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MBChB1 Phase 1 > Week 3 > Flashcards

Week 3 Flashcards

1
Q

What is critical appraisal?

A

The process of assessing the outcome of scientific research to judge its trustworthiness, value and relevance

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2
Q

What does critical apprasial include?

A

Looking for potential bias
Checking relevance of research results to your specific context
Making judgements about value e.g. benefit/cost

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3
Q

What is evidence-based medicine?

A

The integration of best research evidence with clinical expertise and patient values

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4
Q

What are the 5 steps of evidence based medicine?

A
  1. ask a focused question
  2. find best evidence to answer question
  3. critically apprasie evidence for validity
  4. integrate research with clinical expertise and patients values/beliefs/circumstances
  5. evaluate process
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5
Q

What is the 5 a’s in cycle of enquiry?

A

Ask: forumulate clinical question
Acquire: search for evidence
Appraise: appraise evidence
Apply: incorporate evidence into decision making
Assess: evaluate process

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6
Q

What is the composition of blood?

A

55% plasma
45% erythrocytes
<1% wbcs and platelets

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7
Q

What is plasma composed of?

A

92% water
8% proteins, antibodies, electrolytes

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8
Q

Functions of plasma?

A
  • collects waste around body from tissues and takes to kidneys for excretion
  • maintains body temperature
  • albumin: maintains osmotic pressure
  • fibrinogen: important clotting factor component
  • antibodies fight infection
  • electrolytes maintain blood pH
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9
Q

Functions of blood?

A
  • delivers substances around the body (oxyegn, water, nutrients)
  • removes waste (co2, excess salt and water, debris from dead cells)
  • containes wbc to fight infection
  • contains clotting factors
  • transports hormones from endocrine system (adrenaline, melatonin, insulin, testosterone)
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10
Q

Purpose of RBC being biconcave?

A

Allows elasticity to fit through capillaries

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11
Q

Function of RBCs?

A

Gas exchange - transports oxygen around the body via hemoglobin and carries carbon dioxide to lungs to be expelled

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12
Q

How long do RBCs live?

A

120 days

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13
Q

Where are RBCs broken down?

A

Spleen/liver

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14
Q

Where do all blood cells stem from?

A

Pluripotent hamatopoietic stem cell

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15
Q

Where are pluripotent hamatopoietic stem cells produced?

A

Bone marrow

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16
Q

Function of thrombopoietin?

A

Hormone growth factir increasing platelet production

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17
Q

Function of erythropoietin?

A

Hormone growth factor increasing erythrocyte production, low oxygen conc triggers increased EPO

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18
Q

2 qualities of pluripotent stem cells?

A

Self renew and proliferate/differentiate into progenitor cells

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19
Q

What would the first aid procedure be for a bleeding wound?

A
  • Wear gloves
  • apply pressure with dressing and bandage
  • remove clothes covering wound
  • dont pull objects out of wound
  • lie patient down to prevent shock and cover with blanket
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20
Q

What is the triage system?

A

Categorisation of sick/wounded people
red = immediate
orange = very urgent 10-15 min
yellow = urgent 60 min
green = standard
blue = no danger

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21
Q

What are anticoagulants?

A

compounds that prevent blood clotting

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22
Q

What are clotting factors?

A

enzymes/proteins required for clot formation

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23
Q

What is coagulation?

A

The conversion of liquid blood to a gel like solid

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24
Q

What is haemostasis?

A

The stopping of bleeding

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25
Q

What are proteases?

A

Enzymes that break down proteins

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26
Q

What is proteolysis?

A

Cleavage of peptide bonds in proteins

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27
Q

What is thrombin?

A

An enzyme that forms clots

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28
Q

What is thrombosis?

A

Formation of a blood clot

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29
Q

What is a thrombus?

A

A blood clot

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30
Q

What are the three phases of haemostasis?

A
  • vasoconstriction
    -formation of platelet plug
  • coagulation
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31
Q

What is haemophilia?

