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Random Revision Flashcards

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1
Q

What ECG change would you expect to see in hypertrophy of the left ventricle

A

Larger QRS complex (ie the QRS complex in lead 2 is greater than 2 large squares)
This is heart failure with preserved ejection fraction (>/= 50%) so there is decreased diastolic function

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2
Q

Which cardiac ECG parameter changes with heart rate

A

RR interval

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3
Q

Major disadvantages of spirometery lung function test

A

Heavy reliance in technique

May be uncomfortable for the patient, reduces their motivation to apply maximum effort

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4
Q

How to calculate peak expiratory flow rate from a time(secs) volume (Litres) graph

A

Read up from x = 0.2 seconds to see where it crosses the y axis
And multiply the value by 300 for L/min

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5
Q

How to obtain FVC value from flow volume loops

A

Highest observed x value on expiratory curve (which is top one)

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6
Q

How to obtain PEFR from flow volume curves

A

Read off peak value of curve in y axis and multiple by 60 for answers in L/min

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7
Q

Where do the left and right adrenal veins drain into

A

Right adrenal vein Into inferior vena cava

Left adrenal vein into renal vein which then drains into inferior vena cava

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8
Q

3 types of corticosteroids and where are they each produced

A

Mineralocorticoids (aldosterone) - zona glomerulosa of adrenal cortex
Glucocorticoids (cortisol) and Sex Steroids (androgens/oestrogen) - both produced in zona fasciculata and zona reticularis

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9
Q

Effect of PTH on the bone

A

Binds to receptor on osteoblast
Causes the release of osteoclast activating factors
These factors cause the osteoblast to change into an osteoclast
This increases bone resorption

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10
Q

Where is PTH released from and what is it released as

A

Released from chief cells of parathyroid gland as pre-pro-PTH

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11
Q

Where is calcitonin released from

A

Parafollicular cells of thyroid gland

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12
Q

How is PTH secreted

A

From chief cells of parathyroid gland as pre pro PTH then cleaved into PTH
(protein coupled receptors sense calcium levels as calcium in blood binds to them - this determines how much PTH they secrete)

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13
Q

Causes of hypercalcaemia

A

Excess PTH - parathyroid adenoma
Excess vitamin D
Malignancy - bony metastases produce local factors which activate osteoclasts which release calcium

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14
Q

Causes of vitamin D deficiency

A

Less sunlight exposure - less UVB to convert 7 dehydrocholesterol into vit D3
Less dietary intake/ malabsorption - less ergocalciferol (vit D2)
Liver disease - less 25 hydroxylase
Renal disease - less 1 alpha hydroxylase
Less vitamin D 3 receptors

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15
Q

Symptoms of hypocalcaemia

A 
CATs go numb 
Convulsions 
Arrhythmias 
Tetany 
Parasthesia
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16
Q

Causes of hypoparathyroidism

A

Surgery - neck surgery
Auto immune
Magnesium deficiency
Congenital

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17
Q

Where is calcitonin released from

A

Parafollicular cells of thryoid gland

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18
Q

PTH effects in kidney

A

Increase calcium reabsorption
Increase phosphate excretion
Increase 1 alpha hydroxylase activity

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19
Q

How does FGF23 regulate serum phosphate

A

Inhibits the sodium phosphate co transporter so less phosphate is absorbed from the urine
Inhibits calcitriol so less phosphate is absorbed from the gut

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20
Q

Which layer of the uterus is shed during menses and why

A

The endometrium due to vasoconstriction of arteriole causing necrosis and ischaemia. This leads to the shedding and haemorrhage of menstruation

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21
Q

Why are males continuously fertile

A

Spermatogonia undergo differentiation and self renewal, maintains the pool for subsequent spermatogenic cycles throughout life

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22
Q

What is the tunica propria

A

Lines the seminiferous tubules

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23
Q

What is adrenarche

A

Onset of adrenal androgen production

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24
Q

What are the first signs of gonadarche

A

Boys - testicular enlargement (below 4 mls prepubertal, above 15mls for adult size)
Girls - thelarche

