QF 11 Flashcards
(80 cards)
1
Q
Parkinson’s arises specifically from degredation of which part of the brain? [1]
A
substantia nigra pars compacta (SNc)
2
Q
What is a Rinne positive and negative test result? [1]
A
If the bone conduction through the mastoid process is heard louder than through the air, the patient is Rinne negative
Positive state indicates healthy state
3
Q
[] Hz tuning fork is the most commonly clinically used tool to test for vibratory sensation
A
128 Hz tuning fork is the most commonly clinically used tool to test for vibratory sensation
4
Q
A
In bone marrow aspiration, a needle is used to withdraw a sample of the fluid portion. In bone marrow biopsy, a needle is used to withdraw a sample of the solid portion.
5
Q
Bone marrow aspirate or biopsy?
A
Aspirate
6
Q
Bone marrow aspirate or biopsy?
A
Biopsy
7
Q
Average lifespan of platelet? [1]
A
Platelet lifespan
8 to 14 days
8
Q
Primary haemostasis (platelet number and function) is tested in lab using bleeding time. What is the range for normal bleeding time?
A
Normal bleeding time: 1-3 minutes
9
Q
Where is VWF synthesised [2] and stored? [3]
A
Synthesised by
* Endothelial cells
* Megakaryocytes
Stored in
* Subendothelial matrix (immobilized state)
* Present in the soluble state in the plasma
* Alpha granules of the platelets
10
Q
State two granule contents released from platelets and their roles during primary haemostasis [4]
A
ADP: Aggregation of platelets
Synthesis & release of thromboxane A2: Vasoconstriction
11
Q
Fibrinogen binds to [] on adjacent platelets
A
Fibrinogen binds to GPIIb/IIIa on adjacent platelets
12
Q
thrombin works by postive feedback due to continued activation from which factor? [1]
A
Va
13
Q
Factor X works by postive feedback due to continued activation from which factor? [1]
A
Factor VIIIa
14
Q
Which Factor does thrombin activate in the common pathway, which helps fibrin become crosslinked? [1]
A
Factor XIII
15
Q
A
16
Q
Describe a downregulator of coagulation cascade [1]
A
Thrombomodulin is a cofactor for thrombin that converts Thrombin from a procoagulant to an anticoagulant by stimulating activation of the anticoagulant serine protease protein C.
17
Q
A
18
Q
What are the 3 main anticoagulants of the body? [3]
A
antithrombin
protein c
protein s
19
Q
What are the borders of the triangle of safety? [4]
A
Triangle of safety: Pec major, lat, 5th intercostal space, axilla
20
Q
What volumes of blood are lost of classes I-IV of shock? [4]
A
21
Q
A
22
Q
Describe the characterstics of haemophilia [1]
A
People with Haemophilia (PWH) do not bleed faster but
bleed for a longer period of time.
23
Q
This person has ?
A
haemophilia
24
Q
What is inheritence of hameophilia? [1]
A
Hemophilia A and hemophilia B are inherited in an X-linked recessive pattern
25
What is inheritence pattern for VDW types? [3]
Type 1 and 2: Autosomal Dom
Type 3: Autosomal Rec
26
Describe how we differentiate between iron deficiency anaemia (IDA) from anaemia of
inflammation? [2]
How do you tell if a person has inflammation AND IDA the iron deficiency?
The most useful blood test is **serum ferritin** – it will be **low** in pure **IDA** and **high** in
anaemia of **inflammation**.
**Serum transferrin receptor** levels will be **elevated** in **IDA** and **normal** in anaemia
**inflammation**
The key caveat is that in a person with inflammation AND IDA the iron deficiency may be “masked” because ferritin is an acute phase reactant – **in that case ferritin will be normal but in the low normal range**.
27
Describe pathophysiology and characteristics of Hirschsprungs disease
**Nerve cells are absent** in **myenteric plexus** of **rectum and distal bowel**
**Parasympathetic cells** do not travel all the way to **colon**; can't relax and move: **obstruction of the bowel**
28
Which population is Hirschprungs disease often found in? [1]
Down Syndrome
29
vomiting green fluid (bile), failing to pass meconium within 48 hours and a swollen belly could indicate? [1]
Hirschsprungs Disease
30
[] occurs when a remnant of the yolk sac (Vitelline duct) persists.
