Set the Language

We weren't able to detect the audio language on your flashcards. Please select the correct language below.

Front

Back

Related Flashcards

Flashcards
»
Pathophysiology

Pathophysiology

by Debz, Feb. 2017

Subjects: Pathophysiology

Favorite

Add to folder

Flag

Shuffle
Toggle On

Toggle Off
Alphabetize
Toggle On

Toggle Off
Front First
Toggle On

Toggle Off
Both Sides
Toggle On

Toggle Off
Read
Toggle On

Toggle Off

Reading...

Front

Card Range To Study

through

Play button

Progress

1/663

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

663 Cards in this Set

Front
Back

	Define Zygote.	When there is fusion of the chromosomes from the sperm and ovum into a single fertilized cell.
	What are autosomes?	These are the 44 non sex chromosomes present in the cell nuclei.
	When will autosomal dominant disorders be manifested/	This will occur if there is a single copy of the abnormal gene present in the individuals genotype. When one parent is affected by a dominant disorder, any of the children have a 50% chance of inheriting the condition.
	List 2 conditions transmitted by a dominant gene.	Achondraplasia and Huntington's disease.
	What is Neurofibromatosis/	This results in small tumors that develop from the sheaths of peripheral and cranial nerves.
	When is an autosomal recessive disorder present?	These are present only if there are 2 copies of the abnormal gene, on each of a pair of chromosomes. These diseases may occur from two normal parents, one of each that carry a recessive copy.
	List four diseases that are considered autosomal recessive disorders.	Thalessemia Phenylketonuria Sickle cell anemia Cystic fibrosis
	Sex linked disorders are nearly always transmitted on the X chromosome. True/false	True. These are also called X linked conditions. Hemophilia, Muscular dystrophy and color blindness are X linked conditions. Females have 2 copies of the X chromosome and males have only one. women often transmit X linked disorders which their sons suffer from.
	What is another term for Down's syndrome?	Trisomy 21. This suggests that there are three of the 21st chromosome present as opposed to the normal two. There is a total number of 47 chromosomes.
	What is Kleinfelter's syndrome?	This is identified as XXY syndrome. Boys have small testes, are infertile and may have some breast development, all caused by an additional X chromosome.
	What is turner's syndrome?	Some females are born with only 1 X chromosome, so they have a total of 45 chromosomes. They are usually of short stature, with neck webbing, and they infrequently menstruate.
	What does Cyanide inhibit?	It inhibits energy generation in all cells.
	Utter lack of protein causes Kwashiorkor. True /false	True. this is characterized by abdominal edema.
	What is marasmus?	This occurs due to a lack of dietary carbohydrate. Body weight may be reduced to 60% of normal.
	Iatro is derived from the Greek, and means doctor. True/False	True.
	Why is the risk to exposure of teratogens greatest at 12 weeks of development?	This is the time when most tissue differentiation and generation of form takes place.
	Cytomegalovirus, a member of the Herpes virus family, can be teratogenic. True/False	True.
	What are Oncogenes?	Some mutations tend to rise in genes which normally function to stimulate cell division. Other mutations may arise in genes which normally inhibit cell division. These are tumor suppressor genes.
	How do most chemical carcinogens work?	They work by changing the chemical composition of the DNA molecules. These processes result in mutations.
	Tobacco smoke contains benzopyrenes. True/False	True.
	How may chemical or tobacco carcinogens result in bladder cancer?	The carcinogens from smoke are absorbed through the lungs and excreted via the kidneys and the bladder.
	What is a direct carcinogen?	These are chemicals capable of causing cancer that are not first modified in the body. Indirect carcinogens are altered or changed first. Aflatoxin is an indirect carcinogen.
	What are N-nitroso-compound?	These are found in salted, smoked or pickled meat products. They have been known to cause esophageal, nasopharyngeal, bladder and liver cancer.
	What are free radicals?	They are highly reactive substances produced inside of cells as a result of metabolic processes. They have an unpaired electron in the outer orbital. They may occasionally steal an electron from other molecules around them. A molecule that loses an electron is oxidized. This can occasionally result in DNA damage. This is a form of mutation.
	If radiation forms ions in DNA molecules, can this result in mutations as well?	Yes. Radiation entering a cell can react with water in the cell to convert it into a free radical species, such as hydroxyl ions (OH-).
	What is DNA excision repair?	Special intracellular proteins can detect and remove damaged sections of DNA.As DNA consists of a double helix, the damaged strand may be restored, using the undamaged strand as a template.
	Why is the immune system not always able to eradicate cancerous cells?	Neoplastic cells derive from the persons own cells. They have the same antigens as when the cells were normal.
	In the UK, what is the equivalent of one unit of alcohol?	One unit is equal to 10ml of pure alcohol.
	Where do most CNS tumors arise from?	As neurones do not divide, CNS tumors derive from dividing glial cells forming gliomas. Teratomas and seminomas form from germ cells.
	What is hyperplasia?	This is an increase in cell numbers.
	What is the histological change noted in Barrett's esophagus?	In this metaplasia the normal squamous epithelium of the esophagus is replaced by columnar cells.
	What is meant by carcinoma in situ?	Carcinomas begin as small localized growths in the epithelium from where they arise. As long as they do not penetrate the basement membrane, they are referred to as carcinomas in situ.
	List four basic ways that tumor cells may spread.	1. Direct spread 2. Lymphatic spread 3. Blood 4. Body cavities
	What is menat by carcinamatosis?	When a cancer is widely distributed throughout the body.
	What does the TNM cancer staging protocol suggest/	T is for tumor and describes the size and extent of local invasion. N is for nodes, the lymph nodes, and how and where they are involved. M is for metastases which are found at distant sites of the body.
	What would T1N0M0 mean?	This would describe a small localized tumor which has not yet spread to local lymph nodes or distance sites.
	What does T4N3M3 suggest?	This describes a large primary tumor with significant local invasion which has extensively spread to regional LNs and distant metastatic sites.
	Are low grade tumors well differentiated?	Yes.This means that the cells retain many of the appearances of the original tissue from which they derived. These tend to have slower growth rates and may be less invasive with diminished metastasis. High grade tumors would be the reverse of this.
	List three types of tumor markers.	PSA- prostate cancer CEA- carcino-embryonic antigen in colorectal cancer CA-125 in ovarian cancer.
	What is meant by stroma in cancerous tissues?	Malignant tumors consists of cancerous cells and other non malignant cells, and tissues in a tumor are called stroma.
	What is contained in stromal cells?	These include endothelial cells and fibroblasts which form a supportive framework which gives structure to the tumor itself. Fibroblasts produce fibrous tissue which is rich in collagen. This is what gives some tumors the hard feel and texture.
	What is a paraneoplastic syndrome?	These are clinical features which occurs in patients with cancer but are not readily explained by the actual presence of the tumor. Most paraneoplastic features are caused by bioactive compounds synthesized and released by malignant cells. Some patients have fevers, which are a result of pyrogens being released from the tumor.
	What are cytokines?	These are often produced by the body's macrophages. These macrophages can be activated by malignant disease to release cytokines such as tumor necrosis factor(cachexin) which induces cachexia.
	Can Cushing's disease result from oat cell carcinoma?	Yes. In this carcinoma of the lung, excess ACTH may be produced leading to increased release of hydrocortisone and consequent Cushing's disease.
	What are some other paraneoplastic effects/	Finger clubbing Skin rashes Peripheral neuropathy cerebral degeneration of the brain.
	A skin lesion which progresses and does not heal may be a basal cell carcinoma. True/False	True. Also known as a rodent ulcer. These grow locally, but rarely metastasize.
	Squamous cell carcinomomas are likely to metastasize than basal cell carcinomas. True/False	True.
	Can pale colored stools sometimes be associated with pancreatic tumors?	Yes. A possible growth or tumor on the head of the pancreas can obstruct bile ducts.
	What is the ABCDE rule for malignant melanoma?	A-Asymmetry B-Border C-Color D-Diameter E- Elelvation
	Breast cancer is dependent on ongoing stimulation by estrogen. True/False	True. Tamoxifen can block estrogen receptors on the breast derived cancer cells and remove the stimulating hormonal effect.
	Viruses have a typical diameter of about 30-100nm. True/False	True. There are a thousand nm in a um, and a thousand um in a mm.
	What does prokaryotic mean in terms of bacteria?	This means that the cell does not have membrane bound organelles, such as mitochondria or a nucleus. Eukaryotic and plant cells do. some bacteria can divide every 20-30 minutes.
	Mycoplasma are about the same size of normal bacteria. True/False	False. These organisms are about one third the size of bacteria. They typically cause pneumonia, opportunistic urethritis in men. It is a possible cause of pelvic inflammatory disease. Erythromycin and tetracycline are viable treatment options.
	What do Chlamydia, Rickettsiae, Ehrlichiae and Coxiella have in common with viruses?	They can only produce within a host cell. They do however, produce peptidoglycan cell walls as do bacteria. They are infrequently referred to as atypical bacteria. They havwe been treated with tetracycline and doxycycline.
	It is suspected that HIV originated from the simian immunodeficiency virus which affects primates. True/False	True. HIV-1 arose from chimpanzees and HIV-2 from sooty mangabey monkeys. HIV-1 was first identified in 1983. HIV-2 was identified in 1986.
	Why is HIV referred to as a retrovirus?	It contains an enzyme called reverse transcriptase. This enzyme takes RNA from the virus and codes it into DNA, which is then incorporated into the genetic material of the host cell.
	The HI virus comes into contact first with T cells. True/False	True. It binds onto a molecule found on the outer cell membrane called a CD4 receptor. It can only bind onto these receptors.
	What happens once the virus binds onto the CD4 receptor?	1. It inserts its own RNA into the cell. This RNA carries the genetic material of HIV which contains pertinent reproductive information to produce more viral particles. 2. From this RNA, the reverse transcriptase enzyme makes a copy of the viral genes in DNA.
	If you stab yourself with a dirty needle, what is the probability of acquiring an HIV infection?	It is about 0.3%. Should this occur, it is best to let the wound bleed as much as possible. Hot water will cause vasodilation and allow more blood to exit the wound.
	Should contaminated blood be splashed in the eye, what is the best thing to do immediately?	Eyes should be irrigated from the inside, pouring the water over the surface of the cornea. Eyes should be irrigated from medial to lateral aspect.
	In atherosclerosis, there is an accumulation of abnormal material called atheroma under the inner layer of the arterial wall. True/False	True. It is under the tunica intima.
	What is contained in an atheroma?.	An A. is fatty cholesterol based material which contains inflammatory cells, smooth muscle and connective tissues such as collagen. Its presence often involves the tunica media.
	What is cholesterol?	It is a steroid based molecule which is fat soluble. Some comes from the diet, the rest is made in the liver and intestine. It is found in cell membranes and steroid based hormones such as hydrocortisone and aldosterone.
	is cholesterol water soluble?	No. In fact, it is carried in the plasma via special transporter particles caleed high density lipo protein.
	HDL is a form of protective cholesterol. True/False	True. It takes cholesterol and fats from cell membranes in arterial walls and transports it, via the blood, to the liver.
	What occurs once the cholesterol is in the liver?	It is biochemically changed to make it less atherogenic.
	What is the function of LDL particles?	These transport cholesterol and fats from the liver, into the blood and increases the proportion of cholesterol and other lipids in the blood. Often called the " bad cholesterol".
	Define colic.	Colic occurs when smooth muscle walls of hollow structures such as the ureters, bile ducts, bowel or uterus contract spontaneously or due to some other cause.
	What are three factors that encourage thrombus formation?	1. decrease of blood vessel lining 2. Reduced rates of blood flow 3. Increased coagulability. These are called Virchow's triad.
	When is thrombus formation least likely to occur?	As long as the fibrous cap is intact and stable, thrombus formation is less likely to occur. Should the cap become unstable, thrombic formation is increased.
	What is a white thrombus?	As inflammatory processes thin the fibrous cap, fissures and ulcers may form which cause effective rupture of the cap. The blood is no longer separated from the thrombogenic core. As blood contacts the core, paltelet aggregation will be triggered. This is a white thrombus.
	What is a red thrombus?	The presence of white thrombus and continued exposure of the blood to the thrombogenic core can also cause the conversion of fibrinogen into fibrin. RBCs will stick to this resulting in a red blood clot or red thrombus. This can completely occlude the arterial lumen.
	Why do smokers produce more red blood cells?	This is so in order to compensate for the proportion of their hemoglobin which is inactivated by the presence of CO in the form of carboxyhemoglobin. despite their increased pcv, they have a reduced O2 carrying ability.
	What does it mean to prime an I/V set?	During priming, air is excluded from the system by running through the I/V fluid which is to be infused.
	Can emboli be caused by fat?	Yes. After some fractures, fatty material from bone marrow may leak into the circulation leading to fat embolism. It is most common after multiple fractures, and fractures of the pelvis or long bones.
	What is a dissecting aneurysm?	This occurs commonly in the aorta, especially the abdominal portion. Atheroma on the aortic wall causes pressure effects on the inner layers of the artery which slowly degenerates. A tear may develop in the inner layer of the artery (intima), allowing blood to penetrate into the weakened deeper layers. Blood then flows or tracts between the middle and outer third of the arterial media, dissecting the arterial wall.
	Where do berry aneurysms most commonly occur?	They frequently occur at the base of the brain called the circle of Willis. They are usually caused by congenital weakness in the arterial wall. They are a common cause of subarachnoid hemorrhage.
	Arterial or venous claudication is named after whom?	Claudication is named after Emperor Claudius, 10BC-54AD who had a limp.
	DVT is typically a late complication of surgery. True/False	True.Most incidences develop about 10 days after surgery. Other influencing factors are a history of chronic venous insufficiency, prolonged immobility, dehydration and obesity. Pregnancy and the puerperium(first 6 weeks after delivery), may be a risk factor as well.
	What are TED stockings?	Compression bandages such as thromboembolic deterrent stockings reduce the pooling of blood in the legs. Correctly designed and fitted, antiembolic stockings should give a graduated compression being highest at the bottom and reducing in pressure as they fit up the leg.
	Blood gases usually show a reduced PaO2 as is expected from the reduced blood flow through the lungs. True/False	True. However, the tachypnea will maintain the level of PaCO2 normal or below normal.
	What is the D-dimer test?	This test looks for the presence of degradation products from thrombi and emboli. V/Q scanning uses radioactive isotopes to study V which is ventilation of the lungs with air, and Q which describes the perfusion of blood through the pulmonary arteries.
	As the pulmonary circulation is occluded, blood will not be able to drain freely. True/False	True. They will not drain freely from the systemic veins into the right atrium. This will give rise to the distended neck veins seen in raised jugular venous pressure.
	What are communicating veins?	Blood is able to pass from the superficial to the deep venous system via shorter veins called communicating veins. These are also called perforating veins.
	What is the difference between a venous and arterial ulcer?	Chronic venous hypertension caused by venous insufficiency is the most common cause, these are venous ulcers. Ulcers may also be caused by chronic ischemia seen in peripheral vascular disease. These are arterial ulcers.
	What is normal venous portal pressure?	It is about 5-8 mm/Hg. in portal hypertension this may rise above 12mm/Hg. Increased venous pressure in the esophagus, can lead to esophageal varices. If these vessels break, this can lead to torrential blood loss.
	Venous hypertension can cause dilation of capillaries which permit RBCs to escape into the tissues. True/False	True. Over time this leads to a characteristic brown staining caused by the presence of hemosiderin, a breakdown product of hemoglobin.
	Quality of the arterial supply should be assessed how?	It should be assessed by the determination of the ankle brachial pressure index (ABPI). This assessment is vital as arterial ulcers must not get compression therapy.
	In a purely venous ulcer what will the ABPI be?	It will be greater than 0.8. In practice, some patients have venous and arterial insufficiency in a leg. This can result in both venous and arterial ulcer blood features.
