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Flashcards in Fundamentals of Medicine Deck (266):
1

Carcinoma

Malignant tumour of epithelial cell origin

2

Adenocarcinoma

Malignant tumour of epithelial cell origin with a glandular growth pattern

3

Squamous cell carcinoma

Malignant tumour of squamous epithelial cell origin

4

Sarcoma

Malignant tumour of mesenchymal tissue

5

Chondrosarcoma

Malignant tumour of cartilage

6

Fibrosarcoma

Malignant tumour of fibrous tissue

7

Osteosarcoma

Malignant tumour of bone

8

Leiomyosarcoma

Malignant tumour of smooth muscle

9

Rhabdomyosarcoma

Malignant tumour of striated muscle

10

What cancer does alcohol cause?

Hepatocellular carcinoma

11

What cancer does smoking cause?

Lung carcinoma

12

What cancer does soot cause?

Squamous cell carcinoma

13

What cancer does asbestos cause?

Lung methothelioma

14

What cancer does HIV cause?

Kaposi sarcoma

15

What cancer does EBV cause?

Burkitt's lymphoma

16

What cancer does HPV cause?

Cervical cancer

17

What cancer does hepatitis C cause?

Hepatocellular carcinoma

18

What cancer does H. pylori cause?

Gastric cancer

19

Errors in nucleotide excision repair can lead to what condition?

Xeroderma pigmentosum

20

Errors in DNA mismatch repair can lead to what condition?

Colon cancer

21

Errors in homologous end joining can lead to what condition?

BRCA2
Breast and ovarian cancer

22

Paraneoplastic syndrome

Non-metastatic systemic effects accompanying malignant disease
Endocrine - Cushing's disease hypo/hyperglycaemia
Neurological - Lambert-Eaton myastenic syndrome
Musculocutaneous - acnthosis nigricans
Haematological = granulocytosis

23

Characteristics of anaplastic tissue

Abnormal and prominent nuclei
Hyperchromasia
High nuclear-cytoplasmic ratio
Chromatin clumping
Loss of polarity

24

Overall cancer incidences

NMSC, breast, lung, colorectal, prostate

25

Children cancer incidence

Leukaemia, brain tumour, lymphoma

26

Cancer mortality

Lung, colorectal, breast, prostate, pancreatic

27

Death %

Pancreatic, lung, brain, stomach, oesophagus

28

Where do T cells develop?

Thymus

29

What interleukin promotes T cell clonal expansion?

IL-2

30

What do Th1 T cells release?

IL-2, IFN,g, TNFa

31

What do Th2 T cells release?

IL4, IL5, IL3, IL13

32

What causes Th0-->Th1?

IL-12, IL-23

33

What causes Th0-->Th2?

IL-4

34

What causes Th0-->Th17?

IL-6, IL-21, TGFb

35

What do Th17 cells release?

IL-17

36

What causes Th0-->T-reg?

TGFb

37

Inflammatory cytokines

IL-1, TNFa, IL-6

38

Anti-inflammatory cytokines

IL-10, TGFb

39

Which chemokine drives neutrophil recruitment?

CXCL8

40

Which cytokine increases endothelial stickiness?

TNFa

41

What enzymes do CD8 cells release?

Perforins and granzymes

42

Where do B cells develop?

Bone marrow

43

What does the Fc portion of the antibody dictate?

Function

44

What does the Fab portion of the antibody dictate?

Which antigen the antibody can bind to

45

Which antibody exists as a pentamer?

IgM

46

Functions of antibodies

Agglutination
Opsonization
Antibody-dependant killing
Neutralisation
Activation of complement

47

Secondary lymphoid tissues

Spleen
Tonsils
Lymph nodes
Liver
Peyer's patches
Appendix

48

What does TLR4 recognise?

LPS

49

What does TLR5 recognise?

Flagellum

50

What does TLR9 recognise?

CpG DNA

51

What does TRL7 recognise?

Double stranded viral NRA

52

Which antibody is made first?

IgM

53

Which is the most commonly found antibody in the blood?

IgG

54

Which is the second most commonly found antibody in the blood?

