second_year_exams_copy_20180310144444 Flashcards
name 3 symptoms of a pleural effusion
SOBpleuritic chest paindry coughfeverweigh lossmalaise
exudative pleural effusions are most likely to be unilateral or bilateral?
unilateral as most of them are due to inflammation
which of the following drugs should not be used in pregnant women?A. verapamilB. nifedipine MRC. atenololD. methyl dopa
verapamil should not be used in pregnant women. it is a rate limiting CCB that can cause bradycardia - diltiazem can have a similar effect
t wave inversion is present in STEMI’s - true or false?
false. correct answer is NONSTEMIT wave inversion is characteristic of partial coronary occlusion and so in NSTEMI there will be no ST elevation and no pathological Q waves but there will be inverted t waves with subendocardial damage
tetralogy of fallot is caused by what cardiac defects?
- pulmonary stenosis-RVH- VSD- dexposition of the aorta
What are CT-PET scans used for?
to check the metabolic activity of active tumours
What are the following results in a patient with life-threatening asthma?PEF?PaO2?PaCO2?SaO2?
PEF will be below 33%PaO2 will be below 8kPaPaCO2 WILL BE NORMAL SO REMEMBER THIS OBISaO2 will be below 92%
what is the process for real time sampling in lung cancer tissue investigation?
endobronchial ultrasound- transbronchial needle aspiration (EBUS-TBNA)
stable angina will usually last for under 20 minutes - true or false?
true
what structure forms the ligamentum venosum
ductus venosus
suggest 3 signs that may be biochemically and clinically seen in a patient with hyperlipidamia
clinically:corneal arcusxanthomataxanthalasmata obese (BMI>30)Hypertensionbiochemically:- LDL- HDL-cholesterol- TAG
the muscular part of the IV septum (interventricular) of the primordial heart will develop from the fusion of the bulbar ridges with the endocardial cushions - T/F?
false it develops from the proliferation of the medial wall. the IV foramen is closed from fusion of the bulbar ridges with the endocardial cushion forming the membranous part of the IV septum
what are the investigations done for bronchiectasis? Name 5 most important ones
- HRCT of thorax gold standard- serum immunoglobuins (including IgE)- sputum culture for infection- Aspergillus precipitations - Cystic fibrosis genotyping
What are the main 3 surgery treatments for pulmonary hypertension?
- pulmonary septostomy which will create a shunt to increase the cardiac output - pulmonary endarterectomy but is mainly done for hypertension from a proximal pulmonary embolism- transplant
spacers used in inhalers will affect how much of the drug in the propellant will reach the lung - T/f?
trueslows down the speed of the propellant and so less deposition in the oropharynx and more to the target
what is the major complication of thrombolysis?
hemorrhage (generally bleeding)
what are two contraindications of giving thrombolysis]be specific and name 3
- previous intracranial bleed2. recent stroke3. severe hypertension4. surgery/warfarin (be cautious)
Name the 3 main functions of the chorion in embryology
- forms the placenta2. allows for implantation3. responsible for secreting HCG
the foramen ovale will arise form the closure of the septum primum true or false?
false. the septum secondum will turn into the foramen ovale
what are the risk factors for venous thrombosis?
- OCP/ HRT2. pregnancy3. age4. trauma5. smoking6. cancer
what is heritable thrombophilia?
the genetic predisposition to venous thrombosis
what is the most preventable thrombophilia?
Factor V leiden
How is DVT diagnosed?
D dimer testthen do a duplex scan
how is a pulmonary embolism diagnosed?
Computer tomography pulmonary angiography - CTPA gold standardD dimerV/Q scan
what are the pressures imposed by the anti-embolism stalkings?
18mmHg at the ankle14mmHg at the mid-calf8mmHg at the upper thigh
what is the management plan for dilated cardiomyopathy?
