PasTest Flashcards
What is the main determinant of fasting plasma phosphate concentration?
Rate of renal tubular absorption.
Therefore 1* hyperparathyroid, hypercalcaemia of malignancy, inherited hypophosphatemic rickets, prolonged IV nutrition = low PO4
What is the main site for the tumour in Zollinger Ellison?
Proximal wall of duodenum (90% located there or tail of pancreas)
Where does the ampulla of vater enter the bowel?
Descending (2nd) part of duodenum
Viral Causes of Pancreatitis
mumps
Coxsackie B
Hepatitis B
Posterior hip dislocation
Internal rotation, adduction, flexion at the hip
Anterior hip dislocation
Leg extended and externally rotataed at the hip
Therapeutic management of thromboembolic stroke
Thrombolysis - tPa
Aspirin 300 mg OD
Warfarin - AF, LV thrombus, enlarged L atrium
MDT rehab
Kussmaul’s Sign
Paradoxical rise in JVP in acute tamponade.
Supranuclear Palsy
Symmetrical Parkinsonism, initially slow saccades (esp vertical), progressing to limitation of eye movements.
Corticobasal syndrome
Asymmetrical cortical syndrome, prominent gait unsteadiness, falls, parkinsonism, apraxia, alien limb syndrome
Potencies of steroid creams
Help EVERY BUDDING DERMATOLOGIST
Hydrocortisone Eumovate Betnovate Dermovate
Causes of Carpal Tunnel - mnemonic
CARPAL C - cardiac failure / COCP A - acromegaly R - renal (nephrotic, DM) A - arthritis of wrist (RA, OA) L - large size (obesity)
What is the correct B12 replacing regimen?
Hydroxycolbalamin 1mg IM 3 times a week for 2 weeks, monthly for 3 months, once every 3 months
Risk factors for cataracts + mneumonic
DEHYDRATION DM / dehydration Eye disease - glaucoma, uveitis Hypertension, hypocalcaemia dYstophia myotonica Diet - low in carotene and antioxidants Race and FH Alcohol Toxicity - steroids, tobacco Ionising radiation Old age No protection (prophylactic aspirin, osetrogens)
Pemphigus vulgaris - what is it caused by?
IgG autoAb to desmoglein 3 leading to intra-epidermal splitting
Which carpal bone dislocates most frequently?
Lunate
Typically disloctes anteriorly into carpal tunnel, compressing median nerve
Meckel’s Diverticulum rule
Rule of 2s
2 inches in length, 2 feet from ileocaecal junction, 2% of population, 2 types of tissue - gastric and pancreatic
Which main vessels exit the abdominal aorta?
T12 - coeliac plexus (stomach, spleen, liver)
L1 - SMA (D2 - right 2/3 transverse colon)
L3 - IMA (transverse colon L to dentate line)
Gonadal Arteries
4 paired lumbar arteries
Birucation into CI arteries
Triad of Pellagre
3 D
Diarrhoea, dermatitis, dementia
Yellow Nail Syndrome
yellow deformed nails, lymph oedema, exudative pleural effusion. Maldevelopment of lymphatic system.
Branches of the abdominal aorta
T12 - coeliac trunk L1 - SMA L3 - IMA Paired gonadal arteries (from which ureteric arise) 4 paired lumbar arteries Common iliac
Cerebello-pontine angle tumour
V, VI, VII, VIII palsy
Likely acoustic neuroma in NF-1
Causes of pellagra - primary and secondary
Presents with diarrhoea, dementia and dermatitis (B3 niacin def)
Primary due to dietary insufficiency
Secondary due to decreased absorption in chronic alcohol, carcinoid tumour or GI disease (e.g. IBD)
Which MODY associated with hepatic neoplasm?
MODY3
Classifying severity of eczema
Clear - no signs
Mild - areas of dry skin, infrequent itching ± small erythematous patches
Moderate - dry skin, frequent itching, erythematous patches + excoriations
Severe - widespread, continous itching, redness, excoriations, bleeding, oozing, skin thickening or altered pigmentation
Smudge cell?
CLL
Clonal population of immature cels with intracytoplasmic dark pink rods?
