Transition Block Flashcards
Treatment for uncomplicated Lyme’s disease
doxycycline
treatment for TB
RIPE
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
what side effect does isoniazid cause
peripheral neuropathy - pyridoxine (vit B6) given to prevent this
(zzzz makes your hands feel fuzzzzy)
what side effect does rifampicin cause
liver toxicity and bodily fluids orange
(‘picin out orange fluids’)
what side effect does ethambutol cause
visual disturbances
(alcohol makes you see blurry)
what side effect does pyrazinamide cause
liver toxicity, hyperuricaemia and athralgia
causative agent of whooping cough
bordetella pertussis
What is the definition of epistasis?
where expression of one gene is modified by expression of another gene/s
What is the definition of genetic anticipation?
symptoms of a genetic condition become more severe and start at younger age
seen in Huntington’s disease, myotonic dystrophy and fragile X syndrome
Which DNA bases can undergo methylation?
typically cytosine but also adenosine
What gene is responsible for sex determination in humans?
SRY gene
What mode of inheritance is Cystic Fibrosis?
autosomal recessive
What mode of inheritance is congenital adrenal hyperplasia and describe the presentation of it
autosomal recessive 21alpha hydroxylase deficiency
clinical features
present at birth
genital ambiguity
adrenal failure : collapse, hypotension, hypoglycaemia, poor weight gain
inheritance of two BRCA2 mutations leads to what condition?
fanconi anaemia
definition of sensitivity
portion of patients with the condition who have a positive result
what is tidal volume?
the volume of air inhaled and exhaled during a normal quiet breath
normal = 500mL (m) or 340 ml (f)
what is inspiratory reserve volume?
the volume of additional air inhaled above tidal volume
normal = 3000mL
what is expiratory reserve volume?
volume of air that can be forcefully exhaled after a normal resting expiration
leaves only residual volume in lungs
normal = 1000mL
what is the residual volume?
Forced Residual Capacity - Expiratory Reserve Volume = RV
volume of remaining air after maximal exhalation
normal = 1500mL
what is vital capacity?
IRV + TV+ ERV = VC
volume of air that can be forcefully exhaled after maximal inhalation
normal = 4500mL
what is inspiratory capacity?
TV + IRV = IC
volume of air that can be forcefully inhaled after quiet exhalation
normal = 3500mL
what is functional residual capacity?
ERV + RV = FRC
volume of remaining air in lungs after quiet expiration of tidal volume
normal = 2500mL
what is total lung capacity?
TV + IRV + ERV + RV = TLC
volume of air in lungs after maximal inhalation
normal = 6000mL
A tumour containing mucin will be what type?
an adenocarcinoma
(glandular)
management of torsades de pointes
magnesium sulphate and cardiac monitoring
management of asymptomatic bacteriuria in pregnant women
TREAT
1st and 2nd trimester = nitrofurantoin
3rd trimester= trimethoprim
classical presentation of klebsiella pneumoniae
Red jelly coloured sputum
Prader-Willi syndrome genetics
mutation on paternal chromosome 15
typical presentation of Campylobacter infection
flu-like prodrome followed by abdominal pain, vomiting and bloody diarrhoea
most sensitive test for current TB
Sputum culture
two shockable rhythms
ventricular fibrillation
pulseless ventricular tachycardia
two non shockable rhythms
asystole
pulseless- electrical activity
management of renal/ureteric stones
GOLD standard investigation = CT KUB
renal stones
<5mm watchful waiting
5-10mm = shockwave lithotripsy
10-20 mm = shockwave lithotripsy OR ureteroscopy
>20mm = percutaneous nephrolithotomy
uretic stones
<10mm= shockwave lithotripsy +/- alpha blockers
10-20 mm ureteroscopy
empirical antibiotics for staph aureus infection
flucloxacillin
empirical antibiotic for staph epidermidis
vancomycin
empirical antibiotics for strep pyogenes
doxycycline
empirical antibiotics for gram negative infection
clindamycin
empirical antibiotics for anaerobic infection
metronidazole
antibiotics that act on bacterial cell wall
penicillins - e.g. flucloxacillin, amoxicillin
cephalosporins - e.g. cefaclor, ceftriaxone
glycopeptides- e.g. vancomycin
antibiotics that inhibit protein synthesis
macrolides - e.g. erythromycin, calrithromycin
aminoglycosides - e.g. gentamicin
others - clindamycin, chloramphenicol, tetracyclines
antibiotics that act on bacterial DNA
metronidazole
trimethoprim
fluroquinolones - e.g. ciprofloxacin, levofloxacin
hyperkalaemia management
- stabilisation of cardiac membrane - IV calcium gluconate (but does NOT lower serum potassium levels)
- combined insulin/dextrose infusion - short-term shift in potassium from extra to intra
- calcium resonium, loop diuretics, dialysis - removal of potassium from body
process involved in difficulty breathing in anaphylaxis
respiratory smooth muscle contraction -> caused by histamine release from mast cells (IgE) mediated
what factors cause a shift to the right of the oxygen dissociation curve?
