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MET2 > MET2 Revision5 > Flashcards

MET2 Revision5 Flashcards

1
Q

Which of the following is hepato-renal recess?

A
B
C
D
E
F

A

Which of the following is hepato-renal recess?

A
B
C
D
E
F

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2
Q

Label A-E

A

A: Right triangular ligament
B: Posterior coronary ligament
C: Left triangular ligament
D: Falciform ligament
E: Anterior coronary ligament

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3
Q

Which of the following is the ligamentum venosum ?

A
B
C
D
E
F

A

Which of the following is the ligamentum venosum ?

A
B
C
D
E
F

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4
Q

Label A-C

A

A: Ligamentum venosum
B: Falciform ligament
C: Round ligament of the liver/ Ligamentum teres

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5
Q

At what vertebral level do the two common iliac veins unite to form the inferior vena cava?

L2
L5
T5
T8

A

At what vertebral level do the two common iliac veins unite to form the inferior vena cava?

L2
L5
T5
T8

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6
Q

Which of the following is not a tributary to the splenic vein?

Short gastric veins
Pancreatic veins
Left gastric vein
Left gastro-omental vein

A

Which of the following is not a tributary to the splenic vein?

Short gastric veins
Pancreatic veins
Left gastric vein
Left gastro-omental vein

The left gastric vein is a tributary of the portal vein.

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7
Q

What does this CT show?

A

Ascites

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8
Q

Explain mech. of portal htn causing ascites

A
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9
Q

Why does hepatic portal HTN cause splenomegaly? [1]

A

increased HPV pressure causes blood to back up into spleen causing enlargement

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10
Q
A

A: cystic duct
B: common hepatic duct
C: Right hepatic duct
D: Left hepatic duct
E: Common bile duct

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11
Q

Gall stones in gall bladder causes which symptoms? [1]

A

often asymptomatic

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12
Q

Why does jaundice occur if gall stone occurs in common bile duct?

A

Stone blocks bile leaving the gall bladder and the Liver.

So bilirubin in bile is not able to be broken down

accumulates in blood causing jaundice and biliary colic.

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13
Q

What symptoms would occur here? [3]

A

biliary colic, jaundice and pancreatitis

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14
Q

Portosystemic Anastomoses at the Esophagus is made from? [2]

A

splenic (HPV) and azygous veins (IVC)

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15
Q

Caput meduase is caused by htn in anastomoses in which two veins?

A

Paraumbilical veins (ligamentum teres recanalised)

Intercostal and inferior epigastric veins

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16
Q

Label A-F

A

A: splenic artery
B: gastroduodenal artery
C: hepatic artery proper
D: SMA
E: SMV
F: Hepatic portal vein

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17
Q

Label A-C

A

A: Coronary Ligament
B: Right Triangular Ligament
C: Left triangular Ligament

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18
Q

What is the chemical name for active form of thyroid hormone?

What is the chemical name for inactive form of thyroid hormone?

A

Liothyronine (T3)
Thyroxine (T4)

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19
Q

Branchial pouch embryology:

Pouch = endodermal outpouching of pharynx

Which pouch made the inferior parathryoid and thymus? [1]
Which pouch made the superior parathryoid and ultimobranchial body? [1]

A

Pouch 3 - inferior parathyroid and thymus
Pouch 4 - superior parathyroid and ultimobranchial body
Ultimobranchial body - C-cells

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20
Q

Where does the thryoid originate? [1]

What duct does it move down to get to perm position? [1]

A

Thyroid originates from foramen cecum

Travels along thyroglossal duct. to cricoid cartilage

Normally thyroglossal duct disappears but in some it can remain: contains thyroid tissue

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21
Q

Thyroid follicle cell:

What receptors does it contain and what do they transport?

MoA of how is T4 / T3 made/

A

NIS - Na/I symporter - transports 1 iodine with 2 Na+ into the cell.

PDS - transports iodine out of the cell into the colloid.

DUOX2 creates iodine oxidising agent: H2O2 outside of cell

TPO oxidises the iodine with H2O2. Allows it bind it to Tyroglobulin (is produced in the golgi apparatus of the cell and is iodonated)

Tyroglobulin is taken back into the follicular cell. Decomposed to produce T3 and T4 (~80%), which is released into the blood stream/colloid.

IYD - A means of recycling iodide – iodotyrosine dehalogenase 1

TSHR – receptor for thyroid stimulating hormone

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22
Q

describe the -ve feedback loop of thyroid hormone production

A

-ve feedback loop:

  • Hypothalamus releases TRH
  • TRH stimulates release of TSH in AP
  • TSH stimulates release of T4 / T3 from thyroid
  • As T4 rises it suppresses TRH and TSH production
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23
Q

How is T3 transported around the body? [3]

A

Predominately via Thyroid Binding Globulin

Also by albumin and transthyretin

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24
Q

Why are pregnant people in a hypothryoid state?