APML (auer rods)
Note can cause DIC, treated with all-trans retinoic acid
Lymphocytes with thin projections of cytoplasm?
Hairy cell leukaemia
What is indapamide? What are its advantages?
Thiazide diuretic, less propensity for hyponatreamia and no effect on insulin resistance vs bendroflumathazide
Why must sodium nitroprusside infusions be covered?
Degrades in sunlight to form cyanide. If poison - sodium thiosulphate
Cat scratch disease?
Bartonella henselae - brownish red papules around inoculation site after 3-10 days. Can take 6-12 months to resolve completely. Also fever, malaise, anorexia.
Azithromycin 5 days
Post herpatic neuralgia?
TCA
What can increase T1/2 of morphine?
Imparied renal and/or liver function
Gilbert’s mutation?
UDP glucuronyl transferase
SE - cisplatin
Tinnitus, metallic taste in mouth
SE - bleomycin
Lung injury
SE - imatinib
Fluid retention, esp peri orbital
SE - vincristine
Peripheral neuropathy
SE - capecitabine
Loose stool and severe diarrhoea
SLE symptoms - pneumonic
DOPAMINE RASH Discoid Lupus Oral Ulcers Photosensitivity Arthritis Malar Rash Immunological (dsDNA, Ro, La, Smith) Neuroloical ESR Renal ANA Serositis (pleurisy, pericarditis) Haematological (HA, leukopenia, thrombocytopenia)
What is the mechanism of osteoporosis in cushings?
Elevated cortisol reduced intestinal Ca absorption, leading to secondary hyperPTH which favours PO4 loss. Results in increased osteoclast activity and bone turnover. Also causes less osteoid matrix synthesis
Rose spots, salmon pink spots
Typhoid fever
Ciprofloxacin
Anion gap
Na+K-Cl-HCO3
P450 inducers
Qunidine Barbiturates Phenytoin Rifampin Griseofulvin Carbamazepine Chronic Alcohol intake
P450 inhibitors
Protease inhibitors, isionizid, cimetidine, ketoconazole, erythromycin, grapefruit juice, sulfonamide
Lhermitte’s phenomenon
test for intrinsic lesion of the cervical cord usually seen in multiple sclerosis but can occur in SACD. Passive flexion of the neck gives an electric shock like sensation down the back.
Ddx diabetes with cord compression, tabes dorsalis, friedichs ataxia
Lesions of the temporal lobe classically produce which visual field loss?
Superior quadrantinopias
Lesion of the parietal lobe classically produce which visual field loss?
Inferior quadrantinopias
what is another name for Wallenbergs syndrome?
Lateral medullary syndrome (PICA)
Lateral Medullary Syndrome (Wallenbergs)
Loss of pain and temperature sensation on the contralateral side of the body and ipsilateral side of the face.
Dysphagia (IX and X) slurred speech, ataxia (broad based gait), facial pain, vertigo, nystagmus, Horner’s (ipsilateral), diplopia, and possibly palatal myoclonus.
Anoscoria - def
difference in size between pupils
What suppresses gastrin? Name of drug in this group?
Somatostatin - octreotide e.g. for ZE syndrome
Treatment of dermatitis herpetiformis?
Dapsone
Papulovesicular rash caused by IgA complex deposition in papillary dermis
Which is the only laryngeal muscle not supplied by recurrent laryngeal?
Cricothyroid muscle - external laryngeal branches of superior laryngeal nerve
Turner’s and heart problems
Coarctation, dissection, congenital bicuspid valve, mitral prolapse
Anatomical boundaries of the inguinal canal
MALT - muscles, aponeuroses, ligaments, tendon/transversalis
Superior - Muscles (internal oblique and transversus abdominis
Anterior - Aponeurosis (internal and external oblique)
Inferior - Ligments (Inguinal and lacunar)
Posterior - Tendon (conjoint) and Transversalis fascia
Which lymph nodes drain testes?