	is there an available treatmrnt for venous ulcers?	Sometimes the administartion of oral flavanoids further increases the proportion of ulcers healed. This may be due to their antioxidant effect on harmful free radicals inside cells. Other possible considerations include the use of cultured skin replacement and oral pentoxifylline.
	What causes esophageal varices?	These occur in the walls of the esophagus.A common cause of this is fibrosis of the liver seen in hepatic cirrhosis. abnormal fibrous tissue present in the liver obstructs the entry of venous blood from the hepatic portal vein.
	Which structures form the portal vein?	It is formed by a union of the veins which drain the lower third of the esophagus, spleen, pancreas, gall bladder and most of the GI tract.
	How does portal venous hypertension result in esophageal varices?	As blood entry into the liver is partially obstructed in cirrhosis, a backup of blood in the venous portal system develops which gives rise to a portal venous hypertension. This eventually leads to varicosity in the veins of the lower esophagus.
	What are possible therapeutic approaches for esophageal varices rupture?	This includes fluid resuscitation, endoscopic variceal band ligation or balloon tamponade.
	Blood pressure=_____________________________	Cardiac output X Peripheral resistance
	Cardiac Output=_____________________________	Heart rate X Stroke volume
	A normal CO at rest is about how many litres?	It is about 5600 ml/min. Women generally have an output of about 10% lower. It is correlated with body surface area.
	Cardiac output is determined largely by venous return. True/False	True. This is Starling's law of the heart. The increased stretching in turn results in a stronger contraction of the myocardium to eject the increased blood volume.
	What is pulse pressure?	Pulse pressure is the difference between the systolic and diastolic blood pressures.
	What resultant effect does anerobic metabolism have on respiration?	In ischemic tissues this leads to an accumulation of CO2 and lactic acid, both of which can stimulate respiratory effort.
	When is oliguria often diagnosed?	It is diagnosed when urine output falls below 30mls per hour per kg of body weight. This will indicate reduced perfusion of the kidneys.
	What is generally considered to be the minimum required urine output in children?	It is about 1ml per hour per kg.
	What is compensated shock?	Compensated shock is sometimes described as nonprogressive. Here, the sympathetic and endocrine responses are able to maintain blood pressure at efficient levels.
	what is meant by " the golden hour" of shock?	This suggests that shock is a major cause of death after trauma. Poor tissue perfusion leads to irreversible chemical changes and tissue damage in the body, but these take about an hour to develop. Those in critical shock for more than an hour, are likely to succumb to the condition. this hour period is the golden hour.
	Early thrombolysis along with other reperfusion therapies are a key in preventing cardiogenic shock after infarction. True/False	True.
	one of the most common causes of infective cardiomyopathy is viral infection. True/False	True.
	Hemorrhage is the most common cause of shock in trauma patients. True/False	True. As an example,750mls of blood can be lost into the tissues from a fractured tibia or humerus. Up to one and a half litres of blood can be lost into the tissues from a fractured femur. Up to 2 litres can be lost from a fractured pelvis.
	Fluids and electrolytes are lost through a burned area as a result of increased rates of evaporation from exposed tissue fluids. True/False	True. Children with burns affecting 10% or more of body surface, and adults with 15% or more of burns require fluid replacement therapy.
	Fluid volume required=___________________	4mls X weight (kg) X % of burned area.
	With respect to fluid third spacing, what would be the first and seconf dfluid spacing regions?	The first and second fluid spaces are the intracellular and extracellular fluid compartments.
	Why does the pulse feels thready during hypovolemic shock?	When stroke volume is decreased, the volume of the pulse will also be reduced.
	Oral rehydration salts (ORS) are quite effective in rehydration. True/False	True. The most simple are made up of water, sugar, salt and some potassium. Mashed banana is a good source of potassium.
	Whata re crystalline fluids?	These fluids contain small molecules which tend to crystallize if removed from the water they are dissolved in. Examples are normal saline,, dextrose saline and Hartmann's solution (Lactated ringers). The small molecules in crystalloid fluids may pass out of the capillaries into the interstitial fluids, and into the intracellular fluid compartment.
	Large molecules are osmotic and so retain water in the blood increasing plasma volumes. True/False	True. This is why colloids are sometimes called plasma expanders. if a colloid increases venous return, this will increase cardiac output and blood pressure.
	Where may fluid be administered into, if it is difficult to locate a viable blood vessel?	A central line should be considered. Interosseous infusions, running fluids directly into a bone such as the tibis, may be used in emergency situations. I/V fluids should be warmed to 39 C before being administered. It is desireable to avoid hypothermic conditions.
	What is a desireable fluid to administer after significant hemorrhage?	Isotonic crystalline solutions should be given for initial fluid treatment. With more than 1.5 litres of blood loss, a transfusion should be considered.
	What is the 3 for 1 rule therapeutic protocol/	The patient should receive 3 mls of crystalloid fluid for every 1 ml of blood loss. Fluid replacement is usually tailored to individual needs.
	What are cytokines?	Cytokines are signal molecules released from cells. WBCs will release cytokines when they come into contact with bacterial derived components. Cytokines with bacterial toxins can severely injure many tissues and organs.
	What are six types of shock?	Cardiogenic Hypovolemic Obstructive Septic Allergic Neurogenic
	If a patient is suffering from meningococcal septicemia, I/V benzylpenicillin may be infused. True/False	True.
	Blood pressure may also be helped by administering inotropes. True/False	True. Drugs such as dobutamine, increase the force of cardiac contraction.
	Ananphyllactic shock is classified as a severe type of type 1 hypersensitivity. True/False	True.
	An inadvertent I/V dose of epinephrine may lead to ventricular fibrillation. True/False	True. Chlorpheniramine, hydrocortisone and salbutamol may also play an important role.
	What initially occurs in neurogenic shock?	It begins with a problem in the CNS. There is a reduction in sympathetic or an increase in parasympathetic outflow from the CNS.
	What is spinal shock?	Normally sympathetic nerves leave the spinal cord from level T1-L2. If this sympathetic outflow is disrupted, as in a spinal cord injury or high spinal anesthesia, the stimulation of the vagus parasympathetic nerve is unopposed.
	Atropine can be used for treatment of acute low blood pressure. True/False	True.
	Vasovagal syncope is also termed neuroregulatory or neurogenic syncope. True/False	True.
	Total child blood volume can be estimated as 80mls/Kg of body weight. True/False	True. A child of 6 months has an approximate blood volume of 500mls. At one year it can reach 750mls. At two years it can rise to 1 litre. Adults average about 5 litres of blood.
	What is primary hemorrhage?	This is bleeding which occurs at the time of injury. When a surgeon makes an incision, and bleeding immediately ocuurs.
	What are some complications of a tourniquet left on too long?	Healthy tissues in the limb will lose blood and O2 supply. Tissues distal to the tourniquet will convert to anarobic metabolism. As a result of this localized hypoxia, there will be accumulation of lactic acid and other metabolic waste products which cannot leave via the occluded venous drainage.
	With consideration to the above scenario, what can occur when the tourniquet is loosened?	The toxins that ahve accumulated enter the systemic circulation as a bolus. This could be life threatening.
	Why is alcohol contraindicated in hemorrhage?	Alcohol is a vasodilator.
	What is secondary hemorrhage?	This occurs as a result of infection complicating a wound.
	Bleeding from the ear may be a sign of what?	This could be a sign of a basal skull fracture. Loss of clear fluid from the nose or ears may be a sign of CSF leakage.
	What is hemoptysis?	This is the coughing up of blood.
	In an average 70kg man, blood volume is about 7% of body weight. True/False	True. If a person is obese, their blood volume should be calculated on what their ideal weight would be for their height. Adipose tissue does not have an extensive blood supply. In children, the blood volume is about 8-9% of body weight.
	What is Class 1 hemorrhage?	In class 1 blood loss, hemorrhage is less than 750mls, or up to 15% of total blood volume. Blood pressure should be normal in this class.
	What is Class 2 blood loss?	This represents blood loss of 750-1500mls or 15-30% of total blood volume. There will be compensatory tachycardia(100-120bpm). Respiration will rise to 20-30 breaths per minute.
	What is Class 3 hemorrhage?	This involves blood loss of 1500-2000 or 30-40% of total blood volume. Blood pressure will be dangerously low.
	What is Class 4 hemorrhage?	If more than 2 litres of blood are lost, about 40% of blood volume, death can quickly ensue unless immediate blood replacement is instituted.
	What are hematinics?	These substances assist in the formation of hemoglobin and RBCs. Iron, folic acid and vitamin B12 are hematinics.
	What is the approximate mean arterial pressure in the aorta?	It is about 100mmHg. It drops to about 90 at the junction of smaller arteries. in capillaries, the pressure may drop to about 32mm/Hg. As blood passes from the arterial end to the venous end, it will drop to about 12mm?Hg.
	Blood pressure in the arterial end is essential for the formation of tissue fluid. True/False	True. This is hydrostatic pressure. The reduced pressure at the venous end of capillaries allows for the reabsorption of tissue fluid.
	How is reabsorption facilitated/	It is facilitated by a plasma osmotic pressure of about 25mm/Hg, which is generated by plasma proteins.
	What is a reticulocyte?	These are immature RBCs, that have shed the nucleus. They are characterized by the presence of residual ribosomal material in their cytoplasm. They make up about 1 % of the total RBC count. Their numbers will likely increase in anemia and hemorrhage.
	P waves are generated by atrial depolarization. True/False	True. They are descriptive of atrial contraction.
	QRS complexes are generated by ventricular myocardial contraction. True/False	True.
	How are T waves generated?	T waves are generated by ventricular myocardial repolarization, and do not really represent active muscular contraction.
	What is stable angina?	This is termed stable because there is reduced coronary arterial perfusion as a result of fixed or stable areas of atheroma within the coronary arteries.
	With stable angina, at what point do patients start to complain about symptoms?	Patients usually complain when the coronary arteries are 75% occluded by atheroma.
	What specifically causes the pain in angina episodes?	Anerobic metabolism generates lactic acid as a waste product which accumulates in the myocardium. The presence of lactic acid is associated with pain.
	What is a standard treatment protocol for angina?	Sublingual glycerol trinitrate.
	What is Prinzmetal's angina?	Also called variant angina, this typically occurs when the patient is at rest as a result of coronary spasm. As only a section of coronary artery goes into spasm, the lumen is greatly reduced leading to an acute hypoperfusion of an area of myocardium. In these cases, an ST elevation is observed. This can occur in patients with little to no atheromatous plaques.
	What is Syndrome X?	A minority of patients complain of stable angina on exertion but have little to no atheromatous buildup. Occasionally, myocardial ischemia may be found. There might be some microvascular dysfunction.
	In a low risk unstable angina there is usually no release of troponin from the myocardium. True/False	True. In high risk unstable angina there tend to be higher levels of troponin detected in the blood. This is released from damaged myocardium.
	How long does it take for infarction to begin after vessel occlusion?	After a thrombus has occluded an arterial lumen, the affected area will be deprived of blood supply and irreversible cellular necrosis will develop 20-40 minutes after infarction.
	What is an inferior MI?	The right coronary artery curls around the back of the heart to supply blood to those areas. because the lower areas of the myocardium are affected by occlusion of the right coronary artery, the infarct is often called an inferior MI.
	can fever occur after an MI?	Yes. Several days after an MI, a low grade fever often occurs as a result of pyrogens being released from necrotic myocardial tissue.
	is ST elevation detectable after some MIs?	Yes. ST elevation occurs as a result of the occluded blood supply and the myocardial injury present in the acute stages of STEMI is quite pronounced.
	If there is a full thickness transmural infarct, are other changes in the ECG detectable?	Yes. The Q waves will widen and deepen. This change supports the cardiac condition.
	Troponins are released from damaged myocardium. True/False	True. These may be detected in the blood 4-6 hours or sooner, after high risk unstable angina. Raised levels of troponins may persist for several weeks.
	What is the most common type of measured troponin?	Clinically, this would be troponin type T, but type 1 may be used.
	What is another marker for MI?	CK (creatine kinase) and cardiac specific troponins are released into the circulation from the necrotic area of myocardium. These serve as markers.
	Normally, contraction of papillary muscles causes tight closure of the AV valves. True/False	True. As the left side of the heart is usually involved in MI, rupture of a left ventricular papillary muscle will lead to sudden onset of mitral incompetence.
	Patients who suffer AMI should be given 300mg of aspirin to chew. True/False	True. If the aspirin is left in the mouth, it will be absorbed more rapidly. This is because absorbed aspirin does not need to pass through the hepatic portal circulation and liver before reaching the systemic circulation.
	Is analgesia administered after an MI?	Yes. I/V diamorphine or morphine are used combined with a suitable antiemetic, such as metaclopramide. other drugs such as beta blockers and nitrates may also be considered. Post MI, ventricular fibrillation is always a possibility.
	Right heart failure may also be caused by acute or chronic lung diseases or pulmonary embolism. True/False	True.
	Blood pressure = CO X PR. True/False	True. As cardiac output falls there will be reduced perfusion of the kidneys. This causes activation of the renin angiotensin mechanism. This results in formation of angiotensin 2 which causes constriction of the systemic arterioles, also increasing afterload, ventricular workload and blood pressure.
	What is Orthopnea?	This is labored breathing upon lying down.
	What is Pulmonale?	This is pulmonary heart disease and describes right sided heart disease which is caused by pulmonary arterial hypertension.
	If part of the lung is well oxygenated, the blood supply to that area will increase to maximize the volumes of O2 which can be absorbed. True/False	True. However, if oxygenation of an area of lung is poor, perhaps due to infection, then there is no point perfusing that area with a lot of blood as there is no O2 to pick up.
	Ventricular tachycardia occurs when there is an ectopic electrical focus in the ventricular muscle. True/False	True. There may be a pulse, and therefore some CO.
	What is PEA?	Here, the electrical activity of the heart is relatively normal. The impulse is generated and propagated along the usual pathways from the SA node. Myocardial cells depolarize, but depolarization is not associated with contraction as normal. The ECG may appear normal. There is no central pulse.
	What are some causes of PEA?	Extensive MI Acute hypovolemia Cardiac tamponade Pulmonary embolism Hypothermia Tension pneumothorax. This condition used to be called electromechanical dissociation.
	What are the approximate pressures generated by the right ventricle in the pulmonary arteries/	It is about 25/8mmHg.
	Blood pressure= CO X PR. True/False	True.
	Low birth weight babies are more likely to become hypertensive as adults. True/False	True. This may be caused by fetal under nutrition affecting the development of the vascular system.
	Are African Americans more salt sensitive than other races?	Possibly. It is suggested that African populations, used to high temperatures and higher levels of sweating possess a salt thrifty gene that allows them to better conserve salt.
	Doses of alcohol over 21 units per week are associated with increased BP. True/False	True. All alcoholic drinks contribute to hypertension with the systolic BP being affected more than the diastolic. BP readings are also higher during a hangover due to an increased sympathetic response.
	Can higher potassium intake sometimes lower BP?	Yes. High potassium intake encourages more sodium excretion. Fruit and tea are good sources of potassium.
	What is metabolic syndrome/	Also called insulin resistance, is a collection of metabolic risk factors which promote the development of atherosclerosis. Dyslipedemia, hypertension, central abdominal obesity and hyperglycemia are the most widely recognized components of the syndrome.
	Hyaline means transparent. True/False	True.
	Hyaline arteriosclerosis develops and reduces the blood supply to the glomeruli. The rigidity caused by this presence of the hyaline means the blood flow to the glomerulus can no longer be regulated by vasoconstriction or vasodilation. True/ False	True.
