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Medical School Questions Flashcards

1
Q

Describe the relationship between TSH and circulating thyroxine levels

A

The two are in balance in a negative feedback loop - a reduction in thyroxine will increase circulating TSH similarly high thyroxine levels will act on the pituitary to reduce TSH

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2
Q

Give for classical symptoms of hyperthyroidism?

A

Weight loss but increased appetite, heat intolerance, sweating, diarrhoea, tremor, irritability, emotional liability and psychosis, itch , oligomenorrheo

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3
Q

At what BMI is an individual obese?

A

Above 30 kg/m2

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4
Q

How can pituitary tumours cause Clincial features?

A

Compression on local structures e.g. optic chiasm - bitemporal hemianopia
Direct pressure on normal pituitary - hypopituitarism
Effects due to secretion from a non functioning tumour

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5
Q

What 3 pituitary hormone diseases can you mainly get>

A

Prolactinomas, acromegaly, cushings disease

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6
Q

What electrolyte abnormalities do you see in Addison’s?

A

Low sodium, high potassium due to reduced aldosterone
Metabolic acidosis due to increased sodium loss - increased H+ ion management in the kidney so increased H+ in the serum
Decreased glucose due to reduced cortisol
Raised calcium - volume depletion

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7
Q

What’s the commonest cause of an addisonian crisis?

A

Abrupt cessation of long term steroid treatment - give hydrocortisone

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8
Q

What would you see in hyoPTH, primary, secondary and pseudo?

A

Hypo: Gland failure, raised calcium, normal or high phosphate and normal ALP
Secondary: Surgical cause leads to the same thing
Pseudo: Reduced calciu, , raised phosphate and normal or raised ALP - resistance to PTH

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9
Q

Give for symptoms of hypercalcaemia?

A 
Weakness
Tiredness
Renal stones 
Fractures - osteopenia and pyrosis 
Abdomianl pain - constipation and pancreatitis 
Depression and confusion 
BONES STONES MOANS AND GROANS
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10
Q

What can DI and DM cause?

A

Polyuria, polydipsia so dip urine for glucose as DM will show glycosuria

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11
Q

Define T1DM and T2DM in terms of there pathophysiology ?

A

T1DM is due to insulin deficiency due to selective destruction of insulin secreting pancreatic beta cells

T2DM is due to reduced insulin secretion and peripheral insulin resistance

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12
Q

What’s the first line drug for T2DM and how does it act?

A

Metformin - decreases hepatic glucose production and internstial absorption of glucose therefore improving insulin sensitivity by increasing peripheral glucose uptake and utilisation

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13
Q

Give 4 common complications of diabetes?

A

Neuropathic pain
Autonomic neuropathy: Orthostatic hypotension, erectile dysfunction , constipation
Peripheral sensory loss and consequences: Charcots joints, falls, traumatic ulceration
Retinopathy
Nephropathy

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14
Q

What are the 4 main functions of the liver?

A

Glucose and fat metabolism
Detoxification and excretion
Protien synthesis
Defence against infection

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15
Q

Give 6 physical manifestations of chronic liver disease

A 
Ascites
Caput medusa
Telangiectasia
Hepatomegaly 
Splenomegaly 
Peripheral oedema 
Muscle wasting/ cachexia 
Spider naevi 
Gynecomastia
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16
Q

List four causes of AKI

A 
Viral
Illicit or medical drugs 
Obstruction ( gallstones, strictures, masses /cancer)
Vascular thrombosis 
Alcohol 
CCF
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17
Q

What are the main risk factors for gallstones

A

Female, fat, fair, forty and fertile

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18
Q

How do you image gallstones and then treat them?

