other Flashcards
d. The paediatrician suspects Beckwith–Wiedemann syndrome.
This syndrome is associated with increased risk of which of the following childhood cancers?
Wilms’ tumor, a cancer of the kidney, is the most common cancer found in these children. Ninety five percent of Wilms’ tumors occur in Beckwith-Wiedemann syndrome or hemihypertrophy patients by age 7.
what is beck with-wiedemann syndrome
Beckwith-Wiedemann syndrome is a genetic disorder commonly characterized by overgrowth.
macroglossia, hepatomegaly and renomegaly as well as a characteristic ear crease
Where in the gastrointestinal tract is the majority of water absorbed?
jejunum
bladder during uriantion what nerves and then again in holding urine
During urination, the detrusor muscle is contracted via parasympathetic branches from the pelvic splanchnic nerves
The bladder receives sympathetic innervation from the superior and inferior hypogastric plexuses
normal cell lining of the bladder
The bladder is lined with transitional epithelia. This is a form of stratified epithelia which has a varying appearance based on bladder state. In an empty bladder, these cells are large and round. When these cells are stretched, due to bladder distension, they become much flatter. This property allows these cells to adequately cope with varying fluid levels. The cells also have a role in maintaining a barrier between the urine and the bloodstream
signs of bladder cancer
Haematuria in an elderly male with a smoking history is an extremely worrying sign and may be due to bladder cancer
penis drains to
deep inguinal
drainage of spleen liver and pancreas
Superior mesenteric lymph nodes
drainage to vulva or scrotum
Superficial inguinal lymph nodes
amiodarone treat
gout or aarhyias
hyper acute transplant rejection what hypesnesitivty
Hyperacute transplant rejection is a type II hypersensitivity reaction - a cytotoxic reaction that is caused by pre-existing antibodies to the ABO or HLA antigens. This causes widespread thrombosis and ischaemia/necrosis within the graft and requires surgical removal of the transplanted orga
Type I (allergic) hypersensitivity is an immediate IgE mediated hypersensitivity. This is a fast response that typically occurs in minutes. Examples include anaphylaxis.
Type III (immune complex) hypersensitivity is an IgM mediated hypersensitivity. Antibodies bind to soluble antigens, forming a circulating immune complex. This type of hypersensitivity is seen in systemic lupus erythematosus and hypersensitivity pneumonitis.
Type IV (delayed-type) hypersensitivity is a cell-mediated response that typically takes weeks to occur. This is seen in chronic graft rejections.
Type V (autoimmune) hypersensitivity is an IgG/IgM mediated reaction. The auto-antibodies bind to cell surface receptors, which either prevents the intended ligand binding with the receptor or mimics the effects of the ligand. Type V hypersensitivity is seen in Graves’ disease and myasthenia gravis.
at what range do the kidneys maintain systolic blood pressure re
between 80-100mg with little change to maintain perfusion as kidneys are sensitive to reduced perfusion
The pelvic splanchnic nerves are the parasympathetic innervation for the bladder.
Sympathetic innervation of the bladder is from the hypogastric nerve plexuses.
The sympathetic nervous system regulates the process of urine storage in the bladder. In contrast, the parasympathetic nervous system controls bladder contractions and the passage of urine
extreme anxiety, palpitations, and fear with associated sweating about twice a week for the past 6 months.
adrenaline
what in the anion gap
The anion gap may be calculated by using (sodium + potassium) - (bicarbonate + chloride)
= (142 + 4.0) - (104 + 19) = 23 mmol/L
It is useful to consider in patients with a metabolic acidosis:
Causes of a normal anion gap or hyperchloraemic metabolic acidosis
gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
renal tubular acidosis
drugs: e.g. acetazolamide
ammonium chloride injection
Addison’s disease
Causes of a raised anion gap metabolic acidosis lactate: shock, hypoxia ketones: diabetic ketoacidosis, alcohol urate: renal failure acid poisoning: salicylates, methanol 5-oxoproline: chronic paracetamol use
how does alhcol increase polyuria
Alcohol bingeing can lead to ADH suppression in the posterior pituitary gland subsequently leading to polyuria
bleeding activates
renin-angiotensin system
low blood pressure activates
renin angiotneion system
when is EPO secreted
Erythropoietin is secreted by the kidney in response to cellular hypoxia.
Progesterone to 11-deoxycorticosterone
21-hydroxylase
Hypernatraemia Rising haematocrit Metabolic acidosis Rising lactate Increased serum urea to creatinine ratio Urinary sodium <20 mmol/litre Urine osmolality approaching 1200mosmol/kg
dehydration
polycythaemia
increased Hb in blood
A 54-year-old man who has end stage diabetic nephropathy is being assessed for a renal transplant. When assessing the HLA matching between donor and recipient what is the most important HLA antigen to match?
DR
The human leucocyte antigen (HLA) system is the name given to the major histocompatibility complex (MHC) in humans. It is coded for on chromosome 6.
Some basic points on the HLA system class 1 antigens include A, B and C. Class 2 antigens include DP,DQ and DR when HLA matching for a renal transplant the relative importance of the HLA antigens are as follows DR > B > A
90% of bladder cancer are
transilitonal cell carcinoma present with persisitant heamtuia
what viruses are associated with post transplant
unwell with jaundice, fatigue and arthralgia. On examination she has jaundice, widespread lymphadenopathy and hepatomegaly
Post transplant lymphoproliferative disorder is most commonly associated with Epstein-Barr virus. It typically occurs 6 months post transplant and is associated with high dose immunosupressant therapy. Remember cytomegalovirus presents within the first 4 weeks to 6 months post transplant.
aldosterone does what
Stimulates the reabsorption of sodium from the distal tubules, with a consequant excretion of potassium
sepsis increases acute phase proteins what are they
Acute phase proteins CRP* procalcitonin ferritin fibrinogen alpha-1 antitrypsin caeruloplasmin serum amyloid A serum amyloid P component** haptoglobin complement
albumin
transferrin
transthyretin cortisol binding protein
are not
Which substance can be used to achieve the most accurate measurement of the glomerular filtration rate?
insulin
A 92-year-old female is brought into the emergency department following a fall at home. She was found by her neighbour and told the paramedics she had fallen 6 hours before but had been unable to get up due to osteoarthritis in her knees. Which blood test is it important to do in a patient who has had a long duration of time lying on the floor unable to move?
creatinine kinase
lead to hyperkalalmia
Locoregional spread of bladder cancer is best determined using
pelvic MRI
