2 Flashcards
what are the three phases of gastric acid secretion
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
what is gastric acid stimulated by
acetylcholine, gastin and histamine
what is gastric acid inhibited by
somatostatin-D cells
secretin-S cells
Cholecystokinin-I cells
what should be suspected in patients with coeliac who have been previously doing well but now now
t cell lymphoma
what is topical sprue and how is it treated
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
whipples disease describe and treatement
pas positive macrophage in lamina propria
double strength trimoxazole
what is murphs sign
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
what do chief cells secrete
pepsinogen
what do parietal cells secrete
HCL and intrinsic factor
how is persistalsis conducted
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
describe the G protein receptor
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
why does temperature increase in infection
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
what are the classic combination of symotomr s with dyspepsia
epigastric burning pain
post prandial fullness
early satiety
what are the causes of dyspepsia
peptic ulcer disease
drugs esp NSAIDS and COX inhibitors
gastric cancer
what are the alarm symptoms
anaemia loss of weight anorexia recent onset/progressive symptoms melaena/haematemesis swallowing difficulties
low caeruloplasm is typical of
wilsons disease
AMA postitve
PBC
ANA or anti smooth muscle antibody positive
autoimmune hepatitis
describe HBPM
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
describe ABPM
2 measurements per hour for 14 hours
what type of diplopia do you get with a cranial nerve 4 palsy
vertical diplopia
what kind of diplopia do you get with a cranial nerve VI palsy
horizontal diplopia
where is the trachea palpated
in the jugular notch
what is the treatment of a PE
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
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
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
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*******
what does S1 signify
the closure of mitral and tricuspid valves
what does S2 signify
closure of the aortic and pulmonary valve
when is s1 loud
mitral stenosis
what is s3
diastolic filling of the ventricle
when is s3 heard
in left ventricular ventricular failure eg dilated cardiomyopathy, constrictive pericarditis and mitral regurgitation
when is s4 heard
in aortic stenosis, HOCM and hypertension
what tuning fork is used for rinnies and webers test
512 Hz
what is rinnies postitve
normal hearing
what is laryngotracheobronchitis
croup
how does a thyroglossal cyst move
when sticking out the tongue
how does a dermoid cyst move
it doesn’t move
what is the most common cause of a third nerve palsy
aneurysm in the posterior communicating artery
what type of drug is acetazolamide
a carbonic anhydrase inhibitor
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
describe the appearance of the pupil in anterior uveitis
small and irregular pupil, hypopyon, sero negative arthropathy HLA B27
what is the treatment of anterior uveitis
topical steroids and topical mydiatic
which part of the lung does adenocarcinoma tend to affect
the periphery
what is the tumour marker for adenocarcinoma
TTF1
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
how is a SVT treated
acute management-vagal manoeuvres eg Valsalva manoeuvre
Iv adenosine 6mg-12mg, contraindicated in astmatics |(give verapamil instead)
how do you remember bundle branches
William Morrow
what does a right bundle branch show on ECG
M in V1
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
what is 1st degree heart block
Pr interval is >0.2 seconds
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
what is 3rd degree heart block
no association between P waves and QRS complexes
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
what metabolic disturbance can be caused by SIADH
hyponatraemia
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
where do loop diuretics act
in the ascending limb of the loop of henle
where do thiazide diuretics act
in the distal convoluted tubule
what metabolic changes do loop diuretics cause
hypokalaemia metabolic alkalosis hypovolaemia and hypotension depeletion in calcium and magnesium hyperuricaemia-gout
how can thiazides be used in renal stones
they reduce the urinary excretion of calcium and discourage stone formation
what electrolyte change do you get in loop but not thiazide
loop diuretics cause hypocalcaemia but thiazides don’t cause hypocalcaemia
what type of hormone is aldosterone
steroid hormone
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
what type of receptor does ADH act on
G protein coupled receptor to increase the number of h20 channels (aquaporins in the cell membrane)
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
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)
which disease states produce oedema
increase in plasma capillary pressure or decrease in interstitial oncotic pressure
which lymph nodes does testicular cancer spread to
para-aortic lymph nodes
how are humeral shaft fractures most commoly treated
non operatively with a functional brace
how are fractures dislocations of the surgical neck treated
ORIF
how is an olecranon fracture treated
ORIF to restore triceps function and restore the articular surface
what way do elbows normally dislocate
posteriorly
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
what is a late complication fracture of colles
rupture of extensor pollicis longus which usually requires a tendon transfer
what are the order of the carpal bones
proximal row scaphoid, lunate, triquetrum, pisiform
distal row, trapezium, trapezoid, capitate hamate
the scaphoid is at the base of the fingers/thumb?
at the base of the thumb
where does the common extensor mechanism arise from
the lateral epicondyle
where does the common flexor origin originate from
the medial epicondyle
when are undisplaced spiral fractures of the tibia common
in toddlers
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
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
significant valgus stress can cause what
MCL injury, ACL rupture, fracture of the lateral condyles and tear of the lateral meniscus
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)
what is calcitonin release triggered by
gastrin or high plasma calcium levels
what is spondylolisthesis
slippage of one vertebrae over another
when does spondylolisthesis usually present
in adolescence due to increased body weight and increased sporting activity
what is the cause of spondylolisthesis
can be due to spondylosis
what test can be done to assess for chronic pancreatitis
pancreatic elastase
test for steatorrhoea and recent travel
OGD and duodenum biopsy
what stage in development do the lobar bronchi form
embryonic
what stage do the terminal sacs form with capillaries associated with them
saccular
what stage of 16 generations of branching give rise to terminal bronchioles
pesudoglandular
which stage in development of the lungs continues into early childhood
alveoloar
what happens in the cannalicular stage
bronchioles and alveolar ducts form
how is the pulse in shock
fast due to sympathetic response to low blood volume
which influenze virus causes pandemics
influenza A
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
what does increasing skeletal muscle activity do to venous return
increases it
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
st elevation in v2-v5
anterior
st elevation in v1-v3
anteroseptal
st elevation in v4-6, 1 and AVL
anterolateral
what is the cell change in GORD
metaplasia of squamous epithelium to columnar epithelium
what is barretts oesophagus
uncontrolled proliferation of mucous glands in the lower 1/3rd of oesophagus
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
what does terlipressin do
it can improve renal flow, it is a vasoactive drug used in the management of low BP and hepatorenal syndrome
what does lysozyme do
destroys bacterial cell wall
what does lactoferrin and transferring do
gram postitive bacteria
tear lipids function
antibacterial to cell membrnaes/scavengers products
what is the function of sebaceous glands
they maintain the skin barrier
