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233 Cards in this Set
- Front
- Back
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List 3 types of inflammatory mediators in asthma. Give an eg of each
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1. prestored mediators eg histamine
2. lipid mediators eg prostaglandins and leukotrienes 3. cytokines eg ILs, IFN, GMCSF |
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which Tcell subtype leads to the allergic phenotype?
a)Th1 b)Th2 |
b) Th2 (IL4 IL5 predominate = eosinophils and IgE synthesis)
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name 4 inhaled corticosteriods.
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beclomethasone, budesonide, fluticasone, ciclesonide.
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what is atopy?
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genetic predisposition to make IgE antibody responses against normally harmless antigens
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The parasympathetic nervous system is also known as?`
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The cholingeric system (actylcholine as main NT)
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The sympathetic nervous system is also known as the?
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adrenergic system (nor adrenaline as the main NT)
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what class of drugs are brochodilators?
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1. ß2 adrenoreceptor agonists (activate symp nervous system - brochodilation)
2. muscarinic receptor antagonists ie anticholinergics (suppress parasymp) |
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What class of drugs are salbutamol and salmeterol?
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ß2 agonists - relaxes airway smooth muscle - symp NS activation.
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State the normal blood gas values for
pH, pO2, pCO2, HCO3, & BE |
pH - 7.35-7.45
pO2 - 80-100mmHg pCO2 - 35-45mmHg HCO3 - 22-26mM BE - +/- 2mM |
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what type of lung epithelial cells secrete surfactant? What does it do?
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Type II, it decreases surface tension of alveolar fluid.
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what muscles make up the rotator cuff of the shoulder?
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Supraspinatus
Teres minor Infraspinatus Deltoid Subscapularis |
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What is a Colle's fracture?
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Fracture of the distal radius within 3cm of the wrist. Has a dinner fork appearance.
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name the carpal bones
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scaphoid, lunate, triquitrum, pisiform, trapezium, trapezoid, capitate, hammate
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aldehyde dehydrogenase has many different forms. ALDH2 is the most important. Tell me about the activity of the subtypes.
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ALDH2*1 = high activity = good alcohol metabolisers
ALDH2*2 = low activity = bad alcohol metabolisers > protects against alcohol dependence. Homozygotes = flushing syndrome. |
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Thiamine (B1) deficiency is bad. Name the two syndromes you can get.
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1. Wernicke's Encephalopathy (acute disorientation and paralysis of extraocular muscles)
2. Korsakov's Psychosis (permanent brain damage - memory loss etc) |
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aldehyde dehydrogenase has many different forms. ALDH2 is the most important. Tell me about the activity of the subtypes.
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ALDH2*1 = high activity = good alcohol metabolisers
ALDH2*2 = low activity = bad alcohol metabolisers > protects against alcohol dependence. Homozygotes = flushing syndrome. |
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Thiamine (B1) deficiency is bad. Name the two syndromes you can get.
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1. Wernicke's Encephalopathy (acute disorientation and paralysis of extraocular muscles)
2. Korsakov's Psychosis (permanent brain damage - memory loss etc) |
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what is the incubation period for Hep C?
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6-7 weeks (2-26weeks)
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State the Frank-Starling law
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The greater the filling of the ventricle the greater will be the force of contraction.
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What does PTH do?
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increases Ca2+ in the blood
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What does Calcitonin (parafollicular cells) do?
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decreases Ca2+ in the blood
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What does calcitriol/125OH vitD do?
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increases Ca2+ in blood by stimulating gut absorption and reducing urine Ca losses
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state normal blood parameters for:
MCV Hb |
MCV = 80-100fL
Hb = males 130-180g/L, females 120-160g/L |
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define megaloblastic anaemia
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anaemia due to impaired DNA synthesis because of a B12 and/or folate deficiency.
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Tell me about B12 absorption
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B12 binds to intrinsic factor (which is secreted by gastric parietal cells). B12-IF complex travels to terminal ileum for absorption.
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Tell me about folic acid absorption
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folic acid is absorbed via concentration dependent diffusion in the proximal jejunum.
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What 4 factors increase Hb unloading of O2?
