Clinical Sciences
Clinical Sciences 2
Clinical Skills
Clinical Skills 2
100
Fill in the following synthetic pathway:
X -----------> Y --------------> Albumin
Signal Furin
Peptidase
X: Preproalbumin
Y: Proalbumin
100
What is the scientific name for upper vomiting blood?
Haematemesis
100
If an unstable patient presents with an upper GI bleed, what should your first assessment be?
ABCDE primary survey
100
List two symptoms of alcohol withdrawal syndrome.
Tonic-clonic seizures, delirium tremens, alcoholic hallucinosis
200
List the four causes of hypoalbuminemia.
1. Over-excretion - renal (nephrotic syndrome) or GIT (Crohn's disease)
2. Intravascular volume increase (pregnancy)
3. Increased catabolism (sepsis)
4. Decreased production (malnourishment)
200
What % of alcoholics progress from alcoholic fatty liver to alcoholic steatohepatitis
10-35%
200
What rating scale can be used to rank severity of upper GI bleeds?
Glasgow-Blatchford Bleeding Score (GBS)
200
List the two most common causes of upper GI bleeds.
Gastric ulcer, oesophageal varices
Other causes (cancer, Mallory - Weis tear, gastritis)
300
List two key qualities of each strain of viral hepatitis
· Hep A and E are faecal oral and are acute, Hep B spread mainly through blood or sexual fluids or vertical transmission, Hep C is mainly transmitted through blood
· Hep A and B have vaccines
· Hep D needs Hep B to infect
· Hep E during pregnancy due to immune system and hormone changes and faster viral growth life-threatening liver failure
300
Why does alcohol consumption cause the development of liver disease? Give two mechanisms.
1. Creation of toxic metabolites like acetaldehyde which are hepatotoxic
2. Increases levels of ROS, leading to fatty acid oxidation and carcinogenesis
3. Alcohol is a CYP2E1 inducer, and can trigger the creation of toxic metabolites by this cytochrome
300
Classify the different stages of shock and give two features of each stage.
300
What vitamin deficiencies are most prominent in alcoholics? Give 3.
A, Thiamine (B1), B6, Folate (B9), B12
400
List two causes of extra-hepatic and intra-hepatic hepatobiliary disease.
Extra-hepatic - gall stones, tumours
Intra-hepatic - biliary cirrhosis, primary biliary cholangitis, secondary sclerosing cholangitis
400
Explain why CDT levels rise with heavy and prolonged alcohol consumption
Carbohydrate-deficient transferrin (CDT) increases with alcohol consumption because alcohol interferes with the liver's ability to properly process transferrin, a protein that carries iron in the blood. Specifically, alcohol disrupts the addition of sugar molecules (carbohydrates) to transferrin, leading to an increase in forms of transferrin that lack these carbohydrates, which are then measured as CDT
400
When assessing a patient with a lower GI bleed, what exams would you perform and what would you want to note from these exams?
- Abdominal exam: Check for tenderness, distension, masses
- DRE: Assess for haematochezia, haemorrhoids, masses
- Proctoscopy: Useful if available, to visualise anorectal causes
- Blood colour clues:
- Bright red: Usually left-sided bleed (but can be brisk right-sided)
- Maroon/clots: Often right-sided or small bowel source
400
Explain what a fibroscan is and what it can tell us about the liver.
FibroScan is a non-invasive device that assesses the ‘hardness’ (or stiffness) of the liver via the technique of transient elastography. Liver hardness is evaluated by measuring the velocity of a vibration wave (also called a ‘shear wave’) generated on the skin.
"A patient with chronic hepatitis C and a liver stiffness >14 kPa has approximately a 90% probability of having cirrhosis, while patients with liver stiffness >7 kPa have around an 85% probability of at least significant fibrosis."
500
What is the difference between Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT)?
PT:
Extrinsic (and common)
Key Factor: VII
Half Life: 4–6 hours
Prolongs early: Yes
Most sensitive to early liver dysfunction
Factor VII drops quickly when liver synthetic function is impaired, making PT a sensitive early marker of liver dysfunction.
APTT
Intrinsic (and common)
Key factors: IX, VIII
Half lives: IX: 18–24 hours, VIII: 12 hours
Prolongs early: No
Less sensitive to early liver dysfunction because these factors take longer to decrease.
500
What are the five stages of Alcoholic Liver Disease and describe one histological feature for each.
1. Initial Stage - hepatocytes contain small vacuoles around their nuclei
2. Steatosis - fatty liver disease, characterised by larger vacuoles, with well differentiated vesicles.
3. Steatohepatitis - neutrophil infiltrate, presence of mallory-denk bodies
4. Fibrosis - scar tissue depositions appear throughout liver
5. Cirrhosis - islands of regenerative nodules encased in fibrous bands
500
Differentiate between the clinical signs of gastric ulceration and gastroesophageal varices? Give one history, one exam, and one investigation finding that is different for each disease.
Gastric ulceration: Hx - abdo pain, pain with eating, dyspepsia, more chronic picture
Ex - Nonspecific findings, most commonly epigastric pain (80%) but signs of anaemia, other.
Inv - endoscopy, ulcer with smooth rounded edges
Varices: Hx - history of signs that point to portal hypertension
Ex - evidence of liver disease i.e. jaundice, ascites
Inv - endoscopy, varices visible within lumen