Mixed all 2nd year systems Flashcards
what are 3 general tests that are involved with coeliac disease serology?
- Gliadin
- tissue transglutaminase
- IgA levels
what may a urea breath test be used for diagnostically?
helicobacter pylori infection
Name 2 other breath tests that can be carried out in GI disease investigation
- Hydrogen breath test - bacterial overgrowth
2. lactose intolerance
Suggest 2 tests which are used to assess oesophageal motility
- manometry
- Barium swallow
- oesophageal pH test
- Upper GI endoscopy
Name 2 general complications of endoscopic investigation
- perforation
- hemorrhage
- aspiration
suggest a bowel preparation that is used prior to endoscopy
picolax
aspartate and alanine require a ratio greater than what to be considered in the diagnosis of alcoholic liver disease?
AST/ALT>2
for diagonsis of alcoholic liver disease you can also carry out an USS
alcoholic patients will also have a raised gamma GT, macrocytosis and thrombocytopenia
describe 3 exclusions you would like to make before you make a diagnosis of hepatic encephalopathy?
- infection
- intracranial bleed
- hypoglycaemia
this is known as the differential diagnoses of hepatic encephalopathy
describe the treatments which are used for hepatic encephalopathy
suggest 4 things
- enema
- lactulose
- antibiotics
- NG tube
- ITU
- airway support
- bowel clear out
what condition is more likely to present with malabsorption?
A - Crohns disease
B - Ulcerative colitis
the majority of absorption will occur inside the small intestine. UC will only affect the large colon with the exception of extra-intestinal manifestations. Crohns disease will affect the SI so is the most likely to cause malabsorption.
Name 5 inflammatory indices that will be found in inflammatory bowel disease or IBD
- CRP elevation
- ESR elevation
- low albumin
- low haemoglobin
- high platelets
- high white cell count
ulcerative colitis will not have which of the following?
a. erythema nodosum
2. uveitis
3. renal calculi
4. sclerosing cholangitis
although a common extra-intestinal manifestation of IBD, renal calculi are only found in Crohns disease (CD)
the rest of the listed conditions will be found in ulcerative colitis.
what is the standard dose of melasazine in first line treatment of IBD?
3g per day
bare in mind that there will be no significant improvement in remission rate or adverse side effects.
steroids are 2nd line treatment for outpatients with IBD. what are two steroids used?
prednisolone (40mg/day with tapering reduction over 4 weeks)
budesonide - less effective than prednisolone but there are less adverse side effects. budesonide can only be used in ileal and ascending colon disease also.
name 3 side effects of using the thioprine, azathioprine as immunosupression for IBD
- leukopenia
- hepatotoxicity (therefore will require blood monitoring weekly for 8 weeks then every 8 weeks)
- pancreatitis
- long term lymphoma risks
which cranial nerve will provide innervation to the middle ear? (maleus, stapes and incus)
Jacob’s nerve which is a branch of the glossopharyngeal nerve (CN IX)
- the tympanic branch of the glossoopharyngeal
what is Arnald’s nerve?
arnalds nerve is the auricular branch of the vagus nerve. it will innervate the posterior third of the external auditory canal.
what nerve will innervate the anterior external auditory canal?
the facial nerve CN VII
which aminotransferase is likely to be elevated in steatohepatitis?
alanine aminotransferase (ALT)
describe a method of definitive diagnosis of steatohepatits
liver biopsy
what is the treatment for steatohepatitis?
- weight loss
2. exercise
what are the two most important treatments in alcoholic hepatitis?
- steroids
2. thiamine
3 structural changes at neurons will occur during long term memory. describe them
- more neurotransmitter release sites
- neurotransmitter release vesicles stored and released
- increase in the number of pre-synaptic vesicles
describe the 4 classes of biliary atresia
I - common bile duct affected
II - common hepatic duct
III - common hepatic duct and the bile and cystic duct
IV - hepatic ducts, common hepatic duct, bile and cystic ducts
name 4 risk factors of cholangiocarcinoma
- primary sclerosing cholangitis
- congenital cystic disease
- contrast dyes such as thorotrast
- carcinogens (aflatoxins)
what are 3 main presentations of cholangiocarcinoma?
- obstructive jaundice
- pruritis
- non-specific symptoms
what is the main treatment for inflammatory muscle disease?
immunosupression
what investigations should you carry out for inflammatory muscle disease?
EMG
biopsy
CK
what 3 tests must be carried out for epilepsy?
CT/MRI
EEG
video telemetryy
what differences may be found between polymyositosis and derrmatomyositosis
DM will have a characteristic rash and is humoral mediated with CD4 and B cells
polymyositosis will have CD8 cells on biopsy
alkaline phosphate is an aminotransferase found within hepatocytes and is elevated when there is obstruction or liver infiltration - T/F?
false.
alkaline phosphatase is found in bile ducts. it is however elevated in obstruction or liver infiltration
alkaline phosphatase is also present in bone, placenta and in the intestines.
what clinical presentations may a patient have with hepatic jaundice in comparison to post-hepatic jaundice
hepatic jaundice will present with 1. ascites 2. spider naevi 3. gynaecomastia patient is likely to be an IVDA
post hepatic jaundice will present with
- abdominal pain
- cholestasis (pale stool, pruritis and very dark urine)
- palpable gall bladder
describe 3 investigations you would carry out for a patient with jaundice
- USS of abdomen
- Hep B and Hep C
- antibody profile
- serum immunoglobulins
- ferritin
- transferrin saturation
- copper
- caeruloplasm
what are 3 treatment options for hepatic encephalopathy?
- neomycin
- rifaximin
- phosphate enema
- lactulose
all of the semicircular canals in the ear will connect to the utricle - T/F?
true
what is the function of the semicircular canals?
to inform the brain on rotational acceleration
what is the respective functions of the utricle and the saccule?
the utricle will detect back and front tilts
the saccule will detect vertical movements (in a lift)
what is the name of the reflex that will make rapid postural adjustments to stop you from falling?
dynamic righting reflex
describe the static reflex
this reflex will cause you to either intort or extort your eyes to compensate for the angle of your head
basal cell papilloma (seborrhoeic keratosis) is typically greasy, flat, brown and oval. is it related to sun exposure?
no
name an important precursor for malignant melanoma
melanocytic naevus
suggest preventative measures for sudden death caused by hypertrophic cardiomyopathy
- ICD
- septal ablation
- surgical resection
- screening for Vtach syncope and exercise hypotension
where are the somites derive from?
para-axial mesoderm
there are 33 somites in total
describe the nerve innervation of the branchial arches
1 - V3
- facial
- glossopharyngeal
- superior laryngeal nerve (external)
- recurrent laryngeal
how many processes is the face made from?
