Miscellaneous stuff I get wrong p1 Flashcards
1
Q
What structures suspend the spinal cord within the dural sheath?
A
denticulate ligaments
2
Q
What is tidal volume
A
volume of air inspired and expired in a normal breath
500 males
350 female s
3
Q
what is the inspiratory reserve volume
A
maximum volume per inspiration
c. 3000mls
4
Q
what is the expiratory reserve volume
A
maximum volume per expiration
c. 1000mls
5
Q
what is the reserve volume
A
volume in lungs after a max expiration
c 1500mls
6
Q
what is the FRC lungs
A
volume in lungs at the end of a normal expiration
= RV + ERV
7
Q
what is the vital capacity
A
maximum volume of air that can be forcibly exhaled after a maximum inhale
c 4000mls male
c 3500mls female
8
Q
what is the TLC (total lung capacity)
A
volume of air in lungs after max insp
FRC + TV + IRV
c. 6000mls
9
Q
what is lung compliance
A
change in lung volume per unit change in air pressure
10
Q
what increases lung compliance? (2)
A
age
emphysema
11
Q
what decreases lung compliance (4)
A
pulmonary oedema
pulmonary fibrosis
pneumonectomy
kyphosis
12
Q
management of transection of a nerve - <1cm gap
A
primary surgical repair
13
Q
management of transection of a nerve - >2.5cm gap
A
autologous nerve grafting
14
Q
management of median nerve injury in distal 1/3 forearm
A
fascicular repair
15
Q
management of closed tibial shaft fracture
A
manage conservatively
16
Q
management of transphincteric fistula
A
seton
17
Q
how does hypovolaemia lead to AKI
A
hypovolaemia –> decreased renal blood flow –> hypoxic injury –> ATN
18
Q
pre-operative management if comes back as MRSA +ve
A
mupirocin nasal ointment
chlorhexidine mouth wash
19
Q
when to use full thickness over partial thickness skin grafts
A
very small area of burn/skin needing fraft
20
Q
how to urgently reverse warfarin pre-operatively
A
prothrombin complex
21
Q
pre-operatively - if patient is anaemic Mx
A
2 weeks of oral iron pre-surgery
22
Q
who to avoid O+ blood transfusions in
A
women of childbearing age
23
Q
lidocaine dose adults
A
3mg/kg without adrenaline
7mg/kg with adrenaline
24
Q
thyroid tumour >4cm Mx
A
total thryoidectomy
+ RAI to reduce risk recurrence
25
tension pneumothorax 1st step Mx
needle decompression 5th ICS Mid axillary line
then after can do chest drain
26
Bohr curve - which states shift to the LEFT
increased pH (hence decrease CO2)
decreased DPG
decreased temp
27
Bohr curve - which states shift to the RIGHT
decreased pH (hence increase CO2)
increased temp
increase DPG
28
ABx which act on the cell wall (2)
penicillins
cephalosporins ee.g. ceftraixone
29
ABx which inhibit protein synthesis (5)
fusidic acid
aminoglycosides (misread MRNA)
chloramphenicol
macrolides (50s subunit ribosomes)
tetracyclines
30
ABx which inhibit DNA synthesis (4)
quinolone (ciprofloxacin - inhibit topoisomerases)
metronidazole
sulphonamides
trimethoprim (bacterial folate synthesis inhibition)
31
which ABx inhibits RNA synthesis
rifampicin
32
how does cutting mode on monopolar diathermy work
pressure is applied to the tissues to vaporise the water content
33
how does coagulation mode on the monopolar diathermy power
pressure is applied, lower than cutting mode so coagulum is form instead of vapor
34
blend mode monopolar diathermy
alternates between cutting and coagulation mode
for procedures e.g. polypectomy
35
how does bipolar diathermy work
electric current flows from one electrode to the other, both contained within the same device e.g. a pair of forceps
36
e.g.s of USS based devices surgery
CUSA
Harmonic scalpel
37
how do CUSA/Harmonic scalpels work
high frequency oscillations to seal and coagulate tissues
different energy settings allow them to dissect + seal vessels simultaneously
38
hazards of diathermy (2)
patient burn
explosion/fire
39
which week of embryogenesis do dermatomes arise from
3rd week
40
embryogenesis of dermatomes
3rd week
31 somites --> 31 spinal nn
split into dorsal + ventral
ventral = sclerotome (ribs/VC)
dorsal = dermomyotomes
41
myotomes - UL - C5
abduction shoulder
42
myotomes - UL - C6
elbow flexion
43
myotomes - UL - C7
elbow extension
44
myotomes - UL - C8
finger flexion
45
myotomes - UL - T1
finger abduciton
46
myotomes - LL - L2
hip flexion
47
myotomes - LL - L 3
knee exptension
48
myotomes - LL - L4
ankle dorsiflexion
49
myotomes - LL - L5
hallux extension
50
myotomes - LL - S1
ankle plantarflexion
51
conditions associated with oslers nodes (4)
SLE
gonorrhoea
typhoid
haemolytic anaemia
endocarditis
52
bouchards are found at
PIPJ
53
heberdens are found at
DIPJ
54
liver injury grade 1
<10% SA haematoma
laceration <1cm
55
liver injury grade 2
