Paper 1 Flashcards
(41 cards)
List four (4) clinical features of diabetes mellitus.
Fasting hyperglycaemia
Glycosuria
Angiopathy (macro and micro)
Neuropathy
If Mrs White fell pregnant, list two (2) fetal complications if her diabetes is not controlled.
congenital malformation, large foetus, obstructed labour, polyhydramnios, neonatal distress
syndrome
Outline the macrovascular complication that she is at risk for if her diabetes is not well controlled.
Briefly explain the mechanism by which this complication occurs.
Myocardial infarction/stroke/diabetic foot (0.5)
2. Increased glucose levels result in endothelial wall damage (glycation) (0.5) and increased
permeability (0.5) which leads to accelerated atherosclerosis (0.5).
Outline three (3) WHO recommendations that you would advise this patient with respect to
exercise.
The WHO recommendations for this individual would be 1) any exercise is better than no exercise for
his health, 2) that he should ideally aim to accumulate between 150-300 min of moderate exercise
during the week (or 75 min of vigorous, or some combination of both), 3) that muscle strengthening is
also important for health, and particularly in his line of work, and that he should undertake this 2 x per
week minimum, and whenever possible, limit time in sitting and sedentary activities.
Outline to what extent regular exercise would reduce his risk for all-causes of death and multi-
morbidity.
Studies show that he can reduce his risk of all cause mortality by at least 20-25% by meeting these
guidelines.
Outline four (4) reasons why exercise will benefit his health, to help motivate him to exercise.
Regular exercise may prevent him from having to take hypertensive medication or oral hypoglycaemic
agents. Regular exercise increases vessel diameter and causes vasodilation, it improves his insulin
sensitivity, which can help to lower blood glucose, even in the absence of weight loss, and it can
increase his lean muscle mass and reduce his central adiposity. It may also make it easier for him to be
insured.
Obesity is typically characterised by hyperinsulinaemia or elevated insulin concentrations, with
either normal glucose concentrations, or impaired glucose control. Explain why this occurs.
In the obese, insulin-resistant state, adipose tissue, muscle and other target cells are less sensitive to
prevailing circulating insulin concentrations, either as a function of fewer receptors, or altered insulin
signalling pathways. With a reduction in insulin sensitivity, the beta cells of the pancreas will secrete
more insulin, in response to prevailing glucose concentrations, which then results in hyperinsulinaemia.
If the beta-cell can no longer produce enough insulin to maintain euglycaemia, then the person will
progress to Type 2 diabetes.
List the three (3) most common types of support cells in the CNS (1½ marks) and briefly describe
how they affect axon regeneration after traumatic injury
(Astrocytes, reactive gliosis/glial scar; oligodendrocytes, neurite growth inhibitory proteins block axon
regrowth; microglia, clear cell debris but may further damage neurons by releasing cytotoxic factors)
Name the cell types that will be primarily affected by de-myelinating diseases. CNS and PNS
a. of the CNS
Oligodendrocytes
b. of the PNS
Schwann cells)
State the principal structural difference between these cell types.
(Schwann cells myelinate only one axon segment, oligodendrocytes many)
State the clinical diagnosis of this patient.
Meningococcal meningitis/ bacterial meningitis
List all the laboratory investigations that you would request to assist you in managing this patient.
Cerebrospinal fluid (CSF) microscopy, culture and susceptibility testing; CSF cell count and chemistry,
blood culture, full blood count, SARS-CoV-2 PCR
State the definitive treatment of this condition and outline the infection prevention precautions that
you would implement.
Intravenous penicillin for 7 days, institute droplet precautions to prevent spread on the infection
Is this a notifiable condition.
Yes
In this case all the patients close contacts must be given post exposure prophylaxis, briefly explain
the term close contact.
Close contacts are people living in the same house or sharing eating utensils (1) with the index case in
the seven days (1) prior to the onset of illness
Complete the table below describing cerebrospinal fluid (CSF) characteristics in different infections.
Use the following terms: elevated, increased, moderately increased, decreased or normal.
Bacterial meningitis Elevated, polymorphonuclear
leaucocytes
Increased Decreased
Tuberculous meningitis Elevated, lymphocytes Increased Decreased
Viral meningitis Elevated, lymphocytes Moderately
increased
Normal
Fungal meningitis Elevated, lymphocytes Increased Decreased
List the routes by which a brain abscess can develop.
Haematogenous, direct trauma, contiguous spread
State three (3) organisms that can cause brain abscesses (use full name where possible).
Streptococcus anginosus
Anaerobes
Gram negative bacilli e.g. E. coli
Staphylococcus aureus
Nocardia
Actinomyces
State the anatomical location of the inflammation in each of the following syndromes. Meningitis, encephalitis, myelitis
a. Meningitis
Meningitis – meninges
b. Encephalitis
Encephalitis – brain parenchyma
c. Myelitis
Myelitis – spinal cord
List two (2) symptoms or signs of each syndrome.Meningitis, encephalitis, myelitis
a. Meningitis
Meningitis – headache, neck stiffness, photophobia, nausea and vomiting - with normal brain
function
b. Encephalitis
Encephalitis – altered brain function – various: decreased level of consciousness, altered mental
status, motor or sensory deficits, altered behavior and personality changes, and speech or
movement disorders
c. Myelitis
Myelitis – paralysis of parts of body, incontinence
Outline the concept of acute disseminated encephalomyelitis (ADEM).
Associated with many different viral/bacterial infections. Usually post-infectious. Usually in the
convalescent phase. Not directly caused by the organism. Auto-immune response to myelin by T-cells.
The typical cell predominance, glucose level, and protein level in aseptic viral meningitis is: Use
the following terms: increased, decreased or normal.
Cells: Lymphocytes
Glucose: Normal
Protein: Normal
List the three (3) different types of CNS disease caused by measles, state the status of the affected
person’s immune system, and state the most likely outcome.
With or after the
rash, Days
Acute measles post-
infectious
encephalitis / ADEM
/ PIEM
Immunocompetent Recovery
Months Measles inclusion
body encephalitis
Immunocompromised Death
Years Subacute sclerosing
pan-encephalitis
Immunocompetent Death
Explain why normal chloride levels are higher in cerebrospinal fluid than in plasma.
CSF has very low protein levels compared to plasma. Most plasma protein is albumin that carries a negative
charge at physiological pH. To maintain electroneutrality in the CSF in the absence of protein Chloride anions
increase.
