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year 3 > Trafford block one notes > Flashcards

Trafford block one notes Flashcards

1
Q

What is Gamma GT?

A

a marker of hepatic obstruction, it is raised in alcohol abuse e.g every fresher has raised gamma GT

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2
Q

When do levels of ALP rise?

A

rises in hepatic obstruction but also in bone disorders. A

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3
Q

In what patient group is ALP physiologically high?

A

Children: transient hyperphosphatasmeia due to growth so higher osteoblast function. It is also higher in pregnant women in the third trimester

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4
Q

What symptoms indicate cholangitis e.g sepsis in biliary duct?

A

Biliary Colic right upper quadrant pain with associated jaundice and fever

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5
Q

Pain in pancreatitis starts from where and radiates to where?

A

severe epigastric pain that radiates to the back.

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6
Q

why is painless jaundice worrying?

A

Indicates liver or pancreatic cancer. Especially head of the pancreas

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7
Q

Two symptoms of portal hypertension

A

Splenomegaly and acites

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8
Q

Rise in ALT and AST greater than rise in Alk Phos?

A

hepatocellular damage

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9
Q

RISE in ALT and AST less than rise in Alk Phos?

A

obstructive cause

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10
Q

Is liver cancer usually primary or secondary?

A

secondary

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11
Q

test done in patients with painless obstructive jaundice over 40?

A

exclude carcinoma of head of the pancreas via imaging

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12
Q

What should you suspect if you can palpate the gall bladder, and is this common?

A

Very rare, you should suspect cholangiocarcinoma

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13
Q

What does a rise in ALP suggest?

A

Biliary tree pathology

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14
Q

What level of bilirubin do you need for jaundice?

A

50 or more

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15
Q

Haemolytic jaundice signs and symptoms

A

Liver function normal. Glucuronyl transferase is saturated. rise in unconjugated and conjugated bilirubin. Dark urine but no pale stools as there will still be bilirubin going into the GI tract

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16
Q

Hepatocellular jaundice.

A

Bilirubin fored at a normal rate but the liver can’t excrete it. e.g hepatitis, cirrosis, steatohepatitis. Unconjugated bilirubin increase. Small increase in conjugated possible. ALT will be greatly increased.

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17
Q

Jaundice in babies

A

Neonatal jaundice when bilirubin higher than 85 micromoles per letre. Happenes in 60% full term and 80% preterm. Due to slow glucuronyl transferase activation. Rise in unconjugated is normal. Rise in conjugated is pathological and always toxic, this is actually a sign of biliary tree obstruction.

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18
Q

What does itching, dark urine, pale stools and generally feeling unwell indicate? what would you find in biochemistry?

A

Obstructive jaundice, possibly cancer or gall stone. Rise in conjugated bilirubin, soluble so goes into urine, not going into GI tract so pale stools. ALP will be high

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19
Q

Next step if obstructive jaundice and high ALP?

A

MRCP

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20
Q

What aspects of history to focus on if hepatocellular damage is suspected?

A

Alcohol history, drugs, cigarettes and sexual history.

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21
Q

Jaundice examination:

A

Sclera, scratches for prurities (bile salts under skin cause itching), evidence of weight loss and troisiers node for cancer (left supraclavicular)

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22
Q

Hep A

A

Never chronic, faeco-oral spread

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23
Q

Difference between IgM and IgG

A

IgM in acute and IgG chronic

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24
Q

Info on Hep B:

A

Blood, sex, vertical transmition. Endemic in Africa and Asia. Increase risk of liver cancer. Prognosis determined by rate of fibrosis progression and viral turnover. Tests: Anti-C IgM for acute. Presence of HBsAg determines chronic.

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25
Q

Info on Hep C:

A

Blood borne. No immunisation is possible. 75% of patients become chronic. Treatment is interferon and ribavirin.

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26
Q

AST, ALT, CK and Troponins.

A

AST not specific to liver but ALT is. if CK is raised, then muscle damage could be the causes of raised AST. Troponins and raised AST: cardiac cause.