- treat arrhythmia’s and heart failure then give thromboembolic prophylaxis2. then give synchronization therapy with an ICD
Name 3 types of emphysema patterns
periacinar (bullous emphysema)panacinarcentriacinar
the somatopleuric mesoderm will give rise to the serous (parietal) pericardium and the fibrous pericardium - T/F?
true
In bronchitis, there is no wheeze or crepitations - T/F?
true, bronchitis doesn’t present with wheeze or crepitations
what are the common nodes which are sampled in endoscopic bronchial ultrasound of lung cancer
- hilar nodes2. sub-carinal nodes3. para-tracheal nodes
suggest a chemotherapy drug used to treat SCLC, adenocarcinoma and squamous cell cancer
cisplatin
what is the treatment of obstructive sleep apnoea in children?
CPAPweight lossadenotonsilectomy avoid tobacco smoke
how many times can streptokinase be used for thrombolysis?
once as after this time people will develop resistance to it
where are oogonium found?
found in the follicles of ovaries
how may loss of normal epithelium will result in an ectopic pregnancy (may be the case in pelvic inflammatory disease)
loss of normal epithelium will mean that the blastocyst cannot migrate to the endometrium wall and therefor the blastocyst is stuck inside the uterine tubes leading to an ectopic prgenancy
what are the 3 main functions of the placenta?
- remove waste such as CO22. provide nutrients - O2 and Glc3. immunological role
what is neuralation?
the formation of the neural tube
which germ layer do somites develop from?
to get the mark must say paraxial mesodermal layers
what does the QT interval relate to on an ECG - systole or diastole?
systole
in which patients should an ACEI and ARB not be given to as an anti-hypertensive treatment?
black peopleover 55 pregnant
Name the 4 types of mesothelioma cancers
desmoplastic epithlioid biphasicsarcomatid
what is the frank stirling law?
the stroke volume of the heart is related to the pre-load of the heart.
what structure is the chorion made from?
the trophoblast will go on to form the chorion
where is the decidua basalis located?
in the endometrium deep to the implanted conceptus
the cartilage of the larynx will develop from which pharyngeal arches?
the 4th to 6th
where do SCLC tend to develop?
larger airways
where do carcinoid tumours develop?
in the endocrine system and in the large airways
hypertrophic pulmonary osteoarthropathy - HPOA is common to which kind of cancer?
adenocarcinoma
what is the presentation of hypertrophic pulmonary osteoarthropathy - HPOA
pain in the hands and legs
name a feature of large cell lung cancer
gynecomastia
name 4 neoplastic syndromes that will accompany SCLC
SIADHACTHSVCOCarcinoidEaton larmbert
what are three neoplastic syndromes that will accompany squamous cell LC
pancoast tumour - weakness in upper limbshorners syndorme - ptosis, anhydrosis and miosisPTHrH (hypercalcaemia)
what are 3 general tests that are involved with coeliac disease serology?
- Gliadin2. tissue transglutaminase3. IgA levels
what may a urea breath test be used for diagnostically?
helicobacter pylori infection
Name 2 other breath tests that can be carried out in GI disease investigation
- Hydrogen breath test - bacterial overgrowth2. lactose intolerance
Suggest 2 tests which are used to assess oesophageal motility
- manometry2. Barium swallow3. oesophageal pH test4. Upper GI endoscopy
Name 2 general complications of endoscopic investigation
- perforation2. hemorrhage3. aspiration
suggest a bowel preparation that is used prior to endoscopy
picolax
aspartate and alanine require a ratio greater than what to be considered in the diagnosis of alcoholic liver disease?
AST/ALT>2for diagonsis of alcoholic liver disease you can also carry out an USSalcoholic patients will also have a raised gamma GT, macrocytosis and thrombocytopenia
describe 3 exclusions you would like to make before you make a diagnosis of hepatic encephalopathy?
- infection2. intracranial bleed3. hypoglycaemiathis is known as the differential diagnoses of hepatic encephalopathy
describe the treatments which are used for hepatic encephalopathysuggest 4 things
- enema2. lactulose3. antibiotics4. NG tube5. ITU6. airway support7. bowel clear out
what condition is more likely to present with malabsorption?A - Crohns diseaseB - Ulcerative colitis
the majority of absorption will occur inside the small intestine. UC will only affect the large colon with the exception of extra-intestinal manifestations. Crohns disease will affect the SI so is the most likely to cause malabsorption.
