Other Flashcards
What is observer bias?
Information is collected differently from cases vs. Controls because the examiners know which is which
What is attrition bias?
Due to loss of participants during a study
What is selection bias?
Certain groups can be over or under represented in research
Can fix by randomising who is chosen
What is observation bias?
Participants are aware they are being studied so they may alter how they act or what they say
What is confirmation bias?
During interpretation of results, researchers may look for patterns to confirm beliefs they already have
What is sensitivity?
How well a test can detect a disease
= true positives / total diseased
What is specificity?
How well a test detects NOT having the disease
= no. Of true negatives / total non-diseased
What is a positive predictive value?
Percentage of truly diseased people out of those who tested positive
Affected by prevalence
What is a negative predicted value?
Percentage of truly non-diseased people who tested negative
Affected by prevalence
Cost effectiveness ratio
Costs / benefits
Incremental cost-effectiveness ratio (ICER)
Difference in cost between two things / difference in effect
Cost utility analysis
Like cost effectiveness but measured in QALYs
ICER - extra cost per QALY gained
What is a cohort study?
Like case-control but over time
What does double-blind study mean?
Neither participants nor the examiners know who is getting what treatment
Which ecg leads help determine the axis of the heart?
I and aVF
What on an ecg shows a normal axis?
I and aVF are both positive
What on an ecg shows left axis deviation?
I positive
aVF is negative
What on an ecg shows right axis deviation?
I negative
aVF positive
What on an ecg shows extreme right axis deviation?
I and aVF both negative
6 stages to analysing an ECG
- Verify name and DOB
- Check date and time it was taken
- Calibration of paper (25mm/sec, 10mm is 1mV aka. 10 small boxes
- Determine the axis (I and aVF)
- Rate and rhythm
p waves present? Regular? HR? PR interval? QRS duration - Any other changes? e.g. ST elevation
Which ecg leads are septal and which artery?
V1 and V2
LAD
Which ecg leads are anterior? Which artery do these correspond to?
V3 and V4
Distal LAD
Which ecg leads are lateral and what artery?
I, aVL, V5 and V6
Circumflex artery
Which ecg leads are inferior and which artery?
II, III and aVF
Right coronary artery
What areas does the right coronary artery supply?
Right atrium and ventricle
SA and AV nodes
What areas does the left anterior descending artery supply?
Right and left ventricles and the ventricular septum
What areas does the left circumflex artery supply?
Left atrium and ventricle
What areas do the right and left marginal arteries supply?
Right supplies the right ventricle and apex
Left supplies the left ventricle
Describe aortic stenosis
Ejection systolic murmur (crescendo-decrescendo)
Heard loudest over aortic valve but commonly radiates to carotid arteries
May help if patient is sitting forwards
Describe mitral regurgitation
Pansystolic murmur
Loudest over the mitral area and radiates to axilla
Describe aortic regurgitation
Early diastolic murmur
Loudest at left sternal edge
May have a collapsing pulse
Heard louder with them leaning forward and holding an out breath
Describe mitral stenosis
Mid-diastolic murmur that’s low pitched and rumbling
Heard loudest over the apex
Associated with A. Fib
PR interval
3-5 small boxes
0.12-0.2 sec
AV nodal delay
How to determine HR from ECG
If regular, 300/no.of large squares between beats
If irregular, number of QRS in 30 large squares and times by 10
What does ST depression on an ECG indicate?
Ischaemia
Treatment for C.Diff
Vancomycin
Metronidazole
What are the 4 C causes of C.Diff
Co-amoxiclav
Clindamycin
Cephalosporins
Ciprofloxacins
Treatment for H.Pylori
PPI twice a day plus penicillin plus metronidazole/clarithromycin
If penicillin allergic, PPI plus metronidazole plus clarithromycin
Which arteries make up Little’s area?
Anterior and posterior ethmoidal
Splenopalantine
Greater palantine
Superior labial
What is the Chorda Tympani
Branch of facial nerve that runs through middle ear and is needed for taste signals to get back to brain
Tensor Tympani
Muscle in middle ear connecting malleus to tube wall
Innervated by CNV3
Dampens noise from chewing and shouting etc.
Stapedius
Smallest muscle in the body connecting the temporal bone to the neck of stapes
Innervated by CN VII
Protects the ear from loud sounds
What level is the hyoid?
