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Buzzwords > Transition Block > Flashcards

Transition Block Flashcards

1
Q

muscle for active flexion of the hip?

A

iliopsoas

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2
Q

muscular back pain localised immediately to the left of the midline, worse on lateral felxion and active extension of spine?

A

erector spinae

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3
Q

proximal prgression of vein after the inguinal ligament?

A

external iliac

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4
Q

anaesthesia in first web space of foot?

A

deep fibular nerve

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5
Q

what supplies the dorsum of the foot?

A

superficial fibular nerve

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6
Q

cause of foot drop?

A

common fibular nerve

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7
Q

fracture at the left neck of the fibula?

A

foot drop

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8
Q

function of the anterior compartment of the leg?

A

dorsi flexion

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9
Q

function of posterior compartment of the leg?

A

plantar flexion

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10
Q

function of lateral compartment of the leg?

A

eversion

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11
Q

What does the sciatic nerve supply?

A

motor posterior compartment of the thigh and everything sensory and motor below knee except saphenous nerve (sensation medial calf)

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12
Q

What is the sensory supply to the posterior thigh?

A

posterior femoral cutaneous

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13
Q

ankle jerk

A

put on shoe S1/2

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14
Q

knee jerk

A

kick down door L3/4

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15
Q

biceps reflex

A

pick up sticks C5/6

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16
Q

triceps reflex

A

serve the plate C7/8

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17
Q

what tendon is involved in ankle jerk?

A

calcaneal tendon

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18
Q

innervation of anterior compartment of the leg?

A

deep fibular nerve

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19
Q

what is the largest branch of the femoral nerve and only has sensory properties?

A

saphenous nerve

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20
Q

saphenous nerve function?

A

innervates medial lower leg

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21
Q

where is dorsalis pedis pulse?

A

lateral to extensor hallucis longus tendon of big toe

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22
Q

What structure is transected in laminectomy procedure?

A

ligamentum flavum

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23
Q

What is decompression surgery?

A

laminectomy

removal of lamina to create space in spinal column

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24
Q

injury to ankle stumbling off a curb?

A

avulsion fracture of the base of 5th metatarsal

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25
Q

What causes trendelenburgs gait?

A

weakness of gluteus medius and minimus supplied by superior gluteal nerve L4-5

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26
Q

spinal stenosis releif?

A

flexion exercises- cycling

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27
Q

deep fibular nerve damage?

A

absence of dorsi flexion in big toe. loss of sensation in first web space. loss of ankle dorsi flexion

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28
Q

superficial fibular nerve damage?

A

cant evert the ankle

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29
Q

what is a key mechanism for kidneys regulating blood volume?

A

kidney excretion

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30
Q

What does aldosterone do?

A

increases sodium reabsorption thus water to increase blood vol

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31
Q

what happens in pseudohyponatremia?

A

protein fraction occupies more of the plasma volume giving the picture of decreased Na levels

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32
Q

how do you distinguish between central (neurological- deficiency of vasopressin) and nephrogenic diabetes insipidus?

A

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

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33
Q

what is addisons?

A

primary adrenal insufficiency- AI destruction of gland reduced cortisol and aldosterone production (loss of sodium and K retention due to lack of aldosterone)

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34
Q

test for addisons?

A

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

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35
Q

patients with adrenal insufficiency are less able to retain what and why?

A 
infused saline(sodium)
adrenal insufficient patients lack aldosterone so cant reabsorb sodium and water from the tubules therefor saline will just flush out
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36
Q

what is used to distignuish primary and secondary adrenal insufficiency?

A

ACTH measurement

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37
Q

what happens in primary adrenal insufficiency?

A

problem in the glands so reduced cortisol resulting in over production of ACTH by ant pituitary

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38
Q

What happens in secondary insufficiency?

A

lack of ACTH secretion leads to decreased activity of cortisol gland

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39
Q

what are the common causes of secondary adrenal insufficiency?

