12/4/22

Question 1

When does the femoral vein become the external iliac?

Answer 1

At the inguinal ligament

Question 2

What area does the internal iliac drain?

Answer 2

Perineal areas

Question 3

For each reflex what is spinal roots is it testing for?

Nice mnemonic.

Answer 3

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

Question 4

What nerve innervates the first web space in the foot?

Answer 4

Deep fibular

Question 5

What supplies the vast majority of the hand?

What muscles are the excpetion?

Answer 5

Ulnar

LOAF muscles - median

Question 6

What are the nerve supply to the lower limb?

Answer 6

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

Question 7

What is the only part of the skin below the knee not supplied by sciatic nerve?

Answer 7

Median leg - saphenous nerve - branch of the femoral nerve

Question 8

What is the most common med used to treat N+V with chemotherapy?

What is the MoA?

Answer 8

Ondansetron

5HT3 antagonist

Question 9

What kind of hormones are in HRT?

Answer 9

Oestrogen and progesterone

Question 10

What condition happens to baby as a result of Rhesus -ve and Rhesus +ve mixing?

Answer 10

Haemolytic disease of the newborn

Question 11

What type of ovarian cancer is the most common?

What subtype is associated with Psammoma bodies?

Answer 11

Epithelial tumours

Serous cystadenocarcinoma

Question 12

What kind of drug is risperidone?

Answer 12

Atypical anti-psychotic

Question 13

What is used to treat Athlete’s foot?

Answer 13

Terbinafine

Question 14

How can you tell the difference between a thyroid lump and a thyroglossal lump?

Answer 14

Thyroid - ascends on swallowing but not protusion

Thyroglossal - ascends on swallowing and protursion

Question 15

What is the preferred surgical management for subdural haemorraghe?

Answer 15

Burr hole crainostomy

Question 16

Where is ADH produced?

Answer 16

Posterior pituitary

Question 17

What investigations would you like to do for polyuria?

Answer 17

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

Question 18

Why don’t you do fasting glucose for T1 diabetics?

Answer 18

Risk of hypoglycaemia

Question 19

What diabetes drug is assoc. with glucouria?

Answer 19

SGLT-2 inhibitors

Question 20

A raised specific gravity of urine suggests what?

Answer 20

Concentrated urine (can be due to diabetes, SIADH etc.)

Question 21

Times when you need to avoid HbA1c?

Answer 21

• Pregnancy
• Times when RBC are affected
• rapid onset - HbA1c takes time to change

Question 22

What do you need to do immediately after taking blood glucose with the wee pinprick?

Answer 22

Put it in the sharps bin!!

Question 23

Why is it important to do an ECG in DKA ABCDE?

Answer 23

To check for hyperkalaemia

Question 24

What regular monitoring do you want to do for DKA?

Answer 24

Cap Glucose
Ketones
Fluid input and output - insert a catheter
K+

Question 25

What should you remember in B for ABCDE for DKA?

What is important in C along with ECG?

Answer 25

Check breath odour

ABG - to check for acidosis

Question 26

What does insulin do to the serum potassium?

Answer 26

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

Question 27

How do you explain T1 diabetes to a patient?

Answer 27

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

Question 28

Driving regulations in diabetes?

Answer 28

You need to inform DVLA if you have insulin treatment for 3mnths+ or have hospitilasing hypoglycaemia

Question 29

Safety netting examples

Answer 29

Leaflets

Arrrange followup appointment with GP

Question 30

Sick day rules for T1DM?

Answer 30

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

Question 31

What diabetic drug should you prescribe if got history of heart failure?

Answer 31

SGLT-2

Question 32

Mnemonic for hypoglycamia

Answer 32

TIRED

Tachycardia
Irritability
Restlessness
Excessive hunger
Diaphoresis

Question 33

What is the best way to tell you where the insulin is coming from?

Answer 33

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

Question 34

If neuropathy follows a dermatome what is it called?

Answer 34

Radiculopathy

Question 35

III nerve palsy with pupil sparing?

Why is there sometimes pupil involvement?

Answer 35

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