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Phase 2a > liver/ GI/ gu > Flashcards

liver/ GI/ gu Flashcards

1
Q

signs of excess estrogen?

A

spider naevi - small spiderlike red arteries on skin
palmar erythema

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2
Q

what happens if something goes wrong in urea cycle?

A

Hepatic encephalopathy from build-up of ammonia that crosses blood-brain barrier

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3
Q

liver failure and carbohydrate metabolism

A

hypoglyceamia

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4
Q

liver failure and albumin production?

A

oedma
ascites - fluid build up in abdominal cavity
Leukonychia- -white nail beds

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5
Q

liver failure and bilirubin regulation?

A

jaundice and pruritus - itching

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6
Q

kuppffer cells and bilirubin regulation?

A

spontanous bacterial infection

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7
Q

best indicator of liver function?

A

PROthrombin time and serum albumin

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8
Q

prothombin time ?

A

how quickly blood clots

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9
Q

pre hepatic jaundice blood test results?

A

total bilirubin is must higher ratio than conjuglated (direct) bilirubin

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10
Q

complications of gilberts syndrome?

A

not efficient UGT so build up of unconjugated bilirubin and therefor pre hepatic jaundice

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11
Q

blood test in cholestasis?

A

increased ALP + GGT due to build up (increased) conjuglated bilirubin in liver

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12
Q

is ast specific to liver>

A

no its also found in skeletal muscle and heart

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13
Q

if ast/ alt are 10X normal, this is a sign of?

A

acute heptocellular inflammation (intra cellular jaundice) - paracetemol od

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14
Q

if ast/ alt are 5x normal, this is a sign of ?

A

chronic hepatocellular damage - such as long alchohol damage- ast is slightly higher with alcohol damage

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15
Q

cause of A1 antitrypsin defiency ?

A

autosomal ressesive mutation of serpina 1 on chromosome 14

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16
Q

does being post menopausal effect lfts?

A

yes, Early osteoporotic changes like in this
case, would cause an increase in ALP.

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17
Q

symptoms for upper gi bleed?

A

melaena
blood in vomit
coffee ground vomit

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18
Q

possible causes of upper GI bleed?

A

peptic ulcer - 50%
oesophogeal varices

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19
Q

0-1 on glasgow blatchford score means?

A

consider outpatient - low risk

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20
Q

Ix for upper GI bleeding?

A

A
B
C
D
E

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21
Q

when to suspect variceal bleed?

A

liver cirrhosis or alchol excess

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22
Q

tx for variceal bleeds?

A

antibiotics
terlipressin reduce mortality
request endoscopy within 12 hours

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23
Q

when to suspect non variceal bleed?

A

peptic ulcers
NSAIDS
anticogulants or antiplatelets

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24
Q

tx for non variceal bleed?

A

proton pump inhibitors - endoscopy within 24 hours

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25
Q

diaphragm disease?

A

caused by nsaids
lumen of bowel restricted and smaller

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26
Q

presentation of diviticular disease

A

washboard stomach due to peritonitis

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27
Q

SBO vs ileus

A

ileus - when gut cant push things forward but no blockage
SBO - syndromes - inability of movement through the gut via blockage in small bowel

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28
Q

symptoms of SBO?
history?

A

colic
bilious vomiting - color
green/ dark green - bile
bloating/ distension
sudden vs gradual onset
previous surgery - 90% have sbo afterwards
weight loss

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29
Q

assesment for SBO?

A

hydration status
weight loss
pulse/bp
dehydrated
o2 sats
abdomina distension
PR exam - really blown up - obstructed

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30
Q

ix for sbo?

A

fbc - cancer anemia/ infection high wbc + high crp
U+E
lactate - Anearobic resp
CT scan - indicates cause/ tell if ischaemic/ localises obstruction

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31
Q

tx for sbo?

A

MORPHINE - iv
urinary catherter to see urine production
nasogastric tube - pressure valve to stop pt from being sick
nutrition - > 5 days or more without intake parenteral feed
iv fluids

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32
Q

gastrografin challange?

A

after drainage of pt - give them ct contrast to drink
do abdominal xray

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33
Q

when to operate on hernia?

A

groin - iguinal/ femoral or umbilical

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34
Q

how to treat incisional hernia?

A

treat like adhesion sbo

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35
Q

really common sbo cancer?

A

right sided colon cancer

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36
Q

tx to cancercous sbo?

A

11-2 5% mortality
single level blockage - operation
multiple levels - possible stoma proximal to blockage
medical palliation

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37
Q

early management of sbo

A

IV FLUIDS
NASogastric tubes
urinary catheter
analgesia

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38
Q

early assesment for sbo?

A

CT scan
venous blood gas
U+E
CLINCAL examination

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39
Q

most common complication of sbo

A

renal failure

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40
Q

advise surgery in adhesive SBO ?

A

WHEN There are signs of ischeamia on ct scan

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41
Q

barretts oesophagus is a risk factor for?

A

Risk of progressing to oesophageal cancer – premalignant for adenocarcinoma of oesophagus

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42
Q

cancer associated with smoking?

A

squamous cell carcinoma

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43
Q

tx for barrets oesophagus?

A

endoscopies and proton pump inhibitors

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44
Q

adenocarcinoma of stomach why ?

A

because lined with glandular epithelium
adenocarcinoma arise from glands!

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45
Q

who gets colorectal cancer?

A

ppl with adenocarcinoma get colorectal cancer - because tissue is dysplastic

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46
Q

pathophysiology HNPCC?

A

2 hit hypothesis - damage to these repair proteins

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47
Q

sign of positive hep b active infection?

A

HBsAG surface antigen is present in blood
however this also present in vaccine !!!
HBeAg also present and sign of acute infection
IgM - acute infection

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48
Q

sign of previous infection from hep b ?

A

HBeAG is not present but the antibody is present
IgG HBcAB

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49
Q

how to test for hep B viral Load?

A

hbv dna

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50
Q

2 year old child with loose stools, no fever, miserable , contact with animals? what could it be?

A

e.coli - gram negative

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51
Q

common causes of diarrhoea in adults?

A

norovirus and campylobacter jejuni

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52
Q

works in take away and low bouts of bloody stool?

A

shigella, salmonella or campylobacter

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53
Q

timing for diarrhoea onset after eating ? toxins, bacteria, viral ?

A

toxin - quick (within 1-2 hours)
viral - 6 hours
bacteria - 1-2 days

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54
Q

diarrhoeal infection from overuse of antibiotics? resistant to ?

A

c. diff - resistant to cleaning alcohol
clindamycin, cephalosporins (in particular second‑ and third‑generation cephalosporins), quinolones, co‑amoxiclav

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55
Q

pathology of c.diff?

A

creates toxin to damage bowel lining

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56
Q

management for c.diff patients in hospital?
ix and tx?

A

isolate
enteric precautions
test stool sample
enviromental cleaning
- metronidazol or vancomysin

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57
Q

59 yrs old, altered bowel motions increased frequency and mucousal ? for 6 months and some weight loss and sweats?

A

bowel cancer -because older

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58
Q

symptoms of Shigella
E. coli (EIEC, EHEC)
Salmonella enteridis
V. parahaemolyticus
C. diff
C. jejuni
infection?

A

bloody and mucosal diarrhoea
in colon

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59
Q

symptoms of Vibrio cholerae
E. coli (ETEC)
Clostridium perfringens
Bacillus cereus
S. Aureus
infections?

A

watery diarrhoea

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60
Q

acute vs chronic diarrhoea?

A

Abnormal passage of loose or liquid stool more than 3 times daily
Acute – lasts less than 2 weeks
Chronic – lasts more than 2 weeks

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61
Q

infection caused by swimming outdooor?

A

cryptosporidian, giardia - parasites

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62
Q

descending weaknes and diarrhoea?

A

Clostridium botunilum

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63
Q

cause of ascedning weakness weeks after diarrhoea epsiode?

A

C. jejuni

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64
Q

role of loperamide?

A

Loperamide is commonly used for treating diarrhea, including IBS-D. It is an opioid agonist that does not cross the BBB, and works to reduce the release of acetylcholine & prostaglandins, thereby reducing GI motility.