the need for lowering affinity of oxygen to haemoglobin
-increased carbon dioxide concentration
-increased temperature
-increase 2.3-DPG
-increased H+ (decreased pH)
what factors cause a shift to the left of the oxygen dissociation curve?
- need to maintain oxygen bound to haemoglobin
decreased temperature
decreased 2,3- DPG
decreased CO2
decreased H+ (increased pH)
What is the primary function of negative intrapleural pressure in the respiratory system
prevents lung collapse
- acts like a suction force maintaing adherence between lungs and chest wall
examples of inactivated whole cell vaccine
polio, hepatitis A, rabies, cholera
examples of inactivated fractional vaccines
hepatitis B, influenza, HPV, influenza type B, haemophilus
advantages of inactivated vaccines
can be made quickly
elicit good antibody response
easy to store
usually safe
disadvantages of inactivated vaccines
not very potent
require multiple injection - don’t stimulate clonal expansion of B and T cells
examples of live attenuated vaccines
MMR, chicken pox, yellow fever, rotavirus, small pox, polio
advantages of live attenuated vaccines
localised strong response
usually one dose required
disadvantages of live attenuated vaccines
may cause infection- not always safe
must be stored and handled carefully
is functional residual capacity increased or decreased in COPD
increased- elasticity increased so taking in more and losing more
what percentage of total lung capacity is Functional Residual Capacity
40%
around 3L
what is the normal FEV1/FVC ratio
> 75%
what FEV1/FVC ratio is likely seen in pulmonary fibrosis
85% - restrictive lung pattern
does COPD fev1/fvc respond to bronchodilators
no- but asthma does
what does hyperventilation cause
respiratory alkalosis- CO2 being washed out
what does a low PO2 cause in pulmonary vessels
vasoconstriction - diverts blood to better-oxygenated lung segments
does parasympathetic cause bronchoconstriction or bronchodilation
bronchoconstriction
does sympathetic cause bronchoconstriction or bronchodilation
bronchodilation
examples of conditions causing decreased pulmonary compliance
pulmonary fibrosis
pulmonary oedema
lung collapse
pneumonia
absence of surfactant
when is dynamic airway compression likely to occur in COPD patients
during active expiration
what does decrease in pulmonary compliance mean to the change in pressure needed to produce a change in volume
a greater change in pressure is needed to produce change in volume
what happens to intrapleural pressure during inspiration
falls- airways pulled open, thorax expands, diaphragm contracts (moves down)
what happens to intrapleural pressure during expiration
rises - chest recoils, diaphragm relaxes (moves up)
what does the rising pressure during expiration do to alveoli and airway
compresses it
what happens to the pulmonary compliance in a patient with emphysema
increases - elastic recoil of lungs lost
patients have to work harder to get air out of lungs
does compliance increase or decrease with age
increases
what is likely to happen to blood pressure in patient with pneumothorax
patient likely to be hypotensive
what happens to intrapleural pressure in tension pneumothorax
becomes more positive
what side does the trachea deviate in tension pneumothorax
opposite side
is PO2 dependent or independent on haemoglobin or saturation
independent
is saturation dependent or independent on partial pressure
dependent
what happens to PTH levels when calcium rises
PTH levels decrease
pulmonary function results in a COPD patient
increased total lung capacity, decreased lung diffusion capacity and decreased FEV1/FVC ratio
management of pulmonary oedema
POND
position
oxygen
nitrate infusion
diuretic - furosemide
what conditions cause respiratory alkalosis
hyperventilation - breathing out a lot of CO2=> getting rid of acid
venous drainage of the lower leg
anterior - dorsal venous network -> great saphenous vein -> femoral vein
posterior- short saphenous vein -> popliteal vein -> femoral vein
femoral vein -> external iliac -> common iliac -> IVC -> right atrium
proximal progression of a DVT in the femoral vein will extend into which vein next
external iliac
what muscles cause active flexion of the hip
iliopsoas, iliacus and psoas major
what muscles cause active extension of the hip
gluteus maximus, long head of the biceps femoris, semitendinosus, and semimembranosus
