liver/ GI/ gu Flashcards
1
Q
signs of excess estrogen?
A
spider naevi - small spiderlike red arteries on skin
palmar erythema
2
Q
what happens if something goes wrong in urea cycle?
A
Hepatic encephalopathy from build-up of ammonia that crosses blood-brain barrier
3
Q
liver failure and carbohydrate metabolism
A
hypoglyceamia
4
Q
liver failure and albumin production?
A
oedma
ascites - fluid build up in abdominal cavity
Leukonychia- -white nail beds
5
Q
liver failure and bilirubin regulation?
A
jaundice and pruritus - itching
6
Q
kuppffer cells and bilirubin regulation?
A
spontanous bacterial infection
7
Q
best indicator of liver function?
A
PROthrombin time and serum albumin
8
Q
prothombin time ?
A
how quickly blood clots
9
Q
pre hepatic jaundice blood test results?
A
total bilirubin is must higher ratio than conjuglated (direct) bilirubin
10
Q
complications of gilberts syndrome?
A
not efficient UGT so build up of unconjugated bilirubin and therefor pre hepatic jaundice
11
Q
blood test in cholestasis?
A
increased ALP + GGT due to build up (increased) conjuglated bilirubin in liver
12
Q
is ast specific to liver>
A
no its also found in skeletal muscle and heart
13
Q
if ast/ alt are 10X normal, this is a sign of?
A
acute heptocellular inflammation (intra cellular jaundice) - paracetemol od
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
15
Q
cause of A1 antitrypsin defiency ?
A
autosomal ressesive mutation of serpina 1 on chromosome 14
16
Q
does being post menopausal effect lfts?
A
yes, Early osteoporotic changes like in this
case, would cause an increase in ALP.
17
Q
symptoms for upper gi bleed?
A
melaena
blood in vomit
coffee ground vomit
18
Q
possible causes of upper GI bleed?
A
peptic ulcer - 50%
oesophogeal varices
19
Q
0-1 on glasgow blatchford score means?
A
consider outpatient - low risk
20
Q
Ix for upper GI bleeding?
A
A
B
C
D
E
21
Q
when to suspect variceal bleed?
A
liver cirrhosis or alchol excess
22
Q
tx for variceal bleeds?
A
antibiotics
terlipressin reduce mortality
request endoscopy within 12 hours
23
Q
when to suspect non variceal bleed?
A
peptic ulcers
NSAIDS
anticogulants or antiplatelets
24
Q
tx for non variceal bleed?
A
proton pump inhibitors - endoscopy within 24 hours
25
diaphragm disease?
caused by nsaids
lumen of bowel restricted and smaller
26
presentation of diviticular disease
washboard stomach due to peritonitis
27
SBO vs ileus
ileus - when gut cant push things forward but no blockage
SBO - syndromes - inability of movement through the gut via blockage in small bowel
28
symptoms of SBO?
history?
colic
bilious vomiting - color
green/ dark green - bile
bloating/ distension
sudden vs gradual onset
previous surgery - 90% have sbo afterwards
weight loss
29
assesment for SBO?
hydration status
weight loss
pulse/bp
dehydrated
o2 sats
abdomina distension
PR exam - really blown up - obstructed
30
ix for sbo?
fbc - cancer anemia/ infection high wbc + high crp
U+E
lactate - Anearobic resp
CT scan - indicates cause/ tell if ischaemic/ localises obstruction
31
tx for sbo?
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
32
gastrografin challange?
after drainage of pt - give them ct contrast to drink
do abdominal xray
33
when to operate on hernia?
groin - iguinal/ femoral or umbilical
34
how to treat incisional hernia?
treat like adhesion sbo
35
really common sbo cancer?
right sided colon cancer
36
tx to cancercous sbo?
11-2 5% mortality
single level blockage - operation
multiple levels - possible stoma proximal to blockage
medical palliation
37
early management of sbo
IV FLUIDS
NASogastric tubes
urinary catheter
analgesia
38
early assesment for sbo?
CT scan
venous blood gas
U+E
CLINCAL examination
39
most common complication of sbo
renal failure
40
advise surgery in adhesive SBO ?
WHEN There are signs of ischeamia on ct scan
41
barretts oesophagus is a risk factor for?
Risk of progressing to oesophageal cancer – premalignant for adenocarcinoma of oesophagus
42
cancer associated with smoking?
squamous cell carcinoma
43
tx for barrets oesophagus?
endoscopies and proton pump inhibitors
44
adenocarcinoma of stomach why ?
because lined with glandular epithelium
adenocarcinoma arise from glands!
45
who gets colorectal cancer?
ppl with adenocarcinoma get colorectal cancer - because tissue is dysplastic
46
pathophysiology HNPCC?
2 hit hypothesis - damage to these repair proteins
47
sign of positive hep b active infection?
HBsAG surface antigen is present in blood
however this also present in vaccine !!!
HBeAg also present and sign of acute infection
IgM - acute infection
48
sign of previous infection from hep b ?
HBeAG is not present but the antibody is present
IgG HBcAB
49
how to test for hep B viral Load?
hbv dna
50
2 year old child with loose stools, no fever, miserable , contact with animals? what could it be?
e.coli - gram negative
51
common causes of diarrhoea in adults?
norovirus and campylobacter jejuni
52
works in take away and low bouts of bloody stool?
shigella, salmonella or campylobacter
53
timing for diarrhoea onset after eating ? toxins, bacteria, viral ?
toxin - quick (within 1-2 hours)
viral - 6 hours
bacteria - 1-2 days
54
diarrhoeal infection from overuse of antibiotics? resistant to ?
c. diff - resistant to cleaning alcohol
clindamycin, cephalosporins (in particular second‑ and third‑generation cephalosporins), quinolones, co‑amoxiclav
55
pathology of c.diff?
creates toxin to damage bowel lining
56
management for c.diff patients in hospital?
ix and tx?
isolate
enteric precautions
test stool sample
enviromental cleaning
- metronidazol or vancomysin
57
59 yrs old, altered bowel motions increased frequency and mucousal ? for 6 months and some weight loss and sweats?
bowel cancer -because older
58
symptoms of Shigella
E. coli (EIEC, EHEC)
Salmonella enteridis
V. parahaemolyticus
C. diff
C. jejuni
infection?
bloody and mucosal diarrhoea
in colon
59
symptoms of Vibrio cholerae
E. coli (ETEC)
Clostridium perfringens
Bacillus cereus
S. Aureus
infections?
watery diarrhoea
60
acute vs chronic diarrhoea?