IgA

55

MHC class I

Present on all cells
Presents endogenous ligands
Presents to CD8 T cells

56

MHC class II

Present only on APCs
Presents exogenous ligands
Presents to CD4 T cells

57

Polygenic

More than one type of each MHC class molecule

58

Polymorphic

There are multiple alleles within the population meaning most individuals are heterozygous

59

MHC class I types

A, B, C

60

MHC class II tupes

DR, DP, DQ

61

EC50

Half of the maximum response

62

Effect of competitive antagonism on EC50

High EC50

63

Effect of non-competitive antagonism on EC50

EC50 the same
Maximum response reduced

64

Intrathecal route of administration

Into CSF

65

Epidural route of administration

Outside dura

66

How does hepatic elimination work?

Through bile

67

Drugs with zero order elimination

Aspirin, phenytoin, ethanol

68

Which phase of reactions is more affected by age?

Phase I reactions

69

Volume of distribution formula

Amount of drug in body / plasma concentration

70

Tachyphylaxis

Reduced drug effect on a short time scale

71

Glycopeptides

Gram positive cell walls

72

Beta lactams

Gram positive and negative but depends on the drug itself
Target cell wall synthesis

73

Aminoglycosides

Gram positive and negative
Target 30s ribosome

74

Tetracyclines

Gram positive and negative
Target 30s ribosome

75

Macrolides and linsosamines

Target 50s ribosome

76

Quinolones

Target DNA gyrase and topisomerase
Broad spectrum

77

Rifampicin

Targets RNA polymerase

78

Polymyxin

Targets bacterial cell wall

79

Mechanisms of antibiotic resistnace

Target modification
Efflux pump
Degrading enzyme
Impermeability
Resistance genes

80

Amantidine, rimantidine

Antivirals
Inhibit M2 protein
Prevent hydrogen ion influx
Inhibit uncoating and coating of new virions

81

Ribavarin

Guanine analogue

82

Neuraminidase inhibitor

Prevents cleavage of sialic acids
Prevents release from membrane

83

Influenza specific adherance

Haemagluttinin
Sialic acid

84

E. coli specific adherance

Haemagluttinin
Mannose

85

S. aureus stealth mechanism

Binds antibody in wrong orientation

86

Functions of exotoxins

Facilitate pathogenic spread
Lyse cells
Block protein synthesis

87

Prokaryotes

Bacteria
Archaea

88

Eukaryotes

Fungi
Protozoa
Algae
Helminths
Arthropods

89

Gram positive cell wall

Thick peptidoglycan layer with no outer membrane

90

Gram negative cell wall

Thinner peptidoglycan layer with an outer membrane

91

Shapes of bacteria

Spherical = cocci
Cylindrical = bacilli
Spirals = spirochaetes

92

Groups of bacteria shapes

Ball = staphylo-
Chain = strepto-
Pair = diplo-

93

Catalase test

Divides gram positive cocci
Staphylococci = catalase positive
Streptococci = catalase negative

94

Staphylococci divisions

Coagulase positive = S. aureus
Coagulase negative

95

Streptococci divisions

Alpha, beta, non haemolytic

96

Cellulitis pathogen

Streptococcus pyogenes

97

Erysipelas pathogen

Group A strep

98

Scarlet fever pathogen

Group A strep

99

Impetigo pathogen

Staphylococci or streptococci

100

Enterobacteriaceae divisons

Lactose fermenters (pink) - E. coli
Lactose non-fermenter (colourless) - pseudomons, salmonella

101

Glandular fever pathogen

EBV

102

Chicken pox pathogen

VZV

103

Nucleocapsid structure

Aggregations of capsomeres to produce the capsid
Capsid associated with viral nucleic acid

104

Diseases of the nucelus

Laminopathies
Emery Dreifuss muscular dystrophy
Hutchinson-Gilford progeria syndrome

105

RER function

Protein synthesis
Glycosylation

106

SER function

Synthesis of lipids and carbohydrates
Storage of calcium
Detoxification of drug toxins

107

Golgi function

Packaging of secretions
Proteins tagged for delivery

108

Tay Sachs disease

Lysosomal disease

109

Peroxisome functions

Metabolism of fatty acids
Detoxification of free radicals and hydrogen peroxide
Synthesis of plasmalogens

110

Actin microfilaments

Polymerise in cell-cell movement
Maintain cell shape
Organelle and vesicle transport

111

Intermediate filaments

Keratins in skin and hair
Muscle desmin
Provide tensile strength

112

Diseases of laminin (intermediate filament)

