1 Flashcards
what is the blood supply to external and internal oblique muscles
lower 6th thoracic nerves
what is the conjoint tendon made of
internal oblique and transversalis fascia
where does long head biceps attach
supraglenoid fossa
where does short head biceps attach
coracoid process
positions of appendix
retrocaecal, pelvic, subcaecal, pre and post ileal
what type of joint is atlanto-axial
pivot
what type of joint is carpal and first metacarpal of thumb
saddle joint
what type of joint is TMJ
modified hinge joint
what juvenile structure forms clivus
spheno-occipital
what runs in jugular foramen
IJV (continuation of sigmoid sinus), inferior petrosal sinus and CN 9,10,11
benign tumours of PCF
meningioma, acoustic neuroma, ependymoma, haemangioblastoma
which bone makes up middle ear
petrous part of temporal bone
what ia achalasia
motility disorder involving smooth muscle layer of oesophagus and lower oesophageal sphincter, resulting in incomplete LES relaxation, increased LES tone and lack of peristalsis of oesophagus
what is facial nerve intracranial course
origin between pons and medulla, internal acoustic meatus, facial canal (through petrous part of temporal bone), exit through stylomastoid foramen
what level is carotid bifurcation
C4
where does long and short head of biceps femoris originate
ischial tuberosity long
linea aspera of femur for short
what is adhesive capsulitis
chronic fibrosing condition characterised by insidious and progressive severe restriction of both active and passive shoulder range of motion
ligments attached to odontoid process
alar ligament
transverse atlantal ligament
apical odontoid ligament
ligaments between c1 and c2
anterior and posterior atlantoaxial and transverse ligament
layers to pass through for LP
skin, subcutaneous tissues, supraspinatous ligament, interspinatous ligament, ligamentum flavum, epidural space, dura mater, arachnoid mater
what type of joint is IV joint
secondary cartilaginous jointd
describe anatomy of IV disk
inner nucleus pulposus surrounded by annulus fibrosis
level of spinal cord in newborn and adult
L3 new born, L1/2 adult
how do spinal mets happen
direct arterial invasion
retrograde invasion through bartons venous plexus
direct invasion through intervertebral foramina
contents of epidural space
connective tissue
lymphatics
spinal nerve roots
fatty tissue
small arteries
network of internal venous plexuses
why cant you feel any spinous processess before C7
because they are short and bifid and are attached to nuchal ligament
what parts of the brain are supplied by the vertbero-basilar system
brainstem, cerebellum, thalamus, and occipital lobes
contents of carapl tunnel
Flexor pollicis longus, flexor digitorum superficialis and flexor digitorum profundus
what supplies supraspinatous muscle
suprascapular nerve
what supplies infraspinatous muscle
suprascapular nerve
what supplies teres minor
axillary nerve
what supplies subscapularis
subscapular artery
where do supraspinatous, infraspinatous and teres minor attach
greater tubercle humerus
what muscles insert into bicipital groove
teres major, lat dorsi and pec major
what are the boundaries of the quadrangular space
superior: teres minor
inferior: teres major
lateral: surgical neck of humerus
medial: long head triceps
anterior: subsapularis
what is contained in the quadrangular space
axillary nerve
circumflex humeral vessels
why does DIC happen
infections, burns, trauma, liver failure, massive transfusion, hypothermia, malignancy, obstetric causes (amniotic fluid emobolism)
what does APTT test
intrinsic/common pathway all factors except facotr VII
what does PT test
extrinsic pathway-deficiencies in factors, 1,2,5,7,10
causes of hypothyroidism
autoimmune-hashimotos
iodine deficiency
iatrogenic
drugs eg. lithium
transient thyroiditis
difference in T3 and T4
t3 is x4 more potent than T4, peak effect within 24-48 hours, plasma protien binding capacity is less
