Mixed Q’s 2 Flashcards
Duodenal atresia associations ?
Assoc with Down’s syndrome
Double bubble sign
Polyhydramnios
Bile vomiting
Oesophageal atresia is assoc with?
Polyhydramnios
Malrotation of volvulus presentation?
Asymptomatic at birth
Occurs after a few weeks
Bld in stool
Vomiting bilious material
Tender distended abdomen
Imperforate anus presentation?
Inability to pass meconium in first 24 hrs
Assoc with
cardiac abnormalities, tracheoesophageal fistulas
renal agenesis
Characteristics of anal canal above the pectinate canal?
Columnar epithelium
Superior and middles rectal arteries bld supply
Non painful haemorrhoids
Lymph drainage to internal iliac nodes
Where do haemorrhoids drain into?
Venous system
What is Li-Fraumeni syndrome?
A history of sarcoma, leukaemia, adrenal, brain and breast cancer.
2o to autosomal mutation of TP53
Cancers that cause sclerotic bone Mets ?
Osteoblastic ( sclerotic)
Prostate cancer
Small cell lung cancer
Hodgkin lymphoma
Cancers that cause lucent bone Mets?
Osteolytic (lucent)
M2N2R
Multiple myeloma
Non small cell lung cancer
Non Hodgkin lymphoma
Renal cell carcinoma
Melanoma
Cancers that cause mixed bone Mets ?
Gastrointestinal cancer
Breast cancer
BRAF is associated with ?
BRAF is a protooncogene
Mutation is assoc with
Melanoma
Non Hodgkin’s lymphoma
Papillary thyroid cancer
BRCA1 and BRAC2
Tumour suppressor gene
Mutation associated with
Breast cancer
Ovarian cancer
Pancreatic cancer
MEN1 associated protein?
Tumour suppressor
Menin
RET?
Protooncogene
Mutation associated with
MEN 2a + MEN 2b
Papillary thyroid cancer
What is RB associated protein ?
Tumour suppressor gene
associated with with HPV
Leading to
Head and neck cancer
Cervical cancer
Anal cancer
Penile cancer
What is the first step in adenoma to carcinoma sequence?
Mutation of APC tumour suppressor gene
Malignant cells metastasis pathway ?
- Down regulation of cadherin decrease cell adhesion
- Detachment from basement membrane by loosening integrin attachment
- Degradation of extracellular matrix by type IV collagenase
- Migration by upregulation non integrin Lamin receptors
- Dissemination
Hereditary nonpolyposis colon cancer?
Lynch Syndrome
MSH2 MSH1
Tumour suppressor gene
Assoc with
Colorectal cancer
Endometrial cancer
Ovarian cancer
Phosphorylation of Rb protein leads to?
Rb becomes inactive releasing the E2F transcription factor allowing cell to divide
Which zone of the liver metabolises phenytoin?
Zone 3
Annular pancreas is caused by?
Failure of pancreatic ventral bud to rotate
The pancreas and pancreatic duct are derived from?
The foregut
What is Hirschsprung’s disease?
Failure of neural crest cell migration into the intestinal wall
Hirschsprung disease presentation?
Functional bowel blockage
Neonate with chronic constipation
Tight anal sphincter and empty rectum
Rectosigmoid narrowing with proximally distended bowel loops on barium study
Failure to pass meconium, think?
Hirschsprung’s disease
Cystic fibrosis
(Imperforate anus)
What is the gold standard for diagnosis of Hirschsprung’s disease ?
Deep rectal suction biopsy —> shows lack of ganglion cells
Nerve fibre hypertrophy
What is cause of achalasia ?
Damage to ganglion cells in the myenteric plexus (Auerbach’s plexus)
Achalasia presentation?
