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Danielle's MD1 > Renal > Flashcards

Renal Flashcards

1
Q

What are some functions of the kidney?

A
  • H20 and Na homeostasis
  • control of ECF ion concentration
  • acid base balance
  • excretion of waste products and xenobiotics
  • endocrine functions
    • EPO
    • renin
    • vit D3
    • PGI2
  • formation of concentrated urine
  • formation of diluted urine
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2
Q

What are the forces that affect filtration?

A
  • hydrostatic P in glomerular capillaries (50mmHg)
  • hydrostatic P in Bowmans capsule (10mmHg)
  • oncotic P in glomerular capillaries (25-40mmHg)
  • oncotic P in Bowmans capsule (0mmHg)
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3
Q

What happens to GFR when the afferent arteriole is constricted?

A

GFR decreases

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4
Q

What happens to GFR when the efferent arteriole is constricted?

A

GFR increases

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5
Q

What part of the nephron is considered the filtration unit?

A

the glomerulus

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6
Q

What part of the nephron is considered the workhorse?

A

the proximal tubule

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7
Q

What part of the nephron is considered the concentrator?

A

descending loop of henle and the thin ascending loop of henle

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8
Q

What part of the nephron is considered the dilutor?

A

thick ascending limb of henle

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9
Q

What part of the nephron is considered the fine tuner?

A

the distal tubule

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10
Q

Nephrons that have a short loop of henle/ascending limb are called

A

cortical nephrons

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11
Q

Nephrons that have a long loop of henle/ascending limb are called

A

juxtamedullary nephron

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12
Q

What does the term autoregulation mean?

A
  • function= it maintains ~ constant GFR in the face of changing MAP between 80-180mmHg
  • glomerular P is held constant against changing systemic P
  • mechanisms
    • myogenic response
      • when s.muslce of vv are stretched by increased blood vol, they open ion channels which causes depolarisation–> s muscle contraction–> decreased BF and decreased GFR
    • tubuloglomerular feedback
      • when GFR is increased, flow through tubule and macula densa is increased–> macula densa detects decreased Cl- conc–> releases paracrine substances–> afferent arteriole constriction–> increased resistance in afferet arteriole–> hydrostatic P decreases–> GFR decreases to normal
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13
Q

Describe the filtration, reabsorption, secretion and excretion of the various electrolytes

A
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14
Q

Describe the clearance of penicillin

A
  • =150mL/min
  • freely filtered, not reabsorbed, and fully excreted
  • also secreted which is why the clerance is > than GFR
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15
Q

Describe the clerance of inulin

A
  • =GFR = 100mL/min
  • because it is freely filtered, not reabsorbed and fully excreted
  • this is the max clearance of a substance that ISNT secreted
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16
Q

Describe the clearance of glucose

A
  • =0ml/min
  • 100% is reabsorbed
  • therefore no glucose is in the urine normally
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17
Q

What is the equation for excretion?

A

Excretion= Urine concentration x urine volume

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18
Q

What is the equation for renal clearance? and what does the term mean?

A

Renal clearance= excretion/plasma concentration

The amount of plasma clerared of the substance per time

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19
Q

How much oxygen does the kidney consume?

A
  • 80% of oxygen is consumed by the kidney
  • it has a high O2 requirement
  • it is absorbed by active transport
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20
Q

Describe the reasorption processes that occur in the early proximal tubule

A
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21
Q

Describe the reabsorption processes that occur in the late proximal tubule

A
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22
Q

Describe the reabsorption processes that occur in the thin ascending limb of the loop of henle

A
  • Na is reabsorbed via passive diffusion (in response to a conc gradient) across the tight junctions of the paracellular pathway
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23
Q

Describe the reabsorption processes that occur in the thick ascending limb of the loop of henle

A

*

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24
Q

Describe the reabsorption processes that occur in the distal convoluted tubule

A
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25
Q

Describe the reabsorption processes that occur in the collecting ducts

A
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26
Q

Name some clinical UTIs and their brief characteristics

A
  • acute cystitis
    • infection of the bladder
  • sterile pyuria
    • pus(WBC) in urine without growth of bac
    • causes= non-infectious conditions, partial treatment, difficult to grow bac e,g, TB
  • pyelonephritis
    • infection of the kidneys from an ascending infection
  • asymptomatic bacteriuria
    • important in pregnancies
    • repeated >105 CFU/ml without symptoms
  • community acquired UTI
  • recurrent UTI
    • most are re-infections
    • causes= genetic predisposition, behaviour-sex, spermicide, incontinence
  • nosocomical UTI
  • catheter-associated UTI
  • viral UTI
    • usually asymptomatic
    • can cause haemorrhagic cystitis
    • can cause renal disease
    • dont cause a classical UTI
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27
Q

How do you diagnose a UTI?

A
  • Hx and physical exam
  • imaging
  • collect samples of urine
    • MSU
    • catheter/nephrostomy
    • bag sample (rarely done!)
    • SPA (NB any growth is significant)
  • interpret lab reports
    • infection is present if: WBC >10^5/ml, RBCs, if bac is present >10^5 CFU/ml
    • if squamous epithelial cells are present= poor sample
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28
Q

What 2 ways/routes can a person develop a UTI from?

A
  • ascending infection
  • from the blood
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29
Q

What are some innate immune factors that protect against UTIs?

A
  • transitional epithelium resists colonisation
  • epithelium is relatively resistant
  • some dont like growing in urine
  • constant flushing
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30
Q

What are some host factors and microbial factors that promote the development of an UTI?

A

Host factors

  • short urethra
  • female
  • pregnancy
  • sexual intercourse
  • colonisation of distal urethra
  • no circumcision
  • incomplete bladder emptying
  • catherisation

Microbial factors

  • adhesins
  • flagella
  • polysaccharide capsule
  • limited invasion
  • biofilm formation
  • haemolysis
  • siderophores
  • urease
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31
Q

What are some treatments for UTIs?