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65
Q

management of vomiting?

A

Antiemetics – treat vomiting e.g. metoclopramide

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66
Q

lesions crohns vs UC?

A

chrons - transmural and skipping lesions
UC - continous and only lining

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67
Q

alpha interferon on HBV and hcv ?

A

prevent viral replication by increasing JAK to increase production of antiviral proteins to kill infected liver cells

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68
Q

role of ribavirin?

A

inhibits dna/rna replication in HCV (w/ INF alpha) and HIV

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69
Q

nucleoside analogues for HBV?

A

tenofir and entecavir
ribavirin - HCV!

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70
Q

side effects of nuceloside analogues?

A

headaches
abdo pain
HCV - ribavirin - haemolytic anaemia and hyperuricemia

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71
Q

pathophysiology of h.pylori?

A

lies in muscularis layer of stomach
releases cytokines and forms ammonia from urea and raises pH
only found in gastric like epithelium (metaplasia)
depletes somatostatin release( d cells) and increase gastrin release - creates ulcer

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72
Q

symptoms of h.pylori?

A

mostly asymptomatic and healthy

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73
Q

consequences of h.pylori infection?

A

gastric cancer
duodenal + gastric ulcer

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74
Q

gold standard for h.pylori?

A

microbiological culture - very slow + invasive

urea breath
endoscopy from barium meal

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75
Q

tx for h.pylori

A

PPI - omeprazole
2 antibiotics - metronidazole and amoxicillin, carithromycin - 7 days

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76
Q

side effects of metronidazole?

A

metallic taste
peripheral neuropathy
flushing and vomiting with alcohol

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77
Q

drug to enhance mucosal defense?

A

bismuth
blacken tongue and teeth and poo

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78
Q

most common cases for liver transplant?

A

cholestatic liver cirrhosis
primary biliary cirrhosis
alcoholic cirrhosis
hcv heptitc cirrhosis

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79
Q

contraidications for liver transplant?

A

sepsis
AIDS
MALIGNANCY
active alcohol misuse
cv dysfunction

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80
Q

definiton of porta hypertension?

A

prolonged elevation of portal venous pressure ( above 12 mmHg) normal 2-5 mmHg

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81
Q

cause of portal hypertension in adults?

A

90% cirrhosis

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82
Q

proteases from pancreas?

A

trypsinogen
chymotrypsinogen
get activated by interoendocrine cells in duodenum - interokinase

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83
Q

acute pancreatitis ?

A

autodigestion of pancreas by pancreatic enzymes by premature trypsingoen

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84
Q

causes acute pancreatitis?

A
  1. acinar cell destruction - alcohol
  2. ductal obstruction - small gallstones
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85
Q

causes of excess acid in dyspepsia?

A

helicobacter pylori - causes acute inflammation as well
stress

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86
Q

causes of defective intraluminal digestion in malabasorption?

A

pancreatic insufficiency
- pancreatitis
- cystic fibrosis
defective bile secretion
- bile obstruction - block cysytic duct
- ileal resection (surgery)
bacterial overgrowth

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87
Q

causes of insufficent absorption area in malabsorption?

A

ceoliac disease - villous atrophy + crypt hyperplasia.
crohns disease
parasite - Giardia Lamblia
infarcted small bowel

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88
Q

cause of lack of digestive enzymes leading to malabsorption?

A

lactose intolerance - disaccharide insuffiencincy
bacterial brush boarder damage

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89
Q

causes of defective epithelial transport leading to malabsorption?

A

abetalipoproteamia
Primary bile acid malabsorption

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90
Q

what is gallstones made of?

A

cholesterol mainly
some are pigment based

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91
Q

gallstones causes?

A

diet weight loss
haemolytic anaemia
cirrhosis
genetics - gallbladder motility
sickle cell

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92
Q

symptoms of gallbladder stones ?
cholelithiasis

A

colic pain - cant get comfortable
sharp pain
dietary upset after fatty foods
pale stools - steatorrhea
fever
jaundice

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93
Q

ix for gallstones?

A

blood test
- ast/ alt - liver damage
- bilirubin
- amylase - VERY HIGH = pancreatitis (most common cause in uk)
US scan - is wall thick and inflamed and gallstones?
MRCP (MRI scan)
CT SCAN - pancreatitis + cholecystitis

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94
Q

tx for gallstones?

A

watch and wait
radiological drain - cholecysteostomy
ERCP - endoscopy
cholecystectomy - surgery - keyhole

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95
Q

biliary colic gallstone? symptoms

A

RUQ pain due to gallstone block in bile duct
gallbladder attack

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96
Q

diagphramatic inflammation from gallbladder presents as?

A

pain in RUQ and right shoulder blade

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97
Q

cholecystitis acute symptoms?

A

pain ruq and right shoulder
Radiates AROUND side
Pain on breathing in
May have low grade fever
RUQ tenderness/Murphy’s +ve
press on RUQ and ask to breath - they will not want to inhale

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98
Q

common bile duct gallstones symptoms ?

A

pain colic crampting
worse after fatty foods
dark urine/ pale stools
fever
jaundice

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99
Q

cholangitis

A

pain colic cramping
worse after fatty foods
dark urine/ pale stools
fever
ruq pain
jaundice

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100
Q

Epigastric pain, radiating to the back
Worse on lying down/better sitting forward
No jaundice (liver tests slightly deranged)
No fever
Epigastric tenderness
high amylase

A

acute pancreatitis

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101
Q

Pain, intermittent, crampy around
umbilicus
Nausea and bilious vomiting
No jaundice
No fever
Distended abdomen

A

gallstone ileus

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102
Q

criteria for ceoliac disease?

A

marsh criteria
has to be 3a or above

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103
Q

management of ceoliac disease?

A

gluten free diet
dietitian review
bone density review
- no more prescription

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104
Q

dermatits herpetiformis linked to ?

A

coeliac disease
rash and itchy on skin

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105
Q

IgAtTg and villous atrophy?

A

coeliac disease

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106
Q

where does UC start ? skipping lesion?

A

starts at rectum and no skipping lesions compared crohns

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107
Q

bowel wall in crohns disease?

A

full thickness and inflammation (fat wrapping) - infammation transmural

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108
Q

histology uc vs crohns?

A

uc - cryptitis, crypt abscesses
crohns - 50-70% granulomas cobblestoning

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109
Q

aeitology of IBD ?

A

not sure ?
inherited
diet + smoking
bacteria - change in biome

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110
Q

nsaids on gut ?

A

cause inflammation of small bowel and colon

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111
Q

symptoms of uc ?

A

LLQ abdominal pain
Fever
Diarrhoea with blood and mucus
Cramps
smoking history - stopped now

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112
Q

ix of UC ?

A

monitor BM
stool cultures
stool chart
AXR - colonic dilations
flexible sigmoidoscopy

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113
Q

tx of uc ?

A

prophylactic LMWH - prevent blood clots (ibd increases risks)
IV steroids - 3 days - no response use infliximab or ciclosporin
Anti-inflammatory e.g. sulfasalazine – 5-aminosalicylic acid (5-ASA) absorbed in small intestine

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114
Q

how is UC classfied?

A

truelove and witts criteria

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115
Q

truelove and witts criteria ?

A

bloody stool a day > 6 a days
tachycardia
pyrexia
hb
ESR > 30 mm/h inflammatory activity

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116
Q

ix for crohns disease?

A

monitor bm
stool cultures
stool charts
axr
mre - drink contrast
FBC
- Raised ESR/CRP
- Often low Hb due to anaemia
Faecal calprotectin – indicates IBD but not specific
Colonoscopy – diagnostic

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117
Q

tx for acut crohns disease?

A

prophylactic lmwh
iv steroids

Oral corticosteroids e.g. budesonide and prednisolone
Add anti-TNF antibodies e.g. Infliximab if no improvement
Has predisposition for TB – night sweats, haemoptysis (coughing up blood) and weight loss
Consider adding azathioprine or methotrexate to remain in remission if there are frequent exacerbations
Surgery – doesn’t cure disease - right hemicolectomy

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118
Q

inflammation distribution in crohns vs uc ?