A

exogenous steroid use

pituitary adenoma

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40
Q

why is primary hyperparathyroidism diagnosed much earlier than in the past?

A

hypercalcemia

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41
Q

What test should you do if you discover highcalcium levels?

A

PTH

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42
Q

What do high PTH and high calcium indicate?

A

primary hyperparathyroidism (parathyroid hyperplasia)

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43
Q

What do high calcium and low PTH indicate?

A

secondary hyperparathyroidsim (problem out with the parathyroid gland eg malignancy secreting calcium- normal glands respond by lowering PTH)

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44
Q

what is key in management of severe hypercalcemia and why?

A

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)

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45
Q

what are the main causes of hyperkalemia?

A

haemolysis
renal failure
antihypertensive drugs (esp spironolactone)

46
Q

What do the findings of gross hyperkalemiaand hypocalcemia suggest?

A

contamination with potassium containing EDTA the anticoagulant used in FBC- purple top bottle

47
Q

What colourr bottle is used for FBC samples?

A

purple

48
Q

How do you treat DKA?

A

K+ (insulin causes rapid influx of K which can lead to hypokalemia)
IV insulin

49
Q

What are the key signs in addisons?

A

hypovolemia and hyponatremia

50
Q

What is cushings syndrome?

A

primary hypercortilsolism

effects due to prolonged exposure of cortisol- medications, or cortisol producing tumour of adrenal cortex

51
Q

what is cushings disease?

A

increased secretion of ACTH (secondary hypercortisolism)

commonly due to pituitary adenoma

52
Q

how do you diagnose cushings?

A

dexamethasone supression test
if acth low- syndrome
acth high- disease or ectopic acth production

53
Q

primary hypercortisolism test results to low and high dose dexamethasone?

A 
ACTH low (cortisol secretion is independent of ACTH levels)
Cortisol production not suppressed by high or low
54
Q

esctopic ACTH production (small cell tumours in lung) results to high and low dose dexamethasone?

A

ACTH very high

Cortisol not supressed by high or low

55
Q

Secondary/cushings disease/pituitary adenoma?

A

ACTH high

suppressed by high (some function of the pitutary negative feedback remains)

56
Q

what is gold standard to assess the HPA axis?

A

insulin stress/ tolerence tests

57
Q

what causes primary hyper parathyroidism?

A

PTH secreting adenoma in parathyroid gland

58
Q

what causes secondary hyperparathyroidism?

A

PTH increase due to low serum calcium

59
Q

what causes tertiary hyperparathyroidism?

A

prolonged overstimulation of parathyroid glands transform into autonomous tissue- constant secretion of PTH despite normal Ca

60
Q

What part of the immune system are NK cells from?

A

innate

61
Q

How does the lectin pathway increase bacterial elimination?

A

opsinisation

MAC

62
Q

What do formation of memory B cells after vaccination allow?

A

rapid IgG production at re-exposure

63
Q

what two conditions are CD4+ cells massively reduced in?

A

SCID

HIV

64
Q

What happens in severe combined immunodeficiency/SCID?

A

X linked recessive
lack of interleukin receptors leads to
failure of T and NK cell development thus reduced activation of B cells

65
Q

Why is shingles more common in the elderly?

A

poorer immune systems

66
Q

Where is IgA found?

A

mucosa

67
Q

Why are granulomas formed and what forms them?

A

protective encasement

infected macrophages are stimulates to produce IL2 which induces a T cell response and TNF production

68
Q

what are granulomas?

A

organised collection of activated macrophages and lymphcytes

69
Q

what are biologicals such as anti TNF (etanercept, Adalimumab)?

A

pre-formed ABs thus a form of passive immunity

70
Q

Give some examples of delayed type hypersensitivity?

A

type IV
hypersensitivity
granulomatous reactions- tb leprosy
complec immune dysfunction- RA, MS

71
Q

What drugs are used secondary prevention following MI?