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Increase pCO2, increased temperature, increased 2,3DPG and decreased pH (acidosis). This is the same as a right shift on the curve.
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Name 3 clinical consequences of bone marrow failure
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anaemia, leukopaenia, thrombocytopaenia.
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Talk about bcr-abl
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It is an oncogene, a dysregulated tyrosine kinase. It leads to uncontrolled cell division. Results from a chromosomal translocation. t(9:22) = CML, ALL.
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Name the 3 major inherited clotting factor diseases and the defective factor
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1. Haemophilia A (f VIII)
2. Haemophilia B (f IX) 3. von Willebrand's disease (vWf) |
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What is thalassaemia?
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A diverse group of inherited disorders. The rate of production of certain globin chains is decreased leading to an imbalance, this results in the formation of abnormal amounts of normal Hb. RBCs = hypochromic and microcytic.
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What part of DNA is the coding region?
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exons
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What are the 3 points of Virchow's Triad for thrombus formation?
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hypercoaguability, endothelial damage, abnormal blood flow.
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What levels of the sympathetic trunk innervate the heart? And what type of sympathetic receptors are in the heart?
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t1-t4/5.
ß1 receptors - NA |
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Cardiac output is equal to a multipe of what two factors?
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CO = HR x SV
(SV = stroke volume which is largely determined by the preload) |
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What is digoxin?
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A cardiac glycoside. It increases Ca2+ entry into heart cells and increases force of contraction by slowing down the ventricular rate.
It does not decrease mortality and morbidity in congestive heart failure. Just improves QoL. |
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Why are drugs that cause peripheral vasodilation (eg ACEi) good at treating hypertension?
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Because they reduce afterload.
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How many patients with strep throat develop rheumatic fever?
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3%
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Left sided heart failure results in?
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Pulmonary congestion
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Right sided heart failure results in?
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Systemic venous congestion (peripheral oedema, liver (nutmeg liver) and spleen congestion)
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ST elevation on and ECG is indicative of what?
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transmural ischaemia of the myocardium.
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ST segment depression is the hallmark of what?
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subendocardial ischaemia.
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When do you see T wave inversion on an ECG?
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Usually after ischaemia has passed or if there has been an infarction.
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What is the most common heart defect at birth?
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High ventricular septal defect.
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What encompasses a tetralogy of Fallot heart defect?
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1. ventricular septal defect
2. overriding aorta 3. right ventricular hypertrophy 4. right ventricular outflow obstruction |
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How do statins lower cholesterol levels?
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Statins = HMG CoA reductase inhibitors. They supress cholesterol synthesis especially in the liver. This increases LDL receptors in the liver (cholesterol for bile salt synthesis) and so reduces circulating LDLs.
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what are fibrates?
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drugs that reduce high TAG levels. They promote reverse cholesterol activity.
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What is essential hypertension?
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Hypertension with no attributable cause. Consistent BP > 140/90 at rest.
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Name the three types of incontinence.
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urge
stress overflow |
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sate risk factors for urolithiasis formation
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Diet: high salt, protien
dehydration |
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what vertebral levels does the oesophagus sit next to?
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C6 to T11
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What region of the prostate undergoes BPH
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the transitional zone
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In what region of the prostate are most cancers formed?
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the peripheral zone
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What is the prevalence of BPH in men
a) over 50 years b) over 75 years |
a) 50%
b) 95% |
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when does the cranial neuropore close?
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day 24
(failure to close leads to ancephaly) |
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When does the caudal neuropore close?
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day 26
(failure to close leads to spina bifida) |
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name the 5 subdivision of the neural tube in the head. What does each part become?
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1. telencephalon (cerebral hemispheres)
2. diencephalon (thalamus, hypthalamus, epithalamus) 3. mesencephalon (midbrain) 4. metencephalon (pons and cerebellum) 5. myencephalon (medulla) |
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What are some known seizure triggers?
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low BSL, sedative withdrawal, severe sleep deprivation, stimulant intoxication.
