What to study - Molecular Medicine MRCP 1 - 123Doc Education

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What to study as part of the Molecular Medicine MRCP 1 course. These are slideshows only. The demonstration with video presentation and explanation that goes along with these slides, as well as free example exam questions and the paid full e-lecture can be viewed at https://www.123doc.com/electures/molecular-medicine/

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What to study - Molecular Medicine MRCP 1 - 123Doc Education

  1. 1. Molecular Medicine for MRCP Part 1 Alistair Lindsay BSc (Hons), MBChB, MRCP (UK)
  2. 2. What does that mean? The MRCP (UK) website states that 25/200 marks will be on questions on “Clinical Science” Topic include:- Cell, Molecular & membrane biology Clinical Anatomy Clinical Biochemistry & Metabolism Clinical Physiology Genetics Immunology Statistics, Epidemiology, EBM
  3. 3. What to study? • Obviously covering these topics in detail would be an enormous task; you can not know it all. • It is important to be selective; this is certainly an area where you must focus on “hot topics” • The one exception to this is Clinical Anatomy, where seemingly any anatomical area can come up (Although not to FRCS level!) e.g. blood supply to the liver.
  4. 4. Topics Covered • The cell membrane & ion channels • Second messenger & G proteins • Steroid receptors • Cancer • Genetic inheritance • Trinucleotide repeats • Genetic mutations • Imprinting • Non-disjunction • Mitochondrial DNA disorders • BNP • Electrolytes
  5. 5. The cell membrane • This is an important place to start • You need to be aware of the basic structure of the cell membrane to understand many of the other “hot topics” in molecular medicine. • Questions in the exam are most likely to be on ion channels or gap junction.
  6. 6. Cell fluid mosaic membrane Remember the fluid mosaic model?
  7. 7. Cell Membrane
  8. 8. Cell membrane components • Phospholipid bilayer • Proteins: Integral and peripheral • Intracellular junctions: Tight junctions, gap junctions • Ion channels are integral proteins, that means they span the membrane and permit the passage of certain ions. • Gas junctions current flow and electrical flow between myocardial cells
  9. 9. Ion channel • The most important ion channel for MRCP purposes is the sodium/potassium ATPase • Remember Na+ is transported FROM the intracellular to extracellular fluid against the electrochemical gradient. • Specific inhibitor of the pump ouabain ouabain and digoxin- as a result sodium leaks back into the cell and a sodium/calcium pump is upregulated. This increased calcium makes contraction more forceful. This makes digoxin a positive inotrope.
  10. 10. Digoxin toxicity can be caused by which of the following electrolyte abnormalities?
  11. 11. Digoxin toxicity can be caused by which of the following electrolyte abnormalities? Answer A Hypermagnesaemia HYPOmagnesaemia can predispose to arrhythmias, whether digoxin is present or not.
  12. 12. Digoxin toxicity can be caused by which of the following electrolyte abnormalities? Answer B Hyperkalaemia Although it certainly can caused malignant arrhythmia, hyperK decreases digoxin binding site and hance is arrhythmogenic potential.
  13. 13. Digoxin toxicity can be caused by which of the following electrolyte abnormalities? Answer C Hyponatramia Potassium and digoxin bind to the same site on the sodium/potassium pump. A low potassium level means excress digoxin can bind and have a toxic effect
  14. 14. Digoxin toxicity can be caused by which of the following electrolyte abnormalities? Answer D Hypokalaemia
  15. 15. Digoxin toxicity can be caused by which of the following electrolyte abnormalities? Answer E Hypercalaemia Hypercalcaemia causes a shortened QTc, making arrhythmia less likely.

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