Pass MED difficult Flashcards
Where does Ivabradine act on the heart?
Acts on the funny current (If) ion in the SA node.
Anti anginal drug
Used in heart failure to reduce the heart rate.
What effect can cortixosteroids have on diabetes
Use of corticosteroids can worsen diabetic contorl due to their anti insulin effects
WHta is the point of attachment of the thyroglossa duct to the tongu
Foramen cecum (remant of thyrodi diverticulum lying at base of tonue during embryonic development)
WHy does the lung not reinflate with a pneumothorax
Increase in intrapleural pressure
What layers of the aoerta are affected in an aortic dissection
Taer in tunica intima - blood pools between intima and media,
WHta usually sitmulates platelet production
Thrombopoetin
What antibiotics ar strongly linked to C.Difficle
Cephalosporins
Where is cortisol predominately produced by
Zona fasiculata of adrenal
Mechanism pernicious anaemia
Autoimmuen disease, female predominace. Leads to impaired absorption B12 due to lack of intrinsic factor
What does Giardia Lmablia causes
Fat malabsroption, so greasy stool can occur and reisstance to chlorination, hence why it can trasnfer in swimming pools
WHat is Atomoextine
NA reuptake inhibitor
Pulmonary embolism signs on ECG
- Sinus tachycardia
- Signs right heart strain
- T wave inversion in anterior leads
- S1Q3T3
Sideroblatic anaemia on bloods
- Hypochromic microcytic anaemia
- Hihg ferritin ion ans transferring saturation
What is th eprimary ketone body involved in DKA
Acetoacetate
what is the pathophysioogy of DKA
Uncontrolled lipolysis which results in excess of FFA that are ultimately conerted to ketone bodies.
Young perosn with syncope and chets symptos and storng family hsitory shoud raise suspicioun for…
Asymmetric septal hypertrophy. Genetic defect is in the beta myoinsin hevay chain
What is the inheritance of lynch syndrome and what does it lead to
Autosomal dominant fashion with micrsatellite instability in DNA mismatch repair genes. 80% affecte d individuals will get colonic/and or endometrial cancer
Differntiating between small and large bowel obstruction
SMall bowel obstruction - vomitign is ealrier on, before constipation. Large bowel obstruction is more likely de to the longer hsitory of constipaiton and a later onset of vomiting.
3 phases of gastric acid secretion
- cephalic phase (smell/taste of food) - 30% acid producted, vagal cholinergic stimualtion causing secretion HCL and gastrin release from G cells
- Gastric phase (distention stomach) - 60% acid produced, atomach distention/low H+/peptides causes gastrin release
- intestinal phase (food in duodenum) - 10% acid prduced, high acididty/distention/hypertonic solutions in duodenum inhibits agstric acid secretion via enterogastrones (CCK, secretin) and neural reflexes
What is an atrial myxoma
Most common primary cardiac tumour, most occur in left atrium. You get systemic fetures likes syncope, fatigue, weight loss, pyrexi aunknown origin, clubbing. Get emboli, Atrial fibrillation, mid-diastolic murmur
When foreign bodies are lodged in the piriform recess- what nerves is most likley damaged
intenal laryngeal nerve.
What conversion is essential in steroid producing tissue
Conversion of cholesterol to pregnenolone as pregnenolone is a precursor for all steroid hormones and its formaiton represents the rate limiting step of steroid synthesis.
What happens in hemolytic crisis with patients with sickle cell disease
Haemoglobin drops and haptoglobin binds to this so haptoglobin reduces too
in ascites - what gradient indicated portal hypertension
high Serum ascites albumin gradient (>11g/L) indicate dportal hypertension. This is becaise increas ein hydrostatic pressure in portal system so water pushed into peritoneal cavity while leaving proteins behind.
Dipryidamole - MOA
Non specific phosphodiesterase inhibitor and decreases cellular uptake of adenosine. Anti-platelet med alongside aspiri following ischaemic stroke or TIA
WHta is Kallmann syndrome
Combo of hypogonadotrophic hypogonadism and anosmia, occuring due to neuron migration failure. SO lacks secondayr sexual characteristics. Genetic disorder form deficiency GnRH.
Firts sign of male puberty
Testicular grwoth
Omeprazole MOA
Gastric parietal cell H+/K_-ATPase inhibition
Where can a kidney infeciton spread
Retropertionesl so another structure within that space like psoas muscle.
Where does the porral vein begin
Tanspyloric plane
Commonets cause of addisons disease in UK
Autoimmunity (antoibodies targeting 21=hydroxylase)
What causes right shift of the oxygen diasociation curve
CADET FACE RIGHT
- CO2
- Acidosis
- 2,3-DPG
- Exercise
- Temp
Describe the features on bloods of sideroblastic anaemia
- Hypochromic microcytic anaemia
- Hight ferritin iron and transferrin saturation
- Can be inherited or caused by alcohol, lead posoning, vitamin B6 def, myelodysplastic ysndromes o rvariety of drugs. Standard TB treatment includes isoniazid which is causative agent of sideroblastci anaemia.
- (Uroin ddef has low ferritin)
What are the main causes of haematuria
- Trauma - Injury to renal tract, ureter or bladder
- Infection - TB
- Mlaignancy - renal cell carcinoma, urothelial malginancies, squamous cell carcinoma, prostate cancer, penile cancer
- Renal disease - glomerulonephritis
- Stones- microscopic haematuria common
- Structural abnormlaities - BPH, cyctisc renal lesions, vascular malformations, renal veint hrombosis
- Goagulopathy - cause sbleeding of underlyign lesions
- Drugs
- Beign - exercise
- Gynae - endometriosis
- Iatrogenic - catheter
- Psedohaematuria
how do you relieve chest pain in pericarditis
Sitting/leanign forward
What is COurvoisier’s sign?