Para-aortic
Measuring burns areas
9% head, arm
18% leg (9% anterior/posterior)
36% torso (18% front, 18% back)
1% genitals/perineum
Warfarin - which juice to avoid
Grapefruit and cranberry
Symptoms of Paget’s disease of bone - mnemonic
PANICS Pain Arthritis Nerve Compression Increased bone size Cardiac Failure osteoSarcoma (1-2% of cases)
What iron chelator is given in both B Thalassaemia major and haemochormatosis
Desferrioxamine
Which infection commonly precedes Guillan Barre’ syndrome?
Campylobacter gastroenteritis
Lithium poisoning
Diarrhoea, hypokalaemia, hypotension, arrythmias, seizures, coma, metallic taste, fine tremor
Treating septic arthritis
Irrigation and drainage of joint (open or arthroscopic approach), + targeted IV Abx 2/52 + PO 4/52
Boxer’s Fracture - presentation and management
Fracture of 5th MCP after punching. Usually wool + crepe bandage but i angulated/rotated may need manipulation + K-wire
MM pt with neck pain + focal neurological deficit?
Plasmacytoma (malignant plasma cell tumour, occur in axial skeleton/soft tissue and may cause compression/fracture)
MRI spine
Rx needed
What anatomical landmark key to fistula in ano?
Pectinate (detonate) line. Junction of columnar (above line) with SC epithelium (below line). Low fistula = not lie across sphincter = lie it open. High fistula = crosses sphincter above line = seton (thread woven into fistula then tightened over several weeks to cut through surface
Managing fractures - mneumonic
6 Rs Resuscitate Radiology (XR) Reduce Restrict (fixate, internal vs external) Remain Rehabilitate
Causes of erythema nodosum - mnemonic
NODOSUM NOne (idiopathic0 Drugs (sulphonamides, penicillin) Oral contraceptive pill Sarcoidosis UC (IBD) Microbiology (strep throat, TB)
Causes of alveolar haemorrhage
SLE, Goodpasture, GPA
Traumatic splenic injury grades
I - sub scapular haematoma <10% surface area; laceration <1cm depth
II - haematoma 10-50% SA or intraparenchymal <5cm; laceration 1-3cm w/o involving vessel
III - haematoma >50% SA or expanding, or ruptured or intraparenchymal >5cm; laceration >3cm involving vessel
IV - major devascularisation (>25% spleen(
V - completely shattered spleen, hilar vascular injury
RF for cataracts - mnemonic
DEHYDRATION DM, dehydration Eye disease - glaucoma, uveitis HTN, hypo Ca dYstrophia myotonica Diet low in fit A and antioxidants Race and FH Accidents, Alcohol excess Toxicity - roids, tobacco, toxoplasmosis Ionising radiation Old Age No protection - oestrogens, aspirin use
Normal presure hydrocephalus triad
Unsteady gait dementia with psychomotor retardation and urinary incontinence.
Typically gait broad based and small stepping with difficulty on initiation.
Risk factors for different renal stones
CaPO4 - idiopathic, hypercalcuria, hyperparathyroidism
Struvite (MgNH3PO4) - chronic UTI
Uric acid - hypercalcuria
Cysteine - intrinsic metabolic defects
Drug precipitation - Acyclovir, Indinavir, Mg Silicate, Sulfasalazine
Site of bronchiectasis can point to underlying disease. Which?
Upper lobe: CF, TB
Middle lobe: mycobacterium avium complex infection
Lower lobe: congenital immunodeficiency, recurrent aspiration
Central: allergic bronchopulmonary aspergillosis
Was is a common cause of paraphimosis?
The foreskin retracted during catheterisation has not been replaced leading to glans swelling. Urological emergency.
Attempt gradual manual reduction. If fails, inform urologist.
What is the distribution of myasthenia gravis?
Bimodal - in 30s and 60/70s
What scan is performed in varcioceles and why?
