Extra Flashcards
The HPA axis is a term used to represent
the interaction between the hypothalamus, pituitary gland, and adrenal glands; it plays an important role in the stress response.
Goitre
- Definition
- Causes
- Presentation
- Investigaation
- Abnormal enlargement of the thyroid gland.
- Most common: iodine deficiency
- Hyperthyroidism or hypothyroidism (Hashimoto’s and Graves’ disease)
- TFT, thyroid antibodies,
H1N1 (influenzae A) contained genes from 5 different flu viruses
- North american swine Inf
- North American avian inf
- Human influ
- and 2 swine inf
Pandemic
World wide spread of a new disease and most people dont have immunity
Epidemic
infectious disease spreads rapidly in a community at a particular time
Most common type of influenza:
- Type A
- Rapidly mutating every year resulting in pandemics
- Wild birds are the natural host (unlike type B which is only found in humans)
Influenza C do not cause..
Epidemics
Treatment for influenzae
- Usually self limiting
- however common antiviral include Tamiflu (oseltamivir) and are neuramindase inhibitors
- (usually enters the cells via NA)
You do not need to issue a sick note for the first
- 7 days (includes non-working and working days)
- patient can self certify
Sick note assesses
- if health condition has impaired their fitness to work
- if they are fit for work
*
What is a sprain?
- Injury to ligament
- usually heals in a few weeks
- symptoms include inflammation, swelling, and bruising around affected joint
- commonly lateral sprains i.e. talo-fibular or calcaneo fibular ligament
The severity of sprain is graded by how badly the ligament has been damaged and whether or not the ankle is unstable
- Grade 1: mild stretching with no instability
- grade 2: partial tear of the ligament but without joint instability
- Grade 3: a severe sprain with a complete rupture of the ligament + joint instability i.e. greater than normal movement in any plain
Treatment of sprain
PRICE + avoid HARM
- Protect from further injury
- Rest - 1st 3 days
- Ice (soon after injury)
- Compression with bandage
- Elevation
- Avoid Heat, alcohol, running and massaging (can cause bleeding)
The maximum time for a fit note
3 months
- but If a condition has lasted longer than six months, a fit note can be for any clinically appropriate period up to ‘an indefinite period’
URTI’s/cold in children presentation and course
- Starts with runny nose and nasal decongestion
- Should last more than a few days but can last up to 3 weeks
- it is normal for older kids to have colds 5-7 times a week and younger 10-12 times
***cant use abx***
What is lactose intolerance
Inability to digest lactose due to the absence of enzyme called lactase present in the SI (brush border of epithelial cells)?
- common in Asians
- Lactase breaks down lactose into glucose and galactose
Which one is the most common primary or secondary lactase deficiency?
Secondary lactase deficiency!
- Common causes: gastroenteritis, Crohns disease, Coeliac OR Ulcerative colitis
Most common signs of Lactose Intolerance
- Bloating
- diarrhea
- flatulence - if undigested lactose enters the colon it is broken down by bacter = H2 gas production
- abdominal pain/distention
- nausea
*** note: Constipation is NOT a common cause***
The rectum recieves its arterial supply from 3 main arteries
- Superior rectal artery – continuation of the inferior mesenteric artery.
- Middle rectal artery – branch of the internal iliac artery.
- Inferior rectal artery – branch of the internal pudendal artery.
Mallory weiss tear is common in which eating disorder
Bulimia nervosa - due to self induced vomiting
- symptoms include bloody vomit/ chnage in voice
Contents of femoral triangle
NAVEL
- Fem nerve
- Artery
- vein
- empty space
- lymphatics
Abdominal aorta starts at x and ends at x where it bifurcates
T10
L4
In appendicitis, if u palpate LIF and get pain in the RIF. This sign is called
Rovsing’s sign
What is Mc Burney’s point
is the pain from appendicitis being present 2/3 of the way from the umbilicus to the right anterior superior iliac spine?