A

patients lack a clotting factor and cannot form a blood clot

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32
Q

Function of sodium citrate?

A

Prevents blood coagulation in storage

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33
Q

Difference between in vivo and in vitro?

A

In vivo: in glass
In vitro: living subjects

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34
Q

What is the extrinsic clotting pathway initiated by?

A

Damaged tissue - tissue factor (III) exposed to blood

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35
Q

What is the extrinsic clotting pathway tested by?

A

Prothrombin time (PT)

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36
Q

What is the intrinsic clotting pathway activated by?

A

Activated platelets

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37
Q

What is the intrinsic and final clotting pathway tested by?

A

Activate partial thromboplastin time APTT

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38
Q

How is the intial clotting response amplified?

A

Stepwise activation of coagulation factors

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39
Q

Which three things are required for both clotting pathways?

A

Calcium ions
Clotting factors
Negatively charged phospholipid surfaces of platelets

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40
Q

What are stem cells?

A

Unspecialised cells which can renew indefinitely and can differentiate into specialised cells

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41
Q

What are two common traits of stem cells?

A

Self renewal and differentiation capabilities

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42
Q

What is differentiation?

A

Process of unspecialised cells e.g. stem cells acquire specialised structural/functional features that characterise the cells, tissues or organs of an organism

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43
Q

Which type of cell division do stem cells undergo?

A

Asymmetric producing 2 dissimilar daughter cells

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44
Q

What are the two types of stem cells produced from stem cell division?

A

Identical daughter cell maintaining stem cell line
Different daughter cell with different genetic instructions and reduced proliferative capacity

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45
Q

What do the non identical daughter cells of stem cells become?

A

Progenitor cells: commit to producing one/few terminally differentiated cells e.g. neutrons, muscle cells

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46
Q

What is cell potency?

A

Cells ability to differentiate into other cell types

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47
Q

What is the hierarchy of stem cell potency?

A

Totipotent, pluripotent, multipotent, unipotent

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48
Q

Describe totipotent cells?

A

Can give rise to embryonic membrane and any cell type of adult body e.g. zygote/morula

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49
Q

Describe pluripotent cells?

A

Can give rise to any cell type of adult body e.g. ICM of blastocyst

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50
Q

Describe multipotent cells?

A

Can give rise to tissue specific cell types of adult body e.g. mesenchymal or neural stem cells

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51
Q

Describe unipotent cells?

A

Can give rise to one specific type of adult body tissue cells e.g. skin cells

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52
Q

Which diseases can haematopoietic stem cells transplantations treat?

A

Leukaemia and myeloma

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53
Q

What cells can mesenchymal stem cells produce?

A

Adipocyte, chondrocyte, osteocyte

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54
Q

What are induced pluripotent stem cells?

A

Adult somatic stem cells reprogrammed back to pluripotency so they can differentiate into other cell types

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55
Q

What qualities do iPSCs have?

A

Self renewal capability
Differentiation potential
Ability to be cultured (grown in lab)
ability to form all germ layers

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56
Q

Where are human embryonic stem cells derived from and what are they used for?

A

ICM of blastocyst
IVF

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57
Q

What are somatic stem cells?

A

Non reproductive cells e.g. sperm/eggs that replenish and regenerate dying/damaged cells

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58
Q

Examples of somatic stem cells?

A

Mesenchymal and haematopoeitic stem cells

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59
Q

Where are haematopoietic stem cells produced?

A

Femur and pelvic bone marrow

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60
Q

How are iPSCs made?

A

Treated with transcription factors to switch genes back on to induce pluripotency

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61
Q

Some properties of cancer stem cells?

A

Characteristics of stem and cancer cells
Can self renew and differetiate
Seed tutors when transplanted into host

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62
Q

Issue with cancer stem cells?

A

Isn’t killed by traditional cancer therpay
Has to have cancer stem cell targeted therapy

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63
Q

Potential uses of stem cells?