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Describe the 3 forms of spina bifida
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1. occulta - missing spinous process
2. meningocele - meninges on outside, SC contained within 3. myelomeningocele - central canal open to outside - CSF leakage |
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Can NSAIDS cause high BP?
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Yes. Prostaglandins inhibit Na+ reabsorption in the loop of Henle.
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Tell me about atrial natriuretic hormone/peptide?
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It is released from the atria under conditions of volume expansion and inhibits Na+ reabsorption at the distal tubule.
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What does aldosterone do?
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Aldosterone is a mineralocorticoid released from the adrenal cortex (zona glomerulosa) and acts on the distal collecting tubule to increase Na+ resorption and K+ secretion.
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Give an example of a carbonic anhydrase inhibitor. Where does it act, what does is it do?
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Acetazolamide.
Acts on the proximal tubule, removes H+ to drive exchanger. Lose Na+, HCO3- and H2O into urine. |
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How does frusemide work?
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It is a loop diuretic. It binds to the NaClK triple transporter.
Lose Na, K, Mg, Cl, Ca into urine (also H+ at CCD) |
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What diuretic acts at the early distal tubule?
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Thiazides. They block the Na+ Cl- cotransporter
Lose Na+, Mg, Cl (also H and K at CCD) |
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What diuretics act at the CCD?
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1. Amiloride - it blocks the Na+ epithelial channel in lumen. (lose Na, Cl, H2O, retain K and H).
2. Spironolactone - blocks aldosterone receptor. Aldosterone revs up the cell, this doesn't happen. |
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What are the two mechanisms of ADH regulation?
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1. osmoregulation - very sensitive, when plasma osmolality increases its detected by the hypothalamus and ADH released from post. pit.
2. Non osmotic:- hypotension, pain, nausea, stress, hypovolaemia also activate ADH release from post pit. |
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What effect does diabetes insipidus have on the body's water balance?
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No ADH means no ability to conserve water in times of need. Need to drink a lot to maintain plasma osmolarity.
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What are the three clinical classifications of dehydration?
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4% body weight = mild
7% = moderate 10% = severe |
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How does hyperkalaemia affect the heart?
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It prevent SA node activation as well as rendering ventricular myocytes inexcitable. >8mM is lethal through asystole.
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Where do K+ losing diuretics act?
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In the early part of the nephron - frusemide and thiazides
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What is commonly associated with hypokalaemia?
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Alkalosis
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Which side effects are more commonly seen with thiazides than frusemide?
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hypercalcaemia (frusemide has the opposite effect)
hyperlipidaemia hyperuricaemia (gout) hyperglycaemia |
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Which diuretics can cause deafness?
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IV loop diruetics are ototoxic
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What is the normal range for serum Na+ concentration?
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135-145mM
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How is glucose taken up by hepatocytes?
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It is concentration dependent via GLUT2
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What is the "triple whammy" of medications that leads to acute renal failure?
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NSAIDS
ACEi diuretics |
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What is gastric acid and which cell produces it?
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HCl, parietal cell.
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How do NSAIDS cause gastroduogenal damage?
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They decrease prostaglandin production which decreases HCO3- secretion which decreases mucous production - you lose the protective layer over gastric epithelium
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Name the four types of papillae on the tongue
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circumvallate
foliate fungiform filliform |
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What do the chief cells make? Where are they found?
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pepsinogen - which at pH<4 = pepsin a proteolytic enzyme.
In the fundus of the stomach |
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What do parietal cells secrete?
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HCl and intrinsic factor
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What do D cells in the stomach secrete?
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somatostatin - this inhibits gastrin secretion
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What do G cells in the stomach secret?
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Gastrin - released in the antrum
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Can NSAIDS cause sodium retention and oedema?
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Yes. They block the synthesis of prostaglandins PGE2 and PGI2. These PGs enhance glomerular
filtration and inhibit the tubular reabsorption of sodium. |
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What are the four mechanisms of diarrhoea?
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secretory
osmotic motility exudation |
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State the 4 mechanisms of fat malabsorption
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1. Pancreatic insufficiency eg CF
2. Inadequate solubilisation - bile acid deficiency 3. impaired mucosal absorption eg coeliac disease 4. impaired transfer of fat frim enterocytes to lymphatics |
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what is the normal villae to crypt ratio?
