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1
Q

what are the three phases of gastric acid secretion

A

cephalic-which results in the production of gastric acid before food actually enters the stomach
gastric-most significant, initated by the presensce of food in the stomach cuased by stimulation of G cells
histamine-intestinal phase luminal distension plus the presence of amino acids and food in the duodenum stimulate acid production

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2
Q

what is gastric acid stimulated by

A

acetylcholine, gastin and histamine

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3
Q

what is gastric acid inhibited by

A

somatostatin-D cells
secretin-S cells
Cholecystokinin-I cells

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4
Q

what should be suspected in patients with coeliac who have been previously doing well but now now

A

t cell lymphoma

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5
Q

what is topical sprue and how is it treated

A

presents with chronic diarrhoea, weight loss and vitamin B 12 and folate deficiency, with stool examination negative for ova and parasities
mononuclear infiltration and less vilous atrophy throughtout the intestine
treatment is borad spectrum antibiotic like tetracyclin and folate supplementation

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6
Q

whipples disease describe and treatement

A

pas positive macrophage in lamina propria

double strength trimoxazole

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7
Q

what is murphs sign

A

hand placed over the RUQ and patient asked to breathe in, pain resulting from inflamed gallbladder striking the hand is serve enough to arrest the respiratory effort
sign of cholecystitis

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8
Q

what do chief cells secrete

A

pepsinogen

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9
Q

what do parietal cells secrete

A

HCL and intrinsic factor

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10
Q

how is persistalsis conducted

A

induced by the release of serotonin 5 HT from neuroendocrine cells in response to luminal distension
serotonin activates the HT4 receptors which in turn results in the activation of secretory neurons

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11
Q

describe the G protein receptor

A

extracellular NH2 and intracellular COOH
when no signalling present g protein alpha subunit binds toGDP, g protein alpha unit combines with and modifies activity of effector
agonist may dissociate from receptor but signalling can persist
to turn the signal off, alpha subunit acts as an enzyme (a GTPase) to hydrolyse GTP to GDP and Pi the signal is turned off
G protein alpha subunit recombines with the By subunit

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12
Q

why does temperature increase in infection

A

chemicals released from macrophages in response to infection or inflammation act as an endogenous pyrogen
endogenous pyrogens eg interleukins stimulate the release of Prostaglandins in the hypothalamus
prostaglandins act on the hypothalamic thermo-regulatory centre to reset the thermostat at the higher temperature

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13
Q

what are the classic combination of symotomr s with dyspepsia

A

epigastric burning pain
post prandial fullness
early satiety

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14
Q

what are the causes of dyspepsia

A

peptic ulcer disease
drugs esp NSAIDS and COX inhibitors
gastric cancer

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15
Q

what are the alarm symptoms

A 
anaemia 
loss of weight 
anorexia 
recent onset/progressive symptoms 
melaena/haematemesis 
swallowing difficulties
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16
Q

low caeruloplasm is typical of

A

wilsons disease

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17
Q

AMA postitve

A

PBC

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18
Q

ANA or anti smooth muscle antibody positive

A

autoimmune hepatitis

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19
Q

describe HBPM

A

2 consecutive measurements while seated, 1 min apart record twice daily for 4-7 dyas, discard the 1st day readings, use average to diagnose hypertension

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20
Q

describe ABPM

A

2 measurements per hour for 14 hours

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21
Q

what type of diplopia do you get with a cranial nerve 4 palsy

A

vertical diplopia

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22
Q

what kind of diplopia do you get with a cranial nerve VI palsy

A

horizontal diplopia

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23
Q

where is the trachea palpated

A

in the jugular notch

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24
Q

what is the treatment of a PE

A

correct hypotension with fluids can give morphine give LMWH heparin and warfarin, stop the LMWH when INR>2 and continue warfarin for a minimum of 3 months

