General Flashcards
Define these suffixes
-otomy
-oscopy
-ectomy
-plasty
-pexy
-centesis
-ostomy
-itis
-algia
-gram
-otomy: surgically cutting open
-oscopy: viewing with a scope in keyhole surgery
-ectomy: refers to removal
-plasty: changing in shape
-pexy: fixing something in place
-centesis: puncturing with a needle
-ostomy: creating a new opening
-itis: inflammation
-algia: pain
-gram: recording or imaging
Fistula definition
abnormal connection between two epithelial surfaces
Hemicolectomy
removing a portion of the large bowel (colon)
Hartmann’s procedure
(proctosigmoidectomy)
removal of the rectosigmoid colon with closure of the anorectal stump and formation of a colostomy
Anterior resection
removal of the rectum
Whipple procedure
pancreaticoduodenectomy
removal of the head of the pancreas, duodenum, gallbladder and bile duct
what is a kocher incision
from an open cholecystectomy
What is a chevron/ rooftop incision from
liver transplant
Whipple procedure
pancreatic surgery or upper GI surgery
Mercedes Benz incision from
liver transplant
Midline incision for
general laparotomy
Paramedian incision for
laparotomy (midline usually instead
Hockey-stick incision
renal transplant
Battle incision (paramedic)
open appendectomy
Mcburney incision
open appendectomy
Lanz incision (transverse)
open appendectomy
Rutherford Morrison incision (extended version of gridiron)
open appendectomy and colectomy
Laparascopic surgery and port sites
several 5-10mm incisions to allow the cameras and instruments to be inserted into the abdomen via port sites. A site just above or below the umbilicus is usually used as a port site.
What is diathermy
high frequency electrical current to cut through tissues or to cauterise blood vessels to stop bleeding
Monopolar diathermy
can be used in small or large operations
A diathermy probe is used by a surgeon and produces an electrical signal. A grounding plate or grounding pad is placed under the leg or buttock. A circuit is formed in the patient’s body, where the electricity goes in through the diathermy instrument and out through the grounding plate. At the site where the electrical energy is applied, it causes localised burning and tissue damage. As the electrical signal spreads through the body to the grounding plate, it becomes less intense and does not cause damage to other tissues.
Bipolar diathermy
involves an instrument with two electrodes
current passes between electrodes affecting tissues in this area
often used in microsurgery (like operations of the hand)
helpful to prevent the electrical signals from passing through the rest of the body, for example in patients with a pacemaker.
Absorbable sutures
slowly absorbed and disappear over time
Examples: Vicryl and Monocryl
used for tissues that will heal well and remain sealed after suture had been absorbed
such as abdominal cavity and closing tissues beneath the epidermis
Non absorbable sutures
remain in place for a long time and provide support to the tissues
example: silk, nylon and polypropylene
How they might be used:
closing skin by interrupted, or mattress suture technique, removed later once skin has healed
fixing drains in place, removed later with the drain
connective tissues that heal slowly such as repairing tendons
5 ways to close the skin
staples (rapid way to close skin and need removing later)
interrupted sutures (series of individual knots)
Mattress sutures (series of individual sutures that each go from one side of the wound, under and out the other side, then back under again to the other side)
Continuous sutures (single suture that goes in and out the wound along a spiral shape)
subcuticular sutures (single absorbable suture side to side just below skin to pull skin together)
Chest drains
method of removing air and fluid from the pleural space. The external end of the drain is placed underwater, creating a seal to prevent air from flowing back through the drain into the chest. Air can exit the chest cavity and bubble through the water, but the water prevents air from re-entering the drain and chest. During normal respiration the water in the drain will rise and fall due to changes in pressure in the chest (described as “swinging”).
Define guarding
involuntary tensing of the abdominal muscles when palpated
Define rebound tenderness
rapidly releasing pressure on abdomen creates worse pain than the pressure itself
what is generalised peritonitis caused by
by perforation of an abdominal organ releasing the contents into the peritoneal cavity and causing generalised inflammation of the peritoneum
What does serum lactate identify
indication of tissue ischaemia
product of anaerobic respiration and can also be raised in dehydration or hypoxia
Glasgow score
The criteria for the Glasgow score can be remembered using the PANCREAS mnemonic
P – Pa02 < 8 KPa
A – Age > 55
N – Neutrophils (WBC > 15)
C – Calcium < 2
R – uRea >16
E – Enzymes (LDH > 600 or AST/ALT >200)
A – Albumin < 32
S – Sugar (Glucose >10)
classification of haemorrhoids
1st degree: no prolapse
2nd degree: prolapse when straining and return on relaxing
3rd degree: prolapse when straining, do not return on relaxing, but can be pushed back
4th degree: prolapsed permanently
charcots triad
for acute cholangitis
Right upper quadrant pain
Fever
Jaundice (raised bilirubin)
what increases iron absorption
gastric acid and vitamin c
Transport of iron
carried in plasma as Fe3+ bound to transferrin
How is iron stored
as ferritin in tissures
How is iron excreted
lost via intestinal tract following desquamation
What is iron absorption decreased by
PPi
tetracycline
gastric achlorhydria
tannin (found in tea)
Where is iron absorbed
upper small intestine especially the duodenum
What organism causes toxic shock syndrome
staphylococcal aureus
Adrenaline dose for anaphylaxis in an adult
500 micrograms (o.5ml 1 in 1,000) IM
Scarlet fever
reaction to erythrogenic toxins produced by Group A haemolytic streptococci (usually streptococcus pyogenes)
peak incidence of 4yrs old
spread via respiratory route by inhaling or ingesting droplets etc.