A

Regenerative medicine
Tissue repair
Drug screening

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64
Q

What is regenerative medicine?

A

Reapir/replace damaged or diseased human cells or tissue to restore normal function

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65
Q

What is stem cell therapy and who can donate?

A

Bone marrow transplant to treat blood disorders e.g. leukaemia
Autologous or allogenic transplant from individual with same tissue type e.g. family members

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66
Q

What happens in stem cell therapy?

A
  • blood stem cells removed from donor
  • patient treated to remove defective stem cells
    -patient injected with donors blood stem cells to produce all blood cells needed throughout their lifetime
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67
Q

What does allogenic mean?

A

Transported to current location from else wherw

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68
Q

What does autologous mean?

A

Obtained from same individual

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69
Q

Supine vs prone position?

A

Supine: lying upwards
Prone: lying downwards (back dissection)

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70
Q

Ventral vs dorsal?

A

Ventral: belly
Dorsal: back e.g. dorsal fin

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71
Q

3 anatomical planes?

A

Median: r and l halfs
Frontal: front and back
Transverse: top and bottom halfs

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72
Q

What is a longitudinal section?

A

Section through length of median plane e.g. leg

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73
Q

What is circumduction?

A

flexion, abduction, extension, adduction

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74
Q

What is plantar and dorsal?

A

Plantar: sole of foot
Dorsal: top of foot

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75
Q

Clinical relevance of APTT?

A

Determines how fast or slow clotting is taking place, determines if people are missing clotting factors etc.
Determines if treatment for blood clot is working

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76
Q

What are the functions of platelets and how long do they live?

A

Initiate hemostasis when damage to blood vessels occurs
5-9 days
no nucleus

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77
Q

Where are platelets broken down?

A

spleen

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78
Q

Why is the intrinsic pathway required in blood clotting?

A

To form clots of a sufficient size

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79
Q

Is clot lysis or formation slower?

A

Clot lysis

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80
Q

What are the 3 steps of hemostasis briefly?

A
  1. vasoconstriction occurs to reduce blood flow
  2. platelet plug formed
  3. coagulation cascade
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81
Q

Which 2 things promote platelet adherence and activation in injury?

A

Exposure of Von Willebrand factor and collage in sub endothelial layer

82
Q

What allows more platelets to migrate to site in hemostasis?

A

Platelets secrete granules to recruit more platelets

83
Q

How is factor X activated in extrinsic pathway?

A

tissue factor (III) is bound with Calcium and turns Factor VII to factor VIIa

84
Q

Which factors are required to activate factor X in the intrinsic pathway?

A

IXa
Calcium
VIII

85
Q

What activates factor VIII in intrinsic pathway?

A

Thrombin

86
Q

What happens in final common pathway of coagulation?

A

prothrombin converted to thrombin by factor X
thrombin converts soluble fibrinogen to insoluble fibrin
fibrin cross links to form a hard clot from a soft clot with XIIIa

87
Q

How does plasmin lyse clots?

A

tPA coverts plasminogen to plasmin

88
Q

What is shock?

A

A life threatening form of acute circulatory failure with inadequate oxygen delivery

89
Q

What happens if shock is left untreated?

A

Multiple organ dysfunction
End organ damage
Death

90
Q

How can you recognise shock?

A

Clinical parameters e.g. HR, BP, RR, GCS
SOFA scoring
Specific symptoms e.g. fever, bleeding
Lactate always elevated

91
Q

Four types of shock?

A

Obstructive
Distributive
Cardiogenic
Hypovolemic

92
Q

What is distributive shock and what can it be caused by?

A

Severe peripheral dilation = decreased blood pressure so blood isnt supplied to vital organs
Sepsis: toxic effect of inflammatory response, cytokine release causes vasodilation
Anaphalaxis: release of biochemical mediators e.g. histamine causes vasodilation

93
Q

What is hypovolaemic shock and what can it be caused by?

