GENERAL MEDICINE

Question 1

What is a normal FVC range

Answer 1

~3.5 - 5.5 (men higher than women)

Question 2

List types of non-invasive and invasive ventilation

Answer 2

Non-invasive: cpap, bipap

Invasive: volume targeted ventilation

Question 3

List some of the medical complications of steroids that you immediately have to monitor after starting treatment

Answer 3

Hyperglycaemia (need to monitor in diabetics) can induce diabetes like state
Gastro protection - cause increase gastric acid secretion and pepsin which may cause ulcers

Question 4

List some of the end stage symptoms of cirrhosis

Answer 4

Hepatic encephalopathy (portal hypertension)
Ascites (portal hypertension)
Pleural effusion
Varcies (portal hypertension)
Congestive heart failure (raised hepatic vein pressure)

Question 5

What is the treatment for hepatic encephalopathy

Answer 5

Laxatives - lactulose, movical

Rifaximin - antibiotic that increases ammonia excretion from the gut

Question 6

What is an adenoma

Answer 6

Benign growth of secretory tissue

Question 7

What is the most common complication of thyrotoxicosis

Answer 7

AF

Question 8

How does insulin affect potassium

Answer 8

Drives potassium into cells. Can cause hypokalaemia.

Question 9

What are incretins

Answer 9

Hormone released by the duodenum in response to glucose - stimulates insulin response. 
GPP4 enzymes breakdown incretins. 
GPP4 inhibitors (glyptins) prevent the breakdown of incretins and therefore promote insulin release. Helps DM II.

Question 10

Which diuretics are potassium sparing and why

Answer 10

Spironolactone

Inhibits aldosterone so there is no aldosterone mediated resorption of water in collecting duct. Risk of hyperkalaemia.

Question 11

Which diuretics are loop

Answer 11

Furosemide

Question 12

Where to thiazides act

Answer 12

On distal tubule

Question 13

What is the management of glaucoma

Answer 13

Prostaglandin analogues (reduce fluid to the eye)
Beta blockers (reduce fluid to eye)
Alpha agonists (reduce secretions/ occular fluid)

Question 14

What is the treatment for acute angel closure glaucoma

Answer 14

acetazolamide

Reduces introcular fluid production and helps uveoscleral drainage

Question 15

What is the difference between cpap and bipap

Answer 15

Cpap - same pressure in and out

Bipap - different inspiratory and expiratory pressures

Question 16

What are the different layers of the skin

Which layers is cellulitis and infection of

Answer 16

Epidermis
Dermis
Cutaneous layer (hypodermis)
Cellulitis - dermis and cutaneous layer

Question 17

What are the main differences between nephrotic and nephritic syndrome

Answer 17

Nephrotic = lots of protein loss.
Proteinuria, hypoalbuminaemia, HTN, Odema
Nephritic = lots of blood loss.
Haematuria, HTN, odema

Question 18

What is DIC, what are the causes

Answer 18

It is when you are clotting and bleeding at same time
Causes are anything that hyperactivates the coagulation system, eg sepsis, pregnancy complications.
As clots start to form, this uses up platelets, clotting factors etc, so get bleeds in other areas.
In PET, increased clotting factors plus hypertension can cause clots to form and bleeding in other areas.

Question 19

What are the blood results you see in DIC

Answer 19

Low platelets

Prolonged thrombin and prothrombin time reflecting that all clotting factors have been used up

Question 20

What is HUS how is it different to DIC

Answer 20

HUS, complication of e coli. The problem is in the kidney. You dont get clots forming anywhere as in DIC, just the kidney, this causes increase in urea (uremic), and damages RBC (because of splicing in fibrin mesh of microvascular capillaries) (haemolytic). Clotting profile is normal in HUS because its not a disseminated pathology (i think), you do get low platelets and Hb though.

Question 21

What are the different types of laxatives

Answer 21

Bulking agents - used if low fibre - never use if low fluid intake as can cause obstruction
Stimulant - increases gut motility - use for acute constipation
Osmotic -increases fluid in colon, softner and distension - use for chronic constipation

Question 22

which thyroxine is more metabolically active and potent, t3 or t4

Answer 22

t3

Question 23

What is the function of hepcidin

Answer 23

To regulate serum iron levels. Does this by inhibiting ferroportin in gut, macrophage and liver. When serum iron is high hepcidin ‘turns off’ iron release into blood stream. In haemochromatosis hepcidin is low which leads to high flux of iron into blood from gut, liver and macrophage.

Question 24

What are the causes of microcytic anaemia

Answer 24

Iron deficiency (diet, malabsorption)
Thalassaemia (beta - not enough Hb protein production)
Chronic disease (inflammation = incresed hepcidin = low iron, or 'sick person, sick marrow')

Question 25

What are the different drug management options for type 2 diabetes and how does these work

Answer 25

Metformin - inhibits hepatic glucose production, glucose absorption, increases insulin sensitivity peripherally
Sulfonylureas - stipulate beta cells in pancreas to produce more insulin
Gliclazides - increases the amount of insulin the body produces
DPP4 inhibitors - stimulate incretins, that stimulate insulin release, for longer

Question 26

How do steroids affect bone

Answer 26

Stimulate osteoclasts, facilitate bone breakdown

Osteoporosis