Human Disease YR3 #2 Flashcards
(497 cards)
1
Q
Name 5 causes of normocytic anaemia?
A
CancerRAIBSRenal problemsTB
2
Q
What is the definition of microcytic?
A
Red cell is <80 fl in size and is usually associated with reduced intra-cellular haemoglobin (Hb), which creates a hypochromic appearance
3
Q
What is the definition of macrocytic?
A
Reflects an increased MCV but with reduced Hb level
4
Q
What is the definition of normocytic?
A
The Hb is low but the MCV is within normal limits
5
Q
Name 4 causes of microcytic anaemia?
A
Iron deficiencyAnaemia of chronic diseaseSideroblastic anaemiaThalasseamia
6
Q
How is iron absorbed via the GI?
A
Absorbed in the duodenum in acidic conditions and carried in the blood as transferrin but stored in the marrow, liver and muscle as ferritin
7
Q
Name 5 common causes of iron deficiency anaemia?
A
PeriodGI blood lossIncreased demandSmall bowel diseasePoor diet
8
Q
What is the FBC diagnosis for iron deficiency anaemia?
A
Low Hb and low MCVLow ferritinTotal iron binding capacity is increased
9
Q
What is the management for iron deficiency anaemia?
A
Treat causeOral iron (Ferrous sulphate)IM
10
Q
Name the 2 types of Thalassaemia?
A
Alpha| Beta
11
Q
Name the 3 types of Beta Thalassaemia?
A
MajorIntermediaMinor
12
Q
What causes megaloblastic anaemia?
A
Vit b12 deficiency| Folate deficiency
13
Q
Name the 6 main reasons for B12 deficiency?
A
Pernicious anaemiaGastrectomyVeganIleal resectionCoeliac diseaseBacterial overgrowth
14
Q
Name the 4 main reasons for folate deficiency?
A
DietMalabsorptionHigh demandDrugs
15
Q
What is the definition of sickle cell anaemia?
A
Inheritance of a gene for HbS, sickle haemoglobin. This is needed for the exchange of valine for glutamic acid in position 6 of the Hb beta chain
16
Q
What is the role of G6P dehydrogenase?
A
Glucose-6-phosphate dehydrogenase deficiency is vital to maintain glutathione in a reduced state to help the movement of electrons (H) through the metabolic pathways (oxidation)
17
Q
Blood group O - serum abs and info?
A
Anti A and B| Universal donor
18
Q
Blood group A - serum abs and info?
A
Anti B
19
Q
Blood group B - serum abs?
A
Anti A
20
Q
Blood group AB - serum abs and info?
A
None| Universal recipients
21
Q
Name 6 respiratory symptoms?
A
BreathlessnessCoughSputumHaemoptysisChest painWheeze
22
Q
What assessments would a dentist carry out to assess respiratory disease?
A
Pulse oximetryPulse rateRespiratory ratePeak flow meter
23
Q
What is the definition of TI respiratory failure and give 2 examples?
A
Low PO2Normal or low PCO2Acute asthmaPneumonia
24
Q
What is the definition of TII respiratory failure and give 2 examples?
A
Low PO2High PCO2COPDObesity hypoventilation syndrome
25
Signs and symptoms for asthma and COPD?
BreathlessnessWheezeCough
26
What is the difference between COPD and asthma?
COPD:- irreversible airflow obstructionAsthma:- reversible airflow obstruction
27
What tests can be carried out to help diagnose asthma and COPD?
HistoryPeak flow recordingLung function
28
Name the 5 treatment options for Asthma and COPD?
```Inhaled bronchodilators (salbutamol)Inhaled corticosteroids (beclomethasone)Oral theophyllineOral leukotriene receptor antagonist (montelukast)Oral prednisolone```
29
What is the definition of pneuomina?
Infection of the lower respiratory tract
30
What are the signs and symptoms of pneumonia?
```FeverMyalgiaHeadacheCoughChest painSputumDyspnoea```Can proceed to TI respiratory failure
31
What are the treatment for pneumonia?
AntibioticsOxygenintravenous fluids
32
What is the definition of obstructive sleep apnoea?
Loud snoring and cessation of breathingDaytime sleepinessPoor concentration
33
How to treat obstructive sleep apnoea?
Weight lossCPAPMandibular repositioning splint
34
What is the definition of a pulmonary embolism?
Blood clot in the lungs, that typically arises in the leg veins
35
Name 4 risk factors for pulmonary embolism?
Recent major operationRecent major traumaImmobilityMajor chronic disease
36
What are the signs and symptoms of pulmonary embolism?
BreathlessnessChest painHaemoptysis
37
What is the treatment for pulmonary embolism?
Anticoagulation
38
What is the definition of a pneumothorax?
Collapsed lung
39
Name the 2 types of pneumothorax?
Primary| Secondary
40
Signs and symptoms for a pneumothorax?
Chest pain| Dyspnoea
41
How to treat a patient with pneumothorax?
Aspiration of air around collapsed lungObservationChest drain
42
Signs and symptoms for lung cancer?
CoughHaemoptysisWeight loss
43
What is the definition of a chronic cough?
Cough lasting longer than 8 weeks
44
Name 3 common causes of chronic cough?
AsthmaGastro-oesophageal refluxPostnasal drip
45
What is the definition of bronchiectasis?
Dilated and damaged airways
46
Signs and symptoms of bronchiectasis?
CoughLarge amount of sputumHaemoptysis
47
What are the treatment options for chronic cough/
Inhaled corticosteroidsgastric acid suppression (omeprazole)Intranasal steroid spray (beconase)
48
How to diagnose sleep apnoea?
Sleep study
49
How to diagnose lung cancer?
CT scan| Bronchoscopy
50
How to diagnose chronic coughing?
Lung function test
51
How to diagnose bronchiectasis?
CT thorax
52
What is the definition of interstitial lung disease?
Thickening, inflammation of interstitium of the lung
53
Signs and symptoms of interstitial lung disease?
Dyspnoea| Dry cough
54
How to diagnose interstitial lung disease?
CT scan
55
Treatment options for interstitial lung disease?
CorticosteroidsOxygenPulmonary rehabPirfenidone
56
Explain the process of the platelet plug?
Vessel damage leads to platelet adhesion to the VWfPlatelets then aggregate to other platelets to form a plug + some fibrinogenFibrinogen is hen broken down to form fibrin forming the clot
57
What is the intrinsic pathway for clotting?
```IX --> IXaIXa --> X via VIIIaX --> XaProthrombin --> Thrombin via XaFibrinogen --> Fibrin by thrombin```
58
What is the extrinsic pathway for clotting?
```VII + Tissue factorVIIIa/TF --> XaX --> XaProthrombin --> Thrombin via XaFibrinogen --> Fibrin by thrombin```
59
Name 4 pathological causes for bleeding disorders?
Decreased number of plateletsAbnormal platelet functionVon Willebrand diseaseCoagulation factor (deficiency or inhibition)
60
Name 5 points to think about when gauging bleeding history?
```Do you have a bleeding disorder?How severe is the disorder?Pattern of bleedingCongenital or acquiredMode of inheritance```
61
Name 6 times history of bleeding can give information?
```BruisingEpistaxisPost-surgical bleedingMenorrhagiaPost-partum haemorrhagePost-trauma```
62
Name 5 types of platelet type of pattern of bleeding?
```MucosalEpistaxisPurpuraMenorrhagiaGI```
63
Name 3 types of coagulation factor for pattern of bleeding?
ArticularMuscle haematomaCNS
64
How to determine the difference between acquired and congenital?
Previous episodesAge at first eventPrevious surgical challengesAssociated history
65
What is the definition of Haemophilia A and B?
X-linked Identical phenotypesSeverity of bleeding depends on the residual coagulation factor activity
66
What are the clinical features of haemophilia?
