RACP 2023 rapid fire Flashcards
Describe the roles of the phrenic nerve and its location
- C3-C5 nerve roots
- motor - diaphragm innervation
- sensory - central diaphragm, pericardium, central pleura
Name the 4 phases of Hep B infection
tolerance -> clearance -> control -> escape
In the tolerance phase of chronic Hep B, what is the management approach?
Monitor every 6-12 months
Why should treatment be considered in the immune phase of chronic Hep B?
- high HBV DNA, High HBe Ag, abnormal LFTs
- RISK of progression to cirrhosis & HCC
Describe the immune control (phase 3) of chronic Hep B
- Anti-Hbe, Hbe-Ag NEG
- HBV DNA low
- monitor - observe 6-12 months
Describe the features of immune escape in chronic HBV
- Anti-Hbe, Hbe-Ag - low
- HBV DNA HIGH
- normal LFTs
- TREAT as risk of progression to HCC and fibrosis
When should a pregnancy patient be treated with Hep B?
- If the viral load is >200,000
- re-check bloods 26-28 weeks and commence treatment 3rd trimester; treat with TDF monotherapy
When assessing the phase of chronic B infection, what are the key blood tests?
- HBV-DNA
- HbeAg, Anti-HbeAg
- liver panel
What would be required at birth for a baby with a Hep B +ve mother, regardless of HBV DNA level?
Hep B vaccination
Hep B IG
True or false. Breast feeding is a risk for Hep B transmission
False
A mother wants to have a vaginal delivery. what is the implication if she has Hep B
- should be guided by levels* (for decision for treatment with procedures that confer risk, levels guide this)
What is the clinical significance of Hepatitis E with respect to population
- rapid progression to fulminant liver failure
- particular high risk groups = pregnant women, solid transplant recipients, pre-exisitng chronic liver disease
95% of non-occlusive bowel ischaemic occur in the watershed areas. What are these?
splenic flexute, rectosigmoid junciton
Name two common alpha 2 agonists and antagonists
- angonists - dexmedtomadine, methyldopa, clonodine
- antagonists - some 2nd gen antipyschotics e.g. quetiapine, risperadone
Name two common alpha 1 antagonists and agonists
- agonists = metaraminol, midodrine
- antagonists = tamsulosin (selective), prazocin
Name one b1 antagonist and agonist that is commonly used
b1 agonist = dobutamine
b1 antagonist = all your beta blockers really
What is the role of the beta 2 receptor
- smooth muscle vasodilation
Type 1 (distal) and Type 2 (proximal) RTA have common associated causes. What are these?
- Type 1 distal
- autoimmune causes - SLE, Sjogrens, SSc, PBC, lithium, NSAIDs, MM, paracetamol overdose
Type 2 proximal
- most common MM, TENOFOVIR
What is the most common cause of hyporenic hypoaldosteronism?
diabetic nephropathy-destruction of JG apparatus due to vascular hyalinosis
Describe the pathophys of type 1 RTA
- affects the distal tubule
- causes by damage to intercalated cells
- unable to SECRETE HYDROGEN (cant produce bicarb and therefore get it reabsorbed)
- low bicarb, low K (as trying to reduce serum acidosis)
- basic urine pH>5.5
Describe the pathophys of type 2 proximal RTA
- DECREASED ability to reabsorb bicarb
- urine pH>7, will reduce to <5.5 if bicarb is low (when serum bicarb is low, some reabsorbtion takes place)
- hypokalemia, low bicarb
- test by giving bicarb and seeing if pH>7.5 and bicarb excretion >15%
Explain the pathohys of Type 4 ETA
aldosterone deficiency or resistance
- unable to secrete K or H = hyperK
- reduced excretion of NH4+ (main buffer for acid base balance)
- LOW urine pH
*often caused by hyporenemic hypoaldosteronisim
What is the mechanism of type 4 RTA if a patient has diabetes?
Hyporeninemic hypoaldosteronism: most common cause in adults is diabetic nephropathy-destruction of JG apparatus due to vascular hyalinosis
A cell contains many important structures. What is the role of the following - ribosome, rough ER, smooth ER, golgi, lysosome?
- ribosome - protein production
- rough ER - protein folding
- smooth ER - hormone/lipid synthesis
- golgi - protein transport
- lysosome - recyling + apoptosis