5
1 frontonasal
2 maxillary
2 mandibular
in MS, activated t cells will cross the BBB to cause the demyelination of white matter. t/f?
true
describe the most effective imaging test for the diagnosis of MS
MRI
males are more likely to develop MS - T/F?
false - females
describe 3 presentations of optic neuritis
subacute loss of vision pain on moving the eye colour distortion optic disc swelling and atrophy pupillary reflex deficit
there is a resolution of symptoms over a few weeks
what are 3 differential diagnoses of optic myelitis?
- neuromyelitis optica
- ischaemic optic neuropathy
- sarcoidosis
- wegners granulomatosis (c-ANCA)
there are no relapses in primary progressive MS - TF?
true
in primary progressive MS there will however be bladder symptoms and it will present in the old. there is no predilection towards males and females
the gold standard for detecting coeliac disease is a distal duodenal biopsy - what may be found?
increased intra-epithelial lymphocytes
patial/subtotal villous atrophy with IgA deposits
what are 2 other diagnostic tests which can be carried out?
anti-endomysial IgA
anti-gliadin
anti tissue transglutaminase (95% specific and sensitive)
describe 3 complications of coeliac disease
- small bowel lymphoma
- esophageal carcinoma
- colon cancer
- small bowel adenocarcinoma
describe the symptom and treatment of Giardia Lambia
Giardia Lambia will result in malabsorption and hypogammaglobulinaemia
treatment is with metronidazole
describe 2 treatments for lyme disease
oral doxycycline
IV ceftriaxone
what are 3 investigations you can carry out for lyme disease
PCR of CSF EMG Nerve conduction studies (NCS) MRI brain and spine serological testing
what is the treatment for tertiary syphillis
very high dose penicillin
what is the treatment for tetanus in increased risk patients
penicillin and immunoglobulins
describe 3 investigations for CJD (Creutzfeldt–Jakob disease)
MRI (pulvinar sign in variant CJD)
CSF
EEG
what may be found in the CSF of someone with Creutzfeldt–Jakob disease?
increased protein or immunoassasay 14-3-3 brain protein
describe an electrophysiological test which records optic nerve function
Visually evoked potential
Electroretinogram will measure the retinal function and record action potentials from the retina - TF?
true
a wave will correspond to the photoreceptors
b wave will correspond to the Muller cells
describe an electrophysiological test that measures the RPE and photoreceptors of the eye
electro-oculogram. it will measure the resting potential difference between the RPE and the photoreceptors.
it will measure the maximum and potential difference in a light and dark adapted eye
the Arden ratio is equal to 1.85
what is the difference between an electro-oculogram and an electro-retinogram?
electro-oculogram will measure the resting potential difference between the RPE and the photoreceptors. the electroretinogram will measure the retinal function and record action potentials from the retina
the optic nerve is around 20 degrees from the fovea and is a physiological blind spot - TF?
true.
there are no rod or cone receptors on the optic nerve
the peak amount of which photoreceptors are at the fovea centralis?
there is the peak amount of cones and incidentally the minimum number of rods
hypo and hyperkalaemia can have the same effect on the heart - TF?
true
they can both induce fibrillation and heart block
what is the need for DAPT (dual anti-platelet therapy) in cardiac stenting
the stents will need time to vascularise so to prevent thrombosis and blockage of the vessel give anti-platelets. premature discontinuation may lead to death. DAPT is for up to a year.
what are the diagnostic tests for ACS (acute coronary syndrome)?
troponin ECG CT angiography GFR anaemia cholesterol
what layer of the lateral plate mesoderm is closest to the endoderm?
splanchnic mesoderm
what is the most common type of tracheo-oesophageal fistula?
oesophageal atresia with distal tracheo-oesophageal fistula (OATOF)
what is the causative agent in whipples disease?
Tropheryma Whipelli
describe 3 symptoms of Whipple’s disease
weight loss
abdominal pain
malabsorption
(PAS material may be seen in the villi)
What is the treatment of Giardia Lamblia?
Metronidazole
what is the first line treatment for partial and secondary generalized seizures?
lamotrigine
carbemazepine
what is the first line treatment of absence seizures?
ethosuxamide
what is the second line treatment for status epilepticus
valproate and phenytoin
what is first line treatment for status epilepticus?
lorazepam and diazepam
describe 2 side effects of using the anti-convulsant topiramate
weight loss
difficulty finding words
tingling in hands and feet
which two lobes of the brain will the lateral sulcus separate?
temporal and frontal lobes
which sulcus will separate the parietal from the occipital lobes?
parieto-occipital sulcus
what is the exact location of the primary auditory cortex - also give the Broddman areas
superior temporal gyrus BA areas 41 and 42 - Herschel’s convolutions
which hemisphere is Wernicke’s area and what does it do?
Wernicke’s area is the Receptive area of speech (undertsanding spoken word)and is found in the dominant hemisphere - in most people the left hemisphere
what is the score of glasgow alcoholic hepatitis that requires steroidal treatment of alcoholic hepatitis?
9
name the 5 components of the score
age WCC urea INR bilirubin
what is the treatment of alcoholic hepatitis?
If Maddrey’s discriminant function is greater than 32 then treat with oral steroids
4.6x (PT-control PT) +bilirubin
thiamine
prevent against GI bleed, constipation, infection, alcohol withdrawal and airway protection
suggest three causes of fatty liver (non-alcoholic)
obesity
diabetes
hypercholesterolaemia
What are the lines of Zahn composed of?
platelets
fibrin mesh-work
RBC
what is Cushing syndrome?
excess production of cortisol (non-ACTH dependent) from the adrenal glands
Name 2 outcomes of critical limb ischaemia
gangrene
ulceration
critical limb ischaemia is when the patient will have pain at rest
if after CXR, CT and aspiration there is still no diagnosis of pleural effusion, what test can be done next?
video-assisted thorascopy which allows for the direct inspection of the pleura with directed biopsies. it can be therapeutic
name the reflex that is responsible for the axis of the head in a constant relationship with the rest of the body?
labyrinthine reflex
if you irrigate the left ear of someone with cold water in caloric stimulation what direction would they experience nystagmus?
right nystagmus
Suggest 5 bedside investigations for GI disease
BMI pulse oximetry ECG capillary glucose urinalysis
faecal elastase is an indication of what conditions?
malabsorption
pancreatic insufficiency
calprotectin will be raised in IBS - TF?
false
it is raised in inflammatory conditions and allows for the quantitative analysis useful for monitoring disease activity
obstructive liver function tests would see what elevations in blood tests?
alkaline phosphatase
bilirubin
Name 3 risk factors for vitamin D deficiency
age
Asian
pigmented skin is less able to to make vitamin D3 in repsonse to UV radiation
malnutrition
kidney disease
Chapatti flour will contain phyphate that binds dietary calcium
in the sympathetic nervous system the synapses between the pre and post ganglionic cells are…
finish the sentence
cholinergic and nicotinic
this is also true for the parasympathetic nervous system
in the parasympathetic nervous system the synapses between the post ganglionic cells and their targets are adrenergic and nicotinic - TF?
false
they are muscarinic and cholinergic
which of the following is false?
post-ganglionic cells in the adrenal medulla will
a. release adrenaline
b. have no axons
c. are part of the sympathetic nervous system
d. contributes to mass activation
none are false - all statements are true
tremor is a consequence of which of the following anti-convulsants?