A

uncomplicated cystitis

  • alkalinise urine (check pH first)
  • trimethoprim or cephalexin or co-amoxyclav or nitrofurantoin (for 5 days for women and children or 7 days for men)
  • if <2/yo check for urinary tract abnormalities

pyelonephritis

  • trimethoprim or cephalexin or co-amoxyclav for 10-14 days (treat for longer because its more severe)
  • also check for tract abnormality
  • if severe sepsis is present, treat with ampicillin/amoxycillin and gentamicin

asymptomatic bacteriuria

  • treat with cephalexin or co-amoxyclav or others

you can also change behaviour and use antimicrobial prophylaxis

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32
Q

Describe the histology of the renal corpuscle

A
  • expanded head of tubule with capillaries pushed into it
  • receives blood via afferent arteriole
  • efferent arteriole drains it and forms vasa recta
  • bowmans space lined with podocytes over capillaries and paietal cells over outer layer
  • vascular pole= whwere capillaries enter
  • urinary pole= where tubule drains bowmans space
  • squamous parietal cells–> cuboidal epithelium of tubule
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33
Q

Describe the histology of the proximal tubule

A
  • cuboidal epithelium
  • lots of microvilli
  • interdigitating cell boundaries
  • basal membrane is folded and has Na/K ATPase pump
  • its the functional unit
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34
Q

Describe the histology of the loop of Henle

A
  • thin part= squamous cells
  • permeable to urea and electrolytes
  • descending limb= more permeable to water than ascending
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35
Q
A
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36
Q

Describe the histology of the distal tubule

A
  • part in cortex is convoluted
  • cells= cuboidal cells
  • lacks microvilli
  • lots of mitochondria
  • impermeable to water and urea
  • has Cl- and Na pumps
  • JGA = modified smooth muscle (releases renin)
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37
Q

Describe the histology of the collecting ducts

A
  • large lumen
  • cuboidal cells
  • normally impermeable to water and urea
  • ADH makes it permeable to H20
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38
Q

Where are all renal corpuscles found in the kidney?

A

in the cortex

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39
Q

Distinguish between juxta-medullary nephrons and cortical nephrons

A

juxta-medullary nephrons

  • loop is deep into medulla
  • comprise 15% of all nephrons

cortical nephrons

  • loop is 1/2 way into the medulla
  • comprises 85% of all nephrons
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40
Q

Describe the juxta-glomerular apparatus

A
  • each distal tubule returns to its glomerulus that gave rise to it
  • it passes between the afferent and efferent arterioles
  • consists of macula densa(specialised cells of the distal tubule), juxtaglomerular cells, and extraglomerular mesangial cells
  • function= monitors filtrate volume and Na concentration, causes glomerular cells to release renin to constrict afferent arteriole to change GFR
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41
Q

What are vasa recta? and what is their critical function?

A
  • they are the capillaries from the efferent arteriole that envelope the tublue
  • they form hair pin loops in the medulla among the loops of henle
  • they are critical for urine concentration
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42
Q

Describe the histology of the ureter

A
  • transitional epithelium
  • distinct lamina propria
  • thick muscularis
  • s muscle contracts in peristaltic waves to force urine into bladder
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43
Q

Describe the histology of the urethra

A
  • transitional epithelium and stratified squamous epithelium
  • penetrates pelvic floor
  • male urethra also penetrates the prostate gland and has many diff glands/ducts entering into it
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44
Q

What are the muscles that attach the pectoral girdle to the trunk from the thoracic wall

A
  • pectoralis major
  • pectoralis minor
  • subclavius
  • serratus anterior
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45
Q

What are the muscles that attach the pectoral girdle to the trunk from the vertebral column?

A
  • trapezius
  • latissimus dorsi
  • levator scapulae
  • rhomboid minor
  • rhomboid major
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46
Q

Describe the attachments of pectoralis major

A
  • superficial
  • Has clavicular and sternocostal heads
  • Extensive origin and attachment
  • Fibres converge towards the upper limb
  • Clavicular fibres overlap the sternocostal fibres as they head to their insertion into the humerus
  • Function
    • Adductor
    • Medial rotator
    • Accessory muscle of respiration (because any muscle that attaches to the thoracic wall is an accessory muscle of respiration)
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47
Q

Describe some characteristics of subclavius muscle

A
  • Small
  • Passes laterally
  • Under the clavicle
  • From the anterior medal part of the first rib
  • Function= stabilises the clavicle
  • Attaches the pectoral girdle to the anterior chest wall
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48
Q

Describe some characteristics of pectoralis minor

A
  • From the anterior ribs 3,4,5, just lateral to the costal cartilage
  • Converging onto the coracoid process
  • Function= stabilises the scapula
  • Weaker accessory muscle of respiration
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49
Q

Describe some characteristics of serratus anterior

A
  • On lateral aspect of the thoracic wall
  • Saw tooth appearance
  • Attaches to ribs 1-8
  • Fibres underlap the scapula (between the scapula and the posterior aspect of the thoracic cage)
  • Attaches to the vertebral boarder of the scapula
  • Function= keeps scapula against the chest wall during protraction
  • Aka boxers muscle
  • Thoracic nerve = branch of brachial plexus
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50
Q

What happens when you damage your serratus anterior muscle?

A
  • you get a winged scapula during protraction
  • it is no longer hold against the chest wall
  • most common cause= de innervation of serratus anterior
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51
Q

Describe the fascia of the muscles around the shoulder and chest wall

A
  • clavipectoral fascia to subclavius
  • spits to enclose pec minor
  • down to insert into skin of the axilla (gives you an arm pit)
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52
Q

What are the muscles that attach the humerus to the scapula?

A
  • deltoid
  • rotator cuff (neumonic=SITS)
    • subscapularis
    • infraspinatous
    • teres minor
    • supraspinatous
  • teres major
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53
Q

Describe some characteristics of deltoid

A
  • attachment= posterior to the spine of the scapula–> around acromion–> onto the anterior part of the clavicle
  • deltoid tubercle of the humerus
  • it has 3 parts
    • posteroir
    • lateral
    • anterior
  • can act separately or as whole
  • as a whole its an abductor
  • posterior separately= extensor
  • anterior separately=flexor
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54
Q

Describe some characteristics of subscapularis

A
  • on the anterior surface of the scapula
  • blends with the capsule
  • stabilises the capsule of the shoulder joint
  • attaches to the smooth fossa of subscapula
  • converging on the lesser tubercle of the humerus
  • passing infront of the axis of rotation
  • function= medial rotator at the shoulder joint and an abductor
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55
Q

Describe some characteristics of supraspinatous

A
  • runs along top of the shoulder reinforcing it
  • attaches to the superior facet of the greater tubercle
  • function= abduction
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56
Q

What are some characteristics of infraspinatous?

A
  • runs along the back of the shoulder joint and reinforces the posterior aspect of the shoulder joint
  • attaches to the middle facet of the greater tubercle
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57
Q

What are some characteristics of teres minor

A
  • its like a part of infraspinatous
  • edge to edge
  • runs along the back of the shoulder joint and reinforces it
  • attaches to the inferior facet of the greater tubercle
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58
Q

What are some characteristics of teres major?

