the patient Flashcards

Question

what is dyspepsia

Answer 1

overeating-GORD Stomach irritation: Food Alcohol Nicotine Medicines – GORD

Answer 2

bloating feeling Churning stomach Stomach cramps Discomfort/pain Excess acid Wind Doll stomach ache

Answer 3

symptoms can include nausea/discomfort Can occur after gastroenteritis/food poisoning Normally acute but can become chronic Epigastric, pain syndrome – interaction between nerves of the gut and central nervous system Post prandial distress syndromes– problems with stomach, emptying relaxing

Answer 4

diet – foods to avoid Avoid stress/anxiety drug therapy – PPIs – even though there may be no evidence that excess acid is involved

Answer 5

weekend/malfunctioning oesophageal sphincter Pregnancy

Answer 6

severe pain in the upper chest Burning in the back of the throat Taste of acid Burning pain rising to mouth Excess acid Sore throat/dry cough

Answer 7

pain radiating down the arm Cardiac problems Pain radiating to the back or the shoulder Pain waking up the patient Patient is over 50 Bleeding Weight loss Anaemia Assistant vomiting dysphasia Breathlessness and frequent symptoms

Answer 8

raise the bed or extra pillow to reduce symptoms at night Stop smoking and reduce caffeine/alcohol intake Decrease weight/low-fat diet Avoid spicy/oily foods, or other foods that may trigger symptoms Small, regular meals

Answer 9

antacids Magnesium salt Aluminium salt Sodium salt Calcium salt

Answer 10

evidence that they are superior to H2 antagonists at controlling symptoms of heartburn there are many drug interactions If there is no relief of heartburn after two weeks, refer to GP

Answer 11

change of eating/lifestyle/routine Ageing Medication/other medical conditions IBS Pregnancy Depression Toddler constipation Cancer (rare)

Answer 12

increase fluid intake Increase dietary fibre intake Increase levels and frequency of physical activity no delay in passing a motion

Answer 13

stimulate nerve endings in the gut The increase peristalsis Take 8 to 12 hours to work Risk of lazy bowel Caution in pregnancy

Answer 14

same effect as increasing dietary fibre Stool will be easier to pass as volume will be increased must have an adequate fluid intake Side effects can be flatulence and bloating

Answer 15

where water is drawn into intestines

Answer 16

buying large amount of laxatives Buying laxatives on a regular basis Physical signs: thin Pale clammy skin Dry brittle hair Dark circles around the eyes Malnourished appearance

Answer 17

pain on defecation Patient over 40, with a sudden change in habit with no cause Duration of more than two weeks Tiredness Alternating constipation/diarrhoea (IBS?) Substantial blood loss dark tarry stools

Answer 18

prolapsed anal cushions rare under the age of about 20

Answer 19

pain when passing motion with external haemorrhoids Itching Mucus discharge Bleeding – bright, red, fresh blood

Answer 20

constipation Straining Being overweight Lack of exercise Heavy lifting Those who stand or sit for long periods of time Pregnancy or after child birth Genetic disposition

Answer 21

consider formulation – cream or ointment or suppository Local anaesthetic – effect is short lived anatrigents - little evidence they work corticosteroids – hydrocortisone reduces swelling, and inflammation. Not in pregnancy. You have to be over 18.

Answer 22

Patient over 40 with sudden change in habits with no cause Treatment failure Patience, manually, reducing haemorrhoids Severe pain Blood mixed in with stool Significance of bleeding

Answer 23

rotavirus Norovirus

Answer 24

highly infectious virus resulting in 10% of children, and then up in hospital, due to dehydration Vaccine introduced in 2013, and it has decreased cases by 70%

Answer 25

winter vomiting bug Small particles of vomit, or stores from person, getting in your mouth, contaminated, food, airborne, touching contaminated surfaces Virus mutates, so no chance to get an immunity

Answer 26

cholera – bacterial infection Typhoid – bacterial infection Associated with severe diarrhoea, dehydration, dysentery (blood in stool) Vaccinations are available for travel. Travellers should still follow personal/food hygiene advice.

