My Things I should know.txt

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Author:
Mike2556
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132619
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My Things I should know.txt
Updated:
2012-02-04 07:44:19
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Everything medicine ever
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Everything in medicine ever
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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
    • A: Fornix
    • B: Pouch of Douglas
    • C: Vagina
    • D: Rectum
    • E: Fallopian tube
    • F: Ovary
    • G: Uterus
    • H: Bladder
    • I: Pelvic bone
    • J: Urethra
  19. 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
  20. Give six risk factors for cervical cancer
    • HPV; mainly 16 and 18
    • HIV
    • Chlamydia
    • Smoking
    • Hormonal contraception
    • Multiple pregnancies
  21. 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
  22. 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
  23. Give four histopathological features of psoriasis
    • Microabscesses
    • Acanthosis
    • Parakeratosis
    • Loss of granular layer
  24. Give major side effects of:
    - Sulfasalazine
    - Hydroxychloroquine
    - Methotrexate
    • Renal failure/GI bleeding
    • Thrombocytopenia/retinal damage
    • Encephalopathy
  25. What are the core therapies when managing osteoarthritis?
    • Patient education
    • Exercise for local muscle strengthening
    • Weight loss
    • Use of suitable footwear
  26. 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
  27. Outline the mangement of rheumatoid arthritis
    • Methotrexate
    • Another DMARD
    • Short-term glucocorticoids
    • Analgesia ladder.
  28. What DMARDs are used in rheumatoid arthritis
    • Rituximab
    • Methotrexate
    • Infliximab
  29. 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)
  30. 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
  31. Describe the arterial circulation of the lower limb
  32. 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
  33. 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
  34. 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
  35. 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
  36. 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)
  37. 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
  38. Describe the antigens and antibodies detectable in viral hepatitis infections
  39. What investigations are available for HIV infection?
    • Anti glycoprotein 120 antibody ELISA the main test
    • Genome assay (PCR)
    • Lymphopenia
    • Clinical history
  40. 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
  41. 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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