todays questions Flashcards
Both ALP and GGT are elevated
Bile duct disease, liver
Liver function biomarker most raised in post-hepatic jaundice
ALP
Reticulonodular shadowing in lower lobe
Mycoplasma
Muscles used in forced expiration
Internal intercostals
Stimulates action of central chemoreceptors
Hydrogen ions
Reduced levels of G6PD effect on rbcs
More susceptible to stress, more haemolysis
Franky starlingy lawwwwww
As EDV increases, SV increases
Axes of FS curve
Y SV and X EDV
Y Save Very much when you can eXpend on EDVentures
Normal ejection fraction
60%
GLP-1 affect on pancreas
Stimulates insulin synthesis from b cells
Increases somatostatin increase in D cells
GLP-1 and GLP-2 released from
Enteroendocrine L cells
Reversal drug for digoxin
Digibind
Electrolyte imbalance that exacerbates digoxin toxicity
Hypokalaemia
Reduced transient Ca(2+) in heart
Reduced contractile force
Left ventricular ejection =
SV / EDV
ACE inhibitors SEs
Cough obvs
Angioedema
Hypotension
Hyperkalaemia
Sudden decrease in perfusion triggers
Vasodilation
Furosemide
LOOP diuretic
How does fuosemide treat heart failure
Increased water excretion and salt by kidneys and peripheral vasodilation
Most common HAP causes
Pseudomonas aeruginosa, staph aureus and enterobacteria
Dullness to percussion
Pneumonia
Pleural rub
Pneumonia
Bronchial beathing
Pneumonia
Increased vocal resonance
Pneumonia
Urine investigations in pneumonia
Legionella or pneumococcal
Cephalic phase of acid secretion
Vagal stimulation of chief, parietal and ECL cells
Inhibiting bile acid reuptake reduces
Rate of bile acid production by liver
Parietal cells action
In fundus and body of stomach, secrete HCL (gastric acid duh) using H+/K+ ATPase pump
PPIs inhibit
H+/K+ ATPase pump used by parietal cells
Profuse vomiting effect on ABGs
Metabolic Alkalosis
Your anus sphincter is under the control offffff
Somatic innervation
2 forms of vitamin K
Phylloquinone ( Diet)
Menaquinones ( Gut bacteria )
Clotting factor 2
Prothrombin
Trypsin responsible for
Protein digestion - released by pancreas will give you that one for free ;)
Brunner’s gland
Provide alkaline mucous to neutralise chyme from stomach
Enterogastric reflex
Stimulated by distension of SI by presence of chyme - stops vagal stimulation and gastric acid secretion
Incretin ( GIP ) release triggered by
eating a meal containing glucose
Pernicious anaemia
Parietal cells undergo autoimmune destruction
Loop diuretics inhibit
Na -K-Cl cotransporters
Why does ramipril cause dry cough
Increases bradykinin levels
Amiodarone
Potassium-channel blocker, class III anti-arrhythmic
Amlodipine and amiodarone
Ones a CCB and ones a K channel blocker silly fresher
PPAR? receptor
Nuclear receptor that increases transcription of genes for lipoprotein lipase, increasing LDL uptake and reducing levels in blood
Fibrates action
decrease serum triglycerides
Statins mechanism of action
Competitive HMG-CoA reductase inhbitor
Process of atherosclerosis
1 - Endothelial destruction - altered NO synthesis
2 - Cell injury - adhesion molecules expressed
3 - Foam cell formation - LDL oxidised and taken up by macrophages - foam cells
4 - Foam cell fatty streak
5 - Smooth muscle proliferation and connective tissue deposition
6 - Plaque rupture
HMG-coA reductase reductase
Catalyzes conversion of HMG to mevanolic acid (rate-limiting) Competitively inhibited by statins
Na-K-l cotransporters location
Thick ascending limb of the loop of henle
Digoxin
Increases vagal outflow and has a negative chronotropic effect on the heart
Inotropic
Force of contraction
Chronotropic
Change in rate
Cardiac glycosides
Inhibit Na/K ATPase pump, increasing intracellular sodium
Rhabdomyolysis
Breakdown of skeletal muscle
Foam cells
Macrophages that have absorbed LDL
Test that should be done before putting patient on a statin
LFTs
Asthma patients should not be prescribed
NON SELECTIVE beta blockers such as Propanolol
Aldosterone
Mineralocorticoid
Spironolactone
Mineralocorticoid antagonist
Mineralocorticoids produced in
zona glomerulosa of adrenal cortex
How much water is reabsorbed in SI?