**Meckel’s diverticulum** occurs when a remnant of the yolk sac (Vitelline duct) persists.
31
32
Draw the tracts of the spinal cord
33
Describe the effects of Brown-Sequard Syndrome:
- at level of lesion [2]
- Below level of lesion [1]
- 1-2 levels velow [1]
34
Describe the key characteristics of anterior spinal cord syndrome [2]
Damage to the anterior portion of the spinal cord will cause **bilateral disruption of the spinothalamic tracts**, resulting in **bilateral loss of pain and temperature sensation.**
The **corticospinal tracts** are also likely to have been affected, resulting in **bilateral spastic paralysis and UMN signs**
35
This is ? [1]
name 3 causes [3]
**Howell–Jolly body**
Common causes include **asplenia** (post-splenectomy) or c**ongenital absence of spleen** (right atrial appendage isomerism). Spleens are also removed for therapeutic purposes in conditions like **hereditary spherocytosis**, trauma to the spleen, and autosplenectomy caused by **sickle cell anemia.**
36
Name an example of each type of hypersensitivity reaction
Type I – Allergic; Type II – Cytotoxic; Type III – Immune complex deposition; Type IV – Delayed.
37
After how many days do you get zygote, morula and blastocyst being produced? [3]
**Day 1** produces the fertilised egg (**zygote**) and by late day 1 the zygote has reached 2 cell stage, early day 2 4 cell stage, early day 3 8 cell stage, and late day 3 16 cell stage on
**day 4 the morula** is formed and then the
**blastocyst by day 5.**
38
Explain mechanism of proliferation versus apoptosis in normal prostate vs BPE
Testosterone is converted to **oestradiol** in the **stromal** cells via the enzyme **aromatase**.
**oestradiol** then goes to the **enzyme oestrogen receptor alpha** and **drives cell proliferation** after it binds to in the stromal cells.
Oestradiol also goes into the **epithelial cells** and activate **oestrogen receptor beta** of the glands (in both the basal and luminal epithelial cells) and causes **apoptosis**
**Testosterone** can also enter directly into the **basal epithelial cells** converted to Dihydrotestosterone **(DHT)** by **5-alpha reductase** in the epithelial cells. **DHT** can then pass into **luminal epithelial**, binds to **androgen receptor** and stops **apoptosis**
With BPE most of the oestradoil goes to the stomal cells and ERa and causes proliferation. Very little goes to ERbeta to cause apoptosis.
Due to increased Testosterone and therefore DHT: get more of androgen receptor, which drives luminal cells to hypetrophy.
Get proliferation of stromal cells and hypertrophy of epitheilial cells
39
Nucleus reticularis paragigantocellularis is a major afferent from which nuclei? [1]
Where does it go to? [1]
The nPGi is one of two **major afferents of the locus coeruleus (LC)**, and sends collateral projections to the LC and to the **nucleus of the solitary tract (NTS)**
40
Draw the cycle of the PAG thing
41
Which anti-emetic is used for motion sickness & vestibular disturbances? [1]
**Hycosine**
42
Describe MoA of hycosine and state use [2]
**Hycosine**:
* **M5** receptor **antagonist**; **prevents Ach action** in **brainstem** or **vestibular** **nuclei**
43
Name two drugs given for motion sickness [2]
**Diphyenydramine / dramamine**
**Cyclizine**
44
Describe the MoA of:
**Diphyenydramine / dramamine** [2]
**Cyclizine** [1]
**Diphyenydramine / dramamine**: H1 antagonist; M2 antagonist
**Cyclizine**; H1 antagonist
45
Which drug is used for gastroparesis (delayed gastric emptying)? [1]
**Metclopramide**
46
What is the MoA of **Metclopramide**? [2]
**D2 receptor antagonist** & **5HT4 agonist**
47
Name a CB1 receptor agonist [1]
**THC**
48
What is the MoA of ondans**etron** and alos**etron**? [1]
What is the clinical use? [1]
**5HT3 agonist**; used for chemo and radiotherapy induced emesis
49
Name an atypical antiphyschotic used as an anti-emetic [1]
**Olanzapine**
50
What are the antigens and antibodies for different blood groups?
51
Which blood groups are the universal donor and recipients? [2]
Explain why [2]
O is therefore the universal donor as O blood cells have no antigens
AB is the universal recipient as it has no circulating AB antibodies
52
Which group has no antibodies
Group A
Group B
Group AB
Group O
Which group has no antibodies
Group A
Group B
**Group AB**
Group O
53
Which group has no antigens
Group A
Group B
Group AB
Group O
Which group has no antigens
Group A
Group B
Group AB
**Group O**
54
Describe the genotypes that make a person rhesus D postive [2] or negative [1]
The D status is the most immunogenic and therefore what determines the +ve/-ve state:
**DD or Dd genotype** -> express the immunogenic D antigen = **rhesus positive**
**dd genotype** -> no expression of the D antigen = **rhesus negative**
55
Describe pathophysiology of Haemolytic Disease of the Newborn
56
Maternal anti-D is which immunoglobulin? [1]
**Maternal anti-D** = **IgG** is rapidly produced on repeat exposure to Rh D antigen following sensitisation in the first pregnancy.