haematoma 10-50% SA or intraparenchyma <10cm
laceration - capsular tear 1-3cm in depth
56
liver injury grade 3
haematoma >50% SA or intraparenchymal >10cm
laceration - capsular tear >3cm depth
vascular injury within parenchyma
57
liver injury grade 4
laceration - involving 25-75% hepatic lobe or 1-3 segments
vascular injury breaching parenchyma into peritoneum
58
liver injury grade 5
>75% hepatic lobe
juxtahepatic vessel injury
59
which cells produce gastric acid
parietal cells
60
what are the 3 phases of gastric acid secretion
1) cephalic phase - smell/taste food - 30% acid prod
- vagal stim --> HCL + gastrin release
2) gastric phase - distension stomach - 60% acid prod
stomach distends + low H+ + peptides --> gastrin release
3) intestinal phase - 10% gastric acid prod
- decr pH/distention/hypertonic solution in the duodenum inhibs gastric acid prod via CCK + secretin + neural reflexes
61
factors that increase gastric acid production (3)
CN X
gastrin
histamine release
62
which cells release histamine in the GIT
enterochromaffin cells
63
factors that decrease gastric acid production (3)
somatostatin
cholecystokinin
secretin
64
which cells produce gastrin
G cells in atrum
65
role of gastrin
increase HCL, peptin + IF secretion
increase gastric motility
66
here is cholecystokinin produced
I cells of the upper SI
67
what stimulates CCK
proteins/TG
68
role of CCK
increases secretion of enzymes from the pancreas
contracts GB
decreases gastric emptying
induces satiety
69
where is secretin produced
S cells of the upper SI
70
what stimulates secretin
acidic chyme + fatty acids
71
role of secretin
increased secretion of HCO3 fluid from liver/pancreas
decreases gastric acid secretion
72
where is VIP produced
SI + pancreas
73
role of VIP
stimulates secretion by pancreas + intestines
inhibits gastric acid + pepsinogen secretion
74
where is somatostatin secreted from
D cells pancreas + stomach
75
what stimulates somatostatin
fat, bile salts, glucose
76
role of somatostatin
dectreases acid production, pepsin + gaastric secretions
decreases pancreatic enzyme, insulin +glucagon secretion
stimulates gastric mucus production
77
Allograft transplant
tissue from genetically non identical donor of same species
78
Isograft transplant
tissue from genetically identical donor
79
Autograft transplant
transplant from same individual - from one organ/site to another
80
Xenograft transplant
transplant from a different species
81
hyperacute organ transplant rejection is due to
presence of preformed antibodies e.g. ABO incompatibility
82
when does hyperacute organ transplant rejection occur
immediately
83
when does acute organ transplant rejection occur
during first 6 months
84
acute organ transplant rejection is due to
T cell mediated
85
when does chronic organ transplant rejection occur
after 6 months
86
what type of transplant is most vulnerable to hyperacute rejection?
renal
87
what type of transplant is least vulnerable to hyperacute rejection
liver
88
cell type dominating in acute transplant rejection
mononuclear cell infiltrates
89
process of chronic transplant rejection
Vascular changes are most prominent with myointimal proliferation leading to organ ischaemia.
90
head of pancreas tumour surgical Mx
Whipples
91
carcinoma of body/tail pancreas surgical Mx
distal pancreatectomy
92
embryological origin of the pancreas
ventral and dorsal entodermal outgrowth from the duodenum
ventral remanent will ultimately become the pancreatic duct
93
FEV1:FVC obstructive diseases
low
94
pathway of impulses of baroceptors
increase BP stimulates baroceptors
relayed to tractus solitarius -> vasomotor centre of brain
95
what is the name of the most important ligament supporting the uterus?
cardinal ligament
96
which pathogens are patients with Sickle Cell at risk from? (3)
Strep pneumonia
H influenza
N meningitis
97
What is Stills disease
autoimmune syndrome
PS with high fever, bright pink rash, arthralgia, HSmegaly, abnormal LFTs
mistaken for EBV
98
Mx of trimalleolar fracture post reduction
elevate, then delayed ORIF
99
where would be tender on bimanual palp in ovarian torsion?
lateral fornices
100
spread of mastoiditis to the brain
mastoiditis --> mastoid air cells --> temporal bone --> epidural space
101
effect of coning of brain on Urine output and why
high UO, low osmolality
due to pituitary ischaemia --> diabetes insipidis
102
Adelta fibres transmit which pain
sharp pain
103
Abeta fibres transmit which pain
light pain
104
C fibres transmit which pain
dull/diffuse pain
(note these fibres are smallest and unmyelinated)
105
which immunoglobulin can cross the placenta to fetus
igG (i Got it from my mumma!)
