SAQ 2011 Flashcards by Rachel Sheard

Describe the symbols in a pedigree

Circle = female square = male
coloured = diseased shaded or half/half = carrier blank = normal
line through = deceased

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Define laws of mendelian inheritance

Law of segregation = During gamete formation, the alleles for each gene segregate from each other so that each gamete carries only one allele for each gene.
Law of independent assortment = Genes for different traits can segregate independently during the formation of gametes. (during metaphase of meiosis)
Law of dominance = Some alleles are dominant while others are recessive; an organism with at least one dominant allele will display the effect of the dominant allele.

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Name the cells of the stomach, what they secrete and where they are found

G cells - antrum
Parietal – BODY AND FUNDUS
Chief cells – body, FUNDUS AND PYLORUS - secrete pepsinogen (HCl activates to pepsin - protein digestion)
(Enterchromaffin-like = release histamine gastric glands in vicinity of parietal cells)

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Where is somatostatin released from?

Delta cells in the pyloric antrum, the duodenum and the pancreatic islets
Acts on parietal cells in the stomach to reduce HCl secretion, can also act of G cells and ECM-like cells

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What 3 processes would you advise someone to go through to quit?

Ready – plan, find out info from GP, stead-set a date and throw out lighters, cigerettes etc, go- make a plan for the plan and try to avoid triggers, reward yourself

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Ethics – 14 year old girl having sex without a condom, has contracted STI and refuses to use condoms even though she’s on the contraceptive pill
o What are 2 ethical considerations in this case?

Autonomy – respecting her decision to make her own decisions,
Utilitarianism– if she doesn’t start using condoms she is likely to spread STI and hurt other people

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What is a disadvantage of virtue ethics

what is ‘right’ can be culture specific
too broad?
individual understanding can ignore social and communal dimensions
which are the most important virtues when they contradict each other?

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What is a limitation of deontology?

What document by the GMC advocates the use of deontology?

Can duties conflict?
1- It does not take into consideration the complexity of life situations and sometimes the results of the decisions taken by deontologists can be very drastic (it might reach the death of an innocent person like case study 1).
2- It faces big dilemma when 2 principles are involved and usually applying it would not be effective.

-Duties of a doctor - deontology/virtue ethics

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What type of theory is used to maximize greater good

Utilitarianism = max good for max people

Consquentialism

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Describe the main ethical theories

Ethical Theory - philosophical attempts to create ethical theories:

i virtue
ii categorical
iii imperative
iv utilitarianism
v 4 principles (autonomy, beneficence, non-maleficence, justice)

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What utilitarian/consequentialism (teleological)

An act is evaluated solely in term of its consequences

* Maximising good and minimizing harm

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What is KANTIANISM (Deontological)?

KANTIANISM (Deontological)
• Features of the act themselves determine worthiness (goodness) of that act
• Following natural laws and rights
• Categorical imperatives - a set of universal moral premises from which the duties are
derived (do not lie; do not kill; …)
• A person is an end itself, never a means to an end
• deon = duty (from the Greek)
• Know the criticisms

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What is virtue ethics? What are the five focal virtues?

VIRTUE ETHICS (Deontological)
• Focus is on the kind of person who is acting, deemphasizes rules
• Is the person in action expressing good character or not?
• We become virtuous only by practicing virtuous actions
• Integration of reason and emotion

• The Five Focal Virtues: (CDTIC)
i Compassion
ii Discernment
iii Trustworthiness
iv Integrity
v Conscientiousness
• Know the criticisms!

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What are the 4 principles

THE FOUR PRINCIPLES (Prima Facie)

Autonomy (self-rule, the obligation to respect the decisions of our patients)
The decision is intentional
The decision is done with understanding
There are no major controlling influences over the decision
Benevolence (providing benefits, balancing the benefits against risks)
Non-maleficence (do no harm, reduce or prevent harm)
Justice (Utility/QUALY, need vs. benefit, fairness in the distribution of benefits and risks)

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What are the GMC duties of a doctor?

Protect and promote the health of patients and the public
Provide good standard of practice and care
Recognise and work within the limits of your competence
Work with colleagues in the ways that best serve patients’ interests
Treat patients as individuals and respect their dignity

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What are the 4 principles?

Autonomy
Beneficence
Non-maleficence
Justice

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What are the challenges of utilitarianism?

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Should minorities suffer for the sake of the majority?
Should ethically questionable experiments be conducted for the greater good of the population?
How can you define ‘good’ or ‘better’?

What are the fraser guidelines for?

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Contraception advice to under 16s

that the girl (although under the age of 16 years of age) will understand his advice;
that he cannot persuade her to inform her parents or to allow him to inform the parents that she is seeking contraceptive advice;
that she is very likely to continue having sexual intercourse with or without contraceptive treatment;
that unless she receives contraceptive advice or treatment her physical or mental health or both are likely to suffer;
that her best interests require him to give her contraceptive advice, treatment or both without the parental consent.”(Gillick v West Norfolk, 1985)

(Gillick in general)

What is mean arterial pressure?

