2nd yr help part 4 Flashcards
1
Q
What is cushings disease?
A
- Too much cortisol!
- ↑ACTH from pituitary
- Cortisol has the opposite effect effect to insulin raising blood glucose
- can be caused by steroids
- 24hr dexamethasone test. Pituitary tumour keeps producing ACTH even when ↑cortisol should stop it production.
2
Q
What is addisons disease?
A
•Cortisol and aldosterone deficiency
It is caused autoimmune destruction of the adrenal gland leading to inadequate secretion of hormones by the adrenal cortex.
3
Q
What is conns syndrome?
A
•Too much aldosterone!
primary hyperaldosteronism or Conn’s syndrome, is excess production of the hormone aldosterone by the adrenal glands resulting in low renin levels
4
Q
What is a Phaeochromacytoma?
A
- is a rare tumor of adrenal gland tissue. It results in the release of too much adrenaline and noradrenaline
- adrenergic storm
5
Q
What optic problems does cushing sometimes present?
A
- Bitemporal hemianopia
* mimics problems with optic chiasm
6
Q
What is the test for addisons?
A
Synacthen test
7
Q
What does aldosterone do?
A
It increases blood pressure
8
Q
How does aldosterone raise blood pressure?
A
It promotes the re-absorbtion of sodium back into the blood stream.
9
Q
Where does Aldosterone act?
A
at the distal convoluted tubule
10
Q
What happens if your aldosterone is low?
A
- Sodium reabsorbtion isnt happening
- Peeing out Sodium/salt
- hyponatremia → lethargy, decreased level of consciousness, headache, and (if severe) seizures and com
11
Q
With low Aldosterone,what will your BP be doing?
A
Low BP
12
Q
What happens in a syacthen test?
A
Because the adrenal gland is being destroyed it cant put out more cortisol so synacthen has no effect on cortisol lvls.
13
Q
What is the treatment for Addisons?
A
Hydrocortisol →replacement cortisol
fludricortisone → replacement aldosterone
14
Q
What does conns syndrome also called?
A
Primary hyperaldosteronism.
15
Q
what is primary hyperaldosteronism also called?
A
Conns syndrome.
16
Q
What happens in conns syndrome?
A
Adrenal adenoma (~2/3rd of cases) means high Aldosterone production independent of the renin angiotensin system causes increased retention of sodium and water and low potassium.
17
Q
What happens to your body with to much aldosterone and low potassium?
A
- hypertension
- cardiac arhythmias
- electrolyte imbalance→ weakness and cramps
18
Q
Tests for Conns syndrome?
A
U+E’s, Renin and aldosterone →renin will be low, Aldosterone will be high.
19
Q
What is the triad of symptoms associated with pheochromacytoma?
A
S.E.T.
Sweating
Episodic headaches
Tachycardia
20
Q
What is the test for pheochromacytoma?
A
3 x 24hour urinary free catecholamoines
21
Q
Treatment for pheochromacytoma is what?
A
Alpha blockade folled by removal of the tumour.
22
Q
What causes congenital adrenal hyperplasia?
A
21 hydroxylase deficiency
23
Q
What does 21 hyproxylase definciency cause?
A
High lvls of 17 hydroxprogesterone
24
Q
What symptoms does congenital adrenal hyperplasia present with?
A
↑ androgens ↓aldosterone.
- Vomiting and salt wasting
- Excess androgens→ early onset pubic hair, enlarged clitoris
25
What decreases Calcium lvls in the blood?
Calcitonin
26
What increases calcium lvls in the blood?
PTH
27
What is 1, 25 hydroxyvitamin D also known as?
Calcitrol
28
Where is 1, 25 hydroxyvitamin D produced?
In the kidney
29
What does 1, 25 hydroxyvitamin D do?
It acts on the small intestine to promote the absorption of calcium and increase blood Ca+ lvls.
30
What are 3 causes of Spinal cord compression?
* Tumour
* Abcess
* Vertebral disk rupture
31
What are the symptoms of spinal cord compression?
* Back pain
* Loss of sensation distal to the compression
* Loss of movement/paralysis distal to the compression
32
What is the treatment for spinal cord compression?
* Dexamethasone
| * surgical decompression
33
What is cauda equina?
* MEDICAL EMERGENCY
| * Compression of the lumbrosacral nerve roots.
34
What does Cauda equina present as
* Sever back pain
* Numbness tends to be more localized to saddle area; can be asymmetrical
* decreased anal spyncter tone.
* Loss of bowel and bladder function
* Sciatica like pain bilaterally
35
What is a brown sequard syndrome?
This is ahemisection of the spinal cord being compressed/occluded.
36
What is syryngomeylia?
* This is the development of a fluid filled cavity within the spinal cord.
* Tends to affect the cervical spine
* Causes a cape like loss of sensation (across upper chest and back and down both arms).