A

USS of the abdomen visualising the gall bladder and the common bile duct
ERCP - endoscopy and fluoroscopy visualises biliarytree and allow stone retrieval or stone destruction or stenting

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19
Q

What results would you see in prehepatic jaundice viruses cholestatic jaundice when looking at urine and stool and LFTs

A

PreHepatic: Haemolysis and Gilbert’s syndrome there is an increase in unconjugated bilirubin therefore urine and stool appears a normal colour and LFTs are normal
In cholestatic jaundice e.g. bile duct obstruction or intrinsic liver disease there is an increase in in conjugated bilirubin so urine looks dark ( conjugated bilirubin is filtered by the kidney ) and stools are pale - reduced bile flow with abnormal LFTS

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20
Q

What do most people overdose on and how do you treat and whats the most useful blood test?

A

Paracetomal - N-Acetyl Cysteine ( 21 hours for infusion)

Prothrombin time and LFTs

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21
Q

Why are patients with chronic liver disease more prone to infection?

A

Damage to the reticuloendothelial system
Reduced opsonic activity
Leukocyte function
Permeable gut wall

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22
Q

What infection must be ruled out when ascites is present ?

A

Spontaneous bacterial peritonitis - extract ascetic fluid for analysis and do protien cell count and culture

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23
Q

What are the causes of intestinal obstruction and the categories ?

A

Intraluminal: Tumours, gallstone ileus, meconium ileas ( CF) diaphragm disease
Intramural: Crohn’s, diverticulitis, tumours, hirshprungs disease
Extraluminal: adhesions, volvulus , tumour

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24
Q

What are the main 4 symptoyms present in acute bowel obstruction?