Loss of oesophageal motility
Dysphagia for solids and liquids
Bird beak sign on barium swallow
pilocarpine
MoA: muscarinic acetylcholine agonist
Use:- glaucoma, dry mouth sjogren
SE:- Sweating
Urinary frequency
Diarrhoea
Bradycardia
Nausea
Weakness
Flushing
Hypotension
Pupillary Miosis
Pleomorphic adenoma presentation?
Benign
Painless, firm, mobile parotid swelling
Histology :- disorganised tissue containing epithelial and cartilage components
Warthin’s tumour presentation?
Aka papillary cytadenoma lymphatosum
Swelling of parotid
Fluid filled cystic spaces with epithelial cells
Assoc with smoking
Mucoepidermoid carcinoma presentation ?
Painful mass usually parotid
Invading facial nerve
Histo:- mix of squamous and epithelial cells
Congenital diaphragmatic hernia is due to a defect in the?
Pleuroperitoneal membrane
Direct inguinal hernia are medial to ?
Inferior epigastric artery
Indirect hernia is usually caused due to failure or which structure to close?
Processus vaginalis
Necrotising enterocolitis features?
GI emergency affecting newborns
Bacterial invasion and necrosis of the bowel wall in prems after initiation of enteral feeding.
Abdo XR :- curvilinear areas of lucency that parallel bowl wall lumen( pneumatosis intestinalis)
Acute diverticulitis presentation?
Pt > 60
Abdo pain
Nausea and vomiting
Change in bowel habit
Low grade fever
Leukocytosis
Tender mass in LT Lower quad
Acute diverticulitis presentation?
Pt > 60
Abdo pain
Nausea and vomiting
Change in bowel habit
Low grade fever
Leukocytosis
Tender mass in LT Lower quad
Diffuse oesophageal spasm presentation?
Periodic, simultaneous and non peristaltic contractions of the oesophagus due to impaired neural inhibition.
Dysphagia for liquids and solids
Chest pain 2o inefficient propulsion of food
Hepatitis B presentation?
Tender hepatomegaly and abnormal LFT
With a suggestive hx
Positive HBsAg
Hyperammonemia in advanced liver failure features?
Ammonia crosses blood brain barrier cause excess glutamine to accumulate in astrocytes. —->
Decreased glutamine available for conversion to glutamate in neurons
Abdominal distention
Jerky tremor
Innervation of external haemorrhoids?
Inferior rectal nerve a branch of the pudendal nerve
Which arteries would be affected by compression of splenic artery?
Short gastric artery
Primary sclerosing cholangitis features?
More common in males
Assoc with UC
Fatigue, pruritis, jaundice
Raised ALP , bilirubin
Histology :- fibrous obliteration of bile ducts and concentric periductal connective tissue deposition
Treatment with Vitamin B12 affect on retics in background on atrophic gastritis?
Retics count increases +++ and peaks at 1 week then gradually increases
Unconjugated excess bilirubin affect on newborn?
Deposits in basal gangilia and brain stem nuclei
Can cause irreversible neurologic damage
Chorea, dystonia
Upward gaze palsy and hearing
Pathologic features of Chronic bronchitis?
Thickened bronchial walls
Lymphocytic infiltration
Mucous gland enlargement
Patchy squamous metaplasia of bronchial mucosa
Hx of smoking
Phaechormocytoma is derived from?
Chromaffin cells of adrenal medulla
Originate from neural crest cells which also gives rise to melanocytes and neural ganglia
Cardiorespiratory response to exercise?
Incr HR
Inc C.O
Inc RR
N PaO2
N PCo2
An outlier would affect which measures ?
Mean
Median
Std deviation
Variance
It does NOT affect mode
What is mode?
The most frequently observed data point
Pyruvate dehydrogenase deficiency presentation?
Unable to convert pyruvate to acetyl-CoA
Causing lactic acidosis and neurologic defects
Failure to thrive, hypotonia
High levels of what substance in pyruvate dehydrogenase will lead to increase energy without inc in lactic acid?
Ketogenic amino acids Lysine, leucine
Mgx for chest wall pain to parietal pleura and ribs?