Kidney US, L sided varicocele associated with L renal malignancy. Anatomy of gonadal veins asymmetrical, R drains into IVC, L drains into L renal vein (and the fore may be compressed by tumour to cause L varicocele)
RF for avascular necrosis of femoral head
Chronic corticosteroids, excessive alcohol consumption
MRI is investigation of choice
Tropical sprue - presentation, biopsy and treatment
Chronic diarrhoea, weight loss, B12 & B9 deficiency, positive travel Hx
SI biopsy - mononuclear infiltration and villous atrophy
Broad spectrum Abx - tetracyclines and B9 supplements
Whipple’s disease - biopsy and treatment
PAS-positive macrophage in lamina propria
Double strength trimethoprim and sulfamethaxozole
Causes of dilated cardiomyopathy
Dilation of all 4 chambers of the heart Viral - Coxsackie, Parvovirus B19, HIV Alcohol Methamphetamines Chaga's disease
Carcinoid syndrome
Neuroendocrine GI tumour producing serotonin. Does not manifest until liver mets - as liver metabolises serotonin
Facial flushing, diarrhoea, right sided valvular disease (does not cause L sided as lungs metabolise serotonin)
Tinea versicolour
Malassezia furfur (fungus) Pale, velvety, hypo pigmented macule which does not tan and is non scaly
Causes of TEN
NSAIDS, steroids, methotrexate, allopurinol, penicillins
Sutures: Silk
Non absorbable natural multifilament suture
Sutures: Prolene
Non absorbable, synthetic monofilament suture
Sutures: Polyester
Non absorbable synthetic multifilament suture
Sutures: Vicryl
Absorbable, synthetic, multifilament suture
Polyarteritis nodosa spares which arteries?
Associated with hep B
Spares pulmonary arteries
Humeral fractures and neuro deficits
Mid-humeral shaft fracture - Radial
Medial humeral epicondyle - Ulnar
Supracondylar humeral fractures - Median
What is a classical examination finding in P. jirovecii infection?
Destauration on exercise
Pulse oximetry before and after walking up and down on ward
What is transient hypocalcaemia?
Common complication of partial thyroidectomy, usually resolves.
If Ca <1.9 or frank tetany, OV calcium glucuronate bolus
Usually patients preloaded with 1alphacalcidol pre-op
Behcet’s antibodies
Anti saccharomyces cervisiae
Penicillamine is associated with which type of GN?
Membranous
Protein Deposition: Alzheimer’s
Amyloid precursor protein (APP) and Tau hyperphosphorylated protein
Protein Deposition: Lewy Body dementia
Alpha synuclein
Protein Deposition: PD
Alpha synuclein
Protein Deposition: Fronto-temporal dementia and ALS
TAR DNA binding protein 43 (TARDBP43)
Protein Deposition: Pick’s disease
Tau protein, Pick bodies (large ballooned neuronal cells)
Branches of the facial nerve - mnemonic
Ten Zulus Baked My Cat Temporal Zygomatic Buccal Mandibular Cervical
Steroid regimens for surgery
Pre-op requirement <10mg and minor surgery - none
Pre-op >10mg daily and minor surgery - 25mg IV hydro + normal post op
>10mg and intermediate - 25mg IV + 25mg TDS 24h
>10mg and major - 50mg IV + 50mg TDS 72h
SIRS criteria
T >38 / <36
RR >20 / PaCO2 <4.25
HR >90
WCC >12 / <4
Pre-op management of pt with IDDM
Two common regimens - 1:1 (50u insulin in 50ml saline) or PIG (potassium insulin glucose)
Continue normal SC insulin until NBM before surgery
Mount Vernon formula for fluid replacement in burns
Use rule of 9s
(weight x % burn)/2 = Volume of colloid (mL)
First 3 sets every 4h, 2 sets every 6 hours, final set over 12h
Classes of shock
I - <15% blood loss (750ml), Obs within range
II - <30% (1500ml), tachycardia, tachypnoea, anxiety
III - <40% (2000ml), tachycardia, low BP, RR 30-40, low UO, confusion
IV- >40% (2500ml), Obs fucked, confused/drowsy
On which grade od splenic injury do we operate?
IV only
I-III conservative
GCS in intubated patients
Discount vocal entirely, out of 10 points, rest normal
Monroe-Kellie concept
In cranial bleeding (fixed space), initial compensation (volume sacrificing) is provided by loss of CSF and venous volume. However when overwhelmed (150ml), exponential increase in ICP
Foramen of Winslow
Only communication between greater and lesser sac
IVC, D1, hepatoduodenal ligament (contains portal triad), caudate lobe of liver
What runs in hepatoduodenal ligament?