active in vitro
thyroid gland only produces 20% of T3
what is the Berlin criteria for ARDS
contains 3 must have criteria
1-timing withing 1 week of clinical insult
2-CXR shows bilateral opacities not fully explained by other pathollogy
3-respiratory failure-not fully explained by cardiac failure/fluid overload
management of fluid overload
1-ABCDE
-high flow oxygen, IV furosemide, GTN
ITU review, CXR, ABG, ECG
pre-load reduction-nitrates
after-load reduction ACEI
inotropic support-dobutamine
what is the purpose of fluid therapy
1-basal requirements of water and electrolytes
2-replace fluid and electrolytes lost eg vomiting, diarrhoea, pancreatic fistula
3-maintain arterial pressure incases of shock by increasing plasma volume and improving tissue perfusion
what is the compensatory response to respiratory acidosis
1-initial response is small, cellular bufffering elevates bicarb slightly approx 1mEq/L for each 10mmg of PaCO2
1-renal compensaion that occurs over 3-5 days, renal excretion of carbonic acid and increased biocarb reabsoption
how does the body sense hypercarbia
central chemoreceptors
what is a consequence of this
increase respiratory rate to blow off more CO2
what are the side effects of naloxone
sweating, nausea, vomiting, tachycardia, abdominal cramps
ways to measure ICP
invasive-external ventricular drain, subdural catheter, ICP transducer
non-invasive, transcranial doppler can measure MCA velocity and derive a pulsality index correlating with ICP
how and where is bilirubin conjugated
in liver, conjugates with glucouronic acid by enzyme glucuronyltransferase
describe metabolism of bilirubin
most unconjugated bilirubin around 95% is reabsorbed in the terminal ileum
conjugated biliriubin passes into colon and is not absorbed, metabolised and deconjugated to urobilinogen (colourless) and oxidised to stercobilin (give stool brown colour)
pre hepatic caused of jaundice
G6PD, hereditary spherocytosis, autoimmune haemolytic anaemia, gilberts syndrome
causes of hepatic jaundice
hepatitis, drug induced, chronic autoimmune hepatitis
causes of post hepatic jaundice
head of pancrease carcinoma, gallstones, sclerosing cholangitis, cholangiocarcinoma
what is a fistula
an abnormal communication lined by granulation tissue between two epithelial or endothelial surfaces
how to classify fistulas
congenital or acquired
cause-eg infection, malignancy
simple or complex
where the fistula is colovaginal, colovesciular
internal or external
physiology-low or high output
management of fistula
SNAP, control sepsis, nutritional support, anatomical access/adequate fluid/electrolyte balance
how does T4 come about
ATE ICE
-active transport of ioding into follicular cell
-thyroglobulin is formed in follicular ribosomes and placed into secretory vesicles
-exocytosis of thyroglobulin into follicle lumen where it is stored as colloid
-iodination of thyroglobulin
-coupling of MIT (monoiodotyrosine and diiodotyrosine) to form T3 and t3
-endocytosis of iodinated tyhroglobulin into follicular cell
how is T4 converted to T3
deiodinase system D1,2,3 in multiple tissues and organs especially skeletal muscle, liver, brain and thyroid
how to classify hyponatraemia
Depletional-burns, diretics, diarrhoea
dilutional-heart fialure, iatrogenic through too much IV fluids,
endocrine-addisons and hypothyroidism
pseudohyponatraemia-mulitple myeloma and SIADH
how are BCC treated
curretage and elctrodissection, imiquimod, topical fluoracil, radiotherapy, photodynamic therapy
lymphocytes, PMN, histiocytes and cells with bilobed nuclei
Reed Sternburg cells-lymphoma, Hogkins lymphoma
familial MM
CDKN2A, CDK4, BRAC2
encapusulated bacteria
strep pneumonia, e coli, klebsiella, neiserria menginitisi
how does valve stenosis occur
lipid accumulation, calcification, stiffening and thickening of valve leading to stenosis
signs of aortic stenosis
slow rising pulse, spliting of S2, narrow pulse pressure, ejection systolic pulse, displaced apex beat
