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MET EOYS3 Flashcards

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1
Q

Name two Calcineurin inhbitors [2]

A

Cyclosporin and tacrolimus

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2
Q

Prednisolone targets which cytokine gene activation? [1]

A

IL-2

Learn x

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3
Q

Which of the following targets IL-2 gene activation / suppresses IL-2 activation

Azathioprine
Prednisolone
Cyclosporin
Tcrolimus
Mycophenolic acid

A

Which of the following targets IL-2 gene activation / suppresses IL-2 activation

Azathioprine
Prednisolone
Cyclosporin
Tcrolimus
Mycophenolic acid

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4
Q

Immunosuppressant drugs

Which of the following are calcineurin inhibitors? [2]

Azathioprine
Prednisolone
Cyclosporin
Tacrolimus
Mycophenolic acid

A

Which of the following are calcineurin inhibitors? [2]

Azathioprine
Prednisolone
Cyclosporin
Tacrolimus
Mycophenolic acid

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5
Q

Immunosuppressant drugs

Which of the following are calcineurin inhibitors? [2]

Azathioprine
Prednisolone
Cyclosporin
Tacrolimus
Mycophenolic acid

A

Which of the following are calcineurin inhibitors? [2]

Azathioprine
Prednisolone
Cyclosporin
Tacrolimus
Mycophenolic acid

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6
Q

Immunosuppressant drugs

Which of the following are anti-proliferative? [2]

Azathioprine
Prednisolone
Cyclosporin
Tacrolimus
Mycophenolic acid

A

Which of the following are anti-proliferative? [2]

**Azathioprine **
Prednisolone
Cyclosporin
Tacrolimus
Mycophenolic acid

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7
Q

Describe the action of calcineurin [1]

A

Calcineurin is an enzyme that activates T-cells of the immune system.

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8
Q

How long should ischaemia be limited to prevent acute transplant rejection:

-Cold ischaemia? [1]
- Warm ischaemia? [1]

A

Cold ischaemia time: 12 hrs
Warm ishaemia time: 1 hour

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9
Q

Which gene causes this disease? [1]

Describe the structure that this gene predominately codes for [1]

A

Polycystin gene - codes for primary cilia

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10
Q

What type of hormone is aldosterone? [1]

A

Mineralocorticoid hormone

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11
Q

Describe the effect of aldosterone on sodium and potassium levels [2]

A
  • increase sodium reabsorption
  • increase potassium excretion
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12
Q

Conn’s syndrome causes which of the following effects

  • increase sodium reabsorption; increase potassium excretion
  • decrease sodium reabsorption; increase potassium excretion
  • decrease sodium reabsorption; decrease potassium excretion
  • decrease sodium reabsorption; decrease potassium excretion
A

Conn’s syndrome causes which of the following effects

  • increase sodium reabsorption; increase potassium excretion

Conns syndrome: XS aldosterone

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13
Q

What are the triad of signs of Conns syndrome? [3]

A

hypokalemia, hypernatremia and metabolic alkalosis

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14
Q

A patient presents with Conns syndrome. Which of the following would they most likley have?

What laboratory findings will most likely be found in this patient?

A. Increased serum potassium, increased urinary potassium, and increased extracellular fluid volume

B. Decreased serum potassium, increased urinary potassium, and increased extracellular fluid volume

C. Increased serum potassium, decreased urinary potassium, and decreased extracellular fluid volume

D. Decreased serum potassium, increased urinary potassium, and decreased extracellular fluid volume

A

B. Decreased serum potassium, increased urinary potassium, and increased extracellular fluid volume

increased production of aldosterone. Serum levels of potassium are decreased, and the urinary excretion of potassium is increased. Decreased serum potassium levels result in the symptoms of polyuria and polydipsia due to hypokalemia-induced nephrogenic diabetes insipidus.

As a result of increased reabsorption of sodium due to aldosterone excess, more water is retained. The retained water causes extracellular fluid volume expansion, which is the mechanism behind persistent hypertension.

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15
Q

Conns syndrome patient presents with

Respiratory alkalosis
Respiratory acidosis
Metabolic alkalosis
Metabolic acidosis

A

Conns syndrome patient presents with

Respiratory alkalosis
Respiratory acidosis
Metabolic alkalosis
Metabolic acidosis

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16
Q

This symptoms is suggestive of

Conns syndrome
Cushings syndrome
Addisons disease
Sunburn

A

This symptoms is suggestive of

Conns syndrome
Cushings syndrome
Addisons disease
Sunburn

Hyperpigmentation is characteristic and occurs in almost all patients.
Elevated ACTH and melanocyte-stimulating hormone are causative factors. It is believed that ACTH binds to the melanocyte receptors, which are responsible for pigmentation

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17
Q

Describe the changes in adrenal hormones in Addisons disease [2]

A

low cortisol and aldosterone levels

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18
Q

What method is the most practical and accurate way to measure regional adiposity?

