yuefbhjwdshiujknvsdiohuewjkd Flashcards
investigation for bronchiectasis
High resolution CT
- tram tracking / signet ring sign
- bronchiole wider than neighbouring arteriole
what does lung malignancy cause
exudative pleural effusion ie protein >35
thrombolysis drug
alteplase
curb65 score >4
admit to hospital
tumour marker for HCC
alphafeto protein
transmural
crohns
reduced goblet cells
uc
rockall and ggow/blatchford
upper gi bleeding / pre-endoscopy
hepatic encephalopathy grade 3
somnolent but arousable
0- nothing wrong
1 - tired / mild confusion / disordered sleep
2 - lethargic / asterixis
4 - coma
anaemia associated with autoimmune diseases
pernicious
vitB12
complication of Barrett oesophagus
oesophageal adenocarcinoma
dry skin dry eyes itching jaundice extreme fatigue
anti mitochondrial antibodies +
PBC
women under 40yrs
1st 6 weeks tx for h pylori
amoxicillin clarithromycin and a PPI
if still present post 6 weeks then try metronidazole instead of clarithromycin
h pylori pre endoscopy
The patient should not have taken antibiotics or bismuth products for four weeks and no PPI for two weeks before H. Pylori diagnosis
prophylaxis for hepatic encephalopathy
lactulose
what populations are you likely to see wolf parkinson white
younger pop.
if someone has pleuritic chest pain 1-6 weeks after an MI what we thinking !?
dresslers !!!!
what is dresslers
secondary pericariditis post MI
pleuritic chest pain
low grade fever
worse when lying down
hepatitis most associated with IVDUs
C
trans-oesophageal echocardiogram - when to use diagnostically ?
anything wrong with heart valves ie infective endocarditis ALWAYS do a TOE
is anaphylaxis any good for IE
nopeeeeee just prophylactic antibiotics
features of rheumatic fever
polyartritis
chorea
subcutaneous nodules
erythema magnum
left circumflex artery affected ?
anteroseptal leads
ie V1-v4
sympathetic activity on the GI system
reduced GI blood flow ie fight or flight response - blood is redirected to more things like skeletal muscle
hirschsprungs disease
absence colonic innervation
-absent or defective intramural nerves
ie 1 month old baby not passing any stools for two weeks - bad constipation
most common cause of pre-hepatic jaundice
glucose-6-phosphate dehydrogenase deficiency
neonatal jaundice
sickle cell anaemia
gilberts
what is mainly responsible for the secretion of GIP (gastric inhibitory peptide)
presence of glucose in the duodenum
K cells secrete GIP
what are the functions of GIP
induces insulin release from beta cells in the endocrine pancreas
decreasing blood sugar levels (ie signal = glucose in the duodenum)
MoA of GIP
binds to a GPCR > ATP - cAMP > protein kinase A
does pyruvate > acetyl coa require o2
yeah bro if not it becomes lactate
enzyme required for pyruvate oxidation
pyruvate dehydrogenase
2 Co As are also required
by-products of pyruvate oxidation
two carbon dioxide molecules
two NADH+
which layer of the GI tract is responsible for peristalsis and segmentation
muscularis externa
how does the myenteric plexus work
auerbach’s
so food stuffs in the lumen will interact with epithelial cells and the cells can essentially tell if the food is in front of it or behind it ,
the cells signal the sensory neurones that connects the epithelial cells to the : ascending and descending neurone network in the muscularis externa
the sensory neurones trigger either :
ORAL
-the ascending neurones to cause contraction of the circular inner muscularis via Ach and Sub. P
-the descending neurones to cause relaxation of the outer longitudinal muscle via NO and VIP
ABORAL
the opposite essential ie Ach and Sub P redirected to longitudinal
parasympathetic action on GI tract
rest and digest
which cells in the intestinal crypts contain digestive enzymes
enterocytes
why does HF cause oedema then mate
reduced co
kidneys aren’t being perfused as well as they could be do can’t filter blood as well (ie increase of solutes etc in circulation)
this increases venous pressure
this increase hydrostatic pressure
this means that the pressure gradient needed for tissue fluid to be reabsorbed at the venue is decreased so lots of tissue fluid staying in the tissue
=oedema
is a VSD a cyanotic lesion
not initially
> pulmonary hypertension (eisenmenger’s)
what congenital defect is most common in people with Down’s Syndrome
VSD
what type of lesions is a PDA
ASD
how to calculate MEAN ARTERIAL PRESSURE not mapb
cardiac output x total peripheral resistance
chronic mechanism to compensate for HF
increase right atrial pressure
acute mechanisms to compensate for HF
increase sympathetic activity
in heart failure - excitation coupling is deranged by what ?
the upregulation of the sarcolemmal Na/Ca exchanger
In heart failure, the sarcolemmal Na+/Ca2+ exchanger is upregulated. The Na+/Ca2+ exchanger is located in the sarcolemma, acting to transport Na+ into cardiomyocytes and Ca2+ out of cardiomyocytes.
what does adrenaline act on IN THE HEART
b1
what effect does adrenaline have on the funny current
increases
obligate anaerobe
killed by oxygen
microaerophile
needs lower oxygen levels
facultative anaerobe
can grow in both absence and presence of oxygen
anaerobic bacilli gram +
clostridium bacilli
what abx to treat coliforms
gentamicin
associated with staph epidermis infection
foreign devices
the three bacteriostatic antibiotics
macrolides
tetracyclines
trimethoprim
4cs
co-amoxiclav
clindamycin
cephalosporins / ceftriaxone
ciprofloxacin
antibiotic resistance - CDE
change in gene to abx
destruction of abx
efflux pumps increase
when might FISH not be appropriate
looking for small chromosomal changes
Philadelphia chromosome
reciprocal translocation between 9 and 22
promoter mutation
no protein
missense mutation
different non-functioning protein
nonsense
short or absent protein
splice site mutation
abnormal or absent protein
peptide bond formation enzyme
peptidyl transferase
central dogma
DNA RNA protein
what direction does DNA grow
5 to 3
enzyme in TCA cycle
succinate dehydrogenase
TCA cycle net yield
ATP - 4 NADH - 10 FADH2 - 2 H+ - 10 CO2 - 6
role of pyruvate dehydrogenase
catalyses decarboxylation of pyruvate releasing carbon dioxide and producing H+ and NADH
ventricular fibrillation tx
electrical defibrillation
ventricular tachycardia tx
lignocaine / amiodarone
dc cardiovert
atrial fibrillation tx
beta blockers
atrial flutter tx
radio-frequency catheter ablation
