain necrosis, dementia, Sompolence syndrome (CNS effects)
111
What cells does acute and long-term toxicity affect?
Acute: Self-limiting damage to normal cells | Long-term: Organ damage
112
How can chemotherapy cause neutropenic sepsis?
Decrease in WBC, RBC and platelets
113
Define neoadjuvant and adjuvant in regard to chemotherapy
Neoadjuvant: Pre-surgery Adjuvant: Post-surgery
114
``` What can chemotherapy cause to happen to the: Lung CNS Heart Endocrine ```
Lung: fibrosis CNS: dementia Heart: cardiomyopathy Endocrine: decreased growth
115
How can cancer cells build up resistance to cytotoxic drugs?
Increased expression of MDR-1 gene which causes drug efflux
116
How do cancer cells become resistant to methotrexate?
Decreased sensitivity and binding to the target | Increased permeability of transporters decreases drug accumulation
117
How do cancer cells become resistant to cisplatin? | Which mechanism is also used for resistance to doxorubicin?
Increased permeability of transporters decreases drug accumulation Chemicals which trap the drug (doxorubicin) Increased nucleic acid repair
118
Who did the tyrosine kinase inhibitors work best in?
People who had a deletion in 19 and a point mutation in 21 Deletion in 19 - the receptor prefers to bind to the drug rather than ATP
119
How does growth factor binding to EGFR cause cell proliferation? What is special about these pathways?
P13K --> AKT --> mTOR RAS --> RAF --> MAP2K All of these can be inhibited!
120
What are the receptors called on tumour cells and T cells? What antibodies overcome this? Problem with them
Tumour cell: Programmed death receptor ligand 1 T cell: Programmed death receptor 1 PDL-1 and PD-1 antibodies can overcome this (immune checkpoint inhibitors) Can cause autoimmune issues
121
Explain how PABP inhibitors can be used as a cancer treatment
Damage to DNA = PABP repairs the damage Inhibit PABP = no repair and apoptosis

Medicine - Year 2 (19 decks)

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