A. Waist and hip circumference
B. Skin-fold thickness testing
C. Body mass index (BMI)
D. Impedance measurement

A

What method is the most practical and accurate way to measure regional adiposity?

A. Waist and hip circumference
B. Skin-fold thickness testing
C. Body mass index (BMI)
D. Impedance measurement

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19
Q

What is the best way to measure nutritional status in a pregnant female?
A. Waist circumference
B. Body mass index (BMI)
C. Mid-upper arm circumference
D. Triceps skinfold measurement

A

What is the best way to measure nutritional status in a pregnant female?
A. Waist circumference
B. Body mass index (BMI)
C. Mid-upper arm circumference
D. Triceps skinfold measurement

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20
Q

How does the metanephric kidney develops from which two structures? [2]
How? [1]

A

Uteric bud and fuses with mesenchyme (metanephric bud). Mesenchyme elongates and fuses to collecting tubules to make the excretory system.

Bifurciates to make major calyx.
Bifucates again to make minor calyx
Bifucates x lots to make

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21
Q

During renal development:

  • the uteric bud becomes which overall part of kidney?
  • the metanephric system becomes which overall part of kidney?
A

Uteric bud: collecting system (ureter, renal pelvis, major and minor calyxes, CD)

metanephric system: excretory system (Renal glomerulus -capillaries
Bowman’s capsule. PCT
LoH, DCT)

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22
Q

Describe the ascent of the kidneys during development:

Where do they start from? [1]

Where do they finish? [1]

(Include vert levels)

A

Describe the ascent of the kidneys during development:

Where do they start from? [1]
Sacral region S1

Where do they finish? [1]
Lumbar region T12

(Include vert levels)

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23
Q

Why wont babies survive bilateral kidney agenesis? [2]

A

If kidneys dont develop then effects creation of amniotic fluid (reduced: oligohydramnios)

This causes failure of lung development

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24
Q

What are two types of ectopic kidney? [2]

A

Pancake kidney: Usually (one) kidney remains in pelvic region

Horseshoe kidney: kidneys fuse in pelvice region and form a single U. Can’t ascend because of IMA