A

UC - only mucosa - continous
crohns - transmural and spread around

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119
Q

when would UC need surgery ?

A

toxic dilation - thinning of colonic wall
fatty change and fibrosis of liver and bile duct

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120
Q

defintions of FGIDSs?
examples ?

A

chronic GI symptoms in the absence of organic disease to explain the symptoms
IBD
functional dyspepsia

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121
Q

causes of IBS?

A

Psychosocial – stress, depression, anxiety
Psychological stress and trauma
GI infection - gastroenteritis
Sexual, physical or verbal abuse
Eating disorders

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122
Q

most common location of FGID?

A

GASTRODUODENAL AND BOWEL

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123
Q

ix for ibs

A

Since there is nothing physical to be found, diagnosis made by ruling out the differentials
Bloods
FBC – for anaemia
ESR and CRP – for inflammation
Coeliac serology for EMA and tTG – if either positive 🡪 high chance of coeliac disease
Faecal calprotectin – raised in IBD
Colonoscopy – to rule out IBD or colorectal cancer

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124
Q

dyspepsia is mostly …. on endoscopy ?

A

mostly functional dyspepsia
so shows normal on endoscopy

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125
Q

symtpoms of ibs?

A

non specific
Abdominal pain relieved by defecating or passing of wind
Bloating
Alternating bowel habits
Constipation
Diarrhoea

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126
Q

when to do an edoscopy in suspected iBS ?

A

limit it to only with alarm features
blood in stool
weight loss

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127
Q

alarm features of gi symptoms?

A

first time
over 45 age
short onset of symptoms
weight loss unintentional
symptoms in the night
family history - cancer
gi bleeding
abdominal mass
anaemia
inflammation in blood or stool

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128
Q

ix for ibs ?

A

symtpoms
history
1st line
- fbc, feacal calprotectin
- serology - infections
- Ca-125 for women

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129
Q

tx for ibs?

A

Lifestyle modification – fluids, avoid caffeinated drinks, alcohol and fizzy drinks, fibre (in wind and bloating NOT diarrhoea and bloating)
Treat symptoms
Pain/bloating – Buscopan
Constipation – laxative e.g. Senna
Diarrhoea – anti-motility e.g. Loperamide
If none of the above work - amitriptyline - not for depression!!! to dampen brain gut axis

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130
Q

gene involved in coeliac disease?

A

hla dq2/8 neccessary for coeliac but not always results in ceoliac disease

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131
Q

gold standard for coeliac disease?

A

Endoscopic intestinal biopsy. - gold standard diagnosis. Classic
finding for coeliac: jejunal/ duodenal biopsy showing villous
atrophy, crypt hyperplasia and lymphocytes.

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132
Q

nerve supply of visceral vs parietal peritonium?

A

visceral lack of nerve supply
parietal rich nerve supply

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133
Q

cause of peritonitis ?

A

A – Appendicitis – umbilicus to RIF pain
E – Ectopic pregnancy – low abdominal pain, sudden onset, tachycardia, low BP
I – Infection with TB
Bacterial – most common
Gram-negative e.g. E. Coli and Klebsiella
Gram-positive staphylococcus e.g. S. Aureus
O – Obstruction – colicky pain, history of abdominal surgery
U – Ulcer – epigastric pain radiating to shoulder
Peritoneal dialysis

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134
Q

bacterial causes of peritonitis ?

A

Anaerobes (e.g. bacteroides and clostridium)
E. coli
Klebsiella
Enterococcus
Streptococcus

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135
Q

symptoms of peritonitis ?

A

abdominal pain
N+V
malaise
anorexia
fever
distention

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136
Q

signs of peritonitis ?

A

signs:
rebound tenderness
localised guarding
tachycardia
shoulder pain if under diaphragm (phrenic nerve)
infrequent bowel sounds early on and then goes away - parlytic ileus

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137
Q

ix for peritonitis?

A

urine dip stick for uti
ECG
FBC
U+E
serum amylase - high in acute pancreatitis or perferated duodenal ulcer
CXR + AXR - for subdiagphramatic gas
CT : can show inflammation, ischaemia or cancer.

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138
Q

tx for peritonitis ?

A

correction of fluid loss and volume
urinary catheter and GI decompression
antibiotic therapy
analgesia

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139
Q

normal fluid in peritoneal cavity ?

A

men - no fluid
women - up to 20 ml

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140
Q

classification of ascites?

A

stage 1
stage 2
stage 3
stage 4 - tense

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141
Q

cause of ascites?

A

transudates - low protein
portal hypertension - liver cirrhosis ( MOST COMMON!)
low plasma protein - malabsoprtion
exudates - high proteins
malignancy (2nd MOST COMMON)
Budd chiari syndrome

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142
Q

signs of ascites?

A

jaundice
abdominal distension
puddle sign
pitting oedma
shifting dullness
spider naevi
flank dullness + shifting dullness
umblicial hernia

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143
Q

anemia in vegans ?

A

Dietary iron primarily exists in the form of haem iron, found in meat, and non-haem iron, found in green vegetables.

non-haem iron exists primarily as ferric (Fe3+) iron, which is insoluble and must be converted into ferrous (Fe2+) iron before it is absorbed by enterocytes.

the body is able to absorb non-haem iron however , the amount of iron absorbed via this method is often cannot allow for the sufficient absorption of iron.

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144
Q

ix for ascites?

A

LFT
cardiac function
imaging - xray
ut scan
ct abdomen
ascitic aspiration - fluid removal - microscpoy and cytology + CULTURES

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145
Q

tx for ascites ?

A

tx for underlying cause
sodium restriction
diurectics
paracentesis
peritoneovenous shunting - connection between hepatic vein and portal vein

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146
Q

A 52-year-old woman referred from GP with fatigue and deranged LFTs (raised ALT and ALP). Normal ultrasound liver. Hepatitis screen negative, antimitochondrial antibodies +ve. What is the most likely diagnosis

A

Primary biliary cholangitis mostly found in females
PSC - mostly males !!

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147
Q

conditions with gallstones in common billiary duct ?

A

pancreatitis
choledocholithiasis
cholangitis

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148
Q

conditions with gallstones in gallbladder or cystic duct ?

A

mucocele
empysema
acute cholecystitis
bilary colic

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149
Q

where is alkaline phosphatase found?

A

in hepatobillary tree and musculoskeletal

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150
Q

high levels of ALP found in?

A

cirhosis
biliary disease
preganancy
hyperthryoidism

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151
Q

pelvic nerve location?
parasymp or symp?
roll on bladder?

A

s2 - s4
parasympathetic
involuntary control

contraction of detrusor muscle
relaxation of sphincter

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152
Q

hypogastric plexus role on micturation?
parasymp or symp?
location?

A

t11 - L2
sympathetic control
involuntary control

storage inhibition of detrusor muscle contraction - storage

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153
Q

pudendal nerve?
role on micturation?
location?

A

S2-S4
somatic voluntary control of external sphinctor

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154
Q

role of onuf nucleus ?

A

ACh neurotransmitter
stimulated by pudendal nerve -> closes external sphinctor

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155
Q

OAB definition?

A

overactive bladder
urgency with frequency, with or without nocturia, but no local pathology
contractions of detrusor muscle

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156
Q

tx for oab?

A

behavioural therapy - no caffeine and alcohol
anti-muscarinic agents - decrease parasympathetic activity by antagonist of m2/m3 receptors - oxybutynin
b3 agonist - increase sympathetic innervation
botox - for incomplete emptying
sacral neuromodulation
cystoplasty

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157
Q

role of botox in pathological micturation?

A

botox - block ACH junction to relieve retention

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158
Q

what is sacral neuromodulation?

A

electrode inserted into S3 to regulate afferent signal from bladder

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159
Q

causes of voiding dysfunction?

A

obstructive - benign prostate enlargment, prolapses
non obstructive - detrusor underactivity

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160
Q

overflow incontinence ?

A

incomplete badder emptying due to detrusor underactivty or obstruction
urine loss without warning

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161
Q

ix and tx for overflow incontinence?

A

tx: clean intermittent catherterization
ix: post void residual volume measurements
urodynamic testing

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162
Q

treatment for BPE with LUTS ?