```HaemarthrosisMuscle haematomaCNS bleedingRetroperitoneal bleedingPost surgical bleeding```
67
What questions to ask a dental patient with a suspicion of bleeding disorders?
Do you have a history of bleeding disorder?Do you have a family history of bleeding?Have you had any previous operations?Are you taking any anticoagulant drugs?
68
What advice is given for severe haemophilia for dental procedures?
Enhanced preventive GDP| All treatments except prosthetics in specialist hospital setting
69
What advice is given for moderate haemophilia for dental procedures?
Enhanced preventive GDP| All treatments except prosthetics specialist hospital setting
70
What advice is given for mild haemophilia for dental procedures?
Enhanced preventive advice and treatment GDPMany procedures at GDP2 yearly review specialist dental centre
71
What treatment should a haemophiliac +ve patient have for dental management?
```Prevention as normalMild Haem A:- DDA VP/tranexamic acidMod/Severe Haem A:- coagulation factor replacement for VIIIAll Haem B:- coagulation factor replacement```
72
What dental LA procedures require factor elevations?
IAN| Lingual infiltration
73
What dental LA procedures DO NOT require factor elevations?
Buccal infiltrationIntrapapillary injectionIntraligamentary injections
74
What adjunctive to treatment is useful for bleeding disorder patient?
Suturing and local haemostatic measure for extractions| Resorbable and non-resorbable sutures acceptable
75
Name 8 local haemostatic agents?
```Oxidized celluloseSurgicelAbsorbable gelatine spongeGelfoamCyanoacrylate tissue adhesivesSurgical splintsLyostyptAnkaferd blood stopper```
76
Hwat complications can occur with haemophilia treatment?
```Viral infections:- HIV, HBV and HCVInhibitors- DDAVPFlushing Rare arterial eventsHyponatremia in babies```
77
What is the definition of Von Willebrand disease?
```CommonVariable severityAutosomalMucosal platelet bleeding typeQuantitative and qualitative abnormalities of vWF```
78
What precautions should you advice to a Von willebrand disease patient before treatment?
vWF concentrate or DDAVPTranexamic acidTopical applications
79
Name the 4 valves of the heart?
PulmonicAorticBicuspidTricuspid
80
Name the 3 types of valvular heart disease?
Valvular stenosisValvular regurgitationAortic coarctationCHD
81
What does the aortic valve look like?
Inverted Merc badge
82
Name the 2 types of aortic stenosis?
Degenerative| Bicuspid
83
What is the aetiology of degenerative aortic stenosis?
Becomes thick and calcified| Can fuse in the future
84
What is the aetiology of bicuspid aortic stenosis?
2 leaflets rather than 3 leaflets
85
Name 3 symptoms of aortic stenosis?
Chest painBreathlessness on exertionSyncope/Dizziness
86
Name the 2 types of causes of aortic regurgitation
Aortic defects| Leaflet defects
87
How can the aorta cause aortic regurgitation?
Dilated aorta
88
How can the leaflets of the aortic valve cause aortic regurgitation?
BicuspidRheumatic heart diseaseEndocarditis
89
Explain how Rheumatic heart disease occurs?
Occurs from primary infection that leads to cross-abs to heart structure
90
Name the 2 symptoms of aortic regurgitation?
Dyspnoea:- orthopnoea- paroxysmal nocturnal dyspnoeaChest pain
91
Name the 4 aetiologies for mitral valve disease?
```Myxomatous degeneration (valves become redundant and elongated)Functional MR (enlarged ventricles, valves don't match up)Rheumatic heart diseaseInfectious endocarditis```
92
Name the 3 symptoms for mitral valve disease?
BreathlessnessPalpitations due to AFEmbolisation
93
What is the definition of mitral stenosis?
Thickening and scarring of the leaflets| Fusion of the commissures
94
WHat is the definition of mitral regurgitation?
Leaflet abnormality| Mitral annular dilatation
95
Name the 2 right sided valves?
Tricuspid| Pulmonary
96
Name 2 types of congenital heart disease?
Ventricular septal defects| Compex CHD
97
Name 2 types of material for prosthetic heart valves?
Mechanical| Tissue
98
What medication must you be on if you have a mechanical heart valve?
Warfarin
99
How often should a blood INR be carried out?
Every 6 weeks
100
What is the INR for AF?
2-3
101
What is the INF for metallic heart valves?
2.5-4
102
How long should a tissue valve transplantee stay on anticoagulants for?
3 months
103
What to ensure about your patient with bleeding disorders before invasive treatments?
Ensure INR 2-4 72 hrs prior Ensure no other antiplatelet therapy (aspirin or clopidogrel)DO NOT prescribe NSAIDs or COX-2 inhibitorsEnsure proper local haemostasis
104
What are the risks of stopping oral anticoagulation?
Small, but fatal
105
What is the definition of infective endocarditis?
Infection on the cardiac or vascular endotheliumForms vegetationContains platelets, fibrin, microorganisms and inflammatory cell
106
Name the 2 predisposing factors and their subtypes for infective endocarditis?
```Endothelium subjected to turbulent flow:- any valvaular or cardiac abnormality- prosthetic heart valvesBacteremia:- IV drug users- dental procedures- surgical procedures at infected sites```
107
Name the 6 aetiologies for infective endocarditits?
```Bacteria:- streptococcus- staphylococcus- enterococcus- pneumococcus- gram -ve bacilliFungiMycobacteriaRickettsiaeChlamydiaMycoplasma```
108
Name the 7 signs and symptoms for infective endocarditis?
```FeverMalaiseAnorexiaWeight lossHF due to acute valvular destructionSystemic embolisationAcute renal failure```
109
What are the NICE guidelines for antibiotic prescription?
High risk patients when a high risk procedure is performed
110
What is the emphasis for dentists when treating patients with bleeding disorders?
Good oral hygiene| Regular dental review 2 yearly
111
Which patient count as a high risk patient for antibiotic prescription?
Prosthetic valve or prosthetic material used for cardiac valve repairPrevious infective endocarditisCHD:- unrepaired cyanotic disease- complete repair up to 6 months after procedure- residual defects persists at the site of implantation of prosthetic material
112
What is the definition of a invasive dental procedure?
Procedures requiring the manipulation of the gingival or peri-apical region of the teeth or perforation of the oral mucosa including scaling and RCT)
113
What are the ESC 2015 guidelines for infective endocarditis prophylaxis?
```No allergy: single dose 30-60 mins before procedure- amoxicillin or ampicillin - 2 g po/IV adult- 50 mg/kg po/IV childAllergy to penicillin: single dose 30-60 mins before procedure- clindamycin- 600 mg po/IV adult- 20 mg/kg po/IV```
114
Which procedures do not need antibiotic prophylaxis for infective endocarditis/
LA injections in non-infected tissue (superficial caries)Removal of suturesDental x-raysPlacement or adjustment of removable orthodontic appliances or bracesShedding of deciduous teeth or trauma to the lips or oral mucosa
115
Name 11 invasive dental procedures?
Placement of matrix bands• Placement of sub-gingival rubber damclamps• Sub-gingival restorations including fixedprosthodontics• Endodontic treatment before apical stophas been established• Preformed metal crowns (PMC/SSCs)• Full periodontal examinations (includingpocket charting in diseased tissues)• Root surface instrumentation/subgingival scaling• Incision and drainage of abscess• Dental extractions• Surgery involving elevation of a mucoperiosteal flap or muco-gingival area• Placement of dental implants includingtemporary anchorage devices, mini implants• Uncovering implant sub-structures
116
Name 8 non-invasive dental procedures?