Portal triad (HA, PV, CBD)
The anorectal ring is made up of?
Combined fibres of the puborectal muscle and external sphincter
Carcinoma of the anal canal presents with:
RF: Gay man (HPV)
Bleeding and incontinence
70% have sphincter involvement at resentation
25% have palpable mass
Peri-anal abscesses - different presentations
Majority of abscesses originate from infection within gland between internal and external sphincters.
65% will track down - perianal abscess (discrete red swelling close to anal verge)
15% track through external sphincter into ischiorectal fossae (systemic illness, extreme pain on palpation/DRE)
15% remain within muscle layers - intersphincteric abscess (chronic anal pain)
5% upwards through levitator ani - supralevator abscess (next to bladder - braider irritation)
Most CRC occur in the:
Rectum (33%) Sigmoid (25%) Caecum and ascending colon (18%) Transverse (9%) Descending
Inguinal Canal anatomy: MALT
Superior: M (internal oblique and transversus abdominis)
Anterior: A (aponeurosis of EO and IO)
Floor: L (Inguinal and Lacunar ligaments)
Posterior: T (transversalis fascia and conjoint tendon)
MoA colchicine for gout
Inhibits activation of neutrophils by irate crystal through inhibiting polymerisation of B tubulin
Breast imaging - cut off for US vs mammogram
35 years
Triple assessment
Examination + Hx
Imaging (mammogram / USS)
FNA ± core biopsy
Abx for acute mastitis
Flucloxacillin
Pathogens likely skin commensals - majority Staph
Suitability for carotid endarterectomy - who?
Pts with symptomatic (TIA) carotid artery stenosis >70-80% good candidates
Symptomatic pts with stenosis 50-70% - optimise medical therapy and review regularly - if continue to be symptomatic operate
If asymptomatic but stenosis >80% consider endarterectomy but may be controversial
AAA - indications for surgery
> 5.5 cm (at this size will increase 4-6mm per annum)
<5.5 but growing at rate of 1cm per annum or more
Symptomatic - back pain, distal embolisation
AAA repair principles
Either lapatotomy with dacron artificial graft or EVAR (endovascular aneurysm repair)
EVAR - femoral approach, radio guidance, endoluminal stunting. Better for patients less fit for surgery, shorter inpatient stay with less blood transfusions
Varicose veins - treatment options
Conservative - compression stockings, weight loss, avoiding standing, frequent periods of walking
Medical - injection sclerotherapy (e.g. Na tetradecyl) increases amount of granulation tissue (injection followed by compression bandage for few weeks). Foam sclerotherapy also done. SE: long term pigmentation changes at site.
Surgery - best option, if QoL severely impaired. Ligation of saphenopopliteal or saphenofemoal junctional endoluminal RF ablation
High recurrence rates all methods
Complications of carotid endarterectomy
Post-op HTN (66% pts) - close eye on BP for 72h
Stroke (5-8%)
Cranial nerve injury (5%)
Wound infection / patch rupture
Causes of necrotising fasciitis
Group A strep, vibrio vulnificus, clostridium perfringens, bacteroides fragilis
Indications for amputation
Useless limb - fixed flexion deformity, vestigial fingers
Dead limb - unsalvageable trauma, necrosis, PVD
Lethal limb - malignancy
Causes of Raynauds phenomenon
Primary - idiopathic
Scleroderma, SLE, polyarteritis nodosa, RA, cervical rib, polycythaemia, cryoglobulinaemia, B blockers,
Ix –> FBC, TFT, LFTs, ANA, RF, cold provocation tests, cryoglobulins
Popliteal aneurysms are associated with?
AAA - always look
50% B/L, 40% with AAA
What is the anatomy of the femoral artery?
As the external iliac passes under the inguinal ligament, it becomes the common femoral and gives of the profunda femurs artery before continuing down as the superficial femoral artery
Broadly, when would you use synthetic grafts, when organic?
