Stuff I can never remember Flashcards
Where are Fe, B12 and folate absorbed in the gut?
Iron first bro
So Fe in duodenum, folate in jejunum and B12 in ileum (terminal)
What is the acronym for crohns and what does it stand for?
- No blood or mucous
- Entire GI tract
- Skip lesions on endoscopy
- Terminal ileum + transmural inflammation
- Smoking (sets the nest on fire)
What is the acronym for UC and what does it stand for?
- Continuous inflammation
- Limited to colon and rectum
- Only superficial mucosa
- Smoking is protective
- Excrete blood and mucous
- Use aminosalicylates
- Primary sclerosing cholangitis
How is a remission of Crohns induced?
First line = steroids (oral prednisolone/ IV hydrocortisone)
How is remission of Crohns maintained?
Azathioprine (only if needed/ wanted)
How is remission induced in mild/ moderate UC?
- First = aminosalicylate
- Second = steroids
How is remission induced in severe UC?
- First = steroids (IV)
- Second = ciclosporin
How is remission of UC maintained?
- Aminosalicylate
- Azathioprine
Give an example of an aminosalicylate?
- Mesalazine
- Sulphasalazine
Side effects of steroids acronym and meaning?
- Cataracts
- Ulcers
- Striae/ skin thinning
- Hypertension/ hirsutism
- Immunosurpression
- Necrosis of femoral heads
- Glucose elevation
- Osteoporosis
- Impaired wound healing
- Depression/ mood changes/ diabetes
Where are muscarinic receptors 1, 2 and 3 found?
- 1 = Brain
- 2 = Heart
- 3 = Lungs
Where are adrenergic receptors found?
- Alpha 1 = vessels + sphincters (e.g. bladder)
- Alpha 2 = smooth muscle (mixed effects)
- Beta 1 = heart
- Beta 2 = lungs
- Beta 3 = adipose (cause lipolysis), bladder relaxation
What is the pre and post synaptic connections in parasympathetic neurones?
- Pre = nicotinic receptor
- Post = muscarinic receptor
What is the pre and post synaptic connections in sympathetic neurones?
- Pre = nicotinic
- Post = adrenergic receptor (except sweat glands = muscarinic receptor)
What is the pre and post synaptic connections in motor neurones?
NO pre synaptic
@ muscle = nicotinic receptor
What is the medication order for diabetes type 2?
- First = metformin
- Second/ third = sulfonylurea, pioglitazone, DPP-4 inhibitor, SGLT-2 inhibitor
- Then … insulin
What are some side effects of metformin?
- Lactic acidosis
- GI symptoms
Does not cause hypoglycaemia
Which diabetes medication increases glucose excretion in the urine?
SGLT-2 inhibitors (therefore increases the risk of UTIs)
What are the function of the first 6 interleukins?
Hot T-Bone** stEAK
* 1 = hot (fever)
* 2 = T cell stimulation
* 3 = bone marrow stimulation
* 4 = IgE production, B cell growth
* 5 = IgA production, eosinophils
* 6 = aKute inflammation
What are the 3 types of T cells?
- T - cytotoxic (CD8), interact with MHC1
- T - helper (CD4), interact with MHC2
Helper 1 = help cytotoxic T cells
Helper 2 = help B cells
What is the acronym for myeloma and what does it stand for?
- OLD people
- Calcium (high)
- Renal failure
- Anaemia
- Bone lesions/ pain
What feature is diagnostic of myeloma?
Bence jones proteins in urine
What are the two precursors of myeloma called?
Smouldering myeloma … then … MGUS (monoclonal gammopathy of undetermined significance)
What is smouldering myeloma with lots of IgM specifically called?
Waldenstroms macroglobulinaemia
What blood cancer causes gum infiltration?
AML
What is the key diagnostic feature in each blood cancer?
- AML = Auer rods
- CML = Philadelphia chromosome
- ALL = nothing really
- CLL = smudge cells
- Hodgkins lymphoma = reed Sternberg cells
What can CML and CLL progress to?
- CML –> AML
- CLL –> richter transformation to aggressive lymphoma
What ages are the leukaemia most common and which ones are most common in certain age groups?
- ALL = in kids
- AML, CML = in adults
- CLL = older people, most common OVERALL
Where does an atherosclerotic plaque form, and what is in it?
Intima/ media
* Lipids
* Smooth muscle
* Macrophages
* Foam cells
* Platelets
* Firboblasts
What are the stages of an atherosclerotic plaque formation?
- Fatty streak
- Lipid accumulation
- Platelet aggregation
- Fibrin mesh + RBC trapping
- Fibrous cap
Functions/ features of the immunoglobulins?
- G = most common in blood, can cross the placenta
- A = most common in body, found in mucosa
- M = acute, faster acting than G
- E = allergic responce, histamine release, parasite protection
- D = basophil activation, parasite defence?
Cancer of smooth and striated muscle names?
- Smooth = leiomyoma/ sarcoma
- Striated = rhabdomyoma/sarcoma
What are the symptoms of brown sequards syndrome and what tracts are involved?
- Ipsilateral = weakness, proprioception, vibration and fine touch (DCML and corticospinal)
- Contralateral = pain + temperature (spinothalamic)
Where does DCML and spinothalamic decussate?
- DCML = medulla oblongata
- Spinothalamic = after entering spinal cord
Causes of hyperthyroidism?
- Graves disease
- Inflammation (thyroiditis)
- Toxic multinodular goitre
- Solitary toxic thyroid nodule
What are 2 causes of thyroiditis?
- De Quervain’s (after infection)
- Hashimotos (autoimmune)
Genes associated with key diseases (HLA ones)?
