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2nd year help prt 4 > 2nd yr help part 4 > Flashcards

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.
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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.

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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

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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
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5
Q

What optic problems does cushing sometimes present?

A
  • Bitemporal hemianopia

* mimics problems with optic chiasm

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6
Q

What is the test for addisons?

A

Synacthen test

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7
Q

What does aldosterone do?

A

It increases blood pressure

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8
Q

How does aldosterone raise blood pressure?

A

It promotes the re-absorbtion of sodium back into the blood stream.

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9
Q

Where does Aldosterone act?

A

at the distal convoluted tubule

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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
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11
Q

With low Aldosterone,what will your BP be doing?

A

Low BP

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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.

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13
Q

What is the treatment for Addisons?

A

Hydrocortisol →replacement cortisol

fludricortisone → replacement aldosterone

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14
Q

What does conns syndrome also called?

A

Primary hyperaldosteronism.

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15
Q

what is primary hyperaldosteronism also called?

A

Conns syndrome.

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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.

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17
Q

What happens to your body with to much aldosterone and low potassium?

A
  • hypertension
  • cardiac arhythmias
  • electrolyte imbalance→ weakness and cramps
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18
Q

Tests for Conns syndrome?

A

U+E’s, Renin and aldosterone →renin will be low, Aldosterone will be high.

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19
Q

What is the triad of symptoms associated with pheochromacytoma?

A

S.E.T.
Sweating
Episodic headaches
Tachycardia

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20
Q

What is the test for pheochromacytoma?

A

3 x 24hour urinary free catecholamoines

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21
Q

Treatment for pheochromacytoma is what?

A

Alpha blockade folled by removal of the tumour.

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22
Q

What causes congenital adrenal hyperplasia?

A

21 hydroxylase deficiency

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23
Q

What does 21 hyproxylase definciency cause?

A

High lvls of 17 hydroxprogesterone

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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
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25
Q

What decreases Calcium lvls in the blood?

A

Calcitonin

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26
Q

What increases calcium lvls in the blood?

A

PTH

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27
Q

What is 1, 25 hydroxyvitamin D also known as?

A

Calcitrol

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28
Q

Where is 1, 25 hydroxyvitamin D produced?

A

In the kidney

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29
Q

What does 1, 25 hydroxyvitamin D do?

A

It acts on the small intestine to promote the absorption of calcium and increase blood Ca+ lvls.

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30
Q

What are 3 causes of Spinal cord compression?

A
  • Tumour
  • Abcess
  • Vertebral disk rupture
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31
Q

What are the symptoms of spinal cord compression?

A
  • Back pain
  • Loss of sensation distal to the compression
  • Loss of movement/paralysis distal to the compression
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32
Q

What is the treatment for spinal cord compression?

A
  • Dexamethasone

* surgical decompression

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33
Q

What is cauda equina?

A
  • MEDICAL EMERGENCY

* Compression of the lumbrosacral nerve roots.

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34
Q

What does Cauda equina present as

A
  • 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
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35
Q

What is a brown sequard syndrome?

A

This is ahemisection of the spinal cord being compressed/occluded.

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36
Q

What is syryngomeylia?

A
  • 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).
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37
Q

What are the investigations for Cauda equina?

A

Urgent MRI→ surgical referal

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38
Q

What is a syringiobulbia?

A

Cyst of the brain stem

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39
Q

What is a chiari malformation?

A

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

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40
Q

What happens in a chiari malformation?

A

The cerubellum presses on the spinal cord.

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41
Q

What symptoms would you have with a brown sequard lesion?

A

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

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42
Q

Where do motor tracts in the brain begin and which way do they run in the spinal cord?

A
  • The start in the precentral gyrus

* They run down the spinal cord

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43
Q

Which way do sensory tracts run in the spinal cord?

A

•They run up the spinal cord

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44
Q

Where do signals coming from the brain decussate?

A

In the medulary pyramid.

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45
Q

Where do propriocetion and vibration decussate?

A

In the medullary pyramid

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46
Q

Where do pain and heat decussate?