Answer 27

bottled water not tap Sterilised tap water? Food freshly prepared and hot Avoid uncooked vegetables Eat fruit, that can be peeled Avoid ice cubes Avoid locally produced ice cream/mayonnaise and other sauces

Answer 28

caused by contaminated, drinking water aboard always ask about foreign holidays when patients have diarrhoea Watery, foul, smelling, diarrhoea, epigastric, pain, bloating, and wind Refer to GPS suspected

Answer 29

anxiety Food intolerance Medication IBS Impaction

Answer 30

glucose/rice powder with salt made up with water to form an isotonic solution Often prescribed – check suitable ages over the counter Make up with a 200 mL of plain water Taken after each loose bowel movement Discard if not drunk after 24 hours

Answer 31

loperamide It’s reduces duration by 30 to 50% It allows for reabsorption of fluid to take place Should not be taken within 24 hours of fever, or if a bacterial cause of diarrhoea is suspected age 12 and over – take two capsules initially, and one capsule after each episode of diarrhoea and up to 6 capsules in one day. Side-effects include nausea, abdominal pain, drowsiness, dizziness, and dry mouth.

Answer 32

wash your hands thoroughly with soap and water after going to the toilet and before eating Don’t prepare food for others Clean the toilet, including the handle on the seat with disinfectant after each bout of diarrhoea avoid sharing towels, flannels, cutlery Don’t visit the people if unwell Stay off work for two days after symptoms have cleared Avoid swimming pools for up to 2 weeks after diarrhoea

Answer 33

medication such as diuretics Patients are unable to drink Change in bowel habit in patient over 50 Recent travel to tropical/subtropical climate Blood or mucus in stool Suspected impaction in children/elderly Severe abdominal pain Intolerance

Answer 34

feeling thirsty and lightheaded Dry mouth Passing water less than four times a day Having dark coloured/strong, smelling urine Passing urine, less often than usual serious signs Extreme Tiredness Weak, rapid pulse Dizziness that does not go away Seizures

Answer 35

Seem drowsy Breathe fast Have a few or no tears when they cry Have a soft spot on the head that sinks inwards Have a dry mouth Have a dark yellow urine How cold and blotchy looking hands and feet Have not passed water in the last 12 hours

Answer 36

wear close-fitting underwear at night remove in the bath and in the morning Wear cotton gloves at night to avoid collecting eggs, when scratching Wash hands and scrub under the nails regularly Discourage nailbiting and finger sucking Don’t share towels/flannels

Answer 37

vacuum and dust thoroughly Wash toys Throwaway Play-Doh Change and wash clothes daily Change and wash, bedlinen/towels, following treatment

Answer 38

treat the whole family, even if not, all members are showing symptoms Repeat treatment after 14 days to cover the whole life cycle works by stopping the worm from absorbing glucose There are interactions with anti-epileptics Avoid in pregnancy Suitable for children over 2

Answer 39

treatment failure Secondary infection, due to scratching around the anus

Answer 40

digested residues are further processed here water and electrolytes absorbed Leftover compact is to become stool

Answer 41

Peristatic waves move the stool into the sigmoid colon and rectum Sensory nerves in rectum are stimulated Individual becomes aware of the need to defecate Stool moves into the anal canal, when the internal and external sphincters relax

Answer 42

last for less than three days, probably due to an acute infection from Saturn pathogens, or from medications, with diarrhoea as a side effect

Answer 43

lasts for more than three days, probably due to several reasons. Could also be due to more severe problems such as ulcerative colitis

Answer 44

norwalk virus Rotavirus Travellers diarrhoea amoeba which causes amebiasis Expired food Side-effects of medications like antibiotics

