1.04 UTF-8 0 0 0 What percentage of presentations in general practice comprises tiredness? 2 5-10% 0 Chronic fatigue syndrome should be considered in patients with 2 fatigue lasting longer than six months in whom other diseases have been excluded 0 Chronic Fatigue was first considered a pathological entity in the 2 1750s 0 Chronic fatigue syndrome was in recent history most fully described as 2 Myalgic Encephalomyelitis (ME) 0 Myalgic Encephalomyelitis (ME) was thought to be related to a * infection and first occurred in Coventry and then at the Royal Free Hospital in London in 1955 2 coxsackie virus 0 Chronic fatigue reached its peak inliterature in the 2 1980s 0 Most authorities seem to believe that chronic fatigue is a combination of 2 physical and psychological factors 0 Hepatitis C and HIV characteristically mutate to form * in response to immune pressure 2 'quasi-species' 0 Subacute sclerosing panencephalitis following measles and squamous carcinoma due to papillomavirus are two famous examples of what? 2 chronic viral diseases caused by persistence of defective virus in the tissues 0 Chronic viral infections may cause apparently * particularly by reactivation 2 acute illness 0 Chronic viral infections may ead to 'non-communicable' diseases including malignancies such as 2 Burkitt's lymphoma and cancer of the cervix 0 Chronic viral infections also induce on-going production of lymphokines such as 2 interferon 0 in chronic viral infection fatigue may be the presenting symptom in patients with 2 cumulative tissue damage 0 The most common cause of syncope is associated with changes in sympathetic and cardiac vagal activity. What is it? 2 vasovagal syndrome 0 Arterial blood pressure is normally regulated by the 2 baroreceptor reflex 0 ventricular tachycardia may occur as a result of abnormalities of the cardiac pacemaker (sino-atrial node) or in the 2 conduction of action potentials through the heart 0 A feature of these conditions is a reduction in blood pressure when the subjects stand up (postural hypotension). 2 Neurological disorders 0 Studies in humans have demonstrated that the vasodilation associated with vasovagal syncope is due to an inhibition (usually complete abolition) of 2 sympathetic vasoconstrictor nerve activity 0 2 0 The female external genitalia are collectively called 2 vulva or pudendum 0 The internal genitalia are located in 2 the pelvic cavity 0 The female external enitalia are located in the 2 perineum 0 The vagina traverses both the 2 pelvic cavity and the perineum 0 The birth canal comprises the 2 cervix and vagina 0 During pregnancy the fundus and body of the cervix undergo 2 great expansion 0 The narrower isthmus of the cervix (upper third of cervix) is gradually taken up into the uterus in the second month of pregnancy to form the 2 lower uterine segment 0 The uterine cavity is * from front to back 2 triangular and flattened 0 while the cervical canal is * in shape 2 fusiform 0 The cervical canal communicates with the uterine cavity by the 2 Internal uterine opening 0 The cervical canal communicates with the vagina by the 2 external uterine openings 0 Uterine tubes (10 cm long) extend laterally from the junction of 2 body and fundus of the uterus 0 Fertilisation normally takes place in the 2 ampulla 0 Fimbriae are finger-like extensions at the distal end of the 2 infundibulum 0 One fimbriae usually attaches to the 2 ovary (ovarian fimbria) 0 The ovary is attached to the uterus by the 2 ovarian ligament 0 Lateral to the uterus and below the uterine tube the double sheet of peritoneum forms the * to which the ovaries attach 2 broad ligament 0 The vagina is directed 2 down and forward 0 The cervix projects through the vaginas upper anterior wall creating 2 the fornices 0 Below the cervix the anterior and posterior walls of the vagina are 2 in contact 0 The opening of the vagina is between the 2 labia minora 0 The urethral opening is * to the vagina 2 anterior 0 the perineal body and anal canal are * to the vagina 2 posterior 0 Lateral to the lower walls of the vagina are 2 erectile tissue 0 Above the erectile tissue lateral to the lower walls of the vagina are the muscle of the *and * diaphragms 2 urogenital and pelvic 0 True or False: The cervix projects though the posterior wall of the vagina creating the fornices 2 False - The cervix projects through the anterior wall of the vagina. 0 True or False: The vagina lies within the pelvic cavity and perineum 2 True 0 True or False: The uterine tubes connect to the junction of the body and cervix of the uterus 2 False - The uterine tube joins the uterus at the junction of fundus and body. 0 In UTI antibodies produced in circulation are usually 2 IgM and IgG 0 In UTI antibodies in the urine are predominantly 2 IgA 0 Urinary tract infections are mainly caused by 2 Escherichia coli 0 True or False: Antibodies directly damage antigens 2 False 0 Antibodies alone may physically block * interactions such as those required for toxins and viruses to enter cells 2 receptor-ligand 0 Antibodies are recognition molecules that specifically bind to a target and 'mark' it for disposal by non-specific [innate] mechanisms such as 2 complement and phagocytosis 0 The * parts of antibody molecules determine the involvement in secondary interactions leading to the removal and destruction of the antigen 2 constant or Fc 0 Pathogens coated with specific antibodies bind to Fc receptors and the efficiency of phagocytic processes is greatly enhanced. a process called: 2 opsonisation 0 UTIs can cause * damage if untreated 2 kidney 0 True or False: B lymphocytes are the main source of cytokines that initiate the ‘switch’ from IgM to IgG antibody secretion 2 False - B lymphocytes secrete antibodies not cytokines 0 Antibody-coated microorganisms activate the 2 complement cascade 0 Wheezes are