	The state of retinal vessels is generally a good indicator of the condition of the vessels in other organs, such as the heart, kidney and brain. True/False	True.
	What are thiazide type diuretics?	Thiazide diuretics such as bendroflumethiazide promotes moderate diuresis which will have the initial effect of reducing total plasma volume.
	What are some other drugs used for hypertension?	Angiotensin 2 receptor antagonists, alpha blockers and vasodilators such as hydralazine or minoxidil.
	What is Cryptic asthma?	This is a form of intrinsic asthma. An external cause is not known. These cases usually start in adult life. Salbutamol is usually given for bronchodilation. O2 is required in the very severe cases.
	In severe attacks adding ipratropium bromide provides further bronchodilation. True/False	True. Steroids may be used to abate inflammation.
	What typical organisms can cause pneumonia?	In addition to streptococcus pneumoniae, it may be caused by other organisms such as Mycoplasma, legionella or Mycobacterium turberculosis. S. aureus can cause a severe form of pneumonia.
	What is PCP pneumonia?	This is caused by a protozoa and is often found in immunocompromised patients.
	A principle pathophysiological process in pneumonia is called consolidation. True/False	True. This means to make solid. In lobar pneumonia this affects a lobe and in bronchopneumonia, the process is patchy over both lung fields. here the capillaries exude inflammatory fluid. Dilated capillaries allow fibrinogen and red cells to escape into the bronchioles and alveoli.
	COPD usually includes two common disorders which occur together. What are they?	This would be chronic bronchitis and emphysema. Chronic asthma and bronchiectasis are also included in this group of disorders.
	What is bronchiectasis?	This refers to chronic dilation of the bronchi and is usually caused by chronic inflammation of these airways. Tbc is the most common global cause.
	Can chronic inflammation result in a change of tissue lining in the airways?	yes. This is called metaplasia. The normal ciliated columnar cells are replaced by non ciliated squamous cells.
	Can the chronic presence of smoke particles cause inflammation?	Yes. This process will attract neutrophils and macrophages. These will ingest the smoke particles, but can also release harmful digesting enzymes such as proteases, including elastase by neutrophils which destroy healthy tissue as well.
	Why is exhaling difficult in edematous conditions?	As expiration begins, the lack of air pressure from the alveoli causes the bronchioles to collapse. The effect is increased by external pressure on bronchioles from surrounding hyperinflated alveoli.
	A normal chest is twice as broad as it is deep. True/False	True.
	What is emphysema?	This condition describes a loss of alveolar elasticity with a permanent enlargement of the air spaces due to destruction of the alveolar walls.
	In emphysema, macrophages secrete a group of proteases. True/False	True. One of these proteases is elastase, which digests elastin. Normally, it is the presence of elastic elastin which gives the alveoli their elastic properties.
	Emphysematous patients are able to maintain relatively low levels of CO2 in the blood, and so preserve the sensitivity of the medulla oblongata to CO2. True/False	True. This means that when CO2 levels do increase there is massive stimulation of the respiratory center, which stimulates respiratory effort. These patients seldom develop pulmonary heart disease.
	Is it accepted that giving long term O2 therapy at home in severe respiratory conditions prolongs life?	Yes. This is usually given via a nasal cannula at a flow rate of 2 litres minute. Blood O2 saturation levels should target about 90% or above.
	What is the intradermal injection challenge of turberculosis?	The development of specific immunity can be demonstrated by a positive localized inflammatory reaction if some proteins from turbercle bacilli are injected intradermally. This is the basis of the turberculin Mantoux skin test. The result of antibody production and he development of cellular immunity is that most(90%) of primary infections resolve.
	What is BCG vaccination?	A harmless bovine form of turbercular bacteria can be grown on potatoes. This can then be injected to promote the development of cellular immunity to tbc and forms the basis of the BCG vaccination.
	Why does the BCG injection leave a scar?	It leaves a scar due to the presence of the attenuated turbercular bacteria that produce a small turbercle in the skin where they are injected. A turbercle also develops in the lymph nodes of the axilla. This individual should have about 70% increased resistance to tbc infection in the future.
	What are some of the treatment protocols for tbc?	The WHO guidelines the use of rifampicin, isoniazid, pyrazinamide, ethambutol and streptomycin. Compliance is the key to success.
	Bronchial carcinoma is the second most common form of primary cancer in the west. True/False	True.
	How is bronchial carcinoma classified?	It is classified as small cell or non small cell. Small cell(oat cell) accounts for about 20% or more cases of bronchial carcinomas. This form is highly associated with tobacco smoke.
	What are Kulchitsky cells?	The cells which become malignant in small cell disease are endocrine neurosecretory, and called Kulchitsky cells. They are found in the bronchial lining. Despite this form being malignant, it does respond to chemotherapy.
	Briefly describe non small cell carcinomas.	These include tumors which arise from and are composed of several other types of cells, the main ones being squamous adenocarcinoma and large cell. Large cell carcinomas cause about 15% of all bronchogenic carcinomas.
	When do histologists use this larg cell classification?	They use this when the malignant cells are not squamous or glandular and have been shown not to be small cell. around 80% of patients will die within a year of diagnosis. Diaphragm paralysis can occur if this tumor spreads to this muscle and its surrounding region.
	Is cystic fibrosis considered a genetic disease?	Yes.It is an autosomal recessive, caused by a defective gene on chromosome 7.
	When does the disease actually present?	It presents when a child is homozygous, i.e. it has 2 copies of the CF gene. defective genes cannot produce normal proteins.
	What is the name of the abnormal protein in CF?	It is called cystic fibrosis transmembrane regulator (CFTR) protein.
	In what ethnic group is CF most common?	It is most common in caucasians. It is very rare in African Americans and even rarer in Asians.
	Where is CFTR protein located/	It is located in the membranes of epithelial cells. In the airways, this protein normally exports chloride from inside the cells, into the respiratory lumen. In CF this process is inhibited.
	What is the result of reduced secretion of chloride?	Reduced secretions of chloride also result in reduced levels of sodium in bronchial secretions. Bronchial secretions become dehydrated. Secretions are too viscous. CF is also called mucoviscidosis.
	Are other organs of the body affected by this disorder?	Yes. Pancreatic secretions are also too viscid. This prevents normal drainage of of digestive enzymes from the pancreas into the duodenum. These plugs cause progressive atrophy, destruction and secondary fibrosis of the digestive enzyme producing exocrine tissue. This results in a poor digestive process.
	Is steatorrhea common in CF?	Yes. This condition describes, bulky, greasy, offensive stools which contain undigested fat. Pancreatic fibrosis may occur, leading to diabetes mellitus in some older patients.
	Are gall stones common in CF?	yes. Gall bladder secretions become viscous. hepatic cirrhosis has also been noticed along with hepatic hypertension. About 97% of males are infertile, due to viscous secretions causing atrophy and fibrosis of the seminal vesicle ducts.
	Is it true that CF patients taste salty when kissed?	Yes. This is because they excrete more NaCl from their sweat glands.
	A reliable test for CF is gauging the quantity of salt excreted from sweat glands. True/False	True. Their excretions may in fact contain 2-5 X more NaCl than found in non CF patients.
	The common cold is also called acute coryza. True/False	True.
	Influenza B causes a milder form of the disease and occurs in local outbreaks. True/false	True. Influenza A causes more severe disease and may spread globally, causing a pandemic.
	O2 is present in the air at a concentration of 20.84% and is required by the mitochondria. True/False	True. Significant volumes of O2 cannot be stored in body tissues. This is why people need a constant supply. As a cell loses its energy supply it is no longer able to pump sodium out of the cell. Water also accumulates within the cells causing them to swell. These cells can recover if O2 supplies are quickly replenished.
	What is meant by extrinsic hypoxia?	This condition describes inadequate oxygenation of the lungs for extrinsic reasons, that is outside the lungs.
	Can extreme altitude cause death?	Yes. Clinically, the 2 presentations are pulmonary edema and cerebral edema. These conditions are called HAPE(high altitude pulmonary edema) and HACE (high altitude cerebral edema). Both of these conditions can be fatal.
	Which conditions may result in hypoventilation?	Neurological conditions causing paralysis, such as myasthenia gravis and Guillian Barre syndrome. It may occur after an elapid snake bites. Elapids are snakes such as cobras, mambas and krates. These bites result in defective neuromuscular transmission, so respiratory muscles will lack motor innervation.
	Some patients receiving muscle relaxing drugs may need to be maintained by artificail positive pressure ventilation. True/False	True.
	Can opioid drugs induce respiratory depression?	Yes. Opioid drugs were originally based on sap from opium poppies. Currently used examples are morphine, diamorphine, alfentanil and pethidine.
	What is Naloxone?	Naloxone is an opioid antidote. The dose of it should be titrated for each patient in order toachieve sufficient respiratory response. An initial dose may be 100-200 micrograms, I/V. It also reverses the analgesic effects of opioids as well as respiratory depressant effects.
	What is flail chest segment?	When several ribs are fractured at the same time, especially if some ribs have 2 or more fractures. This can lead to an area of chest wall which is not mechanically secured to the rest of the chest wall.
	What is stridor?	This describes the abnormal sound generated as air passes a partially occlusive obstruction in the airway.
	if there is tongue blockage of the pharynx due to lack of tongue and pharyngeal innervation, what is an appropriate therapeutic emergency procedure?	The jaw thrust maneuvre. This is done by placing the forefingers of both hands behind the angle of the mandible(lower jaw) and pulling the mandible forward. This will move the tongue forward, away from the airway. The recovery position is engaged (lying on side) to prevent the tongue from from falling backwards.
	What can be done if there is an obstruction above the level of the larynx?	For those appropriately trained, a cricothyroidotomy. This is done by making an opening through the center og the cricothyroid cartilage, above the cricoid cartilage.
	For the first 6 months of life, babies can only breathe through their noses. True/False	True. (Obligate nose breathers)
	in the space between between the visceral and parietal layers on the lungs, there is a slight negative pressure and some lubricating serous fluid. True/False	True. The negative pressure sucks the two pleural membranes together and so ensures lung expansion when there is chest or diaphragmatic expansion.
	What is a pneumothorax?	Air in the pleural space.Penetrating chest trauma will cause a traumatic pneumothorax and a pathological lesion in the pleural membranes will cause a spontaneous pneumothorax.
	A collapsed lung can be restored to normal function if the foreign material is removed from the pleural space. True/False	True. The foreign material is usually air. This is acheived using a chest drain. A plastic drainage tube is inserted between the pleural membranes, into the pleural space, and air is drained out.
	How can one prevent air from being sucked backed in the pleural space?	A valve is attached to the drainage tube. One can form a valve by placing the end of the tube under water forming an underwater sealed drain. These drains can be removed after a few days.
	What is anemic hypoxia?	Even if the atmospheric air is clean and fresh, and the lungs are functioning normally, tissues can still be hypoxic. This can result from impaired O2 delivery by the blood. If there are not enough RBCs, sufficient O2 cannot be brought to cells.
	What is stagnant hypoxia?	Sluggish circulation(stagnant hypoxia) may occur in congestive heart disease or shock.
	What is the ductus arteriosus?	It is a special fetal artery which connects the pulmonary artery with the aorta. blood ejected from the fetal right ventricle enters the pulmonary artery with the aorta, but instead of going o the lungs, it passes through the ductus arteriosus into the aorta to join the systemic circulation.
	What is histotic hypoxia?	Occasionally, even if a normal quantity of O2 arrives at cells, the cells are not able to utilize the O2 in the process of tissue respiration. This is what occurs in cyanide poisoning.
	How does cyanide work?	It blocks the enzyme which catalyzes the last reaction of this process, so it prevents all energy generation.
	What is O2 flux?	The flow of O2 from lungs to the tissues is described as O2 flux. O2 flux= cardiac output X arterial O2 saturation X hemoglobin concentration X 1.39. 1.39 is the volume of O2 in mls carried by 1 gram of hemoglobin.
	Is O2 flux increased by increasing CO?	Yes. Increasing oxygen saturation or the amount of hemoglobin in the blood, will also increase O2 flux.
	Hypoxia results in cerebral vasodilation. True/False	True.
	In normal physiology, the basic stimulus for respiration is a decrease in the amount of CO2. True/False	False. It is an increase in the amount of CO2.
	What causes central cyanosis?	This is caused by hypoxemia and is seen in the center of the body in areas such as the lips, tongue, face, neck and chest
	When is cyanosis clinically apparent?	It is likely apparent when the O2 saturation has dropped to 85%. Clinical cyanosis is not present until there is 5g of deoxyhemoglobin per 100mls of capillary blood.
	Severe hypoxia with saturations below 65% will lead to coma. True/False	True. Convulsions and death may also follow if immediate treatment is delayed. Neurons are very prone to hypoxic damage. They require a constant supply of O2 in order to metabolize glucose.
	In emergency situations an hour or two on pure O2 is likely safe for most people. True/False	True.
	What are the effects of prolonged O2 inhalation?	O2 can in fact be toxic. After 4-5 hours on high concentrations over 50%, there can be respiratory features, such as cough, reduced clearance of sputum and decreased vital capacity. Accumulation of free radicals causes pulmonary endothelial and macrophage damage. Pulmonary edema and death will follow. O2 retinopathy is more common in young children.
	What is the considered the 5th vital sign?	Pulse oximetry monitors oxygen saturation in blood. This is often considered the fifth vital sign.
	How is O2 saturation measured?	Oxygen saturation(SaO2) is measured as a percentage of blood which is 100% saturated with O2. Saturations as recorded using oximetry are referred to as SpO2. S is for saturation, and p indicates it is measured in the periphery of the body.
	What is the normal range for O2 saturation?	It ranges from 95-100%. 97% is often quoted as a normal figure. If it drops below 94%, the patient is considered hypoxemic. Venous blood has a typical O2 saturation of 75%.
	How does oximetry work?	1. Oximetry probes have 2 sides which are positioned over the site to be monitored. 2. One side has a light emitting diode which shines a red and an infrared light. These two lights pass through the finger and are picked up by detectors in the other half of the probe. 3. These detectors measure the intensity of the light that has passed through the finger, and from this a microprocessor is able to calculate how much of each form of light has been absorbed. 4. These lights are diversely absorbed by oxyhemoglobin and deoxyhemoglobin. The machine is able to calculate the proportions of oxygenated and deoxygenated hemoglobin. 5. PO is able to differentiate between the pulsatile blood in arteries and arterioles from the smoothly flowing blood in capillaries, venules and veins.
	Two diode POs are unable to compensate for the presence of carboxyhemoglobin. True/False	True. Saturation readouts may be inaccurate in cases of CO poisoning. Even small amounts of carboxyhemoglobinin the blood can cause an oximeter to overestimate O2 saturation. CO in the blood may result in a false readout of 100%.
	Finger nail polish or other pigments on the nails or skin may distort the results of PO. True/False	True.
	What are upper motor neurones?	These are nerve pathways which start and control movement. These are located in the brain and spinal cord.
	What are lower motor neurones?	These carry impulses from the spinal cord via peripheral nerves to the muscles. In motor neuron disease there is no involvement of the sensory neurones which continue to function normally. occasionally, MND is also called amyotrophic lateral sclerosis(Lou Gherig's disease)
	What is the exact cause of multiple sclerosis/	An exact cause is not known, but the presence of activated T lymphocytes in areas of CNS inflammation suggests an autoimmune mechanism.
	MS is rare at the equator, but becomes more common in people who live nearer to the poles. True/False	True.. Environmental factors have long been suspected.
	What happens in MS?	There is loss of the myelin sheath, which normally protects, insulates and nourishes nerve fibers. Myelin is necessary for normal nerve transmission.