A

Significant blood and fluid loss of body
Trauma/GI bleeding/dehydration (stomach ulcers)
Burns

94
Q

What is cardiogenic shock and what can it be caused by?

A

Pump failure
Myocardial infarction (heart attack)
Arrythmias

95
Q

What is obstructive shock and what can it be caused by?

A

Barriers to cardiac flow/filling
Pulmonary embolism (pulmonary artery blocked by blood clot)
Cardiac tamponade (blood in pericardium)
Tension pneumothorax (air buildup in pleural space causing lung collapse)

96
Q

How can you treat disributive shock?

A

Fluid
Vasopressors - constricts blood vessels to inc pressure
Antibiotics

97
Q

How can you treat hypovolemic shock?

A

Fluid/blood

98
Q

How can you treat cardiogenic shock?

A

Vasopressors, inotropes, fluids

99
Q

How can you treat OBSTRUCTIVE shock?

A

Improve circulation
Needle
Thrombolysis - breakdown of blood clots

100
Q

What increases and what decreases in shock?

A

Inc: HR, RR
Dec: BP, organ function, GCS, urine output

101
Q

What are the stages of shock?

A

Intravascular volume loss
Decreased cardiac output
Impaired tissue oxygenation
End organ dysfunction
Death

102
Q

How to calculate cardiac output?

A

CO = HR x SV

103
Q

What is blood shunting?

A

Blood is taken from visceral non essential areas to provide heart with enough blood to perfuse vital organs

104
Q

What happens if you leave a blood shunt for a long time?

A

Kidneys, liver and bowel begin to fail

105
Q

What happens in blood loss?

A

All components lost equally
Oxygen carrying ability and clotting ability impaired

106
Q

What is the vicious cycle of blood loss?

A

Increased lactic acid in blood = acidosis
Decreased heart performance = hypothermia
Decreased coagulation = blood clotting issues
(Acidic environemnt affects blood clotting ability)

107
Q

What is CABCDE in emergency treatment?

A

Catastrophic haemorrhage control
Airway with C-spine control
Breathing with oxygenation
Circulation with haemmorrhage control
Disability
Exposure

108
Q

Two methods of opening airway?

A

Adjuncts
Intubation

109
Q

Three breathing complications in trauma?

A

Haemopneumothorax
Fractures
Cardiac tamponade

110
Q

How can you stop bleeding in trauma

A

Pressure, tourniquet, elevate
Pelvic binder
Suture

111
Q

What is an abrasion injury?

A

Dragging against irregular surface

112
Q

How to treat abrasion injury?

A

Clean debris
Dress
Usually no bleeding

113
Q

What is a laceration injury?

A

Tearing/splitting of skin caused by blunt force trauma
Irregular levels of depth

114
Q

How to treat laceration injury?

A

Irrigate/clean
Close with glue, staples, sutures

115
Q

What is an incision wound?

A

Sharp/penetrating trauma
Slash/stab
Clean edges

116
Q

What should you be cautious of in incision wounds?

A

Depth and underlying damage

117
Q

What is a degloving injury?

A

Skin and blood supply are torn off - major trauma in limbs/digits usually

118
Q

How do you treat bite wounds?

A

Antibiotics, tetanus, vaccines
Irrigation, delayed closure/non closure

119
Q

What should you be aware of in bite wounds?

A

HPV viruses
Cat bites are very prone to infection

120
Q

What bacteria is associated with bite wounds?

A

Pasturella

121
Q

What is the genome?

A

All of the genetic information in a cell (DNA)

122
Q

What is the transcriptome?

A

All mRNA both coding and non coding expressed by a cell.

123
Q

What is the proteome?

A

The complete set of proteins expressed by an organism

124
Q

Which biological processes are proteins part of?

A

Enzymes
Antibodies
Growth factors
Muscle
Breathing

125
Q

What three RNA species are needed to assemble a protein?