In cardiogenic and hypovolaemic shock you get
- increased SVR (systemic vascular resistance)
increased HR
decreased cardiac output
decreased blood pressure
Risk factors of Gall stone (cholecystitis)
3 F’s
- Female
- forty
- fat
- RUQ radiating to shoulder
- Murphys sign can confirm (Inspiratory arrest upon palpation of the right upper quadrant)
Bile salts are absorbed in the
terminal ileum & recycled to the liver
- Bile is composed of bile salts, bicarbonate, cholesterol, steroids and water.
- There are three main factors regulating bile flow; hepatic secretion, gall bladder contraction and sphincter of oddi resistance.
Pathophysiology of gall stones -
Involved Bile salts which act as a detergent - they form micelles with lipids being in the centre which allows there transport
- too much lipids make it difficult for them to be transported = cholesterol rich gall stones
Brush border enzymes include
- maltase: glucose + glucose
- sucrase: glucose + fructose
- lactase: glucose + galactose
How to differentiate between Femoral and inguinal hernia
- They are inferolateral to the pubic tubercle whereas inguinal hernias are superlateral to the pubic tubercle;
- Typically non-reducible + no cough impulse (femoral)
- Most common complication: strangulation - requires surgery
Blood supple to the gut
Paritetal cells secrete acid in response to
- Histamine - acts on H2receptors on parietal cells
- Acetylcholine from PS nerve stimulation via vagus
- Gastrin (booster)
Inhibited in response to: somatostatin. prostaglandin, secretin, GIP and cholecystokonin
Syndrome characterized by
- oversecretion of gastrin
- over acid production
- hypermotility of GI tract
- & eventually peptic ulcer disease
Zollinger - Ellison syndrome (ZES)
* caused by ectopic G cell tumors (gastrinomas)
Clinical presentation of H pylori infection
- Dull, burning pain (may come and go)
- felt most on empty stomach
- can be relieved by food/ milk or anti acid
Aspirin and ibuprofen block x receptors resulting in
Prostaglandin receptors
- excess acid products as PG inhibitory effects is prevented
- PG also stimulates the production of mucus in the stomach which protects the gastric mucosa
- hence always give omeprazole
B12 is only absorbed in the
Terminal ileum and must be complexed with intrinsic factor
- Function: RBC maturation
What causes secretory diarrhea
Cholera
- From contaminated water/food due to production of cholera toxin
- effect mainly Proximal SI - causes increase secretion of na and cl and water: cause hypovolaemia
- Treatment: oral rehydration therapy (glucose + Na - can drive absorption back due to Na/glucose symporter)
Osmotic diarrhoea is usually caused by
- Disaccharide malabsorption due to disacc deficiences e.g. lactose intolerance
- mutation in LCT : responsible for the brush border (SGLT1 ) results in decreased galactose/glucose absorption
- Leads to an increased conc of unabsorbed nutrients in the chyme
insulin is secreted by
Beta cells in the pancreas
whereas Glucagon is secreted by alpha cells
**somatostatin by D or S cells and inhibits glucagon/stimulates insulin secretion
insulin inhibits
- Glucogenolysis from liver
- Gluconeogenesis from sources glycerol/lactate and AA
ECG changes
Axis of deviation
Look at I and II
Hypokalaemia vs hyperkalaemia on ECG
Hypo: Prolonged P-r + u waves
Hyper: tall tented T waves
What represents atrial repolarization on ECG
- Nothing
- generally not visible on the ECG strip. It occurs during the QRS complex.
Tall QRS complex throughout whole ECG - what does this point too
Left ventricular hypertrophy
Common cause of RBBB
Cor pulmonale -right ventricular hypertrophy
** others (PE, MI, cardiomyopathy)
When considering anticoagulation which 2 factors are weighted most
AGE and Previous TIA/stroke
What 4 factors increase stroke volume
Cardiac size, contractility (inotropy), preload and afterload
What palsy is this
6th nerve (abducens)
Corneal reflex
- Afferent pathway
- Efferent pathway
- Opthalmic nerve of trigeminal
- Facial nerve
Abduction of the eye is formed by
Lateral rectus muscle (supplied by abducens)
- Cranial nerve 2 (optic nerve) - innervates the retina.