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5:1
This ratio decreases in coeliac disease with crypt hyperplasia and villous atrophy |
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Tell me about Crohn's disease
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It can affect any portion of the GIT 'skip lesions'
Transmural inflammation (all 4 layers) |
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Tell me about ulcerative colitis
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It affects the colon and rectum only, is a continual lesion.
It only involves the mucosa and submucosa. Secretory diarrhoea |
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What is the immune reactive part of gluten?
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alpha-gliadin
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What regulates adaptive thermogenesis?
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hypothalamus (sensing)
thyroid hormone and SNS (affecting) |
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State the five ways heat production is regulated by thyroid hormone.
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1. increased expression of uncoupling protein
2. decreased efficiency of mt H+ pumping 3. feeding electrons via complex II rather than I (less H+ pumping) 4. promoted SERCA expression and impairs its efficiency 5. SNS effects - increases ß2 adrenergic receptor expression in muscle |
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State the activity of the different forms of thyroid hormone.
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T3>T4>>rT3
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How do adrenalin and cortisol affect BSL?
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They counteract the effects of insulin and so increase BSL by increasing gluconeogenesis and glycogenolysis as well and increasing hepatic glucose output.
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Why are stressed people more prone to illness?
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High cortisol levels supress the immune system.
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How is basal metabolic rate defined?
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The energy expended by humans when completely at rest
but not asleep, in the absence of muscle movement and without any sympathetic nervous system arousal. (Resting metabolic rate (RMR) is generally what is measured and is 10-15% higher than BMR.) |
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Name 3 catecholamines
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adrenaline - secreted in the adrenal medulla
noradrenaline dopamine - secreted in the CNS |
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What are catecholamines synthesised from? State the pathway.
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Tyrosine --> DOPA (tyrosine hyroxylase) --> dopamine --> noradrenaline --> adrenaline
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What are the receptors types for catecholamines?
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alpha 1, 2 and beta 1, 2 adrenoreceptors
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On a global scale what is the most common cause of goitre?
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iodine deficiency (1.5 billion people)
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Name two anti thyroid drugs
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thiopropyluracil
carbimazole Both of these block the peroxidase activity in the thyroid and prevent the organification of iodide and the coupling of iodotyrosine molecules to form triiodothyronine (T3) and thyroxine (T4) |
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what is the normal plasma concentration of potassium?
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3.5-5.0 mM
(intracellular concentration is 150mM) |
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What are the three mechanisms of acute renal failure?
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pre renal (hypoperfusion, hypovolaemia)
intrinsic (glomerulonephritis, acute tubular necrosis, ischaemia) post renal (obstruction) |
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What does net acid excretion by the kidney entail (equation)
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NAE = NH4 + TA (HPO4) - HCO3
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What is the aetiological breakdown of the causes of chronic renal failure?
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34% diabetic nephropathy
22% glomerulonephritis 15% hypertension |
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what is the definition of oliguria?
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<500mL urine in 24 hours
(lab clues urea:creat <80, elevated haematocrit, urine osmolarity >450mosmol/kg |
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How is ammonium eliminated? What organs are required?
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NH4+ is eliminated via the urea cycle which takes place in the liver. Urea is then excreted by glomerular filtration in the kidneys.
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State the 4 EUC findings characteristic of ARF
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raised creatinine
hyperkalaemia hypocalcaemia hyperphosphataemia |
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Where in the brainstem is the dopaminergic system located?
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substantia nigra and ventral tegmental area
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Where would a patient's face be paralysed if there was an upper motor neuron lesion on the left corticobulbar tract?
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The right lower face.
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What is the breakdown of stoke prognosis 1 year post stoke?
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1/3 die, 1/3 recover, 1/3 have persistent disability.
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State the two types of cerebrovascular disease and the prevalence of each.
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1. Infarction (embolus, thrombus, hypoperfusion) - 80%
2. Haemorrhage - 20% |
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Where in the closed medulla do the motor and sensory fibres cross?
