12/4/22 Flashcards
When does the femoral vein become the external iliac?
At the inguinal ligament
What area does the internal iliac drain?
Perineal areas
For each reflex what is spinal roots is it testing for?
Nice mnemonic.
1,2 buckle my shoe = S1,S2 = achilles
3,4 kick the floor = L3,L4 = patellar
5,6 pick up sticks = C5,C6 = biceps
7,8 lay them straight = C7,C8 = triceps
What nerve innervates the first web space in the foot?
Deep fibular
What supplies the vast majority of the hand?
What muscles are the excpetion?
Ulnar
LOAF muscles - median
What are the nerve supply to the lower limb?
Deep fib - anterior part of leg
Superfical fibular - lateral part of leg
Tibial - posterior of leg
Anterior of thigh - femoral
Median thigh - obturator
Posterior thigh - sciatic
What is the only part of the skin below the knee not supplied by sciatic nerve?
Median leg - saphenous nerve - branch of the femoral nerve
What is the most common med used to treat N+V with chemotherapy?
What is the MoA?
Ondansetron
5HT3 antagonist
What kind of hormones are in HRT?
Oestrogen and progesterone
What condition happens to baby as a result of Rhesus -ve and Rhesus +ve mixing?
Haemolytic disease of the newborn
What type of ovarian cancer is the most common?
What subtype is associated with Psammoma bodies?
Epithelial tumours
Serous cystadenocarcinoma
What kind of drug is risperidone?
Atypical anti-psychotic
What is used to treat Athlete’s foot?
Terbinafine
How can you tell the difference between a thyroid lump and a thyroglossal lump?
Thyroid - ascends on swallowing but not protusion
Thyroglossal - ascends on swallowing and protursion
What is the preferred surgical management for subdural haemorraghe?
Burr hole crainostomy
Where is ADH produced?
Posterior pituitary
What investigations would you like to do for polyuria?
Basic obs
Urinalysis
Urine osmolaity
Cap glucose and ketones
U+E’s
Serum osmolaltiy
Blood glucose
T1 - C-peptide and anti-GAD antibodies
T2 - fasting glucose, HbA1c, lipid profile
DI
- serum and plasma osmolality
- prolactin (v raised could suggest pituitary tumour which is causing low ADH production)
- others
Why don’t you do fasting glucose for T1 diabetics?
Risk of hypoglycaemia
What diabetes drug is assoc. with glucouria?
SGLT-2 inhibitors
A raised specific gravity of urine suggests what?
Concentrated urine (can be due to diabetes, SIADH etc.)
Times when you need to avoid HbA1c?
- Pregnancy
- Times when RBC are affected
- rapid onset - HbA1c takes time to change
What do you need to do immediately after taking blood glucose with the wee pinprick?
Put it in the sharps bin!!
Why is it important to do an ECG in DKA ABCDE?
To check for hyperkalaemia
What regular monitoring do you want to do for DKA?
Cap Glucose
Ketones
Fluid input and output - insert a catheter
K+
What should you remember in B for ABCDE for DKA?
What is important in C along with ECG?
Check breath odour
ABG - to check for acidosis
What does insulin do to the serum potassium?
Insulin drives potassium into cells
- without it potassium high in serum
- when insulin is given potassium begins to lower which is why we give potassium replacement and monitor it closely
How do you explain T1 diabetes to a patient?
Insulin is what lets sugar get into our cells - cells need sugar for energy
In T1DM the cells that make insulin are getting destroyed
Without insulin we have high levels of sugar in our blood which can cause symptoms like weeing a lot and drinking a lot. It can also cause complications when sugar levels are too high for long periods of time - damage different organs
- feet, eyes, kidneys and heart
Important to maintain sugar levels as normal as poss.
Use insulin injections to be able to manage symptoms and maintain sugar levels
Need to be injected because insulin can be digested in the stomach so can’t be taken as a tablet
Driving regulations in diabetes?
You need to inform DVLA if you have insulin treatment for 3mnths+ or have hospitilasing hypoglycaemia
Safety netting examples
Leaflets
Arrrange followup appointment with GP
Sick day rules for T1DM?
SICK
Sugar - increase blood glucose monitoring
Insulin - never stop insulin
Carbohydrates - maintain hydration and carbohydrate if sustained vomitting/reduced oral intake - seek immediate medical attention
Ketones - check every 2-4hrs
What diabetic drug should you prescribe if got history of heart failure?
SGLT-2
Mnemonic for hypoglycamia
TIRED
Tachycardia Irritability Restlessness Excessive hunger Diaphoresis
What is the best way to tell you where the insulin is coming from?
C-peptide - produced when insulin is cleaved pre-release
C-peptide low = exogenous
C-peptide high = endogenous
high could be caused by tumour (insulinoma) or excess SU use
If neuropathy follows a dermatome what is it called?
Radiculopathy
III nerve palsy with pupil sparing?
Why is there sometimes pupil involvement?
Diabetic cause
Surgical = with pupil involvement
Pupil constriction is controlled by Parasympathetic signals which are found on the Periphery of the CN III - if obstructed or disturbed = pupil dilation
