Medical School Questions Flashcards
Describe the relationship between TSH and circulating thyroxine levels
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
Give for classical symptoms of hyperthyroidism?
Weight loss but increased appetite, heat intolerance, sweating, diarrhoea, tremor, irritability, emotional liability and psychosis, itch , oligomenorrheo
At what BMI is an individual obese?
Above 30 kg/m2
How can pituitary tumours cause Clincial features?
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
What 3 pituitary hormone diseases can you mainly get>
Prolactinomas, acromegaly, cushings disease
What electrolyte abnormalities do you see in Addison’s?
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
What’s the commonest cause of an addisonian crisis?
Abrupt cessation of long term steroid treatment - give hydrocortisone
What would you see in hyoPTH, primary, secondary and pseudo?
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
Give for symptoms of hypercalcaemia?
Weakness Tiredness Renal stones Fractures - osteopenia and pyrosis Abdomianl pain - constipation and pancreatitis Depression and confusion BONES STONES MOANS AND GROANS
What can DI and DM cause?
Polyuria, polydipsia so dip urine for glucose as DM will show glycosuria
Define T1DM and T2DM in terms of there pathophysiology ?
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
What’s the first line drug for T2DM and how does it act?
Metformin - decreases hepatic glucose production and internstial absorption of glucose therefore improving insulin sensitivity by increasing peripheral glucose uptake and utilisation
Give 4 common complications of diabetes?
Neuropathic pain
Autonomic neuropathy: Orthostatic hypotension, erectile dysfunction , constipation
Peripheral sensory loss and consequences: Charcots joints, falls, traumatic ulceration
Retinopathy
Nephropathy
What are the 4 main functions of the liver?
Glucose and fat metabolism
Detoxification and excretion
Protien synthesis
Defence against infection
Give 6 physical manifestations of chronic liver disease
Ascites Caput medusa Telangiectasia Hepatomegaly Splenomegaly Peripheral oedema Muscle wasting/ cachexia Spider naevi Gynecomastia
List four causes of AKI
Viral Illicit or medical drugs Obstruction ( gallstones, strictures, masses /cancer) Vascular thrombosis Alcohol CCF
What are the main risk factors for gallstones
Female, fat, fair, forty and fertile
How do you image gallstones and then treat them?
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
What results would you see in prehepatic jaundice viruses cholestatic jaundice when looking at urine and stool and LFTs
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
What do most people overdose on and how do you treat and whats the most useful blood test?
Paracetomal - N-Acetyl Cysteine ( 21 hours for infusion)
Prothrombin time and LFTs
Why are patients with chronic liver disease more prone to infection?
Damage to the reticuloendothelial system
Reduced opsonic activity
Leukocyte function
Permeable gut wall
What infection must be ruled out when ascites is present ?
Spontaneous bacterial peritonitis - extract ascetic fluid for analysis and do protien cell count and culture
What are the causes of intestinal obstruction and the categories ?
Intraluminal: Tumours, gallstone ileus, meconium ileas ( CF) diaphragm disease
Intramural: Crohn’s, diverticulitis, tumours, hirshprungs disease
Extraluminal: adhesions, volvulus , tumour
What are the main 4 symptoyms present in acute bowel obstruction?
Absolute constipation
Vomiting
Abdominal Pain
Abdominal distension
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
What’s the most common colorectal cancer and how would you examine it?
Adenocarcinoma do a DRE and colonoscopy !
Life 5 non infective causes of diarrhoea?
Neoplasm, hormonal, inflammatory, radiation, irritable bowel, chemical, anatomical
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,
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
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 )