```Infiltration or block local anaestheticinjections in non-infected soft tissues• BPE screening• Supra-gingival scale and polish• Supra-gingival restorations• Supra-gingival orthodontic bands andseparators• Removal of sutures• Radiographs• Placement or adjustment of orthodonticor removable prosthodontic appliances```
117
What dose of amoxicillin is needed for an adult with bleeding disorder patient prophylactically?
3g 60 mins before procedure
118
What dose of amoxicillin is needed for a child with bleeding disorder patient prophylactically?
Max dose 3g50 mg/kgOral suspension
119
What dose of clindamycin is needed for an adult with bleeding disorder patient prophylactically?
600mg 60 minutes before procedure
120
What dose of clindamycin is needed for a child with bleeding disorder patient prophylactically?
20 mg/kg| 600 mg max dose
121
What is consisted of the lower GI tract?
```JejunumIleumAscedning ColonDescedning colonSigmoid colonRectumCaecum```
122
What is the function of the small bowel?
Enzymatic digestionabsorptionGut hormone secretionImmune
123
What is the function of the large bowel?
Storage and elimination of waste| FLuid and electrolyte reabsorption
124
What are the symptoms for colorectal cancer?
Change in bowel habitRectal blood lossAbdominal painWeight lossCo-incidental anaemia
125
When does bowel cancer screening occur?
```50-74 YOEvery 2 yearsFaecal occult bloodImmunochemical test+ve result referral for colonoscopy2% require colonoscopy```
126
Explain how the adenoma can develop into a carcinoma?
Normal epitheliumSmall adenomaLarge adenomaInvasive adenocarcinoma
127
What are the stages of colorectal cancer?
Dukes A-D
128
Dukes A?
Tumour confined to mucosa| 93% survival
129
Dukes B?
Extension through mucosa to muscle layer| 77%
130
Dukes C?
Extension through mucosa to muscle layerInvolvement of lymph nodes48%
131
Dukes D?
Distant spread| 7%
132
What is the surgical management for Dukes A?
Endoscopic resection possible for polypsPossible need for stoma if low rectal tumours or perforated or obstructed tumours
133
What is the genetic and environmental contribution for colorectal cancer?
Mainly sporadicCan be geneticIncreased risk with IBD
134
What is the definition of familial adenomatous polyposis and its dental significance?
Autosomal dominantMutation of APC geneHigh risk cancerAnnual colonoscopySupernumerary teethUnerupted teethMultiple osteomas of mandible (cotton wool like appearances)
135
What is the definition of Inflammatory bowel disease?
Chronic relapsing inflammatory conditions of the bowelUC and Crohn'sPeak incidence in 20s
136
What is the aetiology for IBD?
EnvironmentalGeneticCandidate genes identified
137
What are the triggering factors for IBD?
Bacterial infectionDietVaccination historySocial factors - smoking
138
Where does UC effect?
```Continuous mucosal inflammationAffects the colonRectum - proctitisLeft sided hemiExtensive pan```
139
What are the symptoms for UC?
Bloody diarrhoeaAbdominal crampingWeight lossMalaise
140
What are the signs and symptoms of Crohn's disease?
```DiarrhoeaBleedingWeight lossVomitingPerianal symptoms```FistulaAbscessesFissures
141
What are the signs and symptoms of Crohn's disease?
```DiarrhoeaBleedingWeight lossVomitingPerianal symptoms:- fistula- abscesses- fissures```
142
What are the extra-intestinal manifestations for IBD?
Eyes: uveitis and conjunctivitisJoint: sacroiliitis, monoarticular arthritis and ankylosing spondylitisLiver: fatty, gallstones, pericholangitis and sclerosing cholangitisSkin: vasculitis, pyoderma gangrenosum and erythema nodosum
143
What is the definition of toxic megacolon?
Colonic dilatation and systemic toxicity due to severe flare of colitis
144
What is the definition of toxic megacolon?
Colonic dilatation and systemic toxicity due to severe flare of colitis
145
What is the medical treatment for IBD and their dental impact?
ImmunosuppressionCorticosteroids for acute flare upsThiopurines (BM suppression)Biologics - infliximab (anti-TNF)Ensure no dental infection ongoing prior to administration
146
What is the definition of Coeliac disease?
Intolerance to gluten| Loss of microscopic villi in the SI, resulting in malabsorption
147
What are the symptoms for Coeliac disease?
DiarrhoeaWeight lossBloatingAnaemia
148
Diet changes for coeliac +ve patient?
No:- bread- pasta- cake- cereals- sauces- pre-prepared meals- beer
149
What is the definition of small bowel infarction?
Acute mesenteric ischaemiaUsually due to arterial thrombus or embolism blocking blood flowRapid onsetEmergency resection required
150
Name 2 eating disorders?
Anorexia nervosa| Bulimia nervosa
151
What is the definition of anorexia nervosa?
Refusal to maintain normal wightFear of weight gainDistorted perception of body image
152
What's the definition of bulimia nervosa?
Binge eating followed by attempts to restrict weight gain| Purging
153
Oral manifestations for vomiting?
```Palatal erosionOcclusal erosion of maxillary teeth:- incisal edges of incisors thin and knife-edged- cupped out appearanceSwollen parotid glands```
154
What is the definition of hereditary hemorrhagic telangiectasia?
Autosomal dominantPerioral telangiectasiaSmall bowel lesions can bleedPhotocoagulation/embolisation/surgery
155
What is the definition of Peutz-Jeghers syndrome?
Autosomal dominantMucocutaneous pigmented maculesMultiple polyps throughout bowel (block or bleed)GI cancers risk hight
156
Oral manifestations for Crohn's disease?
```Orofacial granulomatosis:- inflammatory condition affect the oral mucosa- found before Crohn diagnosis- non-caseating granulomasRecurrent mouth ulcers```
157
Treatment for oral manifestations for Crohns?
Local/systemic corticosteroids| Cinnamon-free diet
158
What is the definition of diverticular disease?
Asymptomatic| Bulging sac of tissue protruding from colonic wall
159
Complications for diverticular disease?
BleedingPerforationInfection + abscessesRequire surgeryHigh fibre diet good
160
Name 3 types of small bowel diseases?
Crohn'sCoeliac diseaseIschaemia/infarction
161
What are the symptoms of hereditary hemorrhagic telangiectasia?
Epistaxis| Pulmonary and cerebral lesions
162
Oral manifestation for iron-deficiency anaemia?
Angular cheilitis
163
What are the functions of the digestive system?
DigestionSecretionAbsorptionMotility
164
What is the sequence of organs that the food passes through?
```MouthOesophagusStomachSIColonRectumAnus```
165
What organ is responsible for digestion?
Stomach
166
Which organ is responsible for absorption and secretion?
```Absorption:- upper SI- colonSecretion:- lower SI- colon```
167
Name the 2 forms of digestion?
Chemical| Enzymatic
168
Name each organ/tissue present in the GI tract?
```MouthSalivary glandsPharynxTracheaOesophagusLiverGallbladderStomachPancreasLISIRectumAnus```
169
Describe the cross-sectional structure of the GI tract wall? Out to In
```SerosaLongitudinal muscularis externaMyenteric plexusCircular muscularis externaSubmucous plexusSubmucosa (BVs and nerves)Mucosa (epithelium)Lumen```
170
Name the 2 autonomic controls of the GI system?
Long (para)| Short (ENS) reflexes
171
Describe how the parasympathetic NS control the GI function during digestion?
```Vagus nerve mainlyExcept salivation (VII and IX)Stimulatory:- increased secretion- increased motility```
172
Describe how the sympathetic NS control the GI function during fight/flight?
Splanchnic nerveInhibitor (except salviation):- reduced secretion- reduced motility
173
Where does the blood from the GI system drain to?
Hepatic portal vein
174
What 2 main vessels enter the Liver?