Answer 45

Secretory diarrhoea osmotic diarrhoea exudative diarrhoea

Answer 46

Due to chronic diseases

Answer 47

Due to increased salt and sugar

Answer 48

Due to increased active secretion of mucus

Answer 49

happens when the stool remains in the large intestine for too long

Answer 50

in adequate diet Infrequent exercise Stress and anxiety Suppression of the urge to defecate Pregnancy

Answer 51

A vestigial organ. Tubular in shape and about 8 cm long. The lumen joins the cecum

Answer 52

Icronic gastrointestinal disorder of an unknown cause 20% of people experience it at some point in life

Answer 53

abdominal pain or cramping Diarrhoea or constipation Flatulence Bloated feeling Feeling of incomplete bowel movement Mucus in stool

Answer 54

Inflammatory bowel disease

Answer 55

abdominal pain or cramping Bloody diarrhoea Weight loss Extreme tiredness Inflammation of the got Crohn’s disease or ulcerative colitis

Answer 56

Surgically creating an opening in the stomach in the abdominal wall for the elimination of dietary waste – maybe permanent or temporary

Answer 57

a ostomy from a section of the colon

Answer 58

an ostomy from a section of the ileum

Answer 59

to remove waste products Regulation of extra cellular fluid volume Regulation of osmolarity Regulation of ion balance Regulation of pH Production of hormones

Answer 60

water and solutes from plasma Nephrons of the kidneys ureters Bladder Urethra Excreted as urine

Answer 61

there are 10 million nephrons per kidney 80% are in the cortical 20% in the juxtamedullary Juxtamedullary nephrons are important in producing concentrated urine glomeruli all lie in the cortex

Answer 62

renal artery Smaller arteries Afferent arterioles Capillaries of the glomerulus Afferent arterioles Peritubular capillaries Venules and small veins Renal vein

Answer 63

excretion Filtration and secretion Reabsorption

Answer 64

movement of fluid and salute from blood into lumen of tubule Plasma proteins and erythrocytes are not filtered this occurs in the renal corpuscle The glomerulus and Bowmans capsule

Answer 65

endothelium of glomerular capillaries Basal lamina The epithelium of Bowmans capsule

Answer 66

180 L 3 L of blood volume Approximately 1.5 L of urine is produced daily.

Answer 67

glomerular filtration rate volume of plasma filters in a given time Indication of how well kidneys are functioning This is affected by: Net filtration, pressure (blood pressure and blood flow) Filtration, coefficient (surface area of capillaries and permeability)

Answer 68

auto regulation of renal blood pressure to maintain GFR over a range of systemic blood pressure If the systemic blood pressure increases/decreases, then renal blood flow, increase/decrease GFR will also increase/decrease if not regulated

Answer 69

an increased stretch of smooth muscle cells in the afferent arteriole (due to increased systemic blood pressure) This triggers contraction of the afferent arteriole, thereby reduced blood flow. Maintaining GFR If systemic blood pressure decreases afferent arteriole will dilate

Answer 70

The distal convoluted tubule (DCT) runs between the afferent and efferent arterioles specialise, macula, densa cells in DCT release paracrine factors. That act on juxtaglomerular cells in afferent arterioles If flow increases in the distal convoluted tubule. Factors released to constrict afferent, arteriole

Answer 71

angiotensin II is a vasoconstrictor prostaglandin’s are vasodilators

Answer 72

its of a drop in blood pressure will result in an increased sympathetic output Vasoconstriction of arterioles with reduce GFR and conserve fluid

Answer 73

movement of substances from plasma to tubular filtrate Active transport of potassium, ions, hydrogen ions, organic acids, and bases, foreign substances, and metabolite Uses selective membrane proteins to move molecules across the epithelium

Answer 74

Na+ in the PCT and DCT

Answer 75

Na+ in the DCT and collecting duct

Answer 76

99% of filtrate is reabsorbed 70% happens in the proximal convoluted tubule (PCT) Fine regulation in the DCT and collecting duct reabsorption is an active process, as filtrate is isosmotic with extra cellular fluid It is driven by the sodium potassium pump and ATPase. On basolateral membrane of the tubular epithelial cells.

