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MET2 Revision5 Flashcards

1
Q

Which of the following is hepato-renal recess?

A
B
C
D
E
F

A

Which of the following is hepato-renal recess?

A
B
C
D
E
F

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2
Q

Label A-E

A

A: Right triangular ligament
B: Posterior coronary ligament
C: Left triangular ligament
D: Falciform ligament
E: Anterior coronary ligament

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3
Q

Which of the following is the ligamentum venosum ?

A
B
C
D
E
F

A

Which of the following is the ligamentum venosum ?

A
B
C
D
E
F

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4
Q

Label A-C

A

A: Ligamentum venosum
B: Falciform ligament
C: Round ligament of the liver/ Ligamentum teres

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5
Q

At what vertebral level do the two common iliac veins unite to form the inferior vena cava?

L2
L5
T5
T8

A

At what vertebral level do the two common iliac veins unite to form the inferior vena cava?

L2
L5
T5
T8

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6
Q

Which of the following is not a tributary to the splenic vein?

Short gastric veins
Pancreatic veins
Left gastric vein
Left gastro-omental vein

A

Which of the following is not a tributary to the splenic vein?

Short gastric veins
Pancreatic veins
Left gastric vein
Left gastro-omental vein

The left gastric vein is a tributary of the portal vein.

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7
Q

What does this CT show?

A

Ascites

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8
Q

Explain mech. of portal htn causing ascites

A
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9
Q

Why does hepatic portal HTN cause splenomegaly? [1]

A

increased HPV pressure causes blood to back up into spleen causing enlargement

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10
Q
A

A: cystic duct
B: common hepatic duct
C: Right hepatic duct
D: Left hepatic duct
E: Common bile duct

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11
Q

Gall stones in gall bladder causes which symptoms? [1]

A

often asymptomatic

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12
Q

Why does jaundice occur if gall stone occurs in common bile duct?

A

Stone blocks bile leaving the gall bladder and the Liver.

So bilirubin in bile is not able to be broken down

accumulates in blood causing jaundice and biliary colic.

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13
Q

What symptoms would occur here? [3]

A

biliary colic, jaundice and pancreatitis

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14
Q

Portosystemic Anastomoses at the Esophagus is made from? [2]

A

splenic (HPV) and azygous veins (IVC)

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15
Q

Caput meduase is caused by htn in anastomoses in which two veins?

A

Paraumbilical veins (ligamentum teres recanalised)

Intercostal and inferior epigastric veins

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16
Q

Label A-F

A

A: splenic artery
B: gastroduodenal artery
C: hepatic artery proper
D: SMA
E: SMV
F: Hepatic portal vein

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17
Q

Label A-C

A

A: Coronary Ligament
B: Right Triangular Ligament
C: Left triangular Ligament

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18
Q

What is the chemical name for active form of thyroid hormone?

What is the chemical name for inactive form of thyroid hormone?

A

Liothyronine (T3)
Thyroxine (T4)

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19
Q

Branchial pouch embryology:

Pouch = endodermal outpouching of pharynx

Which pouch made the inferior parathryoid and thymus? [1]
Which pouch made the superior parathryoid and ultimobranchial body? [1]

A

Pouch 3 - inferior parathyroid and thymus
Pouch 4 - superior parathyroid and ultimobranchial body
Ultimobranchial body - C-cells

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20
Q

Where does the thryoid originate? [1]

What duct does it move down to get to perm position? [1]

A

Thyroid originates from foramen cecum

Travels along thyroglossal duct. to cricoid cartilage

Normally thyroglossal duct disappears but in some it can remain: contains thyroid tissue

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21
Q

Thyroid follicle cell:

What receptors does it contain and what do they transport?

MoA of how is T4 / T3 made/

A

NIS - Na/I symporter - transports 1 iodine with 2 Na+ into the cell.

PDS - transports iodine out of the cell into the colloid.

DUOX2 creates iodine oxidising agent: H2O2 outside of cell

TPO oxidises the iodine with H2O2. Allows it bind it to Tyroglobulin (is produced in the golgi apparatus of the cell and is iodonated)

Tyroglobulin is taken back into the follicular cell. Decomposed to produce T3 and T4 (~80%), which is released into the blood stream/colloid.

IYD - A means of recycling iodide – iodotyrosine dehalogenase 1

TSHR – receptor for thyroid stimulating hormone

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22
Q

describe the -ve feedback loop of thyroid hormone production

A

-ve feedback loop:

  • Hypothalamus releases TRH
  • TRH stimulates release of TSH in AP
  • TSH stimulates release of T4 / T3 from thyroid
  • As T4 rises it suppresses TRH and TSH production
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23
Q

How is T3 transported around the body? [3]

A

Predominately via Thyroid Binding Globulin

Also by albumin and transthyretin

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24
Q

Why are pregnant people in a hypothryoid state?

