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first year med > r u not ambarRazzed > Flashcards

r u not ambarRazzed Flashcards

1
Q

hereditary cancer in caecal area

A

Lynch syndrome (HNPCC)

mutation of mismatch repair genes
associated with endometrial cancer

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2
Q

cardiac abnormality associated with Friedreichs ataxia

A

HOCM

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3
Q

effect of endothelin of blood vessels

A

vasocnstrictor

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4
Q

starlings law

A

as preload progressively increases, SV increases gradually then decreases suddenly

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5
Q

KRAS

A

pancreatic cancer

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6
Q

effect of secretin on gastric acid

A

decreases gastric acid secretion

–> released by duodenum

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7
Q

investigation for common side effects of aminosalicylates

A

FBC

_> have a variety of haemological side effects

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8
Q

drugs that open/close ductus arteriosus

A

prostaglandin E1 - keeps open

indomethacin - closes (inhibits prostaglandins)

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9
Q

artery for CABG

A

internal mammary artery

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10
Q

use, MoA + SE of cholestyramine

A

medication to reduce LDL cholesterol

reduces absorption of fat soluble vitamins (ADEK)

SE = vit D deficiency = clotting abnormalities - bruises, bleeds

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11
Q

other histological change in barretts as well as columnar

A

goblet cells

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12
Q

largely elevated lipase + normal amylase

A

chronic pancreatitis

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13
Q

effect of increase stroke volume on pulse pressure

A

increase pulse pressure

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14
Q

effect of raised BNP on preload + afterload

A

decreases both

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15
Q

corkscrew vessels

A

corkscrew vessels of vasa vasorum - in tunica adventitia

–> buergers disease

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16
Q

CA19-9

A

pancreatic cancer

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17
Q

biggest risk factor of development of intestinal diverticula

A

low fibre diet - lack of fruit + veg

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18
Q

“egg on side” looking heart on CXR

A

transposition of great arteries

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19
Q

dresslers

A

AUTO-IMMUNE MEDIATED

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20
Q

coincides with S4

A

p wave

active LV filling

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21
Q

factors increasing gastric acid production

A

vagal nerve stimulation
gastrin release
histamine release - indirectly following gastrin release

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22
Q

factors decrease gastric acid production

A

somatostatin - inhibits histamine release
cholecystokinin
secretin

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23
Q

A 66-year-old man attended hospital to have pre-operative blood tests and an ECG prior to a knee replacement. He suffers from asthma which is well controlled with his inhalers. An ECG shows atrial fibrillation

most appropriate medication to start on?

A

verapamil

ASTHMATIC - beta blocker contraindicated

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24
Q

What is secreted by damaged blood vessel endothelial cells to initiate haemostasis?

A

Von Willebrand factor

activates platelet plug formation

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25
Q

MoA clopidogrel

A

irreversibly inhibits ADP-dependent platelet activation

aspirin = same but COX-mediated

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26
Q

inhaler technique

A

shake
deliver while taking slow breath in
hold for 10 secs
wait 30 before next dose

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27
Q

effect of high compliance (lungs)

A

lower pressures needed to inflate lungs
leading to decrease elastic recoil + less efficient air expulsion
gas-trapping

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28
Q

effect of low compliance (lungs)

A

lungs more difficult to inflate
increased elasticrecoil

lungs TOO GOOD at expelling air

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29
Q

central vs peripheral chemoreceptors

A

central

  • located medulla oblongata
  • relatively insensitive to hypoxia - less sensitive to acidity due to blood-brain barrier
  • stimulated by arterial CO2

peripheral

  • located in carotid
  • faster to equilibrate
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30
Q

phrenic nerves position relative to hilum of lung

A

both lie anterior to hilum of lung

both motor + sensory function - diaphragmatic pain referred to shoulder

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31
Q

latent TB Ix

A

1st line = mantoux test (skin test)

2nd line = IGRA (interferon-gamma release assays)

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32
Q

vitamin involved in collagen

A

vit C

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33
Q

vit deficiency with long term metformin

A

vit b12

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34
Q

which complex does not pump protons as electrons pass through the respiratory chain

A

complex II

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35
Q

effect of doubling dose of IV infusion on plasma conc

A

doubles its plasma conc

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36
Q

is an abnormal karotype a characteristic of malignancy

A

no

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37
Q

where does the anal canal drain its venous blood to

A

directly into systemic venous system

38
Q

where is ilium? common use?

A

hip - part of appendicular skeleton

commonly used for obtaining bone marrow aspirates in adult

39
Q

main source of energy in absorptive state

A

glucose

40
Q

peritoneal structure attached to greater curvature of stomach

A

greater omentum

41
Q

circularly arranged muscle in form of anatomical sphincter under somatic control

A

anus

42
Q

where can pelvic splanchic nerves be found

A

mesentry of sigmoid colon

43
Q

if u out ur finger through gastroomental (gastroepiploic) foramen what space would it be in?

