Fawzia Flashcards
Origin of iliopsoas?
T12-L5
Aldosterone effect is by?
Na-K ATPhase in COLLECTING DUCTS
Lung ventilation effect on the heart?
Decreased preload and afterload
Gallstones causes?
Cholesterol - most common - YELLOW LARGE SINGLE
Unconjugated bilirubin - DARK SMALL (hemolysis, sickle cell)
Polycythemia as a paraneoplastic syndrome?
RCC
Rare complication of ulcerative colitis?
Plyarteriitis
Post splenectomy changes?
Platelets RISE!!!! -> weeks -> Howell Jolly bodies -> target cells and Pappenheimer bodies
Risk of sepsis!
Inferior border of quadrangular triangle?
Teres MAJOR!!!!
Osteomyelitis in sickle cell?
SALMONELLA (S - S)
Cause of discitis?
Staph aureus
Cause of discitis?
Staph aureus
Nerve involved in smiling?
Marginal mandibular
Nerve responsable for hyperacusis?
FACIAL!
NOT TRIGEMINAL! Chorda tympani, membrane etc
Bladder embryologic origin?
Urogenital sinus
Course or right renal artery?
Posterior to IVC, posterior to right renal vein
Course or right renal artery?
Posterior to IVC, posterior to right renal vein
You review a 42-year-old woman 8 months following a renal transplant for focal segmental glomerulosclerosis. She is on a combination of tacrolimus, mycophenolate, and prednisolone. She has now presented with a five day history of feeling generally unwell with jaundice, fatigue and arthralgia. On examination she has jaundice, widespread lymphadenopathy and hepatomegaly. What is the most likely diagnosis?
Hepatitis C Epstein-Barr virus HIV Hepatitis B Cytomegalovirus
Post transplant complications
CMV: 4 weeks to 6 months post transplant
EBV: post transplant lymphoproliferative disease. > 6 months post transplant
Post transplant lymphoproliferative disorder is most commonly associated with Epstein-Barr virus. It typically occurs 6 months post transplant and is associated with high dose immunosupressant therapy. Remember cytomegalovirus presents within the first 4 weeks to 6 months post transplant.
Which of the following transplants is most susceptible to donor- recipient HLA mismatches?
Autologous skin graft Renal allograft Liver allograft Corneal allograft Cardiac valve allograft
KIDNEY!!! VERY DEMANDING FOR HLA MATCHING
Autologous transplant- same individual (genetically identical)
Allograft - Genetically different
The kidney is highly susceptible to HLA mismatches and hyperacute rejection may occur in patients with IgG anti HLA Class I antibodies. The liver is at far lower risk of rejection of this nature. Although the heart is sensitive to HLA mismatches this is less than the kidney. Cardiac valves and the cornea incite little immunological response.
A 48 year old lady with end stage renal failure receives a cadaveric renal transplant. The organ is ABO group matched only. On completion of the vascular anastomoses the surgeons remove the clamps. Over the course of the next twelve minutes the donated kidney becomes dusky and swollen and appears non viable. Which of the following is the most likely process that has caused this event?
IgG anti HLA Class I antibodies in the recipient
IgM anti HLA Class I antibodies in the recipient
IgG anti HLA Class I antibodies from the donor
IgM anti HLA Class I antibodies from the donor
IgM anti HLA Class II antibodies from the recipient
HYPERCAUTE - IGG HLA CLASS I IN RECEPIENT
Episodes of hyperacute rejection are typically due to preformed antibodies. ABO mismatch is the best example. However, IgG anti HLA Class I antibodies are another potential cause. These events are now seen less commonly because the cross matching process generally takes this possibility into account.
A 68 year old farmer presents with a skin lesion on his forehead. It has been present for the past 6 months and has grown slightly in size during that time. On examination, he has an ulcerated lesion with pearly white raised edges that measures 2cm in diameter. What is the most likely diagnosis?
Keratoacanthoma Squamous cell carcinoma Pyogenic granuloma Basal cell carcinoma Bowens disease
RAISED PEARLY EDGES - BCC! SUN - BCC
The raised pearly edges in an ulcerated lesion at a sun exposed site makes BCC most likely.
A 34 year old gardener presents with a lesion affecting the dorsum of his right hand. It has been present for the past 10 days and occurred after he had been pruning rose bushes. On examination, he has a raised ulcerated lesion which bleeds easily on contact. What is the diagnosis?
Keratoacanthoma Pyogenic granuloma Basal cell carcinoma Squamous cell carcinoma Amelanotic melanoma
YOUNG + TRAUMA + BLEEDING ULCER = PYOGENIC GRANULOMA
Trauma is a common precipitant of pyogenic granuloma and contact bleeding and ulceration are common.
A 25 year old man is diagnosed as having an undisplaced fracture of the proximal pole of the scaphoid. What is the best course of action?
Immobilisation in future splint for 5 weeks
Arrange an MRI scan
Immobilisation in plaster cast for 4 weeks
Surgical fixation
Initial immbolisation in plaster cast for 2 weeks with check radiographs at that stage
PROXIMAL SCAPHOID - SURGERY
It is generally accepted that proximal pole fractures of the scaphoid should be surgically fixed as non union rates of up to 34% can be seen when cast immobilization alone is attempted.
In matching donated kidneys to the most appropriate recipient, apart from ABO matching, which of the following is most important?
HLA DR Rhesus HLA A HLA B Duffy antigen
The rhesus group is not important in matching donor and recipient kidneys.
When HLA matching for a renal transplant the relative importance of the HLA antigens are as follows DR > B > A
A 21 year old lady presents with a nodule on the posterior aspect of her right calf. It has been present at the site for the past 6 months and occurred at the site of a previous insect bite. Although the nodule appears small, on palpation it appears to be nearly twice the size it appears on examination. The overlying skin is faintly pigmented. What is the most likely cause?
Pilar cyst Dermatofibroma Spitz naevus Seborrhoeic wart Basal cell carcinoma
Dermatofibromas may be pigmented and are often larger than they appear. They frequently occur at sites of previous trauma.
A 72 year old man presents with a large nodule on his face. It is friable. There is no regional lymphadenopathy. He is lost to follow up and re-attends several months later. On this occasion the lesion has been noted to resolve with scarring. What is the most likely lesion?
Pyogenic granuloma Keratoacanthoma Melanoma Basal cell carcinoma Dermatitis artifacta
Keratoacanthomas may reach a considerable size prior to sloughing off and scarring.
A 72 year old man presents with a large nodule on his face. It is friable. There is no regional lymphadenopathy. He is lost to follow up and re-attends several months later. On this occasion the lesion has been noted to resolve with scarring. What is the most likely lesion?
Pyogenic granuloma Keratoacanthoma Melanoma Basal cell carcinoma Dermatitis artifacta
Keratoacanthomas may reach a considerable size prior to sloughing off and scarring.
Common peroneal nerve roots?
L4, L5, S1, S2
Low TSH + Low T4?
Secondary hypothyroidism
Parotid tumour with rapid growth, invasion?
Adenoid cystic carcinoma
Erythema connected with ulcerative colitis?
Erythema nodosum
Which nerve is responsible for looking downwards and inwards?
Trochlear
Duke’s C?