Intercostal nerve block
Ileal resection complications?
Gall stones 2o to loss of bile salt absorption
Fat malabsorption
Loss of vit B12 absorption
Loss of fluid absorption
Function of the HIV polyproteins?
Gp160, gp120
Glycosylated in RER and cleaved in Golgi apparatus
Function is to help virion attach to target cell
Rett syndrome features ?
More common in girls
Onset 6-18/12
Initial N development
Regression of speech
Loss of purposeful movement
Development of stereotypical movements (e.g. clapping)
Gait abnormalities
Cause —> arrested brain development
Single gene sequencing used when?
Initial genetic test for an unknown mutation on a single gene (e.g Li Fraumeni)
What facilitate phagocytosis?
IgG and C3B
Criggler- Najjar features?
Absence of UDPglucoronyltransferase
High >20 unconjugated bilirubin
Appears in first days of life
Can lead to kerniterus
LFT normal
Gilbert’s syndrome features?
Increased unconjugated bilirubin
Most asymptomatic
Can develop jaundice after illness, heavy exertion, stress, menses
Dubin Johnson syndrome features?
AR
Presents shortly after birth
Or after taking OCP, or pregnancy
Increased conjugated bilirubin
N LFTs
+/- hepatomegaly
Black discoloration of liver
Alcoholic Hepatitis features?
AST:ALT > 2
AST >= 500 -1000
GGT increased 8-10x normal
Asymptomatic
Jaundice
Hepatomegaly
Rotor’s syndrome features?
Benign condition
Conjugated hyperbilirubinaemia
N LFTs
In kernicterus bilirubin deposits where?
Basal ganglia and brain stem nuclei
Administration of omeprazole affect on gastric secretion, gastric acid secretion and parietal cell carbonic anhydrase activity?
Decreased gastric acid secretion
Inc gastrin secretion
Decreased parietal cell CA activity
How does ranitidine work?
H2 antagonist reduces acid secretion by blocking histamine activity leading to fall in intracellular cAMP
Zollinger Ellison syndrome features?
Due to gastrin producing tumour in pancreas or duodenum.
Stimulating the increase of gastric acid production
Leading to peptic ulcers
Wt loss
Abdo pain
Cause of pruritis in cholestasis?
Deposition of cholic and chenodeoxycholic
Function of pancreatic amylase?
To cleave starch into smaller polysaccharides
Initiating event of acute pancreatitis ?
Autodigestion due to activated trypsin
Released after a meal and correlated with increase HCO3?
Secretin
Which pancreatic enzyme catalyses the breakdown of a lipid rich meal?
Pancreatic lipase
Function of type II pneumocyte?
Regeneration of alveolar lining following injury
Surfactant production
‘What is transference?
Unconscious recreation of patterns from past relationships in the present relationship
Impairment of ubiquitin-proteasome system leads to ?
Accumulation of misfolded proteins can lead to Parkinson’s
What is power 1-B?
The probability of rejecting a null hypothesis when it is truly false
Nitroglycerin effect on cardiac output, contractility and venous return?
Is a venodilator —> will cause pooling of bld in veins and decreased venous return.
Does not affect contractility
CO reduced because of reduced Venous return
What is the most highly oxygenated blood vessel in fetal circulation?
Umbilical vein which empties directly into IVC
Wiskott-Aldrich syndrome presentation?
X linked
Recurrent infections that worsen with age
Easy bleeding
Eczema
Combined B Andy cell deficiency
Thrombocytopenia at birth
Endoscopic findings in achalasia?
Hypertrophy and thickening of circular muscle lawyer near lower oesphageal sphincter
Schatzki ring presentation ?
Complete obstruction of the oesophagus by a food bolus
Found in distal oesophagus
Adenocarcinoma assoc risk factors ?
Obesity
HSV1 oepshagitis features?
Dysphagia
Chest pain
Punched out ulcers on endoscopy
Scleroderma oeshageal features are due to ?