Hepatic portal vein| Hepatic artery
175
Why do we chew?
Prolong taste experience| Defence against respiratory failure
176
Explain the voluntary system in which chewing is controlled?
Somatic nerves innervate the skeletal muscles of the mouth and jaw
177
Explain the reflex pathway for chewing?
Contraction of jaw muscles leads to pressure of food against the gums, hard palate and tongue, activating mechanoreceptors that communicate to inhibit jaw muscles thus reduces the pressure causing contraction
178
Name the main organs for swallowing?
```Hard palateSoft palateTongueEpiglottisGlottisLarynx```
179
Explain the oral phase (voluntary) during swallowing?
Bolus pushed to back of the mouth by tongue
180
Explain the pharyngeal phase during swallowing?
On presence of bolus it activates the sequence of reflex contractions of the pharyngeal musclesThis is coordinated y the swallowing centre in the medullaThe soft palate is reflected backwards and upwards (closing off the nasopharynx)As the bolus reaches the oesophagus the upper oesophageal sphincter relaxes and the epiglottis will cover the opening to the larynx stopping food entering the tracheaOnce bolus has entered the oesophagus the sphincter contracts (preventing reflux)
181
Explain the oesophageal phase during swallowing?
The propulsion of the bolus to the stomachPeristaltic waves sweep the bolus along the oesophagus and reaches stomach in 10sAs the bolus nears the stomach the lower oesophageal sphincter relaxes allowing the bolus to enter the stomachReceptive relaxation of the stomach is initiated following relaxation of the sphincter and entry of bolusVagal reflexes communicate to that there is relaxation of the thin, elastic SM of the gastric fundus and body
182
How does the size of the stomach change?
50mL --> 1500mL with no Pa change
183
Name the 3 main parts of the stomach?
FundusBodyAntrum
184
What allows the receptive relaxation of the stomach?
Rugae in the stomach
185
What is the function of the fundus?
Storage of material
186
What is the function of the body?
```StorageMucusHClPepsinogenIntrinsic factor```
187
What is the function of intrinsic factor?
Binds B12Aids haemoglobin formationTravels to terminal ileum and transported to the liver
188
What is the function of HCl and pepsinogen?
Digestion
189
What is the function of the antrum?
Mixing/grinding| Gastrin
190
What is the function of gastrin?
Regulates the secretion of HCl and pepsinogen
191
Name the 4 types of cells of a gastric gland?
Surface mucousMucous neckParietalChief
192
What do mucous neck cells secrete?
Mucus
193
What do chief cells secrete?
Pepsinogen
194
What do parietal cells secrete?
HCl| Intrinsic factor
195
Name the 3 ways mechanism in which gastric acid is controlled?
Neurocrine (vagus)Endocrine (gastrin)Paracrine (histamine)
196
Explain the cepahlic phase of gastric acid secretion?
Sight, smell or taste of food witl activate the vagus nerve which activate parietal and g cells which release gastrin to further activate parietal cellsGastrin/ACh activate ECL cells which release histamine to further activate Parietal cells
197
Explain the gastric phase of gastric acid secretion
Distension of stomach after arrival of food stimulates the vagal and enteric reflexes releasing ACh activating the parietal cellsPeptides present in the lumen activate G cells secreting gastrin will activate parietal cellsGastrin/ACh will activate ECL cells to release histamine and activate parietal cells
198
What cells produce pepsiongen?
Chief cells
199
How is pepsinogen activated?
pH of lover than 3Acid hydrolysis and forms pepsinPepsin continues to hydrolysis of pepsinogen
200
How is pepsinogen packaged?
Zymogens to stop cellular digestion
201
How are pepsin and HCl secretion related?
Proprotional to one another
202
What secrete gastic mucus?
Surface epithelial cells and mucus neck cells
203
What is the function of gastic mucus?
Cytoprotective roleProtects mucosal surface from mechanical injuryNeutralise pH as it has a high HCO contentProtects against gastric acid corrosion and pepsin digestion
204
At what pH is pepsin denatured?
Neutral pH
205
Explain how acid is neutralised before entering the duodenum?
HCO secreted from Brunner's gland duct cells| H + HCO3 --> H2CO3 -> H20 + CO2
206
Explain how the duodenum controls the secretion of HCO3?
Long and short reflex for HCO3 secretion| Release of secretin from S cells increases HCO3 secretion
207
What does secretin activate the release of and from where?
HCO3 from pancreas and liver
208
How is secretin release controled?
Acid neutralisation leads to the inhibition of secretin release
209
What is the function of the duodenum?
To neutralise acid from the stomach
210
What duct enters the duodenum and the name of its sphincter?
Common bile duct| Sphincter of Oddi
211
Name the 2 types of cells of the exocrine pancreas?
Acinar cells| Duct cells
212
What do acinar cells secrete?
Digestive enzymes in zymogens
213
What is the function and location of enterokinase?
Brush border of duodenal enterocytes| Overt trypsinogen to trypsin
214
What is the function of trypsin?
Converts all zymogens to their active forms
215
What stimulates HCO3 secretion in the pancreas?
Secretin
216
What is secretin secreted in response to?
Acid in duodenum
217
What stimulates the release of zymogens from acinar cells?
Chlecystokinin
218
What is CCK secerted in response to?
Fat/aas in duodenum| Vagal reflex triggered by arrival of organic nutrients in the duodenum
219
Explain the process if acid from the stomach reaches the duodenum?
SI increases secretin releaseCausing the pancreas to release HCO3HCO3 flow into SINeutralises the SI acid
220
Explain the process if there is an increase in FA and aas related to pancreatic function?
Increased CCK release in SICausing enzyme release from pancreasIncreased flow of enzymes into SIIncreased digestion of fast and protein in SI
221
Describe the structure of the liver?
Liver lobulePortal triad (hepatic portal veins, hepatic artery and bile canaliculus)HepatocytesHepatic sinusoids
222
What is included in the portal triad?
Hepatic portal veinsHepatic arteryBile canaliculus
223
Do the hepatic artery and hepatic protal vein mix?
Yes
224
What do the hepatocytes produce?
Bile
225
What other fucntions do hepatocytes have?
Nutrient storageNutrient interconversionDetoxification
226
Describe the pathway for blood and nutrients through the liver system?
Hepatic portal vein and hepatic artery form the hepatic sinusoidBlood enters the central veins to the hepatic veins back to the heartThe nutrients are taken out by the hepatocytes and stored or convertedHepatocytes also produce bile that pass into canaliculi to the hepatic ducts to aid in digestion
227
What nutrints are stored in the hepatocytes?
```GlycogenFatB12A DEKCuFe```
228
What is the function of the liver?
Bile production and secretion
229
Name the 6 components of bile?
```Bile acids (secreted by L)Lecithin (secreted by L)Cholesterol (secreted by L)Bile pigments (secreted by L)Toxic metals (secreted by L)Bicarbonate (secreted by pancreas)```
230
What is the function of bile acids, lecithin and cholesterol
Solubilse fat
231
What is the function of bile pigments?
Bilirubin from ahem
232
What is the function of toxic metals?
Detox in liver
233
What is the function of HCO2?
Neutralisation of acidic chyme
234
How do we improve the solubility of bile acids?
Conjugated with glycine or taurine forming bile salts
235
What is the function of the gallbladder?
Overflow area for bile from the common bile duct
236
How are bile salts recyled?
enterohepatic circulation
237
What is the pathway for bile?
```LiverBile ductDuodenumIleumHepatic portal veinBack to the liver5% lost in the faeces```
238
Explain the process of control of bile secretion?