Abnormal passage of loose or liquid stool more than 3 times daily
Acute – lasts less than 2 weeks
Chronic – lasts more than 2 weeks
61
infection caused by swimming outdooor?
cryptosporidian, giardia - parasites
62
descending weaknes and diarrhoea?
Clostridium botunilum
63
cause of ascedning weakness weeks after diarrhoea epsiode?
C. jejuni
64
role of loperamide?
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.
65
management of vomiting?
Antiemetics – treat vomiting e.g. metoclopramide
66
lesions crohns vs UC?
chrons - transmural and skipping lesions
UC - continous and only lining
67
alpha interferon on HBV and hcv ?
prevent viral replication by increasing JAK to increase production of antiviral proteins to kill infected liver cells
68
role of ribavirin?
inhibits dna/rna replication in HCV (w/ INF alpha) and HIV
69
nucleoside analogues for HBV?
tenofir and entecavir
ribavirin - HCV!
70
side effects of nuceloside analogues?
headaches
abdo pain
HCV - ribavirin - haemolytic anaemia and hyperuricemia
71
pathophysiology of h.pylori?
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
72
symptoms of h.pylori?
mostly asymptomatic and healthy
73
consequences of h.pylori infection?
gastric cancer
duodenal + gastric ulcer
74
gold standard for h.pylori?
microbiological culture - very slow + invasive
urea breath
endoscopy from barium meal
75
tx for h.pylori
PPI - omeprazole
2 antibiotics - metronidazole and amoxicillin, carithromycin - 7 days
76
side effects of metronidazole?
metallic taste
peripheral neuropathy
flushing and vomiting with alcohol
77
drug to enhance mucosal defense?
bismuth
blacken tongue and teeth and poo
78
most common cases for liver transplant?
cholestatic liver cirrhosis
primary biliary cirrhosis
alcoholic cirrhosis
hcv heptitc cirrhosis
79
contraidications for liver transplant?
sepsis
AIDS
MALIGNANCY
active alcohol misuse
cv dysfunction
80
definiton of porta hypertension?
prolonged elevation of portal venous pressure ( above 12 mmHg) normal 2-5 mmHg
81
cause of portal hypertension in adults?
90% cirrhosis
82
proteases from pancreas?
trypsinogen
chymotrypsinogen
get activated by interoendocrine cells in duodenum - interokinase
83
acute pancreatitis ?
autodigestion of pancreas by pancreatic enzymes by premature trypsingoen
84
causes acute pancreatitis?
1. acinar cell destruction - alcohol
2. ductal obstruction - small gallstones
85
causes of excess acid in dyspepsia?
helicobacter pylori - causes acute inflammation as well
stress
86
causes of defective intraluminal digestion in malabasorption?
pancreatic insufficiency
- pancreatitis
- cystic fibrosis
defective bile secretion
- bile obstruction - block cysytic duct
- ileal resection (surgery)
bacterial overgrowth
87
causes of insufficent absorption area in malabsorption?
ceoliac disease - villous atrophy + crypt hyperplasia.
crohns disease
parasite - Giardia Lamblia
infarcted small bowel
88
cause of lack of digestive enzymes leading to malabsorption?
lactose intolerance - disaccharide insuffiencincy
bacterial brush boarder damage
89
causes of defective epithelial transport leading to malabsorption?
abetalipoproteamia
Primary bile acid malabsorption
90
what is gallstones made of?
cholesterol mainly
some are pigment based
91
gallstones causes?
diet weight loss
haemolytic anaemia
cirrhosis
genetics - gallbladder motility
sickle cell
92
symptoms of gallbladder stones ?
cholelithiasis
colic pain - cant get comfortable
sharp pain
dietary upset after fatty foods
pale stools - steatorrhea
fever
jaundice
93
ix for gallstones?
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
94
tx for gallstones?
watch and wait
radiological drain - cholecysteostomy
ERCP - endoscopy
cholecystectomy - surgery - keyhole
95
biliary colic gallstone? symptoms
RUQ pain due to gallstone block in bile duct
gallbladder attack
96
diagphramatic inflammation from gallbladder presents as?
pain in RUQ and right shoulder blade
97
cholecystitis acute symptoms?
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
98
common bile duct gallstones symptoms ?
pain colic crampting
worse after fatty foods
dark urine/ pale stools
fever
jaundice
99
cholangitis
pain colic cramping
worse after fatty foods
dark urine/ pale stools
fever
ruq pain
jaundice
100
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
acute pancreatitis
101
Pain, intermittent, crampy around
umbilicus
Nausea and bilious vomiting
No jaundice
No fever
Distended abdomen
gallstone ileus
102
criteria for ceoliac disease?
marsh criteria
has to be 3a or above
103
management of ceoliac disease?
gluten free diet
dietitian review
bone density review
- no more prescription
104
dermatits herpetiformis linked to ?
coeliac disease
rash and itchy on skin
105
IgAtTg and villous atrophy?
coeliac disease
106
where does UC start ? skipping lesion?
starts at rectum and no skipping lesions compared crohns
107
bowel wall in crohns disease?
full thickness and inflammation (fat wrapping) - infammation transmural
108
histology uc vs crohns?
uc - cryptitis, crypt abscesses
crohns - 50-70% granulomas cobblestoning
109
aeitology of IBD ?
not sure ?
inherited
diet + smoking
bacteria - change in biome
110
nsaids on gut ?
cause inflammation of small bowel and colon
111
symptoms of uc ?