Oesphageal Smooth muscle atrophy leading to reduced tone of lower oesphageal sphincter
INR, factor VIII, and albumin levels in hepatic cirrhosis ?
No change factor VIII ( produced elsewhere as well)
Increased INR
Low Albumin
Aetiologies assoc with Budd-Chari syndrome?
HCC
Polycythaemia Vera
Postpartum state
Hypercoagulable states
Budd Chiari affects with zone in the liver?
Zone III ( centrilobular )
Acute alcoholic hepatitis features?
Hepatitis in the setting of acute binge drinking in pt with hx fo alcoholism
RUQ pain
Fever
Jaundice
Presence of Mallory bodies —> intermediate filaments in hepatocytes
Cause of liver abscess in US?
G -ve rods like E.coli, Klebsiella prnuemoiae
Antibodies seen in autoimmune hepatitis ?
ANA (sensitive)
Anti-smooth muscle antibodies (specific)
Antibodies seen in autoimmune hepatitis ?
ANA (sensitive)
Anti-smooth muscle antibodies (specific)
Hepatic angiosarcoma histology findings?
Atypical endothelial cells forming disorganised vascular structures
Infant botulinum toxin features?
Infants given honey
Constipation
Mild weakness
Lethargy
Poor feeding
Flaccid paralysis
Diagnostic : - C.Botulinum spores or toxin in stools
Which sugar substance has the fastest rate of metabolism in the glycolysis pathway
Fructose
It avoids the rate limiting enzyme phosphofructokinase
Alcoholic hepatitis features?
Fever
RUQ pain
Jaundice
AST:ALT >2:1 ( but below 500)
Histo:- intrahepatic neutrophil infiltration, hepatocellular ballooning, Mallory bodies
Dumping syndrome features?
Abdo pain
Cramps
Diarrhoea
Nausea
Diaphoresis
Palpitations
Flushing
Hypotension
Tachycardia
Microscopic polyangitis features ?
Fatigue
Muscle pain
Unintentional wt loss
Palpable purpura /necrotizing vasculitis
Dark brown stool
Inc creatinine
No granuloma
What changes are seen in cardiac loop with AV fistula ?
Blood bypasses high resistance
Decreased after load
Increased preload
Increased S.V
Contractility unchanged
Disulfide bridges and triple helix assembly are ?
Properties of collagen synthesis
Causes of AR?
Bicuspid aortic valve
Endocarditis
Aortic root dilatation
Rheumatic fever
Before starting amiodarone check?
TFT
LFT
CXR
PFT
Where is the AV node found?
Rt atrium
Intra atrial septum near opening of the coronary sinus
What’s Beck’s triad?
Pathognomic for Cardiac tamponade?
Hypotension
Raised JVP
Distant/muffled heart sounds
Other features: electrical alternans (QRS height alters every other beat) and pulsus alternans
Phenylcyclidine SE?
‘Angel dust’
NMDA receptor antagonist
SE:- hallucinations
Violent behaviour
Loss of co-ordination
Nystagmus
Memory loss
Neiserria meningitidis virulence factor?
Lipo-oligosaccharide membrane
Leukocyte adhesion deficiency features?
AR
Absent integrin CD18
Recurrent bacterial infection
Delayed purulence
Late separation of placenta
Leukocytosis
Neutrophilia
Wiskott Aldrich syndrome features?
X linked
Eczema
Thrombocytopenia
Immunodeficiency
Defect in isoskeleton
Early onset lower lobe emphysema think?
Alpha 1 antitrypsin
West Nile Virus/Fever features?
Transmission via bird/mosquito
Flu like illness
Meningitis (neck stiffness, headache, fever)
Encephalitis (confusion, tremor, seizures)
Flaccid asymmetrical paralysis
CSF:- lymphocytes pleocytosis
Mgx:- supportive
Effect of increasing cardiac contractility?