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The level of motor decussation (caudally)
The level of sensory decussation (rostrally) |
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When the dorsal columns cross where do they go into?
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The medial lemniscus
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Name the three possible pathways for motor fibres.
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corticospinal
corticopotine (to cerebellum) corticobulbar |
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How is the midbrain divided up?
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Dorsal to cerebral aquaduct = tectum (roof)
Ventral to the cerebral aquaduct - tegmentum (floor) |
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What is dysarthria?
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Slurred speech that is otherwise linguistically normal
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List 8 stroke risk factors
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Age
FHx Smoking high cholesterol diabetes Heart disease (atrial fibrillation) Hypertension Hx of stroke |
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What are the three mechanisms of syncope?
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1. Vasovagal - reflex-mediated changes in vascular tone or heart rate.
2. Orthostatic hypotension 3. Priamry cardiac conditions |
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What do the parafollicular cells secrete? What does it do?
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Calcitonin.
It is released when calcium levels increase. It reduces Ca++ by inhibiting osteoclasts and increases Ca++ excretion by the kidneys. |
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What are the two cell types in the parathyroid gland - what do they produce?
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Chief cells - PTH
Oxyphils - don't know what they do |
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What is the function of PTH?
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It raises blood calcium levels by:
1. stimulating osteoclasts 2. inhibits osteoblasts 3. decreases kidney excretion of Ca++ 4. Stimulates the formation and secretion of calcitriol by the kidneys |
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Calcitriol is 1,25 OH Vit D. What does it do?
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t increases the level of calcium (Ca2+) in the blood by (1) increasing the uptake of calcium from the gut into the blood, (2) decreasing the transfer of calcium from blood to the urine by the kidney, and (3) increasing the release of calcium into the blood from bone.
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Define a primary, secondary and tertiary endocrine deficiency.
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Primary = deficiency at the endocrine organ
Secondary = at the pituitary Tertiary = at the hypothalamus |
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Which hormones are produced in pulses? What does this mean for measurement of them?
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Cortisol, testosterone, oestrogen, growth hormone.
So you need to measure them either - more than once, after stimulation or at different times of the day. |
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Which synthetic glucocorticoids also have a mineralocorticoid effect?
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hydrocortisone
cortisone acetate |
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What EUC findings would you get in a mineralocoricoid deficiency?
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low Na and high K
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Name a synthetic mineralocorticoid.
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Fludrocortisone
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In males, what cells do FSH act on?
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Sertoli cells (nurse cells for sperm production)
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In males, what cells to LH act on?
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Leydig cells (produce testosterone)
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In females, what does FSH act on?
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Granulosa cell/follicular cell (oestrogen and progesterone?)
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In females, what does LH act on?
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Theca interna (oestrogen) and follicular cells.
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How many units of insulin do you give per 10g CHO?
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2
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What structures make up Hasselbach's triangle? What type of hernia can you get here?
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Inguinal ligament
inferior epigastric artery rectus abdominus This the site for a direct inguinal hernia |
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State the 6 anterior pituitary hormones. Which two are produced by acidophils?
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LH
FSH GH (acidophil) ACTH TSH Prolactin (acidophil) |
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In macroadenomas of the pituitary gland in what order are hormones lost?
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Typically, loss of pituitary hormone secretion progresses in the following order: gonadotropins,
growth hormone, TSH and ACTH |
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Tell me about melotonin.
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Melatonin is an indoleamine produced in and secreted by the pineal gland. Melatonin
production is modulated by sympathetic innervation of the pineal gland. At night, in the absence of light, melatonin synthesis is stimulated via neurons originating in the SCN. |
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What groups (4) are at increased risk of illness from foodborne diseases?
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Elderly
Infants Pregnant women People with suppressed immune systems |
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What are some symptoms of foodborne illness?
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Diarrhoea
Headache nausea and vomiting hepatitis fever muscle aches |
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What is the most common cause of gastroenteritis in institutions?
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Norovirus
(Rotavirus is more common in a child care setting) |
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What proportion of australians are aged over 65?
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13%
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What proportion of total health expenditure comes from public sources?
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68% (22% states, 46% commonwealth)
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How many acute care beds are there per 1000?