37
What are the investigations for Cauda equina?
Urgent MRI→ surgical referal
38
What is a syringiobulbia?
Cyst of the brain stem
39
What is a chiari malformation?
Chiari malformations, types I-IV, refer to a spectrum of congenital hindbrain abnormalities affecting the structural relationships between the cerebellum, brainstem, the upper cervical cord, and the bony cranial base
40
What happens in a chiari malformation?
The cerubellum presses on the spinal cord.
41
What symptoms would you have with a brown sequard lesion?
On the side of the lesion you will have:
•Motor loss
•Vibration + propriocetion loss
On the other side you will have:
•Pain and temperature loss
42
Where do motor tracts in the brain begin and which way do they run in the spinal cord?
* The start in the precentral gyrus
| * They run down the spinal cord
43
Which way do sensory tracts run in the spinal cord?
•They run up the spinal cord
44
Where do signals coming from the brain decussate?
In the medulary pyramid.
45
Where do propriocetion and vibration decussate?
In the medullary pyramid
46
Where do pain and heat decussate?
crosses in the spinal cord
47
What sensation travels in the corticospinal tract?
Pain and temperature
48
What sensation travels in the dorsal column?
propriocetion and vibration
49
What travels in the descending corticospinal (pyramidal) tract?
Motor
50
Which side will we have weakness on in a brown sequard?
On the same side as the lesion.
51
What is a direct pupil reaction?
Shine light into the right eye and the right eye constricts.
52
What is a consensual pupil reaction?
Shine light into the right eye and the Left pupil constricts.
53
Which cranial nerve is the Afferent nerve or sensory limb of the pupillary reflex?
Optic nerve → CN2
54
Which cranial nerve is the Efferent nerve or motor limb of the pupiliary reflex?
occulomotor nerve → CN3
55
What is the parasympathetic action of the pupil?
constriction
56
What is the sympathetic action of the pupil?
dilation
57
What is the optic nerve CN2 responsible for?
carrying information to the brain from the eye.
58
What nerve carries information from the brain back to the eye?
The occulomotor nerve. CN3
59
If one eye is looking down and out, with a drooping eyelid, which nerve has a problem?
Occulomotor CN3
60
A light is shone into the right eye and the pupil constricts. It is then swung into the left eye and the pupil appears to dilate. What is this called?
A relative afferent pupil defect (RAPD)
61
What is happening in a relative afferent pupil defect?
If its the left eye that appears to dilate when alight is shone into it, this is indicitive of damage to the left optic nerve.
62
What would cause a relative afferent pupil defect?
Optic neuritis.
63
What is marcus gunn pupil?
a relative afferent pupil defect
64
Which way do the obliques move the eye?
they abduct the eye both inferiorly and superiorly.
* Inferior oblique moves the eye up and in
* superior oblique moves the eye down and in
65
How do you test for CN4 palsy?
Depress the eye when it is ADDucted.
66
What are the 3 cranial nerves that supply the eye muscles?
LR6, SO4 = 3 (everything else)
67
What is the terminology for looking up?
Elevated
68
What is the terminology for looking down?
depressed
69
If you have a red eye with "gunky" discharge, normal pupil + normal vision, what is this?
* Conjunctivitis.
| * Treat with chloramphenicol
70
If you have photophobia, a white spot on the cornea and hypopyon, what is it?
Corneal ulcer
71
What drug is used to dilate the eye?
Tropicamide
72
What is acute iritis?
inflammation of the uveal tract,
73
What is septic arthritis?
* Inflammation of a joint caused by a bacterial infection. It is also known as infectious or bacterial arthritis.
* The condition is most commonly caused by staphylococcal or streptococcal bacteria.
74
What is a severely inflamed monoarthritis until proven otherwise?
Septic arthritis
75
What is the likely diagnosis for someone who drinks and eats alot and presents with a hot red swollen joint?
Gout
76
What is gout?
Monosodium urate crystals that start an inflamatory reaction.
77
What will monosodium urate crystals looklike?
* needle shaped
| * Positive birefrigence
78
What is the first line treatment for gout if no contraindication is present?
* NSAIDS
| * followed by Colchicine (second line)
79
What drug is prescribed to manage gout long term?
* Alpurinol
| * DO NOT START DURING AN ATTACK
80
What is the method of action for allopurinol
It is a xanthine oxidase inhibitor
81
Where is vitamin D3 sythesized?
* 7 dehydrocholesterol is sythesized by UV rays in the skin to become cholecalciferol (vitamine D3)
* Cholecalciferol (vitamin D3) is then sythesized in the Liver to become 25-hydroxyvitamin D
* 25-Hydroxyvitamin D is then synthesized in the proximal tubule of the kidneys to form 1,25-Dihydroxyvitamin D3 (calcitrol)
82
What does calcitonin do?