106
what makes up the posterior wall of tthe inguinal canal laterally and medially
lateral 2/3 = transversalis fascia
medial 1/3 = conjoint tendon
107
hip pain - ext rotation + shortened =
NOF
108
hip pain - int rotation + shortened =
posterior dislocation
109
how much maintenance fluid does an adult need/day
25-30ml/kg/day
110
which type of lung cancer is the most likely to cavitate ?
squamous cell carcinoma
111
T1 or T2RF - PE
T1RF
112
which tumour marker is most sensitive for testicular teratoma?
AFP
113
layers pierced during a lumbar puncture
skin, fascia, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space, dura mater, arachnoid mater, subarachnoid space
114
if you see cortical bone thickening on an xray what condition should you think of? (+ unsual fracture)
Pagets
115
Where in the body would you find Hassal's corpusles (+fct)
Thymus gland
function unknown
116
Pseudomonas aerguniosa
sweet smell (like grapes)
gram negative rod
117
urachus originates from
allantosis
118
what does the umbilical aa become after birth
medial umbilical ligament
119
what does the umbilical vein become after birth
round ligament of liver (1 week after birth)
120
when does the vitelline duct usually disappear
by 6 weeks after embryogenesis
121
lower limit lumbar cistern
S2 (runs from L2- S2)
122
levels of research pyramid (draw please)
123
which thyroid cancers are calcitonin and amyloid levels greatly raised in?
medullary thyroid carcinoma
124
mutation medullary thyroid carcinoma
RET proto-oncogene
125
hodgkins vs non hodgkins lymphoma - contingous LN involvement
Hodgkins - contingous LN involvement
NHL - non-contingous LN involvement (ie LN are not next to e/o)
126
ACE - which autoimmune condition is this markedly high in?
sarcoidosis
127
how does Zollin-Ellinger syndrome incr gastric acid
incr gastrin binds to CCK-b receptors (on enterochromaffin cells)--> incr histamine --> incr gastric acid secretion
128
mode of action furosemide
binds to Na-K-Cl channels in thick ascending loop Henle
--> inhibition of Na/K/Cl --> H2O diffuses out
129
efferent Angiotensin II on glomerulus
constriction of efferent arterioles
--> increased glomerular pressure
130
effect of ACEi on aquaporin insertion in the nephron
decreases aquaporin insertion hence less water is reabsorbed (due to less ADH)
131
effect of vomiting on the kidneys
hypovolaemia 2' to vomiting --> Na reabsorption in kidneys --> K+ secretion from collecting duct 2' to RAAS
132
most common site for kidney stone obstruction
VUJ
133
where are the central chemoreceptors located?
ventrolateral medulla, between the exits of CN IX + X
134
embryology - notochord forms
anterior parts of VB + nucleus propolsus of IVD
135
embryology - neural tube forms
spinal cord
136
embryology - neural crest forms
pia mater
spinal symp ganglia
adrenal medulla
137
embryology - sclerotome forms
post parts of VB
annulus fibrosus IVD
138
where does Aldosterone act in the kidney?
intercalated cells of the collecting duct to increase Na (+ hence H2O) uptake
139
examples of secondary cartilaginous joints
= 2 bones joined by fibrocartilage + always found in midline
pubic symphysis
xiphisternal
manubriosternal
intervertebral joints between VB
140
examples of primary cartilaginous joints
two bones joined by hyaline - no movement
growing bones betw epiphysis + diaphysis
1st costosternal joint
all costochondral joints
141
Klippel-Trenaunay-Weber (KTW) syndrome
portwine stains
varicose veins
bony/soft tissue hypertrophy --> gigantism of a limb
142
Tx axillary vein thrombosis
catheter directed TPA
143
heaped/raised borders on an ulcer raises supsicion of...
marjolin ulcer
144
extensive iliac aa occlusion + significant co-morbidities Mx
femoro-femoral cross over graft
145
what is a cervical rib?
elongation of the TP of the 7th cervical vertebra
146
extensive bilateral iliac aa occlusion in a young patient Mx
aorto-bifemoral bypass
147
Skew/Burgess flaps are used in
below knee amputation
148
what is a Gritti-Stokes amputation
through knee amputation
149
what is a Syme's amputation
through ankle amputation
150
what is the most common cyanotic Congen heart disease at birth?
