Gen med Flashcards
what do the centracinar cells of the exocrine pancreas secrete? And what is the signal for this cell to secrete it?
Secrete bicarbonate ions
Signal = secretin
What do the basophilic cells of the exocrine pancreas secrete?
What is the signal?
Digestive Enzymes
CCK
What proteases does the pancreas secrete?
trysinogen, chymotripsonogen, lipase, amylase
What enzyme activates trypsinogen
enteropeptidase
What is Conn’s Syndrome
Aldosterone producing adrenal adenoma
2 main features of hyperaldosteronism
Hypertension, Hypokalemia
Best means of differentiating between primary and secondary hyperaldosteronism
ARR: aldosterone to renin ratio
Clinical Features of Infective Endocarditis
Osler's nodes Splinter haemorrhages Janeway lesions Clubbing New or changing murmurs Arthralgia Roth spots Conjunctival haemorrhages Splenomegaly Cerebral emboli Mycotic aneurysm, and Haematuria
Side Effects of Amiodarone
Arrythmias - torsades de pointes, QT prolongation, hepatotoxicity, pulmonary fibrosis, photosensitivity, neuropathy, hyperthyroidism
Amiodarone mechanism of action
potassium channel blocker, it prolongs cardiac action potential duration. It also prolongs the effective refractory period. As well as potassium, it also blocks sodium and calcium channels hence slows phases 0 and 3 and blocks alpha and beta adrenoceptors.
Felty’s Syndrome
arthritis, splenomegaly, neutropenia
Tietze Syndrome
Tietze syndrome is a rare, inflammatory disorder characterized by chest pain and swelling of the cartilage of one or more of the upper ribs (costochondral junction).
blindness resulting from parietal lobe tumour
inferior homonymous hemianopia
Bilateral occipital lobe infarction
cortical blindess
Medical treatment for LUTS in men
alpha1 adrenergic blocker
Tamsulosin: uroselective
Kerh’s Sign
Refers to shoulder tip pain that occurs due to blood in the peritoneal cavity that is irritating the diaphragm
causes of tender hepatomegaly
hepatitis
Factors which cause rapid enlargement: Right heart failure, Budd-Chiari Syndrome, Hepatoma
Reidel’s Lobe
projection of the liver from the inferior surface of the right lobe, normal anatomical variant
Pulsatile liver causes
Most common cause is tricuspid incompetence
Neoplasms: HCC, haemangioma, haemangiosarcoma
AVMs
Budd-Chiari Syndrome
Occlusion of the hepatic veins
3 drugs that cause gingival hypertrophy
Nifedipine, Ciclosporin, Phenytoin
BeriBeri
Deficiency in Thiamine (vitamin B1)
CHF, Peripheral Neuritis, Psychic Disturbances
Pellagra
Lack of NIacin (vitamin B2)
Diarrhoea
Dermatitis
Dementia
Inherited form of zinc deficiency
acrodermatitis enteropathica - skin changes alopecia diarrhoea weight loss emotional disorder increased infections can be fatal
Adult Onset Still’s Disease
rare systemic inflammatory disease characterised by the classic triad of persistent high spiking fevers, joint pain and a distinctive salmon coloured bumpy rash
severe abdominal pain + abnormal illness behaviour + ‘red’ urine
Acute intermittent porphyria
Bactrim
Trimethoprim-Sulfamethoxazole
antifolate drug
what cells does carcinoid tumour arise from
enterochromaffin cells
What do carcinoid tumours secrete
excessive serotonin (5HT)
Test for carcinoid syndrome
24 hour urine levels of 5-HIAA
Charles Bonnet Syndrome
Complex visual hallucinations in a person with partial or severe blindness
Ludwig’s Angina
potentially life threatening cellulitis or connective tissue infection of the floor of the mouth, usually occurring in adults with concomitant dental infections and if left untreated, may obstruct the airways, necessitating tracheotomy
as what is carbon dioxidde primarily transported as in the blood?
bicarbonate
treatment for motion sickness
cyclizine
tapping apex beat
mitral stenosis
non infective endocarditis
Libman-Sacks syndrome
Howel-Evan syndrome
extremely rare condition involving thickening of the skin in the palms of the hands and soles of the feet
associated with high lifetime risk of oesophageal cancer
What type of cancer is associated with Barret’s oesophagus
adenocarcinoma
Diffuse oesophageal spasm on barium xray
corkscrew pattern
Achalasia on barium xray
Birds beak appearance
Risk factors for testicular cancer
cryptorchidism, family history, age 20-40, Klinefelter’s, HIV
Investigations for testicular tumour
Testicular ultrasound
tumour markers: BHCG, AFP
Radical Inguinal Orchidectomy
What medications can be used as adjunct therapy in alcohol dependence
alcamprosate
naltrexone
Disulfiram
CAGE Questionaiire
Have you ever felt you ought to Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt bad or Guilty about your drinking?
Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover ( Eye-opener)?