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25
Describe pathophysiology of autosomal dominant polycystic kidney disease How do cysts grow? [4]
Mutation on polycystin gene: involved in production in primary cilia (**ciliopathy**) Primary cilia involved in cell adhesion, calcium transport and cell cycle. **Cysts growth:** * Cysts originates as dilations of intact tubule * Increased proliferation of cyst epithelium * **Cyst epithelium becomes secretory resulting in increased fluid secretion into lumen of cyst** * Cyst enlarges and **loses contact with nephron**
26
What is creatinine a breakdown product of? [1]
**creatine phosphate:** found in muscle Found at a steady-state concentration in the blood
27
Which variables are used for MDRD equation to measure clearance? [4]
Need: **C**retinine **A**ge **G**ender **E**thnicity
28
Explain the MoA of Kidney absorption
Reduce volume of water and solutes within urine but without changing the concentration: make a **hypertonic medulla** MoA: **At thin descending loop** * **Water** pumped out via **aquaporins** due to increased osmolality produced by thick ascending limb pumping out Na+ **At thick ascending limb** * **Na** is actively pumped into medullary space via **Na/K channel** * **Paracellular transport** of **Na, Ca and Mg** down a **electrochemical** gradient * This wall is impermeable to water. **At distal convoluted tubule**: * **Aldosterone** works to increase Na absorption **At collecting duct**: * **ADH** opens aquaporins to reabsorb more water * Fluid passes down from here to ureter and ladders
29
Name and explain which transport protein in the thick ascending loop of Henle assists NaKCl2 transporter
**Renal Outer Medullary potassium channel or ROMK** * **K is AT pumped** into the tubular lumen / **urine** to generate **positive voltage** within the cell (because less K+ in) * This creates an overall voltage gradient of +80mV; from **+10mV in the tubular lumen** to **-70mV in the tubular cell** * This voltage difference **drives Na into the tubular cell** via NaKCl2 transporter
30
Which transporter do thiazide diuretics inhibit? [1] ​ Where is this transporter located? [1]
Block **Na+/Cl−** cotransporter at **distal convoluted tubules**
31
which arteries supply the kidneys? from what origins? what vertebral level found?
**_renal arteries_** - L1-L2 level - come from **thoracic aorta** - lie inferior to superior mesenteric artery
32
what other function do macula dense cells do ? / what do they produce?
The macula densa cells also tonically produce **prostaglandin PGE2** which acts on **juxtaglomerular cells** to **stimulate renin releas**e low sodium levels = More prostaglandin = more renin
33
what is the location, function and mechanism of action for the NKCC2 channels?
**_NKCC2 (Na-K-Cl cotransporter channel_** - _location:_ **thick ascending limb of the loop of Henle** - _function:_ to get **Na / Cl out** of the ascending limb and into extracellular fluid - _mechanism of action:_ i) luminal walls of the epithelial cells allows **sodium, potassium & chloride ions** to move passively together down their concentration gradient into the cells that make thick ascending limb ii) then, sodium is **actively transported** out into **extracellular space** by **Na/K ATP-ase** iii) **Cl- moves passively** with the sodium iv) most of K+ ions diffuse back into the lumen via K ion channels https://www.youtube.com/watch?v=sapTNUtrPdY
34
which pump assists the NKCC2 pump? explain how xix
**_Renal Outer Medullary potassium channel or ROMK (_**royal orders make knights) - K+ out of the tubule cells into the lumen (where fluid is) - generates **postive voltage**: **10mV in tubular lumen** - creates an overall voltage difference of **80mV** between tubular lumen and tubular cell - this voltage difference **helps propel sodium via NCKK2 transporter** into tubular cells
35
Name 2 sreening methods used (by Bart's Health Trust) for nutritional screening for adults [1] and children [1]?
MUST (adults) and STAMP (paedatrics - Screening Tool for the Assessment of Malnutrition in Paediatrics)
36
How often should you repeat MUST assessment? [1]
weekly
37
How would you calculate a MUST score? [3] How do you work out an Action Plan for MUST? [1]
**MUST:** 1. BMI 2. Weight Loss 3. Acute disease effect 4. Add scores for 1-3 5. Action Plan
38
What is a surrogate measure for measuring weight? [1]
Mid upper arm circumference (MUAC) [1] (can measure in supine position)
39
If MUAC is less than [], BMI is likely to be underweight (<20 kg/m2) If MUAC IS over [], BMI is likely to be overweight ( >30 kg/m2) .
If MUAC is **under 23.5**, BMI is likely to be **under 20 (underweight)** If MUAC IS **>32,** BMI is likely to be **>30 (overweight)**
40
What does Handgrip Dynamometry (HGD) or Grip Strength measure? [1] How do you take? [3]
Measures muscle strength & endurance: predictor of mortatility Can be measured * -supine or sitting position * -dominant or non-dominant side * -repeated measures to mirror original position
41
It is a widely held belief that low albumin arises because of inadequate protein intake. Explain what causes Hypoalbuminaemia in hospital? [2]
Cause in hospital: is **inflammation** and **sepsis**: * increased C-Reactive Protein * White Cell Count * pyrexia * infection In these patients capillary walls become more ‘porous’ and albumin drifts out --> low plasma albumin Low albumin often occurs in sick, malnourished patients, **but it is not caused by poor intake**
42
Which Ptx are at risk of refeeding syndrome? [1] Which Ptx are at high risk of refeeding syndrome? [4] Which Ptx are at very high risk of refeeding syndrome? [4]
**Risk** * Any ptx with very little food for more than 5 days **High risk** ONE OF: Any one the following; * BMI less than 16 * Unintentional weight loss >15% in last 3-6 months * Little or no nutritional intake for more than 10 days * Low levels of K, PO, Mg prior to feeding **Very high risk** TWO OF THE FOLLOWING: * BMI less than 18.5 * Unintentional weight loss >10% in last 3-6 months * Little or no nutrition for more than 5 days * A history of alcohol abuse or drug use including chemotherapy, antacids or diuretics
43