It works in opposition to Parathyroid hormone (PTH) reducing calcium in the blood.
83
What is calcitrol?
1,25-Dihydroxyvitamin D3
84
What does calcitrol do?
Calcitriol increases the level of calcium (Ca2+) in the blood by increasing the uptake of calcium from the gut into the blood, and possibly increasing the release of calcium into the blood from bone.
85
What cells in the Parathyroid gland produce PTH?
Chief cells
86
What cells in the parathyroid gland produce calcitonin?
Parafollicular cells (also called C cells)
87
What are the symptoms of hypercalcaemia?
* Stones (renal or biliary)
* Bones (bone pain)
* Groans (abdominal pain, nausea and vomiting)
* Thrones (polyuria) resulting in dehydration.
* Psychiatric overtones (Depression 30–40%, anxiety, cognitive dysfunction, insomnia, coma)
88
What are the symptoms of Hypocalcaemia?
CATs go NUMB
* Convulsions
* Arrhythmias
* Tetany (muscular spasms)
* Numbness
89
What clinical condition is associated with alack of Vit.D?
•Osteomalacia
90
What is osteomalacia?
* Low mineral content in bone
| * softening of the bones, typically through a deficiency of vitamin D or calcium.
91
What is osteomalacia called when it takes place before the sealing of the epipyseal plate?
•Ricketts
92
If on digital rectal exam a prostate feels irregular and nodular, What is the likely diagnosis?
•Prostate cancer
93
If a patients testicle feels like a bag of worms, what is this?
•A varicocele
94
If a patients testicle is swollen, fluid filled and lights up with a torch, what is this?
•Hydrocele
95
If a patients testicle has a painless cyst on the epididymus what is this?
•Epididymal cyst/spermatocele
96
If a patients testicle painful swollen epididymus, what is this?
•Epididymitis.
97
what causes a hydrocele?
•A patent processus vaginalis fills with fluid.
98
If a patient has a painful swollen testicle, what is this?
•Orchitis.
99
If a patients testicle is enlarged but cannot be isolated, what is this?
•Inguinal hernia.
100
If a patients testicle is enlarged and discoloured following trauma, what is this ?
•Haematocele
101
If a patient presents with an acutely painful testicle what is this?
* Testicular torsion
| * MEDICAL EMERGENCY
102
If a patient presents with a swollen non painful testicle that does not light up with a torch, what is the likely diagnosis?
* Testicular cancer
| * also consider in change of shape of texture
103
What are 95% of testicular tumours?
* Seminomas, germ cell cancer.
| * vascular cancer that responds well to radiotherapy
104
what is the treatment for a testicular seminoma?
Radiotherapy and an orchidectomy
105
What is the cremastic reflex?
When you stroke the inside of the leg and the testicle retracts.
106
What side effect does glanclovir have?
Neutropenia
107
What is the Antiviral used to treat Influenza?
| i = vir
oseltamivir
108
What is the Antiviral used to treat HIV?
A = Aids
RitonAvir
109
What is the Antiviral used to treat herpes?
O = Oh shit I have herpes
Acyclovir
110
What are the 2 proteins on the surface of the flu virus called?
* Haemagluttinin
| * Neuraminadase
111
Smoking protects from which IBD?
Ulcerative colitis
112
Smoking exacernates which IBD?
Crohns
113
What is the treatment for crohns?
CAM - RAM
CAM
•Corticosteroids → first line
•Azathioprin
•Monoclonal antibodies
RAM
•Remission
•Azathioprin
•Methotrexate
114
What is the treatment for UC?
* Aminosalicylates +/- corticosteroids first line
* ciclosporin or infliximab as second line
* colectomy third line
115
What is the first line treatment in diabetes?
Metformin
116
What is the first line treatment for diabetes if the patient is not overweight?
Gliclazide (sulphoyluria)
117
What is a common side effect of metformin?
Metabolic acidosis (lactic acidosis)
118
What diabetic drug slows the break down of carbohydrate?
Acarbose
119
Which 2 drungs work on the incretin effect?
Sitagliptin - DPP-4's
| exenatide - GLP1 agonists
120
What is the pathology of type 1 diabetes?
Autoimmune destruction of the pancreatic B-cells
121
What are the 4 types of shock? name them.
Maldistributive → Anaphylaxis / sepsis
Cardiogenic → MI
Obstructive → PE
Hypovolaemic → dehydration
122
What is the treatment in anaphylaxis?
* IM adrenaline → 1g in 1litre
* Antihistamines → chlorphenamine
* Mast cell triptase test.
123
What is the treatment for sepsis?
FOBSIC
* Fluid resuscitation
* oxygen
* blood cultures
* serum lactate
* IV antibiotics
* catheterise
