miscellaneous Flashcards
1
Q
what will stimulation of baroreceptors lead to?
A
increased sympathetic stimulation>vasodilation
2
Q
define ischaemia
A
reversible damage to tissues due to impaired perfusion which deprives tissues of nutrients and oxygen
3
Q
what is in an atheroma?
A
fibrous cap lipid core smooth muscle cells macrophages lymphocytes calcium cholesterol crystals
4
Q
features of a malignant neoplasm
A
rapid growth high mitotic rate necrosis invasion poor resemblance to normal tissues irregular border
5
Q
which lymph nodes does oesophageal carcinoma spread to?
A
para-oesophageal
supraclavicular
6
Q
what is achalasia
A
failure of smooth muscle cells to relax, leads to birds beak on CXR if in the oesophagus
7
Q
what does inability to swallow solids and liquids at the same time suggest?
A
not malignant, it’s something like tightening of gastrooesophageal junction
8
Q
what is suggested by villous atrophy?
A
coealiac
9
Q
what 3 things must a patient have to be diagnosed with coeliac disease
A
crypt hyperplasia
villous atrophy
raised intraepithelial lymphocytes
10
Q
why does oedema occur
A
raised systemic venous pressure
fluid retention
11
Q
why does orthopnoea occur?
A
pulmonary oedema
12
Q
features of iron deficiency anaemia
A
microcytic
hypochromic
pencil cells
target cells
13
Q
what will produce pale stools and dark urine
A
hepatic and post hepatic causes of jaundice
14
Q
features of enlarged spleen on palpiatation
A
left upper quadrant
can’t feel upper border
15
Q
colorectal cancer predispostions
A
HNPCC
APC
adenoma
positive FHx
16
Q
define median survival
A
the time at which 50% of index cases are still alive
17
Q
bowel cancer symptoms
A
rectal bleeding fatigue abdominal pain tenesmus altered bowel habit constipation diarrhoea
18
Q
define 5 year survival
A
the proportion of patents still living five years after diagnosis
19
Q
what are the 2 types of stress
A
distress and eutstress
20
Q
functions of cell membrane
A
separating intracellular contents from the extracellular environment
regulating access to the cell
semi-permeable membrane
regulating molecular transport into and out of cell
intracellular signalling
maintain cell shape
21
Q
surface markings of oblique fissure
A
T2
mid-axillary line-4th rib
mid clavicular-end of 6th rib
22
Q
what would cause dilated veins in arms and legs but not raised JVP?
A
raised carbon dioxide partial pressure, systemic vasodilation so JVP will be low. It is with heart failure that there would be both, raised pressure throughout systemic veins.
23
Q
why does a small change in diameter result in a large change of blood pressure?
A
Pouseille’s law
24
Q
where are aortic aneurysms likely to be
A
above the line that joins iliac crests
25
abdominal pain in patient with AAA?
aortic aneurysm dissection
| mesenteric artery occlusion from local atherosclerosis
26
what are the two stages of fat digestion
emulsification
| triglyceride hydrolysis
27
what does bile do for fat absorption
lipid transport system
28
where does wheeze come from
expiration from bronchioles
29
signs of anaphylaxis
swollen tongue, lips, eyes
laryngeal oedema
swollen epiglottis
hypotension
30
give the 5 responses to stress
behavioural-more alcohol, abenteeism, poor sleep
cognitive-impaired concentration, negative thoughts
biochemical-endorphin levels altered
emotional-tearful, mood swings, irritable
physiological-increased BP and headaches
31
define carcinoma
malignant neoplasm of EPITHELIUM
32
what is renal cell carcinoma associated with?
obesity
33
what kind of drug is morphine?
receptor agonist
34
what test is used for allergy?
serum tryptase-mast cells
35
sterile areas
CSF
pleural cavity
ureters
36
what is ringworm?
fungal infection
37
what is used to treat MRSA
vancomycin
38
symptoms of mononucleosis (EBV)
```
myalgia
sore throat
tiredness
fever
splenomegaly
```
39
define transfer factor
the ability to pull oxygen out of the air, not reduced in COPD but is in EAA, pulmonary fibrosis
40
in which pulmonary disease is there endothelial destruction?
