2 Flashcards
what is a retrovirus
virus that carries its genetic blue print in form of RNA, revers transcriptase converts RNA to DNA
what are the 6 Ps
pain, pallor, paraesthesia, pulseless, paralysis, perisingly cold
inability to get above scrotal mass suggests?
inguinal hernia
complete scrotal exam
full abdominal exam, US scan of testes
causes of pneumoperitoneum
perforated viscus, DU/GU, appendix, diverticulum, penetrating trauam, cancer (perforated), NEC, IBD perf, brekadown of surgical anastomosis, recent laparotomy/laparoscopy, post endoscopy
DDx of LIF pain
diverticulitis
renal colic
epididymitis
cancer
inflammatory bowel disease
in females, ovarian torsion/large ovarian cyst, ectopic pregnancy, pelvic inflammatory disease
what is charcots triangle
fever, RUQ pain and jaundice
what to see in US in cholecystitis
sonographic +ve Murphy’s sign
thickening of gallbladder wall
gallstones in gallbaldder
pericholesystatic fluid
CBD dilatation
what is a hydrocele
accumulation of fluid within the tunica vaginalis
outline PANCREAS criteria
pao2 <8, age >55, neutrophils >15, calcium <2, urea >15, LDH >600, albumin <32, sugar >10
why decrease in calcium in pancreatitis
fatty acid saponification-free fatty acids mix with calcium in blood making calcium salts that dont dissolve and stress response holding
why increase in blood glucose in pancreatitis
destruction of pancreatic B islet cells that produce insulin, stress response, increased cortisol, gluconeogenesis and glycogenolysis
how is vitamin D metabolised
vitamin D3 is formed in the skin by conversion of 7 dehydrocholesterol under UV light
Vitamin D2 is derived from plant sterol ergosterol
vitamin D is metabolised first to 25 dyhydroxyvitamin D in liver then to hormonal form 1,25 dihydroxyvitamin D in kidney
what is dry gangrene
coagulation necrosis without liquefaction ie mummification of tissue without infection
what is wet gangrene
coagulation necrosis complicated by infective heterolysis and consequent liquefaction necrosis
what is a perianal abscess
cryptoglandular in origin or secondary to anorectal pathology and often communicate with ano rectum
wht is a pilonidal sinus
trapping of hair in midline pits located at natal cleft, no communication with ano rectum
how is bile released
after eating CCK is released from duodenum which stimulates gallbladder contraction and relaxes sphincter of oddi
does culture of abscess have any bearing on likley cause
yes coliforms are increased chance of fistula being present
how and where does bilirubin conjugate c
conjugates in the liver with glucuronic acid by the enzyme glucouronultransferase
complications of acute pancreatits
local: pseudocyst, peripancreatic collection, splenic vein thrombosis, necrotising pancreatitis, bleeding-gastroduodenal artery, portal vein thrombosis, jaundice
ileus, GI bleed
resp: ARDS
DIC
metabolic: hypocalcaemia, hypomagnesaemia, hypoalbuminaemia, hyperglycaemia
CVS: shock arrythmia
components of pseudocyst
collection of amylase fluid, necrotic tissue, blood enclosed in fibrous wall of granulation tissue, location lesser sac
what is CEA like in pseudocyst vs tumour
high in tumour low in pseudocyst
what can persistently high amylase be suggestive of
pancreatic pseudocyst
what does smooth endoplasmic reticulum do
lipid production and detoxification
what does rough endoplasmic reticulum do
protein production
what does golgi apparatus do
protein modification and export
what type of joint are sutures of skull
fibrous joint
what age do sutures of skull fuse and become immovable
around 20-25
what is early fusion of skull sutures called
craniosynostosis
what is contained within the foramen spinosum
middle meningeal artery and vein, meningeal branch of mandibular nerve
which parts of duodenum are retroperitoneal
2nd, 3rd and 4th parts are retroperitoneal
what are the relations of the 3rd part of duodenum
it is located inferiorly to pancreas
SMV and SMA are located anteriorly
where in relation to peritoneum is first part of duodenum
intraperitoneal
where is the CBD in relation to the pancreas
descends behind the head of the pancreas before opeing into 2nd part of duodenum
where does SMA lie in relation to pancreas
SMA lies behind neck of pancreas and anterior to uncinate process
what lies posterior to neck of pancreas