A

Ribosomal rRNA
Transfer RNA tRNA
messenger RNA mRNA

126
Q

Three steps of protein assembly?

A

Initiation: AUG start codon initiates translation, tRNA attaches to mRNA
Elongation: addition of more amino acids to transcript
Termination: stop codon stops trabslation

127
Q

What do free ribosomes synthesise?

A

Soluble intracellular proteins

128
Q

How many amino acids are there?

A

20

129
Q

How many bases are in one codon?

A

3

130
Q

How many amino acids can be made from one base pair and two base pairs?

A

One: 4
two: 16
three: 64

131
Q

What is the start codon called?

A

AUG

132
Q

What are the stop codons?

A

UAA, UAG, UGA

133
Q

How do proteins protect against mutation?

A

Each amino acid can be made by different combinations of amino acids e.g. UGA, UGG both make same (degeneracy)

134
Q

Function of R in amino acid?

A

Variable chemical group which gives amino acids their specific properties
Determines structure and function of proteins and electrical charge of the molecule

135
Q

Where are proteins R groups found in polar molecules?

A

Surface as they are hydrophilic

136
Q

Where are proteins R groups found in non polar molecules?

A

Buried in hydrophobic interior out of water

137
Q

How do amino acids link up?

A

Condensation reaction

138
Q

What is glycosylation?

A

Addition of sugar molecule to protein, affects orientation

139
Q

What is phosphorylation?

A

Addition of phosphate group, done by kinases, affects receptor signalling/enzyme function

140
Q

What is an example of a protein activated by proteolysis?

A

Chymotripsinogen to chymotrypsin by proteolytic enzymes

141
Q

What is chymotrypsin?

A

digestive enzyme

142
Q

What is the primary structure of a protein?

A

Amino acid sequence

143
Q

What is the secondary structure of a protein?

A

Amino acids folded into alpha helices and beta pleated sheets

144
Q

What is the tertiary structure of a protein?

A

Folding of protein into their final shape

145
Q

What is the quaternary structure of a protein?

A

Coming together of subunits to form overall functional protein complex e.g. haemoglobin

146
Q

What is the mutation in sickle cell anaemia? What happens to haemoglobin?

A

Beta globin gene mutation
GAG to GTG at 6th codon
Changes shape/conformation

147
Q

What does CFTR regulate?

A

Mucus transport in lungs/pancreas

148
Q

What is cystic fibrosis caused by?

A

Genetic mutation in CFTR (chloride ion channel)

149
Q

Examples of mutations?

A

Nonsense/deletion
Deletion causing protein misfolding
Premature degregation
Substutiton

150
Q

Examples of proteins in therapy?

A

Recombitant proteins e.g. insulin
Antibodies
Peptide mimetics
Blockers of protein function

151
Q

Where is erythropoietin produced?

A

Kidney

152
Q

Where do platelets adhere?

A

Exposed collagen on injured vessel wall

153
Q

How does sodium citrate prevent coagulation?

A

Bind to calcium in blood which prevents calcium regulating binding

154
Q

Which vitamin is cruical for synthesising coagulation factors and associated with the liver?

A

Vitamin K

155
Q

What is von willebrand disease?

A

Lack of von willebrand factor which is required for platelet adhesion and activating factor VIII

156
Q

What would APTT and PT be in someone with von willebrand disease?

A

APTT prolonged
PT normal

157
Q

What does a functional haemogloibn molecule contain?

A

4 haem groups
4 polypeptide chains

158
Q

Where is the site of synthesis of coagulation factors?

A

Liver

159
Q

What is the APTT and PT in someone with end stage liver failure?

A

Both prolonged

160
Q

What is haemophilia A?

A

Low clotting factor VIII

161
Q

What is haemophilia b?

A

Low clotting factor IX

162
Q

Function of citrate in sodium citrate?

A

Chelates calcium ions required for activation of clotting factors
Rapidly metabolised

163
Q

What factors are the final common pathway?