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27
Q

AST or ALT higher in acute hepatitis?

A

In acute hepatitis, ALT is higher.

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28
Q

is chronic cirrhosis which liver enzyme is higher?

A

AST is higher than ALT in chronic hepatic cirrhosis

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29
Q

What levels of ALT and AST suggest alcoholic cause of cirrhosis?

A

AST two times higher than ALT

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30
Q

how to differentiate between bone and biliary tree causes of high ALP?

A

when ALP is high, the presence of high GGT indicates biliary tree. Normally GGT but high ALP indicates bone pathology

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31
Q

When is ALP physiologically high?

A

Adolescence and third trimester of pregnancy

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32
Q

How do you treat paracetamol overdose?

A

Give N-acetyl cysteine

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33
Q

Normal ICP in adults

A

Less than 15 mmHg, over 20mmHg is pathological although transient elevations normal, e.g up to 75 mmHg when coughing

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34
Q

About ICP auto regulation

A

ICP will auto regulate within a range. Blood and CSP can get pushed out of the skull if space in the skull decreases e.g space occupying lesion. But if the pressure rises too much it will cause ICP to increase

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35
Q

Ways ICP can increase

A
  • Increase in brain, tissue or mass volume
  • Increase in CSF
  • Increase in blood volume - Raises arterial PCO2, venous obstruction, raised temp
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36
Q

Cerebral perfusion pressure

A

The important thing to keep the brain alive. it is mean arterial pressure - ICP. so if ICP rises, you need to increase arterial pressure to keep the brain perfused

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37
Q

Acute symptoms of high ICP

A

Low consciousness, high blood pressure, bradycardia

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38
Q

Some options for the acute management of increased ICP

A

Mannitol, hyperventilation, decompressive craniotomy, barbituate coma

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39
Q

What could a space occupying lesion be?

A

A tumour - benign, malignant or secondary.
Infection
Vascular
Hydrocephalus

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40
Q

Types of hydrocephalus

A
  • Non communicating
  • communicating
  • Overproduction
41
Q

Cause of non communicating hydrocephalus

A

Obstruction to CFS flow

42
Q

Cause of communicating hydrocephalus

A

problem with absorption of CFS

43
Q

Cause of overproduction of CSF

A

Choroid plexus papilloma

44
Q

Late effects of raised ICP

A

Bradycardia, hypertension, papilloedema, blurred vision, vomiting, headaches

45
Q

Commonest primary brain tumour

A

Glioma, non malignant

46
Q

What is Myocitis

A

Inflammation in the muscles

47
Q

What is Vasculitis?

A

Inflammation of the blood vessels, includes arteritis

48
Q

Mechanism of Meningitis rash

A

Inflammation of the blood vessels causing red blood cells to leak out.

49
Q

If someone has vasculitis what do you need to rule out?

A

Sepsis

50
Q

What is a negative inflammatory marker?

A

Goes down when inflammation is present

51
Q

What is a positive inflammatory marker?

A

Increases when inflammation is present

52
Q

Is Albumin a positive or a negative inflammatory marker?

A

Negative inflammatory marker, goes down in inflammation.

53
Q

What does a raised neutrophil count indicate?

A

Bacterial infection

54
Q

What does a raised lymphocyte count indicate?

A

Viral infection

55
Q

What does it mean if white blood cells are very low in someone with bad inflammation?

A

It is actually a very bad sign of things going very wrong

56
Q

Is haemoglobin a positive or negative marker for inflammation?

A

Negative marker and goes down in inflammation

57
Q

Are platelets a positive or negative marker for inflammation?

A

Positive

58
Q

Is ESR a positive or negative marker for inflammation?

A

Positive marker, goes up as there will be more proteins in the blood

59
Q

ESR in acute infections

A

Goes very high as IgM is very heavy

60
Q

What is IgA associated with?

A

digestive system

61
Q

What is IgE associated with?

A

Parasites and allergies

62
Q

What is temporal arteritis and what are the symptoms?

A

Inflammation in temporal arteries, feeds back to opthalmic arteries.