A. sodium valproate
B. carbamazepine
C. lamotrigine
D. levetiracetam
sodium valproate will result in tremor and also the following:
- weight gain
- transient hair loss
- pancreatitis
- hepatitis
- drowsiness
- ataxia
which of the following is not a side effect of carbemazepine?
a. ataxia
b. drowsiness
c. nystagmus
d. insomnia
e. reduced sodium
insomnia
which of the following drugs following drugs will cause irritability and depression?
A. sodium valproate
B. carbamazepine
C. lamotrigine
D. levetiracetam
levetiracetam
describe 2 side effects from using zonisamide
cognitive problems and bowel upset
the urinary system will develop from the cloaca and the para-axial mesoderm - TF?
false - cloaca and the intermediate mesoderm
what arises form the intermediate mesoderm in the urinary system?
kidneys and ureters
the urogenital ridge forms 3 sets of tubular nephric structures - name them
pronephros
metanephros
mesanephros
what is the most common cause of acute hepatitis in grampian?
hepatitis E infection (HEV)
name the 3 risk factors for NAFLD
obesity diabetes hyperlipidaemia genetics - PNPLA3 hypertension age ethnicity
describe 2 tests which can be used for the diagnosis of NAFLD besides the following:
- US
2.MR/CT
AST/ALT ratio
- liver biopsy
- fibroscan
- cytokeratin -18
MR spectroscopy (quantify fat)
what score on the glasgow criteria will suggest severe pancreatitis?
greater than or equal to 3
name 6/8 of the components of the glasgow criteria used to grade pancreatits
- urea
- calcium
- oxygen
- LDL
- AST
- albumin
- Blood glucose
- WCC
Name an inflammatory marker which is not on the glasgow criteria which however can be used as an indication of severe pancreatitis
CRP>150
describe 5 aspects in the management of acute pancreatitis
give oxygen insulin NG tube blood transfusion analgesia IV fluids monitor urine output
what are two management complications in the management of acute pancreatitis?
abscess - antibiotics and drainage
pseudocyst - endocscopic drainage or surgery
name 4 sites of extra-intestinal manifestation of inflammatory bowel disease
joints - arthritis
eyes - epislceritis, conjunctivitis and uveitis
kidney - renal calculi (only in Crohns disease)
skin - erythema nodosum, vasculitis and pyoderma gangrenomsum
liver/biliary tree - sclerosing cholangitis, gall stones, fatty change and pericholangitis
name 6 extra-intestinal manifestations of IBD
renal calculi erythema nodosum episcleritis uveitis conjunctivitis sclerosing cholangitis arthritis gall stones pyoderma gangrenosum
what are the common inflammatory indices of IBD?
ESR/CRP increased WCC increased platelets low haemoglobin low albumin
acute angle closure glaucoma will present with severe pain - TF?
true
how may a patient with acute angle closure glaucoma present? name 4 things
severe pain vomiting fixed/dilated pupil headache pericorneal redness with no discharge
describe the redness in someone with a corneal ulcer
pericorneal redness
what are the 4 main investigations which can be carried out in a cholangiocarcinoma?
USS/EUS ERCP/MRCP CT/MR PTC FDG-PET
cytology and cholangioscopy
what are two treatment options for ampillary tumours?
endoscopic resection
transduodenal excision
pncreatico-duodenectomy
describe the motor and sensory signs observed in a LMN lesion?
motor signs
- weakness
- decreased tone
- absent reflexes
- muscle wasting
sensory
- dermatomal pattern of weakness
which spinal artery will supply the motor tracts?
the anterior spinal artery
what is demyelinating myelitis?
pathological lesions of inflammation/demyelination leading to temporary neuronal dysfunction. it will affect the white matter ans lesions can be numerous
describe the treatment for NAFLD suggest 3 things other than weight reduction and exercise/diet
- diet, exercise and weight loss (may be surgical)
- insulin sensitizers (metformin and pioglitazone - thiazolidinedione)
- GLP-1 analogues such as liraglutide
- farnesoid X nuclear receptor ligand (obetocholic acid)
- vitamin E
suggest a treatment for autoimmune hepatitis
long termazathioprine
what is the difference in diagnosis between autoimmune hepatitis, primary biliary and primary sclerosing cholangitis?
autoimmune hepatitis will have autoantibodies ANA SMA and LKMI/SLA. autoimmune hepatitis will also have an elevated IgG level
primary biliary cholangitis will have anti-mitochondrial antibodies as well as IgM
primary sclerosing cholangitis is found in association with IBD and will also have pANCA with MRCP
what are the two physiologically active thyroid hormones?
thyroxine and triiodothyronine
which will have an elevated IgM level:
a. primary biliary cholangitis
b. primary sclerosing cholangitis
c. atuoimmune hepatitis
a - primary biliary cholangitis will be diagnosed with anti-mitochondrial antibodiesand IgM
where are the body’s main sources of tyrosine and iodine?
diet
what transporter will allow iodine to enter the follicular cells from the plasma?
sodium/iodine co-transporter
the iodine is taken up against a concentration gradient
what is the name of the protein that binds thyroxine and T3 inside the plasma?
thyroglobulin - thyroxine binding globulin
what are the two main cell types in the thyroid gland?
C cells - calcitonin production
follicular cells - surround the colloid
what is the name of the enzyme that catalyses the reaction producing T4/T3 from iodide and tyrosine?
thyroperoxidase
which transporter is responsible for transporting the iodide into the colloid?
pendrin transports
suggest 4 investigations to carry out in the diagnosis of multiple slcerosis
- MRI (black holes or lesions)
- lumbar puncture - oligocloncal bands of IgG
- bloods - exclude other inflammatory conditions
- evoked potentials
optic neuritis is a good prognostic indicator for multiple sclerosis - TF?
true
optic neuritis, being female, having a long interval between the first and second relapses
few relapses for the first 5 years are all good prognostic indicators for multiple sclerosis
being male is a bad prognostic indicator for MS - TF?
true
old age, multifocal and motor signs/symptoms will all be bad prognostic indicators for mutiple sclerosis
how may a patient with hepatic encephalopathy present?
confusion
tremor - asterixis
foetor hepaticus
ascites
what are 3 things that will precipitate hepatic encephalopathy?
infection constipation drugs dehydration GI bleeds SEDATION MEDICATION (pls remember for exam)
what is the typical presentation of a patient with cholestasis?
pale stools
highly colourised urine
pruritis
jaundice
hepatocellular carcinoma is the most common liver cancer and is strongly associated with Hepatitis B and Hepatitis C infection. how may hepatocellular carcinoma present?
jaundice
mass in abdomen
bleeding from tumour - anaemia or haematemesis/malaena
splenomegally
pain weight loss
decompensation signs from the liver - ascites etc
what is the difference between using ERCP and MRCP?