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2.7
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What factors make up EBM?
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patient factors
clinician factors evidence |
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What does PICOT stand for?
|
Population
Intervention Comparator Outcome Time/Type of Study |
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What vertebral levels does the abdominal aorta traverse?
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T12-L4
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What vertebral levels does the inferior vena cava traverse?
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L5-T8
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In what position is a normal uterus and cervix?
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Anteflexed and anteverted. Cervix faces posteriorly.
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In HCV what are the risk factors for progression to cirrhosis?
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male gender
alcohol obesity/type II diabetes immunosupression age at infection |
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What is the treatment for chronic HCV?
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Pegylated interferon (weekly injection) plus Ribavirin (bd oral)
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What is unusual about AST and ALT measurements in alcoholic hepatitis?
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AST > ALT In most other liver diseases it is the other way around.
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Jaundice without dark urine or pale stools means?
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Haemolysis.
(unconjugated bilirubin released into circulation, thus not water soluble and cannot be excreted by kidneys) |
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Jaundice with dark urine and pale stools means?
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Obstructive jaundice.
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What proportion of chronic heavy drinkers will develop hepatitis or cirrhosis?
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15-20%
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What type of kidney stones are radiolucent?
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Uric acid stones.
(treatment = alkalinise the urine) |
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What type of glucose gets passed the BBB?
What transporter is used? |
D-glucose
GLUT-1 |
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What are the leptomeninges?
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the pia and the arachnoid mater.
(lepto = fine, thin, delicate) This is what is inflamed in meningitis. |
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What are the 3 categories of infectious meningitis?
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acute pyogenic (bacterial)
aspectic (viral - usually self limiting) chronic (TB, spirochetal, cryptococcal) |
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What are common bugs of neonatal meningitis?
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Ecoli
group B streptococcus |
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What are the common bugs of elderly meningitis?
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Strep pneumoniae
Listeria monocytogenes |
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If a patient has a brain abscess of otic origin what is the most likely organism?
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gram negative bacilli
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Which part of the thalamus does the retina project to?
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lateral geniculate nucleus
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What part of the vestibular system sensors angular movement?
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The semicircular canal structure: duct, ampulla, crista and receptors.
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What part of the vestibular system senses linear forces?
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The otolith structure: utricular and saccular maculae, otoconia.
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What are the contraindications to lumbar puncture?
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infection over needle site
signs of raised ICP focal neurological signs shock/coagulopathy |
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What is the most common long term complication following bacterial meningitis?
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sensorineural hearing loss.
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Tell me about cytotoxic oedema.
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Cytotoxic edema is the second most common cause of cerebral oedema (the most common type is vasogenic). It can occur if the space-occupying
lesion has caused localised cellular injury. In this type of edema, the fluid collects intracellularly, rather than extracellularly. |
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From which part of the thalamus does the primary auditory cortex receive information?
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The medial geniculate nucleus.
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Where is the secondary auditory cortex located?
|
Posterior to the trasverse gyrus of Heschl's, in the plenum temporale.
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What does the pars plicata of the ciliary body produce?
|
Aqueous humour
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What is a common complication of cataract surgery?
|
Posterior capsule opacification. Epithelial proliferation, migration and fibrosis leads to PCO.
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What type of fibres are nociceptors associated with?
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Nociceptors are associated with unmyelinated (C- or group
IV), and small diameter myelinated (A-delta or group III) fibres. |
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Name the four subcortical regions that the retina projects to.
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lateral geniculate nucleus (thalamus)
hypothalamus (superior chiasmatic nucleus) superior colliculus pretectum |
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State the four classes of multiple sclerosis.
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benign
relapsing remitting secondarily progressive primary progressive |
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What is a DALY?
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Disability adjusted life year.
DALY = YLL + YLD It calculates morbidity and mortality of a disease and therefore is a measure of overall disease burden. |
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Where is the limbus and what does it contain?
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The limbus is the boundary zone between cornea and sclera and contains the trabecular
meshwork, canal of Schlemm, collector channels and aqueous veins |
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Name the basal ganglia
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caudate, putamen, globus pallidus, subthalamus, substantia nigra, pedunculopontine nucleus
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Parkinson's disease is characterised by cell death in which part of the brain?