TGA
151
Ix of choice for upper airway compression
flow volume loop
152
which cell is the majority of tumour necrosis factor secreted by
macrophages
153
intracellular fluid makes up what % of total volume body
65%
154
extracellular fluid makes up what % of total volume body
35%
155
plasma makes up what % of total volume of the body
5%
156
drugs causing SIADH (4)
carbamazepine
Sulfonylureas
SSRIs
TCAs
157
red pulp of spleen is resposnbile for
maintainence of quality of erythrocytes
158
white pulp of spleen is responsible for
reticuloendothelial system + Ab production
159
zona fasciulata adrenals produce
cortisol
160
zona glomerulosa adrenals produce
aldosterone (think of it acting on the kidneys!)
161
where in the GIT is most water reabsorped
jejunum
162
which Amino acid are catecholamines primarily derived from?
tyrosine
163
what is measured to obtain renail plasma flow
PAH
= amount of PAH in urine per unit time / difference in PAH concentration in renal aa/vv
164
normal PAH value
660ml/min
165
PTH half life
10 minutes
166
what % of salivary gland secretions are from the parotid gland
25%
167
which substance is released from the sympathetic nn system to stimulate the adrenal medulla
acetylcholine
168
ventricular tachycardia - which rate limiting drug is contra-indicated
Verapamil
169
which intracranial lesion tends to show more marked necrosis and oedema
glioblastoma
170
how to do LN biopsy for suspected hodgkins lymphoma
excison LN biopsy
171
which oesophageal carcinoma are you more likely to get with Barretts
adenocarcinoma
172
with carcinoid tumours, what is necessary for the diagnosis of carcinoid syndrome
liver mets
173
Sarcomas in which Lymphatic Metastasis is seen?
'RACE For MS'
R: Rhabdomyosarcoma
A: Angiosarcoma
C: Clear cell sarcoma
E: Epithelial cell sarcoma
For: Fibrosarcoma
M: Malignant fibrous histiocytoma
S: Synovial cell sarcoma
174
what are popcorn cells and where are they seen
small cells with hyper-lobulated nucleus and small nucleoli
seen in Nodular lymphocyte predominant Hodgkin's lymphoma
175
what are desmoid tumours
fibrous neoplasms arising from musculoaponeurotic structures. They typically contain clonal proliferations of myofibroblasts.
176
what are psamomma bodies in papillary cell thyroid carcinomas
clusters of calcification
177
what is the dominant necrosis pattern in the CNS
colliquative necrosis
178
what is the dominant necrosis pattern in TB
caseous necrosis
179
what is the dominant necrosis pattern in the body
coagulative necrtosis
180
what is the dominant necrosis pattern in arterioles of hypertensive patients
fibrinoid necrosis
181
what is a Hadfield's procedure
total duct excision
for ductal ectasia
182
risk of AAA 5-6cm rupturing over 5y
25%
183
risk of AAA 6-7cm rupturing over 5y
35%
184
risk of AAA >7cm rupturing over 5y
75%
185
what is Ormond's disease
proliferation of fibrous tissue in the retroperitoneum
present with lower back pain, kidney failure, hypertension, deep vein thrombosis
Tx = steroids, +/- surg +/- ureteric stent
186
which clotting factors are liable to dysfunction 2' to liver disease
1,2,5,7,9,10,11
187
which clotting factors does heparin effect
2,9,10,11
188
which clottting factors are affected by DIC
1,2,5,8,11
189
Haemophilia - APTT, PT + bleeding time
APTT Increased
PT Normal
bleeding time Normal
190
vwD - APTT, PT + bleeding time
APTT Increased
PT Normal
bleeding time Increased
191
vit K deficiency - APTT, PT + bleeding time
APTT Increased
PT Increased
bleeding time Normal
192
which thyroid cancer usually presents as a single thyroid nodule
follicular carcinoma
193
way to remember hypersensitivity type reactions
ACID
EGGT
Anaphylaxsis - IgE
Cytotoxic - IgG
Immune complent mediated - IgG
Delayed - T cells
194
what is the most common extra-colonic lesion in FAP
duodenal polyps
195
what is diaphragm disease + what is its cause
lumen of the small bowel is divided into short compartments by circular membranes of mucosa and sub-mucosa; these membranes have a pinhole lumen leading to frequent bouts of intestinal obstruction.
cuased by L term NSAID use
196
what is the most common adverse affect of a packed red cells transfusion
pyrexia
197
what is the most common adverse affect of a FFP transfusion
urticaria
198
soap bubble appearance XR femur
osteoclastoma
199
what is the most common child brain tumour
astrocytoma
200
Von Hippel-Lindau syndrome features
cerebellar haemangiomas
retinal haemangiomas: vitreous haemorrhage
renal cysts (premalignant)
phaeochromocytoma
extra-renal cysts: epididymal, pancreatic, hepatic
endolymphatic sac tumours