Symptoms - scalp tenderness, jaw tenderness, high ESR

63
Q

What type of joints does rheumatoid arthritis attack?

A

Synovial joints

64
Q

What joints in the hands does osteoarthritis attack?

A

Distal interphalangeal joints

65
Q

What joints in the hand does rheumatoid arthritis attack?

A

proximal interphalangeal joints and metacarpophalangeal joints

66
Q

Do trigger points in fibromyalgia line up with joint lines?

A

Nope, pain all over

67
Q

What does gout do to the skin?

A

Makes it go red

68
Q

signs of systemic sclerosis

A

THickening of skin and loss of wrinkles in skin.

69
Q

What does ‘discrete lesions’ mean?

A

patchy lesions

70
Q

What does confluent lesions mean?

A

Merged non patchy

71
Q

What do SGLT-2 inhibitors do?

A

Inhibits sodium-glucose co-transporters in the PCT. Causes glucosurea, main side effects is thrush and UTIs. Mild diuretic and reduces blood pressure. Rare side effect normal glycemic keto acidosis, blood sugars normal but ketones still produced as no insulin. SGLT-2 protects glomerulus.

72
Q

Diabetes with high blood glucose, ketones and acidosis

A

ketoacidosis

73
Q

What does GLP-1 do?

A

It’s an incritins, decreases blood glucose by increasing glucose dependent insulin secretion by B cells. This means there is no risk of hypos

74
Q

What breaks down GLP-1?

A

GLP-1 is broken down by DPP4

75
Q

Side effects of GLP-1?

A

Slows gastric emptying, promotes satiety and reduces appetite.

76
Q

What part of the nervous system controls the Levator palpebrae superioris?

A

Sympathetic nervous system. Causes lid lag in hyperthyroidism

77
Q

Conjunctval symptoms and oedema of extra-orbital tissue is specific to what endocrine disease?

A

Graves disease

78
Q

Characteristic of goitre in graves disease

A

Smooth large gland, it’s very vascular so you can hear a bruit

79
Q

What causes graves disease?

A

TSH receptor antibody

80
Q

What causes thyroiditis

A

TPO antibodies

81
Q

How do you treat hyperthyroidism?

A

B blockers for symptomatic release and carbimazole or PTU to treat the thyroid.

82
Q

Type of thyroid disease in pregnant woman?

A

Post partum thyroiditis involving TPO as there is a rebound increase in the immune system

83
Q

Types of thyroiditis?

A

Acute, sub acute which is painful with tender neck and chronic which is called as hashimotos

84
Q

Treatment for thyroid storm

A

Treated with beta blockers, cooling and hydrating

85
Q

types of thyroid nodules

A

multinodular, singular nodule, thyroid cancer

86
Q

If you’re taking blood gases from a patient who is hyper or hypo thermic what should you do?

A

Tell the lab as it would throw off your standard results

87
Q

Base excess in alkolotic patients

A

Base excess high

88
Q

Base excess in acidotic patients

A

Negative base excess

89
Q

Effect of asperin overdose on blood glasses

A

Metabolic acidosis but a more powerful respiratory alkalosis.

90
Q

How can DKA happen in T2DM?

A

reduced insulin and stress hormones

91
Q

What ketone can be in urine?

A

Acetoacetate

92
Q

What ketone can be in blood?

A

Beta hydroxyburyrate which causes respiratory compensation

93
Q

What ketone can be in breath?

A

Acetone

94
Q

Diagnosis of DKA

A

Ketonemia higher than three, glucose higher than 11 and diabetes

95
Q

Ion to give when DKA

A

give lots of potassium

96
Q

ECT changes in hyperkalemia

A

Prolonged QRS and tall T waves, long PR intervals

97
Q

ECT changes in hypokalemia

A

depressed ST segments and biphasic T waves

98
Q

What type of ketones to measure in DKA?

A

Blood ketones as more reliable

99
Q

What could a headache be a sign of when treating DKA in a young person?

A

Cerebral oedema

year 3 (26 decks)

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