Sphincter of Oddi controls the release of bile and pancreatic juice into the duodenumIf contracted, stays closed and overflows into gallbladderIf fat is present in the duodenum the response is to release CCK, in turn this relaxes the sphincter and contracts the gallbladderThe bile enters the duodenum and solubilises the fatCCK activates pancreatic enzyme secretion and bile secretion
239
What is the other function of the gallbladder?
Concentrates the bile 5-20 times the normal of the liverAbsorbs Na and H2OVia paracellular pathways
240
What is the cross-sectional structure of the SI?
```MucosaSubmucosaCircular muscleLongitudinal muscleSerosa```
241
What is present on the GI mucosa?
Plica:| - have villi increases SA
242
Describe the structure of the epithelium in the SI
```VilliCryptsLamina propriaGoblet cellsEndocrine cellsAbsorptive cellsMuscularis mucosae```
243
How often os the lining of the gut replaced?
Every 5 days
244
Describe the structure of an enterocyte?
Microvilli - higher SA| Cuboidal
245
Name 3 disaccharides of glycogen/starch?
MaltoseSucroseLactose
246
Which enzymes catalyse maltose, sucrose and lactose to breakdown?
MaltaseSucraseLactase
247
What is maltose broken down into?
2 glucose
248
What is sucrose broken down into?
1 glucose| 1 fructose
249
What is lactose broken down into?
1 glucose| 1 galactose
250
Which enzyme breaks down glycogen/starch?
Amylase
251
Which enzyme breaks down peptides?
Endopeptidases| Forming 2 smaller peptides
252
Which enzyme breaks down the smaller peptides?
Exopeptidases called aminopeptidase and carboxypeptidase to produce amino acids and even smaller peptides
253
How do the enterocytes transport nutrients across their membranes?
Na-coupled secondary active transport:- Na/K pump to bring in K- Na coupled with nutrient into cell- nutrients enter bloodstream- K leaves via K channel- also water follow Na
254
Explain the process of emulsification of fat in the stomach?
Mechanical breakdown in the antrum| Bile salts to stop the droplets from reforming large fat droplets in the duodenum
255
How are the droplets converted to micelles?
Pancreatic lipase| Into FA and monoglycerides
256
How are the FAs absorbed into the cells?
Diffuse into the cell
257
How do the enterocytes convert and package the FA for future use?
FA and monoglycerides travel to the ERConverted to triacylglycerol via triacylglycerol synthetic enzymes and packed via vesicles to form chylomicronsChylomicron will travel in the lacteal via the lymphatic system to be absorbed into the blood
258
What is the defintion of segementation?
Processing the mealSmall sections of the SI constrict and then relax to allow mixingIncreasing Sa of the food to aid absorption
259
What os the defintion of peristalsis?
Contraction behind the bolus and relaxation ahead to move the bolus towards the anus
260
Name the parts of the LI?
```IleumCaecumAsceding colonransverse colonDescedning colonSigmoid colonRectum```
261
Describe the structure of the cross-sectional wall of the LI?
Intestinal crypts (very deep) (goblet cells)SubmucosaCircular muscleLongitudinal muscle (tenia coli 3 lines)
262
Name the 2 sphincters in control of defaecation?
Anus closed by internal anal sphincter (SM under autonomic control) and external anal sphincter (skeletal muscle and voluntary control)
263
Explain the process of defaecation?
Wave of intense contraction (mass movement contraction) from colon to rectumDistension of rectal wall produced by MM of faeces into rectum activates the mechanoreceptors activating the defaecation reflex giving the urge to defaecate
264
Explain the process of the defaecation reflex?
Parasympathetic control via the pelvic splanchnic nerve:- contraction of rectum- relaxation of internal and contraction of external anal sphincter- Increased peristaltic activity in colin increases the PA on the external sphincter- relaxation of external sphincter under voluntary control allow expulsion of faeces
265
Name 6 pathophysiologies for upper GI disease?
```PepticMalignancyAutoimmunityFuncionalInfectiveGenetic```
266
What is the definition of helicobacter pylori and how is it transmitted?
Flagellate bacteria from spirochete| Transmitted human to human
267
How is helicobacter pylori adapted to survive in the stomach?
Adapted to stomach| Converts urea to ammonia to neutralise periplasm
268
What disease does helicobacter pylori cause?
```Chronic gastritisAtrophic gastritis (impaired acid prod)Antral gastritis (increased acid production)Pan gastritis (increased prolif of gastric cells)```
269
Which precancerous conditions can helicobacter pylori cause?
Gastric carcinoma| MALToma
270
How to diagnose for helicobacter pylori infection?
Serum Faecal antigen Urease breath testCLO test
271
What is the definition of gastro-oesophageal reflux disease?
Reflux acid content into the oesophagus
272
What are the symptoms for Gastro-oesophageal reflux disease?
Chronic cough| Hoarse voice
273
What are the predisposing factors for Gastro-oesophageal reflux disease?
```Lifestyle ObesityIncreased Intra-abdominal pressureSmokingAlcohol```
274
What causes GORD?
Lower oesophageal sphincter relaxation| increased or higher frequency
275
What treatment can be prescribed for GORD?
Proton pump inhibitorChange lying positionDiet
276
Name the 4 grades for oesophagitis?
ABCD
277
What is the definition of metaplasia?
Where one organ's lining mutates and becomes the lining of a different organ
278
What is the definition of Barrett's oesophagus?
Metaplasia of the oesophagus from acid exposure| Can be precancerous
279
What is the aetiology for peptic disease for upper GI disease?
Helicobacter pyloriNSAIDsZollinger-Ellison disease
280
Name the 2 types of oesophageal cancer?
Squamous cell carcinoma| Adenocarcinoma
281
Prognosis of squamous cell carcinoma?
1 yr 36%| 5 yrs 12%
282
Prognosis of adenocarcinoma?
5 yrs:- localised 45%- nodes 24%- meta 4%
283
What are the risk factors squamous cell carcinoma?
Smoking
284
How to diagnose and stage oesophageal squamous cell carcinoma?
```EndoscopyBiopsyCTUltrasoundPET```
285
What is the treatment for oesophageal squamous cell carcinoma?
Radiotherapy
286
What are the risk factors adenocarcinoma?
SmokingAlcoholHP
287
What are the signs and symptoms for adenocarcinoma?
Dysphagia
288
How to diagnose and stage oesophageal adenocarcinoma?
```EndoscopyBiopsyCTUltrasoundPET```
289
How to treat oesophageal adenocarcinoma?
RadiotherapyOesophagectomy Chemotherapy
290
What are the risk factors for gastric adenocarcinoma?
HPSmoking Obesity
291
How do patient present when they have a gastric adenocarcinoma?
Late stage:- significant invasion of wall- metastasis to nodesLittle symptoms till disease advanced
292
What is a diagnostic aid for a patient with gastric adenocarcinoma
Iron-deficiency anaemia
293
How to diagnose and stage gastric adenocarcinoma?
```EndoscopyBiopsyCTUltrasoundPET```
294
What is the prognosis of gastric adenocarcinoma?
Less than 20% after 2 years
295
What is the definition of a MALToma?
HP related| Indolent marginal zone b cell lymphoma of the mucosa-associated lymphoid tissue or aggressive large b-cell lymphoma
296
What is the treatment for MALToma?
Resolution of HP infection for MALTomaDLBCL more problematicRadiotherapySurgery (bypass)
297
What is the prognosis for MALToma?
90% survival at 5 years
298
What is the definition of a neuroendocrine tumour and treatment?
Enterochromaffin-like cells of the gastric mucosaIncidental findingTreatment:- treat symptoms
299
What is the definition of a GIST and treatment?
```Gastrointestinal stromal tumour:- SM cells- cajal cells tumour- low malignancy rateTreatment:- surgery```
300
What is the definition of Crohn's disease?
Full GI tractGeneticEnvironment related to vit D
301
What are the symptoms for Crohn's disease?
