ESA 1 Questions

1. ESA 1 Questions • To cover a variety of useful information relating to esa 1. HADPOP, HIC, Molecules, GI • In relation to a specific condition that has a high prevalence in the medical school

2. Disease Frequency Measures • A measure of the burden of disease in a population at a point in time. (No. cases/No. ppl in pop. x100) Define prevalence Define Incidence • A measure of disease frequency and disease risk. (No. new cases/No. of persons at risk in a time interval – person-years)

3. What is your diagnosis? Symptoms – what a person will come to the doctor complaining of • Altered mood and behaviour • Palpitations • Chest pain • Increased breast size (gynecomastia) • Loss of interest in masculine activities Signs – what the doctor finds on examination • Fast pulse and dilated pupils • Soft, tender abdomen • Muscle wasting • Sore nipples • Parma erythema, spidernaivi

4. Bird Gay This is sometimes referred to as ‘under the thumb’ and is used when a lad becomes so infatuated with a girl that his behaviour changes. He stops acting like a lad, he no longer has time for his mates and he starts to do things he would otherwise never have done. Originally it was proposed that Bird gay showed a genetic inheritance pattern. What are the 4 Patterns of Mendalian inheritance?

5. X-Linked Dominant Autosomal Dominant X-linked recessive Autosomal recessive

6. This theory has since been dismissed as several risk factors have now been identified.(Although there may still be a genetic component involved.) Name 2 different types of study that could be used to investigate the causes of this condition? • Cohort study • Is an observational, prospective study that compares 2 groups from a set population. 1 group is exposed and compared to an unexposed group. • Case-Control Study • Is an observational, retrospective study that compares 2 groups. Selected based on whether they have the condition or are free from the condition, looking back in time at the exposures to each group.

7. Epidemiology studies are showing a rise in the cases of BirdGays. There are various theories as to why so the Warwick admin staff are currently carrying out a cohort study based on the intake of medical students over the last 4 years. What are the benefits of a cohort study over a case-control?

8. So what are the risk factors? • Excess fatherly love as a child • Being MFL of body but not mind (mentally weak) • A cohort of 130 hot girls to 50 guys • A profession of independent thinking women • Just being a nice guy • You can start to see how Warwick med school choose their cohort intake to target these risk factors. • 2nd year cohort are definitely MFL

9. The causes of this condition appear to inconsistent as some acute cases appear without a clear cause in the example of patient MH.The results of a study can be caused by bias, confounding factors or because it is real. What are the 9 Bradford Hill Criteria for inferring Causality? • Strength  • Specificity  of Association • Consistency • Temporal sequence  • Dose response  Exposure • Reversibility • Coherence of theory  • Biological plausibility  Other evidence • Analogy

10. So far data has been compiled on 4 cohorts of medical students (720 students). Cohorts 2013 and 2015 were seen as being the exposed groups and cohorts 2012 and 2014 are those unexposed. What risk can be calculated from a cohort study and not from a case-control? Incidence rate ratio IRR Incidence rate in exposed group/Incidence rate in unexposed = a/(a+b) ÷ c/(c+d) Or a/c ÷ b/d Case-control study Odds ratio (because IRR would be influenced by the number in the control group which is chosen in case-control).

11. In what situation are the estimates of relative risk (IRR and Odds ratio) similar? What is attributable risk? When diseases are rare Under rare disease assumption a and c are small Therefore – IRR ~ OR This is the incident of the disease in the exposed group that is attributable to that exposure. = Risk in exposed – risk in unexposed

12. Marcus Dorsan presents to you claiming to have glandular fever. In the history he explains how he once did 10,000 press ups in a week and how he used to have some awesome NGA nights out. Once kid even said to him on the beach ‘you are massive! I want to be like you’. But he says that now he feels he can’t even do 10 push ups and he feels that he has lost control of making his own decisions.On examination you find his belly has turned soft, he has sore nipples and muscle wasting, and he has scratch marks across his back.Unfortunately you easily diagnose him with a classic case of birdgaySo what can be done to help him? It has been suggested that a new drug methylflulanitol (MFL) is available. How would you go about testing the effectiveness of this drug? Counselling Lifestyle changes Randomised control trial An interventional study that compares an exposed group to a control (placebo) group

13. Marcus Dorsan agrees to be put forward into the trial and finds himself among friends as he meets Crossbow, Rellis, Mali and Craggy.What criteria must a randomised control trial meet before it can be carried out? Ethical dilemma (what is best for the patient) Clinical equipoise (uncertainty over which treatment is best) Informed consent (provide information and the patient can withdraw anytime) The manufacturer of MFL, M.H. is worried that some people may tamper with his trial. What factors can divert the results away from the true values? • Confounding factors • Selection Bias • Information Bias

14. In a needs assessment of Warwick medical school what does the Stevens and Raftery Model suggest? Corporate – this is the stakeholders and experts in the issue Comparative – compares levels between places e.g. Warwick vs Nottingham med school Epidemiological – looks at what significance prevalence and other epidemiology data shows

15. Professor MH decides to spread the MFL drug so that all people can benefit so he explains how it worksIt acts on G-protein coupled recptors. list 4 other receptor types? What are the 3 ways a cell can change its behaviour? Intracellular (steroids, thyroid hormones) Ion Channels (Ach, 5-HT) Linked to intrinsic enzymatic activity (Guanylyl Cyclase, ANP, BNP) Linked to soluble protein kinase (Growth factors) • Ion channels • Enzymatic changes • Gene transcription

16. It acts to increase cAMP, what G-protein linked to which enzyme is involved in this cascade? • Gαs • Activates adenylyl cyclase • To increase cAMP • cAMP activates PKA PKA inhibits IP3. What signalling pathway is IP3 involved in? • Gq • Activates PLC • PLC cleaves PIP2 into DAG and IP3 • IP3 causes Ca2+ release • DAG and IP3 activate PKC

17. It turns out that Crossbow is from Africa and as a child he suffered from Marasmus What is Marasmus and is it more serious than Kwashiorkor? • Malnutrition in children • Marasmus – is complete body wasting resulting from a complete lack of energy resources (treated with a high energy diet) • Kwashiorkor is more serious, it results from a protein deficiency which causes ascites (as water leaves the blood because of low oncotic pressure) it is treated with carefully monitored nutrition replacement (otherwise body homeostasis would be interrupted) These days Crossbow never gets past the Fed State (even at night he eats all the time!). What time period relates to the Fed, Fasted and Starved states? • Fed 0-4hrs increased glucose = increased insulin • Glycogenesis occurs in liver and muscles • Fasted 4-12hrs insulin to glucagon switch • Glycogen broken down in liver and muscles • Starved 12hrs+ Noradrenaline and cortisol levels rise • Protein breakdown activated in muscles and adipose tissue releases triglycerides and FFA’s