Increase HR
Increase LVESV
‘Heart is squeezing faster and more bld’
Levels of RBF, ADH and total body Na+ in ascites?
Decreased renal blood flow
Increased ADH
Increase total body Na+
Gastric varices are due to congestion of which vessels?
Short gastric vein in greater curvature drain into the splenic vein which drains into the portal vein
Spironolactone possible ecg changes?
Spironocaltone is K sparing. Use can be associated with hyperkalaemia
ECG changes long QRS
Absent p wave
Peaked T wave
Lactulose changes in stool ?
Increase excretion of ammonia
Increase concentration of fatty acid, H ion in stool
Increased K and Mg in stool
Primary driving force of ascites ?
Increased capillary hydrostatic pressure 2o portal hypertension
Causes of acute pancreatitis ?
Gallstones
Chronic alcoholism
Hypertriglyceridaemia >1000mg/dl
How does hep B cause liver injury?
Viral HBsAG and HBcAG stimulate the host’s cytotoxic CD8+ T cells to destroy infected hepatocytes
Histo pathology of oesophageal sq cell carcinoma?
Solid nests of sq epithelial cells with intercellular bridges forming keratin pearls
Eosinophilic cytoplasm
Pancreatic cancer risk factors?
Smoking
Advanced age
Chronic pancreatitis
Genetics
Enteropeptidase in duodenal brush border activates?
Trypsin from trypsinogen
Enteropeptidase deficiency presents with impaired fat and protein absorption, Diarrhoea, failure to thrive and hypoproteinaemia
High levels of oestrogen in cirrhosis can cause ?
Gynaecomastia
Spider angiomata
Palmar erythema
Testicular atrophy
True positive equation?
TP= sensitivity x number of patients with the disease
False negative equations?
FN=(1-sensitivity) x (number of pts with the disease)
What forms the resting membrane potential of the cell?
High potassium conductance and some sodium conductance
Acalculous cholecystitis features?
Acute cholecystitis due to biliary sludge
Seen in critically ill pts
Differentiating feature between ascending cholangitis due to G-ve bacteria and helminth?
G-ve bacteria —> neutrophilia predominant
Helminth —> eosinophilia predominant
Porcelain gallbladder is due to which bacteria?
Salmonella typhi
Choledocholithiasis bld findings?
Stone blocking common bile duct
Increased ALP > AST/ALT
increased GGT
Increased direct bilirubin
Normal INR
Gallstone ileus triad?
Radio graphic appearance of pneumonia - pneumobilia
Small bowel obstruction
Ectopic Gallstone
Primary sclerosing cholangitis features?
Asymptomatic
Assoc with UC
Fatigue
Pruritis
Jaundice
Dark urine
Imaging dilatations and strictures of biliary tree
Inc ALP
+PANCA
1o biliary cirrhosis findings on liver biopsy?
Dense lymphocytic infiltration with Granulomatous inflammation
Ulcerative colitis classic finding on X-ray?
‘Lead pipe’ appearance —> smooth walls of rectosigmoid
Antibodies associated with 1o biliary cirrhosis?
Anti mitochondrial antibodies
Biliary atresia is associated with which finding?
Abnormal or absent gallbladder
Cells responsible for repithelisation after wound?
Keratinocytes
Continue to migrate and proliferate until they make contact with other cells
Congenital heart defects commonly associated with maternal DM?
Transposition of the great vessels
VSD
Coarctation of the Aorta
ASD
PDA
‘ABC tune C,A,P,T VSD’
Potter’s syndrome presentation?
Bilateral renal agenesis
Oligohydramnios
Pulmonary hypoplasia
Limb deformities
Flat facies
What are mRNA vaccines?
Encoded foreign protein engulfed by APC and expressed —> adaptive immunity
Pulsus paradoxes seen in ?
Constrictive pericarditis
Croup
COPD
Obstructive sleep apnoea
Asthma
Tamponade
Kussumal sign seen in ?