A

In pregnancy: the level of oestrogen increases: increases sialylation of TBG (increases the half life) so it is cleared slowly from plasma: less free thyroid hormone

25
T4 -> T3 (activation) of free TH: What are the effect of Deiodinase enzymes: D1 & D2? [1] D3 [1] Why is this important?
D1 & 2: convert **T4 -> T3 - activation** D3: D3 -> **inactivates** **T4 to rT3** Important because **another level of control** - expression of deiodonase enzymes: these enzymes will be up/down regulated at certain times to increase/decrease metabolism.
26
* Learn * What is main control of thyroid hormone? [1] What are 3 ways body can locally control thyroid hormone? [3]
**Main control:** * Main neg. feedback control. HPT axis. **Local control:** * Transporter expression MCT, OATP * Deiodinase enzymes up/down reg * Thyroid hormone receptor expression.
27
What effects does hyperthyroidism have on cardiovascular system? [5]
**Hyper metabolic state**: need to dissipate the excess heat TH increases **α- to β- myosin ratio** so **positive inotropic effect** **Increased NO**: decreased peripheral resistance Widened pulse pressure! Palpitations are **subjective increase in force or increased pulse** 20% toxic patients have AF
28
Hyperthyroidism: [] insulin turnover [] gluconeogenesis [] insulin secretion
**Increased** insulin turnover **Increased** gluconeogenesis **Reduced** insulin secretion
29
Hyperthyrodism: Weight [] and [] Protein and lipid [] Heat []
Hyperthyrodism: Weight loss and myopathy Protein and lipid degradation Heat intolerance
30
Hyperthyroidism: Effect on Nervous System? [3] Effect on skin [3] Effect on eyes? [1]
Hyperthyroidism: **Effect on Nervous System? [3]** * Increased risk of seizures * Nervousness/tremor. * Hyperphagia - increased hunger **Effect on skin [3]** * Warm and moist - due to vasodilation + heat loss. * 'Plumber's' nails. Or soft and crumbling nails - **acropachy** * Pretibial myxoedema inflammation over the tibia. **Effect on eyes? [1]** * Eyelid retraction and eyelid drag.
31
Hyperthyroidism Effect on GI tract? [4] Effect on bones? [3] Haematological effect [2] Effect on reproductive system [3]
Hyperthyroidism **Effect on GI tract? [4]** * Increased appetite * Weight loss * Increased gut motility * Increased liver enzymes - transaminitis. **Effect on bones? [3]** * * Accelerated osteoclast activity - to provide substrates for metabolism. * Hypercalcemia * **Osteoporosis** - in the long term. **Haematological effect [2]** * Pernicious anaemia - coincidental, autoimmune. * **B12 deficiency** **Effect on reproductive system [2]** * Periods stop (oligomenorrhoea) * Gynecomastia (man boobs) * Erectile dysfunction.
32
What is Hashimoto's disease caused by? [1] What is the characteristics of it? [1]
TPO antibodys present **Autoimmune destruction of thyroid gland**: * **transient hyperthyroidism** as stores of TH are released. * Then **hypothyroidism** **follows**.
33
What is pathophysiology of graves disease? [2]
**Antibodies** bind to and **stimulate** **TSHR**. Causes **hyperthyroidism**.
34
Why does graves disease cause this symptom? [2]
* **Fibrocytes** behind the eye expresses **TSH receptors** * **TSHR** **stimulated**, causing **inflammation** behind the eye -> **pushes eyeball forward** -> ***proptosis + lid retraction***.
35
What are 3 risk factors for graves disease? [3]
**HLA status** - TH17 led autoimmune response Trigger: ** infection, neck trauma, stress** **Female stress** - 1-2% of women. Because connected to X- chromosome.
36
What causes Toxic Multinodular Goitre? [1]
Somatic TSHR mutation: Thyroid always on
37
What is toxic adenoma? [1] How can you diagnose? [1] How do you treat? [1]
**One nodule** of T (where the tumour is) becomes **hyperactive** and the **rest of the gland becomes inactive**. Diagnosed by **ingesting iodine 123** and using gamma camera imaging - will see one area lit up by gamma emitting iodine- 123. Can **treat** with **iodine-131** - emits b-particles to destroy overactive nodules - used in toxic adenoma and thyroid cancer.
38