A

Absolute constipation
Vomiting
Abdominal Pain
Abdominal distension

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25
What’s the most common type of colorectal cancer and what examination would you perform?
Adenocarcinoma: Digital rectal exam as 30% can be palpated with the finger
26
What’s the most common colorectal cancer and how would you examine it?
Adenocarcinoma do a DRE and colonoscopy !
27
Life 5 non infective causes of diarrhoea?
Neoplasm, hormonal, inflammatory, radiation, irritable bowel, chemical, anatomical
28
Name for organisms that can cause diarrhoea
``` Rotavirus, norovirus Shigella Salmonella Campylobacter E.coli Hepatitis A and E Vibrio cholera C.difficile( post antibiotics ) and cryptosporidium, ```
29
What is the underlying reason for world wide diarrheo and how can we prevent this?
Poor sanitation, rotavirus and measals vaccination, early breastfeeding, hand washing, clean water, sanitation of food
30
How can we test and treat the organisms, that causes dyspepsia?
H.Pylori can be tested for by stool antigen test, urea breath test Omeprazole + Amoxicilllin+ Clarithromycin ( or metronidazole )
31
How do you treat dyspepsia?
PPIs e.g. omeprazole and H2 antagonsits e..g ranitidine if you dont treat it risks oesophageal cancer
32
Describe the differences between the two inflamamtory bowel diseases?
Crohn’s disease: Can affect the whole GI tract from mouth to Anus and occurs discontinously - skip lesion, trans mural inflamamtion occurs throughout the intestinal wall Abdominal pain, Nausea, vomiting, diarrhoea and weight loss Ulcerative colitis: Starts at the rectum and progresses through the column and its continuous and shallow mainly involving the mucosa lining and crypt abscesses are commonly found on biopsy Abdominal pain, Recta bleeding and bloody diarrhoea
33
Coeliac disease is a common autoimmune condition, who should be screened? What tests do we use for screening?
Patients with unexplained indigestion, diarrhoea, abdominal bloating and constipation. Faltering growth in children. Prolonged fatigue. Unexpected weight loss Severe or persistent mouth ulcers Unexplained iron, vitamin b12, or folate deficiency Type 1 diabetes mellitus Autoimmune thyroid disease Irritable bowel syndrome in adults A first degree relative with coeliac disease First line bloods tests are immunoglobulin A tissue transglutaminase antibody (IgA tTGA) and total IgA. IgA Endomysial antibody can be sued it IgA tTGA is unavailable. Gold standards are duodenal biopsy showing villous atrophy crypt hyperplasia and lymphocyte infiltration
34
Describe the electrical pathway/components needed for cardiac contraction.
The sinoatrial node is the pacemaker of the normal heart and is located in the atrium. The SA node signals contraction of the atrium, this signal is passed on to the atrioventricular (AV) node which then passes the signal to the bundle of his and purkinje fibers in the ventricle resulting in contraction of the ventricle.
35
What is the most common congenital heart defect and describe how it affects cardiac blood flow.
Ventricular septal defect (VSD). It is an opening in the wall or septum which separates the right and left ventricle. This hole results in what is called a left to right shunt which means that oxygenated blood from the left ventricle is passed to the right ventricle.
36
hat is the underlying pathophysiology that causes angina and what symptoms do patients with stable angina exhibit?
Coronary artery disease (atherosclerosis) is a build-up of plaques or lesions within the coronary arteries that are fibrous and lipid rich. These plaques cause narrowing of the arterial lumen which results in reduced blood flow. Stable angina is defined as chest pain (usually described as central or left sided pain radiating down the left arm or to the jaw or abdomen) that occurs on exertion and resolves with rest. This is do to the increased demand for oxygenated blood during exertion with the restricted ability of the blood to flow through the vessel due to the plaques.
37
What is the underpinning cause of the significant differences in cardiovascular disease risk between the Sheffield areas of Ranmoor and Netherthorpe?
Social deprivation, health inequality (inequity). Loneliness and social isolation have been linked with higher rates of CVD. Higher percentage of smokers in lower socioeconomic groups. Depression and anxiety linked with higher CVD risk.
38
Name four risk factors for cardiovascular disease.
``` Smoking Obesity high cholesterol hypertension diabetes psychosocial status poor diet “Stress” ```
39
A 55 year old male presents to the Emergency Department with crushing central chest pain. His ECG done in the ambulance shows inferior ST elevations. What is the most important intervention for him?
Percutaneous coronary intervention (PCI) or angiogram. This is when the coronary arteries are visualised using a dye to identify areas of obstruction or reduced blood flow which can be stented open. (In triple vessel disease the patient may require a coronary artery bypass graft (CABG))
40
In what other conditions besides myocardial infarction does a patient have increased risk of when diagnosed with artherosclerosis?
Ischaemic stroke or cerebrovascular accident (CVA) critical limb ischaemia Sudden cardiovascular death
