Transition Block Flashcards
muscle for active flexion of the hip?
iliopsoas
muscular back pain localised immediately to the left of the midline, worse on lateral felxion and active extension of spine?
erector spinae
proximal prgression of vein after the inguinal ligament?
external iliac
anaesthesia in first web space of foot?
deep fibular nerve
what supplies the dorsum of the foot?
superficial fibular nerve
cause of foot drop?
common fibular nerve
fracture at the left neck of the fibula?
foot drop
function of the anterior compartment of the leg?
dorsi flexion
function of posterior compartment of the leg?
plantar flexion
function of lateral compartment of the leg?
eversion
What does the sciatic nerve supply?
motor posterior compartment of the thigh and everything sensory and motor below knee except saphenous nerve (sensation medial calf)
What is the sensory supply to the posterior thigh?
posterior femoral cutaneous
ankle jerk
put on shoe S1/2
knee jerk
kick down door L3/4
biceps reflex
pick up sticks C5/6
triceps reflex
serve the plate C7/8
what tendon is involved in ankle jerk?
calcaneal tendon
innervation of anterior compartment of the leg?
deep fibular nerve
what is the largest branch of the femoral nerve and only has sensory properties?
saphenous nerve
saphenous nerve function?
innervates medial lower leg
where is dorsalis pedis pulse?
lateral to extensor hallucis longus tendon of big toe
What structure is transected in laminectomy procedure?
ligamentum flavum
What is decompression surgery?
laminectomy
removal of lamina to create space in spinal column
injury to ankle stumbling off a curb?
avulsion fracture of the base of 5th metatarsal
What causes trendelenburgs gait?
weakness of gluteus medius and minimus supplied by superior gluteal nerve L4-5
spinal stenosis releif?
flexion exercises- cycling
deep fibular nerve damage?
absence of dorsi flexion in big toe. loss of sensation in first web space. loss of ankle dorsi flexion
superficial fibular nerve damage?
cant evert the ankle
what is a key mechanism for kidneys regulating blood volume?
kidney excretion
What does aldosterone do?
increases sodium reabsorption thus water to increase blood vol
what happens in pseudohyponatremia?
protein fraction occupies more of the plasma volume giving the picture of decreased Na levels
how do you distinguish between central (neurological- deficiency of vasopressin) and nephrogenic diabetes insipidus?
DDAVP- synthetic analogue of AVP/vasopressin/ADH
if it decreases the amount of urine then the problem is central. if it doesnt affect it then you know the kidneys are insensitive to desmopressin
what is addisons?
primary adrenal insufficiency- AI destruction of gland reduced cortisol and aldosterone production (loss of sodium and K retention due to lack of aldosterone)
test for addisons?
synacthen test
give ACTH and if it fails to raise cortisol levels you know it is a primary problem in the adrenal gland not a secondary problem of the pituitary or hypothalamus
patients with adrenal insufficiency are less able to retain what and why?
infused saline(sodium) adrenal insufficient patients lack aldosterone so cant reabsorb sodium and water from the tubules therefor saline will just flush out
what is used to distignuish primary and secondary adrenal insufficiency?
ACTH measurement
what happens in primary adrenal insufficiency?
problem in the glands so reduced cortisol resulting in over production of ACTH by ant pituitary
What happens in secondary insufficiency?
lack of ACTH secretion leads to decreased activity of cortisol gland
what are the common causes of secondary adrenal insufficiency?
exogenous steroid use
pituitary adenoma
why is primary hyperparathyroidism diagnosed much earlier than in the past?
hypercalcemia
What test should you do if you discover highcalcium levels?
PTH
What do high PTH and high calcium indicate?
primary hyperparathyroidism (parathyroid hyperplasia)
What do high calcium and low PTH indicate?
secondary hyperparathyroidsim (problem out with the parathyroid gland eg malignancy secreting calcium- normal glands respond by lowering PTH)
what is key in management of severe hypercalcemia and why?
rehydration
hyper calcemia interferes with proximal tubular reabsorption of sodium causing a loss of sodium thus water (will not be able to see the calcium levels in a dehydrated patient)
what are the main causes of hyperkalemia?
haemolysis
renal failure
antihypertensive drugs (esp spironolactone)
What do the findings of gross hyperkalemiaand hypocalcemia suggest?
contamination with potassium containing EDTA the anticoagulant used in FBC- purple top bottle
What colourr bottle is used for FBC samples?
purple
How do you treat DKA?
K+ (insulin causes rapid influx of K which can lead to hypokalemia)
IV insulin
What are the key signs in addisons?
hypovolemia and hyponatremia
What is cushings syndrome?
primary hypercortilsolism
effects due to prolonged exposure of cortisol- medications, or cortisol producing tumour of adrenal cortex
what is cushings disease?
increased secretion of ACTH (secondary hypercortisolism)
commonly due to pituitary adenoma
how do you diagnose cushings?
dexamethasone supression test
if acth low- syndrome
acth high- disease or ectopic acth production
primary hypercortisolism test results to low and high dose dexamethasone?
ACTH low (cortisol secretion is independent of ACTH levels) Cortisol production not suppressed by high or low
esctopic ACTH production (small cell tumours in lung) results to high and low dose dexamethasone?