ERCP will be used to visualise the pancreatic and biliary ducts. it has a higher complication rate than MRCP and has a mortality associated with it. it is also a risk factor for acute pancreatitis
MRCP has intra and extraductal views and is associated with fewer complications however claustrophobia is an issue.
MRCP also doesnt use radiation however ERCP can be used as a therapeutic option
what is the difference between lymphoma and leukaemia?
lymphoma is the proliferation of haematopoeitic cells maturing the lymphatic system
leukemia is the proliferation of haematopoeitic cells maturing inside the blood
what are the tumours called that are derived from connective tissue?
sarcoma
carcinomas are derived from epithelial tissue
what type of cells are blastomas derived from?
precursor cells
name the 4 main causes of sudden painless loss of vision?
- stroke
- ischaemic optic neuropathy
- central retinal vein occlusion
- central retinal artery occlusion
- vitreous hemorrhage
- retinal detatchment
what are 4 symptoms of giant cell arteritis?
- jaw claudication
- scalp tenderness
- headache
- loss of vision
- stiff neck
- nausea and anorexia
how would you diagnose giant cell arteritis?
- temporal artery biopsy
- ESR and CRP
- MRA
- doppler
- PET scan
treat with high doses of prednisolone
Often, one or both of the temporal arteries are tender with a reduced pulse and a hard, cord-like feel and appearance
what are two embryological structures the urinary system will develop from?
the urinary system will develop from the intermediate plate mesoderm and the cloaca
what structure will give rise to the bladder and the urethra?
the cloaca will give rise to the bladder and the urethra
the Wollfian duct will form from which structure in the embryological kidney?
the mesonephros will give rise to the mesonephric tubules and the mesonephric duct (Wollfian) which then persists and opens to the the cloaca
Crohns disease will have a continuous inflammation TF?
false.
crohns disease is characteristic for its skip lesions and can occur anywhere in the gut tube from oesophagus to anus.
suggest 6 things a patient would present with who had Crohns disease
clinically a patient with Crohns disease is likely to have diarrhoea and have lost weight.
- malaise
- lethargy
- anorxeia
- NV
- low grade fever
- abdominal pain
- anaemia and vitamin deficiency
describe 4 histological differences between Crohns disease and Ulcerative colitis
- Crohns disease will have transmural effects of the gut tube where as in ulcerative colitis only the mucosal layer is affect. as a result of this CD may present with fistulae also
- Crohns disease will have characteristic skip lesions whereas ulcerative colitis will have continuous inflammation usually always starting from the anus and then work proximally.
- Ulcerative colitis will have crypt abscesses and depleted goblet cells.
- Crohns disease will have granuloma’s which are non-caseating.
describe 4 things that a patient may present with for you to suspect they have diabetic ketoacidosis
- abdominal pain
- dehydrated
- thirsty
- Kussmaul’s breathing
- tachycardia
- low BP
- sweet breath
suggest 4 investigations to carry out in a patient with diabetic ketoacidosis
do a glucose test and also a venous blood gas first
- Urinalysis sample for ketones and glucose
- FBC/electrolytes
- blood urine culture
- ECG/cardiac monitor
- CXR
before taking any investigations remember to do a rapid ABC assessment of the patient. get their vital signs and IV access as well as doing a clinical assessment too
describe 4 tests which can be used to diagnose myasthenia gravis
- Acetylcholine receptor antibodies
- Anti- Musk anitbodies
- Tensilon test
- CT chest
- EMG/repetitive stimulation
describe 2 treatment options for myasthenia gravis
- anti-cholinesterase
2. prednisolone and azathioprine
what is the treatment for motor neurone disease?
riluzole and supportive treatment (NIV and PEG)
what are the 3 criteria for thyectomy in myasthenia gravis
- female
- under 40
- malignant thyoma
name 4 risks associated with ERCP
- perforation
- acute pancreatitis
- haemorrhage/bleeding
- mortality
- infection
endoscopic ultrasound can be used in the staging and cyst drainage in the GIT. TF?
true
what structure does enteroscopy allow visualisation of?
the small intestine.
enteroscopy will also allow for the biopsy or therapy for small bowel pathology.
capsule enteroscopy is less invasive but no biopsy is possible.
Name 2 non-specific signs of coeliac disease and Crohns disease
- malabsorption
- weight loss
- nausea and vomiting
- aphthous ulceration
- clubbing
what is dermatitis herpetiformis and what GI disease is it associated with?
dermatitis herpetiformis is cutaneous manifestation of coeliac disease. it is intense pruritis, IgA will be deposited within the skin particularly the elbows, shoulders and knees. there will be profound blistering.
describe 4 tests to investigate the structure of the small intestine
- duodenal/jejunal aspirate
- H2 breath test (lactulose and glucose substrate)
- anti-transglutaminase IgA.
- CT
- biopsy
- white cell scan
- capsule/MRI enteroscopy
what is the gold standard diagnosis for coeliac disease?
take a distal duodenal biopsy
name the 3 main electro-physiological eye tests
- Visually evoked potentials - looking at the optic nerve function and records the activity that is in the visual cortex.
latency of the test will suggest optic neuritis and reduced cell function
a decreased amplitude will suggest a decreased cell number or ischaemia
- Electro-oculogram (EOG) - will measure the resting potential difference between the RPE and the photoreceptors. it will measure an arden ratio which should be 1.85. it takes into account the maximum potential difference in a light and a dark adapted eye.
- electro-retinogram - measures the retinal function. a waves are from photoreceptors whilst b waves are from Mullers cells.
Gall bladder polyps are benign - TF?
true
describe 5 risk factors for gall stones
- age
- gender
- oral contraceptive
- obesity
- cirrhosis
- cystic fibrosis
- haemolytic anaemia
- bile infection
describe 5 presentations of a patient with choledocho-lithiasis
- pain
- jaundice
- dark urine
- pale stool
- pruritis
- steatorrhoea
what is the treatment for Multiple sclerosis myelitis?
supportive - methyl prednisolone
the anterior cerebral artery will supply the medial part of the homonculus so its occlusion would result in paralysis and loss of sensation where in the body
in the lower limbs namely the legs and feet.
there will be the loss of gait.
it will have contralateral effects
so for example, if there was an occlusion on the right ACA then the left side would be affected. dont forget the decussation of the fibres is yet to happen for motor fibres
name the 3 most common symptoms of middle cerebral artery occlusion
- hemiplegia
- homonymous hemianopia
- dysphasia
if the LHS was affected then there would be RHS paralysis but gaze deviation to the LHS.
what 5 blood tests may you want to perform in a patient with suspected gall stones?
