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1
Q

what are the three phases of gastric acid secretion

A

cephalic-which results in the production of gastric acid before food actually enters the stomach
gastric-most significant, initated by the presensce of food in the stomach cuased by stimulation of G cells
histamine-intestinal phase luminal distension plus the presence of amino acids and food in the duodenum stimulate acid production

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2
Q

what is gastric acid stimulated by

A

acetylcholine, gastin and histamine

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3
Q

what is gastric acid inhibited by

A

somatostatin-D cells
secretin-S cells
Cholecystokinin-I cells

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4
Q

what should be suspected in patients with coeliac who have been previously doing well but now now

A

t cell lymphoma

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5
Q

what is topical sprue and how is it treated

A

presents with chronic diarrhoea, weight loss and vitamin B 12 and folate deficiency, with stool examination negative for ova and parasities
mononuclear infiltration and less vilous atrophy throughtout the intestine
treatment is borad spectrum antibiotic like tetracyclin and folate supplementation

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6
Q

whipples disease describe and treatement

A

pas positive macrophage in lamina propria

double strength trimoxazole

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7
Q

what is murphs sign

A

hand placed over the RUQ and patient asked to breathe in, pain resulting from inflamed gallbladder striking the hand is serve enough to arrest the respiratory effort
sign of cholecystitis

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8
Q

what do chief cells secrete

A

pepsinogen

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9
Q

what do parietal cells secrete

A

HCL and intrinsic factor

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10
Q

how is persistalsis conducted

A

induced by the release of serotonin 5 HT from neuroendocrine cells in response to luminal distension
serotonin activates the HT4 receptors which in turn results in the activation of secretory neurons

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11
Q

describe the G protein receptor

A

extracellular NH2 and intracellular COOH
when no signalling present g protein alpha subunit binds toGDP, g protein alpha unit combines with and modifies activity of effector
agonist may dissociate from receptor but signalling can persist
to turn the signal off, alpha subunit acts as an enzyme (a GTPase) to hydrolyse GTP to GDP and Pi the signal is turned off
G protein alpha subunit recombines with the By subunit

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12
Q

why does temperature increase in infection

A

chemicals released from macrophages in response to infection or inflammation act as an endogenous pyrogen
endogenous pyrogens eg interleukins stimulate the release of Prostaglandins in the hypothalamus
prostaglandins act on the hypothalamic thermo-regulatory centre to reset the thermostat at the higher temperature

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13
Q

what are the classic combination of symotomr s with dyspepsia

A

epigastric burning pain
post prandial fullness
early satiety

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14
Q

what are the causes of dyspepsia

A

peptic ulcer disease
drugs esp NSAIDS and COX inhibitors
gastric cancer

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15
Q

what are the alarm symptoms

A 
anaemia 
loss of weight 
anorexia 
recent onset/progressive symptoms 
melaena/haematemesis 
swallowing difficulties
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16
Q

low caeruloplasm is typical of

A

wilsons disease

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17
Q

AMA postitve

A

PBC

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18
Q

ANA or anti smooth muscle antibody positive

A

autoimmune hepatitis

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19
Q

describe HBPM

A

2 consecutive measurements while seated, 1 min apart record twice daily for 4-7 dyas, discard the 1st day readings, use average to diagnose hypertension

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20
Q

describe ABPM

A

2 measurements per hour for 14 hours

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21
Q

what type of diplopia do you get with a cranial nerve 4 palsy

A

vertical diplopia

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22
Q

what kind of diplopia do you get with a cranial nerve VI palsy

A

horizontal diplopia

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23
Q

where is the trachea palpated

A

in the jugular notch

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24
Q

what is the treatment of a PE

A

correct hypotension with fluids can give morphine give LMWH heparin and warfarin, stop the LMWH when INR>2 and continue warfarin for a minimum of 3 months

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25
Q

treatment of pneumothorax

A

for a non tension pneumothorax- aspirate in the midclavicular 2nd intercostal space, infiltrate with lidocaine down the pleura
insert a 16G cannula into the pleural space, remove needle and connect canulla to 3 way tap
CXR to confirm resolution of the pnuemothorax

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26
Q

treatement of tension pneumothorax

A

do not delay for a CXR
trachea will be deviated away from the affected side
insert a large bore cannula with a syringe, partially filled with saline into the 2nd intercostal space in the midclavicular line on the side of the pneumothorax, remove plunger to allow tapped air to bubble through the syringe
then insert a chest drain

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27
Q

treatment of an aute exacerabation of COPD

A 
isoap
ipratropium nebulised 
salbutamol nebulised-5ml
oxygen-28% on a venturi mask, check ABGs
start antibiotics 
prednisolone+9*******
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28
Q

what does S1 signify

A

the closure of mitral and tricuspid valves

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29
Q

what does S2 signify

A

closure of the aortic and pulmonary valve

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30
Q

when is s1 loud

A

mitral stenosis

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31
Q

what is s3

A

diastolic filling of the ventricle

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32
Q

when is s3 heard

A

in left ventricular ventricular failure eg dilated cardiomyopathy, constrictive pericarditis and mitral regurgitation