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25
treatment of pneumothorax
for a non tension pneumothorax- aspirate in the midclavicular 2nd intercostal space, infiltrate with lidocaine down the pleura insert a 16G cannula into the pleural space, remove needle and connect canulla to 3 way tap CXR to confirm resolution of the pnuemothorax
26
treatement of tension pneumothorax
do not delay for a CXR trachea will be deviated away from the affected side insert a large bore cannula with a syringe, partially filled with saline into the 2nd intercostal space in the midclavicular line on the side of the pneumothorax, remove plunger to allow tapped air to bubble through the syringe then insert a chest drain
27
treatment of an aute exacerabation of COPD
``` isoap ipratropium nebulised salbutamol nebulised-5ml oxygen-28% on a venturi mask, check ABGs start antibiotics prednisolone+9******* ```
28
what does S1 signify
the closure of mitral and tricuspid valves
29
what does S2 signify
closure of the aortic and pulmonary valve
30
when is s1 loud
mitral stenosis
31
what is s3
diastolic filling of the ventricle
32
when is s3 heard
in left ventricular ventricular failure eg dilated cardiomyopathy, constrictive pericarditis and mitral regurgitation
33
when is s4 heard
in aortic stenosis, HOCM and hypertension
34
what tuning fork is used for rinnies and webers test
512 Hz
35
what is rinnies postitve
normal hearing
36
what is laryngotracheobronchitis
croup
37
how does a thyroglossal cyst move
when sticking out the tongue
38
how does a dermoid cyst move
it doesn't move
39
what is the most common cause of a third nerve palsy
aneurysm in the posterior communicating artery
40
what type of drug is acetazolamide
a carbonic anhydrase inhibitor
41
what should you ask in conjunctivitis
anything like this before-thinking allergic, and do they have hayfever or asthma also ask sexual history if think chlamydia
42
describe the appearance of the pupil in anterior uveitis
small and irregular pupil, hypopyon, sero negative arthropathy HLA B27
43
what is the treatment of anterior uveitis
topical steroids and topical mydiatic
44
which part of the lung does adenocarcinoma tend to affect
the periphery
45
what is the tumour marker for adenocarcinoma
TTF1
46
what therapies can be used for adenocarcinoma
its a non small cell cancer so preferably surgical excision but if that's not possible then targeted therapy-crizotinib=effective in tumours with fusions involving ALK or ROS1 gefitinib, enotinib and afatinib are used for those with mutations in EGFR
47
how is a SVT treated
acute management-vagal manoeuvres eg Valsalva manoeuvre | Iv adenosine 6mg-12mg, contraindicated in astmatics |(give verapamil instead)
48
how do you remember bundle branches
William Morrow
49
what does a right bundle branch show on ECG
M in V1
50
what are the causes of a right bundle branch block
normal variant more common with increasing age right ventricular hypertrophy chronically increase right ventricular pressure eg, cor pulmonale, PE, MI, ASD, cardiomyopathy or myocarditis
51
what is 1st degree heart block
Pr interval is >0.2 seconds
52
what is 2nd degree heart block
increased PR interval until a dropped beat occurs | type 2=PR is constant but P wave is often not followed by a QRS complex
53
what is 3rd degree heart block
no association between P waves and QRS complexes
54
what are the symptoms of ankylosing spondylitis
pain in the joints or back which may be insidious in onset over weeks or months pain gets better with exercise the pain and stiffness is worse in the morning and at night, patient may be woken in the night due to pain
55
what metabolic disturbance can be caused by SIADH
hyponatraemia
56
treatment of SIADH
establish the underlying cause and remove if possible acutely treat with hypertonic 3% saline given via a continuous effusion loop diuretics to treat the fluid overload
57
where do loop diuretics act
in the ascending limb of the loop of henle
58
where do thiazide diuretics act
in the distal convoluted tubule
59
what metabolic changes do loop diuretics cause
``` hypokalaemia metabolic alkalosis hypovolaemia and hypotension depeletion in calcium and magnesium hyperuricaemia-gout ```
60
how can thiazides be used in renal stones
they reduce the urinary excretion of calcium and discourage stone formation
61
what electrolyte change do you get in loop but not thiazide
loop diuretics cause hypocalcaemia but thiazides don't cause hypocalcaemia
62
what type of hormone is aldosterone
steroid hormone
63
what does aldosterone do
increase the synthesis of Na/k ATPase on basolateral membrane increase synthesis of a protein that activate the epithelial Na channel -ENAC
64
what type of receptor does ADH act on
G protein coupled receptor to increase the number of h20 channels (aquaporins in the cell membrane)
65
how do amiloride and triamterene work
they block luminal sodium channels in the collecting tubules enter the nephron via OCT in the proximal tubule triamtere is well absorbed from the GI tract, absorption of amiloride is poor
66
when are aldosterone antagonists used