Mouth ulcersAbdominal painDiarrhoeaObstruction
302
What are the treatments for prognosis? *****
SurgeryMedical managementImmunosuppression
303
What is the definition of coeliac disease?
Allergy to glutenMalabsorption of nutrientsAbs made against glutenInflammation of SI
304
What are the symptoms for coeliac disease?
DyspepsiaDiarrhoeaAbdominal bloatingWeight loss
305
What is the treatment for Coeliac disease?
Diet modification
306
What are the complications for coeliac disease?
Refractory| Lymphoma
307
What is the treatment for oesophageal dysmotility?
Botox injectionRat tail oesophagusSurgery
308
Name 2 types of infection the upper GI tract can get?
Candida| Tropical sprue
309
What are the risk factors for candida infection?
Immunocompromised| Steroid inhalers
310
What is the treatment for candida?
Fluconazole
311
What are the signs and symptoms for candida?
Dysphagia| Odynophagia
312
What causes tropical sprue?
BacteriaParasitesViruses
313
How does tropical sprue cause har,?
Flattens villi causing malabsorption
314
What are the symptoms for tropical sprue?
Nutrient deficiencyDiarrhoeaFatigue
315
What is a form of tropical sprue?
Giardiasis
316
What is the definition of small bowel bacterial overgrowth?
Bacterial overgrowth in the small bowel?
317
What are the predisposing factors for small bowel bacterial overgrowth?
Absence of ileocecal valve Bypass surgeryDiabetesDevelopmental
318
What is the treatment for small bowel bacterial overgrowth?
Antibiotics
319
What are the symptoms for small bowel bacterial overgrowth?
Malabsorption
320
Name 5 other things that can cause harm to the oesophagus?
```Caustic injuryForeign bodyFood bolusStricturesEoE```
321
Name 8 rare oesophageal disorders?
```VasculitisBehcet (ulcer)Churg-strauss (ulcer)Dermatomyositis (ulcer)CT diseaseScleroderma (dysmobility)Mix CT disease (dysmobility)Crest syndrome (dysmobility)```
322
NAme 4 rare gastric diseases?
Genetic:- menetrier disease (overgrowth of mucous cells)- HHT- FAP- Peutz-Jegher
323
What are the oral manifestations for Crohn's?
Oral mucosal ulcerationMucogingivitisCobblestoning
324
What are the oral manifestations for Coeliac disease?
Enamel hypoplasiaDelayed tooth eruptionGlossitisIDA
325
What are the oral manifestations Pernicious anaemia?
Atrophic glossitis
326
What are the oral manifestations Peutz Jegher syndrome?
Melanotic macules
327
What are the oral manifestations Plummer vision?
Stomatitis
328
What are the oral manifestations HP and PUD?
Dental erosionBad taste in mouthHalitosisMucositis
329
What are the oral manifestations Gardner's syndrome?
Osteomas| Supernumerary teeth
330
What are the functions of the liver?
SynthesisExcretoryMetabolicStorage
331
Name 2 types of liver disease?
Acute| Chronic (inflammation, fibrosis and cirrhosis)
332
Name 5 features of liver disease?
```NoneJaundiceSynthetic dysfunctionMetabolic dysfunctionFeatures of portal hypertension```
333
Name 2 types of jaundice for the liver?
Hepatic| Cholestatic
334
Name 2 types of synthetic dysfunction for the liver?
Oedema| Coagulopathy
335
Name 2 types of metabolic dysfunction for the liver?
Hypoglycaemia| Encephalopathy
336
Name 2 features of portal hypertension for the liver?
GI bleedingAscitesHernia
337
What are the risk factors for liver disease?
```Alcohol*Blood-borne virusesObesityDiabetesHyperlipidemiaAutommunityMedicationFamily historyUCChronic biliary tract disease/hepatobiliary surgery```
338
What is the mechanism for alcoholic liver disease?
```Liver excretes the alcoholAlcohol causes fat accumulation in liverAlcohol is a toxin to the liverSteatosisContinued for a while causes fibrosis and cirrhosis```
339
What is the treatment for alcoholic liver disease?
Stop drinking| Possible liver transplant
340
What is the definition of hepatitis A?
```AcuteRNAOro-faecal transmissionLong life diseaseVaccination and avoid contaminated food and water```
341
What is the definition of hepatitis B?
DNAVertical/parenteral/sexual transmissionChronicCo-infection with hepatitis D
342
What is the definition of hepatitis C and its treatment?
```ssRNAParenteralVerticalSexualCombination therapy```
343
What is the definition of hepatitis E?
Via contaminated food and waterHepatic failure in pregnancyNo chronicNo treatment
344
What is the definition of non-alcoholic fatty liver disease?
Fatty liverLeads to steatohepatitisFurther to fibrosis and cirrhosis
345
What are the risk factors for non-alcoholic fatty liver disease?
```ObesityDiabetesHyperlipidemiaMalnutritionTPNAlcohol/DrugsGenetical```
346
How to diagnose for non-alcoholic liver disease and treatment?
Blood testing| No specific treatment
347
What is the definition of autoimmune liver diseases?
Inflammatory| Autoantibodies against nuclear and cytosolic microsomal
348
Name 3 types of autoimmune liver disease?
AIHPBCPSC
349
How to diagnose autoimmune liver disease?
Abs test| Histology
350
What is the definition of drug and toxin-related liver disease?
Zonal necrosis leads to hepatitis leads to cholestasis leads to steatosis leads to fibrosis leads to cirrhosis
351
Name 4 heritable liver diseases?
Hereditary haemochromatosis (Fe overload)Wilson's disease (Cu overlaod)Alpha-1 antitrypsin deficiencyGilbert's disease (more unconjugated bilirubin)
352
Name the most common liver cancer?
Hepatocellular carcinoma:- cirrhosis, hep B and C- scans and detect alpha-fetoprotein
353
Name 4 rare causes of liver disease?
CryptogenicInfections (bac or parasite)Vascular insultsSystemic diseases
354
Name 3 biliary diseases?
GallstonesAutoimmune diseaseCancer:
355
How to monitor liver function test?
```BilirubinAlbumin EnzymesClotting profileFBV```
356
What are 2 types of autoimmune disease of the biliary tract?
- primary biliary cirrhosis| - primary sclerosing cholangitis
357
What are the 2 types of cancer of the biliary tract?
Cholangiocarcinoma| Cancer of the gallbladder
358
Name the 2 most common child cancers?
Leukaemia (80 % ALL)| Lymphoma
359
Name the 5 most common adult cancers?
```BreastProstateLungColorectalBladder```
360
Name the 4 risk factors for breast cancer?
Reproductive historyHormone therapyBreast densityBRAC1/2
361
Name the 6 types of breast cancer?
```Ductal carcinoma in situLobular carcinoma in situInvasive ductal breast cancerInvasive lobular breast cancerInflammatory breast cancerPaget disease```
362
Name the 3 types of treatment for breast cancer?
SurgeryRadioChemoCombo of all
363
Name the 4 types of leukemia?
Acute myeloidAcute lymphoblasticChronic myeloidChronic lymphocytic
364
What is the definition of a leukaemia?
The malignant cell is a bone marrow derived haemopoietic stem cell which grows uncontrollably and invades and takes over the bone marrow.Invade blood cells and enlarge all organs
365
Name the 3 environmental associations for leukemias?
BenzeneChlorambucilRadiation treatment
366
Name the 3 clear genetic events that link to leukaemia progression?
Down's syndrome patientsCML and ALL:- philadelphia chromosome- long arm of Ch22 translocated to long arm of chromosome 9- forms bcr-ablAML:- associated with t15:17 preventing the natural maturation of the myeloid cell line
367
What is the definition of acute leukaemia?