splenic and SMV unite to form hepatic portal vein
what are the boundaries of the popliteal fossa
superior medially: semimembranosus
superiorlaterally: biceps femoris
inferior medially: medial head of gastrocnemius
inferiorlaterally: lateral head of gastrocnemius
what are the contents of the popliteal fossa
popliteal artery, popliteal vein, tibial nerve, common fibular nerve
what are the innervation of the hamstring muscles
posterior thigh is innervated by tibial nerve apart from short head of biceps which is innervated by common fibular nerve
what innervates posterior leg
tibial nerve
which nerve innervates anterior leg
deep fibular nerve
what is transmitted in foramen spinosum
middle meningeal artery and nerve and meningeal branch of mandibular nerve
borders of anatomical snuffbox
medial (ulnar)-tendon of extensor pollicis longus
radial (lateral)-tendon of extensor pollicis brevis
proximal border-styloid porcess of radius
floor: carpal bones, scaphoid and trapezium
what are the potential side effects of lcoal anaesthetic
tremors, restlessness, headaches, blurred vision
vasodilatation can lead to severe hypotension and CV collapse
1% lidocain contains 10mg lidocaine per ml
carotid canal and IAM are located in which part of temporal bone
petrous part
where do roots exit
inbetween scalenius anterior and mediah
where do trunks exit
base of posterior triangle in behind 3rd part of subclavian artery
where do divisions come off
behind middle 1/3 of clavicle
where are cords
related to 2nd part of axillary artery
causes of thyroid swelling
single multinodular goitre
toxic multinodular goitre
thyroid neoplasm
advantage of radioiodine
no surgery
however may aggrevate eye sings, avoid pregnancy and close physical contact and depends on availability of isotope facilities
how could common peroneal nerve be damaged
radiofrequency ablation
fracture head/neck of fibula
prolonged tight plaster case
#/dislocation of knee
clinical picture of common peroneal injury
weakness of foot dorsiflexion(TA muscle), weakness in toe extension (EDL and EHL), weakness in foot eversion (PL and PB), sensory loss in dorsum of foot
sensory loss of anterolateral aspect of lower leg
how could injury to sciatic nerve result in common peroneal injury
dislocation of hip
#femur
hip surgery
treatment of foot drop
ankle/foot orthosis to support foot while walking
physiotherapy
surgical treatment for exploration, decompression, repair, tendon transfer
differential diagnoses of L4-L5 impingement
disc herniation
spinal tumour-primary or secondary
DM
vitamin B12 deficiency
drug therapy
spinal canal stenosis
syphilis myelopathy
what type of joint is ankle
synovial hinge joint
what type of joint is subtalar joiint
synovial plane joint
what do quadriceps dp
knee extension
what is sequestrum
piece of dead bone/tissue formed within a diseased or injured bone, typically in chronic osteomyelitis
what is an involucrum
complication of osteomyelitis and represents a thick sheath of periosteal new bone surrounding a sequestrum
why may pus break through the bone
increased pressure due to increased osmolality which causes tissue breakdown
or due to a large cloacal opening in the involucrum so pus will escape through a sinus tract
at what age is osteomyelitis associated with kingella infection
4 months to 4 years
what is most common cause of osteomyelitis
staph aureus
what is the staging of osteomyelitis
Cierny-Mader staging
what is the pathogenesis of osteomyelitis
invasion and inflammation, suppuration, necrosis (sequestration), new bone formation and resolution
what are the fate of abscess
resolution, rupture, spread, chronic abscess formation
how can ulnar nerve get damaged
medial epiconylitis-golfers elbow, cubital tunnel syndrome due to synovial inflammation or ganglia
OA-osteophytes
neuropathy secondary to alcohol or DM, hypothyroidism
brachial plexus abnormalities
what are the potential problems of local anaesthetic
tremors, restlessness, headaches, blurred vision, nausea, vomiting
vasodilatation can lead to severe hypotension and CV collapse
where does medullary thyroid cancer arise from
parafollicular C cells
differential diagnosis of carpal tunnel
cervical disc disease
diabetic neuropathy
what investigations could you do for carpal tunnel
electromyography and nerve conduction studies, could consider MRI and blood tests for thyroid and glucose