C3
What level is the laryngeal prominence of the thyroid cartilage at?
C4
At what level does the cricoid cartilage end?
C6
At what level is the thyroid?
C5 to T1
Symptoms of hypercalcaemia
Bones, stones, groans and moans
Polyuria and polydipsia
Decreased QT interval on ECG
Constipation and vomiting
If urea is also high it could just be dehydration
Causes, Signs and treatment of hypokalaemia
Causes: diarrhoea, duiretics, insulin
Signs: Weakness, cramping, twitches
ECG: T wave depression, ST sagging, Prolonged P wave interval
Treat with K supplements
Causes, signs and treatment of hyperkalaemia
Causes: ACE inhibitors, B-blockers, NSAIDS, addisons, rhabdomyolysis, burns
Signs: Tall tented T waves, small P waves, wide QRS, V. Fibb
Treatment is URGENT is any ECG changes: Calcium gluconate (stabilises heart), Insulin and glucose (drives K+ into cells), salbutamol
Type of kidney stones if rhomboid shaped crystals
Uric Acid
Cant be seen on CT or x-ray
Type of kidney stones if envelope-shaped crystals
Calcium oxalate
Most common
Type of kidney stone with hexagonal shaped crystals
Cysteine
Type of kidney stone with wedge-shaped prism crystals
Calcium phosphate
2nd most common after oxalate
Describe thyroid hormone synthesis
Iodide taken up by follicle cells and oxidised to iodine
Iodine attaches to tyrosine residues on thyroglobulin to form MIT and DIT (mono- and di- iodotyrosine unit)
MIT+DIT = T3
DIT+DIT = T4
Hormones are stored in colloid until required
ENT sinuses and innervation
Frontal, Ethmoidal and Sphenoidal all CNV1
Maxillary CNV2
What is consequentialism
And action can either be right or wrong, it depends on the consequences
What is Utilitarianism
Acting to maximise the greatest happiness to the most people
E.g. triage
What is communitarianiam
Acting for everyone not just individuals
E.g. notifiable diseases and vaccination programmes
What does SMART goals stand for?
Specific Measureable Achievable Realistic Time-limited
What does contraction of the posterior cricoarytenoid do?
Widens the rima glottidis
E.g. gives more air for forced respiration
What does contraction of the arytenoids and lateral cricoarytenoids do?
Closes the rima glottidis
Adducts for protection
What does contraction of the thyroarytenoids do?
Relaxes the vocal ligaments decreasing pitch
Contraction of which muscle decreases the pitch of voice?
Thyroarytenoid
Contraction of which muscle increases pitch of voice?
Cricothyroid
What does contraction of the cricothyroid do?
Tenses the vocal ligament increasing pitch
What does contraction of just the lateral cricoarytenoid do?
Whispers
What are the three big branches of the aorta?
Brachii cephalic artery which splits into right subclavian and right common carotid
Left common carotid
Left subclavian
At what level is the coeliac trunk?
T12
At what level is the superior mesenteric artery?
L1
At what vertebral level is the inferior mesenteric artery?
L3
Bullous pemphigus (vulgaris) and bullous pemphigoid differences
Pemphigus = younger, desmogelin 3, intraepidermal, rupture easily, nikolskys sign positive, mucosal involvement, net-like IgG on immunofluorescence
Pemphigoid = older, hemidesmosomes, subepidermal, tense and firm, nikolskys sign negative, linear IgG on immunofluorescence
Difference between UVA and UVB
UVA causes longterm skin damage as it penetrates deeper into collagen, causes wrinkles
UVB doesn’t penetrate as deeply, responsible for sunburn
Breslow’s Thickness
Deepest part of the tumour from the granular cell layer in mm
<1mm, 5yr survival of >95%
>4mm, 5 yr survival of 50%
Which skin cancers are related to what type of sun exposure
Basal Cell and Malignant Melanoma is due to peak sun exposure, where youve been burned
Squamous Cell is due to cumulative sun exposure
Type of excisions for what type of skin cancer
MM = primary excision with clear margins BCC = wide excision with histology to ensure clear margins SCC = Complete surgical excision with a minimal margin of 5mm
Treatment for A. Fibb
Rate control: Digoxin, beta blockers, verapamil/diltiazem
Cardioversion with amiodarone
Treatment for sinus bradycardia
Atropine
Treatment for acute supraventricular tachycardia
Manouvres
IV Adenosine
IV verapamil
Phases of ventricular muscle action potential
Phase 0: big upstroke caused by fast Na+ influx
Phase 1: slight downstroke caused by closure of Na+ channels and transient K+ efflux
Phase 2: Plateau caused by Ca++ influx
Phase 3: Sharp downstroke caused by closure of Ca++ channels and K+efflux
Phase 4: Resting membrane potential
Symptoms specific to Crohns Disease and treatment
No blood of mucus Entire GI tract “Skip lesions” Terminal ileum most effected Transmural inflammation Smoking is a risk factor
Also weight loss, strictures and fistulas
Treatment: prednisolone and immunosuppressants e.g. azathioprine
Symptoms specific to ulcerative colitis
Continuous inflammation Limited to colon and rectum Only superficial mucosa is effected Smoking is protective Excrete blood and mucus Use aminosalicylates (mesalazine) Primary Sclerosing Cholangitis
Describe Torsades de Pointes.