LLQ abdominal pain
Fever
Diarrhoea with blood and mucus
Cramps
smoking history - stopped now
112
ix of UC ?
monitor BM
stool cultures
stool chart
AXR - colonic dilations
flexible sigmoidoscopy
113
tx of uc ?
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
114
how is UC classfied?
truelove and witts criteria
115
truelove and witts criteria ?
bloody stool a day > 6 a days
tachycardia
pyrexia
hb
ESR > 30 mm/h inflammatory activity
116
ix for crohns disease?
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
117
tx for acut crohns disease?
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
118
inflammation distribution in crohns vs uc ?
UC - only mucosa - continous
crohns - transmural and spread around
119
when would UC need surgery ?
toxic dilation - thinning of colonic wall
fatty change and fibrosis of liver and bile duct
120
defintions of FGIDSs?
examples ?
chronic GI symptoms in the absence of organic disease to explain the symptoms
IBD
functional dyspepsia
121
causes of IBS?
Psychosocial – stress, depression, anxiety
Psychological stress and trauma
GI infection - gastroenteritis
Sexual, physical or verbal abuse
Eating disorders
122
most common location of FGID?
GASTRODUODENAL AND BOWEL
123
ix for ibs
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
124
dyspepsia is mostly .... on endoscopy ?
mostly functional dyspepsia
so shows normal on endoscopy
125
symtpoms of ibs?
non specific
Abdominal pain relieved by defecating or passing of wind
Bloating
Alternating bowel habits
Constipation
Diarrhoea
126
when to do an edoscopy in suspected iBS ?
limit it to only with alarm features
blood in stool
weight loss
127
alarm features of gi symptoms?
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
128
ix for ibs ?
symtpoms
history
1st line
- fbc, feacal calprotectin
- serology - infections
- Ca-125 for women
129
tx for ibs?
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
130
gene involved in coeliac disease?
hla dq2/8 neccessary for coeliac but not always results in ceoliac disease
131
gold standard for coeliac disease?
Endoscopic intestinal biopsy. - gold standard diagnosis. Classic
finding for coeliac: jejunal/ duodenal biopsy showing villous
atrophy, crypt hyperplasia and lymphocytes.
132
nerve supply of visceral vs parietal peritonium?
visceral lack of nerve supply
parietal rich nerve supply
133
cause of peritonitis ?
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
134
bacterial causes of peritonitis ?
Anaerobes (e.g. bacteroides and clostridium)
E. coli
Klebsiella
Enterococcus
Streptococcus
135
symptoms of peritonitis ?
abdominal pain
N+V
malaise
anorexia
fever
distention
136
signs of peritonitis ?
signs:
rebound tenderness
localised guarding
tachycardia
shoulder pain if under diaphragm (phrenic nerve)
infrequent bowel sounds early on and then goes away - parlytic ileus
137
ix for peritonitis?
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.
138
tx for peritonitis ?
correction of fluid loss and volume
urinary catheter and GI decompression
antibiotic therapy
analgesia
139
normal fluid in peritoneal cavity ?
men - no fluid
women - up to 20 ml
140
classification of ascites?
stage 1
stage 2
stage 3
stage 4 - tense
141
cause of ascites?
transudates - low protein
portal hypertension - liver cirrhosis ( MOST COMMON!)
low plasma protein - malabsoprtion
exudates - high proteins
malignancy (2nd MOST COMMON)
Budd chiari syndrome
142
signs of ascites?
jaundice
abdominal distension
puddle sign
pitting oedma
shifting dullness
spider naevi
flank dullness + shifting dullness
umblicial hernia
143
anemia in vegans ?
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.
144
ix for ascites?
LFT
cardiac function
imaging - xray
ut scan
ct abdomen
ascitic aspiration - fluid removal - microscpoy and cytology + CULTURES
145
tx for ascites ?
tx for underlying cause
sodium restriction
diurectics
paracentesis
peritoneovenous shunting - connection between hepatic vein and portal vein
146
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
Primary biliary cholangitis mostly found in females
PSC - mostly males !!
147
conditions with gallstones in common billiary duct ?
pancreatitis
choledocholithiasis
cholangitis
148
conditions with gallstones in gallbladder or cystic duct ?
mucocele
empysema
acute cholecystitis
bilary colic
149
where is alkaline phosphatase found?
in hepatobillary tree and musculoskeletal
150
high levels of ALP found in?
cirhosis
biliary disease
preganancy
hyperthryoidism
151
pelvic nerve location?
parasymp or symp?
roll on bladder?
s2 - s4
parasympathetic
involuntary control
contraction of detrusor muscle
relaxation of sphincter
152
hypogastric plexus role on micturation?
parasymp or symp?
location?
t11 - L2
sympathetic control
involuntary control
storage inhibition of detrusor muscle contraction - storage
153
pudendal nerve?
role on micturation?
location?
S2-S4
somatic voluntary control of external sphinctor
154
role of onuf nucleus ?
ACh neurotransmitter
stimulated by pudendal nerve -> closes external sphinctor
155
OAB definition?
overactive bladder
urgency with frequency, with or without nocturia, but no local pathology
contractions of detrusor muscle
156
tx for oab?