- alkaline phosphatase
- amylase
- lipase
- WCC
- AST
- ALT
describe 4 radiographic tests which you may wish to perform on a patient with suspected gallstone?
- IV cholangiography
- ERCP/MRCP
- PTC - percutaneous transhepatic cholangiography
- . EUS/US
- CT
describe 2 non-operative treatment of gallstones
- dissolution
2. ESWL - endoscopic shockwave lithotripsy
what is the gold standard operative treatment of gallstones?
laparoscopic cholecystectomy +/- on table cholangiogram (OTC)
a child with a mother who has T1DM is more likely to develop the condition than a child who has a father with T1DM - TF?
false.
father - 6%
mother - 1%
both parents - 30%
sibling - 8%
monozygotic twin - 30%
heterozygotic twin - 10%
name 3 drugs which are known for inducing retinopathy
- anti-malarials - chloroquine and hydroxychloroquine
- phenothiazines
- tamoxifen
how does conjunctivitis affect vision of a patient?
their vision will be normal
to differentiate between viral, bacterial and allergic conjunctivities can be done with the colour of the discharge - yellow (bacteria), clear (viral), mucous (allergic)
describe the redness of the eyes in a patient with conjunctivitis
peripheral diffuse
what eye structures are involved with intermediate uveitis?
- iris
- ciliary body
- vitreous
uveitis can be caused by infection, systemic disease, idiopathic or by masquerade. name a cause from each
systemic - sarcoidosis, wegners and SLE
infection - TB, toxoplasm and syphilis
masquerade - leukaemia, intraocular lymphoma
what is the labyrinthine reflex?
keeping the axis head in a constant relationship with the rest of the body
describe the dynamic righting reflex
rapid postural adjustments to stop you falling
name the risk factors for squamous cell carcinoma of the oesophagus
smoking
alcohol
dietary carcinogens
what is the normal concentration of K ions in the blood
4mmol/l
what is the result of liver cirrhosis on the spleen?
splenomegally
how may an LFT identify the effects of liver cirrhosis on the spleen?
decreased platelets
the liver is an important source of thrombopoeitin
liver cirrhosis is an indirect marker of portal hypertension
true
give 3 characteristics of Devic’s disease?
- optic neuritis
- myelitis
- aquaporin 4 antibodies
Progressive multifocal leukoencephalopathy (PML) is brought on by the JC virus and immunosuppressants/AIDS. give 3 drugs used to treat multiple sclerosis that can predispose a patient to PML
- fingolimod
- dimethyl fumartate
- natazilumab
what is the first line treatment for multiple sclerosis?
- beta interferon and glatiramer acetate.
you can also use teriflunomide and dimethyl fumartate
the side effects are liver dysfunction and infection
what is the treatment for acute illness in multiple sclerosis?
- prednisolone
there is a decreased risk of developing JC virus 3 months post partum -TF?
false - there is an increased risk
prior to AAA therapeutic surgery, what tests/investigations should you carry out?
- Cardiac assessment - ECG, echocardiography and perfusion scanning
- abdominal - CT abdomen
- do bloods for anaemia
- Pulmonary assessment - CXR and PFT
Name the symptoms of varicose veins
- cosmesis
- pruritis
- nocturnal cramps
- acute haemorrhage
- superficial thrombophlebitis
- skin changes
what coronary artery will supply the sino-atrial nodes?
right coronary artery
which artery supplies the atrio-ventricular node?
the right coronary artery
what are the two main revascularisation methods in stable angina?
- PCI
2. CABG
a visually evoked potential is an electrophysiological test which is used to record optic nerve function. it will measure the responses in the visual cortex in response to flashing light or checker board patterns.
what may cause a reduced amplitude in readings and what may cause latency in readings?
- reduced amplitude
decreased number of cells
ischaemia
- latency
optic neuritis (demyelination) reduced cell function
give 4 considerations for a differential diagnoses of blackout
- first, hypoxic or concussive seizure
- syncope
- narcolepsy
- migraine
- cardiac arrhythmias
what are 3 causes of vasovagal syncope?
- standing for a long time
- vasalva manouvre
- coughing/ laughing
- venepuncture
- standing to quickly
- micturition
non-epileptic attacks are commonest in women or men?
women
what 4 things would you want to discuss with a 24 y/o male regarding his diagnosis of ‘first seizure’
- occupation
- driving
- potentially hazardous leisure activities
- copies of the information sheet regarding first seizures
a 29 y/o female comes to clinic with no FH of bowel disease. there is a 2 year history of irregular bowel habits - loose and increased frequency. she also reports having colicky pain but that is alleviated by defecation. there is also no blood or weight loss.
a. what is your most likely diagnosis?
b. what tests would you like to perform?
c. what are the clinical features of IBS
a. IBS
b. physical and rectal exam, faecal occultblood testing (FOBT)
c. bloating, altered bowel habit, abdominal pain, belching wind and mucous in stool
irritable bowel syndrome (IBS) is more common than inflammatory bowel disease (IBD) - true or false?
true
where will the abdominal pain of constipation most likely radiate to?
lower back
give 3 common presentations of bloating
- flatulence
- relaxation of abdominal wall muscles
- mucous in stool
Name 3 signs that may be seen under examination of mitral stenosis
JVP with a prominent a wave RV heave tapping apex beat normal pulse diastolic thrill (after s2)
CAGE, FAST and audit are used for the screening of what condition?
alcoholism
in FAST screening for alcoholism, what score is positive?
> 3
in AUDIT (screening for alcoholism), what score corresponds to possible dependence?
> 20
a patient has an AUDIT score of 17. is it true to say that they are in the increasing risk category for developing alcoholism?
no. they are in the higher risk category.
8-15 = increasing risk
16-19= higher risk
20+= possible dependence
in what layer of skin are nociceptors found?
dermis
proprioception is mediated by which type primary afferent fibres?
A alpha and Abeta - muscle spindles and golgi tendon organs
A beta and C fibres will decussate at different points in the body before reaching the somatosensory cortex. describe their paths.
A beta fibres are responsible for proprioception. they will enter the dorsal column of the spinal cord ipsilaterally and then ascend synapsing at the cuneate and gracile nuclei. they will synapse again in the thalamus and decussate in the medulla. they end up in the somatosensory cortex.
