Wrong answers only Flashcards
What does having a grey tongue mean?
Increased deoxygenated Hb
Septic arthritis
Older. Painful hot unilateral joint pain, shivering, hypotension, high pulse
Gout
Older. Acute pain, swelling, redness and tenderness in the joints, often the joint at the base of the big toe. Episodic, development over 24h. Form tophi with uric acid crystals. Chronic kidney disease exacerbates it.
What is given after an arthroplasty to prevent OA and further fractures?
Alendronic acid
How is glucose taken into kidney epithelial cells?
A glucose/ sodium co-transporter. this works as there is a high extracellular concentration of sodium so it diffuses in
Receptor types for- Adrenaline, Vitamin D, Cortisol, GABA, morphine
Adrenaline- G- protein coupled Vitamin D- nuclear Cortisol- nuclear GABA- channel linked Morphine- G protein coupled
Nerve distribution in the hand
Dorsal-
Ulnar- pinky and half of ring finger
Radial- back of hand until phalanges of remaining fingers
Median- tips of half of ring, index and middle finger, medial half of thumb
Palmar-
Radial- anatomical snuffbox
Ulnar- pinky and half of ring finger
Median- most of the dorsum- thumb, index, middle finger and half of ring finger
Metabolism of Ibuprofen
Inactivated by cytochrome P450 in the liver, excreted through the kidneys
OA symptoms and management
Intermittent dull asymmetrical pain in joint, worse at the end of the day. 10 mins stiffness in the morning. Simple analgesic (paracetamol) and exercise regimen
What type of joint is- Interphalangeal joint, Rib-sternum boundary, Intervertebral disks, Sutures of the skull or the hip?
Interphalangeal joint- synovial
Rib-sternum boundary- cartilaginous
Intervertebral disks- cartilaginous
Sutures- fibrous
If DMARDs are not effective in the treatment of RA, what treatment is advised?
Inhibit tumor necrosis factor α. Use anti- TNF or anti- interleukin 6 treatments
Alkylosing Spondylitis
Younger than 45, lower back stiffness and pain radiating to buttocks. Improved with activity. Likely to involve eyes.
Name the types of shock
Septic, haemorragic, neurogenic, anaphylactic, cariogenic
Symptoms of haemorragic shock
HR > 100, low PB, high rest rate >20, longer than 2s capillary refill time
COPD
Breathlessness on exertion, need to stop when walking on flat ground. White sputum on coughing. Ex- smoker
Effects of ACE inhibitors
Reduced AG2, so decreased water and salt retention. Lower BP so increased renin to attempt to re-establish homeostasis by increasing AG2 and aldosterone. Overall, reduced aldosterone and increased Renin
Pneumothorax
High breaths per minute, low oxygen saturation. Tracheal deviation, reduced expansion, hyper resonant percussion, no breath sounds or flatulent sounds
Vitamin D metabolism and how does Vit D deficiency work/ affect a patient
Synthesis in skin or intake in diet absorption. Activated by hydroxylation in the liver. Fully activated in the kidney.
If patient has renal impairment then low vitamin D production, leading to hyper- calaemia and bone disease.
Septic Arthritis
Short term painful hot joint, shivering, hypotension, high HR. Erythematous and effused joints
What is the prime mover for hip flexion?
Iliopsoas/ Psoas
Main components of Collagen Type 1
Glycine, Proline, Hydroxyproline
Main form of transport of CO2
Dissolved in plasma as bicarbonate
With suspected OA (bilateral knee pain worse at end of the day, swelling and crepitus on passive flexion, with no effusion), what is appropriate investigation/ management?
Main management is active lifestyle and weightless. imaging not required as reasonable doubt above age 60 is confirmation of diagnosis.
RA
Gradual onset. Painful swelling of joints in hands, elbows and wrists, usually bilateral or use- induced. Dry eyes too. exacerbated by smoking history
What investigation is appropriate for Gout?
No need for serum urate test especially of there is associated kidney disease. Aspirate joint and look for crystals to confirm diagnosis and rule out infection
What to do if there is a high serum Calcium conc with associated stomach pain?
Measure PTH levels. If high then this is the cause. If low, then may suggest alternative cause eg cancer
What cells synthesise PG and collagen?
Chondrocytes
Causes of osteogenesis imperfecta- brittle bone disease
Mutations in genes encoding collagen type 1
Features of cancellous and cortical bone
Cancellous- porous, collagen framework ossified. High vascularity. More flexible. Provides strength without disadvantage of weight
Cortical- osteons with vascular tunnels. More strong and dense but also brittle as inflexible
Mechanism for anti- inflammatory properties of glucocorticoids
GCs bind to GC receptors. activated complex upregulates the expression of anti- inflammatory proteins in the nucleus
What is a feature of compartment syndrome?
Pain aggravated by passive stretching due to increased compartment pressure
What is the main type of cholesterol in the lipid bilayer?
low density lipoprotein
What allows for the co-transport of sodium and glucose?
Sodium transported down concentration gradient while glucose transported up. Na transport powers glucose. ATP causes conformational shape change. Antiport mechanism
What feature of an ECG suggests a myocardial infarct?
ST elevation
What drug improves stroke outcome without increasing the risk of intracerebral haemorrhage?
Aspirin
What increases OxyHb dissociation?
High CO2
What is ALS associated with?
Failure of respiratory muscles
The resting membrane potential is maintained by
Open leak potassium channels
Muscle responsible for elevation and retraction of the mandible
Temporalis
Neurotransmitter between pre and post synaptic neurones
ACh
Features of the types of nociceptors
A-α- proprioception, Myelinated. Thick diameter, high speed
A-β- touch. Myelinated. Less thick, lesser speed
A-δ- thermal and mechanical pain. Myelinated. Less thick, lesser speed
C fibres- thermal, mechanical and chemical pain. Non-myelinated. Small diameter. Slow.
Describe paracrine hormone effects
Short lived with local effects
What do protein kinases do?
Add a phosphate group to proteins
What do ribosomes do?
Polymerise amino acids
G protein activation is terminated by-
G-α component hydrolyses GTP into GDP
What muscles form the spinae group?
Iliocostalis, longissimus, spinalis
What is a serology sign of a myocardial infarct?
Raised troponin levels
DMARD for OP treatment
Bisphosphonates- may increase mineral bone density