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
157
role of botox in pathological micturation?
botox - block ACH junction to relieve retention
158
what is sacral neuromodulation?
electrode inserted into S3 to regulate afferent signal from bladder
159
causes of voiding dysfunction?
obstructive - benign prostate enlargment, prolapses
non obstructive - detrusor underactivity
160
overflow incontinence ?
incomplete badder emptying due to detrusor underactivty or obstruction
urine loss without warning
161
ix and tx for overflow incontinence?
tx: clean intermittent catherterization
ix: post void residual volume measurements
urodynamic testing
162
treatment for BPE with LUTS ?
1. alpha 1 blocker - tamulosin (blocks sympathetic)
2. 5 alpha reductase inhibitors
no repsonse to medication - GS - TURP!
163
ix for AKI?
U+E
ULTRASOUND
FBC
dipsticks
outflow of urine
164
mnemomic for oesphalea cancer signs and symptoms?
Anorexia
Loss of weight
Anaemia
Resent onset
Maleana
Swalling difficulties
165
types of gastrci cancer ?
type 1 - well differentiated - good prognosis
type2 - poorly differentiated - bad prognosis
166
histology and appearnece of type 2 gastric cancer?
submucosa invasion and singlet cells
no movment of barium swallow - late stage
167
histology and appearence of type 1 gastric cancer ?
glandular and large polypoid and rough around the edges
168
2 week wait for endocsopy for suspected gastric cancer?
abdominal palpable mass
dysphagia at any age
> 55 year old with weight loss
dyspepsia
reflux
169
medications that can cause upper gi bleed?
Nsaids, SSRI, bisphosphonates
170
rockall scoring ?
scoring system for blood loss - pre and post endoscopic
upper GI bleeds
171
BLOOD test for UC?
FBC - anaemia, raised white blood cells
CRP raised
p- ANCA raised and raised in crohns
ceoliac screen
172
UC occurs where?
only occurs in colon
50% in rectum
173
histology of UC vs Crohns ?
Crohns - fistula, 50- 70% granulomas
UC - cryptisis, crypt absess
174
stool sample for UC?
feacal calprotectin
stool MCS
175
long term steroids use side effects?
weight gain
DM
hypertension
reduced immune system
cushingoid traits
abnormal hair growth
176
GETSMASHED?
mnemonic for causing acute pancreastitis
Gallstones
Ethanol
Trauma
Ercp - ix can cause pancreatitis
177
hypocalaemia and pancreatitis?
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
blood test for pancreatitis?
lipase - more specific than amylase
179
malabsorption behind pancreatitis?
exocrine function!
damaged acinar cells from repeated inflammation - failure for digestive enzymes - malabsorption
180
4 vitamins for nutrional managment for pancreatitis?
VIT ADEK - FAT SOLUBLE
181
FIRST STAGE ix for coeliac disease?
IgA
tTGA (has to been eating gluten prior) compared to total IgA
EMA - less common
FOLLOWED up by endoscopy
182
complication for coeliac eating gluten?
cancer
183
gammaGT and ALP RAISED?
biliary tree obstruction or damage
cholestasis
184
high bilirubin, albumin, PT (prothrombin) sign of ?
synthetic function
damage to function of liver
185
reticulocyte high?
during anaemia the bone marrow produces immature blood cells quickly these are called reticulocyte
186
ix for hiatus hernia?
CXR
barium swallow
followed by endoscopy
eosphogeal manometry - for considering surgery
187
1st line ix for coeliac disease
serology IgA tTG
188
tx for UTI ? contraindications?
TANC (tank! dnb clubbing sex uti )
Trimethoprim - bad for pregnancy as is folate inhibtor
Amoxicillin
Nitrofurantoin
Cefalexin
189
blood test results for carcinoid tumour ?
chromogranin A
neuron-specific enolase (NSE),
substance P
gastrin.
urine 5 HIAA, which is a metabolite of serotonin
190
primary sclerorsing cholecystitis is associated with? ANNUAL IX?
UC! 80%
annual colonoscopy
191
rule of 2 meckels diverticulum?
2 years old
2 inches long
2x more likely in male
2 feet away from ileoceacal valve
192
ix for meckels diverticulum ?
Technetium-99m pyrophosphate scan
differnetiate from appendicitis
193
where are diverticula most likly to be present?
signoid colon
higher pressure
smalled lumenal diameter
194
presentation of diverticular disease?
abdominal pain
left iliac fossa
fever
tenderness, guarding
blood in stool
195
tx of diverticular disease?
antibitocis - metrondiazole
IV fluid s
high fibre diet
surgery
196
KDIGO diagnostic for AKI stages?
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
post renal causes of aki?
urinary tract obstruction - tumours, BPH, stenosis, retroperitoneal fibrosis , urine calculi
198
drugs to avoid with barrets oesphagus ?
NSAIDS
nitrates
TCAs - amytripline - antidepressants
K+ salts
199
symtpoms of lower uti vs upper uti?
lower - frequncy, dysuria, urgency
upper - loin pain, fevers, rigor, heamaturia
200
common organisms for UTI?
e.coli - gram negative bacilli lactose fermenter
s. epidermis - gram positive cocci - cata +/ coag -
klebsiella spp - g. neg bacilli lactose fermenter
enterococci -
201
causes of UTI?
SExual intercourse
catherisation
renal stones
prostate growth
renal tract tumours
202
IX for uti ?
mid stream urine
microscopy - nuetrophils pyuria -significant puss cells
cultures - macockney agar / CLED
sensitivty for antibitocs
203
first line tx for UTI ?
trimethoprim 200mg 2x daily for 3 days
nitrofuritoin 50 mg 4 times a day for 3 days
204
ix for Esophageal cancer?
1st line - endoscopy + biopsy
CT scan or USS
205
key clinical features of nephritic syndrome?
heamaturia
proteinuria
hypertension
206
causes of nephritic syndrome?