Name 5 inflammatory indices that will be found in inflammatory bowel disease or IBD
- CRP elevation2. ESR elevation 3. low albumin4. low haemoglobin5. high platelets6. high white cell count
ulcerative colitis will not have which of the following?a. erythema nodosum2. uveitis3. renal calculi4. sclerosing cholangitis
although a common extra-intestinal manifestation of IBD, renal calculi are only found in Crohns disease (CD)the rest of the listed conditions will be found in ulcerative colitis.
what is the standard dose of melasazine in first line treatment of IBD?
3g per daybare in mind that there will be no significant improvement in remission rate or adverse side effects.
steroids are 2nd line treatment for outpatients with IBD. what are two steroids used?
prednisolone (40mg/day with tapering reduction over 4 weeks)budesonide - less effective than prednisolone but there are less adverse side effects. budesonide can only be used in ileal and ascending colon disease also.
name 3 side effects of using the thioprine, azathioprine as immunosupression for IBD
- leukopenia2. hepatotoxicity (therefore will require blood monitoring weekly for 8 weeks then every 8 weeks)3. pancreatitis4. long term lymphoma risks
which cranial nerve will provide innervation to the middle ear? (maleus, stapes and incus)
Jacob’s nerve which is a branch of the glossopharyngeal nerve (CN IX)- the tympanic branch of the glossoopharyngeal
what is Arnald’s nerve?
arnalds nerve is the auricular branch of the vagus nerve. it will innervate the posterior third of the external auditory canal.
what nerve will innervate the anterior external auditory canal?
the facial nerve CN VII
which aminotransferase is likely to be elevated in steatohepatitis?
alanine aminotransferase (ALT)
describe a method of definitive diagnosis of steatohepatits
liver biopsy
what is the treatment for steatohepatitis?
- weight loss2. exercise
what are the two most important treatments in alcoholic hepatitis?
- steroids2. thiamine
3 structural changes at neurons will occur during long term memory. describe them
- more neurotransmitter release sites 2. neurotransmitter release vesicles stored and released3. increase in the number of pre-synaptic vesicles
describe the 4 classes of biliary atresia
I - common bile duct affectedII - common hepatic ductIII - common hepatic duct and the bile and cystic ductIV - hepatic ducts, common hepatic duct, bile and cystic ducts
name 4 risk factors of cholangiocarcinoma
- primary sclerosing cholangitis2. congenital cystic disease3. contrast dyes such as thorotrast4. carcinogens (aflatoxins)
what are 3 main presentations of cholangiocarcinoma?
- obstructive jaundice2. pruritis3. non-specific symptoms
what is the main treatment for inflammatory muscle disease?
immunosupression
what investigations should you carry out for inflammatory muscle disease?
EMGbiopsyCK
what 3 tests must be carried out for epilepsy?
CT/MRIEEGvideo telemetryy
what differences may be found between polymyositosis and derrmatomyositosis
DM will have a characteristic rash and is humoral mediated with CD4 and B cellspolymyositosis will have CD8 cells on biopsy
alkaline phosphate is an aminotransferase found within hepatocytes and is elevated when there is obstruction or liver infiltration - T/F?
false. alkaline phosphatase is found in bile ducts. it is however elevated in obstruction or liver infiltrationalkaline phosphatase is also present in bone, placenta and in the intestines.
what clinical presentations may a patient have with hepatic jaundice in comparison to post-hepatic jaundice
hepatic jaundice will present with 1. ascites2. spider naevi3. gynaecomastia patient is likely to be an IVDApost hepatic jaundice will present with 1. abdominal pain2. cholestasis (pale stool, pruritis and very dark urine)3. palpable gall bladder
describe 3 investigations you would carry out for a patient with jaundice
- USS of abdomen2. Hep B and Hep C 3. antibody profile4. serum immunoglobulins5. ferritin6. transferrin saturation7. copper8. caeruloplasm
what are 3 treatment options for hepatic encephalopathy?
