r u not ambarRazzed Flashcards
hereditary cancer in caecal area
Lynch syndrome (HNPCC)
mutation of mismatch repair genes
associated with endometrial cancer
cardiac abnormality associated with Friedreichs ataxia
HOCM
effect of endothelin of blood vessels
vasocnstrictor
starlings law
as preload progressively increases, SV increases gradually then decreases suddenly
KRAS
pancreatic cancer
effect of secretin on gastric acid
decreases gastric acid secretion
–> released by duodenum
investigation for common side effects of aminosalicylates
FBC
_> have a variety of haemological side effects
drugs that open/close ductus arteriosus
prostaglandin E1 - keeps open
indomethacin - closes (inhibits prostaglandins)
artery for CABG
internal mammary artery
use, MoA + SE of cholestyramine
medication to reduce LDL cholesterol
reduces absorption of fat soluble vitamins (ADEK)
SE = vit D deficiency = clotting abnormalities - bruises, bleeds
other histological change in barretts as well as columnar
goblet cells
largely elevated lipase + normal amylase
chronic pancreatitis
effect of increase stroke volume on pulse pressure
increase pulse pressure
effect of raised BNP on preload + afterload
decreases both
corkscrew vessels
corkscrew vessels of vasa vasorum - in tunica adventitia
–> buergers disease
CA19-9
pancreatic cancer
biggest risk factor of development of intestinal diverticula
low fibre diet - lack of fruit + veg
“egg on side” looking heart on CXR
transposition of great arteries
dresslers
AUTO-IMMUNE MEDIATED
coincides with S4
p wave
active LV filling
factors increasing gastric acid production
vagal nerve stimulation
gastrin release
histamine release - indirectly following gastrin release
factors decrease gastric acid production
somatostatin - inhibits histamine release
cholecystokinin
secretin
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?
verapamil
ASTHMATIC - beta blocker contraindicated
What is secreted by damaged blood vessel endothelial cells to initiate haemostasis?
Von Willebrand factor
activates platelet plug formation
MoA clopidogrel
irreversibly inhibits ADP-dependent platelet activation
aspirin = same but COX-mediated
inhaler technique
shake
deliver while taking slow breath in
hold for 10 secs
wait 30 before next dose
effect of high compliance (lungs)
lower pressures needed to inflate lungs
leading to decrease elastic recoil + less efficient air expulsion
gas-trapping
effect of low compliance (lungs)
lungs more difficult to inflate
increased elasticrecoil
lungs TOO GOOD at expelling air
central vs peripheral chemoreceptors
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
phrenic nerves position relative to hilum of lung
both lie anterior to hilum of lung
both motor + sensory function - diaphragmatic pain referred to shoulder
latent TB Ix
1st line = mantoux test (skin test)
2nd line = IGRA (interferon-gamma release assays)
vitamin involved in collagen
vit C
vit deficiency with long term metformin
vit b12
which complex does not pump protons as electrons pass through the respiratory chain
complex II
effect of doubling dose of IV infusion on plasma conc
doubles its plasma conc
is an abnormal karotype a characteristic of malignancy
no
where does the anal canal drain its venous blood to
directly into systemic venous system
where is ilium? common use?
hip - part of appendicular skeleton
commonly used for obtaining bone marrow aspirates in adult
main source of energy in absorptive state
glucose
peritoneal structure attached to greater curvature of stomach
greater omentum
circularly arranged muscle in form of anatomical sphincter under somatic control
anus
where can pelvic splanchic nerves be found
mesentry of sigmoid colon
if u out ur finger through gastroomental (gastroepiploic) foramen what space would it be in?
lesser sac
contains circularly + longitudinally arranged muscle which are stimulated to contract by pelvic splanchic nerves (S2, 3, 4)
sigmoid colon
retroperitoneal structure under control of postganglionic fibres from celiac plexus
3rd part of duodenum
difficulty swallowing with history of GORD
stricture / carcinoma
balloon dilatation + PPI - biggest complication = oesophageal perforation
how would you differentiate a pericardial effusion to other complications of pericarditis?