	Are peripheral nerves affected in MS?	No.These nerves are not affected in MS. It is limited to the CNS, and the optic nerve.
	In the peripheral nervous system, how is myelin surrounded?	It is surrounded by Schwann cells. In the CNS it is formed by oligodendrocytes. It is a disease of the oligodendrocytes.
	What awas the old name for MS?	It was disseminated sclerosis because the areas of hardened plaques are found in various parts of the CNS.
	What are the three forms of MS?	1. Relapsing and remitting 2. Primary progressive 3. Secondary progressive. Relapsing and remitting appears to be the most common form.
	in health, spread of brain electrical activity is inhibited by the action of inhibitory synapses. True/False	True. These reduce the transmission of electrical activity between adjacent neurones.
	In epilepsy, these inhibitory synapses fail to occur. True/False	True. When large groups of nerve cells are switching on and off together in this way, it is called hypersynchronicity.
	In primary generalized epilepsy, most seizures probably originate in the area of the diencephalon. True/False	True. This area contains fibers which communicate upwards to both cerebral hemispheres, explaining why the seizure begins synchronously throughout the cerebral cortex.
	What is meant by a partial seizure?	The abnormal electrical activity is restricted to a localized(focal) area of the brain. If the abnormal electrical activity is confined to a part of the left cerebral hemisphere, the clinical features will be limited to part of the right side of the body.
	What is a complex partial seizure?	In partial complex there is disturbance of awareness. before the attack begins there may be an advent called an aura. (period that the seizure is about to begin). an aura is usually a sensory experience such as a characteristic smell, taste in the mouth or tingling.
	What is a Jacksonian seizure?	This is a partial motor seizure. There is involuntary jerking movements, often beginning in the thumb and fingers. These then spread to affect the limbs on one side of the body. Consciousness is usually preserved.
	What are absence seizures?	These used to be referred to as petit mal fits. The person appears to be absent for a short time, often just a few seconds. These almost always present in childhood. patients start staring into space.
	what is Status epilepticus/	In this form, repeated epileptic fits occur one after another without recovery of consciousness between seizures. These are a medical emergency and can a carry a risk of death from cardiac or respiratory failure.
	What is Guillian- Barre syndrome?	GB syndrome develops 1-4 weeks after a viral infection which is often not in itself serious. gastrointestinal campylobacter is also known to be a cause in some people.
	What is the pathophysiology of GB syndrome?	It is caused by an acute inflammatory demyelinating polyneuropathy. Many peripheral nerves become inflammed and stop functioning normally. Both motor and sensory nerves are involved.
	What are the three most commkon forms of bacterial meningitis?	1. Meningococcal 2. Streptococcal 3. Hemophilus meningitis. Viral meningitis may present a similar symptomatic form, but is usually less serious.
	What is Kernig's sign?	Neck and back stiffness and a positive Kernig's sign(inability to extend a leg with the hip joint flexed without extreme pain, develop within a few hours of feeling unwell. The patient will not be able to curl up enough to touch their nose on their knees. These signs are generated by the stretching of the inflammed meninges and the muscle guarding this produces.
	How is clinical meningitis usually treated?	It can be immediately treated with benzylpenicillin, prior to arriving at the hospital. In the hospital, a lumbar puncture is performed, which is often diagnostic.
	What is found in the CSF upon puncture?	It may reveal a cloudy cerebrospinal fluid with increased numbers of monocytes and neutrophils. protein levels might be elevated.
	What is Hib?	This is the hemophilus vaccine. This will not protect the individual from all forms of meningitis. The meningococcal vaccine is effective against serogroups A and C.
	People who come into close contact with those affected with meningococcal infections should be given a short course of prophylactic rifampicin or ciprofloxacin. True/False	True.
	In Alzheimer's disease, there is a general loss of neurones resulting in a cortical atrophy. True/False	True. This is most notable in the parietal and temporal lobes. Loss of brain tissue also also leads to enlargement of the ventricles. Brain tissue is replaced by cerebrospinal fluid.
	Are amyloid deposits found int the brain?	Yes. There are extracellular deposits of abnormal amyloid found in the brain. This is a protein that accumulates in tissues.
	Where else is amyloid found/	It is also found in numerous senile neurotic plaques which are surrounded by damaged neurones. Amyloid may also damage blood vessels in the brain.
	What are neurofibrillary tangles?	Within the cytoplasm of abnormal neurones are pathological structures called neurofibrillary tangles. In a normal cell there is an internal framework composed of microtubules. These contain the protein tau. In AD these proteins get intertwined causing affected cells to die off. Severity of the disease depends on the number and distribution of these plaques.
	In AD, what might be responsible for memory loss?	Reduction in production of acetylcholine. Multi-infarct dementia might be a cause of other forms of dementia.
	What is Lewy body dementia?	Lewy bodies are collections of abnormal protein found inside neurones.
	What are some other forms of dementia?	Pick's disease Creutzfeldt-Jacob Huntingdon's disease
	What is the pathophysiology of Parkinson's disease/	In the substantia nigra and basal ganglia, there is progressive death of cells which produce dopamine. The substantia nigra is a strip of dark pigmented cells located in the midbrain and the basal ganglia are collections of nerve cell bodies located near the base of the cerebrum.
	What is the function of the substantia nigra and basal ganglia?	They modify motor activity initiated by the motor cortex. They are also involved in maintenance of muscle tone, posture and making fine adjustments to movements. These structures comprise the extrapyramidal motor system.
	What does the pyramidal motor system consist of?	It consists of the nerve pathways which arise in the motor cortex and pass directly through the midbrain, pons and medulla in the bundle of motor fibers called the medullary pyramids.
	The extrapyramidal system involves the passage of motor impulses through the basal ganglia and substantia nigra where they are modified. True/False	True. However, these extrapyramidal tracts do not pass through the pyramids of the medulla. This system needs dopamine to function normally.
	Why is bradykinesia a common finding in Parkinson's disease?	The dopamine producing neurons in the substantia nigra have an indirect effect on the function of the motor cortex.
	The characteristic Parkinsonian tremor is present at rest. True/False	True. It has a frequency of 4-7 Hertz or cycles per second. As the extrapyramidal system is involved in control of fine and precise movements, the tremor may be seen as an abnormality of this control mechanism, again, caused by the lack of dopamine.
	What is Levadopa?	This is a medication often used in the management of PD. It is a precursor to dopamine. A potential side effect of levodopa is that it can produce excessive movements and hallucinations. Anticholinergic agents may have a place in early therapy.
	What are the two main types of stroke?	Thromboembolic and hemorrhagic. Thjromboembolic is the most common cause of stroke.
	Emboli from the left side of the heart can pass into the cerebral circulation via the aorta and account for about 20% of thromboembolic strokes. True/False	True.
	Which cerebral artery is most often occluded as a result of embolism?	The middle cerebral artery. This artery carries much blood from the circle of Willis to large areas of the brain.
	There is an internal capsule in both hemispheres of the brain. What is their function?	These capsules carry nerve fibers between the cerebral cortex and brain stem. All of the motor fibers from the motor cortex pass through this capsule. All of the sensory fibers travelling to the sensory cortex also pass through the internal capsule.
	Hemorrhagic stroke caused by intracerebral (within the cerebrum) bleeds account for about 10% of cases. True/False	True. Bleeds may occur as a result of a ruptured aneurysm, which is a weakness in the wall of a blood vessel. Large bleeds may result in raised intracranial pressure, shifting of intracranial contents and death from coning.
	Are there other forms of strokes that are not truly considered thromboembolic or hemorrhagic?	Yes. These may be caused by cerebral hypoperfusion, subarachnoid hemorrhage and subdural or extradural hematoma.
	What is meant by a stroke in evolution?	There may be a sudden onset(several minutes) of focal neurological deficit. features may continue to develop over the next few hours. This is a stroke in evolution. usually the clinical features reach a maximum after about 6 hours, when the stroke is considered to be completed.
	A stroke affecting the left side of the brain will cause neurological deficit on the right side of the body. Why is this so?	As most nerve fibers cross over at the level of the medulla oblongata, this tends to be the case. This is also true conversely.
	What is dysarthria?	An impaired ability to generate speech is called dysphasia. Other patients know what they want to say but find it difficult to articulate words as a result of loss of motor function. This is termed dysarthria. Dysphagia(difficulty swallowing) is also common after a stroke.
	What are the Corona radiata?	From the cerebral cortex(both motor and sensory) numerous fibers pass down into the white matter of the brain. These fibers are called projection tracts(corona radiata).
	What anatomically occurs to all of the fibers in the corona radiata as they continue to descend?	They are all collected together in an internal capsule to be carried through the brain to the brain stem. Most nerve fibers cross over at the level of the medulla oblongata, before communicating with the body via the spinal cord.
	Specialist stroke units now give thrombolysis to suitable patients as soon as the diagnosis of thromboembolic stroke is confirmed. True/False	true. This is done usually by CT or MRI. Thrombolysis is conttraindicated in a hemorrhagic stroke.
	In thromboembolic stroke aspirin started within 48 hours has been demonstrated to improve the long term outcome. True/False	True.
	what is a subarachnoid hemorrhage?	There is spontaneous bleeding into the subarachnoid space which means blood enters the cerebrospinal fluid. Most of these bleeds occur from small berry aneurysms which develop on the circle of Willis. Other bleeds can occur from arteriovenous formations.
	What is a coup injury of the brain?	External forces cause the skull to accelerate rapidly and impact on the area of brain below the point of contact. This results in in injury to the underlying area of the brain.
	What is a contracoup injury to the brain?	When the inside of the skull hits the brain, this force also causes the brain to accelerate rapidly causing it to hit the inside of the skull on the opposite side of the head. This causes the brain to decelerate rapidly leading to further primary injury.
	What is a concussion?	This describes a reversible loss of cerebral function with or without a period of unconsciousness. Mild concussion is caused by some diffuse stretching of the white matter caused by sheering forces, which leads to a reversible disruption in the function of some axons.
	What is a classic cerebral concussion?	This is caused by diffuse axonal injury(DAI) which results in some disconnections between the brain stem reticular activating system and the cerebrum. The patient will be unconscious as the RAS generates consciousness. Patients may be unconscious for 24 hours or more.
	What is secondary brain injury?	This describes any further damage to the brain which occurs after the initial trauma.
	What can occur if there is an increase in the concentration of CO2 in the blood perfusing the brain?	This can lead to a significant cerebrovascular vasodilation with a consequent increase in cerebral blood flow. Excess CO2 will be carried away as a result of the increased blood flow. This vasodilation also protects the brain against acidosis as CO2 combines with H2O to form carbonic acid.
	Considering the above scenario, how would this change in patients with head injuries/	The increased blood flow may also contribute to cerebral edema and raised ICP. Adequate ventilation must be assured to maintain lower levels of CO2.
	What is cerebral perfusion pressure?	The pressure of blood flowing through the brain is termed the CPP. This is determined by the mean arterial blood pressure and the resistance encountered as a result of intracranial pressure. CPP=MABP - ICP.
	What is an extradural hematoma?	This is a collection of blood external to the dura mater. It collects between the dura and the skull. This usually results by rupture of the middle meningeal artery as a complication of a skull fracture.
	What are the most common sites for an extradural hematoma?	The temporal or temporal-parietal regions. all intracerebral hematomas can be clearly seen using CT or MRI scanning. Ligation of the bleeding vessel is an appropriate therapy.
	What is a subdural hematoma/	This is a blood clot which develops under the dura mater, just above the arachnoid mater. This usually occurs as a result of severe head trauma. These may develop from 48hrs to 2 weeks after the initial injury.
	What is raised ICP?	ICP decscribes the pressure within the cranial cavity. This is usually about 10mm/Hg.
	As ICP rises there is a corresponding reduction in the Glasgow coma scale. True/False	True. Lumbar puncture is contraindicated in cases of raised ICP as it can cause a sudden release of pressure below the level of the foramen magnum. if the ICP is raised sufficiently this can push or force brain tissue down into the foramen magnum causing coning.
	An increase in the pressure within one cerebral hemisphere will compress the oculomotor(111 cranial) nerve on the affected side. True/False	True.
	What is the tentorium?	The tentorium is an infolding of dura mater which is composed of tough, supportive fibrous tissue. Its function is to support the delicate lobes of the cerebrum above and covers the cerebellum below.
	The area of the cranial cavity above the tentorium is called the_________________________ and the area below, occupied by the cerebellum and brain stem is called the ___________________________ region.	Supratentorial, Infratentorial
	What is a tentorial herniation?	If a hematoma continues to expand, the pressure in the supratentorial space will also increase. This will push part of the cerebrum down into the infratentorial space. This is a tentorial herniation.
	What else can result as a consequential increase of pressure below the level of the tentorium?	A part of the cerebellum will be forced or pushed into the foramen magnum. This will further compress the brain stem and its vital centers.
	What is meant by the term "coning"?	If the intracranial pressure above the tentorium increases, eventually the tentorium will fail to retain the cerebrum and part of the temporal lobe will be forced through to the infratentorial area normally occupied by the cerebellum and brain stem.
	What are the consequences of coning?	The pressure on the cerebellum will be increased and may force part of it down through the foramen magnum which will compress the medulla oblongata. This part of the stem has vital centers such as cardiac, respiratory and vasomotor centers as well as part of the RAS. Brain stem death results.
	What is tonsillar herniation?	The part of the cerebellum which is forced into the foramen magnum is the cerebellar tonsils. This is tonsillar herniation. When the cerebellar tonsils herniate through the foramen magnum, they compress vital centers in the medulla oblongata. This is coning because the herniating brain tissues are forced into a cone shape..
	What are the two forms of thyroid hormone?	The two forms are T3 and T4. Tri-iodothyronine and tetraiodothyronine respectively. T3 is more active in stimulating metabolic processes.
	What is Goitre?	This term describes a chronic enlargement of the thyroid gland. This causes a swelling in front of the neck. It can occur in both hypo and hyperthyroidism.
	Are most goitres toxic?	No. Many goitres are non-toxic, that is not associated with the features of hyperthyroidism.
	Simple goitres are are about 8 times more common in women then in men. True/False	True. Dysphagia(difficulty swallowing) and inspiratory stridor from tracheal compression may occur as consequences. occasionally, venous congestion of the head and neck can occur. if there is compression of the recurrent laryngeal nerve, the voice can become hoarse.
	In some parts of the world, there is a deficiency of iodine in the diet, which can result in hypothyroidism. True/False	True.
	What is the relationship between levels of thyroid hormone and thyroid size?	As the levels of thyroid hormone drop, the anterior lobe of the pituitary gland produces more thyroid stimulating hormone (TSH). Increased TSH stimulates the growth of the thyroid gland.
	What is Hashimoto's thyroiditis?	In the majority of cases antibodies to thyroid tissues may be found in the blood. This indicates that the disease has an autoimmune basis.
	What is secondary hypothyroidism?	This is much less common than the primary form and is caused by a disorder of the pituitary gland resulting in a lack of THS or reduced secretion of TSH releasing hormone from the hypothalamus.
	What is myxodema?	In hypothyroidism, In the skin there is a change to the matrix or ground substance which occupies the intercellular spaces(ground substance is composed of proteoglycans). This substance retains more water and the patient develops a form of edema called myxodema. This is the typical puffy, boggy appearance.
