My Things I should know.txt

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  1. Define and describe osteoarthritis
    • Most common type of arthritis, affecting synovial joints
    • Probably a multifactorial process with mechanical/cellular damage
    • Whole joint affected, but particularly hyaline cartilage damage
  2. Describe the pathological features of osteoarthritis
    • Enthesophytes: projection at bone/tendon interface
    • Chondrophytes: Cartilage projection
    • Osteophytes: Bony projections into joint space
    • Periarticular structures
    • Cartilage structure alteration
    • Joint space narrowing
    • Inflammation
  3. List 6 risk factors predisposing to osteoarthritis
    • Obesity
    • Family history
    • Gender (women)
    • Hypermobility
    • Joint trauma
    • Occupation (manual)
    • Exercise
  4. List 6 clinical features of osteoarthritis
    • Joint pain/tenderness
    • Joint stiffness/loss of function
    • Joint instability
    • Crepitus
    • Effusion
    • Muscle wasting
  5. Outline the use and risks of amniocentesis and chorionic villus sampling
    • Amniocentesis: Tests amniotic fluid for fetal DNA karyotyping. Performed 15-20th week. Miscarriage 1/200
    • Chorionic villos sampling: DNA karyotyping. Performed >8 weeks. 1/100 risk of miscarriage
  6. List eight dysmorphic or external structural abnormalities that might be present in a newborn with Down syndrome
    • Epicanthic folds
    • Protruding tongue
    • Low set ears
    • Flat face
    • Small nose, head and mouth
    • Slanting eyes
  7. Outline the metabolism of alcohol
    • Rapidly absorved in upper GI (within 1 hr of consumption)
    • Majority metabolised in liver, but also urine/breath elimination
    • Once in hepatocytes, oxidised to acetaldehye by either alcohol dehydrogenase (normal) or microsomal ethanol oxidising system (excess)
    • Acetaldehyde oxidised to acetate by aldehyde dehydrogenase in cytoplasm (excess) and mitochondria (normal)
    • Acetate converted to acetyl coA
  8. List five organ systems damaged by alcohol, and give examples of effects
    • CNS: Wenicke-Korsakoff syndrome
    • CV: Hypertension, CHD
    • GI: Gastritis, malnutrition
    • Skin: Psoriasis
    • Muske: Osteoporosis
  9. Describe 6 features of alcohol dependence
    • Strong desire to drink
    • Difficulty controlling timing or amount of drinking
    • Withdrawal state on cessation
    • Increased tollerance and narrowing of drinking repertoire
    • Prioritisation of alcohl over other needs
    • Rapid re-instatement of alcohol use after abstinence
  10. Describe 3 types of duiretic and give their mechanism of action
    • Thiazide: Act on DCT, inhibit Na/Cl simporter to reduce Na resorption and allow water secretion
    • Loop: Act on ascending loop, inhibit K/Na/Cl simporter to reduce resorption and allow reduced osmotic gradient, preventing water reabsorption
    • K+ sparer: Aldosterone antagonist, reducing K excretion in DCT and CT to prevent Na resorption
  11. What should the patient be informed of before starting warfarin?
    • INR monitored daily
    • Avoid pregnancy
    • Be wary of any abnormal bleeding
  12. What blood tests can detect Coeliac disease?
    Tissue transglutaminase antibodies, using ELISA
  13. Outline the pathogenesis of Coeliac disease
    • Gluten is fractionated in the bowel, creating peptides
    • Alpha-gliadin, a peptide, crosses the epithelium and is deaminated by tissue transglutaminase
    • The deaminated peptide binds to APCs and presented to CD4 T cells
    • Reexposure causes IL-15, cytokine and transglutaminase production
    • Inflammatory cascase releases proteases and mediators which causes villous atrophy and crypt hyperplasia
    • Enterocytes are no longer able to mature, leading to inefficient absorption and malnutrition
  14. What is a "Jacksonian" seizure?
    • A seizure in the primary motor cortex, which presents with hyperactivity of a group of motor neurones
    • Presents with tingling/twitching usually
    • Procession of symptoms varies widely
  15. List the milestones of gross motor development
    • Lift head: 6 weeks
    • Hold upright: 3-4 months
    • Primitive reflex loss: 5 months
    • Sitting: 6 months
    • Crawling: 8 months
    • Supported walk: 10 months
    • First step: 1 year
    • Walking: 15 months
    • Further activity: 20 months
  16. List the milestones of fine motor and vision development
    • Follow face/light: Birth
    • Head turn: 6 weeks
    • Hand regard: 3 months
    • Palmar grasp: 6 months
    • Pincer grip: 10 months
    • Both hand grasp/transfer: 6 months
    • Manipulation: >14 months
  17. List the milestones of social behaviour
    • Smile response: 6 weeks
    • Waving: 10 months
    • Separation anxiety: 8 months
    • Caring for self/feeding: <2 years
    • Symbolic play: 18-24 months
    • Parallel play: 2 years
    • Interactive play: 3 years
  18. List the milestones of speech/hearing development
    • Still/startle response: Birth
    • Respond to voice: 6 weeks
    • Vowel sounds: 4 months
    • Monosyllables: 6 months
    • Turn to voice: 7-8 months
    • Appropriate use: 13 months
    • 10 word lexicon: 18 months
    • 2/3 word combo: 20/24 months
    • Conversing: 2-3 years
  19. Image Upload 1
    • A: Fornix
    • B: Pouch of Douglas
    • C: Vagina
    • D: Rectum
    • E: Fallopian tube
    • F: Ovary
    • G: Uterus
    • H: Bladder
    • I: Pelvic bone
    • J: Urethra
  20. Describe the signal transduction of insulin in peripheral tissues
    • Insulin receptor a tyrosine kinase (adds phosphate to protein)
    • Insulin receptor substrate causes cellular vesicles to release GLUT-4
    • Increased GLUT-4 molecule expression on cell membrane
    • Increase in glucose uptake
  21. Give six risk factors for cervical cancer
    • HPV; mainly 16 and 18
    • HIV
    • Chlamydia
    • Smoking
    • Hormonal contraception
    • Multiple pregnancies
  22. Describe the WHO pain relief ladder
    • First: Non-opioid with or without adjuvant (calm fear/anxiety)
