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JB 2010 Smash Hit
Clinical
Spiral Learning
100

What are signs of shock?

- slow capillary refil
- pallor
- cool peripheries
- tachycardia
- low blood pressure
- tachypnea (rapid shallow breathing)

200

What is a Category D drug? Provide an example

  • drugs which have caused/suspected to cause increase incidence in fetal malformations and irreversible damage
  • statins, sartens, ramiprol
200

What clinical tests could you run to confirm delirium  

  • confusion assessment method and neurological exam 
  • run tests to find organic causes
  • vital signs
  • blood glucose levels
  • FBC
  • UEC
  • TSH
  • brain CT (exclude bleed, trauma, dementia)
200

What are the three types of haematopoiesis

  • erythropoiesis = RBC
  • leukopoiesis = WBC
  • thrombopoiesis = platelets
300

Describe how pregnancy changes the binding affinity of O2 to Hb

  • 2,3-DPG formed in RBC during glycolysis (anaerobic metabolism)
  • 2,3-DPG increases by 30% in pregnancy 
  • increased 2,3-DPG reduces Hb:O2 affinity meaning Hb gives up O2 more easily and picks up CO2 easily
  • shifts maternal Hb:O2 dissociation curve to the right, promoting release of O2 from mum to bub via placenta and CO2 from bub to mum


300

What is the clinical significance of monitoring estriol (E3)?

  • estriol can't be produced if the fetus isn't healthy because it requires fetal liver to convert fetal DHEAS to byproducts then estriol
  • estriol monitored in pregnancy to indicate how healthy bub is 
  • estriol production requires well functioning placenta, fetal adrenal glands and liver 
300

What are the functional categories of complement proteins

  • Initiators (MBL)
  • Convertase activators (C4b, C2a)
  • Opsonins (C3b) - coat bacteria to allow easier recognition by immune system
  • Anaphylatoxins (C3a, C5a) - chemotractants
  • Membrane attack complex
400

What is the importance of the increased estrogen to progesterone ratio. Reference the effects on uterus and cervix.

  • progesterone in largely inhibitory 
  • a decrease in progesterone will allow estrogen increase gap junction formation, oxytocin responsiveness and prostaglandin release --> changes the myometrium --> increases uterine contractility
  • increased estrogen also promotes break down of cervical collagen and increased cervical distensibility by inducing production of collagenase and elastase.
400

Describe placement of electrodes in a 12 lead ECG

  • 4 electrodes placed on 4 limbs (RA, LA, LA, LL)
  • 6 electrodes placed on precordium (V1-6)
  • V1 = 4th intercostal space, right margin of sternum
  • V2 = 4th intercostal space, left margin of sternum
  • V4 = 5th intercostal space, mid clavicular line
  • V3 = midway between V2 and V4
  • V5 = 5th intercostal space, anterior axillary line 
  • V6 = 5th intercostal space, mid axillary line
400

Describe stages of lipid absorption

  • at brush border: monoglycerides and free fatty acids leave micelles and passively diffuse through cell membrane 
  • Inside cells: monoglycerides and free fatty acids resynthesised into triglycerides 
  • Triglycerides aggregate + covered with lipoprotein to form chylomicrons -> leave basal membrane by exocytosis 
  • Transport around the body: 
    • Chylomicrons enter lacteals (lymphatic vessels) 
    • Fatty acids enter blood stream 
  • Stored in adipocytes and muscle cells
500

Outline hormonal control of the menstrual cycle

  1. primary follicle releases low levels of estrogen: inhibits hypothalmic and pituitary hormones (GnRH, LH, FSH) and stimulates more estrogen production by follicle
  2. antral follicle releases high levels of estrogen - stimulates release of GnRH and LH 
  3. GnRH stimulates release of FSH and more LH 
  4. LH surge triggers final maturation of oocyte and ovulation --> corpus luteum formation 
  5. corpus luteum release prog + estro, prog triggers changes in endometrium, cervical mucus and basal body temp
  6. apoptosis of corpus luteum --> drop in estro and prog --> menses starts 2 days later
500

Describe the DSM5 criteria for major depressive disorder (SIGECAPS)  

  • depressed mood (dysphoria) and anhedonia 
  • over 2 week period
  • presence of five or more symptoms: 

500

Explain how the cochlea transforms sound to neural activity

mechanical vibration --> electrical signals

  1. movement of stapes against oval window causes perilymph in scala vestibuli to move, causing basilar membrane in scala media to vibrate
  2. as basilar membrane moves, hair cells' stereocilia bend against tectorial membrane, opening ion channels (tip links)
  3. K+ ions from endolymph flow into hair cells --> depolarisation --> opening of Ca channels --> release of neurotransmitters
  4. neurotransmitters activate auditory nerve fibres (at base of hair cells)
  5. electrical signals from hair travel along cochlear(auditory) nerve --> brainstem --> auditory cortex --> sound interpretation