Exam Questions Flashcards
what can cause explosive diarrhoea
- viral infections i.e. enterovirus, rotovirus
2. bacterial infections i.e. ecoli, salmonella, campylobacter
which gene protects against neoplasms?
p53 gene on 17th chromosome. it forces the fucked up cells to go into an apoptosis reaction.
oncogenes are cancer promoting genes that occur as a result of mutation.
other examples are -
ABL gene - CML (use imatinib) - promotes tyrosine kinase which causes overproduction
RAS - many cancers especially pancreatic - promotes G protein
HER2 - tyrosine kinase receptor - breast and ovarian cancer
women with chest pain takes a spray to help with her unstable angina. what is the spray and what does it do to elevate pain?
The spray is GTN, it is used to relax smooth muscle, dilating coronary arteries and veins. this slows cardiac output putting less strain on the heart. CALCIUM is REDUCED!!!!
what is the hormone reasonable for growth?
growth hormone (somatotropin) is responsible for growth as well as cell reproduction, maintaining muscle mass, immune system function and growth of organs. you produce it form the anterior pituitary your whole life. it plays a vital role during puberty and 50% of the cells that make up the anterior pituitary releases GHRH.
most GHRH is released during -
- fasting
- sleep (delta sleep)
- exercise
acromegaly is seen to be related with excess GHRH secretion
dysfunction of GHRH is related to short stature.
a 5 year old boy presents with chronic granulomatous disease. he is being treated with recombinant interferon gamma. where do these cells derive from?
chronic granulomatous disease is when the body’s phagocytes (WBC) don’t work properly and you end up getting bacterial and viral infections easily as well as granulomas in the Gi tract
Interferon gamma is derived from natural killer cells and T cells from the lymphocyte pathway. they are an innate immune response to cancerous cell.
interferons are released in the presence of viral infections and neoplasia -
INF-a - these are made from leukocytes (lymphocytes and myeloblast - neutrophils, basophils, eosinophils). used against viral infections (Hepatitis B/C) and metastatic renal cell cancer
INF-b - this is made from fibroblast (collagen making cells) and has good antiviral action. it is also effective against relapsing MS - Katie
INF-gamma - this is made from T cells and natural killer cells (lymphocytes) and is good for treating chronic granulomatous diseases and osteopetrosis (stone bone)
50 year old man complaining of vertical diplopia. no bleed on CT scan. what cranial nerve is damaged
this is fourth nerve palsy results in vertical diplopia that is classically noticed when reading a book or going downstairs. The patient may also develop a head tilt due to diplopia.
Sixth nerve palsy results in horizontal diplopia (worsens on looking distant object) with the inability to abduct the eye.
3rd nerve palsy would result in ptosis, horizontal diplopia and dilation of pupil (parasympathetics carry along the 3rd cranial nerve)
A 45-year-old man with type 2 diabetes mellitus, currently taking metformin, comes in for his diabetic review. His glycaemic control is deemed to be not under control and gliclazide is added to his treatment regimen. The doctor is advising the patient about the side effects of sulfonylureas. What is the main side effect of sulfonylureas?
the main side effect of sulphonylureas is hypoglycaemia.