- Cranial nerve 3 (oculomotor) - innervates the inferior oblique, medial, superior and inferior rectus
- Cranial nerve 4 (trochlear) - innervates the superior oblique
Taste in
- anterior 2/3 of tongue is innervated by
The trigeminal (mandibular)
**while the posterior 1/3rd is the glossopharyngeal
Most common nerve to be injued in an injury causing increased intracranial pressure
- Abducens
* as it has the longest course
checking pupil reflexes involves which 2 nerves
Optic and occulomotor
Management of impetigo
- mild: topical fusidic acid (1st line)
- severe: oral abx e.g. flucloxacillin
Warts are commonly caused by
Human papilloma virus
Graves have antibodies against TSH but Hashmito against
Thyroxine peroxidase
Carpal tunnel syndrome occuring due to damage to median nerve affect what nerve roots
C5-T1
With a hip fracture, the leg is
Shortened and externally rotated
**The affected leg is shortened due to the pull of the muscles which causes the distal aspect of the fractured femur to become misaligned and overlap.
The leg is also externally rotated due to pulling of the short external rotators
The leg may also be abducted.
Which vessel is the main blood supply to the femoral head and is the most risk of injury
Medial femoral circumflex artery
Frozen shoulder is also known as adhesive capsulitis and is caused due to
Inflammation of the shoulder capsule
What muscle initiates abduction of arm to 15 degrees
Supraspinatus then the deltoid is the major abductor of the arm
***Trapezius elevates the shoulder and rotates the scapula when the arm is abducted beyond 90 degrees
What causes internal rotation of shoulder (i.e. put hand on lumbar part of spine - known as gerbers test)
Subscapularis
During a hip examination, John, a 68-year-old male, is found to have a positive trendelenburg’s sign.
When he stands on only his right leg, his left pelvis drops.
Right superior gluteal nerve
* due to weak gluteus medius
What medication is used first line in Rheumatoid arthiritis
Methotrexate - folate antagonist
What nerve damage causes a winged scapula
long thoracic nerve (LTN) which innervates the serratus anterior
* it affects arm abduction
Menachem is a 24-year-old male who presents to the emergency department with an anteriorly dislocated shoulder and fracture of the surgical neck of the humerus.
What is the never damage, which of the following signs will most likely be elicited?
Axillary
Loss of sensation around regimental badge - unable to abduct
Type 1 diabetes is immune-mediated - common genes
HLA DR3 +/- DR4
To diagnose diabetes if no symptoms present
Need to do 2 diagnostic tests
- 2 x fasting glucose
- Hba1C or abnormal GTT
Test to confirm meniscal tear
Mc murrays test
**pt complains of knee getting stuck/catching w difficulty extending and flexing
How to test for acl tear
Anterior draw test + lachman test
* mri gold standard investigation
Lateral epicondylitis test (tennis)
Medial epicondylitis test (golf
mills test (symptoms include pain with resisted wrist extension and grippin)
Golfers test (pain with wrist flexion and pronation
Septic arthritis commonly caused by
- and how to investigate?
- Treatment
Staph aureus
* knee is the most common joint involved
- Gold standard: Aspiration then gram staining etc
- Iv antibiotics (then 6 month after) + urgent washout with saline
Treatment of sciatica
- nsaids- ibuprofen
- physio
- Consider: neuropathic meds if pain uncontrolled e.g. gaba
Diagnosis RA
need 4 or more of the following
- stiffness > 1 hour
- swelling in 3 or more joints
- Rheum nodules
- changes to hand
- Serum Rheum
- symmetrical
Gout investigation and management
- Fluid biopsy - presence of crystale
- Serum uric acid (measured 4-6 week after attach to confirm hyperuriceamia
Management:
- RIPE, lifestyle changes (less purines), anti inflamm meds e.g. diclofenac and naproxen (short term)
- Allopurinol (long term)
All bisphosphonates are licensed for use in women but in men only these 2 can be used
Alendronate and risendronate