How it happens and symptoms
Long QT syndrome (usually inherited) and shows no symptoms but if theres too much sympathetic stimulation like from adrenaline then Torsades de Pointes can happen
Looks like scribble zig zag just up and down on ECG
Torsades de Pointes can cause fainting, seizures and sudden death
A problem with early after depolarisation
Brugada Syndrome
Symptoms: sudden death, syncope, chest pain, SOB
Most likely at rest or after a meal, when feverish, or after alcohol
Predisposes to V. Tach or V. Fibb
ECG: ST elevation (though no plateau part) and with T wave inversion
Wolff-Parkinson-White Syndrome
Accessory Pathway (Bundle of Kent) that doesn’t have as much atrial delay ECG: Short PR interval, Slanted/wide QRS, T wave inversion Predisposes to atrial tachyarrhythmias
Strange Situation: Child is distressed when mother leaves, scared of stranger when alone but will play with mum there, happy when mum returns and uses mum as a safe base to explore.
What type of attachment style is this?
Secure Attachment
Strange Situation: Child is sad when mum leaves, avoids stranger always, in a huff when mum returns, cries a lot and doesnt explore.
What type of attachment is this?
Ambivalent attachment
Strange situation: Child is fine when mum leaves, plays with stranger, doesnt care when mum comes back, is equally happy with both mum and stranger.
What type of attachment is this?
Avoidant attachment
Teenager: self-reliant, doesn’t form relationships, has a negative view of other people.
What type of attachment?
Insecure-avoidant attached - Type A
Teenager: anti-social behaviour, unpredictable, complains.
What type of attachment?
Insecure-ambivalent attached - Type C
6 week milestones
Head control
Follows torch
Responsive to voice
Social smile
6 month milestones
Rolls over, push up and weight bear on legs
Palmar grasp, puts things in mouth
Babbles and screams
Friendly with strangers, plays with feet
12 month milestones
Crawls, may take first steps
Fine grip, bangs toys together
Responds to name, jargon words
Drinks from cup and waves goodbye
18 month milestones
Runs and climbs
Tower of 3-4 bricks, picture books
5-20 words, points to body parts
Feeds with spoon, imitates adult behaviour
2 year milestones
Stairs 2 feet a step
Tower of 6-7 bricks
50+ words, understands simple instructions
Puts on hat and shoes
3 year milestones
Stairs with alternating feet
Copies circle, cuts with scissors
Simple conversation, asks lots of questions
Imaginative play, shares and plays with others
4 year milestones
Runs stairs, kick, throw and catch
Copies cross, draws stick man
Tells stories, counts to 20
Dresses self, can take turns
Developmental Red Flags
Asymmetry of movement Not reaching for object by 6 months Not sitting unsupported by 12 months Not walking by 18 months No speech by 18 months Regression
Endocarditis in a ‘normal’ person or someone who’s recently been to dentist.
Most likely organism and empirical treatment
Strep. Viridans
Amoxicillin and Gentamicin (IV)
Endocarditis in someone with a prosthetic heart valve
Most likely organism and empirical treatment
If <2months then staph. Epidermis. If >2 months then staph. Aureus
Vancomycin and gentamicin (IV) then on day 3/5 add oral rifampicin
Endocarditis in an IVDU.
Most likely organism and empirical treatment
Staph. Aureus or epidermis
Flucloxacillin IV