IgA nephropathy / Berger’s disease
Systemic lupus erythematosus
Henoch-Schonlein purpura
Poststreptococcal GN
Infective endocarditis
x linked condition leading to hearing loss
vasculitis
207
presentation of nephrtic syndrome caused by rapidly progressive Gn?
cough, sob, fatigue, blood from lungs
Oedema - peripheral, periorbital, pulmonary
Visible haematuria - red / brown
Oliguria
208
presentation of nephritic syndrome caused by IgA nephrophathy and strep GN?
URTI - UPPER RESP TRACT INFECTION
oedma
heamturia
oliguria
ureamic signs
209
ix for nephritic syndrome?
urinalysis
24 hour urine collection
SEROLOGY - ANCA
u+e, BUN
renal biopsy
210
diagnostic criteria for nephritic syndrome?
renal biopsy - Crescent shaped glomeruli, Ig depositions, glomerulosclerosis
211
nephrotic syndrome vs nephritic syndrome?
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
what happens when albumin is low? what increase?
liver compensates and increase in lipids
sign of nephrotic syndrome - increase lipids and hypoalbumineamia
213
important proteins that would be low in Nephrotic syndrome?
antithrombin 3
albumin
214
why oliguria in nephritic syndrome?
glomerulus has been damaged
215
causes of storage LUTS?
OAB
BPH
216
causes of voiding LUTS?
BPH
urethral stricture
ovarian cancer
tumours bladder
prolapse
atomic bladder - no contraction and no sensation of full bladder
217
ix for LUTS?
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
classic triad for kidney cell carcinoma?
most likely presentation of kcc?
<10%
haemeturia
loin pain
mass
- 50% incidental scan
paraneoplastic syndrome
varicocele in testicles
219
what is paraneoplastic syndrome?
tumours produces, enzymes, antibodies, cytokines
hypercalcaemia
hypertension
polycythaemia
anaemia
staffer syndrome - rare
220
why varicocele in testicles in KCC?
LEFT TEsicular veins drains dirrectly into left renal vein - blockage from tumour in left renal veins
221
ix for KCC?
1st line - us but CT (renal protocol) is better (gs)
enhancing mass = chest ct
vein = MRI
biopsy is rare unless surgery
222
staging for KCC?
TNM staging
stage 1 < 7 cm
223
management of KCC?
small tumour - active surveillance
two non surgical - ablation or cryotherapy
gs - partial nephrectomy !!! main tx
224
tx for TCC upper tract?
mananaged by nephroureterectomy
225
main cause of bladder cancer?
smoking!!
226
rf for bladder cancer?
cuclophosphamide
smoking
dyes
rubber factory
227
presentation for bladder cancer?
painless visible haematuria - early onset
- 1 in 5 have malignancy
maybe some LUTS
recurrent UTISs
228
ix for bladder cancer?
US first
if high risk - CT urogram
flexible cystoscopy
urine cytology
229
management of of bladder?
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
most common bladder cacner?
transitional cell carcinoma - 90%
sqaumous - chronic inflammation
231
t2 stage tumour in bladder cancer?
muscle invasive
232
T1 stage tumour in bladder cancer?
non muscle invasive
233
higher Grade for bladder cancer?
intravesical treatment required
camera test required more
234
rf for testilar cancer?
cryptochidism
fh
HIV
previous cancer
caucasian males
infertility
235
cp for testicular cancer?
self examination of lump
pain- less common
previous surgery - -scars
sexual history - HIV risk
enlarged lymph nodes
236
differential for scrotal mass
acutely painful scrotum
varicocelel - kidney cancer
epididymal cysts
237
ix for testicular cancer
uss - very good
bloods - tumour markers
AFP
LDH
BETA HDG
CXR in resp symptoms
238
normal venous pressure in portal system ?
5 - 6 mmHg
239
most common cause of portal htn?
90% intra hepatic
cirrhosis
240
pre hepatic causes of portal htn?
wilms tumour - peadiatric kidney tumour
THROMBOSIS in portal venous system
241
causes of post hepatic portal htn?
right sided heart failure
pregnancy
242
pathophysiology of portal hypertension ?
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
portal hypertension complications?
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
Schistosomiasis
damage to liver caused by parasitic infection
245
ANTIBTIOCIS FOR OESPHAGEAL BLEEDS?
prophylactic antibiotics
cephalosporin !!!
246
medication to bring down portal venous pressure? surgical option?
terlipressin
TIPSS - shunt between liver vein and portal vein to reduce pressure
247
treatment for SLE?
STEROID + hydrocoxychloriqune
248
tx for goodpastures syndrome?
steroids + plasma exchange
249
cp for IgA nephropathy (bergers disease)?
nephritic syndrome
young pts
preceded upper resp infection preceeding 48 hours not weeks like post strep infection
250
how can sepsis leads to hypoalbumineamia ?
sepsis - liver favours production of CRP over albumin
251
patients with nephrotic syndrome most likelt to suffer from?
venous thromboembolism
put on low molecular weight heparin
252
pathphysiology of good pastures syndrome?
autoimmune condition with production of anti-GBM antibodies with damage kidenys and lungs -nephritic syndrome
253
causes of erectile dysfunction?
reduced libido - hypogonadism/ depression
intact libido - psychological, vascular insufficiency
DM
Alcohol
BBlockers
post op prosectomy
peyronie's disease - fibrous scar tissue
254
ix for erectile dysfunction?
bloods - testosterone, LH, fsh - these will most likely be normal
255
ROLE OF PHosphodiesterase type 5 inhibitors?
elevate cGMP - vasodilation and erection
256
role of cavernous nerve?
carries both sympathetic and parasympathetic nerve fibres to the penis for an erection - can be damaged by prostectomy
257
clinical presentation of prostate cancer?
ususally asymptomatic or UTI symtpoms
on rectal examination - 45% tumours are unpalpable
weight loss
back pain
anaemia
258
percentage of men with elevated PSA and not got cancer?