Acute leukaemia is when the bone marrow is overrun with immature myeloid and lymphoid precursors are unable to mature further.
368
What are the signs for acute leukaemia?
AnemiaBleedingInfectionOrgan enlargement
369
What are the treatment options for acute leukaemias?
Correction of RBC and platelet problemTreat infectionKeep hydratedGuard against acute tumour lysis syndrome
370
What is the specific treatment for AML?
Cytosine arabinoside| Daunorubicin
371
What is the specific treatment for ALL?
VincristinePrednisoneDaunorubicinIf involves brain needs methotrexate or radiation therapy
372
What are the signs and symptoms for CML?
```Weight loss SweatingAnaemiaBleedingInfectionsEnlarged spleen.```
373
What is the treatment for CML?
Alpha interferon| Hydroxyurea
374
What can CML progress to?
Acute leukemia (blast transformation) can cause rapid death
375
What is the definition of chronic lymphocytic leukaemia?
Incurable malignant proliferation of predominantly mature B cells
376
What ae the signs and symptoms for CLL?
AnaemiaBleeding InfectionEnlarged lymph nodes and spleen
377
How can a blood test confirm a diagnosis of CLL?
Increase in WBC and predominantly lymphocytes, anaemia and thrombocytopenia on blood testingLymphocytes on blood film (smear cells as they rupture)Bone marrow biopsy
378
What is the treatment for CLL?
Oral chlorambucil| +/- prednisolone
379
Name the 9 most common side effects of chemotherapy?
Anaemia (reduced bone marrow)Thrombocytosis (thrombocytopenia)Mandibular toriMucositis (and ulceration)DysphagiaHair loss (hair follicle turnover - reversible)Sterility (affects high turnover sperm cell. Pre-treatment samples can be saved)CataractsVomiting (there is a direct stimulation of the vomiting centre in brain stem)
380
Name the 2 types of lymphoma?
Hodgkin's| Non-Hodgkin's
381
What are the signs and symptoms for Hodgkin's lymphoma?
```Sweating (especially at night)FeverWeight lossPruritusFatigueAnorexiaPain in the lymph nodes on drinking alcohol```
382
How is Hodgkin's lymphoma diagnosed and staged?
Lymph node biopsyChest x-rayCT BM scan
383
What is the definition of Non-Hodgkin's lymphoma?
highly heterogenous disease of malignant lymphatic cells which can infiltrate a variety of structures.
384
What are the 2 types of Non-Hodgkin's lymphoma?
High grade| Low grade
385
What is the treatment regime for High grade NHL?
CHOP:- cyclophosphamide- hydroxyaunrubicin- oncovin- prednisolone.
386
What does CHOP stand for?
- cyclophosphamide- hydroxyaunrubicin- oncovin- prednisolone.
387
What is the treatment for low grade NHL?
Not curable and rumbles on for years with symptomatic treatment with chlorambucil or radiotherapy for masses as they arise.
388
What are the signs and symptoms for NHL?
Bruising| Anaemia and Infections
389
What tests ca be conducted to confirm a diagnosis of NHL?
Reduced RBC and platelet numbers, with raised white cell count on blood testsAbnormal liver function tests if liver involvedA chest x-ray and CT scan will show masses which will require a biopsy to provide sub-type diagnosis.Bone marrow aspirate is needed to determine spread
390
What are the risk factors for lung cancer?
```SmokingUrban livingAsbestos exposureCoal burningPassive smokingArsenicFe oxide```
391
What are the clinical features of lung cancer?
```CoughHaemoptysisChest painBone spread leading to fracturesMetastases to bone and the brainFinger clubbingWeight lossLymphadenopathy```
392
What is the definition of Pancoast's tumour in relation to lung cancer?
Invasion of the brachial plexus causing pain (Pancoast’s tumour)
393
What is the definition of Horner's syndrome in relation to lung cancer?
Invasion of the sympathetic ganglions (Horner’s syndrome); involves recurrent laryngeal nerves leading to hoarseness and invasion of the oesophagus, heart and veins
394
What investigations can be conducted to diagnose lung cancer?
Chest x-ray for massesSputum cytology for malignant cellsBronchoscopy for biopsyCT scan for peripheral lesions.
395
What investigation to use to stage a lung cancer tumour?
MRI
396
Name the 2 types of lung cancers?
Non-small cell| Small cell
397
Name 4 types of non-small cell lung cancers?
Squamous cell carcinomaLarge cellAdenocarcinomaALveolar
398
Name a type of small cell lung cancer?
Endocrine cell
399
How can skin change with lung cancer?
Pigmented skin in axillae (acanthosis nigricans)| Herpes zoster Dermatomyositis
400
What are the treatment options for lung cancer?
```SurgeryRadiotherapyChemo for small cell casesHaemodialysisHaemofiltrationPeritoneal dialysis```
401
What are the risk factors for colorectal cancer?
High meat/low fibre dietFamily historyHereditary non-polyposis carcinoma Familial adenomatous polyposis
402
What genetic mutations contribute to colorectal cancer?
K-ras| c-myc
403
Dukes stage A?
Bowel only
404
Dukes stage B?
Through bowel wall
405
Dukes stage C?
Spread to regional lymph nodes
406
Dukes stage D?
Distant metastases
407
What are the signs and symptoms for lower colorectal cancer
descending colon with bleeding, narrowing and obstruction, leading to alternating diarrhoea and constipation, which may be accompanied by bleeding per rectum
408
What are the signs and symptoms for upper colorectal cancer
mass on examination or blood loss related anaemia| Liver involvement will present with jaundice
409
What investaigantions can be done to aid diagnosis?
Barium enemaEndoscopyUSS of LiverBloods
410
What is the treatment for colorectal cancer?
SurgeryChemotherapy for B/C (5-Fluorouracil and levamisole)Radio
411
How to diagnose prostate cancer?
Palpation of hard prostateElevated PSABiopsyTransrectal USS
412
What are the signs and symptoms for prostate cancer?
Presence of prostatic specific antigen| Obstructive urinary flow
413
What is the treatment for prostate cancer?
SurgeryRadiotherapyMetastasis:- androgen ablation therapy
414
Name the 4 risk factors for bladder cancer?
SmokingBenzidineCyclophosphamideChronic infection like schistosomiasis
415
What are the signs and symptoms of bladder cancer?
Haematuria| Painless
416
What investigations aid diagnosis of bladder cancer?
Cytological exam of urineUrographyCystoscopy
417
What is the treatment for bladder cancer?
SurgeryRadioChemo
418
What is an oral side effect for radiotherapy?
Osteoradionecrosis
419
What is an oral side effect for chemotherapy?
Candidiasis
420
What is the 5 Yr survival rate for NSCLC?
25%
421
Name the 4 stages of Hodgkin's disease?
IIIIIIIV
422
Describe stage I of Hodgkin's Lymphoma?
Single site with radio
423
Describe stage I of Hodgkin's Lymphoma?
2 or more sites on same side of diaphragmRadio+/- chemo if symptomatic
424
Describe stage III of Hodgkin's Lymphoma?
SItes on both sides of diaphragm| Chemo
425
Describe stage IV of Hodgkin's Lymphoma?
Widespread involvement of non-lymphatic tissue| Chemo
426
What is SI 5 Yr survival rate for Hodgkin's lymphoma?
90%
427
What is the 5 yr survival for colorectal cancer?
45%| Dukes A 95%
428
What is the 5 yr survival for prostate cancer after surgery?
80-90%
429
Which gender is more at risk of haem cancers?
Men
430
What % of all cancers are haem cancers?
10%
431
What is the most common child cancer?
Leukemia
432
What % of all cancers does leukemia comprise of for childhood cancer?
30%
433
Explain the normal hematopoiesis process for the common myeloid progenitor cell?