One or more “yes” responses constitute a positive screening test.
Buproprion
non nicotine oral therapy - It is effective for smokers with depression, cardiac or respiratory diseases, and also to improve short-term abstinence rates for people with schizophren
5As in smoking cessation
Ask about and document tobacco use at every opportunity
Assess motivation and confidence to quit - ‘are you interested in quitting?’
Advise the smoker to stop
Assist the smoker to stop
Arrange follow-up to maintain non-smoking
Morton’s Neuroma
benign neuroma of an intermetarsal plantar nerve
entraps affected nerve
pain and numbness and shooting pains
direct pressure between metatarsal heads can replicate pressure
most common complication of high dose corticosteroid therapy
insomnia
Tumours most likley to metastasise to bone
Breast, prostate, lung, colon, kidney, thyroid
most common cause of death after spinal cord injury
pulmonary failure
Autonomic Dysreflexia
baroreceptor response that frequently causes bradycardia
Acute management of GI dysfunction after a spinal cord injury
GI decompression via IG tube,
increased protein in diet,
use of PPIs,
placement of PEG or NET for dietary support
Incomplete tetraplegia
arms are paralysed but legs are spared
Neurogenic bowel management plan
high fibre, scheduled stool softners, GI stimulants and rectal stimulants
Problems resulting immediately after spinal cord injury
GI dysfunction; cognitive dysfunction; neurogenic bladder; pressure ulcers
most common outcome of spinal cord injury
incomplete tetraplegia
CREST Syndrome
Calcinosis: calcium deposits on skin
Raynaud’s phenomenon
Esophageal dysfunction: acid reflux
Sclerodactyly: tightening of skin on digits
Telangiectasia: superficial dilated blood vessels
Limites Systemic Sclerosis
Haemophilia B
Factor 9 deficiency
Haemophilia A
Factor 8 Deficiency
Anal Disease in IBD
Crohn’s
Rectum always involved in IBD
Ulcerative colitis
Treatment for haemophilia A
desmopressin
which cause of anaemia most classically has the hair on end appearance on xray
thalassemia
DRESS
Drug Reaction with Eosinophilia and Systemic Symptoms
Liver most commonly involved
Fever, liver abnormalities, lymphadenopathy
Difference between spacticity and rigidity
Spacticity is velocity dependent
rigidity is present throughout all movements
Ichthyosis
‘fish scale’
group of genetic disorders that cause dry scaly thickened skin
Howel-Evan Syndrome
condition involving thickening of the skin in the palms of the hands and soles of the feet (hyperkeratosis)
associated with high lifetime risk of oesophageal cancer
Marjolin’s ulcer
squamous cell ulcer that develop in areas of chronic inflammation such as burn sites or varicose ulcers
Brodie’s Abcess
cavity surrounded by a ‘halo’ of sclerosis, most commonly occur in metaphases of long bones
pituitary mass with calcification in a child with visual field defect
Craniopharyngioma
Features of aspirin overdose
Encephalopathy, deranged coagulation, renal failure, hypoglycaemia
MEN 2A syndrome
Thyroid, parathyroid and phaeochromocytoma
Mutation in the RET gene
Whipple’s Triad
Suggest the patients symptoms result from hypoglycaemia (could be pancreatic insulinomas) and consists of: fasting hypoglycemia. symptoms of hypoglycemia. immediate relief of symptoms after the administration of IV glucose.
Akithesia
motor restlessness, constant semi purposeful movements of arms and legs
athetosis
writhing slow sinuous movements, especially of the hands and wrists
Wernicke’s Area
posterior superior temporal lobe (first temporal gyrus)
Receptive dysphasia
Broca’s Area
posterior inferior frontal lobe
Nominal dysphagia lesion
dominant posterior temporparietal area
Gerstmann Syndrome
Dominant hemisphere parietal lobe Acalculia Agraphia Left-Right disorientation finger agnosia
occipital lobe
homonomyous hemianopia
alexia (inability to read)
seizures (flashing light aura)
Frontal Lobe
personality changes primitive reflexes anosmia optic nerve compression leak weakness gait apraxia dysphagia (expressive) loss of micturition control
Temporal Lobe
Memory loss
upper quandrantopic hemianopia
dysphagia (receptive if dominant lobe)
Psuedobulbar palsy
upper motor neuron weakness that causes spastic dysarthria
What is the distribution of the capillary haemangioma in Sturge Weber Syndrome
Trigeminal
Conversion Disorder
Neurological complaint with motor, sensory deficit, with seizures or convulsions. Initiation is preceeded by conflict or other stressors
not intentionally produced or feigned
cannot be explained by a medical condition
causes distress
Side effect of cisplatin
renal damage and neural toxicity
Side Effect of cyclophosphamide
haemorrhagic cystitis adnd alopecia
side effect of blemoycin
Pulmonry fibrosis
doxarubicin side effect
cardiac toxicity
vincristine
peripheral neuropathy
Drug of choice in severe delirium
Halloperidol