A
  1. alpha 1 blocker - tamulosin (blocks sympathetic)
  2. 5 alpha reductase inhibitors

no repsonse to medication - GS - TURP!

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163
Q

ix for AKI?

A

U+E
ULTRASOUND
FBC
dipsticks
outflow of urine

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164
Q

mnemomic for oesphalea cancer signs and symptoms?

A

Anorexia
Loss of weight
Anaemia
Resent onset
Maleana
Swalling difficulties

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165
Q

types of gastrci cancer ?

A

type 1 - well differentiated - good prognosis
type2 - poorly differentiated - bad prognosis

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166
Q

histology and appearnece of type 2 gastric cancer?

A

submucosa invasion and singlet cells
no movment of barium swallow - late stage

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167
Q

histology and appearence of type 1 gastric cancer ?

A

glandular and large polypoid and rough around the edges

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168
Q

2 week wait for endocsopy for suspected gastric cancer?

A

abdominal palpable mass
dysphagia at any age
> 55 year old with weight loss
dyspepsia
reflux

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169
Q

medications that can cause upper gi bleed?

A

Nsaids, SSRI, bisphosphonates

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170
Q

rockall scoring ?

A

scoring system for blood loss - pre and post endoscopic
upper GI bleeds

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171
Q

BLOOD test for UC?

A

FBC - anaemia, raised white blood cells
CRP raised
p- ANCA raised and raised in crohns
ceoliac screen

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172
Q

UC occurs where?

A

only occurs in colon
50% in rectum

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173
Q

histology of UC vs Crohns ?

A

Crohns - fistula, 50- 70% granulomas
UC - cryptisis, crypt absess

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174
Q

stool sample for UC?

A

feacal calprotectin
stool MCS

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175
Q

long term steroids use side effects?

A

weight gain
DM
hypertension
reduced immune system
cushingoid traits
abnormal hair growth

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176
Q

GETSMASHED?

A

mnemonic for causing acute pancreastitis
Gallstones
Ethanol
Trauma
Ercp - ix can cause pancreatitis

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177
Q

hypocalaemia and pancreatitis?

A

Pancreas autodigest - activation of digestive enzymes
Increases digestion of fats - increase fatty acids in blood - these react with calcium in blood and bind to fatty acids and become hypocalceamia

178
Q

blood test for pancreatitis?

A

lipase - more specific than amylase

179
Q

malabsorption behind pancreatitis?

A

exocrine function!
damaged acinar cells from repeated inflammation - failure for digestive enzymes - malabsorption

180
Q

4 vitamins for nutrional managment for pancreatitis?

A

VIT ADEK - FAT SOLUBLE

181
Q

FIRST STAGE ix for coeliac disease?

A

IgA
tTGA (has to been eating gluten prior) compared to total IgA

EMA - less common

FOLLOWED up by endoscopy

182
Q

complication for coeliac eating gluten?

A

cancer

183
Q

gammaGT and ALP RAISED?

A

biliary tree obstruction or damage
cholestasis

184
Q

high bilirubin, albumin, PT (prothrombin) sign of ?

A

synthetic function
damage to function of liver

185
Q

reticulocyte high?

A

during anaemia the bone marrow produces immature blood cells quickly these are called reticulocyte

186
Q

ix for hiatus hernia?

A

CXR
barium swallow
followed by endoscopy
eosphogeal manometry - for considering surgery

187
Q

1st line ix for coeliac disease

A

serology IgA tTG

188
Q

tx for UTI ? contraindications?

A

TANC (tank! dnb clubbing sex uti )
Trimethoprim - bad for pregnancy as is folate inhibtor
Amoxicillin
Nitrofurantoin
Cefalexin

189
Q

blood test results for carcinoid tumour ?

A

chromogranin A
neuron-specific enolase (NSE),
substance P
gastrin.

urine 5 HIAA, which is a metabolite of serotonin

190
Q

primary sclerorsing cholecystitis is associated with? ANNUAL IX?

A

UC! 80%
annual colonoscopy

191
Q

rule of 2 meckels diverticulum?

A

2 years old
2 inches long
2x more likely in male
2 feet away from ileoceacal valve

192
Q

ix for meckels diverticulum ?

A

Technetium-99m pyrophosphate scan
differnetiate from appendicitis

193
Q

where are diverticula most likly to be present?

A

signoid colon
higher pressure
smalled lumenal diameter

194
Q

presentation of diverticular disease?

A

abdominal pain
left iliac fossa
fever
tenderness, guarding
blood in stool

195
Q

tx of diverticular disease?

A

antibitocis - metrondiazole
IV fluid s
high fibre diet
surgery

196
Q

KDIGO diagnostic for AKI stages?

A

stage 1- serum creatine 1.5–1.9 times baseline
urine <0.5 ml/kg/h for 6–12 hours

stage 2 - creatine 2 times baseline
urine <0.5 ml/kg/h for ≥12 hours

stage 3 - creatine 3 times baseline
urine <0.3 ml/kg/h for ≥24 hours or anuria for over 12 hours

197
Q

post renal causes of aki?

A

urinary tract obstruction - tumours, BPH, stenosis, retroperitoneal fibrosis , urine calculi

198
Q

drugs to avoid with barrets oesphagus ?

A

NSAIDS
nitrates
TCAs - amytripline - antidepressants
K+ salts

199
Q

symtpoms of lower uti vs upper uti?

A

lower - frequncy, dysuria, urgency
upper - loin pain, fevers, rigor, heamaturia

200
Q

common organisms for UTI?

A

e.coli - gram negative bacilli lactose fermenter
s. epidermis - gram positive cocci - cata +/ coag -
klebsiella spp - g. neg bacilli lactose fermenter
enterococci -

201
Q

causes of UTI?

A

SExual intercourse
catherisation
renal stones
prostate growth
renal tract tumours

202
Q

IX for uti ?

A

mid stream urine
microscopy - nuetrophils pyuria -significant puss cells
cultures - macockney agar / CLED
sensitivty for antibitocs

203
Q

first line tx for UTI ?

A

trimethoprim 200mg 2x daily for 3 days
nitrofuritoin 50 mg 4 times a day for 3 days

204
Q

ix for Esophageal cancer?

A

1st line - endoscopy + biopsy
CT scan or USS

205
Q

key clinical features of nephritic syndrome?

A

heamaturia
proteinuria
hypertension

206
Q

causes of nephritic syndrome?

A

IgA nephropathy / Berger’s disease
Systemic lupus erythematosus
Henoch-Schonlein purpura
Poststreptococcal GN
Infective endocarditis
x linked condition leading to hearing loss
vasculitis

207
Q

presentation of nephrtic syndrome caused by rapidly progressive Gn?

A

cough, sob, fatigue, blood from lungs
Oedema - peripheral, periorbital, pulmonary
Visible haematuria - red / brown
Oliguria

208
Q

presentation of nephritic syndrome caused by IgA nephrophathy and strep GN?

A

URTI - UPPER RESP TRACT INFECTION
oedma
heamturia
oliguria
ureamic signs

209
Q

ix for nephritic syndrome?

A

urinalysis
24 hour urine collection
SEROLOGY - ANCA
u+e, BUN
renal biopsy

210
Q

diagnostic criteria for nephritic syndrome?

A

renal biopsy - Crescent shaped glomeruli, Ig depositions, glomerulosclerosis

211
Q

nephrotic syndrome vs nephritic syndrome?

A

nephrotic - non functional podocytes - dissapear = excess proteiuria
nephritic - immune complexes lodging in capillary and elicit immune response - imflammation and rbc to go through opening = heamaturia and proteinuria and pyuria

212
Q

what happens when albumin is low? what increase?

A

liver compensates and increase in lipids
sign of nephrotic syndrome - increase lipids and hypoalbumineamia

213
Q

important proteins that would be low in Nephrotic syndrome?

A

antithrombin 3
albumin

214
Q

why oliguria in nephritic syndrome?

A

glomerulus has been damaged

215
Q

causes of storage LUTS?

A

OAB
BPH

216
Q

causes of voiding LUTS?