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33
Q

when is s4 heard

A

in aortic stenosis, HOCM and hypertension

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34
Q

what tuning fork is used for rinnies and webers test

A

512 Hz

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35
Q

what is rinnies postitve

A

normal hearing

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36
Q

what is laryngotracheobronchitis

A

croup

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37
Q

how does a thyroglossal cyst move

A

when sticking out the tongue

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38
Q

how does a dermoid cyst move

A

it doesn’t move

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39
Q

what is the most common cause of a third nerve palsy

A

aneurysm in the posterior communicating artery

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40
Q

what type of drug is acetazolamide

A

a carbonic anhydrase inhibitor

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41
Q

what should you ask in conjunctivitis

A

anything like this before-thinking allergic, and do they have hayfever or asthma
also ask sexual history if think chlamydia

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42
Q

describe the appearance of the pupil in anterior uveitis

A

small and irregular pupil, hypopyon, sero negative arthropathy HLA B27

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43
Q

what is the treatment of anterior uveitis

A

topical steroids and topical mydiatic

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44
Q

which part of the lung does adenocarcinoma tend to affect

A

the periphery

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45
Q

what is the tumour marker for adenocarcinoma

A

TTF1

46
Q

what therapies can be used for adenocarcinoma

A

its a non small cell cancer so preferably surgical excision but if that’s not possible then targeted therapy-crizotinib=effective in tumours with fusions involving ALK or ROS1
gefitinib, enotinib and afatinib are used for those with mutations in EGFR

47
Q

how is a SVT treated

A

acute management-vagal manoeuvres eg Valsalva manoeuvre

Iv adenosine 6mg-12mg, contraindicated in astmatics |(give verapamil instead)

48
Q

how do you remember bundle branches

A

William Morrow

49
Q

what does a right bundle branch show on ECG

A

M in V1

50
Q

what are the causes of a right bundle branch block

A

normal variant more common with increasing age
right ventricular hypertrophy
chronically increase right ventricular pressure eg, cor pulmonale, PE, MI, ASD, cardiomyopathy or myocarditis

51
Q

what is 1st degree heart block

A

Pr interval is >0.2 seconds

52
Q

what is 2nd degree heart block

A

increased PR interval until a dropped beat occurs

type 2=PR is constant but P wave is often not followed by a QRS complex

53
Q

what is 3rd degree heart block

A

no association between P waves and QRS complexes

54
Q

what are the symptoms of ankylosing spondylitis

A

pain in the joints or back which may be insidious in onset over weeks or months
pain gets better with exercise
the pain and stiffness is worse in the morning and at night, patient may be woken in the night due to pain

55
Q

what metabolic disturbance can be caused by SIADH

A

hyponatraemia

56
Q

treatment of SIADH

A

establish the underlying cause and remove if possible
acutely treat with hypertonic 3% saline given via a continuous effusion
loop diuretics to treat the fluid overload

57
Q

where do loop diuretics act

A

in the ascending limb of the loop of henle

58
Q

where do thiazide diuretics act

A

in the distal convoluted tubule

59
Q

what metabolic changes do loop diuretics cause

A 
hypokalaemia 
metabolic alkalosis 
hypovolaemia and hypotension 
depeletion in calcium and magnesium 
hyperuricaemia-gout
60
Q

how can thiazides be used in renal stones

A

they reduce the urinary excretion of calcium and discourage stone formation

61
Q

what electrolyte change do you get in loop but not thiazide

A

loop diuretics cause hypocalcaemia but thiazides don’t cause hypocalcaemia

62
Q

what type of hormone is aldosterone

A

steroid hormone

63
Q

what does aldosterone do

A

increase the synthesis of Na/k ATPase on basolateral membrane
increase synthesis of a protein that activate the epithelial Na channel -ENAC

64
Q

what type of receptor does ADH act on

A

G protein coupled receptor to increase the number of h20 channels (aquaporins in the cell membrane)

65
Q

how do amiloride and triamterene work

A

they block luminal sodium channels in the collecting tubules
enter the nephron via OCT in the proximal tubule
triamtere is well absorbed from the GI tract, absorption of amiloride is poor

66
Q

when are aldosterone antagonists used

A 
in the treatment of heart failure, primary hyperaldosteronism-conns syndrome
resistant essential hypertension 
secondary hyperaldosteronism (due to hepatic cirrhosis with ascites)
67
Q

which disease states produce oedema

A

increase in plasma capillary pressure or decrease in interstitial oncotic pressure