A

crosses in the spinal cord

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47
Q

What sensation travels in the corticospinal tract?

A

Pain and temperature

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48
Q

What sensation travels in the dorsal column?

A

propriocetion and vibration

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49
Q

What travels in the descending corticospinal (pyramidal) tract?

A

Motor

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50
Q

Which side will we have weakness on in a brown sequard?

A

On the same side as the lesion.

51
Q

What is a direct pupil reaction?

A

Shine light into the right eye and the right eye constricts.

52
Q

What is a consensual pupil reaction?

A

Shine light into the right eye and the Left pupil constricts.

53
Q

Which cranial nerve is the Afferent nerve or sensory limb of the pupillary reflex?

A

Optic nerve → CN2

54
Q

Which cranial nerve is the Efferent nerve or motor limb of the pupiliary reflex?

A

occulomotor nerve → CN3

55
Q

What is the parasympathetic action of the pupil?

A

constriction

56
Q

What is the sympathetic action of the pupil?

A

dilation

57
Q

What is the optic nerve CN2 responsible for?

A

carrying information to the brain from the eye.

58
Q

What nerve carries information from the brain back to the eye?

A

The occulomotor nerve. CN3

59
Q

If one eye is looking down and out, with a drooping eyelid, which nerve has a problem?

A

Occulomotor CN3

60
Q

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

A relative afferent pupil defect (RAPD)

61
Q

What is happening in a relative afferent pupil defect?

A

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
Q

What would cause a relative afferent pupil defect?

A

Optic neuritis.

63
Q

What is marcus gunn pupil?

A

a relative afferent pupil defect

64
Q

Which way do the obliques move the eye?

A

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
Q

How do you test for CN4 palsy?

A

Depress the eye when it is ADDucted.

66
Q

What are the 3 cranial nerves that supply the eye muscles?

A

LR6, SO4 = 3 (everything else)

67
Q

What is the terminology for looking up?

A

Elevated

68
Q

What is the terminology for looking down?

A

depressed

69
Q

If you have a red eye with “gunky” discharge, normal pupil + normal vision, what is this?

A
  • Conjunctivitis.

* Treat with chloramphenicol

70
Q

If you have photophobia, a white spot on the cornea and hypopyon, what is it?

A

Corneal ulcer

71
Q

What drug is used to dilate the eye?

A

Tropicamide

72
Q

What is acute iritis?

A

inflammation of the uveal tract,

73
Q

What is septic arthritis?

A
  • 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
Q

What is a severely inflamed monoarthritis until proven otherwise?

A

Septic arthritis

75
Q

What is the likely diagnosis for someone who drinks and eats alot and presents with a hot red swollen joint?

A

Gout

76
Q

What is gout?

A

Monosodium urate crystals that start an inflamatory reaction.

77
Q

What will monosodium urate crystals looklike?

A
  • needle shaped

* Positive birefrigence

78
Q

What is the first line treatment for gout if no contraindication is present?

A
  • NSAIDS

* followed by Colchicine (second line)

79
Q

What drug is prescribed to manage gout long term?

A
  • Alpurinol

* DO NOT START DURING AN ATTACK

80
Q

What is the method of action for allopurinol

A

It is a xanthine oxidase inhibitor

81
Q

Where is vitamin D3 sythesized?

A
  • 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
Q

What does calcitonin do?

A

It works in opposition to Parathyroid hormone (PTH) reducing calcium in the blood.

83
Q

What is calcitrol?

A

1,25-Dihydroxyvitamin D3

84
Q

What does calcitrol do?

A

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
Q

What cells in the Parathyroid gland produce PTH?

A

Chief cells

86
Q

What cells in the parathyroid gland produce calcitonin?

A

Parafollicular cells (also called C cells)

87
Q

What are the symptoms of hypercalcaemia?

A
  • 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
Q

What are the symptoms of Hypocalcaemia?

A

CATs go NUMB

  • Convulsions
  • Arrhythmias
  • Tetany (muscular spasms)
  • Numbness
89
Q

What clinical condition is associated with alack of Vit.D?

A

•Osteomalacia

90
Q

What is osteomalacia?