A

BPH
urethral stricture
ovarian cancer
tumours bladder
prolapse
atomic bladder - no contraction and no sensation of full bladder

217
Q

ix for LUTS?

A

history and examination
U+E
feel mass of bladder
PR examination
USS
urodynamic studies
dipstick
flowmetry
post void bladder scan
bladder diary - how much they pee, how many times

218
Q

classic triad for kidney cell carcinoma?
most likely presentation of kcc?

A

<10%
haemeturia
loin pain
mass
- 50% incidental scan
paraneoplastic syndrome
varicocele in testicles

219
Q

what is paraneoplastic syndrome?

A

tumours produces, enzymes, antibodies, cytokines
hypercalcaemia
hypertension
polycythaemia
anaemia
staffer syndrome - rare

220
Q

why varicocele in testicles in KCC?

A

LEFT TEsicular veins drains dirrectly into left renal vein - blockage from tumour in left renal veins

221
Q

ix for KCC?

A

1st line - us but CT (renal protocol) is better (gs)
enhancing mass = chest ct
vein = MRI
biopsy is rare unless surgery

222
Q

staging for KCC?

A

TNM staging
stage 1 < 7 cm

223
Q

management of KCC?

A

small tumour - active surveillance
two non surgical - ablation or cryotherapy
gs - partial nephrectomy !!! main tx

224
Q

tx for TCC upper tract?

A

mananaged by nephroureterectomy

225
Q

main cause of bladder cancer?

A

smoking!!

226
Q

rf for bladder cancer?

A

cuclophosphamide
smoking
dyes
rubber factory

227
Q

presentation for bladder cancer?

A

painless visible haematuria - early onset
- 1 in 5 have malignancy
maybe some LUTS
recurrent UTISs

228
Q

ix for bladder cancer?

A

US first
if high risk - CT urogram
flexible cystoscopy
urine cytology

229
Q

management of of bladder?

A

transurehtral resection of bladder
intravesical therapy - mitomycin C reduces recurrence
BCG - inside bladder reduces progression - very bad side effects

Muscle invasive bladder cancer - surgery - cystoprostatectomy - bladder removed- high morbidty
radiotherapy is alternative

230
Q

most common bladder cacner?

A

transitional cell carcinoma - 90%
sqaumous - chronic inflammation

231
Q

t2 stage tumour in bladder cancer?

A

muscle invasive

232
Q

T1 stage tumour in bladder cancer?

A

non muscle invasive

233
Q

higher Grade for bladder cancer?

A

intravesical treatment required
camera test required more

234
Q

rf for testilar cancer?

A

cryptochidism
fh
HIV
previous cancer
caucasian males
infertility

235
Q

cp for testicular cancer?

A

self examination of lump
pain- less common
previous surgery - -scars
sexual history - HIV risk
enlarged lymph nodes

236
Q

differential for scrotal mass

A

acutely painful scrotum
varicocelel - kidney cancer
epididymal cysts

237
Q

ix for testicular cancer

A

uss - very good
bloods - tumour markers
AFP
LDH
BETA HDG
CXR in resp symptoms

238
Q

normal venous pressure in portal system ?

A

5 - 6 mmHg

239
Q

most common cause of portal htn?

A

90% intra hepatic
cirrhosis

240
Q

pre hepatic causes of portal htn?

A

wilms tumour - peadiatric kidney tumour
THROMBOSIS in portal venous system

241
Q

causes of post hepatic portal htn?

A

right sided heart failure
pregnancy

242
Q

pathophysiology of portal hypertension ?

A

organs will have difficulty draining to liver so body bypasses the liver - collateral branches dilate around stomach, oesphagus, umblicus and rectum - oesphogeal varices and heamorroids

243
Q

portal hypertension complications?

A

glucose is regulated because blood isn’t going into liver
lack of detoxification - hepatic encephalopathy
lack of clotting factors - heamorrages - ruptures
fluid into periteneum - ASCITES

244
Q

Schistosomiasis

A

damage to liver caused by parasitic infection

245
Q

ANTIBTIOCIS FOR OESPHAGEAL BLEEDS?

A

prophylactic antibiotics
cephalosporin !!!

246
Q

medication to bring down portal venous pressure? surgical option?

A

terlipressin
TIPSS - shunt between liver vein and portal vein to reduce pressure

247
Q

treatment for SLE?

A

STEROID + hydrocoxychloriqune

248
Q

tx for goodpastures syndrome?

A

steroids + plasma exchange

249
Q

cp for IgA nephropathy (bergers disease)?

A

nephritic syndrome
young pts
preceded upper resp infection preceeding 48 hours not weeks like post strep infection

250
Q

how can sepsis leads to hypoalbumineamia ?

A

sepsis - liver favours production of CRP over albumin

251
Q

patients with nephrotic syndrome most likelt to suffer from?

A

venous thromboembolism
put on low molecular weight heparin

252
Q

pathphysiology of good pastures syndrome?

A

autoimmune condition with production of anti-GBM antibodies with damage kidenys and lungs -nephritic syndrome

253
Q

causes of erectile dysfunction?

A

reduced libido - hypogonadism/ depression
intact libido - psychological, vascular insufficiency
DM
Alcohol
BBlockers
post op prosectomy
peyronie’s disease - fibrous scar tissue

254
Q

ix for erectile dysfunction?

A

bloods - testosterone, LH, fsh - these will most likely be normal

255
Q

ROLE OF PHosphodiesterase type 5 inhibitors?

A

elevate cGMP - vasodilation and erection

256
Q

role of cavernous nerve?

A

carries both sympathetic and parasympathetic nerve fibres to the penis for an erection - can be damaged by prostectomy

257
Q

clinical presentation of prostate cancer?

A

ususally asymptomatic or UTI symtpoms
on rectal examination - 45% tumours are unpalpable
weight loss
back pain
anaemia

258
Q

percentage of men with elevated PSA and not got cancer?

A

70%

259
Q

diagnosis of prostate cancer

A

elevated PSA
with DRE
ultrasound guided prostate biopsies - gs
PElvic MRI

260
Q

staging for prostate cancer ?

A

T1 - NON PALPABLE
T4 - invasion rectum/sphinctor
M - MRI sca

N - bone scan

261
Q

prostate in prostate cancer?

A

stoney hard and nodular

262
Q

raised what in all granulomatous diseases?

A

ACE
raised ACE and calcium - sarcoidosis

263
Q

4 granulomatous diseases we need to know?

A

TB
Crohns
sarcoidosis
leprosy

264
Q

dysplasia what kind of change is this?

A

precancerous change

265
Q

cancers that metasize to bone?

A

KP BeLT
KIDNEY
prostate
breast
lung
Thyroid

266
Q

hypersensitivity in good pastures vs SLE?

A

gp - TYPE 2
sle - type 3

causes of acute nephritic syndrome

267
Q

ix for nephroliathialsis/ renal stones/ urolithiasis?

A

first line - KUB XRAY - scout image (pregnancy - Ultrasound)
GS- NCCT KUB - diagnostic
bloods - FBC, U+E, urine diptsic - UTI, urinalysis - pregnancy

268
Q

non opiate analsgesia? condition used for?

A

diclofenac - NSAIDS painkiller
good for renal colic (stones) - but not for asthmatics

269
Q

complications of renal colic ? tx?

A

pyonephrosis - infection and obstruction KILLS
= sepsis shock (sepsis 6)
tx - antibiotics (GENTAMYCIN) , drainage

270
Q

how to drain kidney in pyonephrosis?

A

nephrostomy
ureteric stent

271
Q

tx for kidney stones?

A

ASYMPOTMATIC If in renal pelvis
small stones- watch and wait + analgasia
Larger stones - surgical ESWL (breaks stone down + non invasive) up to 2cm stones
utereroscopic
PCNL - massive stone

272
Q

tx for ureteric stones ?

A

wait 2 weeks
drainageif sepsis
ESWL if less than 1 cm
ureteroscopy

273
Q

formation of bladder stones?

A

long term catheter use
stagnent urine in bladder
typically larger

274
Q

tx BLADDER STONES

A

ESWL endoscopy - break down stones using shock waves
open surgery

275
Q

target urinary output for 70 kg pt?