What findings would you find for thyrotoxicosis: - T4 / T3 [1] - TSH [1] What treatment would you find for thyrotoxicosis [3]
**Findings**: * Elevated T4 and T3 * Suppressed TSH * Technetium or iodine uptake scans **Treatment**: * Thionamide drugs: **Propylthiouracil; Carbimazole** * Radioactive Iodine I-131 * Thyroidectomy
39
Hypothyroidism effects on: Skin [2] CV [4] GI tract [3]
**Skin [1]** * myxoedema * Accumulation of hyaluronic action -> yellowing. Hair falls our and becomes thin. **CV [4]** * Stroke volume reduces * Cold/reduced circulation * Sinus bradykinin. * J-waves on ECG due to hypothermia. * LDL cholesterol rises. **GI tract [3]** * Reduced appetite * Constipation * Weight increases (fat - due to reduced metabolic rate - and fluid retention).
40
Hypothyroidism effects on: NS [4] Blood and renal system: [3] Reproduction [3]
**On nervous system:** [4] * Impaired foetal brain development -> mental retardation in children. * Dementia * Slow relaxing reflexes * Growth retardation. **Blood and renal system: [3]** * Reduced GFR * Mild hyponatraemia * Variety of anaemias **Reproduction [3]** * Reduced libido * delayed puberty * erectile dysfunction
41
Hypothyroidism on base metabolic rate and GLUT 4 stimulation? [2]
Reduced base metabolic rate & decreased GLUT4 stimulation.
42
Causes of hypothyroidism? [4]
**Hashimoto's disease** **Endemic goitre** (Iodine deficiency) **Lithium** (toxic to thyroid) **Pendred's syndrome** (lack of PDS: improper synthesis of TH)
43
Why is it important the pregnany women have good iodine levels? What is recommended intake for pregnant women? [1]
more TSH: more Th produced/required: easy to become hypothyroid = very bad for foetal brain development 250 micrograms a day - milk, supplements..
44
Why is it important the pregnany women have good iodine levels? What is recommended intake for pregnant women? [1]
more TSH: more Th produced/required: easy to become hypothyroid = very bad for foetal brain development 250 micrograms a day - milk, supplements..
45
What causes cretinism?
Large goitres: Low levels iodine in diet + low levels of iodine produced in thyroid -> increasing TSH production -> stimulates growth of thyroid gland Causes mental retardation
46
Diagnosis [2] and Treatment of HypoT? [1]
**Diagnosis of hypothyroidism:** * Low levels of TSH and low T4 in blood - biochemistry tests **Treatment**: * **Levothyroxine** - only treatment used In UK
47
Classic triad of symptoms for Graves? [3]
Pretibial myxoedema Exophthalmos Diffuse goitre (without nodules)
48
[] is the first line anti-thyroid drug [] is the second line anti-thyroid drug.
**Carbimazole** is the first line anti-thyroid drug **Propylthiouracil** is the second line anti-thyroid drug.
49
Label A-D
A: Falciform ligament B: fundus of gall bladder C: stomach D: Ligamentum teres
50
Label A-F
A: IVC B: Cystic duct C: Cystic artery D: Ligamentum teres E: Ligamentum venosum
51
Label A & B [2]
A: Quadrate lobe B: Caudate lobe
52
Which of the following are the: SMA [1] Middle colic artery [1] Right colic artery [1] SMV [1] Jejunal arteries [1]
11 Superior mesenteric artery 2 Middle colic artery 3 Right colic artery 10 Superior mesenteric vein 13 Jejunal arteries
53
Name this pathology [1]
**Ascites**. Axial CT scan of the abdomen shows low density ascitic fluid surrounding the liver, spleen and stomach.
54
Label 1, 2, 3, 7, 8, 9 & 10
1 Left hepatic duct 2 Right hepatic duct 3 Cystic duct 7 Common hepatic duct 8 Common bile duct 9 Pancreatic duct 10 Greater duodenal papilla
55
Which thyroid pathology is depicted here? [1]
Hashimotos thyroiditis
56
Which thyroid pathology is depicted here? [1]
Graves disease
57
What is the name for this symptom of Graves disease? [1] What is this symptom usually associated with? [1]
Acropachy in association with thyroid ophthalmopathy
58
Name three reasons for hyperthyroidism [2]
Toxic multinodular goitre Graves Disease Toxic adenoma
59
Pendreds symptom is a cause of hypothyroidism. Which transporter is lacking in this disease? [1]
Lack of PDS

MET2 (52 decks)

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