- neomycin2. rifaximin3. phosphate enema4.lactulose
all of the semicircular canals in the ear will connect to the utricle - T/F?
true
what is the function of the semicircular canals?
to inform the brain on rotational acceleration
what is the respective functions of the utricle and the saccule?
the utricle will detect back and front tiltsthe saccule will detect vertical movements (in a lift)
what is the name of the reflex that will make rapid postural adjustments to stop you from falling?
dynamic righting reflex
describe the static reflex
this reflex will cause you to either intort or extort your eyes to compensate for the angle of your head
basal cell papilloma (seborrhoeic keratosis) is typically greasy, flat, brown and oval. is it related to sun exposure?
no
name an important precursor for malignant melanoma
melanocytic naevus
suggest preventative measures for sudden death caused by hypertrophic cardiomyopathy
- ICD2. septal ablation3. surgical resection4. screening for Vtach syncope and exercise hypotension
where are the somites derive from?
para-axial mesodermthere are 33 somites in total
describe the nerve innervation of the branchial arches
1 - V32. facial3. glossopharyngeal4. superior laryngeal nerve (external)6. recurrent laryngeal
how many processes is the face made from?
51 frontonasal2 maxillary 2 mandibular
in MS, activated t cells will cross the BBB to cause the demyelination of white matter. t/f?
true
describe the most effective imaging test for the diagnosis of MS
MRI
males are more likely to develop MS - T/F?
false - females
describe 3 presentations of optic neuritis
subacute loss of visionpain on moving the eyecolour distortionoptic disc swelling and atrophypupillary reflex deficitthere is a resolution of symptoms over a few weeks
what are 3 differential diagnoses of optic myelitis?
- neuromyelitis optica2. ischaemic optic neuropathy3. sarcoidosis4. wegners granulomatosis (c-ANCA)
there are no relapses in primary progressive MS - TF?
truein primary progressive MS there will however be bladder symptoms and it will present in the old. there is no predilection towards males and females
the gold standard for detecting coeliac disease is a distal duodenal biopsy - what may be found?
increased intra-epithelial lymphocytespatial/subtotal villous atrophy with IgA deposits
what are 2 other diagnostic tests which can be carried out?
anti-endomysial IgAanti-gliadinanti tissue transglutaminase (95% specific and sensitive)
describe 3 complications of coeliac disease
- small bowel lymphoma2. esophageal carcinoma3. colon cancer4. small bowel adenocarcinoma
describe the symptom and treatment of Giardia Lambia
Giardia Lambia will result in malabsorption and hypogammaglobulinaemia treatment is with metronidazole
describe 2 treatments for lyme disease
oral doxycyclineIV ceftriaxone
what are 3 investigations you can carry out for lyme disease
PCR of CSFEMGNerve conduction studies (NCS)MRI brain and spineserological testing
what is the treatment for tertiary syphillis
very high dose penicillin
what is the treatment for tetanus in increased risk patients
penicillin and immunoglobulins
describe 3 investigations for CJD (Creutzfeldt–Jakob disease)
MRI (pulvinar sign in variant CJD)CSFEEG
what may be found in the CSF of someone with Creutzfeldt–Jakob disease?
increased protein or immunoassasay 14-3-3 brain protein
describe an electrophysiological test which records optic nerve function
Visually evoked potential
Electroretinogram will measure the retinal function and record action potentials from the retina - TF?
truea wave will correspond to the photoreceptorsb wave will correspond to the Muller cells
describe an electrophysiological test that measures the RPE and photoreceptors of the eye
electro-oculogram. it will measure the resting potential difference between the RPE and the photoreceptors.it will measure the maximum and potential difference in a light and dark adapted eyethe Arden ratio is equal to 1.85
what is the difference between an electro-oculogram and an electro-retinogram?