Epidermalysis bullosa

113

Microtubules

Cell scaffold
Movement of organelles
Mitotic spindle fibres
Cilia and flagella

114

Macromolecules of the ECM

Proteoglycans
Fibrous proteins - collagen, elastin

115

Collagen in basement membrane

Type IV

116

Epithelial junction hierarchy

Tight - prevent passage of molecules
Adherens - tether cells together
Desmosome - resist mechanical stress
Gap - allow passage of small molecules
Hemidesmosome - anchor epithelium to basal lamina

117

Scalded skin syndrome

Caused by Staphylococcus
Bacterial proteases directed at desmosomal cadherins

118

Pemphigus vulgaris

Autoantibodies against desmosomal cadherins

119

Bardet-Biedl syndrome

Cilia disease

120

Primary vs secondary cilia

Primary = sensory antennae
Secondary = motile

121

Microvilli

Formed by actin microfilaments

122

Flagella

Microtubule based

123

Catabolism vs anabolism

Catabolism = synthesis
Anabolism = utilisation

124

G1 phase

Replication of cellular contents

125

S phase

Replication of chromosomes

126

G2 phase

Double checking for errors and making repairs

127

Prophase

DNA condensation
Nucleoli disappear
Nuclear envelope breaks down

128

Metaphase

Chromosomes line up along the centre
Microtubules attach at the kinetochore of the centromere

129

Anaphase

Pulling apart of chromosomes

130

Telophase

Uncoiling of chromosomes
Reformation of nuclear envelope

131

What normally holds sister chromatids together

Cohesin

132

Cytokinesis

Cytoplasmic division

133

When does crossing over occur in meiosis?

Prophase I

134

Which CDKIs block S phase entry?

p16, p21, p27

135

What does the retinoblastoma protein do?

Inhibits function of E2F proteins which control S phase entry, DNA synthesis and chromosome duplication

136

Which CDK inactivates Rb?

CDK2

137

1st cell cycle checkpoint

G1/S
Checks the cell has enough energy, nutrients and size to be able to divide
Checks for DNA damage before it is replication
Can send cells into G0 - quiescence

138

2nd cell cycle checkpoint

G2/M
Can prevent cell division if DNA has been replicated incorrectly

139

3rd cell cycle checkpoint

Metaphase
Checks tension of spindle fibres to ensure they have attached properly

140

Anti-microtubule agents

Vinca alkaloids - prevent microtubule formation
Taxanes - prevent microtubule disassembly

141

Caspases

Initiators and executioners of apoptosis
Initiator = 2,8,9
Executioner = 3,6,7

142

Apo vs holoenzyme

Apo = lacking cofactor - inactive
Holo = with cofactor - active

143

Vitamin B1

TTP for PDC

144

Vitamin B2

Riboflavin for FAD

145

Vitamin B3

Niacin for NAD

146

Vitamin B5

Pantothenic acid for CoA

147

Lyase enzymes

Add atoms
Remove atoms
Form a double bond

148

Ligases

Use ATP to combine molecules

149

Vmax

Maximum activity of an enzyme that occurs when the enzyme is fully saturated

150

Km

Substrate concentration at which the reaction rate reaches half its maximal value

151

Which inhibitor is time dependant?

Irreversible inhibitor

152

Increased enzyme levels following myocardial infarction

Creatine kinase
Lactate dehydrogenase
Aspartate aminotransferase

153

What percent of the body's protein is collagen?

25%

154

Type 1 collagen

Loose and dense CT
Fibrocartilage
Bone
Dentin

155

Type 2 collagen

Hyaline and elastic cartilage
Vitreous body of the eye

156

Type 3 collagen

Reticular fibres
Blood vessels

157

Type 4 collagen

Basement membranes

158

Osteogenesis imperfecta

Defect in type I collagen synthesis
Fragile bones
Thin sclera
Thin skin
Abnormal teeth

159

Marfan syndrome

Loss of stability given to elastin by fibrillin sheaths
Tall stature
Loose joints
Floppy cardiac valves
Eye problems

160

Cell adhesion molecules

Integrins
Cadherins
Selectins

161

Essential fatty acids

Alpha linolenic acid = omega 3
Linoleic acid = omega 6

162

What do fatty acids male using COX enzymes

Prostaglandins, leukotrienes, thromboxanes

163

Cholesterol with glycerophospholipids

More gel like

164

Cholesterol with sphingolipids

More fluid

165

Cholesterol is a precursor for...