C fibres will decussate in the spinal cord and synapse there. they will ascend in the lateral column of the spinal cord and ascend. they synapse again in the thalamus. their tertiary neurones will arrive in somatosensory cortex.
name 4 factors that will activate the signal transduction pathways in nociceptors
- acidity (low pH)
- heat (ASIC and TRPV1)
- bradykinin
- prostaglandins
- histamine
what is the function of calcitonin and where is it produced
calcitonin is produced in the thyroid land by C cells and it will act to regulate and decrease plasma levels of calcium
what is the effect of cortisol on calcium levels within the body?
cortisol will inhibit osteoblasts and increase the renal excretion of Calcium and phosphate. it will reduce the intestinal reabsorption of calcium and also decrease the plasma calcium levels.
all of this will cause PTH levels to rise and cause the bone resorption to increase and inhibition of osteoblasts. a decreased bone formation as well as the combined effects of cortisol will result in osteoporosis.
name the 3 conditions that will encompass NAFLD
- steatohepatitis
- simple steatosis
- cirrhosis and fibrosis
which gene is commonly implicated in NAFLD?
PNPLA3
suggest 5 tests that can be done for the diagnosis of NAFLD?
- USS
- MR/CP
- AST/ALT ratio
- fibroscan
- MR spectroscopy
- cystokeratin - 18
- liver biopsy
name the 6 components taken into account when considering the NAFLD score
- age>45
- platelets <150
- albumin<34
- AST/ALT
- BMI>30
- Diabetes
put this question as 1 until you can name them all consistently 4 times
bilirubin is a breakdown product of haem. bilirubin levels will decrease if there is hepatic parenchymal damage or if there is hepatic haemolysis - TF?
false. under these circumstances the bilirubin levels will actually increase.
what is bilirubin initially bound to before its conjugation in the liver?
it is initially bound to albumin
which aminotransferase is more specific - AST or ALT?
ALT. AST can be found in the heart, brain and kidney tc.
a defective bilirubin uptake, conjugation or excretion by hepatocytes would result in which kind of jaundice?
hepatic jaundice is mainly caused by defective bilirubin uptake, conjugation and secretion.
what may cause post-hepatic jaundice?
defective transport of bilirubin by the biliary ducts-
choledocholithiasis, cholestasis
a 33 year old female will present to clinic with pallor and splenomegally. she is heavily jaundiced. she has a history of fatigue, dyspnoea and chest pain. what type of jaundice may she have?
pre-hepatic jaundice - it typically presents with splenomegally and a history of dyspnoea, chest pain and fatigue (haemolysis)
which kind of cells do sulphonylureas act on?
they will act on sulphonylurea receptors (SUR-1) on pancreatic Beta cells. they are second line treatment for T2DM and is associated with weight gain and moderate risk of hypoglycaemia.
Name a drug from the thiazolidedione family
pioglitazone
which of the following are true statements?
a. metformin should be stopped if the eGFR is below 30 or creatinine is below 150
b. sulphonylureas will block ATP-K channels to increase the release of insulin
c. sulphonylureas and pioglitazone will result in weight loss
d. contraindication of pioglitazone are congestive cardiac failure and bladder neoplasms
e. the main side effects of glitazone is oedema, weight gain and fractures.
everything is true except c
how may a patient with hepatic encephalopathy present?
ascites
asterixis
confusion
foetor hepaticus
what are 3 things that will precipitate hepatic encephalopathy?
infection constipation GI bleeds sedation dehydration
what is the typical presentation of a patient with cholestasis?
pale stool pruritis dark urine steatorrhoea jaundice
hepatocellular carcinoma is the most common cancer and is strongly linked to hep B and hep C. how may HCC present?
- flank pain
- decompensation of the liver
- weight loss
- fever
- raised AFP in serum
- pain
both upper and lower GI bleeds will present with an elevated urea - TF?
false. it is more commonly seen in UGIB
urea is normally normal in a LGIB
what is haematemesis?
blood in vomit
what is malaena?
dark tarry stool caused by an UGIB
what is the term used to describe passing fresh/altered blood per rectum?
haematochezia
name a side effect of using ethambutol in the treatment of tuberculosis
optic neuropathy
In dilated cardiomyopathy, the relaxation of the heart is compromised resulting in a decreased EDV - TF?
false this has just explained the pathology of HCM.
what is the management of DCM?
ICD
thrombo-emoblic prophylaxis
anti-arrhythmics - lidocaine
NSAIDs may precipitate DCM - true or false?
true
relaxation of the ventricular wall is an active process - TF?
true
what investigations should be done for restrictive cardiomyopathy?
ECG (checking for Lbbb - left bundle branch block)
CXR
BNP
bloods - FBC, UE, sarcoid, haemochromatosis
amyloid - non cardiac biopsy
fabry - low plasma galactosidase A activity
Echo
CMRI
what is the effect of GIP on gastrin and parietal cell secretion?
GIP will inhibit their secretion
what is the result of vitamin B12 deficiency?
pernicious anaemia - no maturation of RBC
name the most common organism in bacterial gastritis
h. pylori
what is the function of the direct and indirect pathways of the basal ganglia?
the direct pathway will act to make specific motor actions
there is positive feedback loops to the supplementary motor area (SMA). there is subsequent initiation of movements by the SMA. the globus pallidus neurones are spontaneously active and so they will tonically inhibit the Vl thalamus.
the indirect pathway will act to inhibit/suppress any competing/inappropriate action.
the will antagonise the direct route. the striatum (caudate and putamen) will inhibit GPe. GPe will inhibit the subthalamic nuclei (STN) and the GPi. the cortex will then excite the subthalamic nuclei (STN). STN will then excite GPi. GPi will then inhibit the thalamus.
name 2 common extra-intestinal manifestations which occur in IBD that occur in the eye and the joints
eyes
conjunctivitis, episcleritis, uveitis
joints
ankylosing spondylitis and sacrolitis
what site of colitis in the intestinal tract is most associated with developing colonic carcinoma?
pancolitis - whole colon
what is the medical management procedure for an outpatient with IBD?
melasazine 3g/d
steroids
if still no control then use immunosuppression
- mercaptopurine
- infliximabb
- methotrexate
- azathioprine
what is the purpose of the pacinian corpuscle?
to sense touch
what are the two mechanoreceptive fibres in the transmission of sensory information?