A
  • not a rotator cuff!
  • think of it as a special part of subscapularis
  • i.e. its derived from it
  • it runs parallel to it
  • passes towards the proximal humerus not to the tubercle
  • function= adductor and medial rotator
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59
Q
A
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60
Q

What types of muscles does the anterior compartment of the upper arm contain?

A

flexors

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61
Q

What types of muscles does the posterior compartment of the upper arm contain?

A

extensors

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62
Q

What are the muscles of the anteroir compartment of the upper arm?

A
  • coracobrachialis
  • biceps
  • brachialis
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63
Q

What are the muscles in the posterior compartment of the upper arm?

A

triceps

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64
Q

Describe some characteristics of biceps

A
  • in the anterior compartment
  • superficial muscle
  • 2 heads
    • long head
      • emerges form the capsule
      • origin from the supraglenoid tubercle on the scapula
      • then joint by short head
    • short head
      • attached to the coracoid process
    • forms belly of biceps
    • down to cross the elbow joint
    • inserts into the bicipital tuberosity/radial tuberosity via the biceps tendon
  • function= flexor when the elbow is extended but a supinator when the elbow is flexed
65
Q

Describe some characteristics of coracobrachialis

A
  • in the anterior compartment
  • attaches to the coracoid process
  • like teres major (it organises the terminal neurovascular structures of the brachial plexus)
  • doesnt cross the elbow joint
  • has a weak action on the shoulder joint
  • function= assists in flexion and adduction, helps pectoralis major
66
Q

Describe some characteristics of brachialis

A
  • in the anterior compartment
  • deep muscle
  • arises from the anterior aspect of the distal humerus and the adjacent parts of the medial and lateral intermuscular septa
  • crosses elbow joint
  • inserts into the coronoid process
  • function=it flexors the elbow in all positions
67
Q

Describe some characteristics of triceps

A
  • in the posterior compartment
  • 3 heads
  • Only see 2 of the heads superficially= long head and lateral head
  • Therefore they are superficial muscles
  • Long head comes from the scapula (from the infra-glenoid tubercle)
  • Lateral head comes from the humerus
  • Medial head
    • Deep muscle
    • Closing the whole of the posterior aspect of the shaft of the humerus
  • All 3 unit to form the tendon of the triceps then crosses elbow joint to insert into the olecranon process of the ulnar
  • Function= powerful extensor of the elbow joint
68
Q

What are the muscles that make up the anterior compartment of the forearm?

A

5 superficial muscles

  • pronator teres
  • flexor carpi radialis
  • flexor carpi ulnaris
  • palmaris longus
  • flexor digitorum superficialis

3 deep muscles

  • flexor digitorum profundus
  • flexor pollicis longus
  • pronator quadratus
69
Q

Describe some characteristics of pronator teres

A
  • in the anterior compartment
  • diagonal course
  • only extends halfway down the forearm to insert into the lateral aspect of the radius
  • the radius has a slight bow to it and the point where it has the greatest convexity is where pronator teres inserts
  • has 2 heads/origins
    • one from the common flexor origin
    • one from the ulnar
  • function= pronator
  • contraction–> pulls insertion to its origin
70
Q

Describe some characteristics of flexor carpi radialis

A
  • in the anterior compartment
  • function= flexor
  • carpi= heads to wrist
  • radialis= on radial side
  • has a diagonal course
  • crosses the wrist
  • inserts into the base of the 2nd and 3rd fingers
71
Q

Describe some characteristics of palmaris longus

A
  • in the anterior compartment
  • its not always present
  • has a short belly and a long slender tendon
  • it doesnt insert into bone, it blends with the palmar aponeurosis
  • its a muscle that is disappearing from the species
72
Q

Describe some characteristics of flexor digitorum superficialis (FDS)

A
  • in the anterior compartment
  • has 2 heads/origins
  • can be considered as an intermediate layer
  • spans out to make the bulk of the anterior compartment of the forearm
  • attaches to the common flexor origin= humeroulnar edge and proximal ulnar
  • sweeps down and takes origin from the anterior surface of the shaft of the radius
  • crosses the wrist joint to insert into the fingers
  • attaches to the base of the middle phalanx
  • therefore FDS acts on all hand joints except the distal phalangeal joint
  • function= flexor of the digits
73
Q

Describe some characteristics of flexor carpi ulnaris (FCU)

A
  • in the anterior compartment
  • runs down the ulnar/medial side
  • forms the medial boarder of the forearm
  • aims for the base of the 5th metacarpal but instead inserts into the pisiform bone then there is a ligamentous extension which inserts into the base of the 5th metacarpal
  • also has 2 heads
74
Q

What are some characteristics of flexor digitorum profundus?

A
  • in the anterior compartment
  • Tendon on route to each finger will be deep to FDS
  • Flexor for the digits
  • FDS=superficial muscle splits to insert either side of the base of the middle phalanx therefore no action on the distal interphalangeal joint, allows the FDP to cross the distal interphalangeal joint and then inserts into the base of the middle phalanx
  • The only tendon crossing the distal interphalangeal is the FDP!!
  • Arises from the ulnar and the adjacent part of the intermuscular septa and the interosseous membrane
75
Q

Describe some characteristics of flexor pollicis longus

A
  • in the anteriror compartment
  • ‘longus’ there will also be a brevis
  • 2nd of the deep muscles
  • Arises from the distal shaft of the radius beneath of the linear origin of the FDS
  • Tendon crosses all carpal and interphalangeal joints inserts into the base of the distal phalanx
76
Q

What are some characteristics of pronator quadratus?

A
  • in the anterior compartment
  • closes the distal aspect of the radius and ulnar
  • a deep muscle
77
Q

Describe the organisation of the carpal tunnel and the tendons of FDP and FDS

A
  • 4 FDP tendons are situated deep to FDS
    • Go side by side through the carpal tunnel
  • ​FDS tendon layers
    • Tendon to 3-4th fingers overlie tendons to 2-5th
  • ​Flexor retinaculum= carpal tunnel
    • Keeps tendons in place during flexion
    • Dense Fibro-aponeurotic structure
    • Attaches to the scaphoid and trapezium and then O=hook Of hamate, P=pisiform, mnemonic= STOP
    • Creates a tunnel= doesn’t have any give, so when the tendons swell during inflammationà compresses the median nerve
  • What doesn’t through the flexor retinaculum
    • Pronator teres
    • Palmar longus
    • FCU
  • Flexor carpi radialus doesn’t go through the carpal tunnel because it doesn’t go to the palm of the hand
    • Splits
    • Gets its own tunnel
    • It inserts into the base of the 2nd and 3rd metacarpal
78
Q

What are the muscles that make up the posterior compartment of the forearm?