90%
How much water is reabsorbed in Li
10%
Anterior structure to pancreas
Stomach
Erythema nodosum
Sarcoidosis and IBD and TB legit anything babes
Sheep exposure
Coxiella Burnetii
Small cell lung cancer produces
ADH and ACTH
Squamous cell lung cancer produces
PTH
Respiratory syncytial virus causes
Rotavirus
Why do you get increased mucus cell in chronic bronchitis?
Increased goblet cell numbers
Asthma pyramid
SABA - Inhaled steroid -Theophylline/Leukotriene antagonist/LABA - Oral steroid
Faecal calprotectin
A protein found in stool during intestinal intestinal inflammation
How can H pylori lead to duodenal ulceration?????
Well chronic antral gastritis cause hypergastrinaemia due to gastrin release from antral G cells
Peptic ulcer
Break in superficial epithelial cells penetrating down to muscularis mucosa
Diagnosis of H.Pylori
Stool antigen test/C-Urea breath test, patient shoulda had no PPIs for 2 weeks and nooo antibiotics for 4
5 receptors of the chemoreceptor trigger zone
5-HT, H1, Muscarinic, D2, Substance P
Causes of upper GI haemorrhage
G+D ulcers, haemorrhagic gastropathy and erosions, gastric and oesophageal varices, mallory-weiss, reflux oesophagitis, gastric carcinoma
Acute diarrhoea
Less than 14 days
Chronic diarrhoea
30 + days
Diagnosing IBS
Last 3 months, at last 1 day per week recurrent abdominal pain with 2 or more:
- w/ pooping
- change in frequency of stool
- change in form of stool
Action of sodium cromoglicate
Prevents histamine release from mast cells
Dihydropiridine calcium channel antagonists
Amlodipine and nifedipine, act preferentially on vascular smooth muscle. Typically used as anti-hypertensive not antiarrhythmic
Dihydropiridine calcium channel antagonists
Amlodipine and nifedipine, act preferentially on vascular smooth muscle. Typically used as anti-hypertensive not antiarrhythmic
Verapamil
Phenylalkylamine + more active on calcium channels in cardiac tissue
Flecainide
Class I anti-arrhythmic
Funny (notsofunny) current
Mixed sodium and potassium current activated by hyperpolarisation
Central chemoreceptors dorsal or ventral medulla
Ventrl
PPI mechanism of action
Irreversibly blocks H+K+-ATPase in parietal cells
Acute abdomen pain
Observations Analysis Oxygen Fluids Nausea + pain - Bloods + amylase, ABGs, radiology, AXR and CXR, CT
Perianal disease
Crohn’s
Stenosis formation
- Endothelial dysfunction triggered by smoking, hypertension or hyperglycaemia.
- Pro-inflammatory, pro-oxidant, proliferative changes in the endothelium.
- Fatty infiltration of the subendothelial space by low-density lipoprotein (LDL).
- Macrophages phagocytose oxidised low-density lipoprotein.
- Smooth muscle proliferation and migration from the tunica media into the intima.
Secretory diarrhoea
Transformation of absorptive gut to secretive gut
Rhabdomyolysis
Breakdown of muscle due to direct or indirect muscle injury
Caseating granuloma
TB
Increased goblet cells
Crohns
Non-caseating granuloma
Crohn s
Endothelin
Potent vasoCONSTRICTOR
Mitral regurgitation 2-7 days post MI
Rupture of papillary muscle
Hypokalaemia riddle thing
You have no pot and no T but a long PR and a long QT
S4
Atria contracting forcefully in an effort to overcome an abnormally stiff ventricle
Hesselbach’s triangle
Direct hernias pass through:
Superolateral - epigastric vessels, medial - lateral edge of rectus muscle and Inferiorly - Inguinal ligament
Cholecystitis vs cholangitis
Cholecystitis = Inflammation of gallbladder Cholangitis = Inflammation of bile duct system - charcot's - fever, jaundice and RUQ
Tetralogy of Fallot
Pulmonary stenosis, RVH, VSD and overriding aorta
AAA screening
Offered to men from 65th birthday, positive is d>3cm, 3-4.4 is annual surveillance and 4.5-5.4 is 3 monthly surveillance, 5.5+ urgent referral
Virchow’s triad
Endothelial injury, hypercoagulability and blood stasis