COPD
| in asthma there is endothelial thickening
41
consequences of sarcoidosis
glaucoma
heart block
lymphadenopathy
skin nodules
42
location of CFTR gene?
ch7
43
how much fluid is in the pleural space?
15ml
44
which transporter do diuretics affect?
Na/K/2Cl
45
why are beta blockers used in heart failure?
block reflex sympathetic responses which stress the heart
46
what cardiac drug is likely to be causing postural hypotension?
calcium channel blockers
| nifedipine, amplodipine
47
give an example of a selective beta blocker
bisoprolol
48
which drugs are negative chonotropes and inotropes?
calcium channel blockers and beta blockers
49
how do nitrates work?
vasodilation so reduce preload and after load
50
what anaemia does sickle cell disease lead to?
chronic haemolytic, may have normal Hb from XS reticulocytes
51
what does the coffee bean sign indicate
sigmoid volvulus
52
what will proximal colorectal cancer present with
anaemia rather than faecal blood or
53
features of paracetamol OD
metabolic acidosis
raised prothrombin-INR
hypoglycaemia
high alanine aminotransferase
54
high alanine aminotransferase
paracetamol OD
viral hepatitis
liver ischaemia
55
features of delirium tremens
hyperadrenergic
disorientation
hallucination
impaired consciousness
56
what joints are typical of RA?
MCPs PIPs
57
extra articular manifestations of RA?
subcutaneous nodules
scleritis
peripheral sensory neuropathy
pericardial effusion
58
high ESR
| low CRP
SLE
| systemic lupus erythematosus
59
ANCA -ve, affects over 60s
giant cell arteritis
60
juvenile idiopathic arthritis features
```
thrombocytosis
daily fever
evanescent rash
splenomegaly
hyperferritinaemia
```
61
two types of pain
neuropathic
| nociceptive
62
what kind of aphasia is expressive?
non fluent because Wernicke's is still working so they find meaningful words but say them slowly
63
causes of hypercalcaemia
```
hypercalcaemia of malignancy
multiple myeloma
hyperparathyroidism
sarcoidosis
vitamin D intoxication
```
64
what does calcitonin do?
decreases calcium concentration by inhibiting osteoclast activity and stopping reuptake, produced in thyroid hormone
65
causes of metabolic acidosis
```
uraemia
diabetic ketoacidosis
salycilate overdose (aspirin)
severe sepsis
alcohol intoxication
renal tubular acidosis
```
66
what does immune thrombocytopenic purpura suggest?
AIDS
67
what are second line to beta blockers and calcium channel blockers in a patient with angina?
nicorandil
ivabradine
ranolazine
68
what can be seen in the cytoplasm of those with alcoholic hepatitis?
mallory bodies
69
diagnosis for coeliac disease?
DUODENAL biopsy showing villous atrophy and crypt hyperplasia
70
complications of diverticulitis
peritonitis (it's not spontaneous!)
haemorrhage
abscess
fistulae
71
what neurotransmitter controls the hyperplasia of the prostate
ACh, so use anti cholinergic drugs
72
BPH drugs
anti-cholinergics
5-alpha reductase inhibitors
alpha adrenergic antagonists
73
what parasite can cause bladder cancer?
schistosomes
74
nephritic syndrome causes
post streptococcal glomerulonephritis
rapidly progressive glomerulonephritis (SLE/Goodpasture's)
IgA nephropathy
Thin glomerular basement membrane disease
Mesangiocapillary glomerulonephritis
75
what kidney disease are berry aneurysms and subarachnoid haemorrhage associated with?
autosomal dominant polycystic kidney disease
76
AKI causes
glomerlonephritis, drugs, hypertension, pre-eclampsia, acute tubulointerstitial necrosis, pyelonephritis, cholesterol emboli, haemolytic uraemia syndrome
77
Bouchard's or Boutonniere in RA?
Boutonniere in autoimmune, think button hole and lock and key Ig
78
joint never affected by rheumatoid arthritis?
distal interphalangeal joint
79
antibody specific for SLE?
double stranded DNA antibody
80
extra-articular RA manifestations?
rheumatoid nodules, lymphadenopathy, vasculitis, fibrosing alveolitis, pleural effusion, pericardial effusion, Raynaud's, CTS, peripheral neuropathy, splenomegaly, scleritis, sicca syndrome
81
features of ank spond on XR
sacroiliitis
syndesmophyes (bamboo spine)
calcification
82
Sx of osteomalacia
bone pain
fractures-femoral neck
waddling gait
83
bacteria of acne?