68
Q

which lymph nodes does testicular cancer spread to

A

para-aortic lymph nodes

69
Q

how are humeral shaft fractures most commoly treated

A

non operatively with a functional brace

70
Q

how are fractures dislocations of the surgical neck treated

A

ORIF

71
Q

how is an olecranon fracture treated

A

ORIF to restore triceps function and restore the articular surface

72
Q

what way do elbows normally dislocate

A

posteriorly

73
Q

how are elbow dislocations treated

A

most occur in the posterior direction after FOOSH
uncomplicated dislocations require closed reduction under sedation assessing neurovascular status pre and post reduction, a short period in sling 1-3 weeks followed by elbow exercises

74
Q

what is a late complication fracture of colles

A

rupture of extensor pollicis longus which usually requires a tendon transfer

75
Q

what are the order of the carpal bones

A

proximal row scaphoid, lunate, triquetrum, pisiform

distal row, trapezium, trapezoid, capitate hamate

76
Q

the scaphoid is at the base of the fingers/thumb?

A

at the base of the thumb

77
Q

where does the common extensor mechanism arise from

A

the lateral epicondyle

78
Q

where does the common flexor origin originate from

A

the medial epicondyle

79
Q

when are undisplaced spiral fractures of the tibia common

A

in toddlers

80
Q

what are the potential complications of a supracondylar fracture

A

can get tear/entrapment of the brachial artery which can mean no radial pulse
can get compression of median nerve
if untreated can lead to volkmanns contracture

81
Q

what is volkmanns contracture

A

permanent flexion contracture of the hand at the wrist, resulting in claw like deformity of the hands and fingers, passive extension of fingers is restricted and painful
any fracture in the elbow region or upper arm can lead to it but closely associated with supracondylar fracture of the elbow
results from acute ischamia and necrosis of the flexor muscles of the arm
FLEXOR DIGITORUM PROFUNDUS
FLEXOR POLLICIS LONGUS
its a form of compartment syndrome

82
Q

significant valgus stress can cause what

A

MCL injury, ACL rupture, fracture of the lateral condyles and tear of the lateral meniscus

83
Q

what is pseudo pseudo hypoparathyroidiism

A 
genetic defect of g protein alpha subunit GNASI 
low calcium but PTH elevated 
bone abnormalities (Mccune Albright) 
obesity 
subcutaneous calcification 
learning disability
brachydactly (4th metacarpal)
84
Q

what is calcitonin release triggered by

A

gastrin or high plasma calcium levels

85
Q

what is spondylolisthesis

A

slippage of one vertebrae over another

86
Q

when does spondylolisthesis usually present

A

in adolescence due to increased body weight and increased sporting activity

87
Q

what is the cause of spondylolisthesis

A

can be due to spondylosis

88
Q

what test can be done to assess for chronic pancreatitis

A

pancreatic elastase

89
Q

test for steatorrhoea and recent travel

A

OGD and duodenum biopsy

90
Q

what stage in development do the lobar bronchi form

A

embryonic

91
Q

what stage do the terminal sacs form with capillaries associated with them

A

saccular

92
Q

what stage of 16 generations of branching give rise to terminal bronchioles

A

pesudoglandular

93
Q

which stage in development of the lungs continues into early childhood

A

alveoloar

94
Q

what happens in the cannalicular stage

A

bronchioles and alveolar ducts form

95
Q

how is the pulse in shock

A

fast due to sympathetic response to low blood volume

96
Q

which influenze virus causes pandemics

A

influenza A

97
Q

how is FVC, FEVI and fev1/fvc ration affected in asthma

A

the FVC is normal the FEV1 is reduced the FEV1/FVC ration is reduced and the PEF is reduced

98
Q

what does increasing skeletal muscle activity do to venous return

A

increases it

99
Q

describe gram positive organisms

A

thick layer of peptidoglycan that stains PURPLE with gram stain as well as a phospholipid bilayer
endotoxin is part of the gram negative cell wall and the cell wall doesn’t carry genes for antibiotic resistance

100
Q

st elevation in v2-v5

A

anterior

101
Q

st elevation in v1-v3

A

anteroseptal

102
Q

st elevation in v4-6, 1 and AVL

A

anterolateral

103
Q

what is the cell change in GORD

A

metaplasia of squamous epithelium to columnar epithelium

104
Q

what is barretts oesophagus

A

uncontrolled proliferation of mucous glands in the lower 1/3rd of oesophagus

105
Q

what is brutons agammmaglobulinaemia

A

X linked primary immunodeficiency disease with absence of IgG, usually presents in young children with pulmonary and other bacterial sinopulmonary infections

106
Q

what does terlipressin do

A

it can improve renal flow, it is a vasoactive drug used in the management of low BP and hepatorenal syndrome

107
Q

what does lysozyme do

A

destroys bacterial cell wall

108
Q

what does lactoferrin and transferring do

A

gram postitive bacteria

109
Q

tear lipids function

A

antibacterial to cell membrnaes/scavengers products

110
Q

what is the function of sebaceous glands

A

they maintain the skin barrier

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