70%
259
diagnosis of prostate cancer
elevated PSA
with DRE
ultrasound guided prostate biopsies - gs
PElvic MRI
260
staging for prostate cancer ?
T1 - NON PALPABLE
T4 - invasion rectum/sphinctor
M - MRI sca
N - bone scan
261
prostate in prostate cancer?
stoney hard and nodular
262
raised what in all granulomatous diseases?
ACE
raised ACE and calcium - sarcoidosis
263
4 granulomatous diseases we need to know?
TB
Crohns
sarcoidosis
leprosy
264
dysplasia what kind of change is this?
precancerous change
265
cancers that metasize to bone?
KP BeLT
KIDNEY
prostate
breast
lung
Thyroid
266
hypersensitivity in good pastures vs SLE?
gp - TYPE 2
sle - type 3
causes of acute nephritic syndrome
267
ix for nephroliathialsis/ renal stones/ urolithiasis?
first line - KUB XRAY - scout image (pregnancy - Ultrasound)
GS- NCCT KUB - diagnostic
bloods - FBC, U+E, urine diptsic - UTI, urinalysis - pregnancy
268
non opiate analsgesia? condition used for?
diclofenac - NSAIDS painkiller
good for renal colic (stones) - but not for asthmatics
269
complications of renal colic ? tx?
pyonephrosis - infection and obstruction KILLS
= sepsis shock (sepsis 6)
tx - antibiotics (GENTAMYCIN) , drainage
270
how to drain kidney in pyonephrosis?
nephrostomy
ureteric stent
271
tx for kidney stones?
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
tx for ureteric stones ?
wait 2 weeks
drainageif sepsis
ESWL if less than 1 cm
ureteroscopy
273
formation of bladder stones?
long term catheter use
stagnent urine in bladder
typically larger
274
tx BLADDER STONES
ESWL endoscopy - break down stones using shock waves
open surgery
275
target urinary output for 70 kg pt?
840 - 2520ml
0.5 ml per kg pr hour
276
NSAIDS what kind of renal injury ?
interstitial
decrease prostaglandins
277
pain in right flank radiating to groin + testicles
urinalysis - blood - low wbc , no protein
ureteric calculus
278
common constituent of renal stones
calcium oxalate
279
common underlying cause of AKI after epsidoe of hypotension -> poorly perfused kideny -> ischaema
can be caused by NSAIDS and some abx
acute tubular necrosis
280
most common site of metastases for porstate cancer?
bone
281
cellular changes occur in BPH?
hyperproliferation of peripheral zone
282
heamaturia
swollen left tesicle
first line ix?
USS abdomen
283
drainage of left testicle ?
pampiniform plexus - > left testicular vein - > left renal
284
organism associated with UTI and renal stones?
proteus
285
uncomplicated UTI
NORMAL urinary tract structure and uti within it
286
young pt
SOB
heamoptysis
dark colored urine ?
antiglomerular basement memebrane disease (goodpastures syndrome)
287
IPSS?
INTERNATIONAL prostate symptoms score
288
scoring of IPSS?
0-7 mild
8-19 moderate
20-36 severe
289
rf for BPH?
age
ethnicity + afrocarribean = increases testosterone
castration is protective
290
symptoms for prostatitis?
perianal pain when orgasming
291
translocation in Acute promyelocytic leukemia
t15;17 translocation
sub type of aml
292
example of 5 alpha reductase inhibitors ?
finasteride
293
bowel sound in small bowel obstruction
tinkling bowel sounds
294
examples of pseudo obstruction?
tx?
myopathy - no peristaltic contractions
neuropathy - no nerve innvervation to smooth muscles
congenital Hirschsprung disease - nerves missing at distal end of colon
tx = surgery
295
first line and gs ix for bowel obstruction?
x ray - 1st line
gs - non contrast ct
296
cp of small bowel vs large bowel obstruction ?
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
ix renal stones vs rcc?
rcc - contrast enhanced ct (GS)
renal stones - NCCT (no contrast )
298
what is hydrocele?
abnormal collection of fluid in tunica vaginalis
299
ix for hydrocele?
painless swelling
non tender smooth
translluminates!
300
first line tx for hydrocele?
Watch and wait i.e., expectant management as most resolve by the age of 2 years spontaneously
301
what is an epidydimal cyst?
Smooth extra testicular spherical cyst at the epididymis (top of the testicle)
Contains clear and milky fluid
May be multiple and bilateral
302
ix for epidydimal cyst?
palpate cyst and testicles serperatly
transluminates
303
appropaite surgery for hydrocele?
could be cuased by inguinal hernia
304
pathophys testicular torsion?
twisted spermatic cord - cut off blood supply - ischaemia - EMERGENCY
305
cp tesicular torsion?
acute testicular pain
red, hot and swollen
n+v
UNILATERAL
abdo pain
306
tx for testicular torsion?
surgery - orchidopexy - lower testicle
orchidectomy
manual detorsion of testicle
307
tx for urge incontinence?
Antimuscarinics - oxybutynin - relax detrusor muscle
308
relaxtion of urethra?
alpha 1 antagonists - tamulosin
309
white swarming growth on blood agar?
proteus
310
sglt 2 inhibitors side effect?
can cause GU infections due to high sugar in urinary tract
311
TReatment for DKA?
FIGPICK
fluids
iv
glucose
potassium - prevent hypokalaemia
infections
chart - fluid balance
ketones
312
how to view LAD on ECG?
V1,V2,V3,V4
313
most common place for renal colic?
Pelvi-ureteric junction
Pelvic brim
Vesico-ureteric junction
314
tx for renal colic?
analgasia
antiemetics - prevent n+v
ESWL- SHOCKWAVE for smaller stones
PCNL - removal of stones
315
tx for infected renal cysts
quinolones - ofloaxcin
316
cystitis vs pylonephritis symptoms?
c: urgency, frequency, suprapubic pain, haematuria, dysuria
p: loin pain, fever, rigors, n+v
317
tx for cystitis and pylonephritis in pregnant women?