A palpable gallbladder in the presence of painless jaundice. Unlikely to be gallstones, so more likely a malignancy, Most common are cholangiocarcinoma (bile duct cancer) and adenocarcinom of the pancreatic head.
WHta is acromegaly and the the treatment
- ACromegaly is a caused by excessive growth hormone Somatostatin directly inhibits the release of growth hormone, and hence somatostatin analoigues ar eused to treat acromegaly like octreotide.
- Trans-spenoidal surgery is the first line treatment for acromegaly in most patients. Then if inoperable or unsuccessful then medications: somatostain anlogue, pegvisomant, dopamine agonists.
- Common complicaitons of acromegaly are carpal tunel syndrome an dsleep apnoea.
What is the most commo site of duodenal ulcers that can cause bleeding
Gastroduodenal artery. Pain relieved by food in duodenal ulcer
What are the major drivers of growth in infancy, childhood, puberty
- Infancy (birth-2years) = nutrition + insulun
- Childhood (3-11) = growht hormone ans thryoine
- Puberty (12-18) = growth hormone + sex steroid
During preganncy what pattern of ABGs would you expect (normal for pregnancy)
COmpensated respiratory alkalosis: increased tidal vol means decreased CO2 and hence alkalosis. EVentually the kidneys adapt by reducing bicaebonate in body.
0-24hour postMI histology findings
- Early coagualtive necrosis, neutrophils, wavy fibres, hypercontraction of myofibriils.
- High risk of ventricular arrhythmia, HF and cardiogenic shock.
(Granulationt issue and macrophages - 3-14days after and eventually then scar tissue).
What are the branches of the vagus nerve in the neck?
Superior and ifnerior cervical cardiac branches
Right recurrent laryngeal nerve - hence if vagus damaged,t hen hoarse voice
Branches of the subclavian artery
VIT C &D
- Vertebral artery
- Internal throacic
- Thyrocervixal trunk
- Costocervical trunk
- Dorsal scapular
Descriebt he 4 phases fo the cardiac action potential
- Phase 0 = rapid depolarisation - rapid soidum influx
- 1 = Early repolarisation = K+ efflux
- 2 = plaeau = slow influx of calcium
- 3 = Final repolarisation = efflux of potassium
- 4 = Restoration of ionic concentration = Resting potential restored by Na+/K+/ATPase
What are the 8 branches of the external carotdi artery
- 3 from anteriro surface = thyroid, lingual, facial
- Medial branch = pharyngeal artery
- Posterior branches = Posterior aurociular and occipital
What is Bucks fascia?
Layer of deep fascia that covers the penis in its continuous with the external sermatic fascia and penile suspensesory lgiament. The psongiose part of urethra is contained wholly in Bucks fasvi.
WHat nerve is at risk of damage if thre is a foregin body lodged in the piriform recess?
Internal laryngeal nerve - supplues sensory innervate to piriform recess.
What is polycythaemia and what can cause it?
- High concentration of RBCs in blood so blooc thicker
- Dehydration, stress. Also secondayr causes liek COPD, altitude, obstructive sleep apnea. Pirmayr causes tlike polycythaemia rubra vera.
What is BNP and how is it used in bloods?
BNP released by ventricles of heart in response to excessive stretchign of cardiomyocytes.
What nerves are responsible for theafferent an efferent limb of the corneal pathway
- Opthalmic branch of trigeminal nerve acts as afferent limb in corneal reflex
- The facial nerve acts as the efferent limb
Mcburneys point
2/3 of the way alogn an imaginary line that runs from the umbilicus to the ASIS.
What nerve is responsible for pincer grip
Anterior interosseous nerve
What causes an oxygen dissociation cruve to shift to elft vs right
- Shfits to left = Hbf, low pCO2, Low temp, Low 2,3,DPG, low alklai… (Lower o2 delivery)
- Shifts to right = raised H+ (acidic), raised pCO2, aised 2,3-DPG, Raised temp
What antibiotics are storngly linked to clostirdium difficile
Cephalosporines - eg, ceftriaxone, clindamycin
What will you find on CT for Alzheimers disease
Widespread cerebral atrophy mainly involving cortex and hippocampus
WHat allows CSF to flow from fourth ventricle into cisternal magna
Median aperture (foramen of Magendie)
What amino acid is catecholamine hormones deirved from
Tyrosine
Posterior cord of brachial olexus - what nerves
STAR
- Subscapular (upper na dlower)
- Thoracodorsa
- Axillary
- Radial
WHta is th emechanism o pernicious anaemia
Impaired absorption of B12 due to lack of intrinsic factor
What is anterior uveitis
- Inflammaiton of the anterior portion of the uvea - iris and ciliary body
- Important differential of a red eye
- Associated with hLA-B27
- Acute onsent, ocular discomfort an dpain, pupil may be small, photphobia, blurred vision, red eye, lcrimaion
How does sideroblastic anaemia present on bloods
Hypchromic microcytic anaemi a
high rettin iron and transferring saturation
Basophilic stippling of RBC
Empty sella syndrome
Regression of the pituitary gland causing headaches, hypertension and rhinorrhoea.
What nerves is responsible for taste of posteriro 1/3 of tongue
Glosospharyngeal
Taste of anteiror 2/3 tongue
Facial nerve
What innervates muscle of tongue
Hyperkalaemia on an ECG
Tall tented T waves and Flattened P waves
Hypokalaemia on ECG
T wave depression
Tall P waves
U waves
What do you see on ECG for wolfe- parkinson - white?
Delta waves