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25
What age is premature menopause
Below 40
26
Average age for menopause
45-55
27
Treatment for menopause
Menopause hormone therapy: Oestrogen to stimulate growth of endometrium Add progesterone if the endometrium is intact to prevent endometrial hyperplasia or cancer
28
What is an ovarian reserve marker
Anti Mullerian hormone | Levels of AMH peak in early adult life then gradually decrease until the6 are very low at menopause
29
Structure of myosin
2 globular heads | Tail is formed from 2 alpha helices
30
Changes to muscle fibres as a result of training
Type IIB to IIA
31
Changes to muscle fibres as a result of deconditioning or spinal cord injury
Type I to II
32
Changes to muscle fibres as a result of ageing
Loss of both type I and II but more loss of type II
33
What does cross innervation of fast and slow twitch muscle fibres do
Fast becomes slow | Slow becomes fast
34
Where are upper and lower motor units found
Upper in brain | Lower in brain stem or spinal cord
35
Myoglobin content of different muscle fibres
I : high IIA : high IIB : low
36
Aerobic and anaerobic capacity of different muscle fibres
I: high, low IIA : moderate, high IIB : low, high
37
2 mechanisms by which brain regulates the force a single muscle can produce
Recruitment | And Rate coding
38
What opens the ryanodine receptor
DHP (dihydropyridine) senses change in velocity and changes the shape of the protein linked to the ryanodine receptor This opens the receptor allowing Ca2+ to flow out of sarcoplasmic reticulum
39
Covers of muscle, fascicle and myofibre
Epimysium Perimysium Endomysium
40
2 functions of neurotrophic factors
Prevent neuronal death | Promote growth after injury
41
What effect does aspirin poisoning have in urine
Ketones in urine
42
Features to look for for diabetic nephropathy
Microalbuminuria (albumin:creatinine ratio > 2.5) | Proteinuria
43
What would a Kidney biopsy for nephritic syndrome cause
IgA nephropathy
44
Difference in urine between nephrotic and nephritic syndrome
Nephrotic: foamy urine due to severe proteinuria | Nephritic : haematouria
45
Investigations for kidney stones
X ray Ultrasound CT scan
46
What condition causes colicky loin to groin pain, haemtouria and tenderness of loin and lower abdomen
Kidney stones
47
3 treatments for kidney stones
Shockwave lithotripsy Uteroscopy Percutaneous nephrolithotomy
48
Treatment for polycystic kidney disease
Tolvaptan - slows cyst formation Treatment for hypertension and infection Pain control Dialysis or transplantation
49
Horseshoe kidney and consequences
Kidneys fuse together during development | Increases risk of obstruction stones and infection
50
3 examination tests for ACL injury
Lachmann’s test Anterior drawer test Pivot shift tets
51
Complications from surgery to fix a tendon
Tendon rupture Neurovascular damage Local infection Joint stiffness
52
Which bones contains yellow bone marrow
Cortical bone s
53
What is the role of red bone marrow
Haematopoiesis
54
Compare and contrast the role of tendons and ligaments (3 marks)
1) Tendons joint muscle to bone Ligaments connect bone to bone 2) both are important in maintains joint stability 3) tendons transfer force from muscles to bone, and resist compressive forces Ligaments contain proprioceptors so also have a proprioceptive role
55
Someone recently had a fracture but also Is found to have calcium deficiency. Explain how they could be related
Low calcium can cause increases PTH secretion due to negative feedback The PTH binds to receptors on the osteoblast, releasing osteoclast activating factors to turn the osteoblasts into osteoclasts This is so that the osteoclasts break down bone to release calcium into the blood But this osteoclastic activity also weakens the bone, leading to osteoporosis (decreased bone density) and increasing risk of fractures
56
List some treatments for osteoporosis
Vitamin D and calcium PTH menopausal hormone therapy
57
How does myelin prevent AP spreading
It has a high resistance and a low capacitance
58
For the SAN in the heart what are the receptors for sympathetic and parasympathetic innervation
Parasympathetic: M2 receptors Sympathetic: beta 1 receptors
59
What can cause reduced axon diameter
Regrowth after injury
60
What can cause reduction in myelination
Multiple sclerosis | Diphtheria
61
What reduces Action potential transmission
``` Reduced axon diameter Reduced myelination Cold Anoxia Compression Some drugs eg anaesthetics ```
62
What are the 3 main factors that influence ion movement across the membrane