Answer 77

sodium moves from the lumen into the epithelial cells down an electrochemical gradient Pumped out of the cell into interstitial fluid against a concentration gradient Water is reabsorbed by osmosis Fluid moves from the interstitium into the capillaries due to low pressure in the capillaries sodium linked, secondary active transport Energy from sodium electrochemical gradient is used to move glucose into the epithelial cells against a concentration gradient Facilitated diffusion of the carrier moves glucose out of the cell

Answer 78

trancytosis

Answer 79

glucose carriers Filtration is proportional to the plasma concentration Reabsorption proportional to plasma concentration until maximum transport to rate is reached Urinary excretion of glucose is evident above the threshold concentration

Answer 80

In the descending loop of Henley

Answer 81

in the ascending loop of Henley Sodium ions, potassium, ions, and chloride ions

Answer 82

maintains blood pressure and perfusion Maintains cell integrity and function coordinated by cardiovascular, respiratory, Renal and behavioural responses Kidneys regulate sodium and water balance

Answer 83

it acts synergistically with the sympathetic nervous system to maintain blood pressure and tissue perfusion It’s increases vascular tone Stimulates aldosterone secretion (Increases sodium retention) Stimulates vasopressin (ADH) secretion (Increases water retention)

Answer 84

juxtaglomerular (JG) cells detect a drop in pressure in the afferent arterial macula densa cells in distal tubule detect, a drop, infiltrate flow and sodium concentration

Answer 85

prostaglandins

Answer 86

membrane-bound enzyme on surface of endothelial cells Peptidase – remove dipeptide units from C terminals at the end of peptides inactivates other peptides, for example brandykinin

Answer 87

vasoconstriction Secretion of aldosterone from adrenal cortex Increase in, nor adrenaline released from sympathetic nerve terminals Cell growth Increase sodium absorption from proximal tubule

Answer 88

steroid hormones made in the adrenal cortex It’s increases sodium reabsorption Decrease is potassium, reabsorption Release is increased by: Decreased plasma osmolality And increased plasma potassium ion concentration angiotensin II It’s acts on principle P cells in the distal tubule and collecting duct It increases sodium reabsorption It promotes excretion of potassium

Answer 89

maintaining extracellular fluid (ECF), homeostasis important: Maintains blood pressure and perfusion Maintains sell integrity and function Coordinated by cardiovascular, raspatory, renal and behavioural responses Kidneys regulate sodium and water balance

Answer 90

kidneys conserve water If fluid volume drops, less urine will be excreted Urine osmolality can range from 50 to 1200 mOsm It depends on the permeability of the collecting duct to water

Answer 91

high osmolality of intestinal fluid of renal medulla is essential for water reabsorption maintained by countercurrent multiplier action of the loop of Henley Descending limb is permeable to water but not electrolytes Filtrates becomes more concentrated descends from the core to the medulla The ascending limb is impermeable to water, but actively reabsorbs electrolytes Blood in the vasa recta flows in opposite directions to the filtrate in the tubule The osmotic gradient is created by active transport of electrolytes from the ascending limb of the loop of Henley Is not diluted by water reabsorbed from the descending limb

Answer 92

Its release is stimulated by the increase of plasma osmolality or decrease blood pressure/volume it is released from the posterior pituitary It acts on collecting duct cells to promote incision of aquaporin 2 water channels into Luminal membrane It increases water permeability It increases water reabsorption

Answer 93

The bladder hold approximately 500 mL urine Stretch receptors in bladder sends signals to the spinal cord Reflex can be overridden by Imput from higher brain centres