Cefalexin 10-14 days in p or 7 days in c
318
pylonephritis tx for noncomplicated pts?
Cipro 7 days OR
Co-amox 14 days
319
why positive nitrites in UTI?
bacteria converts nitrates to nitrites
320
type a vs type b intercalated cells?
type A reabsorb bicarc and scerete acid
type b REABSORB acid and secrete bicarb
321
tx for hyperthyroidism?
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
why are NSAIDS a contraindication in acute pre renal injury ?
NSAIDS cause kidney injury as they inhibit blood flow by inhibiting prostaglandins and causing vasoconstriction of the afferent arteriole
323
role of pTH?
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
mnemonic for nephrotoxic drugs ?
DAMN
diuretics
ace i/ arbs
metformin
nsaids
325
role of Diclofenac
inhibits cox1 and cox 2 NSAID
326
function of nebuliser salbutomol?
drives potassium into cells - temporary hypokaleamia
327
AKI: Explain the mechanism by which Insulin corrects the raised electrolyte level and why
Dextrose is always given at the same time
insulin moves potassium into cells decreases serum - prevent hyperkaleamia
dextrose to avoid hypoglyceamia
328
PTH on phosphate levels?
decreases phosphate by increasing excretion
329
tx for hyperparathyroidism?
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
tx for breast cancer HER2 positive?
chemo = TRASTUZUMAB (her2 antibody)
lumpectomy
331
none cancerous breast tissue growth?
cyst
fibroadenoma
hamartoma
Lipomas are soft, fatty lumps that grow under your skin.
332
breast cancer metasize to spine tx?
bisphosphinates
second line chemo
radiotherapy to spine
333
ix for diabetes insipidus ? what to expect?
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
tx for hyperkaleamis?
calcium glutamate
335
tx for acidosis?
sodium bicarb
336
tx for fluid overload
diuretics
337
vaciine given at 8 weeks ?
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
List some drugs that St John’s wort may interact with.
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
drugs for depression?
1st line: SSRI - sertraline, flouxatine
2nd line NSRIs
tricyclic antidepressants - amitriptyline
monoamine oxidase inhibitors - selegeline
340
side effects of TCA?
tricylic antidepressants - can cause long qt interval
341
PREScription flouxeltine?
20mg tablets before breakfast in morning
342
clarithromycin treats chest infections and pneumonia what is it? otitis media
microlide
343
diagnosis of viral infecgtion? is PCR fast?
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
examples of protazoal infections?
Giardia is a protozoal pathogen. So are toxoplasma and Falciparum malaria
345
examples of glycopeptides?
vanocymysic - MRSA!
RAMOPLANIN
346
metformin side effcts?
diarrhoea, abdo cramps, bloating, nausea
347
is metformin excreted?
active tubular excretion - unchanged in urine
348
metformin and risk of renal imapirement?
low dosage or longer intevral s
349
half life intervaL? metformin?
time at which serum concentrate of the drug is 50 %
2-4 hours with metformin?
350
egfr is under 30, can they start metformin?
no!
half dose if 30-45
351
why si metformin dangerous in AKI/ CKD?
CANT BE EXCRETED SO CAUSES LACTIC ACIDOSIS
352
water soluble vs lipid soluble bb?
water soluble less likely to enter brain and cause hallucinations
353
constituents of renal stones?
calcium oxoalte
uric acid
cysteine
354
where do renal stones usually occur?
pelvic brim
utero pelvic junction
Vesico-ureteric junction
355
1 risk factor for testicular torsion?
bell - clapper deformity
356
2 reflexes in testicular torsion?
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
chromosomal abnormalities of ADPKD
CHROMOSOME 16!
358
ix for obstructed bowel?
1st line - xr - dilated bowel loops and transluminal gas shadows
GS - CT abdo
359
clinical presentation of SBO vs LBO?
sbo - VOMITING AND THEN CONSTIPATION
LBO - constripation and vomiting
360
causes of LBO?
MALIGNANCY
VOLVULUS
hirshprung disease
intusesptions - bowel telescopes into itself
361
what is pseudo obstruction?
no mechinal reason for obstruction
post operative state - opiates
362
tx for cholecystitis?
IV fluids
nil by mouth
ERCP + sphincterectomy
cholecystectomy
iv abx
363
most common cause of bacterial peritonitis ?
klebsiella
s. aureus
e.coli
364
cp of peritonitis
sudden onset acute pain
relieved by placing hand on stomach so no movement
lying flat
rigid abdomen
365
ix for peritonitis ?
ascities tap
erect cxr
raied WCC and CRP
amylase to exclude pancreatitis
blood cultures
366
tx for peritonitis ?
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
tx for haemochromatsis?
venesection - removal of blood every 3-4 years
chelation therapy - removal of metals from blood
low iron diet
368
signs and symptoms of wilson disease?
jaundice
parkinsonism
ring around eyes - kayser fleischer rings
369
ix for wilson disease?
copper test - low plasma copper
GS - liver biopsy - high copper
MRI - brain degradation
370
mech of penicillamine
binds to copper and then can be excreted in urine - wilson disease tx
371
gene in a1at def ?
serpina - 1on chromosmoe 14
372
cp of A1AT def?
pink puffer - barrel chest
chronic cough
jaundice
373
ix for A1AT def?
serum A1AT level
CT - PANACINAR EMPHYSEMA
SPirometry - obstruction
geentic test - sperina - 1
374
tx for A1AT def?
no tx
liver transplant ?
inhalers for panacinar epmysema
stop moking
375
west haven criteria?
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
types of hepatic encephalopathy?
type A- caused by acute liver failure
type B - portal shunting
Type c - cirrhosis
377
tx for mild TO MODERATE UC ?