electro-oculogram will measure the resting potential difference between the RPE and the photoreceptors. the electroretinogram will measure the retinal function and record action potentials from the retina
the optic nerve is around 20 degrees from the fovea and is a physiological blind spot - TF?
true.there are no rod or cone receptors on the optic nerve
the peak amount of which photoreceptors are at the fovea centralis?
there is the peak amount of cones and incidentally the minimum number of rods
hypo and hyperkalaemia can have the same effect on the heart - TF?
truethey can both induce fibrillation and heart block
what is the need for DAPT (dual anti-platelet therapy) in cardiac stenting
the stents will need time to vascularise so to prevent thrombosis and blockage of the vessel give anti-platelets. premature discontinuation may lead to death. DAPT is for up to a year.
what are the diagnostic tests for ACS (acute coronary syndrome)?
troponinECGCT angiographyGFRanaemiacholesterol
what layer of the lateral plate mesoderm is closest to the endoderm?
splanchnic mesoderm
what is the most common type of tracheo-oesophageal fistula?
oesophageal atresia with distal tracheo-oesophageal fistula (OATOF)
what is the causative agent in whipples disease?
Tropheryma Whipelli
describe 3 symptoms of Whipple’s disease
weight lossabdominal painmalabsorption(PAS material may be seen in the villi)
What is the treatment of Giardia Lamblia?
Metronidazole
what is the first line treatment for partial and secondary generalized seizures?
lamotriginecarbemazepine
what is the first line treatment of absence seizures?
ethosuxamide
what is the second line treatment for status epilepticus
valproate and phenytoin
what is first line treatment for status epilepticus?
lorazepam and diazepam
describe 2 side effects of using the anti-convulsant topiramate
weight lossdifficulty finding words tingling in hands and feet
which two lobes of the brain will the lateral sulcus separate?
temporal and frontal lobes
which sulcus will separate the parietal from the occipital lobes?
parieto-occipital sulcus
what is the exact location of the primary auditory cortex - also give the Broddman areas
superior temporal gyrus BA areas 41 and 42 - Herschel’s convolutions
which hemisphere is Wernicke’s area and what does it do?
Wernicke’s area is the Receptive area of speech (undertsanding spoken word)and is found in the dominant hemisphere - in most people the left hemisphere
what is the score of glasgow alcoholic hepatitis that requires steroidal treatment of alcoholic hepatitis?
9
name the 5 components of the score
ageWCCureaINRbilirubin
what is the treatment of alcoholic hepatitis?
If Maddrey’s discriminant function is greater than 32 then treat with oral steroids4.6x (PT-control PT) +bilirubinthiamineprevent against GI bleed, constipation, infection, alcohol withdrawal and airway protection
suggest three causes of fatty liver (non-alcoholic)
obesitydiabetes hypercholesterolaemia
What are the lines of Zahn composed of?
plateletsfibrin mesh-workRBC
what is Cushing syndrome?
excess production of cortisol (non-ACTH dependent) from the adrenal glands
Name 2 outcomes of critical limb ischaemia
gangreneulcerationcritical limb ischaemia is when the patient will have pain at rest
if after CXR, CT and aspiration there is still no diagnosis of pleural effusion, what test can be done next?
video-assisted thorascopy which allows for the direct inspection of the pleura with directed biopsies. it can be therapeutic
name the reflex that is responsible for the axis of the head in a constant relationship with the rest of the body?
labyrinthine reflex
if you irrigate the left ear of someone with cold water in caloric stimulation what direction would they experience nystagmus?
right nystagmus
Suggest 5 bedside investigations for GI disease
BMIpulse oximetryECGcapillary glucoseurinalysis
faecal elastase is an indication of what conditions?
malabsorptionpancreatic insufficiency
calprotectin will be raised in IBS - TF?
falseit is raised in inflammatory conditions and allows for the quantitative analysis useful for monitoring disease activity
obstructive liver function tests would see what elevations in blood tests?