Differentiate to erythromegakaryotic progenitor cells formins erythrocytes and plateletsCommon myeloid progenitor cells differentiation to monocytes that become macrophagesMyeloid progenitor cells can also differentiate into neutro, eosino and basophils
434
What cells does acute lymphocytic leukemia affect?
Lymphoid progenitor
435
What cells do Acute myeloid leukaemia affect?
Myeloid progenitor
436
What cells fo chronic lymphoid leukemia?
B cells/T cells
437
What cells do multiple myeloma?
Plasma cells
438
What cells do myeloproliferative disorders affect?
```NeutroEosinoBasoMonoPlateletsRed cells```
439
Name 2 types of acute leukemias?
Acute lymphoblastic leukemia| Acute myeloid leukemia
440
Name 2 types of chronic leukaemias?
Chronic myeloid leukaemia| Chronic lymphocytic leukaemia
441
Name 2 types of malignant lymphomas?
NHL| HL
442
Name 3 other categories of haem cancers?
Multiple myelomaMyelodysplastic syndromeChronic myeloproliferative disease
443
When does NHL peak epidemiologically?
18-35| 75+
444
Describe the difference between acute and chronic leukemias?
```Acute:- leukaemic cells do not differentiate- BM failure- rapidly fatal if untreated- curableChronic:- leukaemic cells can differentiate- prolif without BM failure- survival for a few years- No cure with BM transplant```
445
What diseases has been related for NHL?
Glandular fever| Also has peak at 18-35
446
Describe the difference between leukaemia vs lymphoma?
```Leukemia - BM:- stem cell- lymphoid progenitor- b progenitor- pre B- immature BLymphoma - lymphoid tissue:- Germinal centre B cell- Plasma cell- mature naive b cell- memory b cell```
447
What are the clinical features for acute leukaemia?
BM failure:- anaemia- thrombocytopenic bleeding- infection because of neutropenia
448
What are the key properties for multipotential hematopoietic stem cells?
Self-renewing population| Multi-potent
449
Name 4 myeloid malignancies?
RedPlatGranMono
450
Name 2 Lymphoid malignancies?
B and T
451
What are the systemic symptoms for a patient with lymphoma?
```FeverDrenching sweatWeight lossPruritusFatigue```
452
What are the nodal diseases found with lymphoma presentation?
Lymphadenopathy:- >90% HL with nodal disease- 60% NHL present with nodal disease
453
What was the most common localisation of cancer for head and neck lymphomas?
Waldeyer's ring 149 hits| Parotid and salivary glands 41
454
What are the different presenastions of lymphadenopathy?
Localised and painfulLocalised and painlessGeneralised and painfulGeneralised and painless
455
Give 1 example of a disease present for localised and painful type of lymphadenopathy?
Bacterial infection in draining site
456
Name 5 diseases present for localised and painless type of lymphadenopathy?
```Rae infectionsCatch scratch feverTBMetastatic carcinoma from draining site (hard)Lymphoma (rubbery)```
457
Name 5 disease for generalised and painful type of lymphadenopathy?
```Viral infectionsEBVCMVHepatitisHIV```
458
Why is ALL/Lymphoblastic lymphoma related?
Same disease| Different area
459
Why is CLL/SCLL related?
Same disease with different presentation
460
Why is Burkitt's lymphoma/leukaemia related?
Same disease with different presentations
461
Why is HL/DLBLFL related?
Same disease with different presentations
462
Name 5 diseases for generalised and painless type of lymphadenopathy?
```LymphomaLeukaemiaCT diseasesSarcoidosisDrugs```
463
Name the 7 clinical features for multiple myeloma?
```Bone pain and lytic lesionsAnaemiaRecurrent infectionsRenal failureAmyloidosisBleeding tendencyHyperviscosity syndrome```
464
Name 5 risk factors for oestonecrosis of the jaw?
```Dental disease or surgeryoral traumaPeriodontitisChemotherapy or steroidsNitrogen-containing bisphosphonates```
465
Describe the structure of the lymph node?
CortexParacortexMedullaGerminal centreMantle zoneMarginal zoneForms the B cell follicle
466
Where does osteonecrosis of the jaw normally affect?
Mandible 2/3 cases
467
Explain the B cell maturation pathway?
```Progenitor cellPre B cellImmature B cellNaive B cellEnter GCInteracts with antigenSomatic hypermutationForms centrocyteDifferentiates to Memory B cell or plasma cell```
468
What is the definition of lymphadenopathy?
Swollen lymph nodes
469
What are the extranodal diseases presentation for lymphoma?
40% of NHL present with extranodal component
470
How much fluid does a kidney process?
180L
471
Name the 6 functions of the kidney?
```Maintain homeostasisRegulate body waterEliminate waste products of metabolismRegulate blood pressureCa and bone metaErythropoiesis```
472
Name the 6 ways to assess kidney function?
```Serum ureaSerum creatinineEndogenous creatinine clearanceGFRIsotope GFR (GS) - 55 chromium EDTADerived formulae for GFR```
473
What is the average GFR?
120mL/min
474
When can the kidneys be considered compromised when judging GFR?
Less than 60mL/min
475
What is creatinine and its levels in M/F?
```Breakdown of creatine in musclesMr 113Can give info on renal function60-90 F70-116 M```
476
What are the 2 formulas to estimate GFR?
MDRD| Cockroft-Gault
477
How does estimated GFR equation change for an African patient?
Usually have higher muscle mass compared to other ethnicity (less fat)Raised to 1.210
478
How to measure the degree of renal insufficiency?
```eGFR = % kidney functionOnly an estimateWide CIUsually underestimatesRemember ethnicity```
479
What is a healthy GFR value?
>60 mL/min
480
What is the creatinine difference between blood and urine?
Higher in urine, as it is being excreted| Excretion test may give false results
481
Stage 1 kidney disfunction GFR?
Kidney damage| >90 GFR
482
Stage 2 kidney disfunction?
Mild| 60-89 GFR
483
Stage 3 kidney dysfunction GFR?
Moderate| 30-59 GFR
484
Stage 4 kidney disfunction?
Severe| 15-29 GFR
485
Stage 5 kidney disfunction GFR?
Kidney failure| <15 or RRT GFR
486
What are the levels of kidney disease and their prevalence per 10,000 patients?
```At risk 460Initiation 380Progression 60End stage 6per 10,000 at GP practice```
487
What are the clinical problems of CKD?
Underecognition at earlier stages of kidney dysfunction| Growth of 6-8% per annum of dialysis patients
488
Name the 7 causes of kidney disease?
```Diabetes TI/IIHigh BPGlomerular diseaseCongenital diseaseInherited diseases (polycystic)Obstruction to flow of urineUnknown```
489
What is the size of a kidney?
11cm
490
What type of genetic is polycystic kidney disease?
Autosomal dominant disease
491
What to implement to delay progression and reduce CVS risk for CKD?
ACEIBP controlGlucose controlSMoking cessation
492
What to implement to prevent uraemic complications for CKD?
MalnutritionAnaemiaCaPO4 PTHAcidosis
493
What are the comorbidities of CKD?
Cardiac diseasesVascular diseasesDrug intersNeuropathy/Retinopathy
494
How to prepare for RRT?
EducationInformed choiceTimely access placement/transplant listingTimely initiation of RRT
495
What are the contraindications for dialysis?
BlindnessIHDDementiaNon-english speaker
496
What ae the causes of hypertension in chronic renal failure?
Volume/total body Na excessStimulation of renin-angiotensin systemAugmented sympathetic tone
497
What is the rationale for ACE/All inhibition in chronic renal failure?
Reduction of proteinuria and BPReduced hyperfiltration and reduced loss of albumin and proteinsLess renal cell growth and fibrosis