- HLA-B27 = Seronegative arthropathies, IBD
- HLA-DR2 = SLE
- HLA-DR3 = autoimmune hepatitis, sjogrens, DMT1, SLE
- HLA-DR4 = RA, DMT1
- HLA-DQ2, DQ8 = coeliacs, DMT1
Medications used for parkinsons disease?
- Levodopa = for severe disease
- Dopamine agonists e.g. bromocryptine
- MOA-B inhibitors e.g. selegiline
Hereditary diseases and how they are inherited?
- Autosomal dominant = cardiomyopathies, colorectal cancer (FAP/ Lynch), Von hippel Lindau, hereditary spherocytosis, vWF disease, marfans, EDS, Alzheimers, frontotemporal, Huntington’s, Charcot Marie tooth,
- Autosomal recessive = thalassaemias, sickle cell, haemochromatosis, Wilsons, Gilberts, cystic fibrosis
- X-linked recessive = G6PDH, haemophilia, duschenne muscular dystrophy,
- X-linked dominant = nothing
- Co-dominant = A1ATD
What is a tumour in the apex of the lung that causes ptosis called?
Pancoast tumour –> Horner syndrome
What are the sepsis 6?
- 100% Oxygen
- IV fluids
- Blood cultures
- IV Abx
- Lactate measurement
- Monitor urine output
BUFALO
What is given for angina symptomatic relief?
- CCBs
- Beta blockers
- GTN spray
What are 3 locations kidney stones can become stuck?
- Pelviureteric junction
- Pelvic brim
- Vesicoureteric junction
Where is a biopsy taken from in coeliacs disease?
Duodenum
What are the first two blood tests done to investigate coeliacs?
- Total IgA
- Tissue transglutaminase IgA
Endomysial and IgG can be measured, but not first line
What are the two signs for meningitis and what do they show?
- Brudzinskis sign = neck flexion causes knee + hip flexion
- Kernig sign = knee + hip flexion causes pain/ neck flexion
What is the sign for pancreatic cancer and cholangiocarcinoma and what does it show?
Courvoisiers sign = painless jaundice + palpable gall bladder
What is the triad of symptoms for gall stones and their complications?
Charcot triad = RUQ pain + fever + jaundice
Biliary colic –> cholecystitis –> ascending cholangitis
What extra 2 symptoms can be added to charcots triad, what are they and what are these 5 called?
Reynolds pentad = charcot + hypotension + altered mental state
What is a sign for cholecystitis?
Murphies = pressing in RUQ when patient breaths in causes pain
What are 2 signs of acute pancreatitis?
- Cullen sign = periumbilical bruising
- Grey turners sign = flank bruising
What is the sign for cardiac tamponade?
Becks triad = hypotension, elevated JVP, muffled heart sounds
What are 3 signs for appendicitis?
- Rosvings sign = push on LLQ causes RLQ pain
- Psoas sign
- Obturator sign
What are two signs to do with the testicle?
- Phren’s sign = pain relief on elevation of testicle (suggestive of epididymitis)
- Cremesteric reflex loss = testicular torsion
What are two signs of hypoparathyroidism/ hypocalcaemia?
- Trousseau’s sign = wrist flex when BP cuff put on
- Chvosteks sign = facial nerve spasm when CN7 tapped over parotid gland
What is a sign suggestive of superior vena cava obstruction?
Pembertons sign = arms in air causes facial congestion (redness)
Can suggest lung tumour near apex of lung
What sign is suggestive of high intracranial pressure?
Cushing’s reflex = bradycardia + irregular breathing + hypertension/ large pulse pressure
What is a triad associated with meningitis?
Meningism triad = photophobia + neck stiffness + headache
What triad is associated with reactive arthritis?
Reiters triad = cant see (conjunctivitis), cant pee (urethritis), cant climb a tree (arthritis)
What triad is associated with MS?
Charcot neurological triad = nystagmus, intention tremor, staccato speech
What two triads are associated with asthma?
- Samters triad = asthma, aspirin sensitivity, nasal polyps
- Atopic triad = asthma, eczema, rhinitis
What triad is associated with a lung tumour near the apex?
Horners triad = ptosis, anhydrosis, miosis (all unilateral)
pacoast tumour
What triad of symptoms are associated with RCC?
Haematuria, flank pain, palpable abdo mass
What symptoms are associated with hypercalcaemia?
Stones, bones, groans, moans, thrones
What is a sign associated with duschennes muscular dystrophy?
Gowers sign = difficulty getting up/ climb up legs with hands
What are two signs associated with MS?
- Lhermittes sign = electric shock like sensation with neck flexion
- Uhthoffs phenomenon = worse after shower
Is CT scan used in dementia diagnosis?
No, but lumbar puncture, MRI, MMSE, confusions assessment are.
What test can be used to investigate ankylosing spondylitis?
Schober test
How can alcohol affect bones?
Causes osteoporosis (not osteomalacia)
What vasculitis is associated with pANCA and which with cANCA?
- Granulomatosis with polyangitis = cANCA
- Eosinophilic granulomatosis with polyangitis = pANCA
pANCA is also in UC and PSC
What deformity is associated with granulomatosis with polyangitis?
Saddle shaped nose
What does pagets disease cause a raise in?
ALP in increased
How is AKI staged?
1 to 3
* Stage 2 = creatinine 2-3 times baseline or urine <0.5 ml/kg/h for 12 or more hours or urine <0.3 ml/kg/h for 6 or more hours
What blood marker is raised in seminoma vs teratoma?
- Teratoma = alpha feto protein
- Seminoma = beta human chorionic gonadotropin
How is prostate cancer graded?
Gleason grading system
What is the first line investigation for acromegaly?
- Serum insulin like growth factor - 1
Then OGTT
What is the most common cause of liver cirrhosis?
Chronic alcohol abuse