A
  • Low mineral content in bone

* softening of the bones, typically through a deficiency of vitamin D or calcium.

91
Q

What is osteomalacia called when it takes place before the sealing of the epipyseal plate?

A

•Ricketts

92
Q

If on digital rectal exam a prostate feels irregular and nodular, What is the likely diagnosis?

A

•Prostate cancer

93
Q

If a patients testicle feels like a bag of worms, what is this?

A

•A varicocele

94
Q

If a patients testicle is swollen, fluid filled and lights up with a torch, what is this?

A

•Hydrocele

95
Q

If a patients testicle has a painless cyst on the epididymus what is this?

A

•Epididymal cyst/spermatocele

96
Q

If a patients testicle painful swollen epididymus, what is this?

A

•Epididymitis.

97
Q

what causes a hydrocele?

A

•A patent processus vaginalis fills with fluid.

98
Q

If a patient has a painful swollen testicle, what is this?

A

•Orchitis.

99
Q

If a patients testicle is enlarged but cannot be isolated, what is this?

A

•Inguinal hernia.

100
Q

If a patients testicle is enlarged and discoloured following trauma, what is this ?

A

•Haematocele

101
Q

If a patient presents with an acutely painful testicle what is this?

A
  • Testicular torsion

* MEDICAL EMERGENCY

102
Q

If a patient presents with a swollen non painful testicle that does not light up with a torch, what is the likely diagnosis?

A
  • Testicular cancer

* also consider in change of shape of texture

103
Q

What are 95% of testicular tumours?

A
  • Seminomas, germ cell cancer.

* vascular cancer that responds well to radiotherapy

104
Q

what is the treatment for a testicular seminoma?

A

Radiotherapy and an orchidectomy

105
Q

What is the cremastic reflex?

A

When you stroke the inside of the leg and the testicle retracts.

106
Q

What side effect does glanclovir have?

A

Neutropenia

107
Q

What is the Antiviral used to treat Influenza?

i = vir

A

oseltamivir

108
Q

What is the Antiviral used to treat HIV?

A = Aids

A

RitonAvir

109
Q

What is the Antiviral used to treat herpes?

O = Oh shit I have herpes

A

Acyclovir

110
Q

What are the 2 proteins on the surface of the flu virus called?

A
  • Haemagluttinin

* Neuraminadase

111
Q

Smoking protects from which IBD?

A

Ulcerative colitis

112
Q

Smoking exacernates which IBD?

A

Crohns

113
Q

What is the treatment for crohns?

CAM - RAM

A

CAM
•Corticosteroids → first line
•Azathioprin
•Monoclonal antibodies

RAM
•Remission
•Azathioprin
•Methotrexate

114
Q

What is the treatment for UC?

A
  • Aminosalicylates +/- corticosteroids first line
  • ciclosporin or infliximab as second line
  • colectomy third line
115
Q

What is the first line treatment in diabetes?

A

Metformin

116
Q

What is the first line treatment for diabetes if the patient is not overweight?

A

Gliclazide (sulphoyluria)

117
Q

What is a common side effect of metformin?

A

Metabolic acidosis (lactic acidosis)

118
Q

What diabetic drug slows the break down of carbohydrate?

A

Acarbose

119
Q

Which 2 drungs work on the incretin effect?

A

Sitagliptin - DPP-4’s

exenatide - GLP1 agonists

120
Q

What is the pathology of type 1 diabetes?

A

Autoimmune destruction of the pancreatic B-cells

121
Q

What are the 4 types of shock? name them.

A

Maldistributive → Anaphylaxis / sepsis
Cardiogenic → MI
Obstructive → PE
Hypovolaemic → dehydration

122
Q

What is the treatment in anaphylaxis?

A
  • IM adrenaline → 1g in 1litre
  • Antihistamines → chlorphenamine
  • Mast cell triptase test.
123
Q

What is the treatment for sepsis?

FOBSIC

A
  • Fluid resuscitation
  • oxygen
  • blood cultures
  • serum lactate
  • IV antibiotics
  • catheterise

2nd year help prt 4 (1 decks)

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