A

aspirin
simvastatin (can cause intolerable proximal muscle pain so can be swapped for atovasatin)
bisoprolol
ramapril

72
Q

What drug commonly causes hyperkalaemia?

A

ramipril

73
Q

simvastatin?

A

reduced risk of hypotension

74
Q

secondary prevention following MI?

A

Bisoprolol
Aspirin
Ramapril
Simvustatin

75
Q

Side effect of simvustatin?

A

proximal muscle pains

76
Q

what can furosemide cause?

A

hypokalemia

77
Q

What can ramipril cause?

A

hyperkalemia

78
Q

which one does not interact with the others to cause hypotentsion?

A

simvustatin

79
Q

rifampicin induces enzymes what effect does this have on km and Vmax?

A

unchanged km and higher vmax

80
Q

drug that doesnt need to be used with caution in rennal impairment?

A

omeprazole

81
Q

when is steady state plasma concentration reached by a drug with first order kinetics?

A

rate of admin equals rate of elimination

82
Q

what does apparent vol of distribution allow?

A

calculation of loading dose

83
Q

what is vol of distribution?

A

apparent volume that a drug appears to be distributed in when a small sample is tested (up scaling a plasma sample)

84
Q

Why do some lipophilic drug have a higher vol of distribution than even the total body vol?

A

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)

85
Q

what happens to rate of elimination iwth a large vol of distribution?

A

it increases

86
Q

how do u calculate vol of distribution?

A

dose/plasma conc

87
Q

how many hours for a drug with half life 6 hrs to reach 93% of steady state?

A

24hr

1half life= 6 hours = 50% steady state 2=12=75 etc

88
Q

Copd FEV1/FVC ratio?

A

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

89
Q

what happens to pulmonary complience in emphysema?

A

increases

lack of elastic tissue- lungs can be easily inflated/hyper inflated but full expiration is hard

90
Q

what is complience?

A

lungs ability to strech

91
Q

What is more common in COPD?

A

dynamic airway compression (diseased so easier to compress.

92
Q

dry bibasal crackle?

A

pulmonary fibrosis

93
Q

What happens in pulmonary fibrosis?

A

reduced pulmonary complience- harder to inflate the lungs

diffusion of gas impaired at alveoli

94
Q

does pulmonary fibrosis affect fev/fvc ratio?

A

it is a restrictive diseas so may be norm or increased ratio

95
Q

past MI. sob worse at night what happening in lungs?

A

reduced pulmonary compliance- pulmonary odeama affecting the gas diffusion

96
Q

previously fit 22 yr male cough fever PO2 8.2 what is likely O2 sats?

A

90%

97
Q

functional residual capacity?

A

2.2l in healthy male

98
Q

what happens to the pulmonary vessles with low pO2?

A

pulmonary vasoconstriction

99
Q

patient with pneumothorax is likely to be what?

A

hypotensive

100
Q

what are serotypes L1-3 ass with?

A

lymphogranuloam venereum infection in MSM

101
Q

what is advised for gonorrhoea patients?

A

test of cure

102
Q

treatment of gonorrhea?

A

IM ceftriaxone and azithromycein

103
Q

what are most coliforms sensitive to?

A

gentimicin

gram -ve rods

104
Q

reccomended treatment for patient with suspected intra abdo sepsis?

A

genta
amox
metro

105
Q

treatment for sever CAP?

A

co amox

clarithro

106
Q

diagnosis of septic shock?

A

low blood pressure that does not come back up when IV fluids are given

107
Q

side effect of gentamicin?

A

dizzy

108
Q

bacterial meningitis in healthy young adult?

A

neisseria meningitidis

109
Q

When are steroids best given in bacterial meningitis?

A

with or just before the first dose of abx

110
Q

what infection ass with consumption of soft cheese?

A

listeria

111
Q

why is ceftriaxone chose for suspected bacterial meningitis instead of penicillian?

A

longer half life

Buzzwords (9 decks)

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