Proctitis inflammation lining of rectum
topical aminosalicylate
4 weeks no recovery - oral ASA
IV predisolone
378
tx for mild to moderate UC Proctosigmoiditis and left-sided ulcerative colitis?
descending sigmoid colon aswell as rectum!
topical ASA
oral ASA + topical steriod
stop topical and commence with oral ASA and steroid (predisolone)
379
tx for sever UC?
1. IV cyclosporin or IV steroids
2. no improvement with steroids - use cyclosporin or IV inflimab
3. colectomy
380
example of aminosalicylates
Mesalazine
381
true love and watts score?
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
first line tx for hepatic encephalopathy?
lactulose (15-30 mL three times daily) to promote regular bowel motion
383
xr of bowel ischaemia? GS ix?
thumb prinitng - mucosal oedma
GS - CT with contrast
384
TX FOR bowel ISchaemia?
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
tx for diverticular disease?
laxatives + surgery
386
tx for diverticulitis?
ABX - co-amoxiclav
IV fluids
387
MS involves immune mediated destruction of which myelin producing cells?
oligodendrocytes - myelin sheath production - thinning and complete - axon destroyed
388
swann cells role?
myelinate neurons in PNS
389
FSH stimulates in men?
sertoli cells - nurse cells - spermatogensis
390
hypersensitivy type of haemolytic anaemia?
type 2
391
hypersensitvy type of sjorgen syndrome?
type 4
- T cells mediated
392
hypersensitvy of SLE?
TYPE 3
immune complex mediated
393
epithelium in conjuctiva of eye?
stratified columnar non keratinizing epithlium
394
bifurcation of aorta at what level?
L4
395
4 actions of ICS?
decrease formation of cytokines + microvascular permeabilty
inhibits influx of eosinophils
reduce brochial hyper responsiveness
396
lymphatic drainage of sigmoid colon?
inferior mesenteric nodes
397
lymphatic drainage of rectum ?
internal iliac nodes
398
lymphatic draiange for testis and ovaries?
paraaoritc nodes
399
classical cp of ascending cholangitis ? vs cholecystitis?
charcots triad
RUQ pain
fever
jaundice
cholecystitis - RUQ pain and feever no jaundice
400
burkitts lymphoma translocation
t 8; 14
401
mid shaft humeral fracture what structure is most at risk?
radial nerve - spiral groove
402
neck of humourus fracture what structures are at risk?
axillary nerve
403
antinausea medication mech?
5 ht 3 receptor antagonist
404
left testicular vein drainage vs right?
right - inferior vena cava
left - renal vein
405
biomarksers for ovarian cancer?
CA - 125 - 2 OVARIES
406
BIOMARKERS for pancreatic cancer?
CA19-9
pancreas on its side is 9
407
biomarkers for colon cancer?
CEA - start of ceacum
408
ABX FOR PROTEIN SYNTHESIS?
Tetracyclines
aminoglycacides
macrolides - clindamycin
409
rna polymerase inhibitors abx?
rifampicin
410
DNA inhibitors abx?
quinolones
metronidazole
411
ecg of a fibb?
irregular rr interval
absence of p wave
412
ra VS oa?
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
pharmacodyanmics vs kinetics?
pharmacokinetics - movement of drug through body - bioavailbty / distribution/ metabolism
pharmacodynamics - how drugs affects body - receptor binding / chemical interactions
414
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?
initialy IV injection will have a high plasma conc but rapidly depletes due to distribution to less perfuse areas
415
action of agonists? what is an agonist?
mimic shape of ligand and binds to receptor and activates it
morphine binds to opiod receptors and reduces nocioception in the CNS
416
action of antagonists? example
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
example of transporter receptor?
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
mech of ion channel receptors and exmaple?
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
oral morphine vs IM morphien dose?
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
why lower dose of morphine is pts with renal disease?
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
percussion of abdomen in ascites vs obstruction?
ascites - dull
obstruction - hyperrrenosance
422
XRAY of abdomen with sigmoid volvulus?
coffee bean sign
423
symptoms of haemmroids?
blood on tissue when wiping
pain on passing stools
itchy around anus
424
tx for haemmoroids?
rubber band ligation
stool softeners
topical anusol
topical hydrocortisone
425
adults primary causes of nephrotic syndrome?
membranous glomerulonephritis = antibodies against PLA2R, SLE, NSAIDs
light microscopy - capillary wall thickening
focal segmental glomerulosclerosis= HIV, sickle cells
light microscopy - sclerosis
426
two glasgow scores for what?
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
tx for oesophageal upper GI tear?
surgical clipping
adrenline
PPI
428
what are kidney stones made out of ?
bilirubin
calcium
uric acid
429
Which benzodiazepine may be used to manage the effects of alcohol
withdrawal?
Chlordiazepoxide
430
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.
arrthymias
hypertension
acute confusion
tachycardia
delusions
431
signs of iron def aneamia> ?
glossitis - inflammed tongue
pallor
spoon nails koilonychias
angular cheilitis - cracking at edge of mouth!
432
2nd line ix for iron def aneamia?
colonscopy - check for GI cancer
433
1st line tx for iron def aneamia?
FERROUS SULPHATE TABLETS
434
ALT and AST in NAFLD and AFLD
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
marker for HCC?
Alpha fetoprotein
436
gold criteria COPD?
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
complications of acute pancreatitis ?
hyperglyceamia
necrosis of pacnreas
upper gi bleeds
obstructive jaudice
variceal haemmorage
438
serum copper in wilsons disease?
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
KARYOTYPE TURNERS syNDROME?
45 XO
440
measurement of intrisic vs extrinisc pathways ?
aPTT gives estimated activity for the intrinsic pathway.
- PT gives best estimate for both extrinsic and common pathways.