Reversed (remember valves) autologous vein grafts indicated for below inguinal ligament, above use dacron / PTFE
How do you classify bypass procedures
Anatomical (e.g. femoropopiteal) vs Extra-anatomical (e.g. axillofemoral, axillo-bifemoral)
Branches of the external carotid
Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Maxillary Superficial temporal
Renal arteries - anatomical relation
L1/L2 (right below SMA at L1)
At rest how much blood do kidneys receive?
20% via renal arteries
R renal artery lives posterior to IVC and is the longer one
Which muscle is posteromedial to kidneys?
Psoas. Also separates ureters from lumber vertebrae.
Widest and narrowest part of male urethra
Widest - prostatic, approx 3cm in length, vas deference and prostatic duct open here.
Narrowest - membranous urethra - where pierces the urogenital diaphragm
Frequency of stone composition
60% Ca oxalate 30% triple (Mg, Ca, PO4) 5% Uric acid 2% Cysteine 1% Xanthine
What size stones can a person pass?
Usually <5mm
Which scan can estimate renal function?
DMSA scan
Which organisms predispose to renal calculi?
Proteus Pseudomonas Staphylococcus Mycoplasma Klebsiella These are urease splitting organisms which hydrolyse urea to ammonia causing alkylotic urine and precipitation
Fournier’s gangrene
Rare necrotising fascists of the perineum and genitals
Middle aged - elderly men
Co-morbidities include DM
ADPKD genes
PKD1 chr 16 (85%)
PKD2 chr 4 (15%)
ECG hypokalaemia
Small/inverted T waves Prominent U waves Prolonged PR ST depression Prolonged QT
ECG hyperkalaemia
Tented T waves
Small P waves
Wide QRS
RF RCC
Dialysis (causes acquired cystic disease in 90%) Smoking Lead Asbetos Polycarbons FH: VHL
Treatment of bladder cancer - medical
BCG for 6wks can be tried
Testicular tumours
- Stromal. Leydig cells (secrete androgens); Sertoli cells (secrete androgens and can present with testicular feminisation)
- Lymphoma. <10%, elderly, poor prognosis
- Germ cell. Seminomas - 20 to 40 years, solid, slow growing, very Rx (5yr 90%), AFP. Teratomas - 15 to 35 years, solid or cystic, bHCG + AFP
ALL Drain to para-aortic LN
Peyronie’s disease - associations and treatment
Dupuytren’s and palmar fascitis
1 year conservative - allow disease to stabilise
Surgical –> Nesbit’s (cut opposite side, shortens penis)
Prostate anatomy
Transition zone - innermost, surrounds urethra, enlarged in BPH
Central zone - surrounds ejaculatory ducts, projects beneath bladder to seminal vesicles
Peripheral zone - most Ca here (causes bulky irregular palpable prostate)
Anterior fibromuscular stroma
BPH treatment
Medical - alpha blockers (tamsulosin, alfuzosin); 5 alpha reductase inhibitors (finasteride, dudasteride)
Surgical - TURP
A partial radial nerve injury causing weakness in finger and wrist extension but no wrist drop or sensory loss is associated with?
Radial nerve winds around shaft of humerus, enters the forearm laterally, runs adjacent to head of radius.
Head of radius fracture
Proximal to this gives off superficial radial (sensory), posterior interosseus, superficial radial
RA and OA - valgus or varus?
RA causes valgus (more commonly affects lateral compartment)
OA causes varus (moe commonly affects medial compartment)
However since OA»_space;> RA, overall valgus more likely to be caused by OA
What is the most common cause of traumatic haemarthrosis?
