Formative Flashcards
In a partial gastrectomy which secretion of the stomach is likely to be reduced to a level whereby adverse effects are seen on the body?
Intrinsic factor - necessary for vitamin B12 absorption (crucial for DC function - proprioception, fine touch and conscious proprioception)
What hormones stimulates the pancreas to secrete HCO3- and enzymes?
Secretin - HCO3-
CCK - enzymes
What’s the transport for absorption of amino acids across the luminal and then basolateral membrane in the intestine?
Luminal: symport (cotransport) with Na+
Basolateral: passive diffusion
What’s the role of bile salts and where are they reabsorbed?
Emulsify fats so they can be easily digested by pancreatic lipase
Majority of bile salts are reabsorbed in the terminal ileum
What class of drug is Oxybutinin? What receptors and for what
Doxasozin?
Oxybutinin = anti-spasmodic to treat urinary incontinence by blocking M3 receptors on detrusor
Doxasozin (a1 adrenoceptor blocker) = treatment of retention (BPH) by blocking a1 receptor at internal urethral sphincter to relax
What drug can produce symptomatic relief of diarrhoea and how?
Loperamide = u opioid agonist to increase rhythmic contractions of the colon by reduce propulsive activity
(increasing dietary fibre and osmotic laxatives would increase colonic motility)
What stimulates and inhibits parietal cell acid secretion?
Stimulate: gastrin, histamine, ACh (mAChR)
Inhibit: somatostatin, prostaglandin, intestinal hormones
What would bruits on the transpyloric plane indicate?
Renal stenosis (T1)
What’s a posterior relation to the kidney that’s at risk in superior kidney pole biopsy that’s approached from the back?
Parietal pleura = could damage this and the lung, leading to pneumothorax (air into the damaged pleural cavity will cause pain)
What makes indirect hernia’s clinically obvious?
Reducible, remains reduced when pressure placed over the region of the deep inguinal ring (midpoint of inguinal ligament)
What cell type is raised in acute inflammation?
Neutrophil (able to phagocytose and produce immediate response to injury)
Which class of diuretics can give hypokalaemia?
Loop diuretics (Furosemide) on thick ascending loop of henle, Na+K+2Cl- co transporter inhibitor
What type of epithelium forms the filtration barrier in the glomerulus?
Simple squamous
Which gastric cell type secretes Pepsinogen?
Chief cells
Pepsinogen -> Pepsin to break down proteins when stimulated by low pH
What’s the function of lacteals in the small intestine?
Carry products of digestion through the capillary walls (chylomicrons, packages of triglyceride droplets, are exported across the basolateral membrane into lacteal)
Which cell type has low affinity glucose transporters?
Hepatocytes - glucose uptake via low affinity GLUT2 = activity varies significantly with glucose concentration
What’s a high affinity glucose transporter?
GLUT1 (almost always operating near transport maximum)
GLUT1, 3, 4
What’s a gravity dependent recess in the abdominal space where fluid can accumulate and cause infection?
Hepatorenal (will cause right hypocondrial pain that may radiate to right shoulder because of diaphragm irritation)
How does SIADH and diabetes insipidus differ?
SIADH = too much ADH = too much fluid retention and hyponatreamia
DI = neurogenic whereby insufficient ADH produced by hypothalamus, or nephrogenic whereby CD is insensitive to ADH
What’s the main factor for ADH release?
Released from posterior pituitary in response to raised plasma osmolarity
Why do you get hyponatreamia in SIADH?
Aquaporins inserted into collecting duct
Too much water reabsorption
Plasma electrolytes diluted
What substance controls osmotic gradient of the kidney and therefore what class of drugs are most powerful in regulating this?
Urea Loop diuretics (NaCl also controls - NaK+Cl- cotransporters)
What type of consent is sufficient for taking blood?
Implied consent = Dr explains procedure to patient so that they have enough information, then patient rolls up sleeve and presents arm, implying they understand and agree to having blood taken
Verbal consent = Dr explains procedure to patient and then verbally asks if they agree - patient verbally agrees to having the procedure
What ethical principle underlies the legal doctrine of informed consent?
Respect for autonomy = patient has right to make decisions over their own body and therefore decide to consent to treatment or not
How are thyroid hormones transported in blood?
Freely (T4/T3)
Bound to: plasma albumin, thyroxine binding globulin, thyroxine binding pre-albumin, plasma proteins
Which organs can refer pain to the epigastric region?
Stomach Liver Distal oesophagus Pancreas Gallbladder 1st and 2nd parts duodenum
Outline how PPIs can reduce epigastric pain
Inhibit H+/K+ ATPase pump to prevent formation of HCL (acid) by gastric parietal cells
This neutralises stomach acid so there is less irritation to mucosa by acidic content reflux
Why can symptoms of GORD return after 3 days following PPI?
PPI irreversibly inhibit the proton pump by becoming trapped in parietal cell canaliculi, therefore new proton pumps need to be made and inserted to parietal cell epithelium to restart acid secretion
What are strengths of the infectious diseases notification process?
Timeliness - weekly report to PHE
Representative - routine national data
Linked to other data (labs) to improve accuracy
What are the 2 coding systems for input to Hospital Episode Statistics?
ICD-10 for all admissions, procedures etc
OPCS-4 for all operations
What are the 4 principles of person-centred care?
Personalised
Enabling
Coordinated
Treats patient with dignity, compassion and respect