	Hyperthroidism is also referred to as thyrotoxicosis. True/False	True. Grave's disease(Robert Graves) is the most common cause of hyperthyroidism and has an autoimmune etiology.
	What is the autoimmune pathogenesis of Grave's disease?	A group of B lymphocytes secret an IgG which fits into, and stimulates the TSH receptors naturally present on the cell membrane of the thyrocytes which synthesize thyroid hormones. These antibodies have an agonist effect on TSH receptors.
	Is exopthalamus only seen in Grave's disease?	Yes.This highly typical sign is caused by inflammation in the tissue lining the orbit and of the extraocular muscles which move the eyeball. Fibrosis may result.
	What causes this fibrosis?	This fibrosismay be caused by the stimulation of local fibroblasts by abnormal thyroid stimulating antibodies.
	All forms of hyperthyroidism can result in lid lag. True/False	True. Here, there is a delay in moving the eyelid as the eye moves downwards. This feature is caused by increased sympathetic stimulation of the muscles in the eye lid.
	In hyperthyroidism, blood tests show increased plasma concentrations of T3 and T4 with T3 being the more sensitive marker. True/False	True.
	What are some typical antithyroid drugs available for treatment?	Carbamizole or Methimazole. These drugs inhibit the formation of thyroid hormones. Radioactive iodine involves giving iodine 131 which is radioactive. It is taken up by the gland and emits radiation which eventually destroys thyroid tissue. Subtotal thyroidectomy is also occasionally performed.
	Benign neoplasms may develop in the thyroid gland. True/False	True. These overgrowths of thyroid tissue usually cause the gland to secrete increased volumes of thyroid hormones and may cause hyperthyroidism. These are considered toxic nodules.
	Hyperthyroidism, caused by toxic nodules does not cause exopthalamus, because they are not abnormal thyroid stimulating antibodies present as in Grave's disease. True/False	True.
	What is Addison's disease?	Named after Thomas Addison, this rare disorder causes the patient to not secrete enough of the adrenal cortical hormones, such as cortisone and aldosterone. Most cases are autoimmune in nature.
	What are some clinical features of Addison's disease/	These may include skin pigmentation, anorexia, weight loss, postural hypotension and weakness.
	What treatment is usually given for Addison's disease?	Fludrocortisone is given to replace the absent or reduced aldosterone.
	What is Cushing's syndrome?	Named after Harvey Cushing, this condition describes an increase in the volumes of glucocorticoids(hydrocortisone)
	Excess alcohol consumption can generate a Cushing's like appearance but is not the disease itself. True/False	True.
	Most non iatrogenic cases of Cushing's are caused by what?	Most are caused by increased secretion of ACTH from the pituitary gland from a pituitary adenoma. Rarer cases may be caused by a hormone secreting tumor in the adrenal cortex.
	What are some clinical features of Cushing's disease?	Weight gain with central obesity, thinning of the skin, a rounded moon face, and change in facial appearance. Also, hypertension and striae are commonly noticed. Long term affects may result in chronic hypertension, heart failure and myocardial infarction.
	What are some treatment protocols for Cushing's syndrome?	This involves in controlling the disorder with drugs such as metyrapone and ketoconazole.
	What is Pheochromocytoma?	Increased amounts of catecholamines in the blood tends to occur from time to time to paroxysmal clinical features. There is an exaggerated stimulation of the sympathetic system. Increased blood pressure in the kidneys leads to increased excretion of sodium in the urine which may result in postural hypotension.
	What is the word route meaning of Diabetes?	This relates to large volumes of urine(dia means through and betes means to go. A large quantity of water goes through the body.
	The genetic information to synthesize insulin is carried on chromosome 11. True/False	True. This codes for the synthesis of insulin which is a 51 amino acid protein.
	Does insulin stimulate protein metabolism?	Yes. It also increases the transport of amino acids into cells and stimulates their synthesis into proteins. Its presence also prevents the breakdown of proteins.
	Insulin promotes the synthesis of fatty acids. True/False	True. These are then transported via blood lipoproteins to adipocytes for storage. This occurs when more CHO is consumed than is needed as CHOs are converted to fatty acids in liver cells.
	A lack of insulin allows fat to be released from adipocytes. True/False	True. These will be returned to the blood. Once in the blood, the fatty acids and glycerol may be used by most of the body cells as an energy source. This mechanism permits fat reserves to be used to maintain metabolic processes during times of food shortage.
	In poorly controlled diabetes mellitus, how might this affect fatty acid levels?	In insulin lack, patients will have chronically high levels of fatty acids and glycerol in the blood resulting in hyperlipidemia. This is why insulin lack leads to atheroma development.
	In healthy individuals, blood glucose levels are usually within the range of 3.5-8 mmol/L. True/False	True. The normal fasting range is 3.5-5.8.
	What are GLUT proteins?	Glucose enters most cells via specialized transporting gates. These are specialized transmembrane structures called glucose transporter proteins(GLUT proteins). These will come to the surface of the cell if insulin first binds to insulin receptors.
	What is gluconeogenesis?	This involves the chemical change of molecules derived from fat and protein in order to synthesize essential glucose.
	App. how much glucose does the average brain use each day?	The adult brain consumes app. 100g of glucose per day. The brain is unable to use other fuels such as fatty acids, it functions only on glucose.
	DM may occur as a side effect of steroid or thiazide diuretic treatment. True/False	True. Occasionally, throtoxicosis or Cushing's syndrome can cause DM.
	Why can diabetic mothers give birth to larger than normal newborns?	Glucose from the mothers blood passes into the fetal blood resulting in fetal hyperglycemia. This is detected by fetal beta cells which respond by increasing the production of insulin. Insulin promotes growth by stimulating protein synthesis. The growing fetus will become larger as a result.
	What is the etiology of DM type 1?	It is accepted as an autoimmune progressive disorder mediated through T lymphocytes(type lV hypersensitivity). A viral component(Coxsackie) has been speculated as a possible pathogenetic cause.
	What would a pancreatic biopsy show on the pancreas under this condition?	It can show the presence of lymphocytes, natural killer cells and activated macrophages with inflammatory edema in the pancreatic islets.
	Autoantibodies have been detected in the blood of 90% of newly diagnosed patients. True/false	True.
	Is there a possible relationship between DM and milk?	If some babies are exposed to cow's milk some of the bovine serum albumin can be directly absorbed into the baby's blood leading to increased susceptibility. The gut is partially permeable to non digested proteins in the first year of life. These proteins can trigger the production of antibodies which may go on to attack the beta cells.
	Are patients with type 1 diabetes at more risk for other autoimmune diseases?	Yes.This can explain the increased incidence of celiac disease, pernicious anemia, adrenal or thyroid insufficiency and vitiligo. Vitiligo are white skin spots. Melanocytes are lost in these areas.
	For most people, the renal threshold is 11mmol/L of glucose per liter of blood. True/False	True. This suggests that plasma concentrations greater than 11mmol/L will result in the appearance of glucose in the urine. In fact, about 1% of the normal population will demonstrate glucosuria with normal serum levels of glucose. perhaps they have renal threshold for glucose.
	Why do diabetics who are poorly managed tend to lose weight?	Insulin promotes protein synthesis, so if it is absent less protein will be built up into muscle. It also prevents protein breakdown, so if insulin is absent, more protein will be broken down. This will reduce the amount of protein present in the body.
	As glucose is not transported across cell membranes, cells are obliged to employ fatty acids as a fuel rather than glucose. True/False	True. This tends to deplete fat reserves, resulting in weight loss. stored fatty acids are also converted to ketone bodies which can also be used by mitochondria to produce energy.
	What are ketone bodies?	This is a collective term used to describe acetone and 2 organic keto type acidic compounds which are produced as a result of excessive fat metabolism.
	As the body cells are unable to utilize glucose, stored fatty acids are converted into ketone bodies which are used a s a fuel by the mitochondria, in place of the glucose they would prefer. True/False	True. Ketosis is normal in starvation, when the body is forced to use stored fats as an energy source.
	Acetone is a volatile substance and some is blown off in the expired air from the lungs. True/false	True. This gives the breath an acetone odor. It is fruity in odor.
	What is ketoacidosis?	As two of the ketone bodies produced by excessive fat metabolism are acids, the acidity of the patients blood will increase as the pH falls. This is ketoacidosis.
	How might the body compensate for ketoacidosis?	The respiratory center initiates hyperventilation. This can lower blood acidity by reducing levels of carbonic acid as a result of exhaling more CO2. This gives the patient a form of air hunger (Kussmaul respirations).
	What is the HbA1C test?	This is a method of diagnosis. a blood sample is taken to determine how much glucose has been absorbed into the hemoglobin in the RBCs.The higher the average levels of blood glucose, the more will be absorbed into the hemoglobin. This is glycosylated hemoglobin. a value higher than 6.6% is very suggestive of DM.
	What is metabolic syndrome?	Type 2 DM is often associated with other medical conditions. There may be dyslipidemia with low levels of protective HDL and increased levels of LDL cholesterol and triglycerides. Hypertension and obesity are also present. This is also called insulin resistance syndrome.
	How are small blood vessels and capillaries affected in poorly controlled DM?	In poorly controlled DM, the basement membrane thickens and becomes rigid. Loss of elasticity in arterioles and capillaries means that the blood flow is not smoothed out by the expansion and relaxation of elastic walls.
	What occurs in Nephrotic syndrome?	In this condition, large quantities of protein are lost in the urine resulting in a lowered osmotic potential of the blood plasma which can lead to edema formation. As glomerulosclerosis develops, the glomeruli are progressively lost leading to decreased renal function and eventual end stage renal failure.
	In most western countries, diabetic nephropathy is the most common cause of end stage renal failure. True/False	True.
	What is diabetic neuropathy?	Part of the cause of diabetic peripheral neuropathy is damage to Schwann cells which form the myelin sheath around peripheral nerves. Demyeliation may occur as a result. progressive fiber degeneration can be expected.
	Heart failure may be directly caused by glycosylation of heart muscle proteins. True/false	True. Glycosylation describes the addition of sugar molecules to proteins and lipids.
	Migration of phagocytes is inhibited by high levels of glucose in tissue in tissue fluids. True/False	True. This reduces the efficiency of this important part of the immune process. Microvascular basement membrane thickening decreases blood and O2 supplies to areas of injury and infection, reducing the efficiency of the immune response.
	What is likely to be the most common cause of hypoglycemia?	Over administration of insulin. It can be an iatrogenic disorder. Exercise and alcohol also lower blood glucose levels. It is more common in patients that have systemic infections, due to the increased metabolic requirements of fever generation.
	How do the sulphonylureas work?	These medications stimulate insulin secretion from the remaining functioning beta cells.
	How do the Metformin type drugs work?	These are biguanides. They have a hypoglycemic effect by reducing the amount of glucose generated and released from the liver by inhibiting the process of gluconeogenesis.
	Regarding the avoidance of hypoglycemic attacks, it is advised to keep blood glucose levels above 4mmol L. True/False	True. Before meals glucose levels should be below 7 and below 10mmol L after meals.
	What is anemia?	It is defined as a reduced level of hemoglobin in the blood. Normal levels of Hb are 13.5-18g/dl for men and 11.5-16.5 for women. There is constitutionally a reduced O2 carrying capacity of the blood.
	What is a hemolytic anemia?	There is an increased destruction of RBCs and hemoglobin by the reticulo-endothelial macrophage system, which occurs in the spleen.
	In cases of low iron, the cells which line the duodenum are able to increase the amount they absorb. True/False	True.
	Can Hookworms cause an anemic condition?	Yes. Yes. They bite into the lining of the GI tract and consume blood. It can be treated with Mebendazole.
	Iron in the body can be stored in combination with a protein called ferritin. True/False	True. Blood testing for plasma ferritin levels is a specific test to check for iron deficiency.
	How can the physical size of RBCs be examined?	The size can be detected using the mean corpuscular cell volume(MCV). This is notable when the MCV is below 80fl(fentolitres).
	In anemic cells, what causes the typical pale hypochromic color?	This is the result of a reduced amount of Hb in red cells. This observation is supported by a mean corpuscular hemoglobin(MCH) of less than 27pg(pictograms) per red blood cell.
	With iron deficiency, anemia, there is also more variation in the shape and size of red cells. True/False	True.
	When is microcytic anemia usually observed?	It is also seen in sideroblastic anemia, anemia of a chronic phase and in thalassemia.
	How is anemia treated?	The cause of the anemia should be identified and treated. Oral iron in the form of ferrous sulphate is a standard treatment.
	What is a megaloblastic form of anemia?	It is a large immature RBC(MCV>100fl).
	What is intrinsic factor?I	ntrinsic factor is produced by the gastric parietal cells(oxyntic cells) which also produce HCl acid. Vitamin B12(extrinsic factor) combines with Intrinsic factor in order to facilitate the absorption of V. B12 in the small intestine.
	What is Pernicious anemia?	In this autoimmune disorder, antibodies are produced against the parietal cells and often to the intrinsic factor. The result is a deficiency of intrinsic factor. HCl acid secretion will also be reduced(achlorhydria). This condition in occurrence increases with age.
	Vitamin B12 and intrinsic factor are absorbed into the cells lining the ileum. True/False	True. Here both factors are separated and the B12 fraction is systemically absorbed into the hepatic portal vein.
	What is one way of treating pernicious anemia?	Hydroxocobalamin is given via IM injection. Once corrected, patients usually need 1 mg(1,000mcg) every 3 months indefinitely.
	About 65% of Aplastic anemia cases are idiopathically acquired. True/False	True. There is no known trigger. It is possible that the blood producing stem cells in the marrow are attacked by the body's own cytotoxic T cells.
	Are any secondary causes of aplastic anemia known?	Exposure to ionizing radiation, such as from X rays, or nuclear waste and fallout. These agents can affect fast dividing cells, such as those found in the bone marrow. Chemicals such as benzene and some insecticides are a known risk. Chloramphenicol, an antibiotic, has been considered a risk factor.
	What is hereditary spherocytosis?	In this autosomal dominant disorder, there is a genetic abnormality of a protein which forms the cytoskeleton of the RBCs. Spherocytes are quite rigid and are destroyed at an accelerated rate by macrophages in the spleen.
	What is G6PD deficiency?	This is glucose 6 phosphate dehydrogenase. This is an X linked genetic disorder. Females tend to carry it and males suffer from it. Hemolytic episodes are a result of this, and it can be easily triggered by certain foods, especially fava beans. Black African and Mediterranean peoples appear to be over represented by this disorder.
	What are the main classifications of Thallasemia?	Alpha and Beta Thalassemia. This classification comes from the particular structural globin molecular chains affected. The alpha form is most prevalent in Meditteranean areas. The Beta form is most common in Southeast Asia.
	What causes the anemia in Thalessemia?	The anemia is caused by reduced hemoglobin synthesis, the presence of abnormal hemoglobin and increased destruction of RBCs in the spleen and liver. Splenomegaly and hepatomegaly is a common sequela.
	Bone marrow transplantation has been successfully used to treat Thalassemia. True/False	True.
	What is Mechanical hemolytic anemia?	Sometimes RBCs are broken up by mechanical forces. Prolonged marching or running. When the foot hits the ground, some red cells on pressure bearing surfaces under the foot are crushed. A sufficient and consistent event can result in hemoglobinemia. Hemoglobinuria can result as well.
	When does Hemolytic disease of the newborn occur?	This arises when a mother is Rh negative and a the father is Rh positive. The Rh gene is dominant, the baby will express Rh positivity. some of the baby's blood cells will enter the mothers circulation. The mothers immune system will produce Rh factor antibodies. This occurs during the first few days after delivery of the first born.