A

840 - 2520ml
0.5 ml per kg pr hour

276
Q

NSAIDS what kind of renal injury ?

A

interstitial
decrease prostaglandins

277
Q

pain in right flank radiating to groin + testicles
urinalysis - blood - low wbc , no protein

A

ureteric calculus

278
Q

common constituent of renal stones

A

calcium oxalate

279
Q

common underlying cause of AKI after epsidoe of hypotension -> poorly perfused kideny -> ischaema
can be caused by NSAIDS and some abx

A

acute tubular necrosis

280
Q

most common site of metastases for porstate cancer?

A

bone

281
Q

cellular changes occur in BPH?

A

hyperproliferation of peripheral zone

282
Q

heamaturia
swollen left tesicle
first line ix?

A

USS abdomen

283
Q

drainage of left testicle ?

A

pampiniform plexus - > left testicular vein - > left renal

284
Q

organism associated with UTI and renal stones?

A

proteus

285
Q

uncomplicated UTI

A

NORMAL urinary tract structure and uti within it

286
Q

young pt
SOB
heamoptysis
dark colored urine ?

A

antiglomerular basement memebrane disease (goodpastures syndrome)

287
Q

IPSS?

A

INTERNATIONAL prostate symptoms score

288
Q

scoring of IPSS?

A

0-7 mild
8-19 moderate
20-36 severe

289
Q

rf for BPH?

A

age
ethnicity + afrocarribean = increases testosterone
castration is protective

290
Q

symptoms for prostatitis?

A

perianal pain when orgasming

291
Q

translocation in Acute promyelocytic leukemia

A

t15;17 translocation
sub type of aml

292
Q

example of 5 alpha reductase inhibitors ?

A

finasteride

293
Q

bowel sound in small bowel obstruction

A

tinkling bowel sounds

294
Q

examples of pseudo obstruction?
tx?

A

myopathy - no peristaltic contractions
neuropathy - no nerve innvervation to smooth muscles
congenital Hirschsprung disease - nerves missing at distal end of colon
tx = surgery

295
Q

first line and gs ix for bowel obstruction?

A

x ray - 1st line
gs - non contrast ct

296
Q

cp of small bowel vs large bowel obstruction ?

A

lbo ; Much more abdominal distension than SBO
less vomiting
earlier constipation
normal bowel sounds then no movement
lower abdo pain

SBO:
Initially colicky but then diffuse
Pain is higher in the abdomen than LBO
Constipation with no passage of gas occurs late in SBO
TEDNERNESS - suggests strangulation/ risk of perforation

297
Q

ix renal stones vs rcc?

A

rcc - contrast enhanced ct (GS)
renal stones - NCCT (no contrast )

298
Q

what is hydrocele?

A

abnormal collection of fluid in tunica vaginalis

299
Q

ix for hydrocele?

A

painless swelling
non tender smooth
translluminates!

300
Q

first line tx for hydrocele?

A

Watch and wait i.e., expectant management as most resolve by the age of 2 years spontaneously

301
Q

what is an epidydimal cyst?

A

Smooth extra testicular spherical cyst at the epididymis (top of the testicle)
Contains clear and milky fluid
May be multiple and bilateral

302
Q

ix for epidydimal cyst?

A

palpate cyst and testicles serperatly
transluminates

303
Q

appropaite surgery for hydrocele?

A

could be cuased by inguinal hernia

304
Q

pathophys testicular torsion?

A

twisted spermatic cord - cut off blood supply - ischaemia - EMERGENCY

305
Q

cp tesicular torsion?

A

acute testicular pain
red, hot and swollen
n+v
UNILATERAL
abdo pain

306
Q

tx for testicular torsion?

A

surgery - orchidopexy - lower testicle
orchidectomy
manual detorsion of testicle

307
Q

tx for urge incontinence?

A

Antimuscarinics - oxybutynin - relax detrusor muscle

308
Q

relaxtion of urethra?

A

alpha 1 antagonists - tamulosin

309
Q

white swarming growth on blood agar?

A

proteus

310
Q

sglt 2 inhibitors side effect?

A

can cause GU infections due to high sugar in urinary tract

311
Q

TReatment for DKA?

A

FIGPICK
fluids
iv
glucose
potassium - prevent hypokalaemia
infections
chart - fluid balance
ketones

312
Q

how to view LAD on ECG?

A

V1,V2,V3,V4

313
Q

most common place for renal colic?

A

Pelvi-ureteric junction
Pelvic brim
Vesico-ureteric junction

314
Q

tx for renal colic?

A

analgasia
antiemetics - prevent n+v
ESWL- SHOCKWAVE for smaller stones
PCNL - removal of stones

315
Q

tx for infected renal cysts

A

quinolones - ofloaxcin

316
Q

cystitis vs pylonephritis symptoms?

A

c: urgency, frequency, suprapubic pain, haematuria, dysuria
p: loin pain, fever, rigors, n+v

317
Q

tx for cystitis and pylonephritis in pregnant women?

A

Cefalexin 10-14 days in p or 7 days in c

318
Q

pylonephritis tx for noncomplicated pts?

A

Cipro 7 days OR
Co-amox 14 days

319
Q

why positive nitrites in UTI?

A

bacteria converts nitrates to nitrites

320
Q

type a vs type b intercalated cells?

A

type A reabsorb bicarc and scerete acid
type b REABSORB acid and secrete bicarb

321
Q

tx for hyperthyroidism?

A

beta blockers
carbimazole - Blocks thyroid hormone synthesis and also have immunosuppressive effects which affect Graves’ disease
- Two strategies
- Titration – oral Carbimazole for 4 weeks then reduce according to TFTs
- Block and replace – oral Carbimazole and thyroxine (less risk of going hypo)
radio iodine therpay on thyroid
thyroidectomy

322
Q

why are NSAIDS a contraindication in acute pre renal injury ?

A

NSAIDS cause kidney injury as they inhibit blood flow by inhibiting prostaglandins and causing vasoconstriction of the afferent arteriole

323
Q

role of pTH?

A

Increased Ca2+ resorption from bone by osteoclasts - rapid
Increased intestinal calcium absorption - slow
Activates 1, 25 – dihydroxy-vitamin D (calcitriol) in kidney
Increased calcium reabsorption and phosphate excretion in the kidney

324
Q

mnemonic for nephrotoxic drugs ?

A

DAMN
diuretics
ace i/ arbs
metformin
nsaids

325
Q

role of Diclofenac

A

inhibits cox1 and cox 2 NSAID

326
Q

function of nebuliser salbutomol?

A

drives potassium into cells - temporary hypokaleamia

327
Q

AKI: Explain the mechanism by which Insulin corrects the raised electrolyte level and why
Dextrose is always given at the same time

A

insulin moves potassium into cells decreases serum - prevent hyperkaleamia
dextrose to avoid hypoglyceamia

328
Q

PTH on phosphate levels?

A

decreases phosphate by increasing excretion

329
Q

tx for hyperparathyroidism?

A

removal of adenoma in parathyroid gland
calcimietic that increases sensitivity of parathyroid cells to Ca2+ 🡪 less PTH secretions e.g. oral Cinacalcet
avoid thiazide diuretics

330
Q

tx for breast cancer HER2 positive?

A

chemo = TRASTUZUMAB (her2 antibody)
lumpectomy

331
Q

none cancerous breast tissue growth?

A

cyst
fibroadenoma
hamartoma
Lipomas are soft, fatty lumps that grow under your skin.

332
Q

breast cancer metasize to spine tx?

A

bisphosphinates
second line chemo
radiotherapy to spine

333
Q

ix for diabetes insipidus ? what to expect?

A

Blood tests:
Urea and electrolytes: hypernatraemia
Plasma osmolality: will be high (>295mOsmol/kg)
24 hour urine collection
Urine sodium: Will be low
Urine osmolality: will be inappropriately low
Fluid deprivation test
Deprive patient of fluids for 8 hours, then administer desmopressin (synthetic ADH)
In pituitary deficiency, the urine will become concentrated again
Imaging: MRI brain for pituitary tumour

334
Q

tx for hyperkaleamis?

A

calcium glutamate

335
Q

tx for acidosis?