ACTH very high
Cortisol not supressed by high or low
Secondary/cushings disease/pituitary adenoma?
ACTH high
suppressed by high (some function of the pitutary negative feedback remains)
what is gold standard to assess the HPA axis?
insulin stress/ tolerence tests
what causes primary hyper parathyroidism?
PTH secreting adenoma in parathyroid gland
what causes secondary hyperparathyroidism?
PTH increase due to low serum calcium
what causes tertiary hyperparathyroidism?
prolonged overstimulation of parathyroid glands transform into autonomous tissue- constant secretion of PTH despite normal Ca
What part of the immune system are NK cells from?
innate
How does the lectin pathway increase bacterial elimination?
opsinisation
MAC
What do formation of memory B cells after vaccination allow?
rapid IgG production at re-exposure
what two conditions are CD4+ cells massively reduced in?
SCID
HIV
What happens in severe combined immunodeficiency/SCID?
X linked recessive
lack of interleukin receptors leads to
failure of T and NK cell development thus reduced activation of B cells
Why is shingles more common in the elderly?
poorer immune systems
Where is IgA found?
mucosa
Why are granulomas formed and what forms them?
protective encasement
infected macrophages are stimulates to produce IL2 which induces a T cell response and TNF production
what are granulomas?
organised collection of activated macrophages and lymphcytes
what are biologicals such as anti TNF (etanercept, Adalimumab)?
pre-formed ABs thus a form of passive immunity
Give some examples of delayed type hypersensitivity?
type IV
hypersensitivity
granulomatous reactions- tb leprosy
complec immune dysfunction- RA, MS
What drugs are used secondary prevention following MI?
aspirin
simvastatin (can cause intolerable proximal muscle pain so can be swapped for atovasatin)
bisoprolol
ramapril
What drug commonly causes hyperkalaemia?
ramipril
simvastatin?
reduced risk of hypotension
secondary prevention following MI?
Bisoprolol
Aspirin
Ramapril
Simvustatin
Side effect of simvustatin?
proximal muscle pains
what can furosemide cause?
hypokalemia
What can ramipril cause?
hyperkalemia
which one does not interact with the others to cause hypotentsion?
simvustatin
rifampicin induces enzymes what effect does this have on km and Vmax?
unchanged km and higher vmax
drug that doesnt need to be used with caution in rennal impairment?
omeprazole
when is steady state plasma concentration reached by a drug with first order kinetics?
rate of admin equals rate of elimination
what does apparent vol of distribution allow?
calculation of loading dose
what is vol of distribution?
apparent volume that a drug appears to be distributed in when a small sample is tested (up scaling a plasma sample)
Why do some lipophilic drug have a higher vol of distribution than even the total body vol?
they partition into fats which reduces the plasma conc (plasma sample shows only a small portion of the actual drug making it look like its spread over a larger vol)
what happens to rate of elimination iwth a large vol of distribution?
it increases
how do u calculate vol of distribution?
dose/plasma conc
how many hours for a drug with half life 6 hrs to reach 93% of steady state?
24hr
1half life= 6 hours = 50% steady state 2=12=75 etc
Copd FEV1/FVC ratio?
60%
norm >70
obstructive it decreases
restrictive it may increase (fev doesnt decrease as much as the fvc)
fvc decreases the same in restrictive and obstructive
what happens to pulmonary complience in emphysema?
increases
lack of elastic tissue- lungs can be easily inflated/hyper inflated but full expiration is hard
what is complience?
lungs ability to strech
What is more common in COPD?
dynamic airway compression (diseased so easier to compress.
dry bibasal crackle?
pulmonary fibrosis
What happens in pulmonary fibrosis?
reduced pulmonary complience- harder to inflate the lungs
diffusion of gas impaired at alveoli
does pulmonary fibrosis affect fev/fvc ratio?
it is a restrictive diseas so may be norm or increased ratio
past MI. sob worse at night what happening in lungs?
reduced pulmonary compliance- pulmonary odeama affecting the gas diffusion
previously fit 22 yr male cough fever PO2 8.2 what is likely O2 sats?
90%
functional residual capacity?
2.2l in healthy male
what happens to the pulmonary vessles with low pO2?
pulmonary vasoconstriction
patient with pneumothorax is likely to be what?
hypotensive
what are serotypes L1-3 ass with?
lymphogranuloam venereum infection in MSM
what is advised for gonorrhoea patients?
test of cure
treatment of gonorrhea?
IM ceftriaxone and azithromycein
what are most coliforms sensitive to?
gentimicin
gram -ve rods
reccomended treatment for patient with suspected intra abdo sepsis?
genta
amox
metro
treatment for sever CAP?
co amox
clarithro
diagnosis of septic shock?
low blood pressure that does not come back up when IV fluids are given
side effect of gentamicin?
dizzy
bacterial meningitis in healthy young adult?
neisseria meningitidis
When are steroids best given in bacterial meningitis?
with or just before the first dose of abx
what infection ass with consumption of soft cheese?
listeria
why is ceftriaxone chose for suspected bacterial meningitis instead of penicillian?
longer half life