A

In pregnancy: the level of oestrogen increases: increases sialylation of TBG (increases the half life) so it is cleared slowly from plasma: less free thyroid hormone

25
Q

T4 -> T3 (activation) of free TH:

What are the effect of Deiodinase enzymes:

D1 & D2? [1]
D3 [1]

Why is this important?

A

D1 & 2: convert T4 -> T3 - activation

D3: D3 -> inactivates T4 to rT3

Important because another level of control - expression of deiodonase enzymes:

these enzymes will be up/down regulated at certain times to increase/decrease metabolism.

26
Q
  • Learn *
    What is main control of thyroid hormone? [1]
    What are 3 ways body can locally control thyroid hormone? [3]
A

Main control:
* Main neg. feedback control. HPT axis.

Local control:
* Transporter expression MCT, OATP
* Deiodinase enzymes up/down reg
* Thyroid hormone receptor expression.

27
Q

What effects does hyperthyroidism have on cardiovascular system? [5]

A

Hyper metabolic state: need to dissipate the excess heat

TH increases α- to β- myosin ratio so positive inotropic effect

Increased NO: decreased peripheral resistance

Widened pulse pressure!

Palpitations are subjective increase in force or increased pulse

20% toxic patients have AF

28
Q

Hyperthyroidism:

[] insulin turnover
[] gluconeogenesis
[] insulin secretion

A

Increased insulin turnover
Increased gluconeogenesis
Reduced insulin secretion

29
Q

Hyperthyrodism:

Weight [] and []
Protein and lipid []
Heat []

A

Hyperthyrodism:

Weight loss and myopathy
Protein and lipid degradation
Heat intolerance

30
Q

Hyperthyroidism:

Effect on Nervous System? [3]

Effect on skin [3]

Effect on eyes? [1]

A

Hyperthyroidism:

Effect on Nervous System? [3]
* Increased risk of seizures
* Nervousness/tremor.
* Hyperphagia - increased hunger

Effect on skin [3]
* Warm and moist - due to vasodilation + heat loss.
* ‘Plumber’s’ nails. Or soft and crumbling nails - acropachy
* Pretibial myxoedema inflammation over the tibia.

Effect on eyes? [1]
* Eyelid retraction and eyelid drag.

Pretibial myxoedema i
31
Q

Hyperthyroidism

Effect on GI tract? [4]

Effect on bones? [3]

Haematological effect [2]

Effect on reproductive system [3]

A

Hyperthyroidism

Effect on GI tract? [4]
* Increased appetite
* Weight loss
* Increased gut motility
* Increased liver enzymes - transaminitis.

Effect on bones? [3]
* * Accelerated osteoclast activity - to provide substrates for metabolism.
* Hypercalcemia
* Osteoporosis - in the long term.

Haematological effect [2]
* Pernicious anaemia - coincidental, autoimmune.
* B12 deficiency

Effect on reproductive system [2]
* Periods stop (oligomenorrhoea)
* Gynecomastia (man boobs)
* Erectile dysfunction.

32
Q

What is Hashimoto’s disease caused by? [1]
What is the characteristics of it? [1]

A

TPO antibodys present
Autoimmune destruction of thyroid gland:

  • transient hyperthyroidism as stores of TH are released.
  • Then hypothyroidism follows.
33
Q

What is pathophysiology of graves disease? [2]

A

Antibodies bind to and stimulate TSHR.
Causes hyperthyroidism.

34
Q

Why does graves disease cause this symptom? [2]

A
  • Fibrocytes behind the eye expresses TSH receptors
  • TSHR stimulated, causing inflammation behind the eye -> pushes eyeball forward -> proptosis + lid retraction.
35
Q

What are 3 risk factors for graves disease? [3]

A

HLA status - TH17 led autoimmune response
Trigger: ** infection, neck trauma, stress**
Female stress - 1-2% of women. Because connected to X- chromosome.

36
Q

What causes Toxic Multinodular Goitre? [1]

A

Somatic TSHR mutation: Thyroid always on

37
Q

What is toxic adenoma? [1]

How can you diagnose? [1]

How do you treat? [1]

A

One nodule of T (where the tumour is) becomes hyperactive and the rest of the gland becomes inactive.

Diagnosed by ingesting iodine 123 and using gamma camera imaging - will see one area lit up by gamma emitting iodine- 123.

Can treat with iodine-131 - emits b-particles to destroy overactive nodules - used in toxic adenoma and thyroid cancer.