``` in the treatment of heart failure, primary hyperaldosteronism-conns syndrome resistant essential hypertension secondary hyperaldosteronism (due to hepatic cirrhosis with ascites) ```
67
which disease states produce oedema
increase in plasma capillary pressure or decrease in interstitial oncotic pressure
68
which lymph nodes does testicular cancer spread to
para-aortic lymph nodes
69
how are humeral shaft fractures most commoly treated
non operatively with a functional brace
70
how are fractures dislocations of the surgical neck treated
ORIF
71
how is an olecranon fracture treated
ORIF to restore triceps function and restore the articular surface
72
what way do elbows normally dislocate
posteriorly
73
how are elbow dislocations treated
most occur in the posterior direction after FOOSH uncomplicated dislocations require closed reduction under sedation assessing neurovascular status pre and post reduction, a short period in sling 1-3 weeks followed by elbow exercises
74
what is a late complication fracture of colles
rupture of extensor pollicis longus which usually requires a tendon transfer
75
what are the order of the carpal bones
proximal row scaphoid, lunate, triquetrum, pisiform | distal row, trapezium, trapezoid, capitate hamate
76
the scaphoid is at the base of the fingers/thumb?
at the base of the thumb
77
where does the common extensor mechanism arise from
the lateral epicondyle
78
where does the common flexor origin originate from
the medial epicondyle
79
when are undisplaced spiral fractures of the tibia common
in toddlers
80
what are the potential complications of a supracondylar fracture
can get tear/entrapment of the brachial artery which can mean no radial pulse can get compression of median nerve if untreated can lead to volkmanns contracture
81
what is volkmanns contracture
permanent flexion contracture of the hand at the wrist, resulting in claw like deformity of the hands and fingers, passive extension of fingers is restricted and painful any fracture in the elbow region or upper arm can lead to it but closely associated with supracondylar fracture of the elbow results from acute ischamia and necrosis of the flexor muscles of the arm FLEXOR DIGITORUM PROFUNDUS FLEXOR POLLICIS LONGUS its a form of compartment syndrome
82
significant valgus stress can cause what
MCL injury, ACL rupture, fracture of the lateral condyles and tear of the lateral meniscus
83
what is pseudo pseudo hypoparathyroidiism
``` genetic defect of g protein alpha subunit GNASI low calcium but PTH elevated bone abnormalities (Mccune Albright) obesity subcutaneous calcification learning disability brachydactly (4th metacarpal) ```
84
what is calcitonin release triggered by
gastrin or high plasma calcium levels
85
what is spondylolisthesis
slippage of one vertebrae over another
86
when does spondylolisthesis usually present
in adolescence due to increased body weight and increased sporting activity
87
what is the cause of spondylolisthesis
can be due to spondylosis
88
what test can be done to assess for chronic pancreatitis
pancreatic elastase
89
test for steatorrhoea and recent travel
OGD and duodenum biopsy
90
what stage in development do the lobar bronchi form
embryonic
91
what stage do the terminal sacs form with capillaries associated with them
saccular
92
what stage of 16 generations of branching give rise to terminal bronchioles
pesudoglandular
93
which stage in development of the lungs continues into early childhood
alveoloar
94
what happens in the cannalicular stage
bronchioles and alveolar ducts form
95
how is the pulse in shock
fast due to sympathetic response to low blood volume
96
which influenze virus causes pandemics
influenza A
97
how is FVC, FEVI and fev1/fvc ration affected in asthma
the FVC is normal the FEV1 is reduced the FEV1/FVC ration is reduced and the PEF is reduced
98
what does increasing skeletal muscle activity do to venous return
increases it
99
describe gram positive organisms
thick layer of peptidoglycan that stains PURPLE with gram stain as well as a phospholipid bilayer endotoxin is part of the gram negative cell wall and the cell wall doesn't carry genes for antibiotic resistance
100
st elevation in v2-v5
anterior
101
st elevation in v1-v3
anteroseptal
102
st elevation in v4-6, 1 and AVL
anterolateral
103
what is the cell change in GORD
metaplasia of squamous epithelium to columnar epithelium
104
what is barretts oesophagus
uncontrolled proliferation of mucous glands in the lower 1/3rd of oesophagus
105
what is brutons agammmaglobulinaemia
X linked primary immunodeficiency disease with absence of IgG, usually presents in young children with pulmonary and other bacterial sinopulmonary infections
106
what does terlipressin do
it can improve renal flow, it is a vasoactive drug used in the management of low BP and hepatorenal syndrome
107
what does lysozyme do
destroys bacterial cell wall
108
what does lactoferrin and transferring do
gram postitive bacteria
109
tear lipids function
antibacterial to cell membrnaes/scavengers products
110
what is the function of sebaceous glands
they maintain the skin barrier

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