A alpha and Abeta
what spinal column will they use to ascend to the brain?
ipsilateral dorsal and synapse with cuneate and gracile nuclei. 2nd order fibres decussate in medulla and project to reticular formation, thalamus and cortex.
give 1 advantage and 1 disadvantage of convergence in sensory pathways
advantage - saves on neurons
disadvantage - referred pain
name 2 higher centers responsible for closing the gate for pain
NRM - nucleus raphe magnus
Peri-aqueductal grey matter (PAG)
what is the effect of prostaglandins on bradykinin?
they will sensitise nociceptors to bradykinin
what are the most common family of bacteria to cause a brain abscess?
streptococci in 70% of cases especially penicillin sensitive streptococci milleri group:
a. strep anginosus
b. strep intermedius
c. strep constellatus
describe a method of diagnosing cryptococcal meningoencephalitis in an AIDS patient.
cryptococcal antigen, india ink JC Virus PCR CMV PCR HIV PCR toxoplasma serology (IgG)
what are 3 causative spirochaetes in the CNS?
borellia burgoferi (lyme disease) treponema pallidum (syphilis) leptospira interogans (leptospirosis)
what are the two main causes for acute pancreatitis?
alcohol
gall stones
it may also be caused by trauma: ERCP,steroids, azathioprine, diuretics, pancreatic carcinoma, HIV, CMV, cocksackie B4 and pancreatic carcinoma
what does ERCP stand for?
endscopic retrograde cholangiopancreatography
describe 5 main invesigations for acute pancreatitis
- Bloods -amylase and lipase, calcium, glucose, coagulation, lipids, UE
- LFT
- ERCP/MRCP
- AUS - oedema, gall stones and pseudocyst
- ABG
- AXR/CXR (pleural effusion)
- CT scan and contrast
what are the two main causes of chronic pancreatitis?
alcohol
cystic fibrosis - there are an increased frequency of CFTR gene mutations in CR
what is the typical first line pharmaceutical treatment of T2DM?
metformin + SU if there are weight loss problems or osmotic problems
name 2 side effects of using thiazolidendiones in 2nd line treatment of T2DM
oedema and heart failure and weight gain but there is a low risk of hypos. SU and insulin will also result in weight gain
what effect do SGLT-2 inhibitors have on weight of a T2DM patient?
they result in weight loss and associated symptoms include Gastric ulcers and dehydration
suggest 4 pharmaceutical methods of increasing insulin release
sulphonylureas
DPP-IV inhibitors
metaglinides
incretin mimetics
biguanides, thiazolidinediones and weight reduction will all serve to improve insulin action - TF?
true
describe the difference in screening and definitive testing of microalbuminaemia
screening will do a first morning sample. there should be a normal albumin to creatinine ratio (albumin creatinine). in males it is under 2.5mg/mmol; in females it is <3.5mg/mmol.
definitive testing will do a timed over night urine collections for albumin excretion rate (AER). normally this is under 20 microg/min but in microglobulinaemia it is between20-200microg/min
what is the target BP in those with T1DM?
125/75
suggest a drug group to slow the progression of kidney disease in diabetes
ACEI
what cranial nerves are most likely to be affected by mono-neuritis?
CN III, IV and VI
what nerve results in acute foot drop caused by mononeuritis?
peroneal nerve also - causing a foot drop
suggest 2 treatments for postural hypotension
NSAIDs and fludrocortisone
suggest 2 symptoms in autonomic neuropathy
erectile dysfunction vomiting gastric stasis diarrhoea urinary retention peripheral oedema abnormal sweating
what is the other name for the lesser sac?
omental bursae
what transporter does galactose use to enter the lumen of the small intestine?
SGLUT1 - will also do glucose
what is the classical cinical presentation of diabetic peripheral neuropathy
sensory loss - glove and stocking with burning pain, paraesthesia and numbness. there may also be small muscle wasting
what is the treatment for peripheral neuropathy?
anual foot screen amiotryptilline gabapentin duloxetine capsaiasin cream
in mononeuritis caused y diabetes what nerve is responsible for causing an acute foot drop?
the peroneal nerve
erectile dysfunction is common in diabtes. suggest 2 treatment methods of this symptoms
Cialis and Viagra - phosphodiesterase inhibitors
prostaglandins
implants
implantable devices
what is the treatment of recurrent vomiting in gastric stenosis?
domperidone
will act on dopamine
what is the treatment for diarrhoea?
loperamide and codeine phosphate
a common complication of DM is microscopic retinopathy. describe 2 surgical treatments for proliferative retinopathy
vitrectomy
laser photocoagulation
describe a medical procedure which can be used in the treatment of diabetic maculopathy
tight BP control and grid laser therapy.
poor glycaemic control will increase the likelihood of cataract - TF?
true but there is a very high success rate of surgery
enteroviruses will cause gastroenteritis - TF?
false - enterviruses will cause neurotropic CNS infections
describe the difference between a brain abscess and a subdural empyema
brain abscesses are localized areas of pus within the brain
subdural empyema are thin layer of pus between the dura and the arachnoid membranes over the surface of the brain.
describe 6 clinical features of someone with empyema/abscess
fever
headache
focal signs and symptoms - seizures, dysphasia and hemiparesis
may have an have ICP - papilloedema and false localising signs
meningism - photo/phonophobia and neck stiffness with fever mainly occurs in a subdural empyema)
low GCS
what 4 investigations would you like to carry out for an abscess and subdural empyema?
MRI/CT
culture
biopsy - drainage
investigate source
what is cholestasis?
accumulation of bile in the hepatocytes or in the bile canaliculi
cholestasis is present in which of the following?
A- pre-hepatic jaundice
B - hepatic jaundice
C- post-hepatic jaundice
cholestasis is found in hepatic jaundice
name a cause of hepatic jaundice
liver cirrhosis intra-hepatic bile duct obstruction such as: 1. primary biliary cholangitis 2. primary sclerosing cholangitis 3. tumours: a. hepatocellular carcinoma b. tumours of the intra-hepatic bile ducts c. metastatic tumours
name 4 causes of cholestasis
alcoholic hepatitis
drugs such as OCP and azathioprine
viral hepatitis
liver failure
primary biliary cholangitis is an organ specific autoimmune disease. what liver function test may be elevated
ALP - alkaline phosphatase
the loss of intrahepatic bile ducts are due to granulomatous inflammation. there will also be anti-mitochondrial antibodies (AMA)
which cells in the stomach will produce the following:
a. mucous
b. pepsinogen
c. intrinsic factor
d. HCl
e. bicarbonate
a. mucous neck cells
b. chief cells
c. parietal cells
d. parietal cells
e. bicarbonate isnt produced in the stomach
what is the name of an enzyme that facilitates the following reaction:
CO2 + H2O > H2CO3
carbonic anhydrase
desacribe vitamin D deficiency in children and in adults
children - rickets
in adults - osteomalacia
renal artery autoregulation will work to adjust the resistance of vasculature depending on arterial BP. what is the range of this autoregulation?
60mmHg - 130mmHg
50% of urea filtered at the glomerulus will be reabsorbed from the tubule - TF?