no raised JVP
normal pulmonary vasculature
bloody effusion - probs malignant
pericarditis treatment
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
most common cause of aortic stenosis in young
bicuspid aortic valve
aortic stenosis treatment
valve replacement
TAVI if unfit
complication of anteroseptal MI
ventricular septal defect
-> shock + new systolic murmur, dyspnoea + orthopnoea
long term pharma management of oesophageal varices
non-cardioselective beta blocker = propanolol
LV aneurysm
persisting ST elevation
pain
arrthymias
no erections, raised serum ferritin, signs of cirrhosis
management?
haemochromatosis
venesection = weekly blood removal
hepatic encephalopathy management
lactulose - promotes ammonia secretion
rifaximin (antibiotics) - reduces bacteria producing ammonia
nutritional support
pharma option for hepatocellular carcinoma
sorafenib - kinase inhibitor
inhibits cancer proliferation - extend life by months
lung cancer associated with hyponatremia?
small
when would u use a v/q scan for a PE
allergy to contrast
renal impairment
lung cancer all about hilum
squamous
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?
he has diastolic dysfunction
chain of lakes appearance on ERCP
chronic pancreatitis
main pancreatic duct
you avulse the cystic artery. This is followed by brisk haemorrhage. From which source is this most likely to originate ?
right hepatic artery
The cystic artery is a branch of the right hepatic artery
where in the heart does invabradine act?
ion current in SA node
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?
Dissection of the thoracic aorta is a differential for ST segment elevation in inferior leads
where are endothelin antagonistsuseful
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
infertility in cystic fibrosis
due to absent vas deferens
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?
gonadal vessels
Where are ACE inhibitors activated to the pharmacologically active compound in the body?
under phase 1 metabolism in the liver
lung malignancy increases risk of pulmonary fibrosis
true or false
FALSE
increases risk of pneumothorax
fibrosis may increase risk but is not a complication
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?
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.
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?
dysplasia
not metaplsia
treatment for patent ductus arteriosus
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
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?
Transversalis fascia
cause of varicose veins
incompetency of SUPERFICIALvenous valves
What is the mechanism of action of atrial natriuretic peptide?
antagonist of angiotensin II - hence aldosterone
B-type natriuretic peptides suppress sympathetic tone and the renin-angiotensin-aldosterone system.
what level does portalvein begin
L1
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?
Amiodarone has a very long half-life of 20-100 days - loading doses are therefore often needed
The GP decides to introduce a diuretic. Which of the following act mainly on the distal convoluted tubule?
Bendroflumethiazide - inhibits sodium reabsorption by blocking the Na+-Cl− symporter at the beginning of the distal convoluted tubule
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?
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
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?
Cor pulmonale
Right sided heart failure is a congestive cause of hepatomegaly
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?
large bowel
= later onset of vomiting
constipation before vomiting in large
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?
C diff
Antibiotics are not routinely administered during an uncomplicated cholecystectomy. Indications for administration of broad spectrum antibiotics include intraoperative bile spillage.
h pylori
Gram-negative, oxidase positive, catalase positive comma-shaped rods
peristalsis
Longitudinal smooth muscle propels the food bolus through the oesophagus
common causesof resp alkalosis
anxiety leading to hyperventilation pulmonary embolism salicylate poisoning* CNS disorders: stroke, subarachnoid haemorrhage, encephalitis altitude pregnancy
comment cause of croup? treatment?
parainfluenza, RSV
supportive treatment
–> barking cough, inspiratory stridor, child age 2, slower onset
vit deficiency in alcoholics
thiamine
kid squatting, has DiGeorge, systolic ejection murmur
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
child drooling, high temp, leaning forward + extending neck
epiglottitis - commenest cause = haemophils influenza
rapid onset
DO NOT open mouth
treat IV ceftriaxone
rotavirus common presentation
<3 y/o
nursery outbreak
vaccine
risk of intussception