41
What medications do we give when treating acute coronary syndrome (ACS)?
Aspirin (Anti-platelet) Ticagrelor (Anti-platelet) Fondaparinux (Low Molecular Weight Heparin) A statin (lowers cholesterol) Beta blocker (Decreased oxygen demand due to the reductions in heart rate, blood pressure, and contractility) Morphine (Pain management) GTN (Opens coronary arteries improving blood flow)
42
What risk factors must you consider when assessing a patient for possible PE or DVT and what risk assessment scoring system do we use?
``` Recent surgery or immobility long haul flight or long car ride cancer oral contraceptive pill hormone replacement therapy pregnancy inherited thrombophilia ``` Wells score is the system used for risk assessment
43
What is the most helpful investigation to identify valvular heart disease?
Echocardiogram of the heart which uses ultrasound and doppler flow to visualise the structure and function of the heart including the valves.
44
What are the two most common causes of acute pericarditis and what features are needed to make a diagnosis?
The commonest causes are viral infection and autoimmune disease Diagnosis is based on two of the following: chest pain (sharp and pleuritic relieved with sitting forward and worse with lying down) ECG changes (diffuse ST elevation) friction rub on examination (pathppneumonic - “crunching snow”) pericardial effusion
45
What medications do we use to help relieve the symptoms of heart failure?
Shortness of breath and peripheral oedema are common symptoms due to fluid overload as a result of the poorly functioning heart so diuretics are a mainstay of symptom relief. Furosemide and bumetanide are used initially and spironolactone can be added in if required.
46
What features on physical examination are suggestive of infective endocarditis?
Splinter haemorrhages - fine, thread-like, blood clots appearing vertically in the bed of the fingernail Osler’s nodes - small, tender, purple subcutaneous lesions on the pulp of the finger tips Janeway lesions - erythematous, macular, nontender lesions on the fingers, palms and/or soles of the feet Roth spots - retinal haemorrhages wit white or pale centers seen on fundoscopy New heart murmur Petechiae
47
What are the functions of the kidney and what are the implications of kidney damage on them?
Blood volume/fluid management – peripheral and central oedema Waste/toxin/drug excretion – build up of toxic products leading to illness including neurological and cardiorespiratory symptoms Red cell production – can lead to anaemia Vitamin D metabolism – reduced vitamin D, activation of PTH and calcium shift from bone to the systemic circulation - hypercalcaemia Acid-base regulation – acid accumulation and a metabolic acidosis
48
Define glomerulonephritis. What is the difference in presentation between nephrotic syndrome and nephritic syndrome?
Nephritic syndrome is characterised by blood in the urine (especially Red blood cell casts with dysmorphic red blood cells) and a decrease in the amount of urine in the presence of hypertension Nephrotic syndrome is characterised by finding of oedema in a person with increased protein in the urine and decreased protein and increased fat in the blood. Glomerulonephritis is any of a group of diseases that injure the part of the kidney that filters blood (the glomeruli).
49
Name the medical emergency most associated with acute kidney injury – what ECG changes can this commonly cause?
Hyperkalaemia On ECG this commonly causes tall peaked T-waves, reduction (and eventual disappearance) of P-waves and (late) widening of QRS complexes
50
What are the 4 commonest types of urinary tract stones? Name 5 common symptoms of renal tract stones.
Calcium stones (oxalate, phosphate) 80% Uric acid 10% Struvite 5-10% Cystine 1% ``` Asymptomatic Loin pain (often described as loin to groin) “Renal” colic UTI symptoms dysuria, strangury, urgency, frequency Recurrent UTIs Haematuria - mostly non visible ```
51
What are the criteria for a 2 week wait referral for suspected bladder cancer?
Aged 45 and over and have: Unexplained visible haematuria without urinary tract infection or Visible haematuria that persists or recurs after successful treatment of urinary tract infection Aged 60 and over and have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test
52
List five symptoms common with lower urinary tract obstruction in men.
``` Frequency Nocturia Urgency (and urgency incontinence) Hesitancy Straining Poor/intermittent stream Incomplete emptying Post-micturition dribbling ```
53
What are the two groups of drugs commonly used in symptomatic benign prostatic hypertrophy?
Alpha-adrenergic antagonists e.g. tamsulosin, alfuzosin | 5-alpha reductase inhibitors e.g. finasteride
54
What issues are there which prevent the Prostate Specific Antigen (PSA) test being used routinely for screening?
It is not cancer specific – it can be raised in benign prostatic hypertrophy, UTI, prostatitis 6% of men with a normal PSA will have prostate cancer whilst 70% of men with a raised PSA will not have prostate cancer
55
. What is the commonest presentation of testicular cancer? What differentiates it as a true scrotal mass?