A

lesser sac

44
Q

contains circularly + longitudinally arranged muscle which are stimulated to contract by pelvic splanchic nerves (S2, 3, 4)

A

sigmoid colon

45
Q

retroperitoneal structure under control of postganglionic fibres from celiac plexus

A

3rd part of duodenum

46
Q

difficulty swallowing with history of GORD

A

stricture / carcinoma

balloon dilatation + PPI - biggest complication = oesophageal perforation

47
Q

how would you differentiate a pericardial effusion to other complications of pericarditis?

A

no raised JVP
normal pulmonary vasculature

bloody effusion - probs malignant

48
Q

pericarditis treatment

A

NSAIDs or aspirin for 1-2weeks (gastric protections maybe)

add colchicine for 3 months to reduce recurrence (recurs in 15-30%)

viral = most common cause

49
Q

most common cause of aortic stenosis in young

A

bicuspid aortic valve

50
Q

aortic stenosis treatment

A

valve replacement

TAVI if unfit

51
Q

complication of anteroseptal MI

A

ventricular septal defect

-> shock + new systolic murmur, dyspnoea + orthopnoea

52
Q

long term pharma management of oesophageal varices

A

non-cardioselective beta blocker = propanolol

53
Q

LV aneurysm

A

persisting ST elevation
pain
arrthymias

54
Q

no erections, raised serum ferritin, signs of cirrhosis

management?

A

haemochromatosis

venesection = weekly blood removal

55
Q

hepatic encephalopathy management

A

lactulose - promotes ammonia secretion
rifaximin (antibiotics) - reduces bacteria producing ammonia

nutritional support

56
Q

pharma option for hepatocellular carcinoma

A

sorafenib - kinase inhibitor

inhibits cancer proliferation - extend life by months

57
Q

lung cancer associated with hyponatremia?

A

small

58
Q

when would u use a v/q scan for a PE

A

allergy to contrast

renal impairment

59
Q

lung cancer all about hilum

A

squamous

60
Q

An 80-year-old gentleman comes into the GP surgery, complaining of shortness of breath especially when lying down. His ejection fraction is normal. What could be a possible explanation for this?

A

he has diastolic dysfunction

61
Q

chain of lakes appearance on ERCP

A

chronic pancreatitis

main pancreatic duct

62
Q

you avulse the cystic artery. This is followed by brisk haemorrhage. From which source is this most likely to originate ?

A

right hepatic artery

The cystic artery is a branch of the right hepatic artery

63
Q

where in the heart does invabradine act?

A

ion current in SA node

64
Q

A 56-year-old gentleman presents to the emergency department with sudden-onset central searing chest pain. The pain is 8/10 in severity and began six hours earlier. He describes the pain as ‘tearing’. The patient denies shortness of breath, vomiting, or haemoptysis. The pain is not exacerbated or relieved by any positional changes or during phases of respiration.

His ECG taken on admission reveals sinus tachycardia with ST-segment elevation in only leads II, III, and aVF. Non-specific T-wave changes are visible in praecordial leads. Baseline troponins are undetectable.

What is the most likely diagnosis?

A

Dissection of the thoracic aorta is a differential for ST segment elevation in inferior leads

65
Q

where are endothelin antagonistsuseful

A

primary pulmonary hypertension

Endothelin is a potent, long-acting vasoconstrictor and bronchoconstrictor

Promotes release
angiotensin II
ADH
hypoxia
mechanical shearing forces

Inhibits release
nitric oxide
prostacyclin

66
Q

infertility in cystic fibrosis

A

due to absent vas deferens

67
Q

During a right hemicolectomy the caecum is mobilised. As the bowel is retracted medially a vessel is injured, posterior to the colon. Which one of the following is the most likely vessel?

A

gonadal vessels

68
Q

Where are ACE inhibitors activated to the pharmacologically active compound in the body?

A

under phase 1 metabolism in the liver

69
Q

lung malignancy increases risk of pulmonary fibrosis

true or false

A

FALSE

increases risk of pneumothorax

fibrosis may increase risk but is not a complication

70
Q

On questioning the GP finds out that he is has been using IV drugs for the past few years and after careful examination suspects infective endocarditis.

The structure most likely affected in this patient is derived from which of the following embryological structures?

A

The endocardial cushion is the embryological structure that gives rise to the AV and semilunar valves

Infective endocarditis in a patient positive for IVDU most commonly affects the tricuspid valve. All valves in the heart are derived from the endocardial cushion.