alkaline phosphatasebilirubin
Name 3 risk factors for vitamin D deficiency
ageAsianpigmented skin is less able to to make vitamin D3 in repsonse to UV radiation malnutritionkidney diseaseChapatti flour will contain phyphate that binds dietary calcium
in the sympathetic nervous system the synapses between the pre and post ganglionic cells are…finish the sentence
cholinergic and nicotinicthis is also true for the parasympathetic nervous system
in the parasympathetic nervous system the synapses between the post ganglionic cells and their targets are adrenergic and nicotinic - TF?
falsethey are muscarinic and cholinergic
which of the following is false?post-ganglionic cells in the adrenal medulla will a. release adrenalineb. have no axonsc. are part of the sympathetic nervous systemd. contributes to mass activation
none are false - all statements are true
tremor is a consequence of which of the following anti-convulsants?A. sodium valproateB. carbamazepineC. lamotrigineD. levetiracetam
sodium valproate will result in tremor and also the following:1. weight gain2. transient hair loss3. pancreatitis 4. hepatitis5. drowsiness6. ataxia
which of the following is not a side effect of carbemazepine?a. ataxiab. drowsinessc. nystagmusd. insomniae. reduced sodium
insomnia
which of the following drugs following drugs will cause irritability and depression?A. sodium valproateB. carbamazepineC. lamotrigineD. levetiracetam
levetiracetam
describe 2 side effects from using zonisamide
cognitive problems and bowel upset
the urinary system will develop from the cloaca and the para-axial mesoderm - TF?
false - cloaca and the intermediate mesoderm
what arises form the intermediate mesoderm in the urinary system?
kidneys and ureters
the urogenital ridge forms 3 sets of tubular nephric structures - name them
pronephrosmetanephrosmesanephros
what is the most common cause of acute hepatitis in grampian?
hepatitis E infection (HEV)
name the 3 risk factors for NAFLD
obesitydiabeteshyperlipidaemiagenetics - PNPLA3hypertensionageethnicity
describe 2 tests which can be used for the diagnosis of NAFLD besides the following:1. US2.MR/CTAST/ALT ratio
- liver biopsy2. fibroscan3. cytokeratin -18MR spectroscopy (quantify fat)
what score on the glasgow criteria will suggest severe pancreatitis?
greater than or equal to 3
name 6/8 of the components of the glasgow criteria used to grade pancreatits
- urea2. calcium3. oxygen4. LDL5. AST6. albumin7. Blood glucose8. WCC
Name an inflammatory marker which is not on the glasgow criteria which however can be used as an indication of severe pancreatitis
CRP>150
describe 5 aspects in the management of acute pancreatitis
give oxygeninsulinNG tubeblood transfusionanalgesiaIV fluidsmonitor urine output
what are two management complications in the management of acute pancreatitis?
abscess - antibiotics and drainagepseudocyst - endocscopic drainage or surgery
name 4 sites of extra-intestinal manifestation of inflammatory bowel disease
joints - arthritiseyes - epislceritis, conjunctivitis and uveitiskidney - renal calculi (only in Crohns disease)skin - erythema nodosum, vasculitis and pyoderma gangrenomsumliver/biliary tree - sclerosing cholangitis, gall stones, fatty change and pericholangitis
name 6 extra-intestinal manifestations of IBD
renal calculierythema nodosumepiscleritisuveitisconjunctivitissclerosing cholangitisarthritis gall stonespyoderma gangrenosum
what are the common inflammatory indices of IBD?
ESR/CRPincreased WCC increased plateletslow haemoglobinlow albumin
acute angle closure glaucoma will present with severe pain - TF?
true
how may a patient with acute angle closure glaucoma present? name 4 things
severe painvomitingfixed/dilated pupilheadachepericorneal redness with no discharge
describe the redness in someone with a corneal ulcer
pericorneal redness
what are the 4 main investigations which can be carried out in a cholangiocarcinoma?