What does scarlet fever present with
fever: lasts 24-48hrs
malaise, headache, nausea/vomiting
sore throat
strawberry tongue
rash: fine punctate erythema (pinhead) which generally appears first on the torso and spares the palms and soles, often described as having a rough sandpaper texture, dequamation occurs later in course of illness usually in fingers/toes
Diagnosis for scarlet fever
throat swab is normally taken
Management for scarlet fever
oral penicillin V for 10 days
penicillin allergy = azithromycin
it is a notifiable disease
Complications of scarlet fever
Otitis media -> most common
rheumatic fever: occurs 20 days post infection
acute glomerulonephritis : 10 days after infection
Vitamin C deficiency
known as scurvy -> leads to defective synthesis of collagen resulting in capillary fragility and poor wound healing
features:
gingivitis
poor wound healing
bleeding from gums, haematuria, epistaxis
general malasie
Vitamin K deficiency
increases risk of bleeding
features:
easy bruising
heavy menstrual periods
excessive bleeding from wounds
How does PCR work
used to amplify desired fragments of DNS
it denatures the double helix through heating
primer hybridization and finally polymerase enzymes elongate the chain to enable analysis
ABL oncogene category and associated cancer
cytoplasmic tyrosine kinase
chronic myeloid leukaemia
c-MYC oncogene category and associated cancer
trnasciption factor
Burkitt’s lymphoma
n-MYC oncogene category and associated cancer
transcription factor
neuroblastoma
BCL-2 oncogene category and associated cancer
apoptosis regulator protein
follicular lymphoma
RET oncogene category and associated cancer
tyrosine kinase receptor
multiple endocrine neoplasia (types II and III)
RAS oncogene category and associated cancer
G-protein
many cancers including pancreatic
erb-B2 (HER2/neu) oncogene category and associated cancer
tyrosine kinase receptor
breast and ovarian cancer
Vitamin K clotting factors
II, VII, IX, X
prothrombin
Helper T cells
involved in cell-mediated immune response
recognises antigens presented by MHC class II molecules
what does Helper t cells express
CD4
CD3, TCR and CD28
What are helper t cells a major source of
IL-2
Cytotoxic t cells
involved in the cell mediated immune response
recognises antigens presented by MHC class I molecules
induce apoptosis in virally infected and tumour cells
What do cytotoxic t cells express
CD8
CD3 and TCR
B cells
major cell of humoral immune response
acts as an APC
mediates hyperacute organ rejection
Plasma cells
differentiated from b cells
produces large amounts of antibody specific to a particular antigen
What does IgG do
enhance phagocytosis of bacteria nad viruses
fixes complement and passes to fetal circulation
most abundant isotype in blood serum
What does IgA do
predominant immunoglobulin found in breast milk - also found in secretions of digestive, respiratory and urogenital tracts
provides localised protection on mucous membranes
most commonly produced immunoglobulin in body
transported across interior of cell via transcytosis
What does IgM do
first immunoglobulin to be secreted in response to an infection
fixes complement but does not pass to fetal circulation
anti-A, B blood antiboduies
pentamer when secreted
IgD
role in immune system unkown
involved in activation of B cells
IgE
mediates type 1 hypersensitivity reactions
synthesised by plasma cells
binds to fc receptors found on the surface of mast cells and basophils
provides immunity to parasites such as helminths
least abundant isotype in blood seurm
Hawthorn effect
describes a group changing its behaviour due to the knowledge that it is being studied
Ketamine
NMDA receptor antagonist
may be used for induction of anaesthesia
has moderate to strong analgesic properties
produces little myocardial depression making it suitable agent for anaestheisa in those who are haemodynamically unstable
can produce nightmares
What part of the brain is required for converting short term memory into long term memory?