continuous sounds generated from the within the lungs during breathing. These sounds are superimposed on the normal breath sounds and are often referred to as 2 adventitial sounds 0 The mechanisms underlying the production of a wheezing sound with breathing seem to involve an interaction between the airway wall and 2 gas moving through the airway 0 It is believed that the high pitched sounds of wheezing are produced when the airway lumen is narrowed to the point where the opposite walls 2 are almost in contact 0 The acceleration of gas flow through the narrowed airway induces 2 an oscillation of the airway walls 0 Inspiratory wheezes are often associated with 2 more severe airways obstruction or upper airways obstruction 0 The continuous musical respiratory sound heard in patients with upper airway obstruction 2 is called stridor 0 The commonest cause of stridor is 2 laryngeal obstruction or muscle weakness 0 There is no relationship between the intensity or the pitch of wheezes and the 2 pulmonary function. 0 dynamic narrowing of the trachea or major bronchi may come about during expiration as a result of widespread obstruction of the medium and smaller airways. The physiological explanation for this is referred to as the 2 "equal pressure point theory" 0 The heart and roots of the great vessels are enclosed in a fibrous sac called the 2 pericardium 0 The pericardium consists of two layers: a strong outer fibrous layer and an 2 inner serosal layer 0 The inner serosal layer of the pericardium adheres to the external wall of the heart and is called the 2 viseral pericardium 0 The visceral pericardium reflects back on itself and lines the outer fibrous layer forming the 2 parietal pericardium 0 Myofilaments contain both contractile proteins (actin and myosin) and 2 regulatory proteins (such as troponin and tropomyosin). 0 The interaction of the myosin head with an exposed actin binding site is central to the 2 contractile process 0 This process requires hydrolysis of ATP at the rate of * ATP molecule per power stroke per myosin molecule 2 1 0 The degree to which a sarcomere shortens is dependent upon its initial load (preload) and the 2 load against which it must contract (afterload). 0 An increase in afterload will result in a reduction of the degree of shortening of the sarcomere and a reduction in stroke volume and 2 cardiac output. 0 The arteries contain blood under high pressure but there is a marked reduction in pressure within the 2 microcirculation and capillaries 0 The veins are a low pressure system for 2 return of blood to the heart` 0 The pulmonary circulation normall y operates at a * pressure than the systemic circulation 2 lower 0 In diastole the ventricles are relaxed and fill from the atria with blood flowing across the open 2 atrio-ventricular valves 0 The walls of the ventricle distend as it 2 fills 0 The ventricle continues to contract and pressure within the chamber rises further before forcing the semi-lunar valve open and ejecting blood into the aorta - this is known as the * contraction period 2 isovolumic 0 The amount of blood ejected from the venricle is the 2 stroke volume 0 The semilunar valve closes and ventricular chamber pressure falls further - this is known as 2 isovolumic relaxation 0 Mechanical systole is the period from onset of rise of ventricular pressure to the closure of the 2 semi-lunar valve 0 The normal residual volume in the ventricle at the end-systole is 2 25 +-10 ml/m2 0 The * is the proportion of the end-diastolic volume which is ejected during each systole and is typically 50-70% for the left ventricle 2 ejection fraction 0 The cardiac output is the amount of blood pumped from the heart each minute and is the stroke volume per beat multiplied by 2 the heart rate 0 Heart failure can be defined as the inability of the heart to maintain a cardiac output appropriate to 2 systemic metabolic requirements 0 Examples of low output failure include impaired pump function due to 2 cardiomyopathy or myocardial infarction 0 examples of high output heart failure include 2 thyrotoxicosis and beri-beri 0 The underlying cause of heart failure is the pathological process affecting the heart and leading to impaired 2 mycordial pump function 0 A precipitating cause of heart failure is a factor or event which results in 2 decompensation of the heart and symptoms 0 arrhytimias such as atrial fibrillation amy precipitate overt 2 heart failure 0 Often heart failure is due to an intrinsic dysfunction of the systolic contractile function of the myocardium known as 2 cardiomyopathy 0 Cardiomyopathy results in dilatation of 2 the cardiac chambers 0 Occasionally drugs or heavy metal poisoning can cause cardiomyopathy. An important drug cause is 2 the anti-cancer drug adriamycin 0 A less common cause of heart failure is a * cardiomyopathy 2 restrictive 0 Restrictive cardiomyopathy patients typically have thickened and stiff ventricular myocardium due to fibrous infiltration or deposition of abnormal 2 glycoproteins 0 The assessment of a patient with heart failure is directed towards determining both the severity and the 2 cause of the heart failure 0 The NYHA Class is an important prognostic indicator as well as a useful description of the patient's 2 functional status 0 The electrocardiogram may reveal previous myocardial infarction or signs of left ventricular hypertrophy or 2 document an arrhythmia 0 ejection fraction = stroke volume / 2 end-diastolic volume 0 The normal adult left ventricular ejection fraction is *% 2 50-70 0 In general patients with an ejection fraction below *% has severe heart failure 2 25 0 One in * adults presenting to GPs will be drinking in a hazardours or harmful manner 2 6 0 The most common cause of restrictive cardiomyoptahy in Australia is * which is manifest mostly in older women 2 amyloidosis 0