(Increased JVP with inspiration)
Cardiac tamponade
Constrictive pericarditis
Restrictive cardiomyopathy
RV MI
Colchicine is used in the treatment of?
Gout
Pericarditis
Familial Mediterranean Fever
G-ve cocci in pairs ?
Moraxella
Epigastric pain that decreases with food ?
Duodenal ulcer
Autoimmune gastritis affects which part of the stomach?
Gastric fundus causing inflammation
Duodenal ulcer histology shows?
Submucosal gland (Brunner’s gland) hypertrophy
H Pylori features
G-ve bacilli
Triple positive
+ve catalase, +ve oxidase, + urease
Uses flagella for motility
Lactose fermenting G-ve rods include?
E.Coli
Enterobacter
Klebsiella
Cirtobacter
Serratia
Posterior duodenal ulcers are at risk of causing bleeding from which artery?
Gastroduodenal artery a branch of the common hepatic artery
Risk factors for gastric adenocarcinoma ?
H Pylori infection
Smoking
Obesity
Consumption of NDMA (nitrosmaine)
Abnormal D-xylose test suggests?
Whipple’s disease
Small intestine bacterial overgrowth
Pathologic hallmark of whipple’s diease?
Foamy macrophages in the laminate propria
PAS +ve
Whipple’s disease presentation?
Diarrhoea
Abdominal pain
Wt loss
Migratory joint pain
Tropical spruce is associated with which finding in bld?
High MCV 2o folate deficiency
Antibody testing for Coeliac disease?
IgA anti-tissue transglutaminase
IgG anti-tTG used only in IgA deficiency
Pancreatic pseudocyst features ?
Occurs around 4/52
Failure to improve
Failure of amylase/ lipase to normalise
Abdo pain persists/ recurs
Diagnosis of acute pancreatitis requires?
2 of 3
Epigastric pain
High amylase/lipase 3x normal
CT findings consistent with acute pancreatitis
GLP-1 agonist mechanism ?
Stimulate release of insulin via incretin pathway
Acute pancreatitis 2o hypertryglyceridaemia may involve?
Increased chylomicrons
Turns bld thick milky white
Factors that indicate poor prognosis in acute pancreatitis ?
Age >55
WBC >16,00
Glucose >200
LDH>350
AST >250
Low calcium
Low duodenal pH
Chronci pancreatitis can lead to?
Fat malabsorption
DM
Osmotic laxative used for treatment of hyperkalemia?
Sodium polystyrene sulfonate
Antacid SE constipation?
Aluminum hydroxide
In Carcinoid tumour deficiency in tryptophan leads to what presentation?
Tryptophan deficiency —> niacin (B3) deficiency —> pellagra
In Carcinoid tumour deficiency in tryptophan leads to what presentation?
Tryptophan deficiency —> niacin (B3) deficiency —> pellagra
Pellagra presentation?
Deficiency of niacin (B3)
3 D’s
Diarrhoea
Dermatitis
Dementia
Carcinoid syndrome cardiac complication?
Rt sided valvular lesion
Hirschsprung’s diease diagnostic test?
Rectal suction biopsy
Commonest cause of mechanical small bowel obstruction in adults ?
Adhesions ( fibrous scar tissue)
Commonest cause of ileus in adults?
Recent abdominal surgery
Medication (opioids)
Ulcerative colitis extra-intestinal associations?
Pyoderma gangrenosum
1o sclerosing cholangitis
Ankylosing spondylitis
Uveitis
Ulcerative colitis extra-intestinal manifestations?
Pyoderma gangrenosum
1o sclerosing cholangitis
Ankylosing spondylitis
Uveitis
Ulcerative colitis common colon finding?
Pseudopolyps
Toxic mega colon is associated with?
Ulcerative colitis
Which cell medicate response assoc with which IBD?