where do trunks exit
base of posterior triangle
behind third part of subclavian artery
where do roots exit
between scalenius anterior and medius
where do divisiions happen
behind middle 1/3 of clavicle
where are cords
related to 2nd part of axillary arter
where does ACL attach
anterior tibia to lateral intercondylar notch
bones that make up the lateral arch of foot
cuboid, calcaneus, lateral two metatarsals
bones that make up medial arch of foot
calcaneus, talus, navicular, 3 cuneiforms and first three metatarsal bones
what are the branches of the sciatic nerve
L4-S3
describe the course of sciatic nerve
exits through greater sciatic foramen passing inferiorly to lower border of piriformis, 1/2 way between greater trochanter and ischial tuberosity
what cutaneous function does sciatic nerve have
no direct cutaneous functions
tibial supplies skin of posterolateral leg, lateral foot and sole of foot
common fibular supplies skin of lateral leg and dorsum of foot
what is sural nerve a branch of
common fibular and tibial
what is piriformis syndrome
compression of sicatic nerve by piriformis muscle
what is the venous drainage of the heart
great, middle and small cardiac vein
posterior vein
oblique vein-all drain into coronary sinus
anterior cardiac vein and thesbian veins open into right atrium and ventricle
how is a thrombus formed
atheromatous plaque is disrupted by intra-plaque haemorrhage or mechanical forces,exposing sub-endothelial collagen and necrotic plaque contents to blood
platelets adhere and are activated releasing thromboxane A2, ADP, serotonin causing furhter platelet aggregation and vasospasm
what is contained within the spermatic cord
3 layers of fascia
3 arteries-artery to vas deferens, testicular artery, cremasteric artery
3 nerves-genital branch of genitofemoral, ilioinguinal (outside of cord), sympathetic
3 other-vas/round ligament, pampiniform plexus of veins, lymph nodes
what overlies the cords of brachial plexus
pectoralis minor
what mediates type III reaction
antigen-antibody eg SLE
what mediates type II reaction
IgG or IgM antibody mediated cytotoxic reaction
includes haemolytic disease of newborn, autoimmune haemolytic anaemia, goodpastures syndrome
types of hypovolaemic shock
plasma loss through burns, haemorrhage, GI loss through vomiting/diarrhoea, decreased intake or diuresis
causes of hypothyroidism
- drugs eg lithium or amiodarone
- surgery-iatrogenic
- autoimmune eg hashimotos
- iodine deficiency
- transient thyroiditis
- congenital
what are the three zones of burns
central zone of coagulation-likely unsaveable due to maximal heat damage
then surrounding zone of stasis-decreased tissue perfusion potentially salvageable
then zone of hyperaemia-will invariably recover unless prolonged sepsis/hypoperfusion
: central coagulation, then surrounding stasis, then surrounding hyperaemia
give three indications of platelet transfusion
haemorrhage in thrombocytopaenia
DIC
known thrombocytopaenia prior to a procedure
how does bile help digestions
bile is released when CCK is released from duodenum after a meal, this relaxes sphincter of oddi allowing bile into duodenum
it breaks down fatty substances into smaller droplets which increased surface area for pancreatic lipase
form structures called micelles whic transport into enterocytes where they are reassembled into triglycerides and packed with protien into chylomicrons
risk factors for fistula formation
bowel anastomosis
cancer
crohns disease
radiation to skin
immunosuppression
diabetes
infection
pathophysiology of duputrens
increase in type III collagen compared to type I collagen
cytokine mediated transformation of fibroblasts into myofibroblasts whose contractile properties are exaggerated and abnormal
treatment of duputrens
conservative, splinting, steroid injections, or collagenase injections
operative-fasciectomy or percutaneous cord release under LA
what is psoas sign
increase of pain with patient in left lateral position, extension of right hip increases pain
describe obturator sign
if inflammed appendix is incontact with obturator internus-increased pain on passive internal rotation of flexed thigh
where are pectinate muscles
in atria of heart
where are trebeculae carna
rounded irregular muscles columns which project from right and left ventricle