	Regarding HDN, what if the mother becomes pregnant a second time?	Some of her Rh factor antibodies migrate across the placenta into the fetal circulation. This results in agglutination and hemolysis of fetal RBCs. hepatic enlargement causes reduced liver function.
	How does reduced liver function affect blood osmotic activity?	As albumin is synthesized in the liver, levels of this osmotic protein in the blood drop.This reduces the osmotic potential of the plasma and so tissue fluids are not effectively reabsorbed. Edema results. Affected babies are jaundiced due to RBC breakdown products such as bilirubin. About 20% of these babies die without treatment.
	How is HDN treated?	This problem is usually prevented by giving Rh negative mothers a Rhesus immune globulin. This has antibodies to the Rh factor. if given shortly after birth, this results in agglutination of the Rh positive fetal cells within the mothers circulation before they have had enough time to sensitize her immune system. This prevents the formation of maternal Rh antibodies. The preparatios Rhogam or anti D. The D factor is the most antigenic component of the Rh factor.
	What occurs in Sickle cell disease?	In this autosomal recessive condition, there is an abnormal form of hemoglobin called hemoglobin S present in RBCs. When this abnormal hemoglobin deoxygenates, it changes the erythrocyte into a sickle shape.
	Are sickle cells always sickle in shape?	Toward the end of their life. Initially the sickle shaped cells return to being biconcave discs when they are reoxygenated, but after several cycles they become rigid and fixed in the sickle position.
	Sickle cells are more adherent to the endothelial lining of small blood vessels. True/False	True. This increases the risk of occlusive complications.
	Is bone pain common in true sickle cell diease?	Yes. The clogging of small vessels in the bone marrow also leads to acute, very severe pain in some bones. As many of these cells pass through the spleen, they will be phagocytosed by macrophages resulting in hemolytic anemia.
	Progressive destruction of the spleen leads to reduced immunity in sickle cell patients. True/False	True. These patients are prone to infections, especially Strep. pneumoniae or meningitis.
	What is Sequestration crisis?	This results from a sudden pooling of red cells, especially in the spleen and liver. As blood pools, there is less left for the systemic circulation and death may occur as a result of acute hypovolemia. Acute sickle chest syndrome is the most common form of death.
	The oral cytotoxic agnet, hydrocarbamide has been shown to reduce the occurrence of acute chest syndrome and episodes of pain. True/False	True.
	What is a sideroblast?	A sideroblast is an imature RBC found in the bone marrow. In sideroblastic anemia these cells accumulate an abnormal ring of iron around the nucleus. this results because there is ineffective heme synthesis, leaving excess iron in the sideroblast. These are seen in bone marrow samples. The end result is that mature RBCs lack hemoglobin, resulting in microcytic hypochromic red cells as is seen in iron deficiency.
	Is Sideroblastic anemia genetic?	It may be genetic, primary or acquired. Acquired causes include lead poisoning, alcohol abuse or myeloid leukemia.
	What is anemia of chronic disease?	This is a milder form of anemia and is frequently seen in patients who have chronic infections, malignant or inflammatory diseases, such as rheumatoid arthritis.
	What are some conditions where one might see chronic anemia?	Tbc endocarditis osteomyelitis. There is an abnormality of iron metabolism and storage with reduced levels of erythropoietin. Despite there being normal or even increased reserves of iron in the form of ferritin there is a functional deficiency.
	Oxygen saturation probes cannot differentiate between between oxyhemoglobin and carboxyhemoglobin. True/False	True. O2 pulse oximetry saturations may appear falsely normal.
	What is Hemophilia A?	Hemophilia A is an X chromosome linked, recessive genetic bleeding disorder.It affects about 1/5,000 males. It is caused by a mutation in the normal gene which codes for factor V111 on the X chromosome. Factor V111 is one of the 12 essential clotting factors.
	What is the treatment for Hemophilia A?	This consists of giving infusions of factor V111 to compensate for the deficiency.
	What is the half life of factor V111?	It is about 12 hours. In mild cases the levels of factor V111 may be stimulated by giving synthetic vasopressin.
	Is it now possible to clone for factor V111?	Yes.
	What is Christmas disease?	This is a type of Hemophilia B. This is caused by lack of factor 1X. Von Willebrand's disease is caused by a lack of a type of factor V111 and defective platelet function.
	Vitamin K, like others functions as a cofactor or coenzyme. What does this mean?	This means that vitamins are essential to facilitate specific biochemical reactions. Vitamin k is an essential cofactor for the synthesis of 4 of the clotting factors which are produced by the liver.
	Neonates have little vitamin k at birth. True/False	True. They are usually given some after birth. In adults the form of vitamin K which is best absorbed is synthesized by bacteria living in the colon.
	In disseminated intravascular coagulaion, extensive tissue injury or damage to the vascular endothelial lining triggers off the lotting cascade. True/False	True. This results in the generation of large amounts of fibrin within the blood vessels.
	What is leukocytosis?	Neutrophils are the most abundant form of granulocytes and an increase in circulating neutrophils is termed leukocytosis or neutrophilia.
	When is leukocytosis likely to happen?	It can occur in response to bacterial or fungal infections and tissue damage caused by trauma, surgery, burns or infarction.(cardiac). High inflammatory conditions and Hodgkin's lymphoma may result in this condition.
	Are there still other factors that can cause neutrophilia?	Yes. It is seen after administering corticosteroids, during exercise and in pregnancy.
	When is basophilia seen?	Normal blood has very few basophils. It may be seen in allergies, some infections, malignant and inflammatory conditions.
	What is the main form of leukemia that is seen in children?	Acute lymphoblastic leukemia.
	In the bone marrow, mitosis and differentiation, pluripotent cells divide into myeloid or lymphoid stem cells. True/False	True. Lymphoid stem cells, differentiate, via the blast cell stage, to form natural killer, B or T lymphocytes.
	Where do myeloid leukemias derive from?	Myeloid leukemias derive from the myeloid stem cell line and results in the production of numerous immature granulocytes, erythrocytes or thrombocytes. Leukemias may be acute or chronic.
	What are the broad four types of leukemias?	1. Acute myeloid leukemia(AML) 2. Acute lymphoblastic leukemia(ALL) 3. Chronic myeloid leukemia 4. Chronic lymphocytic leukemia(CLL).
	In normal blood there are about 700 times more RBCs than white cells. True/False	True.
	What is a Hickman line?	It is a central venous catheter.
	What are the 9 anatomical locations of the anterior abdomen?	1. Right hypochondrium- upper right side of abdomen 2. Epigastric -region above the navel 3. Left hypochondrium- upper left side of abdomen 4. Right lumbar- region just right of the navel 5. Umbilical- region of the navel 6. Left lumbar- region just left of navel 7. Right iliac fossa- Lower right region below navel 8. Hypogastric- Region just below navel 9. Left iliac fossa- Lower left region below navel
	If there is sufficient upper GI irritation, there will be stimulaton of the two vomiting centers in the medulla oblongata. True/False	True. These areas will activate the vomiting reflex. Vomiting may also occur by stimulating the chemoreceptor trigger zone. This area more specifically responds to toxins in the blood to initiate vomiting. Motion sickness may stimulate this zone as well.
	What is Steatorrhoea?	This term describes the presence of excessive fat in the stools(stear means fat)
	What is non water soluble fiber?	This is made of cellulose and found in cereals. water soluble fiber is found in fruits and vegetables and oats. Both forms add bulk to feces. This permits efficient peristaltic movement of material along the lumen of the GI tract, especially through the colon. Plenty of fluids help this process as well.
	What is Ascites?	This is a collection of fluid in the peritoneal space, the potential space between the parietal and visceral peritoneum membranes becomes an actual fluid filled space.
	When do dental caries occur?	Caries is latin for rotten. It usually occurs in the presence of a type of bacteria called Streptococcus mutans and dietary sugar.
	How do caries cause tooth decay?	As bacteria(Streptococcus) metabolize, they produce organic acids as waste products which are therefore also in close contact with enamel.
	When do Strep species usually colonize the mouth?	They probably colonize the mouth during early childhood. They can come from the mouths of parents or playmates. Saliva with a pH of 6-7, it is able to decrease the acidity of waste organic acids if it comes into contact with them.
	Why does sugar increase the risk of caries/	Sugar tends to thicken plaque and renders it impervious to saliva. saliva cannot come into contact with the tooth surfaces.
	What is Periodontitis?	This is a common cause of tooth loss in adults. It describes inflammation of tissues surrounding the tooth root. Plaque can build up between the tooth and gum(gingiva) causing gingivitis(inflammation of the gums).
	What is Barret's esophagus?	Barret's is an example of a metaplasia. Meta means change and plasia refers to tissues. Barret's esophagus is associated with a 30 fold increase in esophageal cancer.
	What are the two forms of esophageal cancer?	1. Adenocarcinoma 2. Squamous cell carcinoma
	What is adenocarcinoma of the esophagus?	Adenocarcinoma, affects the lower distal end of the esophagus and usually arises from a Barret's condition.
	What is Squamous cell carcinoma of the esophagus?	Squamous cell carcinoma usually affects the upper two thirds of the esophagus and is more associated with drinking hot fluids, alcohol and tobacco consumption.
	The duodenum is the most common site for peptic ulceration. True/False	True. After this structure comes the stomach and esophagus. The risk of duodenal ulcers(not gastric) is 30% higher in people with blood type O.
	What causes stress ulcers?	These probably result from ischemia of the stomach and duodenum. The sympathetic response reduces blood supply to the gut and redirects it, to the heart, lungs and essential organs.
	What is Virchow's node?	A mass sometimes is palpated in the epigastric area. Sometimes there is a palpable lymph node just above the clavicle. This is Virchow,s node. This develops as lymphatic fluid carrying malignant cells drains via this lymphatic node, before entering the venous circulation. A finding in gastric cancer.
	Helicobacter pylori is a major causative factor in cancer of the stomach. True/FalseTr	ue.
	What are the two forms of inflammatory bowel disease?	Crohn's disease Ulcerative colitis
	Where is Crohn's disease observed?	It can affect any area of the GI tract, however, most lesions are seen in the distal ileum and colon.
	Where is Diverticular disease observed?	This disorder may affect any part of the colon, but is most common in the sigmoid and descending colon regions.
	What is a diverticulum?	This is a blind ended pouch which herniates through the wall of a hollow or tubular organ. feces can collect in these pouches, resulting in accumulation of bacteria and subsequent inflammation. If they are present and cause no issues, it is referred to as diverticulosis. If inflammed, it is diverticulitis.
	What is a fistula?	A fistula is a tubelike pathological communication which develops between two organs or an organ and the surface of the body.
	What happens if there is a perforation of a fistula?	This will allow colon contents into the peritoneal cavity resulting in a potential abscess formation or peritonitis. These should be treated with metronidazole and a cephalosporin.
	Why is red meat sometimes considered a risk factor for colon cancer?	Processed red meat may carry carcinogenic amines formed during cooking.
	Although adenomatous polyps are benign in themselves, they have the potential to develop from adenomas into adenocarcinomas. True/False	True.
	What is Duke's classification in colorectal cancer?	In Duke's stage A(D-A)-the tumor is limited to the mucosa and submucosa and submucosa. When it has penetrated through muscle layers, this is stage B, stage C is more advanced disease with malignant spread through the wall of the colon and lymphatic involvement.
	What is stage D Duke's of colorectal cancer?	Here, the condition is complicated by distant metastases to sites such as the liver.
	The rectum and sigmoid areas are the most common sites of colon cancer. True/False	True. However, any area of the colon can be involved.
	What usually causes acute appendicitis?	This is usually caused by a fecolith obstructing the lumen of the appendix. Swelling around the neck of the appendix is another cause. The wall of the appendix has lymphoid tissue.
	When does intussusception occur?	It usually occurs in young children, usually at the ileocecal junction between the large and small intestine.
	What is a volvulus?	Sometimes a length of bowel may twist around on itself. This is known to occur in the region of the sigmoid colon.
	What is colic?	Vigorous peristalsis above the obstruction initially leads to increased bowel sounds and colicky pain. It is pain from a hollow structure such as the bowel.
	What causes pain in a condition of colic?	Anarobic netabolism(no O2) causes the formation of lactic acid which accumulates in the tissues of the gut wall causing pain.
	What is hepatic conjugation?	Hepatocytes take up bilirubin and join it to a chemical called glucoronic acid. This is conjugation and it increases the solubility of bilirubin to allow excretion in the bile.
	What happens after bilirubin has been conjugated?	It enters the bile ducts and passes into the gall bladder to be stored and concentrated. Once in the bile ducts the bilirubin is oxidized and turns green. This green bile pigment is called biliverdin.
	Why do bruises(contusions) turn yellow as they fade?	The yellow color of bilirubin explains this.The dark colored red cells, trapped in the tissue spaces as a result of the hemorrhage are gradually phagocytosed by macrophages. First, the Hb from the RBCs is degraded into heme pigment and globin components. The heme molecules are destroyed by macrophages leaving the yellow pigment bilirubin.
	A healthy liver can excrete up to 6 times the normal load of bilirubin before the pigment starts to accumulate in the blood. True/False	True.
	Due to reduced liver cell function conjugated and unconjugated bilirubin accumulates in the blood. True/False	True. The swelling of hepatocytes may partially occlude some of the small bile channels, resulting in a obstructive component of the jaundice. Damming back of bile allows this conjugated bilirubin to enter the blood.
	Is conjugated bilirubin soluble?	Yes. Some of it is excreted by the kidneys in urine. This gives the urine a darl color and the bilirubin is easily detected using ward based dipsticks. Bile will not be able to color feces if it cannot enter the duodenum. The result is pale colored feces.
	hepatitis B is caused by a specific DNA based hepatitis B virus(HBV) sometimes called the Dane particle. True/False	True.
	Can Hepatitis D virus exist independently?	No. It can only replicate in the presence of Hep. B virus. hepatitis E is an RNA virus that produces an illness similar ti HAV.
	What is a unit of alcohol equal to?	A unit of alcohol is app. 8 grams or 10ml of pure alcohol. A litre of wine at 10% alcohol by volume would have 100 mls of ethanol(ethyl alcohol), representing 10 units. One unit is roughly the amount of alcohol in a single whiskey, a small glass of sherry, or a small glass of table wine.
	Consumption of about 4 units will result in a blood alcohol level of about 80mg per 100/mls of blood. True/FalseTr	True.
	What are the delirium tremens?	Sudden withdrawal of alcohol in continuous drinkers results in DT. There is anxiety and tension, hand tremors, insomnia, seizures, hallucinations, tachycardia, hypotension, vomiting, diarrhea and fever.
	Why is there a strong relationship between alcohol and fatty liver syndrome?	In the presence of alcohol liver cells are able to take up fatty acids normally. This means fat accumulates within the hepatocytes. The fat inside the cells results in swelling increasing the size of the liver.
	What is Steatosis?	This term describes fatty infiltration of the liver.
	What occurs in liver cirrhosis?	In cirrhosis, fibrous tissue accumulates within the liver, converting the normal hepatic architecture into structurally abnormal fibrous nodules.
	What is the pathogenesis of cirrhosis?	Around liver sinusoids(capillaries) stellate cells are presentin the space of Disse. This is the tissue fluid filled space between the sinusoids and the hepatocytes.As a result of injury, the hepatocytes and Kupffer cells(liver macrophages) release cytokines which activate the stellate cells. Once activated, the stellate cells proliferate and produce collagen which is in fibrous tissue.
	Does a non alcoholic fatty liver disease exist?	Yes. Yes. This is associated with affluence and high fat diets.
	Clinical hepatic failure develops when 80-90% of liver function is lost. True/False	True.
	Reduced numbers of functional hepatocytes will reduce the ability of the liver to take up and conjugate bilirubin. True/False	True. Also cirrhotic fibrous tissue within the liver can compress and obstruct bile ducts.
	Cirrhosis is the most common form of portal hypertension. True/False	True. The presence of fibrous tissue within the liver obstructs blood flow.This prevents the free entry of blood from the hepatic portal vein. As there is a backup of blood within the HPV, the pressure is increased, resulting in hypertension of the portal system.
	What physiologically follows with portal hypertension?	This leads to an increase in pressure within the vessels draining the GI tract and spleen. It can also cause esophageal varices, ascites, hepatic encephalopathy and hypersplenism.