A

sodium bicarb

336
Q

tx for fluid overload

A

diuretics

337
Q

vaciine given at 8 weeks ?

A

6 in 1
Vaccines given at 8 weeks are 6 in 1 vaccine (DTaP/IPV/Hib/HepB) which protects
against diptheria, tetanus, pertussis (whooping cough), polio, Haemophilus
influenzae type b and hepatitis B, and also the pneumococcal vaccine, rotavirus
vaccine, Men B vaccine.

338
Q

List some drugs that St John’s wort may interact with.

A

when taken alongside St John’s wort. SSRI antidepressants are made more potent, increasing the risk of developing serotonin syndrome.
- less potent, including (but not limited to) the oral combined oral contraceptive pill, warfarin, statins, digoxin, anticonvulsants and HIV medications

339
Q

drugs for depression?

A

1st line: SSRI - sertraline, flouxatine
2nd line NSRIs

tricyclic antidepressants - amitriptyline
monoamine oxidase inhibitors - selegeline

340
Q

side effects of TCA?

A

tricylic antidepressants - can cause long qt interval

341
Q

PREScription flouxeltine?

A

20mg tablets before breakfast in morning

342
Q

clarithromycin treats chest infections and pneumonia what is it? otitis media

A

microlide

343
Q

diagnosis of viral infecgtion? is PCR fast?

A

PCR 1-2 DAYS
IgM is an acute antibody response and when detected against a virus in serum may often confirm the diagnosis of an acute infection.

344
Q

examples of protazoal infections?

A

Giardia is a protozoal pathogen. So are toxoplasma and Falciparum malaria

345
Q

examples of glycopeptides?

A

vanocymysic - MRSA!
RAMOPLANIN

346
Q

metformin side effcts?

A

diarrhoea, abdo cramps, bloating, nausea

347
Q

is metformin excreted?

A

active tubular excretion - unchanged in urine

348
Q

metformin and risk of renal imapirement?

A

low dosage or longer intevral s

349
Q

half life intervaL? metformin?

A

time at which serum concentrate of the drug is 50 %
2-4 hours with metformin?

350
Q

egfr is under 30, can they start metformin?

A

no!
half dose if 30-45

351
Q

why si metformin dangerous in AKI/ CKD?

A

CANT BE EXCRETED SO CAUSES LACTIC ACIDOSIS

352
Q

water soluble vs lipid soluble bb?

A

water soluble less likely to enter brain and cause hallucinations

353
Q

constituents of renal stones?

A

calcium oxoalte
uric acid
cysteine

354
Q

where do renal stones usually occur?

A

pelvic brim
utero pelvic junction
Vesico-ureteric junction

355
Q

1 risk factor for testicular torsion?

A

bell - clapper deformity

356
Q

2 reflexes in testicular torsion?

A

negative cremasteric reflex - rub inside of thigh and tesicular should ascend but absent in testicular torsion

phrens sign - absent - lifting teticle to relive pain
positive in epididmytis

357
Q

chromosomal abnormalities of ADPKD

A

CHROMOSOME 16!

358
Q

ix for obstructed bowel?

A

1st line - xr - dilated bowel loops and transluminal gas shadows
GS - CT abdo

359
Q

clinical presentation of SBO vs LBO?

A

sbo - VOMITING AND THEN CONSTIPATION
LBO - constripation and vomiting

360
Q

causes of LBO?

A

MALIGNANCY
VOLVULUS
hirshprung disease
intusesptions - bowel telescopes into itself

361
Q

what is pseudo obstruction?

A

no mechinal reason for obstruction
post operative state - opiates

362
Q

tx for cholecystitis?

A

IV fluids
nil by mouth
ERCP + sphincterectomy
cholecystectomy
iv abx

363
Q

most common cause of bacterial peritonitis ?

A

klebsiella
s. aureus
e.coli

364
Q

cp of peritonitis

A

sudden onset acute pain
relieved by placing hand on stomach so no movement
lying flat
rigid abdomen

365
Q

ix for peritonitis ?

A

ascities tap
erect cxr
raied WCC and CRP
amylase to exclude pancreatitis
blood cultures

366
Q

tx for peritonitis ?

A

ABC (airways, breathing, circulation)
Insertion of nasogastric tube
IV fluids
Treat underlying cause and treat early
Broad spectrum antibiotics e.g. cephalosporin. Following an episode of SBP, patients require prophylactic oral antibiotics e.g. rifaximin.
Surgery for secondary peritonitis:
Laparotomy - perform a full exploration and lavage (clean) of the peritoneum.
Specific treatment of the underlying condition

367
Q

tx for haemochromatsis?

A

venesection - removal of blood every 3-4 years
chelation therapy - removal of metals from blood
low iron diet

368
Q

signs and symptoms of wilson disease?

A

jaundice
parkinsonism
ring around eyes - kayser fleischer rings

369
Q

ix for wilson disease?

A

copper test - low plasma copper
GS - liver biopsy - high copper
MRI - brain degradation

370
Q

mech of penicillamine

A

binds to copper and then can be excreted in urine - wilson disease tx

371
Q

gene in a1at def ?

A

serpina - 1on chromosmoe 14

372
Q

cp of A1AT def?

A

pink puffer - barrel chest
chronic cough
jaundice

373
Q

ix for A1AT def?

A

serum A1AT level
CT - PANACINAR EMPHYSEMA
SPirometry - obstruction
geentic test - sperina - 1

374
Q

tx for A1AT def?

A

no tx
liver transplant ?
inhalers for panacinar epmysema
stop moking

375
Q

west haven criteria?

A

hepatic encephalopathy:
grade 0 - inverted sleep wake cycle
grade 1 - lack of awraness, anxious , shorted attention span
garde 2- lethargy, innapropate behaviour and diorder time and space
grade 3- stuporous + disorientation
grade 4 - comatous/
positive babinski sign extension and fanning of toes

376
Q

types of hepatic encephalopathy?

A

type A- caused by acute liver failure
type B - portal shunting
Type c - cirrhosis

377
Q

tx for mild TO MODERATE UC ?

A

Proctitis inflammation lining of rectum
topical aminosalicylate
4 weeks no recovery - oral ASA
IV predisolone

378
Q

tx for mild to moderate UC Proctosigmoiditis and left-sided ulcerative colitis?

A

descending sigmoid colon aswell as rectum!
topical ASA
oral ASA + topical steriod
stop topical and commence with oral ASA and steroid (predisolone)

379
Q

tx for sever UC?

A
  1. IV cyclosporin or IV steroids
  2. no improvement with steroids - use cyclosporin or IV inflimab
  3. colectomy
380
Q

example of aminosalicylates

A

Mesalazine

381
Q

true love and watts score?

A

severity of UC
mild - <4 poo a day / no blood/ HR<90/ esr<30
Moderate - 4-6 poo a day/ blood/ ESR<30/ HR<90
Severe - 6< poo a day at least one of :
BLOOD IN POOO VISIBLE
pyrexical - fever
HR<90
ESR<30

382
Q

first line tx for hepatic encephalopathy?

A

lactulose (15-30 mL three times daily) to promote regular bowel motion

383
Q

xr of bowel ischaemia? GS ix?

A

thumb prinitng - mucosal oedma
GS - CT with contrast

384
Q

TX FOR bowel ISchaemia?

A

Resuscitation, management of cardiac disease - anticoag - LMWH and intravenous broad-spectrum antibiotic therapy, followed by laparotomy, are key steps
Laparoscopy may also be used for diagnosis

385
Q

tx for diverticular disease?

A

laxatives + surgery

386
Q

tx for diverticulitis?

A

ABX - co-amoxiclav
IV fluids

387
Q

MS involves immune mediated destruction of which myelin producing cells?

A

oligodendrocytes - myelin sheath production - thinning and complete - axon destroyed

388
Q

swann cells role?

A

myelinate neurons in PNS

389
Q

FSH stimulates in men?

A

sertoli cells - nurse cells - spermatogensis

390
Q

hypersensitivy type of haemolytic anaemia?

A

type 2

391
Q

hypersensitvy type of sjorgen syndrome?