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The substansia nigra compacta. So you get indirect pathway overactivity.
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Name the four deep cerebellar nuclei
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dentate
emboliform globose fastigial |
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Describe the sequence of events in dopamine synthesis
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(1) uptake of tyrosine into nerve terminals
(2) conversion to l-DOPA by tyrosine hydroxylase (rate limiting step) (3) conversion to dopamine by DOPA decarboxylase. |
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What proportions of cancer are sporadic mutations? (as opposed to an inherited mutation)
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95%
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What proportion of colorectal cancer patients have a family history?
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25%
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If a cell is damaged and can be repaired what is the signalling cascade that ensues?
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p53 sees damage - Stop cell cycle at G1S
p21 CDK4 |
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Name the 6 classes of chemotherapy drugs
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1. alkylating agents
2. antimetabolites (eg methotrexate, 5FU) 3. cytotoxic antibiotics (doxorubicin (cardiotoxic) bleomycin (pulmonary toxicity)) 4. Vinca alkaloids (eg vincristine (parasthesias) 5. cisplatin/carboplatin 6. taxanes |
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What are the 4 macroscopic appearances of colorectal adenomas?
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pedunculated
sessile flat depressed |
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what are the immediate release and slow release forms of oxycodone called?
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immediate = endone
slow release = oxycontin |
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What is the opioid of choice for pain management of patients with renal impairment?
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hydromorphone (no active metabolites)
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How do bisphosphonates keep bones strong?
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Bisphosphonates inhibit the digestion of bone by encouraging osteoclasts to undergo apoptosis, or cell death, thereby slowing bone loss.
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State the three sequential mutations in Vogelstein's cascade.
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1. Mutation of APC gene, loss of DNA methylation
2. Mutation of RAS gene, mutation of DCC gene 3. mutation of p53 |
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What does BRCA1 gene do?
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It regulates RAD51 a DNA repair protein. It also inhibits cell growth.
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What is DCC gene? What does it do?
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Deleted in colonic cancer gene. It regulates cell-cell matrix communication. Thus, mutation of this gene may decrease the capacity of affected cells to differentiate, rendering them more likely to proliferate.
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What is the APC gene? What does it do?
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Adenomatus polypopis coli gene. It regulates the cell surface protein E-cadherin. E-cadherin is
involved in the formation of intercellular junctions. Both APC and E-cadherin can be mutated in tumours, decreasing intercellular adhesiveness, which may allow detachment and invasion. |
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What does the retinoblastoma gene do?
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It encodes for the Rb protein that is a nuclear phosphoprotein that regulates the G 1 to S transition in the cell cycle. The underphosphorylated form of pRb prevents cell replication by binding nuclear transcription factors such as c- myc . Thus, phosphorylation (by cyclin-dependent kinases) of pRb switches on replication by releasing c- myc from pRb.
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Horner's syndrome is due to?
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Sympathetic nerve paralysis
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What are the effects of hypercalcaemia?
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anorexia
nausea and vomiting increased urinary water loss constipation cardiac arrhythmias |
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Human papilomaviruses are epithelotropic. What does this mean?
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They target stratified squamous epithelium
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What are the oncogenes in HPV? What proteins do they deactivate with in the host cell?
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E6 - binds p53
E7 - binds Rb |
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Which strains on HPV have a high risk of developing into malignancies?
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16
18 31 45 |
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What is the transformation zone?
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It is the junction between the glandular endocervix and the squamous ectocervix
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At what stage(s) in the cell cycle are cancer cells most sensitive to radiation?
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M and G2
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Human herpes virus 8 causes what?
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Kaposi's sarcoma (need immune suppression too)
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What is the most common type of skin cancer?
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Basal cell carcinoma
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Where does breast cancer metastasise to? In order from the most common sites.
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LNs
bone soft tissue liver/lung/brain |
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What does a relative risk reduction of 40% mean in regard to a chemo drug?
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You're chance of recurrence is 60% of the chance if you weren't on the drug.