Answer 94

glomerular filtration rate Volume of plasma, filtered in a given time (millilitres/min) It is an indication of how well the kidneys are functioning It is affected by: Net filtration, pressure Filtration, coefficient

Answer 95

you cannot measure GFR directly creatinine clearance: can be used to give estimate of renal function It is the volume of plasma passing through the kidney, which has been totally cleared of creatine in a given time (ml/min) Creatine as a product of muscle metabolism (it is filtered, but not reabsorbed, and very little is secreted)

Answer 96

ClCr = excretion rate, creatine (mg/min) / plasma concentration, creatine (mg/ml) a healthy adult ClCr is 125ml/min

Answer 97

unnecessary reactions to innocuous antigens types I-IV

Answer 98

another set of chronic immune diseases Auto immune diseases It is a response to self antigens (autoantigens) Mediated by autoreactive antibodies, and T cells Antibodies can block normal physiology T cells can damage healthy tissues A failure of the immune system An unwanted adaptive immune response against self antigens Loss of tolerance

Answer 99

it is a state of immunological on responsiveness to particular antigens Requires education Our immune system must learn what is self so that it can recognise non-self

Answer 100

negative selection in the bone marrow, and thymus Expression of tissue specific proteins in the thymus No lymphocyte access to some tissues Suppression of autoimmune responses by regulatory T cells Induction of anenergy in autoreactive, Reactive B and T cells

Answer 101

immature B. Cells in bone marrow: no self reaction – migrate to periphery, mature B cell Multi valent, self-antigen – clonal deletion - apoptosis Soluble, self-antigen – migrate to periphery , aneroid B cell

Answer 102

positive selection of T cells by cortical epithelial cells in the thymus Negative selection of tea cells by dendritic cells, macrophages, and other cells in the thymus

Answer 103

type II like antibodies against cell/matrix antigen Frequently directed at the blood cells type III like Immune complex mediated (soluble antigens) type IV like Effector, T cells mediated IgE never causes autoimmunity

Answer 104

IgG and IgM bind red cells and activate complement classical activation Ab and C3b coated removal of cells

Answer 105

Abs are shown attached to antigens on the RBC surface

Answer 106

Where are part of the immune system causes the destruction or lysis of target cells. Particularly foreign cells or pathogens.

Answer 107

A group of proteins that work together to defend the body against pathogens, clear, immune complexes, and supports various immune functions

Answer 108

other blood cells are not so sensitive to compliment lysis Clearance by phagocytosis Neutrophils to neutropaenia The white blood cell with antibodies and compliment can still function. Treatment can be To slow their removal splenectomy (to reduce clearance rate)

Answer 109

restricted effects Targeted auto antigens in one or just a few tissues

Answer 110

multiple organs are affected Widespread and varied autoantigens

Answer 111

autoimmune disease of the thyroid graves disease Hyperthyroidism Hashimoto’s Hypothyroidism

Answer 112

normally: TSH activates release of T3/T4 block TSH release autoimmune: activating Ab to TSH receptor Long, acting, thyroid, stimulating antibodies T3&T4 unregulated release Heat, intolerance, nervousness, weight loss, enlargement of the thyroid. Therapy: removal or destruction of thyroid

Answer 113

chronic thyroidiyies loss of capacity to make a thyroid hormones Hypothyroidism Antibody and T cells to thyroid. Antigens are generated. Lymphocyte infiltration Th1 and loss of tissue structure and function. Therapy: synthetic, thyroid, hormones

Answer 114

transfer of the condition Transfer of autoantibodies will cause disease pregnant, mothers: Transfer of disease symptoms too baby only for IgG mediated

Answer 115

organ specific type II like auto antibodies to ACh receptors on muscle cells Receptor, uptake and degradation Muscle is less sensitive to neuronal stimulation Progressive muscle, weakness: Droopy, eyelids and double vision Put the muscles are also affected (chest muscles, leading to raspatory infection) therapy: Acetylcholinesterase inhibitors Immuno suppressants

