Miscellaneous Stuff

Question 1

why is erythropoietin?

Answer 1

glycoprotein
molecular weight of 23,000

Question 2

what increases erythropoietin?

Answer 2

hypoxia
anaemia
haemorrhage
cobalt salts + androgen

Question 3

what decreases erythropoietin?

Answer 3

increased cell volume
- post tranfusion

Question 4

where does EPO come from?

Answer 4

85% = kidney
15% = liver

Question 5

why does anaemia develop if kidneys removed/disease?

Answer 5

EPO decreases
cannot be compensated by liver

Question 6

where is the main site of deactivation of EPO?

Answer 6

liver

Question 7

what is separate from the EPO system?

Answer 7

separate from renin-angiotensin system

angiotensin II has no effect on EPO
EPO has no effect on BP or aldosterone secretion

Question 8

what is erythropoiesis controlled by and what is it a feature of?

Answer 8

controlled by EPO

feature of acclimatisation to altitude

Question 9

what is erythropoiesis inhibited by?

Answer 9

rise in circulating red cell level to supernormal levels

Question 10

why does 5000 units of heparin SC BD peri-operatively reduce post-op DVT?

Answer 10

because

heparin in sub-therapeutic dosage potentiates antithrombin activity

Question 11

why do haemophiliacs have a normal ‘bleeding time’ test?

Answer 11

because

haemophiliacs have a normal platelet aggregatory response to microvascular injury

Question 12

why is freshly taken blood cooled rapidly to 0 degress?

Answer 12

because

low temperature reduces the activity of enzymes necessary for coagulation

Question 13

how does aspirin inhibit platelet aggregation by inhibiting cyclo-oxygenase activity?

Answer 13

because

cyclo-oxygenase converts arachidonic acid to endoperoxides PGG2 and PGH2

Question 14

why do patients with VW disease bleed excessively post-operatively?

Answer 14

because

deficiency in factor VIII and platelet defect

Question 15

a child who is group O Rh negative can have a parent who is?

Answer 15

group B rh +
group O rh +
group A rh +

Question 16

a child who is group rh negative CANNOT have a parent who is?

Answer 16

group AB Rh positive

Question 17

at birth how much of HbF is there?

Answer 17

approx 40%

at birth - approx 10%

Question 18

why does HbF have a high affinity of oxygen than adults?

Answer 18

bc it binds to 2,3 DPG less effectively than HbA

Question 19

why does HbF have a lower P50 than maternal HbA?

Answer 19

bc HbF binds to 2,3 DPG less effectively

Question 20

what is the pathology of congenital aggamaglobulinaemia?

Answer 20

abscess or gross dysfunction of B series of lymphocytes

Question 21

what is the total thoracic duct lymph flow in normal adults?

Answer 21

about 2L in 24 hours

Question 22

what organs can be seen by gamma scintigraphy after the injection of IV 99-mcTc sulphur colloid?

Answer 22

liver
spleen

Question 23

where is gamma globulin produced by?

Answer 23

B lymphocytes

Question 24

what is the protein content of the lymph in the lower limbs?

Answer 24

about 20g/litre

Question 25

what is the half life of factor VIII infusion?

Answer 25

approx 12-16 hours

Question 26

what do prothrombin complexes contain?

Answer 26

factors 2, 9 and 10

Question 27

what is prothrombin complex useful in?

Answer 27

vitamin K deficiency warfarin overdose haemophilia B

Question 28

what does fresh frozen plasma contain normal amounts of?

Answer 28

normal levels of all coagulation factors

Question 29

what does cryoprecipitate contain?

Answer 29

fibrinogen mainly Factor VIII von Willebrand Factor (vWF) Factor XIII fibronectin

Question 30

50M with a PMHx of duodenal ulcer takes Aspirin 4 hourly for painful rheumatoid. = loss of 30ml blood daily in stool what do we expect?

Answer 30

blood = iron deficient anaemia absorption of Fe = affected by arthritis plasma iron binding capacity = increased

Question 31

when is melaena seen on macroscopic examination?

Answer 31

>100mls is lost daily into the large bowel

Question 32

65M, 70kg, vomiting from SBO. He has lost approx 5L of fluid. What do we expect?

Answer 32

urine = high osmolarity decreased urine output plasma protein = increased

Question 33

65M, 70kg, vomiting from SBO. He has lost approx 5L of fluid. What do we NOT expect?

Answer 33

plasma Na will NOT be increased

Question 34

what is streptokinase infusion haemorrhage associated with?

Answer 34

high level of fibrin degradation products hypofibrinogenaemia

Question 35

under basal conditions, where is the most water lost?

Answer 35

via kidney

Question 36

what nerve supplied sensation to skin over external auditory canal?

Answer 36

vagus nerve

Question 37

what does the vagus nerve provide to cardiac ganglia?

Answer 37

pre-ganglionic cholinergic axons

Question 38

what does the vagus nerve provide to the colon up to just before reaching the splenic flexure?

Answer 38

parasympathetic outflow

Question 39

when is serum hyperosmolality least likely to occur as a possible complication of early what?

Answer 39

acute oliguric renal failure

Question 40

what is serum hyperosmolality a complication of?

Answer 40

severe burns hyperpyrexia total enteral nutrition hyperglycaemia

Question 41

acclimatation to altitude shows an increase of what?

Answer 41

increase in tissue content of cytochrome oxidase increase in red cell 2,3 DPG increase in EPO secretion increase in circulating red cell mass

Question 42

what does acclimatisation cause?

Answer 42

lactic acidosis in brain fall in CSF pH thus, enhancing ventilatory response to hypoxia

Question 43

an increase in red cell 2,3 DPG to acclimatation does what?

Answer 43

decreases O2 affinity of Hb