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What clade of HIV1 dominates in Australia?
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B
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What are 3 drug target for HIV therapy?
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reverse transcriptase (nucleoside analogues "nukes")
protease enzyme inhibitors fusion inhibitors |
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How do analytic studies answer questions?
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By making comparisons between groups.
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What is burden of disease?
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An estimate of the total ill health in a community
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What are the three mechanisms of hyperbilirubinaemia?
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1. over production
2. impaired uptake, conjugation or excretion 3. regurgitation from damaged hepatocytes or bile ducts. |
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What does a alkaline phosphatase indicate?
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cholestasis, biliary obstruction and liver infiltration. (this correlates with GGT levels)
(reflects hepatic adaptation to injury) |
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What is the mechanism of hepatopulmonary syndrome (briefly)
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hypoxia due to vasodilation of the pulmonary bed.
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At what total body iron content do you see manifestations of haemochromatosis?
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about 20g.
This means patients present at age 40 in males, 50 in females. |
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What are the two main chronic cholestatic diseases that result in cirrhosis?
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primary biliary cirrhosis (PBC)
primary sclerosing cholangitis (PSC) |
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What is platypnoena?
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Shortness of breath that is relieved by lying down. The opposite of orthopnoea.
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What are bile salts composed of?
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glycine or taurine conjugates of primary bile acids.
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Pregenolone is made from cholesterol. What three important hormones are produced from it?
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cortisol
oestrogens/testosterone aldosterone |
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glucocorticoids upregulate many enzymes. State 3 pathways (and the relevant enzymes) that are affected by cortisol in this way.
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1. the gluconeogenic pathway (e.g., pyruvate carboxylase, phosphoenolpyruvate carboxykinase and fructose 1,6-bisphosphatase
2. the glycogen synthesis pathway (glycogen synthase) 3. fat breakdown (hormone sensitive lipase) |
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In steroid myopathy. Which muscle fibres are affected?
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type IIB. The fast twitch fibres that use predominantly glycolytic metabolism and have a low resistance to fatigue.
(type I and IIA may be involved too but to a lesser extent) |
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ß-oxidation of fatty acids leads to the production of what?
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Acetyl CoA.
This can drive the citric acid cycle or be converted into ketone bodies. |
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Why, in DKA, is ketone body synthesis favoured over the citric acid cycle?
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1. increased FADH2 and NADH
2. gluconeogensis is activated and so all the oxaloacetate has been used up, so there is none for the citric acid cycle. |
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What is the major stimulus for insulin secretion?
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A blood glucose concentration <5mM
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What type of glucose transporters are found on ß cells of the pancreas?
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GLUT2
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What problems make up the metabolic syndrome (syndrome X)?
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insulin resistance
dyslipidaemia central adiposity hypertension |
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How do sulphonureas work?
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They potentiate glucose stimulated insulin release.
They act by closing potassium channels which results in depolarisation of the cell and an influx of calcium which stimulates insulin secretion. |
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Metformin is a biguanide. How does it lower blood sugar levels? (4 mechanisms)
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1. It decreases appetite
2. increased glucose uptake into muscle and fat 3. decreases intestinal glucose absorption 4. suppresses gluconeogenesis |
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What are the three phases of spermatogenesis?
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1. mitosis
2. meiosis 3. spermiogenesis |
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What hormone do you measure and when do you measure it to uncover if ovulation has taken place?
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progesterone on day 21
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The vaginal pH or 'whiff test' (KOH) of vaginal fluid can be used to quickly diagnose which conditions?
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Candiasis and bacterial vaginosis
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What abnormalities do you commonly see in chronic renal failure?
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hyperparathyroidism (most common)
anaemia acidosis hyperkalaemia hyperphosphataemia |
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What type of bonds does salivary amylase attack?
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alpha 1, 4
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What charcterises nephrotic syndrome?
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>3.5g protein in 24 hrs
hypoalbuminaemia oedema lyperlipidaemia lipiduria |
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What characterises nepthritic syndrome?
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macroscopic haematuria
variable proteinuria <3g/day decreased GFR leukocytes rbc casts |