Concentration gradient of ions Voltage difference across membrane Charge of ions
63
Why is the K+ potential negative (-90mV) but the Na+ potential positive (+72mV) if they’re both positive ions
The K+ has a tendency to leave the cell as there’s more in cell than out, so it needs a negative potential in order to attract it and keep it in the cell The Na+ has a tendency to enter the cell as there’s more out of cell than in, so it needs a positive potential to repel it and keep it out of the cell
64
Difference between depolarisation and overshoot
Depolarisation is increasing the membrane potential to 0, overshoot is increasing it to over 0 - making it positive
65
Difference between Passive propagation and active propagation of an Action potential
Passive propagation: only resting K+ channels are open, outward flow of K+ propagates the potential along the membrane from the site of depolarisation Active propagation: local current flow depolarises adjacent areas of membrane towards the threshold
66
What does GABA stand for
Gamma amino butyric acid
67
3 neurotransmitters that look similar
Dopamine Noradrenaline Serotonin
68
What is an adverse effect
Side effect with negative health consequences
69
Receptor for heroin and different areas the receptor is for heroines different effects
Opioid receptors Analgesia: Peri aqueductal grey region Euphoria: ventral tegmental area Cough suppression: solitary nucleus
70
What is pramipexole
A dopamine receptor agonist
71
Safest drugs
Large difference in dose required to produce side effect and dose that produces adverse/side effects (As u increase dose, side effects increase as selectivity decreases - off target effects or on target effects but in the wrong tissue)
72
How much CSF is produced per day
500 ml
73
Where is CSF produced,where does it occupy (and how much CSF occupied these areas), and how is it reabsorbed
Produced by choroid plexus of lateral 3rd and 4th ventricles ~125 ml occupies subarachnoid space and ventricular system Reabsorbed via arachnoid villi into superior sagittal sinus
74
Difference between CSF and plasma
CSF has lower pH and less proteins, potassium, glucose
75
Where are the primary motor cortex and somatosensory cortex
Primary motor cortex: pre central gyrus | Somatosensory cortex: post central gyrus
76
What is special about the six elf somatotropin areas in the somatosensory cortex
Size of somatotropin areas is proportional to the density of sensory receptors in that region (somatosensory homonculus)
77
Where in spinal cord are the corticobulbar and corticospinal stracts
Corticobulbar: genu of internal capsule Corticobulbar: posterior limb of internal capsule
78
What is somatotopy
Point to pint correspondence if an area on body to an specific point on CNS
79
Location of infarct that causes stroke resulting in loss of sensation in left arm and hand
Right parietal cortex in somatosensory cortex
80
Risk factors for septic arthritis
Immunosuppressed Pre existing joint damage Intravenous drug use
81
How many joints are usually affected in septic arthritis and what is the exception
1 joint | Gonococcal septic arthritis - multiple joints at once (poly arthritis)
82
Which bacteria are commonly responsible for septic arthritis
Staphylococcus aureus Streptococci Gonococcus
83
Does PNS or CNS have long pre ganglionic neurons
PNS
84
What neurotransmitters does PNS and CNS use
PNS: only Ach CNS: Ach in pre ganglion neuron and NA in post ganglionic neuron
85
Is adrenal gland innervated by PNS or SNS
Sympathetic nervous system
86
What is diagnosis for low TSH and low T4
SECONDARY hypothyroidism | Ie not a problem with the thyroid gland but rather with the anterior pituitary
87
Most common cartilage which cushions end of long bones
Hyaline (aka articular)
88
How does most T4 travel in blood
Bound to thyroid binding globulin
89
Measures of preload
End-diastolic volume End-diastolic pressure Right atrial pressure
90
Measures of after load
Diastolic blood pressure
91
Why does aortic pressure fall slowly whereas ventricular pressure falls rapidly once the aortic valve closes
The aorta has more elasticity - the recoil of the elastic arteries causes pressure to fall slowly and creates diastolic flow in the downstream circulation
92
Which is more stable, elbow or hip joint and why
Elbow - as there is a relationship trade off between stability and motility Hip joint has more motility than elbow as it can move in more than one plane (ball and socket joint) whereas elbow can only move in one plane) So hip joint is therefore also less stable
93