A painless lump in the testicle is the commonest presentation, may be hard and craggy and does not transilluminate A true scrotal lump you can palpate above it (rather than one arising from the inguinal canal where you cannot
56
Name five medical conditions associated with erectile dysfunction? What is the first line medical treatment for erectile dysfunction in those with a normal testosterone?
``` Diabetes mellitus Cardiovascular disease MI, hypertension Liver disease and alcohol Renal failure Trauma Pelvic fracture Iatrogenic Prostatectomy 75% ``` Erectile dysfunction is treated first line with Phosphodiesterase (PDE5) inhibitors e.g. sildenafil or tadalafil
57
Which sexually transmitted infection is the most commonly diagnosed? How is it tested for and treated?
Chlamydia is the most common STI – it has a 10% asymptomatic prevalence in under 25s ``` Management has several factors Partner management Test for other STIs Doxycycline 100mg bd for 7 days Erythromycin 500mg bd for 14 days or Azithromycin in pregnancy ``` Women can be tested on a self-taken vaginal swab or first void urine sample Men are tested on a first void urine sample
58
How is Urinary tract infection defined? What constitutes an uncomplicated urinary tract infection? What are the implications of UTI in possible bladder cancer?
Urinary tract infection is defined as bacteria in the urine combined with clinical features. Bacteria in the urine alone is asymptomatic bacteriuria. Uncomplicated UTI is one occurring in a non-pregnant female. All others would be classed as a complicated UTI NICE now recommends that those aged 60 and over with recurrent or persistent unexplained urinary tract infection are referred non-urgently due to possibility of bladder cancer
59
What is the classic triad of symptoms in pyelonephritis? How does its antibiotic treatment differ from a lower urinary tract infection?
The classic triad is loin pain, fever and pyuria. In lower tract infection broad spectrum antibiotics should be avoided whereas in upper urinary tract infections they are used first line.
60
What are some risk factors for pneumonia?
``` Extremes of age SMoking COPD Diabetes CVD Severe illness, HIV immunosuppresion ```
61
How do you treat pneumonia?
S.Pneumonia: Amoxicllin or benpen M.pneumoniae - erythromycin or clarithromycin C.pneumoniae : erythromycin and clarithromycin C.pstiacci: Doxycylcin C.burenetti - doxy Legionella: Clarithromycin and rifampin, Repeat CXR
62
What is giardiasis?
An illness caused by the Protozoa giardiasis lamablia, ringworm is not a real worm !
63
Describe some differences between mycobacterium and bacteria
Mycobacterium are resistant to destaining by acid and alcohol , there cell wall contains waxy lipoarabinomann and they can with stand phagolysosomal killing Bacteria can divide 30-60 minutes
64
What is the best diagnosis for EBV ?
Not PCR ! Its often there asymptomatically if you have myalgia, sore throat, tiredness and splenomegaly you should test to show atypical lymphocytes and EBV IgM in serum as neither bacterial or acute viral resp illnesses will cause enlarged spleens !
65
What are some factors to consider in someone presenting with Fungul pneumocystis jirovici penunomia?
They will probably be positive on a HIV test with a CD4 count below 200 and should have a good prognosis with therapy If the HIV test is negative look for immunodeficiency either Priamry or secodnary to iatrogenic immunosuppression
66
What is the difference between gram positive and negative and what is the Clincial implications of this?
Gram positive - thick layers of peptidoglycan and stain purple after the gram stain procedure, gram negative have thin peptidoglycan and stain pink Easier to penetrate the wall of gram positive bacteria - more suspeciitble to antibiotics
67
What’s MRSA and its implication in healthcare?
Methicillin resistant S.aureus - B lactams, gentamicin, tetracycline and erythromycin dont work can be really problematic
68
Nappy and white threads?
Threadworms treat with mebendazole
69
What is a common mycobacterium and how do you describe them in a lab?
Tuberculosis - acid fast resistant to decolouration
70
What a re 5 properties of a virus?
Live inside cells Posses only DNA or RNA No cell wall but an outer protien coat Some have a lipid envelope Inert outside host cells but have fun citing enzyme Protien recpetors to allow attachment to host cells
71
How can viruses cause disease ?
Modify host cells structure and function Direct destruction of host cells Overreacticity of the immune system Cell proliferation and immortalisation Evade extra and intracellualr host defences
72
What’s a new viral vaccine?
HPV to prevent cervical cancer
73
WHats the most common cause of a Fungul nail infection + 3 differentials?
Trichphyton - eczema, trauma, psoriasis, yellow nail, SCC, lichen planus
74
How do you diagnose malaria?
Thick and thin blood films and giemsa
75
How do antibtiocts work?
They are molecules that bind to a target site on a bacteria (. Points of biochemical reactions crucial to their survival of the bacterium
76
Give some HIV situations?
Prolonged HSV , recurrent candidiasis , infections , oral candida, indicators of immune dysfunction, odd mouth lesions, new onsent skin lesions e..g kaposi sarcoma, PJ

Phase 2A case studies (7 decks)

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