A

type 4
- T cells mediated

392
Q

hypersensitvy of SLE?

A

TYPE 3
immune complex mediated

393
Q

epithelium in conjuctiva of eye?

A

stratified columnar non keratinizing epithlium

394
Q

bifurcation of aorta at what level?

A

L4

395
Q

4 actions of ICS?

A

decrease formation of cytokines + microvascular permeabilty
inhibits influx of eosinophils
reduce brochial hyper responsiveness

396
Q

lymphatic drainage of sigmoid colon?

A

inferior mesenteric nodes

397
Q

lymphatic drainage of rectum ?

A

internal iliac nodes

398
Q

lymphatic draiange for testis and ovaries?

A

paraaoritc nodes

399
Q

classical cp of ascending cholangitis ? vs cholecystitis?

A

charcots triad
RUQ pain
fever
jaundice

cholecystitis - RUQ pain and feever no jaundice

400
Q

burkitts lymphoma translocation

A

t 8; 14

401
Q

mid shaft humeral fracture what structure is most at risk?

A

radial nerve - spiral groove

402
Q

neck of humourus fracture what structures are at risk?

A

axillary nerve

403
Q

antinausea medication mech?

A

5 ht 3 receptor antagonist

404
Q

left testicular vein drainage vs right?

A

right - inferior vena cava
left - renal vein

405
Q

biomarksers for ovarian cancer?

A

CA - 125 - 2 OVARIES

406
Q

BIOMARKERS for pancreatic cancer?

A

CA19-9
pancreas on its side is 9

407
Q

biomarkers for colon cancer?

A

CEA - start of ceacum

408
Q

ABX FOR PROTEIN SYNTHESIS?

A

Tetracyclines
aminoglycacides
macrolides - clindamycin

409
Q

rna polymerase inhibitors abx?

A

rifampicin

410
Q

DNA inhibitors abx?

A

quinolones
metronidazole

411
Q

ecg of a fibb?

A

irregular rr interval
absence of p wave

412
Q

ra VS oa?

A

RA -worse in morning but beter throughout the day
OA - worse in morning but worse thorughout the day
subchonerol scleroisis
outbutrst
DIP are more likely

413
Q

pharmacodyanmics vs kinetics?

A

pharmacokinetics - movement of drug through body - bioavailbty / distribution/ metabolism

pharmacodynamics - how drugs affects body - receptor binding / chemical interactions

414
Q

Explain in terms of the drug distribution of the intravenous drug why an additional volatile drug needs to be given as soon as the patient is asleep. What would happen if were no given?

A

initialy IV injection will have a high plasma conc but rapidly depletes due to distribution to less perfuse areas

415
Q

action of agonists? what is an agonist?

A

mimic shape of ligand and binds to receptor and activates it
morphine binds to opiod receptors and reduces nocioception in the CNS

416
Q

action of antagonists? example

A

mimic binding site but does not activate receptor and prevents ligands from binding and activating

Example of an antagonist is naloxone, which is a centrally acting opioid
receptor antagonist. It is used in opioid overdose and the reversal of
respiratory depression associated with opioid use. They bind to the opioid
with a higher affinity than agonists but do not activate the receptors, which
effectively blocks the receptors from responding to opioids and endorphins.

417
Q

example of transporter receptor?

A

Transporters: membrane transport proteins mediate the transport of molecules
across cell membranes.
o SGLT2 inhibitors (gliflozins): type 2 diabetes treatment, help the kidneys
lower blood glucose levels.
o Work by inhibiting sodium-glucose transport protein 2
o SGLT2 is located in the early proximal tubule, and is responsible for
reabsorption of 80-90% of the glucose filtered by the kidney glomerulus.
o Sodium glucose co transporter
o Lower blood sugar by causing kidneys to remove sugar from the body
through urine

418
Q

mech of ion channel receptors and exmaple?

A

Ion channels are important drug targets because they play an important role
in controlling a very wide spectrum of physiological processes, and their
dysfunction can lead to pathophysiology
o Amlodipine: Angio selective calcium channel blocker that inhibits calcium
movement into vascular smooth muscle cells. Leads to vasodilation and less
vascular resistance. Lowers blood pressure.

419
Q

oral morphine vs IM morphien dose?

A

Roughly x2 (because the bioavailability is about 50%)
 To convert 60mg of oral morphine to SC morphine (couldn’t find IM), divide by two
to give 30mg. Thus 2:1 ratio.

420
Q

why lower dose of morphine is pts with renal disease?

A

Many opioids (and their active/toxic metabolites) are renally excreted. In renal
failure, such as in this patient, accumulation could occur, leading to extreme opioid
sensitivity
- Decreased renal clearance of any drug/metabolite closely follows renal function as
measured by creatinine clearance. In consequence, drug toxicity in renal disease
depends on the extent to which renal clearance contributes to total drug/metabolite
clearance and how critical a drug/metabolite concentration is.

421
Q

percussion of abdomen in ascites vs obstruction?

A

ascites - dull
obstruction - hyperrrenosance

422
Q

XRAY of abdomen with sigmoid volvulus?

A

coffee bean sign

423
Q

symptoms of haemmroids?

A

blood on tissue when wiping
pain on passing stools
itchy around anus

424
Q

tx for haemmoroids?

A

rubber band ligation
stool softeners
topical anusol
topical hydrocortisone

425
Q

adults primary causes of nephrotic syndrome?

A

membranous glomerulonephritis = antibodies against PLA2R, SLE, NSAIDs
light microscopy - capillary wall thickening
focal segmental glomerulosclerosis= HIV, sickle cells
light microscopy - sclerosis

426
Q

two glasgow scores for what?

A

glasgow criteria for acute pancreatitis
Pa02
age
BUN
glucose
albumin
calcium
WBC
glasgow blatchford scorefor upper GI bleeds
haemoglobin
BUN
sex
HR
syncope
hepatic disease history

427
Q

tx for oesophageal upper GI tear?

A

surgical clipping
adrenline
PPI

428
Q

what are kidney stones made out of ?

A

bilirubin
calcium
uric acid

429
Q

Which benzodiazepine may be used to manage the effects of alcohol
withdrawal?

A

Chlordiazepoxide

430
Q

Delirium tremens is a medical emergency associated with alcohol withdrawal.
It occurs due to compensatory mechanisms developed by the brain. List three
possible presentations of delirium tremens.

A

arrthymias
hypertension
acute confusion
tachycardia
delusions

431
Q

signs of iron def aneamia> ?

A

glossitis - inflammed tongue
pallor
spoon nails koilonychias
angular cheilitis - cracking at edge of mouth!

432
Q

2nd line ix for iron def aneamia?

A

colonscopy - check for GI cancer

433
Q

1st line tx for iron def aneamia?

A

FERROUS SULPHATE TABLETS

434
Q

ALT and AST in NAFLD and AFLD

A

NAFLD - higher ALT than AST
AST: ALT > LESS THAN 1
AFLD - higher AST than ALT
AST:ALT - 2:1
S for spirits - Alcoholic FLD

435
Q

marker for HCC?

A

Alpha fetoprotein

436
Q

gold criteria COPD?

A

Stage 1 (Early) FEV1/FVC <0.7 FEV1 ≥80% predicted
Stage 2 (Moderate) FEV1/FVC <0.7 FEV1 <80% predicted
Stage 3 (Severe) FEV1/FVC <0.7 FEV1 <50% predicted
Stage 4 (Very Severe) FEV1/FVC <0.7 FEV1 <30% predicted

437
Q

complications of acute pancreatitis ?

A

hyperglyceamia
necrosis of pacnreas
upper gi bleeds
obstructive jaudice
variceal haemmorage

438
Q

serum copper in wilsons disease?

A

Copper is bound to ceruloplasmin in the blood, and as the
ceruloplasmin levels are low (due to the lack of ATP7B), the serum copper levels are LOW
urine copper is high

439
Q

KARYOTYPE TURNERS syNDROME?

A

45 XO

440
Q

measurement of intrisic vs extrinisc pathways ?

A

aPTT gives estimated activity for the intrinsic pathway.
- PT gives best estimate for both extrinsic and common pathways.

Phase 2a (9 decks)

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