Propionibacterium acnes
84
what is blocked in acne?
pilosebaceous duct
85
what is rosacea
inflammation on face, no commodes-treat with immunuosuppresion
86
where does squamous cell carcinoma arise from?
keratinocytes
87
for which skin lesions would you refer with a two week wait
squamous cell
| malignant melanoma
88
benign skin lesions?
basal cell papilloma
dermatofibroma
sebaceous cyst
89
where do most skin cancers arise from?
epidermis-basal cell
90
on which receptors do you want beta blockers to have an effect
beta-1 adrenoreceptors to stop them increasing heart rate and contraction
91
on which receptors do does tamulosin work?
alpha adrenoreceptor 1 antagonist-stops smooth muscle contraction
92
on which receptors do you want formaterol to work?
beta 2 adrenoreceptors because there are to main classes SABA and LABA, they increase bronchodilation
93
what is metformin?
a biguanide
94
give an example of a sulphonylurea
glicalzide
95
what should methotrexate not be given with?
trimethoprim
96
how is paracetamol OD treated
iv n-acetylcysteine
97
when is onycholysis seen?
psoriasis
98
when is leuconychia seen?
CKD
99
functions of the kidneys
```
A WET BED
Acid/base balance
Water balance
Electrolyte balance
Toxin excretion
Blood pressure
Erythropoietin
vit D activation
```
100
statin examples
simvastatin
| lovastatin
101
what must HAART comprise of?
2 non nucleoside reverse transcriptase inhibitors and one nucleoside reverse transcriptase inhibitor/protease inhibitor
102
2NNRTIs
neirapine
| efavirenz
103
NRTI
didanosine
104
PIs for HIV
saquinavir
105
an example of HAART regimen
NED
neirapine
efavirenz
didanosine
106
to which lymph nodes is breast cancer likely to spread to?
axillary
para sternal
posterior intercostal
107
blood and nerve supply of breast
internal thoracic
| anterior and lateral branches of 4-6 intercostal nerves
108
most common cause of bloody nipple discharge?
intraductal papilloma
109
what are the HIV tests?
ELISA and Western blot-enzyme linked immunosorbent assay
| nucleic acid testing
110
treatment for falciparum vivax malaria?
oral chloroquinine
111
treatment for falciparum
oral artesunate
112
severe malaria
IV ARTESUNATE
113
define amyloidosis
extracellular sometimes with intracellular deposition of insoluble abnormal amyloid fibrils which can alter the normal function of tissues-produced in bone marrow
114
what might amyloidosis be secondary to?
multiple myeloma, chronic infectious disease (IBD, RA)
| dialysis related
115
causes of pre renal AKI
skin, liver, heart failure
116
facial sign of amyloidosis
spontaneous periorbital purpura
117
what will the blood film from a patient with amyloidosis show?
howell-jolly bodies
| congo red when stained
118
how is lymphedema reduced in breast cancer surgery?
sentinel node biopsy
119
how is carbon monoxide poisoning treated?
mannitol and hyperbaric oxygen
120
how is paracetamol OD treated
IV N-acetylcysteine
121
opioid OD treatement?
naloxone
122
most common worm in the UK
threadworm-nematode
123
side effects of tamOxifen
Oestrogen inhibition so menopausal flushing, mood change, weight gain, osteoporosis
124
2 features of sarcomas
always mesenchymal and always malignant
125
side effects of chemotherapy
```
nausea and vomiting
fatigue
peripheral neuropathy
rash
fatigue
anaphylaxis
```
126
what are mammograms supposed to detect?
non-invasive ductal carcinoma in situ
127
causes of breast lump other than breast cancer?
fibroadenoma
fibrocystic disease
abscess
128
screening programme for breast cancer
47-73 every 3 years
129
cervical cancer screening
25-49 every 3 years
130
what is seroconversion
```
the early symptomatic phase of HIV
temperature
night sweats
weight loss
diarrhoea
```
131
stages of HIV change in cels
```
fusion
entry
uncoating
reverse transcriptase
integrin
transcription
assembly
budding
```
132
primary cause of lymphadenopathy
AD Milroy's
133
what causes black water?
plasmodium falciparum malaria infection
134
blood films used for malaria?
thick and thin Giemsa
135
side effects of HAART
impaired memory
decreased bone density
diarrhoea
CVD risk
136
ethical grid
Seed house's made up of medical indications, patient preferences, quality of life, contextual features
137
what might osteosarcoma follow?