Bile salts
Vitamin D
Steroids
Sex hormones

166

GLUT transporter on the enterocyte

GLUT2 - facilitated diffusion

167

Collagen amino acid seqence

Pro-Pro-Gly

168

How do chaperones work?

Bind to hydrophobic residues to prevent hydrophobic driven folding
Create a unique environment for the protein
Use ATP

169

D vs L form of sugars

D form = OH group on the right
L form = OH group on the left

170

Heparin

Actvivats a thrombin inhibiotr and factor X - antithrombin III
Released from endothelial cells at sites of damage

171

Interleukin responsible for eosinophil recruitment

IL-5

172

Purines

A, G

173

Pyramidines

T, C

174

5' end

Free phosphate

175

3' end

Free OH

176

Linker histone

H1

177

Direction of DNA synthesis

5'-->3'

178

Topisomerase function

Prevents supercoiling of DNA

179

Why is there a low level of mistakes in DNA replication?

3' to 5' editing of DNA polymerase

180

Base excision repair

Back and backbone removed
DNA polymerase replaces base
Nick sealed by DNA ligase

181

Nucleotide excision repair

Nuclease cuts section of 12 nucleotides
DNA helices removes it
DNA polymerase fills gap
DNA ligase seals nicks

182

DNA mismatch repair

MutS binds to error
MutL finds nearest nick and drags it towards it to form a loop
Strand removed
DNA polymerase fills gap
Sealed by ligase

183

Non-homologous end joining

Double strands simply joined back together
Without missing nucleotides

184

Homologous end joining

Homologous chromosome used to replicate missing sequence and ends joined together with missing copied nucleotides in between

185

Faulty nucleotide excision repair

Xeroderma pigmentosum
Leads to skin cancer, UV sensitivity

186

Faulty mismatch repair

MutS and MutL mutations
Leads to colon cancer

187

Faulty homologous recombination

BRCA2
Leads to breast and ovarian cancer

188

DNA methylation process

Addition of methyl groups to cytosine nucleotides at CpG islands
Done by DNA methyl transferase
Makes genes harder to transcribe

189

Histone modifications

Affects how tightly packed chromatin is
Histone acetylase increases transcription
Histone deacetylase decreases transcription

190

X inactivation

Silencing of one of the X chromosomes of females

191

Nonsense mutation

Amino acid to stop codon

192

Missense mutation

One amino acid to another

193

Frameshift mutation

Disrupts the triplet code

194

Autosomal dominant conditions

Huntingdon's disease
Marfan syndrome
Neurofibromatosis
Achondroplasia

195

Anticipation

Disease manifests at a younger age in successive generations

196

Autosomal recessive conditions

Cystic fibrosis
Sickle cell anaemia
Thalassaemias

197

X linked recessive conditions

Duchenne muscular dystrophy
Haemophilia
Colour blindness

198

X linked dominant conditions

Vitamin D resistant rickets

199

Number of genes

21000

200

Percentage of human genome that codes for proteins

1.5-1.6%

201

What does RNA pol 1 make?

rRNA

202

What does RNA pol 2 make?

mRNA

203

What does RNA pol 3 make?

tRNA

204

Uracil

Modified thymine
Bonds to adenine
Only in RNA

205

5' cap

Addition of a modified guanine to the 5' of the RNA

206

3' polyA tail

Addition of long chain of adenines to the 3' end of the RNA

207

Where does splicing occur?

Nucleus

208

Start code

AUG
Methionine

209

Stop codons

UAA
UAG
UGA

210

Process of checking correct amino acid is added to tRNA

Done by RNA poly3
May need more than one step due to sizes of AAs

211

Ribosome sites

A site - entry
P site - middle
E site - exit

212

Internal ribosomal entry site

Not all translation starts from 5' cap

213

What happens when a stop codon is reached?

Release factors release peptide chain from final tRNA and the ribosome
Second release factor then dismantles ribosome

214

Short vs long arm

Short = p
Long = q

215

G light vs dark band

G light = gene rich, GC rich
G dark = gene poor, AT rich

216

On which chromosome are the MHC genes found?