IgG crosses the placenta and binds to the fetal D antigen causing fetal RBC haemolysis
57
How do you prevent Haemolytic Disease of the Newborn? [1]
**Anti-D immunoglobulin:** neutralises Rh+ve antigens
58
What causes acute haemolytic reaction? [1]
What happens as a result? [1]
**ABO-incompatible blood** e.g. secondary to human error
Causes massive **intravascular** **haemolysis** mediated through **IgM**
59
Which Ig causes acute haemolytic reaction?
IgM
60
What causes non-haemolytic febrile reaction? [1]
Thought to be caused by **HLA antibodies**: Antibodies react with white cell fragments in the blood product and cytokines that have leaked from the blood cell during storage
61
Describe what causes blood anaphylaxis
Occurs when patients with **IgA deficiency** who have **anti-IgA antibodies** are **given blood with IgA**
62
Describe what is transfusion-associated circulatory overload (TACO) [1]
**Fluid overload**: Caused by excessive rate of transfusion in pre-existing heart failure
63
What is Transfusion-related acute lung injury (TRALI)?
**Non-cardiogenic pulmonary oedema**
Thought to be secondary to neutrophils activation
Degranulation of WBCs increases **vascular permeability** leading to **inflammation and oedema**
64
The heart starts to beat on day ...[ ]
**Starts to beat on day 22**
65
This shows? [1]
ToF
66
The PDA closes how long after birth? [1]
PDA stays open approx. 24-48hrs fully closes within week
67
How can you treat Persistent pulmonary hypertension of the new-born? [3]
Inhaled NO
Prostaglandin: PGE1 or PGI2
Others, sildenafil, milrinone
68
Describe pathophysiology of Persistent pulmonary hypertension of the new-born
Characterized by **elevated pulmonary vascular resistance** resulting in right-to-left shunting of blood and hypoxemia
elevated resistance in the pulmonary arteries **causes abnormal smooth muscle development and hypertrophy** in the walls of the small pulmonary arteries and arterioles and **right-to-left shunting via the ductus arteriosus or a foramen ovale, resulting in intractable systemic hypoxemia**
69
State causes of Persistent pulmonary hypertension of the new-born
PPHN often secondary to **parenchymal lung disease** (such as **meconium aspiration syndrome, pneumonia or respiratory distress syndrome**) or **lung hypoplasia** (with congenital diaphragmatic hernia or oligohydramnios) but can also be idiopathic
70
When does neural tube normally close? [1]
CLOSURE OF NEURAL TUBE COMPLETE BY DAY 28
71
Name a risk factor for gastroschisis [1]
Secondary to IUGR
72
Describe pathophysiology of cleft lip [1]
Failure of maxilla to fuse with the medial nasal prominence
73
Describe the pathophysiology of cleft palate [1]
Failure of palatal shelves to fuse (from maxillary prominences)
74
Which pharnygeal arches beome the R and L common carotids and proximal R and L internal carotids? [1]
Which pharyngeal arch becomes the arch of aorta? [1]
1st = small part of maxillary arteries
3rd = R and L common carotids and proximal R and L internal carotids
4th = R side detaches from dorsal aorta subclavian. L side arch of aorta
75
Name two hormones that contribute to gestational diabetes [4]
Pathophysiology thought to be due to placental secretion of anti-insulin hormones ( **cortisol and glucagon; hPGH (human placental growth hormone) and placental lactogen (HPL)**
76
Hyperemesis gravidarum may be caused by a deficiency in which vitamin? [1]
B6 (Pyridoxine)
77
Define Gestational trophoblastic disease (GTD)
What is a partial mole? [1]
What is a monospermic complete mole? [1]
What is a dispermic complete mole? [1]
GTD: When the **trophoblastic tissue** that forms part of the **blastocyst** **proliferates** more **aggressively** than normal
**Partial mole**: two sperm fertilse an egg creating **69 chromosome**
**Monospermic mole:** maternal chromosomes are lost AND paternal chromosomes double up to make **46 chromosome**
**Dispermic complete mole**: maternal chromosomes are lost AND fertilisation by two sperm: **46 chromosome**
78
How does Liddle's syndrome present? [1]
79
What would the following sound like when ascultating:
- asthma / COPD
- pneuomonia / pulmonary oedema
- fixed upper airway obstruction
- pulmonary fibrosis
What would the following sound like when ascultating:
- asthma / COPD: **wheeze**
- pneuomonia / pulmonary oedema: **coarse crackles**
- fixed upper airway obstruction: **inspiratory stridor**
- pulmonary fibrosis: **fine crackles**
80
Give very brief overview of long term potentiation and depression
**LTP:**
- synapse fired and NMDA receptors activated due to Ca2+
- causes increase in AMPA receptors into spine of post-synaptic membrane
**LTD**:
- Involves a decrease in the number of AMPA receptors; They are removed from the spines in vesicles during LTD