71
Q

biopsy is taken from the distal oesophagus. The histopathology report indicates that cells are identified with features of coarse chromatin and abnormal mitoses. The cells are confined to the superficial epithelial layer only. Which one of the following accounts for this process?

A

dysplasia

not metaplsia

72
Q

treatment for patent ductus arteriosus

A

baby recieves indomethacin as a neonate

Patent ductus arteriosus: indomethacin is given to the neonate in the postnatal period, not to the mother in the antenatal period

73
Q

place a mesh on the posterior wall of the inguinal canal to complete the repair, which of the following structures will lie posterior to the mesh?

A

Transversalis fascia

74
Q

cause of varicose veins

A

incompetency of SUPERFICIALvenous valves

75
Q

What is the mechanism of action of atrial natriuretic peptide?

A

antagonist of angiotensin II - hence aldosterone

B-type natriuretic peptides suppress sympathetic tone and the renin-angiotensin-aldosterone system.

76
Q

what level does portalvein begin

A

L1

77
Q

Given the onset of symptoms was less than 48 hours ago, a decision was made to attempt chemical cardioversion with amiodarone. A loading dose is administered initially, followed by an infusion.

What pharmacological feature of amiodarone make a loading dose necessary?

A

Amiodarone has a very long half-life of 20-100 days - loading doses are therefore often needed

78
Q

The GP decides to introduce a diuretic. Which of the following act mainly on the distal convoluted tubule?

A

Bendroflumethiazide - inhibits sodium reabsorption by blocking the Na+-Cl− symporter at the beginning of the distal convoluted tubule

79
Q

Mr Jones is a 73-year-old man who has been admitted with pneumonia. He is frail and receiving antibiotics and fluids intravenously. He has no appetite and a Speech And Language Therapy (SALT) review concludes he is at risk of aspiration.

His past medical history includes hypertension and angina.

Which of the following options would be most appropriate to support him nutritionally?

A

Nasogastric tube (NG tube) - This is the correct answer. This patient only requires short term feeding and no contraindications are found in his past medical history, so an NG tube would be the best initial step

80
Q

A 65-year-old male with long standing chronic obstructive pulmonary disease (COPD) presents to the emergency department (ED) with shortness of breath over the last 2 hours and wheezing. On examination, he is cyanosed, has a third heart sound present and has widespread wheeze on auscultation. The emergency doctor also notices hepatomegaly which was not present 12 days ago when he was in the ED for a moderative exacerbation of COPD.

Which of the following describes the cause of the hepatomegaly?

A

Cor pulmonale

Right sided heart failure is a congestive cause of hepatomegaly

81
Q

64-year-old man has been admitted to the surgical ward for abdominal pain and bleeding per rectum. On the clerking notes it states he has not opened his bowels for five days. Today he has started vomiting and his abdomen is distended.

What is the most likely diagnosis?

A

large bowel

= later onset of vomiting

constipation before vomiting in large

82
Q

A 54-year-old female is admitted one week following a cholecystectomy with profuse diarrhoea. Apart from a minor intra-operative bile spillage incurred during removal of the gallbladder, the procedure was uncomplicated. What is the most likely diagnosis?

A

C diff

Antibiotics are not routinely administered during an uncomplicated cholecystectomy. Indications for administration of broad spectrum antibiotics include intraoperative bile spillage.

83
Q

h pylori

A

Gram-negative, oxidase positive, catalase positive comma-shaped rods

84
Q

peristalsis

A

Longitudinal smooth muscle propels the food bolus through the oesophagus

85
Q

common causesof resp alkalosis

A 
anxiety leading to hyperventilation
pulmonary embolism
salicylate poisoning*
CNS disorders: stroke, subarachnoid haemorrhage, encephalitis
altitude
pregnancy
86
Q

comment cause of croup? treatment?

A

parainfluenza, RSV

supportive treatment

–> barking cough, inspiratory stridor, child age 2, slower onset

87
Q

vit deficiency in alcoholics

A

thiamine

88
Q

kid squatting, has DiGeorge, systolic ejection murmur

A

tetralogy of fallot

cyanosis
causes a right-to-left shunt
ejection systolic murmur due to pulmonary stenosis (the VSD doesn’t usually cause a murmur)
a right-sided aortic arch is seen in 25% of patients

chest x-ray shows a ‘boot-shaped’ heart, ECG shows right ventricular hypertrophy

89
Q

child drooling, high temp, leaning forward + extending neck

A

epiglottitis - commenest cause = haemophils influenza

rapid onset
DO NOT open mouth

treat IV ceftriaxone

90
Q

rotavirus common presentation

A

<3 y/o
nursery outbreak
vaccine
risk of intussception

first year med (15 decks)

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