A

12 muscles

4 groups of 3

  • brachioradialis
  • extensor carpi radialis longus (ECRL)
  • extensor carpi radialis brevis (ECRB)
  • extensor digitorum
  • extensor digiti minimi
  • extensor carpi ulnaris
  • abductor pollicis longus
  • extensor pollicis brevis
  • extensor pollicis longus
  • anconeus
  • extensor indicis
  • supinator
79
Q

What are some characteristics of brachioradialis

A
  • found in the posterior compartment of the forearm
  • a superficial muscle
  • arises from the lateral supracondular ridge
  • inserts innto the distal ends of the radius just above the radial styloid
  • function= flexor at the elbow (confusing because its in the extensor compartment)
80
Q

What are some characteristics of extensor carpi radialis longus (ECRL)

A
  • found in the posterior compartment of the forearm
  • a superficial muscle
  • longer and arises higher up than extensor carpi radialis brevis
  • Arises from the lateral supracondylar ridge
  • Insert into the base of the metacarpals
  • Function= extensors at the wrist
81
Q

What are some characteristics of extensor carpi radialis brevis

A
  • found in the posterior compartment of the forearm
  • a superficial muscle
  • From the common extensor origin
  • Function= extensors at the wrist
82
Q

What are some characteristics of extensor digitorum?

A
  • found in the posterior compartment of the forearm
  • a superfical muscle
  • arises from the common extensor origin
  • Has a split off part to form extensor digiti minimi only as it travels down the posterior aspect of the forearm
  • Spans out and forms an extensor hood/covering over the back of the fingers
  • Within it forms 3 tendinous slits
  • Middle slit inserts into the middle phalanx
  • Two side slits inserts into the base of the distal phalanx
  • Different to the flexor aspect where it’s the opposite:
    • FDS split to go on either side of the middle phalanx
    • FDP to the base of the distal phalanx
83
Q

Describe some characteristics of extensor digiti minimi

A
  • part of the posterior compartment of the forearm
  • a superficial muscle
  • arises from the common extensor origin
84
Q

What is the common extensor origin?

A

lateral epicondyle

85
Q

What is the common flexor origin?

A

the medial epicondyle of the humerus

86
Q

Describe some characteristics of extensor carpi ulnaris

A
  • in the posterior compartment of the forearm
  • a superficial muscle
  • arises from the common extensor origin
  • heads to the ulnar and attaches to the base of the 5th metacarpal
  • mirror image of the flexor carpi ulnaris
87
Q

Describe some characteristics of abductor pollicis longus

A
  • in the posterior compartment of the forearm
  • a deep muscle
  • function= a long abductor
88
Q

Describe some characteristics of extensor pollicis brevis

A
  • in the posterior compartment of the forearm
  • a deep muscle
  • towards the base of the proximal phalanx
89
Q

Describe some characteristics of extensor pollicis longus

A
  • in the posterior compartment of the forearm
  • a deep muscle
  • takes the long way around
  • initially heads to the bak of the hand, until it reaches the dorsal tubercle on the back of the radius, diverts around that and then heads to the thumb
  • forms a boarder of the anatomical snuff box
  • heads to the base of the distal phalanx
90
Q

What are some characteristics of anconeus?

A
  • in the posterior compartment of the forearm
  • a deep muscle
  • function= an extensor of the elbow
91
Q

What are some characteristics of extensor indicis?

A
  • in the posterior compartment of the forearm
  • deep muscle
  • extra extensor to the index finger
92
Q

What are some characteristics of supinator?

A
  • in the posterior compartment
  • a deep muscle
  • primary supinator
  • posterior interosseous nerve
93
Q

What are the 7 layers of the palm?

A
  1. skin and palmaris brevis
  2. palmar aponeurosis
  3. thenar and hypothenar muscles
  4. neurovascular plane
  5. long flexor tendons and lumbricals
  6. adductor pollicis and neurovascular plane
  7. interossei and metacarpals
94
Q

Describe the first layer of the palm

A
  • =skin then palmaris brevis
  • horizontal muscle fibres related to the dermis of the skin
  • bridge over the base of the hypothenar
  • thenar eminence and hypothenar eminence
  • can see the beginnings of the palmar aponeurosis
95
Q

Describe the second layer of the palm

A
  • the palmar aponeurosis
  • Extends form the distal boarder of the palmar retinaculum
  • Divides into 4 slits
    • Attach to the skin creases, fibrous flexor sheath and phalanges
  • Doesn’t extend over the hypothenar or thenar eminence (different to the base of the foot)
  • Its more centrally placed in the palm of the hand
  • clinical note: dupuytrens contracture= thickening and scarring of the poneurosis
    • associated with epileptic, alocoholic, diabetics, and manual workers
96
Q

Describe the different movements of the thumb

A
97
Q

Describe the 3rd layer of the palm

A
  • the thenar and hypothenar muscles
  • Help to cup the palm of the hand
  • Help hold fine objects/fine movements
  • Arise from the flexor retinaculum and the adjacent carpal bones
  • has an abductor, a flexor and a opponens in each eminence
    • abductor (on the outside)= abductor polis brevis
    • short flexor (inside)= flexor digiti minimi
    • opponence (deeply placed)
    • neumonic= all for one, and one for all
98
Q

Describe the 4th layer of the palm

A
  • 1st neurovascular plane
    • superficial
    • Has a palmar arch/arcadesà digital arteries (end arteries for each digit)
    • Landmark= distal boarder of the out stretched thumb
    • Hockey stick shaped in some, but can be completed by another vessel to form a complete arcade
    • Digital nerves to give sensory supply to the skin overlying each of the fingers
    • Median nerve
      • Passes through the carpal tunnel
    • Ulnar nerve
      • Passes with the ulnar artery over the flexor retinaculum
99
Q

Describe the 5th layer of the palm

A
  • Long flexor tendons
    • Only one flexor tendon for the thumb
    • They are enclosed in fibrous and synovial flexor sheaths
    • Each of the pairs of the FDS for the digits have their own fibrous and synovial sheaths
    • Flexor pollicis longus has its own sheath by itself
    • But the paired tendons for the digits, share a common sheath as the enter the palm of the hand then its disrupted before the digital components commence, with exception of the little finger/5th finger
    • Where the sheaths are discontinuous 4 small muscles arise= lumbricals
  • 4 lumbricals
    • First 2 lumbricals=Uni-pennate
    • 3rd and 4th (Ring and little finger)= Bi-pennate
    • Arising from the FDP tendon where it’s not enclosed by the rectus sheath
    • Each winds around the radial side of the finger (thumb side) onto the dorsum and atttaches to the extensor expansion
    • ​Lumbricals is on the palmar aspect of the hand
    • When its contracting, it extends the interphalangeal joints and extends the metacarpal phalangeal joints (fingers curve down)
100
Q