How can you provide nutritional support from supplemental drinks? [3]
Milkshake style * Calorie content varies * Ready made Juice based * Fat free Powdered * Not nutritionally complete * Is the patient able to mix it
44
What nutritonal supplements could you provide for ptx with dysphagia? [5]
* Pre-thickened drinks * Thickening of supplement drinks with a thickener * Yoghurt style drinks * Smoothie style drinks * Yoghurt/dessert pot type supplements
45
What are two mechanisms that acute rejection occurs?
Acute rejection can be either via: **Acute Cellular Rejection (ACR)** - Cytotoxic T **lymphocyte** response - Macrophage response OR **Acute Antibody Mediated Response (AMR)** * B lymphocyte response making **antibodies** (agaisnt **MHC Class 1 /2 antigens** or **ABO blood group** antigens)
46
Antibody-mediated rejection (AMR): What are the main antigens targets of antibodies? [3] Where does this mainly occur? [1]
Antibody targets: * MHC (Class I & II): **HLA** **antigens**: * ABO antigens * MHC class I-related chain A (MICA) Target location: **endothelium** - targets arteries and capillaries (because these are the cells first meet after transplantation)
47
With regards to acute rejection of transplants, how would you detect antibody prescence?
Detect antibody presence with **complement**: **C4d** * The antibody-antigen complex activates the compliment system * This produces **C4d molecules** (which forms covalent bonds with endothelial cells) * C4d molecules are stained easily * This shows that **acute rejection has occurred** *Staining for C4d is a very good proxy for detecting antibodies*
48
What is criteria for diagnosis of acute antibody rejection? [3]
Evidence of **acute renal injury on histology** (often microvascular inflammation) Evidence of **antibody activity C4d staining** in peritubular capillaries Circulating **anti-donor specific antibodies**
49
Explain how AMR causes damage in hyperacute rejection
change from **anti-coagulant** to **pro-coagulant** state: - antibodies bind to surface of epithelial cells: become **pro-coagulant** and **clots form** - causes downstream infarction - causes haem.
50
Summary of hyperacute rejection: Within 1 hr you get [] infiltrate of peritubular capillaries Within 12-24 hrs you get what effects? [2]
Within 1 hr you get **neutrophils** infiltrate of peritubular capillaries Within 12-24 hrs you get **intravascular coagulation and cortical necrosis**
51
How can we prevent hyperacute rejection? [3]
1. Use somone who is **ABO compatabile** (O is universal donor) 2. **screen for preformed antibodies**: * **Direct cross match:** mix donor cells and recipient serum. Look for complement activation (positive is bad) * **Beads with bound HLA**: look to see if recipient serum binds to HLA beads
52
What are the most important HLAs? [3]
HLA A HLA B HLA DR Each have two genes
53
Explain how can you prevent acute rejection of transplants? [2]
**HLA matching** (make sure that not positive for match) **Minimising ischaemia-reperfusion injury**: * Ischaemia causes upregulation of adhesion molecules, which increases adhesion of leukocytes when blood is reperfused. * More leukocytes increases chance of rejection, SO try and limit ischaemia time. * Cold ischaemia time: 12 hrs * Warm ishaemia time: 1 hour
54
What are the two pathways of allorecognition?
**Direct:** * Recipient T-cells recognise allogenic APC (donor APCs) and cause aggressive imune response to foreign HLA **Indirect**: * The allogenic APCs are replaced with auto-APCs * Some of the peptides presented by new auto-APCS are derived from shed HLA molecules * Causes a more gentle immune response
55
Explain how activation of a helper T cell / CD4 cell occurs [3]
1. T helper cell receptor recognising antigen from HLA 2. Co-stimulation from another molecule Both these signals activate nucleus to make IL-2. IL-2 binds to IL-2 receptor on different T helper cell. [3] Causes signal at nucleus to make proliferation of T-helper cells
56
What are the sites of action used for immunosuppressive drugs? [3] and what drugs used?
**Calcineurin inhibitors:** * Calcineurin is an enzyme that activates T-cells of the immune system. * E.g. **Cyclosporin** and **tacrolimus** (learn !) **Anti-proliferative drugs**: * (target nucleus at end stage of T cell activation) * e.g. **Azathioprine** and **Mycophenolic** **acid** **Prevent cytokine (IL-2) gene activation** * Use cortiosteroids * e.g. **Prednisolone** Standard treatment: Calcineurin inhib, steroid and anti-proliferative drugs
57
What kidney pathology is depicted? [1]
Pancake kidney
58
What kidney pathology is depicted? [1]
Pancake kidney
59
What kidney pathology is depicted? [1]
Horseshoe kidney
60
What kidney pathology is depicted? [1]
Polycystic kidney disease
61
Name the gene that has a defect to cause this pathology [1]
Polycystin gene
62
Abdominal CT showing []
Abdominal CT showing **polycystic kidneys**
63
Label A & B of developing kidneys
A: **mesonephric bud** B: **uteric bud**
64
What type of renal pathology is depicted here? IgA neuropathy Membrane change disease Glomerulonephritis Acute rejection from kidney transplant
What type of renal pathology is depicted here? IgA neuropathy Membrane change disease Glomerulonephritis **Acute rejection from kidney transplant** Focal glomerulitis in active antibody mediated rejection-Banff score g3. Dilated glomerular capillaries are filled with swollen endothelial cells and inflammatory cells (PAS, 200×).
65
Describe what pathology is occuring at the arrow heads in this renal artery
Inflammatory cells (arrows) infiltrate the intima in intimal arteritis, due to **acute cell mediated rejection**

Yr 2 EOYS (58 decks)

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