6

217

Robertsonian translocation

Two chromosomes joined at their centromere

218

Trisomy 21

Down syndrome
Hypotonia
Distinct facial appearance
Learning difficulties
Heart malformations

219

Trisomy 18

Edwards syndrome
Multiple malformations
Clenched hands with overlapping fingers

220

Trisomy 13

Patau syndrome
Malformations particularly affecting midline structures

221

Klinefelter syndrome

47,XXY
Infertility
Poorly developed 2ndy sexual characteristics
Female shaped hips
Tall

222

Turner syndrome

45,XO
Short stature
Primary amenorrhoea
Congenital heart disease

223

Amniocentesis

15-18 weeks
Sample of amniotic fluid

224

Chorionic villus sampling

12-14 weeks
Placenta tested

225

Nuchal scan

11-14 weeks
For Down's syndrome
Non-invasive

226

pH of ECF

7.35-7.45

227

Sources of acid

Aerobic respiration --> carbonic acid
Anaerobic respiration --> lactic acid
Incomplete fatty acid oxidation --> ketoacids
Hydrolysis of nucleic acid --> phosphoric acid

228

Phosphate buffer system

Minot relevance in ECF
Important in kidneys

229

Haemoglobin buffer system

HB + H+ --> HHb
Loads in tissues
Releases at lungs

230

Major blood buffers

Bicarbonate
Haemoglobin

231

Renal compensation

Can excrete or conserve bicarbonate or hydrogen ions

232

Respiratory acidosis

Low pH, high CO2, high bicarb
Hypoventilation
COPD
Respiratory centre depression
Sepsis

233

Respiratory alkalosis

High pH, low CO2, low bicarb
Hyperventilation
Stress
Elevated body temperature
Overventilation

234

Metabolic acidosis

Low pH, low bicarb, low CO2
Increased acid production or retention - renal failure, starvation, lactic acidosis, diabetes
Bicarbonate loss - chronic diarrhoea

235

Metabolic alkalosis

High pH, high bicarb, high CO2
Increased bicarb - carbohydrate retention
Loss of organic acids - repeated vomiting

236

Anion gap

Difference between cations and anions
Normal = GI bicarb loss, renal loss
High = lactic acidosis, ketoacidosis, renal failure

237

Gibbs-Donnan effect

Presence of a charged impermeable ion on one side of the membrane

238

Voltage gated sodium channel

Activation gate - opens in depolarisation fast
Inactivation gate - closes in depolarisation slowly

239

Voltage gated potassium channel

Opens in response to depolarisation
Opens slowly
Dont inactivate
Produce hyperpolaristion

240

Stages of AP

1. Resting - Na and K channels closed
2. Na channel opens
3. K channels open, Na channels starting to close
4. Hyperpolarisation - K channels open, Na closed

241

Absolute refractive period

Cannot open regardless of applied stimulus
During depolarisation
1-2ms

242

Relative refractive period

Larger stimulus required to produce action potential
While membrane is hyperpolarised
3-15ms

243

Effect of diameter on conduction velocity

Cytoplasmic resistance decreases with increased diameter
Faster conduction

244

Effect of myelination on conduction velocity

Membrane resistance increases with insulation
Faster conduction

245

Temporal summation

APs occur in rapid succession and combine to reach threshold

246

Spatial summation

Multiple APs from different synapses

247

Meissner corpusle

Light touch

248

Merkel cells

Pressure
Texture

249

Pacinian corpulscle

Vibration

250

Ruffini endings

Skin stretching

251

Origins of sympathetic nerves

T1-L2

252

Myenteric ENS plexus

Between circular and longitudinal muscle layers
Controls motility

253

Submucosal ENS plexus

Between submucosa and circular muscle
Controls secretion and muscularis mucosae motility

254

Sacral parasympathetic nerve roots

S2-4

255

Sympathetic nerves with paravertebral ganglia

T1-4

256

Sympathetic nerves with prevertebral ganglia

T5-L2

257

Total body water

60% body weight
42L

258

Extracellular colume

1/3 TBW
14L

259

Intracellular volume

2/3 TBW
28L

260

Interstitial fluid volume

10.5L

261

Plasma volume

3.5L

262

Red blood cell volume

1.5L

263

Cells other than RBC volume

26.5L

264

Transcellular fluid

1L
CSF
Synovial fluid

265

What does tonicity depend on?

Solutes that cannot cross the membrane freely

266

Obligatory water loss

500ml/day