A

Conversion of X to Xa

164
Q

What is used to treat haemophilia?

A

Factor VIII transfusion

165
Q

Why is plasma a mixture from multiple donors?

A

Individual clotting times vary so it allows an average clotting time to be observed

166
Q

What shape do platelets change to when activated?

A

Spherical to finger like projections

167
Q

What charges does heparin carry

A

Negative

168
Q

Which protein is missing from serum which is in plasma?

A

Fibrinogen

169
Q

Which type of molecule is trypsin?

A

Endopeptidase

170
Q

Which enzymes do streptococci produce?

A

streptokinase

171
Q

What is streptokinase simalar to?

A

urokinase
tissue plasminogen activator (tPA)

172
Q

Function of streptokinase?

A

Can convert inactive plasminogen to activwe plasmin

173
Q

Which pathways does heparin inhibit?

A

Intrinsic and common

174
Q

Why are clots usually red when formed?

A

RBCs are trapped

175
Q

Which test would warfarin affect?

A

pt time due to vit k dependent anticoagulation factors in extrinsic pathway

176
Q

Which type of drugs are heparin and warfarin?

A

Anticoagulants

177
Q

Which factor is thrombin?

A

IIa

178
Q

Which factors are required to activate X in intrinsic pathway?

A

VIII and IXa

179
Q

What activates VIII in intrinsic pathway?

A

Thrombin

180
Q

What are the factors in the final common pathway?

A

Xa and V

181
Q

Which protein is mutated in sickle cell anaemia?

A

Globin

182
Q

Where is plasminogen found in blood?

A

Plasma

183
Q

What happens when calcium is replaced with cheleated calcium in clotting?

A

Clotting doesnt occur as cheleated has citrate

184
Q

Which molecule is a zymogen?

A

Prothrombin

185
Q

What is a zymogen?

A

Inactive substance converted to enzyme when activated by an enzyme

186
Q

Function of alteplase?

A

Converts plasminogen to plasmin

187
Q

Function of transexamic acid?

A

Binds to plasminogen decreasing fibrinolysis
Prevents excessive blood loss

188
Q

Which condition would be red aka immediate in triage system?

A

cardiac arrest/multiple injuries

189
Q

Which condition would be organge aka very urgent in triage system?

A

hypoglycaemia, cardiac chest pain

190
Q

Which condition would be yellow aka very urgent in triage system?

A

eye injury, poisoning, abdominal pain

191
Q

Which condition would be green aka standard in triage system?

A

Insect bite, sprained ankle

192
Q

Which condition would be blue aka non urgent in triage system?

A

Long term symtoms, non acute rashes

193
Q

How is trypsin relevant to blood coagulation?

A

Cleaves part of prothrombin to form thrombin

194
Q

Function of prothrombinase, what factor is thus?

A

Cleaves part of prothrombin to form thrombin
Factor X

195
Q

What is endocytosis?

A

Cell engulfing material using membrane

196
Q

What is exocytosis?

A

Release of a substance via vesicles where the vesicular membrane fuses with the plasma membrane and releases the molecule

197
Q

Describe class I hemorrhagic shock

A

Up to 750ml blood loss
up to 15% total blood
pulse <100
normal BP
resp rate 14-20
urine output >30 mls/hr
normal mental statis

198
Q

Describe class II haemmorrhagic shock

A

750-1500ml blood loss
up to 15-30% total blood
pulse >100
normal BP
resp rate 20-30
urine output 20-30 mls/hr
mild anxiety

199
Q

Describe class III haemmorrhagic shock

A

1500-2000ml blood loss
up to 30-40% total blood
pulse >120
decreased BP
resp rate 30-40
urine output 5-15 mls/hr
anxiety

200
Q

Describe class IV haemmorrhagic shock

A

> 2000ml blood loss
40% total blood
pulse >140
decreased BP
resp rate >40
urine output negligible
confusion

MBChB1 Phase 1 (12 decks)

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