Describe the 6th layer of the palm

A
  • Adductor pollicis (adductor of the thumb)
    • Deeply placed
    • Triangular
    • Same arrangement as the pectoralis major muscle
  • Deep neurovascular plane
    • Deep palmar arch 1cm proximal to the superficial arch
    • Deep branch of the ulnar nerve (gives motor supply)
101
Q

Describe the 7th layer of the palm

A
  • Palmar interosseous muscles
    • Most deeply placed
    • Between the bones
    • 3 palmar interossei
      • Adduct the fingers (PAD= P=palmar, AD=adduct)
      • Adduction or abduction relates to the middle metacarpal
      • Movement towards middle metacarpal = adduction
      • You can’t adduct the middle metacarpal towards itself therefore there are no palmar interossei associated with it
    • unipennate​
  • dorsal interossei
    • bipennate
    • abductors (DAB)
    • on the outside of the fingers
    • don’t need a dorsal muscle for the little finger or the thumb because there are already abductors there i.e. abductor digiti minimi and abductor pollicis brevis muscle
102
Q

Distinguish between acute renal failure and chronic renal failure

A

Acute renal failure

  • occurs suddenly (1- few days)
  • reversible
  • definition= ruine flow < 500ml/day
  • presentation= oliguria, anuria, GFR decreases acutely
  • specific gravity= 1.01

Chronic renal failure

  • occurs gradually (over 6months-years)
  • irreversible
  • definition= GFR <50ml/min
  • decreased functional renal mass
  • aka uraemia
  • leads to end stage renal disease
  • presentation= remaining nephrons hypertrophy, glomerular hyperfiltration, uremia, salt and water imblances, increased [K], pH decreases, increased [PO4], decreased [Ca], low Vit D3, high PTH
  • endocrine impairement
    • RAAS–> xs activation–> vasoconstriction and malignant HT
    • Vit D3 activation–> osteoporosis
    • EPO –> anaemia
103
Q

What are the different causes of acute renal failure?

A

pre-renal

  • most common
  • shock
  • sepsis
  • haemolysis
  • rhabdomyolysis
  • nephrotoxic drugs eg NSAIDS

renal

  • glomerular disease
  • intersitial nephritis
  • tubular damage by ischaemia(acute tubular necrosis) or toxins

post renal

  • outlet obstruction
104
Q

What are some causes of chronic renal failure?

A
  • diabetes
  • increased BP
  • chronic glomerulonephritis
  • cystic disease
105
Q

Distinguish between the 2 types of immunological tolerance

A

central tolerance

  • during dev in primary lymphoid organs
  • removes self reactive lymphocytes during dev
  • via negative selection

peripheral tolerance

  • in the periphery
  • controls self reactive lymphocytes in ways covered in foundation block
106
Q

Describe Type II hypersensitivity

A
  • aka Ab mediated
  • IgM and IgG against cell bound or ECM Ag
  • injury due to
    • activation of effectors (complement and phagocytes)
      • good pastures syndrome
        • ​abs made against collagen type IV
      • haemolytic disease of the newborn
        • ​in Rhesis -ve mothers with a second rhesis +ve baby after a 1st rehsis +ve baby to prime her imm system
      • type II mediated drug allergies
        • ​the drug becomes bound to RBCs or platelets which then are a target of anti drug Abs–> haemolytic anaemia or thrombocytopenia
    • or abnormal physiological response
      • mysasthenia gravis
        • ​inhibitory Ab because it blocks the Ach receptor
      • graves disease
        • ​stimulating Ab because it mimics TSH–> increased thryoid hormones–> hyperthyroidism
107
Q

Describe Type III hypersensitivity

A
  • aka immune complex
  • IgM and IgG immune complex deposition
  • a problem only if complexes are excessively produced and ineffectively cleared (by macrophages in the spleen)
  • size affects clerance
    • large complexes activate C’ better and are better at binding to FcR so they are removed better by RBCs
  • pathology depends on where they deposit
    • vasculitis
    • glomerulonephritis
    • arthritis
    • farmers lungs
      • ​exposure to hay dust and bac–> alveolitis
    • rheumatic fever and endocarditis
    • serum sickness
    • SLE
      • ​autoimm disease
      • anti-DNA abs and imm complexes in the kidneys
      • buttergly rash after UV exposure
  • eventual C’ activation, anaphylotoxin release, macrophage cytokine release, directly activate platelets, basophils, mast cells and vasoactive amines
108
Q

Describe the brachial plexus

A
109
Q

Describe the course and innervation of the musculocutaneous nerve

A
  • Branch of lateral cord
  • Formed by anterior division of upper and middle trunk
  • Upper trunk C5,6 and C7 (root values, ventral rami contributions)
  • All of the above you can get from drawing the picture out!
  • Nerve to the anterior compartment of the arm (flexor muscles, and skin overlying it)
  • Key landmarks in its course
    • Pierces coracobrachialis and supplies it
    • Picks up biceps
    • Runs down between biceps (above it) and brachialis and supplies them
    • Gives motor supply to the muscles mentioned above
    • By the time it gets to the elbow it loses its motor function/loses its motor fibres
    • Then after the elbow it becomes superficial in the superficial fascia just lateral to the tendon of biceps and gives cutaneous supply (supplies skin) therefore changes its name to lateral cutaneous nerve of the forearm
110
Q

Describe the course and innervation of the ulnar nerve

A
  • Branch of the medial cord
  • Formed by anterior divisions fibres of the lower trunk
  • Contributions form ventral rami: C8, T1 roots
  • But nearly always there are C7 fibres in there as well [can come across at the level of the roots]
  • Written as ulnar nerve (C7) C8,T1
  • All above info from drawing out the brachial plexus diagram
  • Supplies flexor muscles and skin because it’s from anterior division fibres
  • Funny bone (you hit it and it tingles)
  • Key landmarks
    • Descends on the medial side of the artery
    • Then disappears because it passes behind the medial epicondyle
    • Descends down on the medial/ulnar side of the forearm
    • Slips under the cover of flexor carpi ulnaris
    • It slips between the 2 heads of flexor carpi ulnaris (the humeral head and the ulnar head)
    • Doesn’t go through the carpal tunnel! Therefore not vulnerable to compression in the carpal tunnel
    • Over the top of the flexor retinaculum
    • But vulnerable because there is only skin and superficial fascia between it and the outside world
    • ​It only supplies what it is directly related to
      • forearm
        • FCU
        • Medial half of the FDP
      • hand (has deep and superficial branches)
        • most of it except what the median does
    • Cutaneous innervation
      • Medial 1 (little finger) and ½ fingers (ring finger) front and back
111
Q