1st line -
Metformin
- high efficacy (lowers HbA1C well)
- no weight gain/loss, no hypoglycaemia risk
- It activates AMP kinase, it jumps on insulin signalling and makes them work well
- GI problems, N/V, metallic taste
- Lactic acidosis as gluconeogenesis is stopped, this builds up lactate, one product required for this. Metformin is secreted via kidneys, do not give in renal impairment (build up) and further lactic acidosis which can also damage the liver (hepatic impairment)
- doesn’t produce more insulin, just makes it work better
then if the isn’t working add -
- Insulin (injection)
- hypoglycaemic risk
- weight gain
- insulin receptor agonist
- high efficacy - Sulphonylureas (glipizide)
- hypoglycaemic risk
- more insulin released form the pancreatic b-cells as the K-ATP channel is closed, this means more +ve ions and therefore depolarisation = more insulin
- weight gain
- metabolised in the liver and removed from the kidneys so be careful in impairment - GLP1 agonists (“tides” - exenatide)
- injectable drug
- high efficacy
- GLP receptor on the pancreatic cell becomes phosphorylised and calcium channel is held open, this allows for more depolarisation)
- hypoglycaemia risk is low
- no weight gain
- GI problems (N/V)
- do not give in thyroid cancer as can lead to hyperplasia
- reduces cardiovascular disease
- TZD (Glitazones)
- these are medium efficacy
- this is a PPAR-gamma receptor (in the nucleus of the
- weight gain is to do with water retention in the kidney, swelling and oedema
- bone loss
- increase risk for bladder cancer
- DO NOT give in heart failure due to oedema
- SGLT2 inhibitors (Gliflozins)
- these work by just stopping absorption of glucose in the gut via SGLT2 receptors
- pee out more glucose (like a diuretic)
- weight loss
- UTI risk
- dehydration and diabetic ketoacidosis risk
- Hypotension risk
- do not give in renal impairment
- DPP4 inhibitors
this works by inhibiting DPP4 receptors on cells which increases GLP1 receptors on the pancreas. Again this causes phosphorylation of the calcium channels and more insulin is created -
- low efficacy
- angio-oedema (swelling of eyelids)
- low hypoglycaemic risk
- has immunological effects, can lead to infections (particularly in the lungs)
- rash
geezer has come back from South America and has encountered an insect bite whilst on his travels. He has episodes of fevers every 2/3 days associated with arthralgia and headaches. what is the likely causative organism?
Plasmodium Falciparum
the patient is experiences symptoms of this. the clue in the question is that he was bitten in an endemic area. Followed by arthralgia, fluctuating fever and headaches.
Bartonela Henselae is the causative agent for Catch scratch fever. (Simpsons has a black cat)
What drugs are part of the corticosteroid ladder?
mild eczema - hydrocortisone
moderate eczema - betnovate
severe eczema - dermovate
add in antihistamines or sedative antihistamines for sleep
make sure patient doesn’t have impetigo or eczema herpeticum
why would you check CK?
for muscular problems and inherent diseases like muscular dystrophy
what are mitochondrial inherited diseases and name some examples
Mitochondrial diseases are encoded by defects in DNA present in the mitochondria. As the sperm contributes no cytoplasm to the zygote, inheritance of these diseases can only occur via the maternal line.
1 - Kaerns-Sayer syndrome (triad of ophthalmoplegia - retinitis pigmentosa, tunnel vision and cardiac conduction problems)
A 30-year-old man presents with worsening retrosternal chest pain which is pleuritic in nature and radiating to the neck and shoulders. On examination, a pericardial friction rub is heard at the end of expiration. He is diagnosed with pericarditis - inflammation of the pericardium.
Which nerve is responsible for supplying this area?
the phrenic nerve innervates this area. sensory to the diaphragm and pericardium area, motor to the diaphragm 3,4,5
a patient gets an axillary node dissection and develops a winged scapula, what nerve is damaged?
the long thoracic nerve is damaged. This supplies the anterior serratus muscles and the pulling down of the scapula.
thoraco-dorsal innervates medial rotation and adduction of the LATS baby
what are symptoms of unilateral sciatica?
1) foot drop (no dorsiflexion - deep peroneal)
2) pain on adduction of hip (gluteal nerve)
3) knee extension is painful (femoral nerve)
4) loss of sensation of posterior and medial aspect of thing
5) pain on lateral aspect of thigh)
Name some features of Campylobacter jejuni infection?
1) present similar to acute appendicitis
2) fever is common
3) 1/4 lead to GBS
4) most common non-viral cause of diarrhoea (bloody)
5) gram -ve stain
6) headache
CLARITHROMYCIN is treatment of choice.