what is rheumatic heart disease
a form of cardiac inflammation with scarring triggered by an autoimmune reaction to infection with Group A strep , type II hypersensitivity reaction occurs who antibodies react with bacterial M proteins
symptoms usually 1-3 weeks after strep pharyngiitis
pathophysiology of RHD
recurren inflammation, narrowing and thickening of leaflets, retraction-thickening and calcifcation leads to scarring and fibrosis
findings of valves with RHD
initially verucae-small deposits in valve
chronic-fusing of chordae tendinae and shortening, valve thickening stiffening and fibrosis
microscopic findings in endocarditis
askoff bodies-granulomatous inflammation which consists of central zone of degenerating ECM infiltrated by lymphocytes, plasma cells and anitschkow cells-activated macrophages, found in all 3 layers of heart
what to look for in ECHO
valvular regurgitation, leaflet prolapse, thickening, annular dilatation, chordae elongation/rupture, pericardial effusion, ventricular dilatation
organisms cause endocarditis
staph aureus, strep viridians, coagulase negative staph, HACEK, enterococcus
what are the Dukes criteria
2 major
1major and 3 minor
5 minor
what are the major criterai
x2 blood cultures with endocarditis common organisms-staph aureus, strep viridans, coagulase negative staph, enterococcus or HACEK organisms and/or
echocardiogram positive for IE, abscess or new partial dehiscence of prostetic valve, new valvular regurgitation
what are the minor cirteria
heart condition or IV drug use, vascular phenomena, microbiological evidence, fever, immunological phenomena-glomerulonephritis, osler’s nodes, roth spots and rheumatoid factor, echo findings
how does heparin work
inhibits factor 9,10,11,12
what are you looking for on ECHO in endocarditis
valvular regurigation
leafelt prolapse, coarptation failure, thickening
annular dilatation
chordal elongation/rupture
pericardial effusion
increased echogeneicity of subvavular apparatus
complications of IE
abscess
arterial or septic emboli
aneursym
pericarditis
arrythmia
valvular insufficiency
-can cause glomerulonephritis
AKI, stroke, mesenteric abcess/infarct
what are the pathological changes in osteoporosis
on DEXA scan 2.5sd below the mean
histologically normal bone that has reduced in quantity
in post menopausal women increased osteoclast activity, trabecular plates become perforate thinned and lose connections and get microfractures and vertebral collapse
how do steroids cause osteoporosis
direct inhibition of osteoblast formation
stimulation of bone resorption
inhibition of GIT calcium absorption
stimulate renal calcium losses
what is a pathological fracute
through abnormal or diseased bone, commonly occuring with little or no trauma
how does fat embolilsm clinical present
SOB with petechiae
stages of haematoma resolution
clot lysis by macrophages-1 week
growth of fibroblasts into haematoma, hyaline tissue
what three things regulate bile flow
hepatic secretion, gall bladder contraction and sphincter of oddi resistance.
what is the effect of immobility of bone
decreased bone mineral density and increased risk of osteoporosis
what is contained in cryoprecipitate
factor VIII, XIII, fibrinogen and vWF
what is contained in FFP
all clotting factors, fibrinofen, protein C&S, ATIII
what malignancies are associated with immunosuppression
SCC, BCC, lymphoma (NHL from EBV), kaposi sarcoma, cervical
conditions associated with PCKD
liver and pancreas cysts, brain anueusysms, mitral valve prolapse
common organisms in NF name 4
staph aureus including MRSA, E coli, pseudomonas, clostridium, group A beta haemolytic strep
mechanism of C diff infection
broad spectrum abx distrupt normal gut micro biome allowing for C diff to overgrow, release enterotoxin, bacteria secretes fibrin and pseudomembrane formation
what cells do medullary thyroid come from
parafollicular C cells