	As the veins in the lower part of the esophagus drain into the hepatic portal vein, portal hypertension will increase tghe pressure in these veins. True/False	True.
	It is albumin which generates most of the plasma osmotic pressure. True/false	True.In hepatic failure, the liver cannot synthesize normal volumes of albumin. The result is lower olasma osmotic pressure.
	In liver failure, the kidneys excrete less sodium. True/falseT	True. This will increase the amount of sodium in the plasma.
	In normal physiology, the majority of the blood draining from the GI tract passes directly through the liver via the hepatic portal circulation. True/False	True.
	What happens to portal blood in portal hypertension?	The poratl blood is diverted directly into the systemic venous drainage. Blood having bacterial waste products does not go directly to the liver for detoxification, but enters the blood allowing the toxins to circulate to the brain where they act as neurotoxins. Untreated cases may result in hepatic coma.
	What is Liver flap?	If the encephalopathy affects the motor areas of the brain, a liver flap can be present.This describes a tremor of the wrists extended in dorsiflexion. Levels of ammonia are increased in patients with this condition.
	Ammonia is a potent neurotoxin. True/False	True. It is generated as a result of protein metabolism and the action of bacteria on proteins in the gut. As proteins have nitrogen, metabolism of amino acids results in the production of some nitrogen as a metabolic waste product. Some of the nitrogen reacts with water to form ammonia which is NH3. The liver normally converts ammonia into urea, which is considerably less toxic.
	Despite encephalopathy can this condition be reversed?	Occasionally it is. This is done using lactulose and antibiotics such as neomycin. This antibiotic is poorly absorbed, so most of it remains in the lumen of the gut. It kills much bacteria, which means that less ammonia and toxins are produced.
	How does lactulose work?	Lactulose works by reducing the pH of the contents of the colon. This acidity neutralizes the ammonia, which is strongly alkaline. As the ammonia is neutralized, there is less to enter the blood.
	As the hepatic portal system also drains the spleen, portal hypertension will cause this organ to become congested with blood. The spleen increases in size. True/False	True. This is splenomegaly.
	What exactly is meant by hypersplenism?	In portal hypertension the spleen is congested and blood will flow through it very slowly. This allows the spleen more contact time with the blood, so it is more able to remove blood components than it normally does. It may remove too many RBCs, platelets and some WBCs resulting in anemia, poor blood coagulation and immunological deficits.
	What is Hepatorenal syndrome?	This describes renal failure which develops secondary to hepatic failure. There will be a reduction in renal blood flow with a reduction in glomerular filtrate rate.
	What is Hepatopulmonary syndrome?	This condition describes the reduced pulmonary function which may present in cirrhosis.
	Can men develop gynacomastia?	Yes. Some male hormones called weak androgens are also converted into estrogen like molecules in peripheral tissues. As a result of raised estrogen levels men can develop breast enlargement.
	Increased levels in the blood of estrogens may explain spider angiomas(spider nevi). True/False	True. Palms of the hands can appear red, also called liver palms).
	What is fetor hepaticus?	This may be noted in advanced liver failure. There is a characteristic smaell of the breath, often described as sweetish or musty. The odor arises from the metabolic waste products of intestinal bacteria which are no longer broken down by the failing liver.
	What is the pathogenesis of gallstone formation?	Normally cholesterol is soluble in bile due to the presence of the bile salts and phospholipids. if the proportions of cholesterol increase, or the amounts of bile salts and phospholipids decrease, cholesterol will become supersaturated and start to precipitate out, resulting in crystal formation.
	Can gall stones form in the common bileducts?	It is possible this can occur after cholecystectomy, but it is a very rare condition.
	Increased concentrations of lactic acid lead to the pain described as biliary colic. True/False	True. Treatment of biliary colic should be started with I/V opiate analgesia. Patients should not eat so as not to stimulate gallbladder contractions.
	About 90% of gall bladder malignancies are adenocarcinomas. True/False	True. About 10% are squamous carcinomas. Local invasion involves the bile ducts, liver and associated lymph nodes.
	How is Trypsin formed?	Trypsinogen is produced in the pancreas. once it enters the duodenum, the enzyme enterokinase converts it into the active protein digesting form called trypsin.
	Why can pancreatitis be an autodigestive process?	In the pancreatic ducts, bile may activate pre-enzymes into their active forms. Reflux of duodenal contents into the pancreatic ductwill also prematurely activate pancreatic enzymes. These enzymes begin to digest pancreas tissue.
	Alcohol binge drinking can cause an acute pancreatitis. True/False	True.
	What are pancreatic pseudocysts?	In severe pancreatitis, necrotizing, enzymes may digest the walls of blood vessels. In areas of the pancreas which survive, areas of inflammatory fluid and edema may be surrounded by fibrous tissue forming these cysts.
	As enzymes leak out of the damaged pancreas they may spread around the peritoneal cavity leading to peritonitis. True/False	True.
	What is a typical diagnostic test for pancreatitis?	Increased amylase. As it leaks out of the damaged pancreas, some of it is absorbed into the blood, where elevated levels may be detected. Ultrasound or CT scanning will demonstrate pancreatic swelling. C reactive protein levels will be elevated. These CRP levels usually indicate serious disease.
	Are morphine analgesics indicated?	Yes. They do have side effects. They may cause a contraction of the sphincter of Oddi, and should be used with discretion.
	Is enteral feeding indicated in pancreatitis?	Generally yes. It should be started at an early stage as the pancreatitis causes a severe catabolic state and nutritional support is required. This feeding should reduce the risk of endotoxemias as bacteria from the gut are less likely to enter the blood. Prophylaxis of thromboembolism(DVT) and PE with low dose SQ heparin should be considered.
	Does chronic pancreatitis exist?	Yes. In developing countries, it is often associated with malnutrition, especially a lack of protein.
	Pain for pancreatitis can also be treated using NSAIDs, tramadol and occasionally tricyclics. True/False	True.
	Vegetables rich in folate and lycopenes may be beneficial at reducing rates of pancreatic cancer. True/False	True.
	Pancreatic cancer is almost always an adenocarcinoma. True/False	True. The majority of tumors are found in the head area. Jaundice results from the tumor compressing the duct that leads to obstruction and jaundice. Extreme pruritus may also be noted.
	Stones forming in the urinary tract vary in size. True/False	True. Some are like small grains of sand, while staghorn calculi can fill the renal calyces.
	Can stones esaily pass through the urinary tract?	Not all. Stones under 4mm in diameter will normally be passed naturally but larger stones may well require some form of intervention.
	Are urinary stones made of a protein matrix?	yes. This framework supports crystallized material, usually calcium salts such as calcium oxylate or phosphate. Other stones are made of magnesium ammonium phosphate(struvite) and are associated with infection. Rarely, stones are made of uric acid or cysteine.
	What is calyceal colic?	Some pain is generated when calculi move around within the calyces. This is calyceal colic. When passing along the ureter, this is called ureteric colic.
	How is renal colic managed?	It is managed with adequate doses of morphine/ I/V morphine works rapidly and can provide relief. 10mg may be titrated as an initial adult dose. NSAIDs such as Diclofenac may be helpful. A high fluid intake is essential.
	What is Lithotripsy?	Some stones can be broken down by using shock wave lithotripsy. Targeted shock waves are externally generated, passed through a water medium and into the patient to fragment stones within the urinary tract.
	What is Nephrolithotomy?	Stones in the kidney or renal pelvis can be removed using percutaneous nephrolithotomy. This is the passing of an instrument directly into the urinary tract through the upper abdominal wall or lower chest, then removing the stone.
	What is the etiology of benign prostatic hyperplasia?	Hyperplasia refers to an increase in the number of cells present.There is some stimulation of prostatic tissue by testosterone. The more active metabolite is dihydrotestosterone. If there is an increase in this factor, this will stimulate an increased cellular proliferation.
	The combination of increased stimulation of cell division with reduced rates of cell death results in an increase in the total number of cells present in the gland. True/False	True. Apoptosis rates may be reduced due to a deficiency of a factor which normally stimulates cell death, called transforming growth factor beta. Increased outflow resistance results in higher pressures within the bladder. This means that the workload of the muscle in the bladder wall(detrusor) is increased.
	Progressive inability to empty the bladder as a result of outflow obstruction can lead to chronic retention of urine. True/False	True.
	What can occur if BPH is not treated?	Residual volumes of urine increase over time, resulting in failure of the valves which prevent reflex from the bladder back into the ureter(vesicoureteric valve) with subsequent hydroureter and hydronephrosis.
	Typically when the retained volume reaches 1 liter the urine can reflux back into the ureters and kidneys. True/False	True.
	Serum levels of PSA increase with increasing mass of the prostate gland. True/False	True. PSA levels can be used as a crude proxy for the degree of gland enlargement. Prostate gland cancer and prostatitis will also reveal increased levels of PSA.
	What are some medical treatments for BPH management?	5 alpha reuctase inhibitors act by inhibiting the enzyme which converts testosterone into dihydrotestosterone. When surgery is required, the preferred surgical option is transurethral resection of the prostate.
	Regarding carcinoma of the prostate early urinary symptoms are usually absent in the initial stages of the disease. True/False	True. Unlike the pathology in BPH, which begins immediately around the urethra, carcinoma of the prostate usually arises from peripheral tissues.
	Aside from toxic accumulation, the most common cause of prostatic carcinoma is chronic cystitis caused by schistosomiasis. True/False	True.
	Is an undescended testis in childhood a recognized risk factor for testicular cancer?	Yes. Pathologically, a seminoma arises from the seminiferous tubules and is usually a fairly low grade malignancy. A teratoma arises from primitive germ cells and can be more aggressive. Leydig cell tumors are rare.
	Regarding the nature of cervical cancer, 95% of cases are caused by HPV infection. True/False	True. This is likely passed on during sexual activity. HPV viral DNA is found in more than 90% of cervical squamous malignant tissue which is examined. HPV types 16 and 18 are the most common forms seen in cervical cancers.
	Cervical cancer is a squamous cell carcinoma in most cases. True/False	True. Malignant cases start in the cervical os. In this area, there is a boundary between the stratified squamous cells of the vagina and the columnar cells of the cervix, known as the squamocolumnar junction.
	The columnar cells in the area of the squamocolumnar junction form a region called the transformation zone. True/False	True. It is the cells in this area which can change into malignant squamous cells. This process of cellular tranformation is referred to as metaplasia and results in a dysplasia with a distinct change from normal to abnormal cells.
	How do cytologists grade dysplasia in cervical cells?	The CIN classification is used. CIN means Cervical Intraepithelial Neoplasia. CIN 1- Mild dysplasia CIN 2- Moderate CIN 3- describes severe dysplasia and carcinoma in situ.
	Most UTIs are caused by coliform bacteria. True/False	True. These bacteria come from the patients bowel, such as E. coli or S. fecalis. In women the urethra is much shorter and the urethral orifice is close to areas which may be heavily colonized with bacteria.
	Detection of pus cells or nitrate in urine is a good indication of bacterial infection. True/FalseT	True.
	Renal tubules are very prone to ischemia. True/FalseT	True. They have a high metabolic rate with a consequently high O2 requirement. This can be a common cause of intrinsic renal failure.
	What is ATN and what can cause it?	Acute tubular necrosis describes the death of some cells which compose the nephrons. It can be caused by ischemia, nephrotoxins, severe systemic infections or tubular obstruction. Necrosed cellsslough away from the epithelium and can block the tubule.
	Why is fluid generally restricted in renal failure?	As the kidneys are not producing urine, the body has no mechanism for the removal of excess water.
	Insensible water loss may be lost in sweat. True/False	True. Insensible water may also be lost as moisture in exhaled air, as a component of feces and some water simply transpires from the skin surface into the air.
	Can fluid loss be calculated?	Yes. Fluid losses from any urine produced, vomiting or other forms of loss should be calculated, and to this figure 500mls should be added per day for insensible loss. The patients fluid intale over the next 24 hours should then be limited to this volume to prevent overload developing.
	Regarding fluid loss, what if it is a hot day?	If environmental temperatures rise or the patient even has a fever, the 500ml allowance fro insensible loss will need to be increased . Accurate daily weight measurements should be recorded.
	Why is sodium and potassium restriction important in renal failure?	The kidneys lose the ability to appropriately excrete sodium and potassium. The intake of these elements should be minimized.
	is asystole an increased risk in renal failure electrolyte disturbances?	Yes. This is true because high levels of potassium in the plasma and tissue fluids alter the electrical function of the myocardial cells, eventually preventing muscular contraction. regular ECG recordings can also indicate the presence of a hyperkalemia of 7.0mmol/L or higher.
	What is considered a normal potassium blood level?	Normal potassium blood levels range from 3.5-5mmol/L. In hyperkalemia the QRS complexes broaden and the T waves develop a spiked appearance.
	As kidneys become less able to secrete nitrogen, it is probably best to give about 40g of protein per day. True/False	True. This level of ingestion will help prevent body proteins being broken down by catabolism, but will not be enough to exacerbate uremia.
	What should many acute renal failure patients eat?	Patients should eat plenty of carbohydrate and fat. These provide adequate fuels for energy and prevent the body breaking down stored proteins in muscle. Alternative fuel sources are considered for diabetic patients.
	When is renal insufficiency diagnosed?	This is normally diagnosed when GFR lies between 20-50% of normal. During this stage urine volumes may be normal but the ability to concentrate urine is progressively reduced. Renal failure develops when GFR is less than 20% of normal.
	When is end stage renal disease diagnosed?	This is diagnosed when GFR falls below 5% of normal.
	Why is itching common in end stage renal disease?	Itching is a common complaint and may be caused by uremia and retention of other metabolic waste products.
	The form of vitamin D in the diet or synthesized in the skin on sunlight exposure is not a very active metabolite. True/False	True. In order to be physiologically useful this form of vitamin D must be converted into a much more active form. It is converted into active vitamin D by an enzyme called 1 alpha hydroxylase which is produced by the kidneys.
	ACE inhibitors are a common therapeutic approach of blood pressure control in renal disease. True/False	True.
	What is Peritoneal diaslysis?	A catheter is placed in the perotoneal cavity and dialysate is placed into this area. This converts the potential peritoneal space into an actual space. The peritoneal space lies in between the visceral and parietal peritoneal membranes which cover a large number of small blood vessels.
	In peritoneal dialysis, it is the capillaries and the peritoneal membranes which act as the semipermeable membrane. True/False	True. As in hemodialysis, unwanted components in the blood such as urea, creatinine, phosphate and potassium diffuse down their gradients into the dialysate.
	What is Glomerulonephritic syndrome?	This syndrome is caused by a group of diseases which can damage the glomeruli. They are referred to as glomerulonephritides.
	What are Anti GBM disorders?	These disorders are mediated by an autoimmune attack on the collagen which is an important structural component of the glomerular basement membrane. Autoantibodies bind to and damage the GBM.
	The above form of glomerulonephritis may also be associated with damage to collagen in the basement membrane of the alveoli resulting in pulmonary hemorrhage. True/False	True. In Goodpasture's syndrome, there is a rapidly progressive crescentic proliferative glomerulonephritis causing renal insufficiency.
	What is Crescentic proliferative glomerulonephritis?	Crescentic means that crescents form in the Bowman's space within the capsule. When the walls of a glomerular capillary are severely damaged, plasma components including clotting factors and inflammatory mediators enter Bowman's space. This results in the formation of fibrin and an accumulation of macrophages.