Answer 116

Antagonistic, oh agonistic

Answer 117

systemic lupus erythematosus more common in African-Americans and Hispanics Many auto antibodies lead to too many antigens leads to a wide range of symptoms malar or butterfly rash is common 50 to 70% Its affects females, 10 times more than males 20 to 40-year-old s

Answer 118

dermatological Musculoskeletal Haematological Inflammation of the lung, liver, kidneys abs to RBC and platelets Self destruction by a compliment activation abs to nuclear antigens are deposited on vascular walls. (immune complex) information vasculitis Activation of compliment and activation of phagocytes

Answer 119

detection against antinuclear antibodies Directed against: ss nucleic acid ds nucleic acid Nucleoprotein Histones nuxleolar RNA

Answer 120

some antigens are Hidden (sequestered) From the immune system: Intracellular antigens Immune privileged sites T cell tolerance is not establish Release of hidden, antigens, through trauma or infection, can cause stimulation

Answer 121

trauma to one eye results in the release of hidden intraocular, protein, antigens released interocular antigen is carried to the lymph nodes and activates T cells Effector, T cells return via bloodstream, and encounter antigen in both eyes

Answer 122

normally a professional antigen presenting cell expresses MHCII However, in Greaves disease – thyroid axon at cells express MHCII sensitises T cells to self derived antigens

Answer 123

A chance, resemblance of self and a pathogen molecule This highlights the need for T cells All autoimmune diseases involve breaking T cell tolerance

Answer 124

follows S.pyogenes infection Antibodies cross react with a heart, joint and kidneys Transient autoimmunity as a self antigens don’t stimulate Th cells so antibody production is short lived

Answer 125

The same MHC molecule presents both a pathogen peptide and a self peptide that mimics it Naive, T cell is activated by the pathogen peptide presented by the particular MHC molecule effector Th1 cell responds to the self peptide, mimic, and activate the macro phage, causing inflammation Self peptide doesn’t activate the T cell, but once a T cell has been activated by the pathogen peptide… This lead to chronic information epitope spreading

Answer 126

early activation phase: response to few autoantigens Autoantigens are never cleared leading to chronic inflammation Chronic phase: Response expand to include more autoantigens (epitope spreading)

Answer 127

released from necrotic cells (failed clearance of AC) a single Th cell stimulated multiple B cells

Answer 128

located at the back/posterior of the brain just above the brain stem and below the occipital lobes crucial role in co ordinating volountary movements, balance and posture higher cognitive functions motor control and conordination

Answer 129

one if the four main lines in the cerebral cortex. outermost layer of the brain sides of the brain near the temples positioned beneath the lateral fissure auditory processing language comprehension memory formation and retrieval visual processing emotion and social cognition

Answer 130

one of the 4 major lives in the cerebral cortex located at the front of the brain behind the forehead and is speedsters by the parietal lobe and central sulcus motor control executive functions language production social and emotional processing higher level cognition

Answer 131

One of the four main lobes of the cerebral cortex Located at the posterior region of the brain behind the parietal and temporal lobes. Visual perception Visual field mapping Visual integration Visual memory

Answer 132

also known as rolandic fissure or central fissure. It is a prominent groove that runs horizontally across the lateral surface of the brain, dividing the frontal lobe from the parietal lobe. Primary motor cortex Primary somatosensory cortex Has a role in the organisation of cortexes

Answer 133

S1 it is located in the parietal lobe of the brain just behind the central sulcus. tackles perception tactile perception proprioception Plain and temperature perception Integration with other sensory modalities

Answer 134

primary motor cortex M1 Located in the frontal lobe of the brain, specifically in the precentral gyrus primary function of the motor cortex is to control voluntary muscle movements throughout the body Fine motor control motor planning Motor learning Integration with other brain regions Initiation and execution of movements

the patient Flashcards

(159 cards)