ACL injury
What disease is associated with Baker cyst rupture
Both OA and RA, rupture with active RA
Papillary thyroid Ca histology
Ground glass “Orphan Annie” nuclei with psammoma bodies (calcified spherical bodies)
Early non-invasive bladder tumours and treatment
CaIS (confined to epithelial layer)
Ta (papillary neoplasm confined to bladder epithelium)
T1 (invasion into subepithelial layer but not muscle layer)
Tx = TUR of bladder tumour (TURBT) + intravesical chemo (e.g. doxorubicin) or BCG intravesical depending on grade:
Low grade (single dose chemo)
Medium (6/52 weekly chemo)
High (5/52 BCG)
5yr survival 80-90%§
Lower parietal lesion
Lower quadrantanopia
Temporal lobe lesion
Upper quadrantanopia
Delayed gastric emptying in DM
Stop GLP-1 agonists
Add pro kinetic agent (metoclopramide / domperidone)
Comedocarcinoma
High grade malignant ductal epithelial cells with dark staining nuclei and mitotic figures under high powered field
Necrosis and central calcification + intact BM
High grade ductal carcinoma in situ
Axillary nerve injury
C5, C6. Commonly anterior dislocation with flattening of deltoid muscle after injury.
Loss of lateral rotation and abduction of affected shoulder, loss of sensation over lateral arm
Median nerve injury
C5 - T1
Supracondylar fracture of humorous.
Loss of flexion of digits, thenar muscle and lumbricals 1&2, loss of pronation and sensory loss on lateral palm and 3 half digits
Meniere’s disease
Episodic vertigo, tinnitus, hearing loss, fullness/pressure in ear before attack
Smith’s fracture
Reverse colle’s
Distal radius fractues with velar angulation of distal bony fragment.
Fall on flexed wrist
Monteggia’s fracture
Proximal ulna with dislocation of radial head
Galleazii’s fracture
Fracture of radius with dislocation of radio ulnar joint
Hangman’s fracture
C2 vertebrae due to hyperextension of neck
Jefferson’s fracture
C1 vertebrae caused by axial loading to head - diving in shallow water and hitting bottom
Air crescent sign
Invasive aspergillosis
Sign of recovering from infection
ASD
Prominent RV cardiac impulse, ESM in pulmonary area & along left sternal border, fixed splitting of S2
HHT
Epistaxis, telangectasia, visceral lesions and FDR with OWR
Penicillamine
Membranous nephropathy
Salter Harris Fracture classification of physeal fractures
SALTR
Physeal = involving the growth plate
I - Slipped (5-7%, though growth plate, cannot occur if gp fused)
II - Above (75%, passes across gp and up through metaphysis)
III - Lower (7-10%, passes some distance along gp and down through epiphysis
IV - Through/Transvers/Together
IV - Ruined (crush injury of growth plate)
Kruckenberg tumours
Gastric Ca mets to ovary - contains signet ring cells
Vaughan & Williams classification
I - Na channel blocker (flecanide) II - Beta blocker (atenolol) III - K channel blocker (amiodarone) IV - Ca channel blocker (diltiazem) V - Other (digoxin) Note amiodarone has I, II, III and IV activity
Epistaxic point?
Little’s area
Surgical neck of humerus fracture
Posterior and or anterior humeral circumflex artery
Axillary nerve
Complications of blood transfusion
Hyperacute: allergic, haemolytic, non haemolytic fever, pulmonary oedema
Acute: haemolytic, TRALI, bacterial infection
Late: viral infection, GVHD, Fe overload, immune sensitisation
Subcostal, transpyloric, supracristal and intertubercular planes
Transpyloric - L1
Subcostal - L3
Supracristal - L4
Intertubercular - L5
Skier’s thumb
Ulnar collateral ligament tear
Pain on ulnar side on MCP, weakness of grasp & pinch
HA - warm or cold
Warm –> Idiopathic, SLE
Cold –> infectious mononucleosis, idiopathic cold haemagglutinin syndrome
Popcorn wool calcification XR
Chondrosarcoma
Paget’s
Codman’s triangle
Ewings sarcoma (+ Onion skin periostitis) Osteosarcoma (+sun ray speculation
Structures passing behind medial malleolus
Tibialis posterior tendon Flexor digitorum longus tendon Posterior tibial vein Posterior tibial artery Tibial nerve Flexor hallucis longus
Anaesthetic muscle relaxants
- Non depolarising (pancuronium, atracurium). Reversible competitive antagonists of acetylcholine at nicotinic receptor. Terminated by anticholinesterase (neostigmine)
- Depolarising (suxamethonium, succinylcholine). Irreversible, initially stimulating.
In which pts suxamethonium dangerous as fuck?