Hippocampus
mechanism of action of doxycycline
Tetracyclines - inhibits protein synthesis by acting on the 30S subunit of ribosomes
what is anaphylaxis
immediate type 1 hypersensitivity reaction characterised by widespread IgE-mediated histamine release from mast cells and basophils.
mechanism and example of type 1 hypersensitivity
Antigen reacts with IgE bound to mast cells
anaphylaxis
atopy
Mechanism and example of type 2 hypersensitivity
IgG or IgM binds to antigen on cell surface
* Autoimmune haemolytic anaemia
* ITP
* Goodpasture’s syndrome
* Pernicious anaemia
* Acute haemolytic transfusion reactions
* Rheumatic fever
* Pemphigus vulgaris / bullous pemphigoid
Mechanism and example of type 3 hypersensitivity
immune complex
Free antigen and antibody (IgG, IgA) combine
Serum sickness
* Systemic lupus erythematosus
* Post-streptococcal glomerulonephritis
* Extrinsic allergic alveolitis (especially acute phase)
Mechanism and example of type 4 hypersensitivity
T cell mediated
* Tuberculosis / tuberculin skin reaction
* Graft versus host disease
* Allergic contact dermatitis
* Scabies
* Extrinsic allergic alveolitis (especially chronic phase)
* Multiple sclerosis
* Guillain-Barre syndrome
Mechanism and example of type 5 hypersensitivity
Antibodies that recognise and bind to the cell surface receptors.
This either stimulating them or blocking ligand binding
graves disease
myasthenia gravis
Mechanism of action of macrolides
Macrolides - inhibits protein synthesis by acting on the 50S subunit of ribosomes
What is amiloride and what does it do
blocks the epithelial sodium channel in the distal convoluted tubule
weak diuretic, usually given with thiazides or loop diuretics as an alternative to potassium supplementation (remember that thiazides and loop diuretics often cause hypokalaemia)
Indications for aldosterone antagonists e.g. spironolactone
ascites: patients with cirrhosis develop a secondary hyperaldosteronism. Relatively large doses such as 100 or 200mg are often used
heart failure
nephrotic syndrome
Conn’s syndrome
where are T cells developed
thymus
consequences of vitamin B12 deficiency
macrocytic megaloblastic anaemia
peripheral neuropathy
Where does dormant tuberculosis most frequently reactivate?
apex of lung
what is co-trimoxazole a combination of
sulfamethoxazole + trimethoprim
where is dopamine made
substantia nigra pars compacta
genetic inheritance of mitochondrial disease
none of the children of an affected male will inherit
all children of affected female will inherit
Histology of mitochondrial disease
muscle biopsy classically shows ‘red, ragged fibres’ due to increased number of mitochondria
first immunoglobulin secreted in response to an infection
IgM
weird side effect of rifampicin
Rifampicin is know for causing a red-orange discoloration of bodily fluids including urine, tears, and sweat.
adrenaline Actions on α adrenergic receptors:
inhibits insulin secretion by the pancreas
stimulates glycogenolysis in the liver and muscle
stimulates glycolysis in muscle
adrenaline Actions onβ adrenergic receptors:
stimulates glucagon secretion in the pancreas
stimulates ACTH
stimulates lipolysis by adipose tissue
where does levothyroxine bind
acts via nuclear receptors
allopurinol mechanism of action
Allopurinol inhibits xanthine oxidase
What does lidocaine act on
ion channels
Falciparum malaria
the commonest, and most severe, type of malaria.
Features of falciparum malaria
schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia
Complications of falciparum malaria
cerebral malaria: seizures, coma
acute renal failure: blackwater fever, secondary to intravascular haemolysis, mechanism unknown
acute respiratory distress syndrome (ARDS)
hypoglycaemia
disseminated intravascular coagulation (DIC)
first line management for cellulitis
Flucloxacillin
What is penetrance
describes the proportion of a population of individuals who carry a disease-causing allele who express the related disease phenotype
Allograft
transplant of tissue from genetically non identical donor from the same species
Isograft
graft of tissue between two individuals who are genetically identical
Autograft
Transplantation or organs or tissues from one part of the body to another in the same individual
Xenograft
tissue transplanted from another species
What should be considered in patients with portal hypertension and lower Gi bleeding
rectal varices
Neurogenic shock
Occurs most often following a spinal cord transection usually at a high level
Result is either decreased sympathetic tone or increased parasympathetic tone
Results in decreased preload and thus decreased caridac output
decreased peripheral tissue perfusion
in contrast with other types of shock peripheral vasoconstrictors are used to return vascular tone to normal
Dumping syndrome
occurs post gastrectomy
occurs as a result of a hyperosmolar load rapidly entering proximal jejunum
osmosis drags water into the lumen
this results in lumen distention and then diarrhoea
excessive insulin release also occurs and results in hypoglycaemic symptoms
Boas’ sign
in acute cholecystitis there is hyperaestheisa beneath the right scapula
Boehaaves syndrome
spotaneous rupture of oesophagus
caused by repeated episodes of vomiting often in association with alcohol
Typically episode of reptitive vomiting followed by severe chest and epigastric pain