Describe the 2 generalisations of the ulnar and median nerve innervations

A
  • Ulnar nerve= Nerve of the hand
  • Median nerve= nerve of the forearm
112
Q

Describe the course and innervation of the median nerve

A
  • Medial root and lateral root (2 roots)
  • From the medial and lateral cords
  • From anterior division fibres from upper and middle trunk
  • Anterior division fibres form medial trunk therefore will supply flexor muscles and the skin overlying the muscles
  • Has all ventral rami contributing to it (C5,6,7,8,T1)
  • All info from brachial plexus diagram
  • Supplies
    • Flexor muscles and the skin overlying them
    • Rest of the forearm and the rest of the hand
  • Key landmarks
    • Starts lateral or on top of/anterior to the axillary artery
    • Crosses the front of the brachial artery then lies medial to it at the cubital fossa/elbow joint
      • Lateral to medial= tendon of biceps–>brachial artery–>medial nerve
    • Then enters the anterior compartment of the forearm
    • Slips under the fibrous arch of FDS (has a humer-ulnar head, and the radius)
    • In the forearm it supplies
      • everything except the medial ½ of FDP and FCU (because these are supplied by the ulnar nerve)
    • Runs down the centre of the anterior compartment between FDS(superficial to it) and FDP (deep)
    • Into the carpal tunnel with the long flexor tendons (8 from FDS and 8 from FDP)
    • In the hand it supplies
      • the thenar muscles and the lateral 2 lumbricals
    • Cutaneous supply
      • Lateral 3 and ½ fingers (lateral ½ of the ring finger) thumb, index, middle and lateral ½ of the ring finger and the associated palm
      • NOTE: DIFFERENT INNERVATION ON THE POSTERIOR PALM
      • It supplies the nail beds of the lateral 3 and ½ fingers (different to the other nerve which is the same on dorsal and palmar surfaces)
    • Gives off a palmar branch before the carpal tunnel that runs over the flexor retinaculum to supply the skin of the palm (not the fingers)
    • If you are testing for median nerve damage: test adduction of the thumb
113
Q

Describe the course and innervation of the radial nerve

A
  • Branch of the posterior cord
  • Carrying posterior division fibres
  • Carries all contributions of ventral rami fibres
  • Gives off its branches very early (very important clinically!)
  • Key landmarks of its course
    • Emerges beneath teres major
    • Between long and lateral head of triceps
    • Spiralling around/following the oblique line of the back of the shaft of the humerus, from medial to lateral
    • A fracture of the shaft of the humerus often will not affect the nerve supply to the triceps because its gives off its fibres really early. Therefore they can still extend their elbow.
    • Then tucks under the cover of Brachioradialis muscle
    • Then moves down the radial side of the anterior compartment
  • ​​gives off the posterior interosseous nerve just as it passes under the cover of brachioradialis
    • Motor supply to the posterior compartment muscles (the 4 muscles that come off the common extensor origin)
    • Also supplies the deep muscle in the posterior compartment
  • Dives deep into the posterior compartment
  • Slips through supinator
  • To reach deep to sit on the posterior aspect of the posterior interosseous membrane (to supply the 4 muscles from the common extensor origin and the deep muscles)
  • Then turns into superficial branch of radial nerve (continuation of the radial nerve)
    • All that is left is cutaneous fibres
    • Runs down the lateral side of the forearm under the cover of Brachioradialis
    • Becomes cutaneous when Brachioradialis inserts
    • Supplies the skin over the dorsum of the hand
  • ​cutaneous innervation
    • skin on the dorsum of the hand
      • lateral 3 and 1/2 fingers on the dorsum (what the median didnt do)
114
Q

Cutaneous supply and motor supply are related to the original ventral rami or the peripheral nerve?

A

the original ventral rami

NOT THE PERIPHERAL NERVE!

115
Q

Describe the dermotomes of the upper limb

A
  • C5,6,8 T1
  • C5 and C6 run down the lateral side
  • C7 always middle finger
  • C8,T1 on the medial side
116
Q

Describe the arteries in the upper limb

A
  • Single stem artery that will change its name according to its location
  • Run on the flexor aspect of the joint therefore less exposed but can still kink in full flexion
  • Upper limb stem artery =Subclavian artery
  • Then changes its name to axillary artery at the outer boarder of the 1st rib
    • Axillary artery passes beneath Pectoralis minor and divides it into 3 parts
      • Above pec minor (Has 1 branch)
      • Deep to pec minor (Has 2 branches)
      • Below/distal to pec minor (Has 3 branches)
    • There is a significant supply to the walls of the axilla
    • Contributes to the anastomosis around the ring around the surgical neck of the humerus
  • At the lower boarder of teres major the axillary artery leaves the axilla and enters the brachium therefore changing its name to the brachial artery
    • Starts medial to the shaft of the humerus but as it descends it ends up in front of the elbow joint in the midline (between the 2 epicondyles)
    • Its where you can feel the brachial point
  • Brachial artery divides into 2 terminal arteries at the neck of the humerus= radial and ulnar artery
    • Radial artery moves with the radial nerve
    • Ulnar artery moves with the ulnar nerve
  • Brachial artery gives off the profundus brachii artery
    • Runs around the back of the humerus/spirals around from medial to lateral
    • Runs together with the radial nerve (which also spirals around)
    • Supplies the posterior compartment of the arm
      • Gives blood supply to triceps
  • Ulnar artery gives off a common interosseous artery (‘common’= there is another division to go)
    • Gives off an anterior and posterior interosseous arteries (running on the back and front of the interosseous membrane)
    • Anterior interosseous supplying the deep muscles of the anterior forearm
    • Posterior interosseous runs with the posterior interosseous nerve=branch of radial nerve
  • Radial and ulnar arteries enter the palm of the hand and then form arches (doesn’t go through the carpal tunnel)
    • Ulnar artery goes over the top of the flexor retinaculum= superficial, forming the superficial palmar arch. (vulnerable!)
    • Radial artery goes around the posterior aspect of the hand then pierces the 1st dorsal interosseous to enter the palm of the hand forms the deep palmar arch
    • Digital arteries= end arteries (one on either side of the finger)
117
Q