    • Second: Mild opioid (codeine), +/- non opiod, +/- adjuvant
    • Third: Strong opioid (oxy, diamorphine), +/- non opiod, +/- adjuvant
  23. Outline seven possible causes of a patient who collapses, convulses and loses consciousness
    • Epilepsy
    • Vasovagal response
    • Sub-arachnoid haemorrhage
    • Stroke/TIA
    • Movement disorders, e.g. asterixis
    • Psychiatric syndrome
  24. Give four histopathological features of psoriasis
    • Microabscesses
    • Acanthosis
    • Parakeratosis
    • Loss of granular layer
  25. Give major side effects of:
    - Sulfasalazine
    - Hydroxychloroquine
    - Methotrexate
    • Renal failure/GI bleeding
    • Thrombocytopenia/retinal damage
    • Encephalopathy
  26. What are the core therapies when managing osteoarthritis?
    • Patient education
    • Exercise for local muscle strengthening
    • Weight loss
    • Use of suitable footwear
  27. What pathological features are seen in osteoarthritis?
    • Chondrocyte infiltration and hyperplasia
    • Subchondral bone sclerosis, with thickened trabeculae and microfractures
    • Osteophyte formation
    • Capillary penetration of calcified cartilage
  28. Outline the mangement of rheumatoid arthritis
    • Methotrexate
    • Another DMARD
    • Short-term glucocorticoids
    • Analgesia ladder.
  29. What DMARDs are used in rheumatoid arthritis
    • Rituximab
    • Methotrexate
    • Infliximab
  30. List and describe the hypersensitivities, giving examples
    • Type 1 IgE mediated: causing mast cell degranulation and oedema, hypotension and airway blockage (anaphylaxis)
    • Type 2 IgG mediated: Ig binds to antigens on cells causing cytotoxicity (Goodpasture's)
    • Type 3 Immune complex mediated: as solvent non-attached antigens cause accumulation of small IgG/IgM complexes which enter tissues and activate complement (SLE)
    • Type 4 T cell mediated: Antigen found on macrophages = T cell activation, cytotoxic T cells destroy any cells with antigen on MHC (hashimoto's; thyroglobulin)
  31. Describe the conduction system of the heart
    • Action potentials arise in SA node, causing atrial contraction
    • Inter-nodal pathways transmit signal to AV node
    • A delay occurs, then signal transmitted via bundle of His to bundle branches then purkinje fibres
  32. Describe the arterial circulation of the lower limb
    Image Upload 2
  33. What are the functions of the ileum?
    • Bile salts
    • Vitamin B12
    • Fatty acids and glycerol
    • Protein/carbohydrate digestions and absorption
    • Prevents bacterial entry into small intestine via Peyer's patches
  34. Outline the HIV life cycle
    • Blood-blood transmission
    • Virus binds to CD4 host cells via an envelope glycoprotein and causes membrane fusion
    • Capsid enters and RNA uncoated
    • Reverse transcriptase used to convert both RNA strands
    • DsDNA formed, then inserted into host chromosome
    • Virus assembled and buds from cell
  35. Outline the life cycle of EBV
    • Latent and lytic periods
    • Transmitted via saliva/blood, replicating in oral epithelium
    • Enters oral lymph nodes
    • Enters B cells via CD21 receptor
    • B cell immortalised, with either latency or replication occuring
  36. Outline signal transduction by adrenergic receptors
    • G protein receptors
    • Ligand binds, causing conformation change and G protein activation and detachement
    • G protein binds to adenyl cyclase, causing cAMP formation
    • cAMP concentration causes protein kinase A activation
    • Protein kinase affects glucose metabolism and calcium concentration
    • PDE does the OPPOSITE: cAMP to AMP
  37. What mechanisms aid in retaining the plasma acid/base balance?
    • Bicarbonate buffering
    • Increased ventilation
    • Kidney bicarbonate reabsorption and hydrogen excretion (using phosphate as urine buffer)
  38. List the pathologenesis of asthma
    • Patient becomes sensitive to triggers as part of type 1 hypersensitivity
    • Exposure leads to IgE attachement and an afferent parasympathetic action potential, causing bronchospasm
    • Inflammation develops, becomin chronic
    • Chronic inflammation increases sensitivity to future bronchospasm
  39. Describe the antigens and antibodies detectable in viral hepatitis infections
  40. What investigations are available for HIV infection?
    • Anti glycoprotein 120 antibody ELISA the main test
    • Genome assay (PCR)
    • Lymphopenia
    • Clinical history
  41. Outline the airway remodelling in asthma
    • Inflammatory cell infiltration
    • Fibroblast infiltration and fibrosis
    • Goblet cell hypertrophy and mucin secretion excess
    • Smooth muscle hypertrophy
    • Myofibroblast hyperplasia
  42. Describe the significance of viral markers in hepatitis B
    • HBsAg: Acute or chronic infection
    • HBeAg: Acute hepatitis B, increased severity
    • HBV DNA: Viral replication occuring
    • Anti-HBe: Seroconversion, low infectivity
    • Anti-HBs: Immunity to HBC
    • Anti-HBc: Acute or past exposure (depending on IgG or M)
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My Things I should know.txt
Everything in medicine ever
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