Paget's disease or irridation to bone
138
bowel cancer screening
faecal occult blood
| 60-74 every two years
139
what effect will administering adrenaline have
vasoconstriction-alpha1
tachycardia and positive inotrope-beta 1
bronchodilation-beta 2
140
how do you see if an allergic reaction has occurred?
measure TRYPTASE
141
define half life
time taken for serum concentration of a drug to reach 50%
142
hyperthyroid treatment
carbimazole if it doesn't work-have to put a 'ole in your thyroid
143
antiepileptic drug
carbimazipine epileptic pine trees
144
cabergoline is used for?
dopamine analogues so prolactinomas
145
acromegaly treatment
somatostatin analogues-ocreotide
146
blocks effects of opioids
naloxone BLOCKs
| naproxene pro....inflammtory? its anti inflammatory
147
complications of type 2 diabetes
```
diabetic retinopathy
diabetic nephropathy-nephrotic syndrome
diabetic neuropathy
CVS risk
recurrent infection and sclerosis of infection sites
slow wound healing
angina
cataracts
```
148
how do you protect the kidneys from diabetic neuropathy?
sartan
149
associated with temporal artery biopsy
polymyalgia rheumatica
150
miscarriages associated with SLE
antiphospholipid syndrome
151
in what condition should a CT be done before lumbar puncture
meningitis
152
neisseria meningitis treatment
cefotaxime
153
treatment for Guillian Barre
Ig
| plasmapheresis
154
MS modifying drugs
aletuzumab
| dimethyl fumarate
155
list the stages of wound healing
vascular response, inflammatory response, proliferation, maturation
156
describe the inflammatory response in wound healing
plts trapped in fibrin mesh (from vascular response), they release inflammatory mediators>vasodilation>exudate of WBCs
157
what mediates the proliferative stage?
fibroblasts-secrete collagen and glycosaminoglycans
158
what is granulation?
angiogenesis
159
what is a keloid scar?
collagen overgrows borders of injury, unlike a hypertrophic scar
160
what is healing by secondary intention
edges are not apposed
161
what is healing by tertiary intention
wound is purposefully left open then cleaned then surgically closed
162
list some barriers to healing
elderly, diabetes, malnutrition, malignancy, renal failure, hepatic failure, immunosuppression, vitamin deficiencies, prev radiotherapy, infection, oedema, vascular insufficiency
163
what is the screening programme for breast cancer?
every 3 years for women 47-53
164
what are aromatase inhibitors
prevent peripheral oestrogen production, post menopausal woman-letrozole
165
why aren't aromatase inhibitors given in pre menopausal women
the decrease in oestrogen>hypothalamic stimulation>overall increase in oestrogen prodcution
166
what is the most sensitive test for DCIS?
mammogram (it is more common in older woman so this fits as to why m for older women)
167
which breast cancer is USS most sensitive for?
invasive disease
168
for which women would you use MRI for to look for breast cancer
high risk woman with multifocal disease or with implants
169
SEs of breast radiotherapy?
pneumonitis
pericarditis
rib fractures
170
what is Paget's disease of breast?
scaly carcinoma near nipple that looks like eczema
171
where does lymph of the breast drain to?
axillary
parasternal
posterior intercostal
172
how is puberty staged?
Tanner's 5 stages
173
what is mammary dysplasia
benign changes in breast tissue
174
describe DCIS?
non invasive
| in lining of breast duct
175
what is the most common form of breast cancer?
invasive/ductal
176
breast cancer risk factors
```
family history
age
uninterrupted oestrogen exposure (nulliparity, 1st preg<30,HRT)
obesity
BRCA
not breastfeeding
previous breast cancer
```