Normally metabolised by pseudocholinesterase
Some pts familial deficiency of this enzyme
PNH
Phosphatidylinositol glycan A defect in RBC
Increased binding of complement to RBC, makes cells susceptible to lysis in mildly acidotic environment (e.g. relative hypoventilation at night)
Thrombosis of major veins common
BRCA1
Breast prostate pancreas ovarian melanoma
Complications of acromegaly
ABCDEFGH Acromegaly BP / Bowel Ca Cardiomyopathy / Carpal tunnel DM Enlarged viscera Field defects Galactorrhoea HF / HTN
Old guy, acute onset dizziness / R hearing loss?
Anterior inferior cerebellar artery stroke
Supplies lateral inferior pons (vestibular and cochlear nuclei
Parkland formula burns
4ml/kg x % burn = 24 hour requirement
1/2 in first 8h, remainder over 16 hours
Otosclerosis
AD, conductive heraing loss, classically worse in pregnancy.
Incomplete penetrance
Fixation of stapes bone in ear
Hearing aids, stapedectomy/stapedotomy
Open angle glaucoma
OPEN
Optic disc pales (atrophy)
Pressure >21mmHg (disk cupping + capillary closure = nerve damage)
Emerging blood vessels have breaks
Nasal and superior fields lost first (last to go temporal)
Acute closed angle glaucoma
CLOSED
Cornea hazy
Lights have haloes and blurred
Occurs due to blocked drainage of aqueous humour from anterior chamber via canal of Schlemm
Shallow anterior chamber is RF
Dilatation of pupil at night worsens condition
Retinal detachment
FFFF Floaters Flashes (migraine) Field loss (dark cloud) Falling acuity
Carpal Bones
Scaphoid Lunate Triquetrium Pisiform Trapezium Trapezoid Capitate Hamate
Silicosis
Small numerous opacities in upper lung zones with hilar lymphadenopathy
Blood supply to NoF
Medial circumflex femoral
Hand of benediction
In median nerve injury, inability to flex MCP of index and middle finger (loss of innervation to lateral 2 lumbricals
Rapid sequence induction
Thiopentona and Suxamethonium
Whipple’s disease
Infection by tropheryma whopplei (actinomycete)
Malabsorption + Intestinal LN ± cognitive decline / arthritis / hyperpigmentation / retinitis / endocarditis
Surface anatomy: R lung
Oblique fissure = rib 6 (inf vs sup & middle lobe)
Horizontal fissure = R 4th costal cartilage (mid vs sup)
Coagulation disease: Vit K def / Warf
PT +
APTT =
PLT =
BT =
Coagulation disease: DIC
PT +
APTT +
PLT -
BT +
Coagulation disease: Thrombocytopenia
PT =
APTT =
PLT -
BT +
Coagulation disease: Bernard Soulier
Giant platelet syndrome, defectin in GP1b. Megakaryocytes on film PT = APTT = PLT - BT +
Coagulation disease: Haemophilia
PT =
APTT +
PLT =
BT =
Coagulation disease: vWD
PT =
APTT +
PLT =
BT +
Coagulation disease: Glanzmann’s
Defect in GP IIb/IIIa PT = APTT = PLT = BT +
Tennis elbow
Extensor carpi radialis brevis
Also known as lateral epicondylitis
Overuse condition
RICE + NSAID + Physio may take a year to fully effect
C1 inhibitor deficiency
Hereditary angiodema
C3 deficiency
Inpaired response to encapsulated bacteria
Terminal compliment deficiency
Neisseria infections
Congenital neutrophil deficiency
Pyogenic bacteira and fungi
Chronic granulomatous disease / Hyper IgE syndrome
Congenital B cell deficiency
Hypogammaglobulinaemia, bacterial and fungal infections
Common variable deficiency
Congenital T cell deficiency
Imparied cell mediated immunity - viral, mycobacterial, fungal infections
DiGeorge
Congenital B and T cell deficiency
Viral, bacterial, mycobacterial and fungal
SCID, Wiskot-Aldrich
t14:18 translocation
BCL2 gene, Follicular lymphoma
t8:14 translocation
cMyc - Burkitt’s