Describe the veins in the upper limb

A
  • One vein draining the medial side–> drains to basilic vein
  • One draining the lateral side–>drains to cephalic vein
    • ​Winds around the lateral/radial boarder of the forearm and then onto the anterior surface of the forearm
  • Communication between the cephalic and basilic vein called the median cubital vein (where blood is taken from)
    • Cephalic vein then ascends, runs lateral to biceps and into the deltopectoral groove–> (pierces deep fascia) calvipectoral fascia–>empties into axillary vein
  • Basilic vein ascends on medial side/ulnar side, its medial to biceps but it only goes halfway up the arm then pierces the deep fascia to join the brachial veins/vena comatanties (roughly at the inferior boarder of teres major)–>unite to form the axillary vein
118
Q

Describe the lymphatic system of the upper limb

A
  • All lymph drains into axillary LN
  • Groups of LNs
    • Posterior group
      • Often called the subscapular group
    • Anterior group
    • Lateral group
  • Also have superficial and deep lymph channels
    • Superficial lymphatics follow superficial veins
    • Deep lymphatics follow deep veins and arteries
  • Enlarged axillary LN doesn’t mean the pathology is in the upper limb!!!! Because they also drain the upper quadrant of the anterior and posterior wall. E.g. breast cancer or melanoma
119
Q

What are some causes of acidosis with a high anion gap?

A
  • lactic acidosis
  • diabetic ketoacidosis
  • renal failure
120
Q

What are some types of acute glomerulonephritis?

A
  • IgA nephropathy
    • commonest form in Oz
    • causes haematuria without acute renal failure
  • membraneous nephropathy
    • the commonest form causing proteinuria
  • glomerulonephritis in SLE
  • cresent shaped= severe acute injury
    • not specific to one form of GN
  • acute post streptococcal glomerulonephritis
    • reversible
121
Q

What causes injury in acute glomerulonephritis?

A
  • injury is immune mediated
    • deposition of immune complexes
122
Q

What glomerular diseases can lead to acute renal failure?

A
  • acute tubular necrosis
  • acute glomerulonephritis
  • acute interstitial nephritis
  • others
123
Q

Describe what nephrotic syndrome/severe proteinuria is

A
  • severe protein loss
  • symptoms
    • oedema
    • proteinuria
    • hypoalbuminaemia
    • hyperlipidaemia
  • causes
    • diabetes melliteus
    • glomerulonephritis
    • amyloid deposition
    • inherited abnormalities in proteins between podocytes
124
Q

What are some techniques used to diagnose glomerular diseases?

A
  • clinical findings
  • light microscopy
  • immunostains
  • EM
125
Q

How do cells react to glomerulonephritis?

A
  • glomerular cells proliferate
  • inflammatory cells arrive
  • basement membrane proliferatees
  • eventually
    • segments of glomeruli are destroyed= necrotising lesions
    • segments scar and contract= sclerosing lesions
126
Q

Describe acute tubular necrosis

A
  • most common cause of acute renal failure!
  • reversible
  • due to ischaemia
    • inadequate blood supply to kidney therefore tubular epithelium dies–> degenerate–> detach from basement membrane forming slough
    • tubules cant fulfill its functions
    • GFR decreases, electrolyte blance fails, urea and creatinine increase in blood
  • can also be due to toxins
127
Q

Describe acute pyelonephritis

A
  • bac infection of the kidney from ascending infection of the lower UT
  • usually from gram -ve bac
    • E.coli
    • Klebiella
    • Proteus
    • Pseudomonas
  • acute onset
  • renal function usually preserved
  • urine contains WBCs and organisms
  • ppl become very sick very quickly
  • systemic febril illness
128
Q

Describe acute or chronic tubulointersitial nephrtis

A
  • presents as acute renal failure with blood or protein in the urine, with fever and maybe a rash
  • interstitium and tubules are infilitrated by inflammatory cells (lymphocytes and eosinophils)
  • often due to drug allergies
129
Q

Describe end stage kidney disease

A
  • akak chronic renal injury
  • kindeys can no longer perform their function
  • irreversible
  • kidney is shrunken, pitted and scarred
  • insufficient GFR
  • mostly caused by
    • diabetic nephropathy
    • glomerulonephritis
    • HT
130
Q

Describe chronic pyelonephritis

A
  • results in interstitial scarring, tubular atrophy, depressed saddle shaped scars visible on renal surface
  • due to recurrent or continuous infection
131
Q

What is the interstitium and how does it relate to tubulo-interstitial diseases?

A
  • normally it is hardly visible
  • tiny amount of collagen
132
Q

Define transplantation

A
  • the process of transferring solid organs (vascularised organs) from one individual to another
133
Q

What is an example of where the immune response acts detrimentally to the transplant recipient

A

graft rejection

134
Q

What are the classifications of transplant types?

A
  • isograft (synergistic)
    • between genetically identical individuals
    • e,g identical twins/monozygotic twins or an inbred strain
  • autograft
    • from one part of the body to another
    • e,g from trunk to arm
  • allograft
    • between different members of the same species
    • e.g. between 2 unrelated people
  • xenograft
    • between members of different species
    • e.g. porcine heart valves
135
Q

What immune cell mediates graft rejection? And what do they recognise?

A
  • T cell (CD8 T cell)
  • they recognise histocompatibility Ags presented in MHC
136
Q

Describe the clinical differences in renal and lung transplants?

A
  • in renal transplants there is a long weighting list and a national registery so lots of donors therefore HLA matching occurs
  • in lung transplants there is a smaller weighting list and no national registry and its more of a critical situation so no matching occurs and HLA mistmatches are very common
137
Q

What are the different types of rejection reactions?

A
  • types are defined by immunological factors that drive it not the time course:
  • hyperacute
    • aka ab mediated rejection
    • mins to hours
    • caused by prefromed anti donor abs and complement from blood groups, MHC, or previous blood transfusions, pregnancies or transplants
  • acute
    • days to weeks
    • caused by primary activation of T cells
  • chronic
    • months to years
    • causes are unclear. Abs, imm complexes, slow cellular rxn, recurrence of disease, viruses, ischaemia reperfusion injury
138
Q

What are some strategies to prevent allograft rejection?

A
  • matching ABO ags
  • matching MHC alleles
  • immunosuppressive drugs
    • calcineurin inhibs e.g. cyclosporin, tacrolimus (decrased IL-2 gene transcription)
    • anti-inflammatory e.g. steriods
    • anti-proliferative e.g. azathioprine (inhibits DNA and RNA synthesis, blocks IL-2 production)
  • xenotransplantation?
  • induction of specific tolerance to transplanted organs?
  • stem cell transplants?
139
Q

Distinguish between the 2 main types of HT?