What are delusions
Fixed false beliefs which are not held by other people in the same culture. They are firmly held even when there’s evidence to the contrary Often held by people with schizophrenia
94
How does airway conductivity change with increasing lung volume
It increases linearly
95
Standard volume of CSF in body
125 ml
96
What arterial system is most of the cerebral hemisphere supplies by, and what about for the brain stem
``` Cerebral hemisphere (anterior part of CNS): internal carotid system Brain stem (posterior part of CNS): vertebrobasilar system ```
97
Difference between Meissner and pacinian corpuscles
Meissner: fine touch and slow vibration Pacinian: deep pressure and high frequency vibrations
98
What is intrapleural bleeding called
Haemothorax
99
What do NA and adrenaline circulate bound to
Albumin
100
What are adrenaline and noradrenaline degraded by
2 hepatic enzymes: monoamine oxidase and catechol-O-methyl transferase
101
Precursor for adrenaline and noradrenaline synthesis
Tyrosine
102
Name given to cycles of smooth muscle contractions sweeping though the gut
Migrating motor complex
103
What is incretin effect
A lot more insulin is produced when glucose is taken orally rather than intravenously
104
How does MS affect conduction velocity and why
Reduces conduction velocity Because the lack of myelin sheath means the impulse cannot travel by saltatory conduction, instead it has to depolarise the hole membrane so travels more slowly
105
Describe ventilation and perfusion across the lung whilst standing
Both are greater at the base
106
What compound makes bile green
Biliverdin
107
Is ACTH involved in aldosterone regulation
No, only cortisol regulation
108
How is pepsinogen converted to pepsin
Activated by HCl
109
Which cranial nerves arise form midbrain pons and medulla
Midbrain: 2, 4 Pons: 5,6,7,8 Medulla: 9,10,12
110
What is gastrin and explain it’s function
Found in the pyloric antrum of the stomach Stimulates release of histamine from chromaffin cells of the lamina propria Stimulated by distension, small peptides and amino acids, and vagus nerve stimulation
111
What is the enterogastric reflex
Stretching of duodenum inhibits gastric motility and slows rate of emoting of stomach
112
Name 2 medications for acid reflux and how they work
Omeprazole: inhibits K+/H+ ATPase Ranitidine: inhibits H2 receptor for histamine
113
How does vitamin D increase calcium absorption in duodenum/ileum
Stimulates the transcription of TRPV6 (calcium moves in via this) and PMCA (calcium moves out via this)
114
Most common bacteria in gut flora
Bacteriodes
115
Which conditions are bacteriodes implicated in the initiation of
Colitis and colon cancer
116
What regulates the depth and frequency of breathing
Pneumotaxic centre
117
Causes of secondary osteoporosis
Hypogonadism Glucocorticoid excess Alcoholism
118
Which channel does glucose enter cell through in intracellular pathway to insulin release
GLUT2
119
What do serous cells secrete in airway
Antibacterial enzymes
120
What is the most common type of joint in body
Synovial
121
What type of jaundice may arise from large blood transfusion
Pre hepatic jaundice
122
4 stages of fracture healing
Bleeding Inflammation Callus formation (soft then hard) Remodelling
123
Which epidermal layer has an active division cells
Stratum basale
124
What is blood flow with constant velocity called
Laminar flow
125
Role of parasympathetic and sympathetic NS in micturition reflex
Parasympathetic contracts the detrusor muscle | Sympathetic relaxes internal sphincter
126
What is law of la place
T = PxR or (/h)
127
What h cells are responsible for sperm development
Sertoli
128
What term is given to condition where person experiences a 20mmHg drop in systolic bp when changing from supine to upright position
Postural hypotension
129
Serum marker for acute pancreatitis
Elevated pancreatic enzymes/amylase/lipase
130
Most common cause of cushings
Prolonged glucocorticoid therapy
131
Scan for confirming pituitary tumour
MRI
132
Why can a stroke lead to sudden twitching movements
Tissue damage due to the stroke can result in propagation of discharge to adjacent areas in primary motor cortex
133
Mechanism of action of diazepam
Indirect GABA agonist
134
Selectivity
Degree to which a drug acts in a specific site reactive to other sites
135
What is diurnal variation of mood a sign of
Depression
136
What is splanchnic vasoconstriction and what disorder is it felt in
Butterflies in tummy feeling | Anxiety

BRS (8 decks)

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