USS/EUSERCP/MRCPCT/MRPTCFDG-PETcytology and cholangioscopy
what are two treatment options for ampillary tumours?
endoscopic resectiontransduodenal excisionpncreatico-duodenectomy
describe the motor and sensory signs observed in a LMN lesion?
motor signs - weakness- decreased tone- absent reflexes- muscle wastingsensory - dermatomal pattern of weakness
which spinal artery will supply the motor tracts?
the anterior spinal artery
what is demyelinating myelitis?
pathological lesions of inflammation/demyelination leading to temporary neuronal dysfunction. it will affect the white matter ans lesions can be numerous
describe the treatment for NAFLD suggest 3 things other than weight reduction and exercise/diet
- diet, exercise and weight loss (may be surgical)2. insulin sensitizers (metformin and pioglitazone - thiazolidinedione)3. GLP-1 analogues such as liraglutide4. farnesoid X nuclear receptor ligand (obetocholic acid)5. vitamin E
suggest a treatment for autoimmune hepatitis
long termazathioprine
what is the difference in diagnosis between autoimmune hepatitis, primary biliary and primary sclerosing cholangitis?
autoimmune hepatitis will have autoantibodies ANA SMA and LKMI/SLA. autoimmune hepatitis will also have an elevated IgG levelprimary biliary cholangitis will have anti-mitochondrial antibodies as well as IgMprimary sclerosing cholangitis is found in association with IBD and will also have pANCA with MRCP
what are the two physiologically active thyroid hormones?
thyroxine and triiodothyronine
which will have an elevated IgM level:a. primary biliary cholangitisb. primary sclerosing cholangitisc. atuoimmune hepatitis
a - primary biliary cholangitis will be diagnosed with anti-mitochondrial antibodiesand IgM
where are the body’s main sources of tyrosine and iodine?
diet
what transporter will allow iodine to enter the follicular cells from the plasma?
sodium/iodine co-transporterthe iodine is taken up against a concentration gradient
what is the name of the protein that binds thyroxine and T3 inside the plasma?
thyroglobulin - thyroxine binding globulin
what are the two main cell types in the thyroid gland?
C cells - calcitonin productionfollicular cells - surround the colloid
what is the name of the enzyme that catalyses the reaction producing T4/T3 from iodide and tyrosine?
thyroperoxidase
which transporter is responsible for transporting the iodide into the colloid?
pendrin transports
suggest 4 investigations to carry out in the diagnosis of multiple slcerosis
- MRI (black holes or lesions)2. lumbar puncture - oligocloncal bands of IgG3. bloods - exclude other inflammatory conditions4. evoked potentials
optic neuritis is a good prognostic indicator for multiple sclerosis - TF?
trueoptic neuritis, being female, having a long interval between the first and second relapsesfew relapses for the first 5 years are all good prognostic indicators for multiple sclerosis
being male is a bad prognostic indicator for MS - TF?
trueold age, multifocal and motor signs/symptoms will all be bad prognostic indicators for mutiple sclerosis
how may a patient with hepatic encephalopathy present?
confusiontremor - asterixisfoetor hepaticusascites
what are 3 things that will precipitate hepatic encephalopathy?
infectionconstipationdrugsdehydrationGI bleedsSEDATION MEDICATION (pls remember for exam)
what is the typical presentation of a patient with cholestasis?
pale stoolshighly colourised urinepruritisjaundice
hepatocellular carcinoma is the most common liver cancer and is strongly associated with Hepatitis B and Hepatitis C infection. how may hepatocellular carcinoma present?
jaundicemass in abdomenbleeding from tumour - anaemia or haematemesis/malaena splenomegallypain weight lossdecompensation signs from the liver - ascites etc
what is the difference between using ERCP and MRCP?
ERCP will be used to visualise the pancreatic and biliary ducts. it has a higher complication rate than MRCP and has a mortality associated with it. it is also a risk factor for acute pancreatitisMRCP has intra and extraductal views and is associated with fewer complications however claustrophobia is an issue.MRCP also doesnt use radiation however ERCP can be used as a therapeutic option
what is the difference between lymphoma and leukaemia?
lymphoma is the proliferation of haematopoeitic cells maturing the lymphatic systemleukemia is the proliferation of haematopoeitic cells maturing inside the blood