38
Q

What findings would you find for thyrotoxicosis:
- T4 / T3 [1]
- TSH [1]

What treatment would you find for thyrotoxicosis [3]

A

Findings:
* Elevated T4 and T3
* Suppressed TSH
* Technetium or iodine uptake scans

Treatment:
* Thionamide drugs: Propylthiouracil; Carbimazole
* Radioactive Iodine I-131
* Thyroidectomy

39
Q

Hypothyroidism effects on:

Skin [2]
CV [4]
GI tract [3]

A

Skin [1]
* myxoedema
* Accumulation of hyaluronic action -> yellowing. Hair falls our and becomes thin.

CV [4]
* Stroke volume reduces
* Cold/reduced circulation
* Sinus bradykinin.
* J-waves on ECG due to hypothermia.
* LDL cholesterol rises.

GI tract [3]
* Reduced appetite
* Constipation
* Weight increases (fat - due to reduced metabolic rate - and fluid retention).

40
Q

Hypothyroidism effects on:

NS [4]
Blood and renal system: [3]
Reproduction [3]

A

On nervous system: [4]
* Impaired foetal brain development -> mental retardation in children.
* Dementia
* Slow relaxing reflexes
* Growth retardation.

Blood and renal system: [3]
* Reduced GFR
* Mild hyponatraemia
* Variety of anaemias

Reproduction [3]
* Reduced libido
* delayed puberty
* erectile dysfunction

41
Q

Hypothyroidism on base metabolic rate and GLUT 4 stimulation? [2]

A

Reduced base metabolic rate & decreased GLUT4 stimulation.

42
Q

Causes of hypothyroidism? [4]

A

Hashimoto’s disease
Endemic goitre (Iodine deficiency)
Lithium (toxic to thyroid)
Pendred’s syndrome (lack of PDS: improper synthesis of TH)

43
Q

Why is it important the pregnany women have good iodine levels?

What is recommended intake for pregnant women? [1]

A

more TSH: more Th produced/required: easy to become hypothyroid = very bad for foetal brain development

250 micrograms a day - milk, supplements..

44
Q

Why is it important the pregnany women have good iodine levels?

What is recommended intake for pregnant women? [1]

A

more TSH: more Th produced/required: easy to become hypothyroid = very bad for foetal brain development

250 micrograms a day - milk, supplements..

45
Q

What causes cretinism?

A

Large goitres:

Low levels iodine in diet + low levels of iodine produced in thyroid -> increasing TSH production -> stimulates growth of thyroid gland

Causes mental retardation

46
Q

Diagnosis [2] and Treatment of HypoT? [1]

A

Diagnosis of hypothyroidism:
* Low levels of TSH and low T4 in blood - biochemistry tests

Treatment:
* Levothyroxine - only treatment used In UK

47
Q

Classic triad of symptoms for Graves? [3]

A

Pretibial myxoedema
Exophthalmos
Diffuse goitre (without nodules)

48
Q

[] is the first line anti-thyroid drug
[] is the second line anti-thyroid drug.

A

Carbimazole is the first line anti-thyroid drug
Propylthiouracil is the second line anti-thyroid drug.

49
Q

Label A-D

A

A: Falciform ligament
B: fundus of gall bladder
C: stomach
D: Ligamentum teres

50
Q

Label A-F

A

A: IVC
B: Cystic duct
C: Cystic artery
D: Ligamentum teres
E: Ligamentum venosum

51
Q

Label A & B [2]

A

A: Quadrate lobe
B: Caudate lobe

52
Q

Which of the following are the:

SMA [1]
Middle colic artery [1]
Right colic artery [1]
SMV [1]
Jejunal arteries [1]

A

11 Superior mesenteric
artery
2 Middle colic artery
3 Right colic artery
10 Superior mesenteric vein
13 Jejunal arteries

53
Q

Name this pathology [1]

A

Ascites. Axial CT scan of the abdomen shows low density ascitic fluid surrounding the liver, spleen and stomach.

54
Q

Label 1, 2, 3, 7, 8, 9 & 10

A

1 Left hepatic duct
2 Right hepatic duct
3 Cystic duct
7 Common hepatic duct
8 Common bile duct
9 Pancreatic duct
10 Greater duodenal papilla

55
Q

Which thyroid pathology is depicted here? [1]

A

Hashimotos thyroiditis

56
Q

Which thyroid pathology is depicted here? [1]

A

Graves disease

57
Q

What is the name for this symptom of Graves disease? [1]

What is this symptom usually associated with? [1]

A

Acropachy

in association with thyroid ophthalmopathy

58
Q

Name three reasons for hyperthyroidism [2]

A

Toxic multinodular
goitre
Graves Disease
Toxic adenoma

59
Q

Pendreds symptom is a cause of hypothyroidism. Which transporter is lacking in this disease? [1]

A

Lack of PDS

MET2 (52 decks)

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