A
  • Primary/essential HT
    • 90-95% of HT
    • no specific identifiable cause
    • only treat symptoms
    • multifactorial causes
      • polygenic
      • role of inflammtion
      • race
      • age
      • gender
      • lifestyle
    • it causes complications by causing concentric LV hypertrophy (because of increased LV afterload) which can cause
      • atherosclerosis
      • aortic dissection
      • berry aneurysm
      • hyaline arteriolosclerosis
  • secondary HT
    • 5-10%
    • has an identifiable cause therefore can treat it
    • causes
      • renal
      • vascular
      • endocrine
      • meds
140
Q

Describe malignant HT

A
  • only a small proportion of HT is this type
  • aka hypertensive emergency
  • =abrupt severe increase in BP
  • can develop de novo in those with normal BP or those with preexisiting primary HT
  • effects
    • retinopathy
    • decreased renal function
    • haemolytic anameia
    • enephalopathy
  • complications occur in small arteries and arterioles
    • hyperplastic arteriolosclerosis
    • fibrinoid necrosis and thrombosis
141
Q

Describe how HT affects the kidney

A
  • HT is a RF for renal injury and end stage renal disease because
    • transmission of increased Ps to glomeruli–> sclerosis
    • hyaline arteriolosclerosis–> chronic ischaemia
  • protinuria= marker of severity of chronic disease and a predictor of progression
  • e.g. systolic HT with wide PP
  • e.g. benign nephrosclerosis
    • ​interstitial scarring
    • chronic inflammation
    • atropic glomeruli and glands
  • e.g. renal artery stenosis
142
Q

What are some factors that influence the final image of musculoskeletal imaging?

A
  • tissue composition (radiodensity)
  • tissue thickness
  • position of the object - film and x-ray source
  • object shape
  • superimposition of tissues
143
Q

What colour does radiolucent structures appear as on imaging?

A

dark structures

144
Q

What colour does radio-opaque structures appear as on imaging?

A

light structures

145
Q

Describe the differences between the two magnetic resonance imaging (MRI) signal intensities

A
  • T1 weighted
    • fluid= dark
    • fat= bright
    • muscle=intermediate
    • spinal cord=intermediate
    • cortical bone= very dark
    • flowing blood= dark
  • T2 weighted
    • fluid= bright
    • fat=intermediate to bright
    • muscle= same as above
    • spinal cord=same as above
    • cortical bone=same as above
    • flowing blood=same as above
    • but fat suppression–> fat and bone marrow appear dark
146
Q

What are some advantages and disadvantages of plain films, MRIs, ultrasound and CTs

A
  • plain films
    • good overview of bones and joints
    • good for alignment
    • some flexivility in positioning e.g. standing views
    • less contrast/spatial resolution than CT
    • radiation but less than CT
    • cheap and quick
    • readily available
  • MRIs
    • good spatial and contrast resolution
    • good for soft tissue and bone marrow
    • good for inside joints
    • cross sectional imaging
    • imaging in multiple planes
    • availability variable
    • limited functional information
    • contraindications (pacemakers, cochelar implants, some aneurysm clips)
    • more expensive
    • long scan times (20 mins for a joint)
  • ultrasound
    • operator dependent
    • high resolution for soft tissue structures
    • small field of view
    • does not see inside the joint of through the bone
  • CTs
    • good for bone detail espc joint fractures
    • more expensive than plain film
    • uses more radiation
147
Q

What structures do we see better on the internal rotation film? what structures do we see better on the external rotation film of the shoulder?

A

internal rotation= good for fractures of the posteriorlateral margin

external rotation= good for checking for fractures

148
Q

Where are the 3 primary ossification centres around the shoulder? Where are the secondary ossification centres around the shoulder?

A
  1. one for the greater tuberosity
  2. one for the lesser tuberosity
  3. one for the head of the humerus

secondary ossification centres

  • 3 in the acromion
  • around the scapula
149
Q

What are some risk factors for adverse drug reactions?

A
  • history of a previous adverse drug reaction
  • pharmacodynamics
    • target selectivity
    • target distribution
    • therapeutic index
  • pharmacokinetics
    • impairment of the organs of excretion
    • extremes of age
    • polypharmacy
150
Q

What are some clinically relevant drugs that have a low therapeutic index

A
  • anticoagulants
  • cardiac glycosides
  • anticonvulsants
  • lithium
  • hypoglycaemics
151
Q

Distinguish between dose dependent and non dose dependent adverse drug reactions

A

dose dependent

  • side effects
  • overdose effects
  • idiosyncratic effects

non dose dependent

  • hypersensitivity reactions (idiosyncratic)
152
Q

Name some examples of on target side effects

A
  • on target action but target at multiple sites
153
Q

Name some examples of dose dependent off target side effects

A
  • poor selectivity of drug
    • e.g. tricyclic antidepressants
  • metabolism
    • e.g. antihistamine- Terfenadine
    • Terfenadine= prodrug, needs to be converted to its active metabolite=fexofenadine
    • grapefruit juice contains dihydroxybergammotin that inhibits CYP3A4
    • terfenadine and grapefruit juice
      • life threatening arrhythmias (it also inhibits K channels–> broadens AP) because terfenadine becomes bioavailable (not fexofenadine) which has decreased selectivity to H receptors than fexofenadine
154
Q

What are some drugs that alter P-450 enzymes?

A
155
Q

Name some examples of dose dependent overdose effects

A
  • occurs when drug accumulates in the plasma
    • drugs with low TI
    • infrequent SEs of other drugs
    • wrong dose
    • drug interaction
  • e.g. atropine–> delirium, coma, death
  • Paracetamol–> gentle on the stomach but toxic to the liver
156
Q

Briefly describe paracetamol toxicity

A
157
Q

Name some examples of dose dependent idiosyncratic effects of drugs

A
  • infrequent
  • dose dependent
  • genetically determined
    • alteration in metabolism
    • e.g. suxamethonium (absence of pseudocholinersterase–> some patients stop breathing straight away at the normal dose because they lack the enzyme that breaks it down therefore its levels rise very quickly)
    • e.g. codeine- slowed metabolism by CYP2D6 to morphine therefore they dont get the analgesic effect
158
Q

Name some examples of non dose dependent hyersensitivity reactions to drugs

A
  • pharmacologically abnormal
  • infrequent
  • not dose dependent!
  • single exposure triggers extremem response
  • has an immunological basis
  • e.g. wide spread ab use in the food chain
  • e.g. low molecular weight compounds can act as haptens–> cross sensitisation
159
Q

Using atropine as an example, explain the different types of adverse reactions

A

Danielle's MD1 (6 decks)

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