	What is crescent formation associated with?	They are associated with severe glomerular damage, and this means that the glomerulonephritis will rapidly progress to complete renal failure.
	What is Acute post streptococcal glomerulonephritis?	This form of acute nephritic syndrome is most common in childhood and typically follows about 10 days after a streptococcal infection, ofen of the throat, tonsils or ears.
	Why is there a gap of time between the initial streptococcal glomerulonephritis and the onset of renal disease.	This gap of time represents the time taken for the formation of antibodies, their deposition in the glomerular capillaries and the development of the associated inflammatory damage.
	Where are renal mesengial cells located?	Mesangial cells are located between the glomerular capillaries. Under the glomerular endothelial cells is the glomerular basement membrane(GBM). This forms a structural base for the glomerular capillary endothelial cells and also acts as a dialyzing membrane.
	What are Podocytes?	Glomerular capillaries are surrounded by podocytes. These specialized cells have numerous pedicels which are foot like extensions of cytoplasm which wrap around the capillaries forming filtration slits. A thin membrane called the slit membrane extends across each filtration slit.
	What is membranous glomerulonephritis.	Membranous glomerulonephritis is a common cause of nephrotic syndrome in adults. In many patients, the initial antigen which triggers antibody formation is unknown.
	What is a frequent cause of membranous glomerulonephritis in the Tropics?	Plasmodium malariae. There is an accumulation of immune complexes between the visceral epithelial cells(the podocytes which surround the glomerular capillaries) and the GBM.
	What is IgA Nephropathy?	This is a focal and proliferative glomerulonephritis formally called Berger disease. It is caused by the accumulation of IgA based immune complexes in the mesangial cells and in more severe cases, there is also IgA deposition in the capillary walls.
	IgA nephropathy usually follows upper respiratory or GI infection, however, other infections may also be implicated. True/False	True. Most patients fall into the 16-35 years of age range. Frank blood may be seen in the urine. 20% of these patients will develop renal failure.
	What is Goodpasture's syndrome?	This disorder presents with a severe form of anti GBM antibody mediated glomerulonephritis which is often crescentic. Hemoptysis is a common sequela. This occurs due to lung hemorrhage.
	Why do lung hemorrhages occur in Goodpasture's disease?	Lung hemorrhages occur because the autoantibody responsibe for the disease attacks a form of collagen which is found in the GBM and in the alveolar capillary basement membrane.
	Minimal change glomerular lesion is the most common single cause of the proteinuria of nephrotic syndrome. True/False	True. This is true regarding children. The pathological changes seen in MCD are likely autoimmune and may be caused by disordered T lymphocytes.
	What does the term "minimal change" refer to?	It refers to the nature of the histopathology seen in the glomeruli which is limited to loss of the foot processes of the podocytes. Increased glomerular permeability leads to significant loss of albumin and lipoproteins into the glomerular filtrate. Hypoalbuminemia results.
	In minimal change syndrome, why is hyperlipidemia often seen?	The liver attempts to compensate for the reduced blood levels of proteins and lipoproteins by synthesizing more lipoproteins resulting in a hyperlipidemia.
	What is Nephrotic syndrome?	In this condition there is a loss of protein in the urine. There will be heavy proteinuria resulting in a protein loss of more than 3.5 grams over 24 hours. Normal urine should not have detectable protein.
	About 80% of malignant neoplasms affecting the kidney are renal cell carcinomas. True/False	True. Malignant cells arise from the proximal tubular epithelial cells.
	What is the treatment for Renal cell carcinoma?	Nephrectomy is the treatment of choice. Drug treatments may include medroxyprogesterone to control metastatic disease and some patients enter remission with immunotherapy using interleukin-2 and alpha interferon.
	Two of the cytokines produced by macrophages in response to the presence of infection are interleukins and tumor necrosis factor. True/False	True. It is the presence of these cytokines in the blood that increase the set point of the hypothalamus in order to generate a fever.
	Damaged tissue cells can release cytokines directly. True/False	True. In addition, damaged tissues can activate macrophages to release cytokines.
	For every 1 degree centigrade increase in body temperature, the metabolic rate increases by 13%. True/False	True. This increases O2 demand of the tissues, probably resulting in an increased respiratory rate.
	For every 1 degree centigrade increase in temperature, the pulse rate rises by about 12 beats per minute. True/False	True. Children under the age of 2 years are not able to effectively regulate their body temperature. Body temperature can rise rapidly without being detected.
	Heat cramps are also known as stoker's cramps. True/False	True.
	What does catabolism describe?	Catabolism describes any biochemical reaction where large molecules are broken down into smaller ones. Fatty acids and sugars are oxidized in the mitochondria of the cells to produce energy. Most of this energy ends up as heat.
	Regarding severe dehydration, more serious cases may require parenteral fluid replacement. True/False	True. If venous access is difficult, an interosseous infusion(usually the tibia) may be necessary.
	If core body temperature levels drop to 28 degrees C, coma can result. True/False	True. Pulse and respirations may not be detectable and the condition can mimic death. Hypothermia also reduces the blood clotting mechanism.
	Cold also seems to increase fibrinogen plasma levels, making thrombus formation more likely. True/False	True.
	Chronic insults such as ongoing exposure to alcohol or Hepatitis C virus may result in the formation of collagen based scars and the development of cirrhosis. True/False	True.
	Like phagocytes, fibroblasts are able to actively migrate through tissues, but more slowly. True/False	True. Fibroblasts are essential for wound healing. They synthesize and secrete collagen and ground substance.
	Smoking may adversely affect wound healing. True/False	True. Nicotine causes vasoconstriction, and reduces blood supply to the skin and the peripheral tissues.
	What are minerals?	These are inorganic nutrients required in small quantities for health. Zinc is one essential mineral required for wound healing. (reepithelialization)
	Stress fractures sometimes termed march or fatigue fractures develop as a result of repeated mild trauma to a bone. True/False	True.
	What is a simple traverse fracture?	In this fracture the break runs at a right angle to the shaft of the bone or has an angle of less than 30 degrees, the fracture is described as oblique.
	What is an unstable fracture?	This is a fracture which is displaced or has the potential to be displaced. Displacement is when the bone ends have shifted relative to one another.
	Why are fractures very painful?	The periosteum and endosteum, lining the outside of a bone and the medullary cavity respectively are well supplied with nociceptors. The result is extreme or exquisite pain.
	What is a subluxation?	A subluxation is a partial loss of contact between the joint surfaces. The articular surfaces are partly displaced, but there is no gross displacement of the bones involved.
	What is Callous formation of a bone?	Within about 2 weeks, the osteoblasts and the collagen they secrete, form a bridging or soft callus which is composed mostly of fibrous tissue with some cartilage(fibrocartilaginous callus).
	Describe a fibrocartilaginous callus?	This substance is soft and flexible and grows outwards from the broken edges of bone forming a bridge connecting the broken ends of the bones together. After 3-4 weeks mineral salts are deposited onto the soft fibrocartilaginous callus to form a hard but immature, callus, which is often called woven bone.
	Describe fracture ossification.	At this stage of consolidation, the fracture has been firmly fixed and the callus is progressively replaced with mature bone. This mature bone is lamellar bone as it contains concentric lamellae which are well organized rings of calcified collagen.
	What happens to excess callus formation?	It is reabsorbed by the action of osteoclasts.
	What is bone remodeling?	Reabsorption of excess callus from the medullary cavity and from around the fracture site continues. remodelling is directed by the lines of mechanical stress which run through a bone, mostly generated by weight bearing pressure.
	Does smoking affect the rate and quality of bone healing?	Yes.Nicotine slows the process of healing, and reduces the strength of the callus and increases the probability of non union. NSAIDs can also delay bone healing. When a fracture does not heal, there may be interposition of soft tissue at the fracture site as this prevents bridging of the gap between the bone ends.
	What is pseudoarthrosis?	Good levels of immobilization reduce the amount of excess callus formed and improve the rate of bone healing. if a fracture is poorly immobilized this can result in the formation of a pseudoarthrotic joint. Fibrous like tissue forms between the ends.
	In a severe burn, what is the zone of stasis?	Around the coagulated burned necrotic tissue there will be an area of constricted blood vessels with platelet coagulation known as the zone of stasis.
	Why is assessing the percentage of body surface area affected by burns very important?	This is important when calculating fluid replacement therapy. Another guiding principle is that the area of the patients palm and fingers is about 0.8% of BSA.
	Does the rule of nine apply to all burn victims regardless of age?	No.It does not apply to children who have relatively large heads and small limbs.
	The risk of systemic complications increase with the percentage of body surface area involved. True/False	True. If the BSA involvement is over 40% the risk of severe systemic complications and death are significantly increased.
	Urine output should be monitored and should be at least 0.5ml per Kg of body weight per hour in adults and 1 ml per Kg in children. True/False	True. Electrolyte balance should also be monitored until the patient is fully stabilized.
	Can severe burn injuries lread to hyperkalemia?	Yes. This is because ICFs have a high concentration of potassium. as long as renal output is good, the excess potassium can usually be excreted in the urine.
	What is the rule of nine in adults?	The rule of nine in adults can be divided into areas of 9%. The head and neck represent 9% of BSA. Anterior and posterior aspects of the trunk represent 18% each, Each arm is 9% and the legs are 18% each. Genitialia and perineum compose the final 1%.
	Can cyanide be produced by some fires?	Yes. Cyanide will inhibit the ability of the mitochondria to produce energy.
	What are Curling's ulcers/	These are acute duodenal ulcers which may develop after significant burns. Multiple gastric erosions are another complication. These ulcers are caused by resuctions in GI mucosal blood flow caused by the sympathetic stress reaction to the injury. Raniditine may be given prophylactically.
	After a burn injury, the meatbolic rate of the body increases significantly. True/False	True.
	Define algesia.	Algesia means pain. Analgesia means without pain.
	After heart transplantaton, if a doanted heart suffers an infarct, the recipient tends not to feel pain. True/FalseTr	True.
	Sensory neurone cell bodies are grouped together near the spinal cord. True/False	True. This is true in an area called the dorsal root ganglion. From the cell body a short axon carries the pain impulse into the spinal cord.
	What exactly are local anesthetics?	These are cocaine based preparations such as lignocaine which work on nociceptor nerve endings and dendrites. When injected onto a nerve they work by blocking the sodium ion(Na+) channels in the axonal membranes.
	What is the advantage of mixing lignocaine with adrenaline?	It can extend the anesthetic effect as it reduces local blood flow by initiating vasoconstriction.
	Is there a physiological explanation that differentiates sharp from dull pain?	Yes. Two different forms of pain transmitting sensory neurones transmit them. Myelinated fibres called type A delta transmit sharp pain. Myelinization of these fibers allows for rapid saltatory transmission of the pain stimulus at speeds of 6-30 meters per second. Thicker but unmyelinated C fibers transmit dull but achy hurting type pains. The lack of myelin sheath, results in much slower rates of neuronal transmission.
	Reflex withdrawal can only work quickly because nerve impulses are transmitted quickly, via myelinated A delta fibers to the spinal cord. True/FalseT	True. Communication from most of the body enter the spinal cord via 31 pairs of spinal nerves.
	Both A and C fibers enter the dorsal horn and here synapse with a short relay neurone. What is this short neurone called?	It is an interneurone.This carries the nerve impulse through part of the dorsal horn until it synapses with a third neurone which then travels diagonally across the spinal cord. This same neurone then turns upward and joins other ascending pain neurones in a nerve bundle called the spinothalamic tract.
	What is the chemical transmitter secreted by the fast A delta neurones?	It is glutamate, or glutamic acid. This is an excitatory transmitter in the CNS with a short duration of action.
	What substance does the slow C pathway neurones use?	They use substance P. It is called this because it is a peptide which is a sequence of aminoacids. Substance P is released more slowly than glutamate and has a longer duration of action.
	Where is the Spinothalamic tract found?	These nerve tracts are located in the white matter of the spinal cord and carry ascending pain transmitting neurones up to the thalamus.
	What are some inflammatory mediators found in damaged tissue?	Chemicals found in inflammed tissue include histamine, substance P, bradykinin, serotonin, prostaglandins and potassium and hydrogen ions.
	Why might the above inflammatory mediators be found in damaged tissue?	Several inflammatory mediators act on local nociceptors to decrease their depolarization. This means that a nociceptive nerve impulse can be generated much more readily than in non inflammed tissue.
	What is referred pain?	This is when a pain originating from one part of the body is experienced in another area.
	What is Phantom pain?	This is a pain that is felt in a part of the body that is no longer present. A person who has lost a foot may feel pain in the toes of the foot that is no longer there.
	Why do Pahntom pains occur?	These occur because all of the body is mapped onto an area of the brain called the sensory cortex located in the post central gyrus of the parietal lobe. When part of the body is lost the area of the sensory cortex which represents the missing part is unaware of the change and continues to provide the person with sensor information.
	About a third of phantom limbs feel to be fixed in an uncomfortable awkward position that the patient cannot change. True/False	True.
	Regarding phantom limb malposition, can the patient improve this situation?	The patient can perform movements in the mirror with the opposite side of the body.The brain may eventually realize that the phantom is not paralyzed, and the malposition feeling can be relieved.
	What is the PQRST system of assessing long term pain?	This is done by asking questions. P-Provoking factors, what makes it worse or relieves it. Q-Quality of pain, deep, superficial or crushing. R- Region and radiation S- Severity and intensity T- Times, related to onset, duration and frequency.
	It is believed that the fetus possesses an active CNS at the 8th week of development. True/False	True.
	Regarding Central descending inhibition of pain, activity in 2 specific parts of the hypothalamus is able to stimulate activity in an area of the midbrain and upper pons called the periaqueductal grey matter. True/False	True. From this area of the upper brain stem, neurones communicate down to an area in the lower pons and upper medulla called the raphe nucleus. from the raphe nucleus, neurones travel down specialized tracts in the cord called the dorsolateral columns.
	The transmitter substance involved in inhibition of pain impulse across the spinal cord is encephalin, one of the endorphins. True/False	True.This transmitter binds to encephalin receptors. Opium molecules have the same molecular shape as endorphin molecules.
	What is meant by the term,"the mind of Livingstone"?	Dr. David Livingstone was once attacked and bitten by a lion. He survived and said that he did not feel any pain. This mindset might help one to survive.
	A nerve fiber from the descending dorsolateral tract communicates with an interneuron which inhibits the transmission of pain across the spinal cord. True/False	True. The release of encephalin from the interneurone inhibits the release of substance P from a C fiber and so inhibits ascending pain transmission. Encephalin may also have some post synaptic inhibition effect.
	What is the gate theory of afferent inhibition?	In the dorsal horn of the spinal cord nerve fibers carrying information about touch inhibit the activity of interneurones which carry pain impulses. This suggests that if part of the body hurts, we can reduce the transmission of pain across the cord by rubbing the painful area. This is the gate theory of afferent inhibition.
	What is the TENS effect?	This involves taping electrode pads to the surface of the patients skin and then allowing them to control the strength of electrical stimulation of the area.

Share This Flashcard Set

Set the Language

Related Flashcards

Pathophysiology

Add to Folders

Upgrade to Cram Premium

Card Range To Study

663 Cards in this Set