sensory supply to first web space
deep fibular
what nerve supplies the posterior cutaneous division of arm
radial nerve
what muscles does the radial nerve innervate
triceps brachii and extensors of forearm
what ligament in most likely injured in an inversion injury to the ankle
anterior talofibular ligament
- calcaneofibular ligament can also be
what ligament is most commonly injured with an eversion injury of the ankle
deltoid ligament
what is impaired with severe sciatica
decreased power of plantar flexion
what is seen with compression of the nerve at the cubital tunnel
ulnar nerve is compressed
- pins and needles of little finger and palm
- wasting of the muscles between metacarpal bones
- weakness of the right hand
which injury causes a foot drop
fractured neck of fibula
what vein runs along the medial aspect of the knee
long saphenous vein
what compartment of the leg does the tibial nerve innervate
posterior compartment
what conditions/ injuries cause a positive trendelenburg test
injury to superior gluteal nerve
weakness of gluteus medius
congenital hip dislocation
what injuries cause inability to straight leg raise
fractured neck of femur
complete quadriceps or patella tendon tear
what is the best study to determine the prevalence of disease
cross sectional study
in a randomised control trial what is reduced by randomisation
selection bias
what is an example of a cohort study
a study that looks at all children born at one hospital in 1 year and measures their height at intervals up to 4 years of age
- best study to explore disease aetiology
what is an example of a controlled trial
a study comparing two groups of 4 year olds
- one group given growth drug and other the placebo
what is an example of a cross sectional study
study aiming to establish normal height of 4 year olds by measuring height at school entry
- best study to determine prevalence of disease
what best describes the term ‘external validity’
the extent to which one can appropriately apply results to other populations
what is the best study design to research the aetiology of a disease
cohort study
what is meant by sensitivity of a test
the proportion of subjects with the disease correctly diagnosed by the test
how do you work out the sensitivity
people with the disease who have tested positive/ total number of people with the disease
what is meant by specificity of a test
proportion of subjects without the disease correctly excluded by the test
how do you calculate the specificity
people without the disease who tested negative/ total number of people without the disease
what is meant by the positive predictive value
proportion of subjects with positive test who have the disease
how do you calculate positive predictive value
number of people who tested positive for disease and have the disease/ total number of people who tested positive
what is meant by the negative predictive value
number of people who test negative for disease and do not have the disease
how do you calculate the negative predictive value
number of people who do not have the disease and tested negative/ total number of people who tested negative
how to calculate the prevalence of a disease
total number of people with the disease/ total number of people tested
what is definition of numbers needed to treat
number of patients you need to treat to prevent one additional bad outcome
are natural killer cells part of innate or adaptive immunity
innate- don’t require prior exposure to know which cells to kill
what key feature is required for vaccination
adapative immunity
anti- Ro antibodies
sjrogren’s
anti- Jo antibodies
polymyositis and dermatomysitis
anti- cyclic citrullinated peptide (anti- CCP)
rheumatoid
anti-scl-70
systemic sclerosis
anti-acetylcholine receptor antibody
myasthenia gravis
when is methotrexate contraindicated
liver disease
or immunodeficiency
where is erythropoietin normally produced
kidneys - in response to low blood oxygen content
what happens during the depolarisation stage of cardiac cycle
voltage gated sodium channels open - increase membrane potential
what is meant by pharmacodynamic
what drug does to the body
(Dynamic- Drug)
what is meant by pharmacokinetics
what body does to drug
- absorption
-distribution
-metabolism
-excretion
what describes the changes in sodium and water balance in Addison’s disease
sodium depletion more than water