Ulcerative ColitisTh2 (no granuloma)
Crohn’d disease Th1 ( Granulomatous disease)
Which treatment for ulcerative colitis can cause oligospermia?
Sulfasalazine
Lynch syndrome is caused by which genetic defect?
DNA mismatch repair gene defect leading to instability of micro satellite DNA
What is Gardner’s syndrome?
AD
2o defect in APC gene on ch 5
Adnenomatous polyposis (hundreds)
Soft tissue tumours
(osteoma in mandible, epidermis cysts, congenial hypertrophy of retinal pigment epithelium)
100% chance of developing colorectal cancer by age 50
Juvenile polyposis syndrome presentation?
Multiple polyps >10
Benign hamartomas
Usually pedunculated
Usually in rectum
Painless rectal bleeding
Increased risk of Ca
Peutz-Jeghers syndrome presentation?
AD
Hamartomatous polyps GI tract
Mucosal hyperpigmentation
Increased risk of Ca
Common sites of Mets for colon Ca?
Liver via haematogenous spread
Lung via haematogenous spread
LN via lymphatic spread
Peritoneum via seeding
Low pulse pressure is seen in ?
Volume depletion
Haemorrhage
Heart failure
High pulse pressure is seen in ?
Exercise
Inotropic drugs
(Increase C.O)
What happens to Coronary blood flow in tachycardia?
Decreases
(Coronary bld flow occurs in early diastole)
Angiogenesis in a tumour is driven by?
FGF
VGEF
What moves venous return curve to the RT
(I.e inc venous return)
Increase volume
Decrease TPR
Increase venous tone (pushing more bld)
SNS stimulation
Exercise
What moves venous return curve to the LT?
Decrease volume/haemorrhage
Decrease venous tone (bld pooling in veins)
Increase TPR
What moves Starling curve to the RT
(Decrease contractility)
Ca Channel blockers
B blockers
Heart failure
Narcotic overdose
Increase resistance / vasopressors
What moves Starling curve to the LT?
(Increase contractility)
Exercise
Stress
Dopamine
Dobutamine
Epinephrine/norepinephrine
Digoxin
Vasodilators
What is the equation for mean arterial pressure?
DBP +1/3 (SBP-DBP)
Pulse pressure equation?
PP= SBP-DBP
Persistent splitting of S2 is found in ?
RBBB
Pulmonary HTN
(Split widens with inspiration)
Loud P2 is seen in ?
Pulmonary HTN
6 P’s of acute limb ischaemia?
Paraesthesia
Pain
Pallor
Paralysis
Poikilothermia
Pulselessness
MCA stroke can be caused by what pathology in the heart?
In AF —> LT atrial appendage thrombus
In Sinus—> Lt ventricular thrombus
Changes in muscle cell in endurance training vs resistance training?
Endurance training:——-> non change in # of myocyte, increase in protein actin/myelin, increase in # of mitochondria
Resistance training ——> no change in # of myocyte, increase in protein actin/myelin, no change in # of mitochondria
T wave inversion seen in ?
Subendocardial ischaemia
Raised ICP
BB Block
Resolving pericarditis
Ventricular hypertrophy
No human subjects used in trial ?
Preclinical study
Small amount of healthy subjects used. Testing for safety, pharmacokinetics and pharmacodynamics?
Phase I
Phase II clinical study ?
Testing efficacy in small # of diseased pts
Phase III clinical study?
Testing safety and effectiveness compared to placebo
Phase IV clinical study?
Studies adverse affect overtime in the market
Concentration of Na and K across the proximal tubule?
No change
Concentration of creatinine and urea along the proximal tubule?
Increases
Concentration of bicarbonate, glucose and amino acids along the proximal tubule?
Decrease
Parathyroid hormone affect on Ca and Po4?
Increases Ca levels
Increases renal Po4 excretion
Effect of panic attack on cerebral bld flow?
Hyperventilation —> hypercapnia
Result is reduced cbf leading to symptoms seen with panic attacks