True
atropine will increase the heart rate - TF?
true
atropine will treat cardiac arrest, SA block and bradycardia.it will increase the firing of the SA node.
name 4 reasons for secondary hypertension
chronic renal failure pregnancy - pre-eclampsia renal artery stenosis phaeochromocytoma cushings disease conn's syndrome sleep apnoea acromegally NSAIDs polycystic kidneys co-arctation of the aorta
if the signs/symptoms of DVT are not present, it is okay to rule out this diagnosis?
false - do imaging tests (US/doppler) and d dmimer
signs and symptoms are not always present on DVT
what is virchow’s triad a risk factor for?
thromboembolic disease (DVT and PE)
in all of the interstitial lung diseases, which is the most important to take an allergy history from?
EAA extrinsic allergic alveolitis - hypersensitivity pneumonitis.
why may the protein content of a pleural biopsy be taken?
to check if it a transudate or exudate and to help generally with the diagnosis - may be due to inflammation or tumour or may be due to RVHF etc.
if the protein is below 25-35 then lights criteria would be used. it is exudate if:
1. serum protein is greater than 0.5
serum LDH is greater than 0.6
LDH is in the top 60% of values.
what is sarcoidosis?
no one knows - it has an unknown etiology and is a multi system granulomatous disorder
just remember than sarcoidosis has granulomas.
intermittent claudication is a persistent pain that is present at rest - TF?
false. the cramp like pain will disappear after rest.
what layer of the lateral plate mesoderm are the fibrous pericardium and the parietal of the serous pericardium not derived from?
splanchnopleuric mesoderm
the anterior chamber of the eye will sit anterior to the iris - TF?
ture
zonules are attached to the ciliary body and the lens - TF?
true
which of the following are permeable to fluorescein - the dye used to investigate retinal disorders:
a. zonula occludens
b. choriocapillaries
c. retinal capillaries
85% of fluorescein is bound. 15% remains unbound. the inner retinal barrier (retinal capillaries and the outer retinal barrier (zonula occludens are impermeable to fluorescein) but choriocapillaries are permeable to free fluorescein.
organisation is the typical outcome of pneumonia. what do COP and BOOP stand for?
cryptogenic organising pneumonia
bronchiolitis obliterans organising pneumonia
name the 3 supplies of blood each horn of the sinus venosus will recieve
cardinal vein - body of embryo (lateral)
vitelline vein - yolk sac (medial vein)
umbilical vein - placenta (innermost vein)
what adverse effects will ICS (inhaled corticosteroids) have on children?
height suppression oral candidiasis adrenal corticosupression cataracts hypertension
in hypertension if the patient has subsequent pulmonary oedema, sublingual GTN should be administered - TF?
false
never give any medication sublingually in hypertension. in this scenario GTN will be given via IV or IV furosemide can be given.
IV encephalopathy is given IV labetalol or IV esmolol
CURB score of 1 should be treated with :
a. amoxicillin and clarithromycin
b. amoxicillin or clarithromycin
c. co-amoxiclav and clarithromycin
d. ethambutol and pyrazidine
b. amoxicillin or clarithromycin
CURB
0-1 = amoxicillin or doxycycline/clarithromycin
2 = amoxicillin and clarithromycin/levotrexate
3-5 = co-amoxiclav and carithromycin/levotrexate
what are the following treatments used for?
- ethambutol
- pyrazidine
and how long are they administered for?
Tuberculosis
2 months
the notochord will induce the mesoderm to thick - TF?
false
the notochord will induce ectodermal cells in the midline to form the neural tube by the thickening and dipping to form the neural plate. the neural tube will induce the mesoderm to thicken.
name a GPIIb/IIIa inhibitor
abciximab
aspirin is a COX1 inhibitor - TF?
true. COX1 will go on to form thromboxane A2
LMWH and fondaparinux are in the same family of anti-platelet drugs - TF?
false - LMWH is an anti-thrombotic
antiplatelets are drugs such as aspirin, ticagrelol, prasugrel and clopidogrel
what coagulation factors foes LMWH act on?
factor Xa
what is the treatment regime for pneumonia?
CURB will determine treatment
0-1= amoxicillin or doxycycline/clarithromycin
2= amoxicillin or clarithromycin/levofloxacin
3-5 = co-amoxiclav and clarithromycin/levofloxacin
also give
1. IV fluids
2. CPAP
3. oxygen as required
4. intubation and ventilation
what is the function of the coronary and falciform ligament?
falciform ligament will connect the liver to the anterior abdominal wall. the coronary ligament will separate the bare area of the liver from the rest of the liver.
Name the layers of the gall bladder
mucosa - rugae
muscularis
serosa
which duct will the gall bladder empty to?
cystic duct
what is the difference between primary sclerosing cholangitis and primary biliary cholangitis?
primary biliary cholangitis is an organ specific autoimmmune disease that mainly affects females. there are autoantibodies for anti-mitochondria in serum (AMA) there will be raised ALP levels and there is the presence of granulomatous inflammation affecting the bile ducts. there is loss of the intra-hepatic bile ducts and there may be the progression to cirrhosis
primary sclerosing cholangitis is chronic inflammation and fibrous obliteration of the bile ducts. intra-hepatic bile ducts are lost. it is associated with inflammatory bowel disease. there will also be the progression to cirrhosis and an increased risk of developing cholangiocarcinoma.
Name the four extrinsic muscles of the tongue
styloglossus
palatoglossus
hyoglossus
genioglossus
which of the extrinsic muscles of the tongue are not supplied by the hypoglassal nerve?
styloglossus - CN X
Name the 4 muscles of mastication
temporalis
medial and lateral pterygoid muscles
masseter muscle
which duct will pierce the masseter muscle?
the parotid duct (Stensons duct)
what nerve will innervate the muscles of mastication?
the mandibular branch of the trigeminal nerve
what are the 3 main advantages of using ERCP over MRCP?
it can be a therapeutic option
some patients may be claustrophobic
it is metal tolerant
whata re the 3 necessary ascitic fluid analysis?
- protein
- cell count
- albumin
describe 5 unhelpful tessts in ascitic fluid analysis
pH
cholesterol
fibronectin
lactase
what is wilsons disease?
excess copper
what is primary haemochromatosis?
excess iron
primary haemochromatosis and Wilson’s disease are both causes of liver cirrhosis. what are the 2 viral hepatitis’ that will cause liver cirrhosis?
HBV HCV
name 3 complications of liver cirrhosis
HCC hepatic jaundice portal hypertension liver failure cholangiocarcinoma.
liver is not a common site of metastases - TF?
false
Name 2 types of tumours in the liver
cholangiocarcinoma is a malignant tumour of the bile duct epithelium
hepatocellular carcinoma a malignant carcinoma of hepatocytes.