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Mean Arterial Pressure– the average arterial pressure in the body
MAP can be used to approximate afterload (↑MAP leads to in ↑resistance and increase↑afterload)

Equation 1 MAP= CO x Total Peripheral Resistance

Equation 2 MAP = 2/3 diastolic + 1/3 systolic

What is ejection fraction?

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Ejection Fraction– Stroke volume / End diastolic volume.

measurement of the percentage of blood leaving your heart each time it contracts

Where are the baroreceptors found?

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Carotid sinus (just after where carotid bifurcates into internal and external, inside internal @ C4) and aortic arch

What are 2 effects of stimulating baroreceptors on peripheral BP

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Increase in parasym, decrease in symp = this means that BP decreases as blood vessels dilate

Bradykinin = peptide that causes dilation because it releases nitric oxide and endothelium-derived hyperpolarising factor
Nitric oxide
Prostacyclin
ANP powerful vasodilation

What stimulates vasoconstriction?

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Hormones = angiotensin II, vasopressin, adrenaline

local = endothelin and myogenic contraction

Name 3 types of cells found in an atheroma

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Macrophages, lymphocytes, smooth muscle

Describe the anatomical relations of the BODY of the pancreas

``` Superiorly = Liver and coeliac plexus Anteriorly = Stomach - omenta bursa (pancreas lies behind the stomach) Posteriorly = Abdominal aorta, L kidney, L supra renal, L renal artery, splenic vein ``` Head of pancreas is in duodenum curve Posteriorly = IVC, renal vessels, Bile duct

Describe blood supply of pancreas

- Splenic artery = tail (neck body and tail) - Superior and inferior pancreaticduodenal arteries = head The body and neck of the pancreas drain into the splenic vein; the head drains into the superior mesenteric and portal veins

o Why would pancreatic islet cells stain with haemotoxylin?

Large levels of ribosomes/RER RNA

Irregularly irregular pulse?

SAN node - Atrium contraction

o Definition of a respiratory acinus (3 structures within

respiratory bronchioles and alveoli duct, alveoli

Describe the stages in CAGE

o CAGE • Have you ever felt you needed to Cut down on your drinking? • Have people Annoyed you by criticizing your drinking? • Have you ever felt Guilty about drinking? • Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

3 consequences of drinking

– can causes fatty liver, hepatitis and cirrhosis of the liver, risk taking, over eating, social problems

Describe main lung volumes and average volume

1. Tidal volume - normal expiration and after norma inspiration aproxx 500ml 2. Vital capacity - max volume of exhalation approx. 4,800 (around 3 and 5 L) 3. FEV1 = ratio to VC should be 80%, max air expired in 1 sec after max inspiration

3 physiological causes of high CO2

-Hypoventilation, extreme exercise, V/Q mismatch

3 causes of metabolic physiological vasodilatation

-Hypoxia = dilation in arterioles and constriction in venous -more parasym -less symp -hypercapnic -acidosis (low pH due to excess co2) prostaglandins NO ANP

Describe process of inhalation

1. Diaphragm and external intercostals contract (T1-T11)= decrease in pressure due to thorax expansion 2. Pressure of intra pleural fluid becomes subatmospheric 3. increase in transpulmonary pressure (pressure inside and outside lung) 4. Air drawn into lungs 5. Pressure in alveoli becomes subatmospheric 6. Air drawn in via bulk flow :)

What are the impressions on the lung?

Right -SVC, Azygos vein Left - Heart, Aortic arch

What is in the carotid sheath?

-internal jugular vein (lateral) ``` -common carotid and internal carotid artery (medial) ``` - vagus nerve (posterior) - deep cervical lymph nodes

What can cause a V/Q mismatch?

Ventilation = dead space, alveoli doesnt function Perfusion = shunt, blood doesnt flow to ventilatied alveoli

What occurs in expiration?

1. Diaphragm and external intercoastals not contracted 2. Thorax decreases in size 3. Intrapleural fluid pressure increases 4. Transpulmonary pressure decreases 5. Lungs recoil to original size (pressure increases = becomes compressed, boyle's law) 6. P alv becomes greater than atmospheric pressure 7. Air flows out via bulk flow

What is Dalton's law?

When temp and volume are constant the total pressure of two gases is the sum of each individual partial pressure

Describe different types of immune response

1. Allergic; IgE/histamine mediated (e.g. asthma, anaphylaxis, hay fever) – Type I Antigen binds to IgE→ Release of mediators (including histamine) → acute inflammation Histamine → bronchoconstriction and mucus hypersecretion (e.g. in anaphylaxis) 2. Cytotoxic antibody mediated (e.g. Goodpasture’s) – Type II 3. Immune complex deposition mediated (e.g. SLE) – Type III 4. Delayed; T cell mediated (e.g. TB) – Type IV

SAQ 2011 Flashcards

(41 cards)