Year 2 Mix Flashcards
how is congenital adrenal hyperplasia inherited and what causes it?
autosomal recessive
deficiency of one of the enzymes in the cortisol synthesis pathway
what is hypogonadotrophic hypogonadism?
AKA Kallmann’s syndrome
isolated deficiency of LHRH or LH/FSH
how is Kallmann’s syndrome inherited and how does it present?
X linked inheritance difficulty with intercourse/failure to get an erection anosmia cleft palate renal abnormalities colour blindness
endocrine test results of PCOS?
raised serum LH and prolactin
normal FSH
low SHBG
what is the most common cause of septic arthritis?
staph aureus
when might E coli cause a septic arthritis?
IV drug users
very old or very young
immunocompromised
when might salmonella cause a septic arthritis?
sickle cell anaemia
describe general presentation of Conn’s syndrome
hypertension and hypokalaemia with no specific symptoms
what is Conn’s syndrome?
primary hyperaldosteronim
what is Pott’s disease?
crush fracture of the thoracic spine as a result of tuberculosis osteomyelitis
what are charcots joints and what typically causes this?
severely deformed joints which result from neuropathic injury
causes = diabetic neuropathy and syringomyelia
which 2 hormones regulate calcium levels?
PTH
calcitonin
how does ACTH affect glucose levels?
ACTH stimulates cortisol release which stimulates gluconeogenesis
useful examination for suspected PCOS?
pelvic ultrasound
first line investigation for all cases of amenorrhoea?
pregnancy test (HCG test)
what hormones levels are associated with PCOS?
high testosterone
low sex hormone binding globulin
raised LH:FSH ratio
name a recognised treatment for head lice
dimeticone gel
what is permethrin used to treat?
scabies
what type of shampoo can be used for fungal infections of the scalp?
ketoconazole shampoo
a colles fracture occurs within what distance of the wrist?
2.5 cm
what are the 4 characteristic components of a colles fracture?
dorsal displacement of the distal fragment
radial displacement of the hand
radial shortening due to impaction
avulsion of the ulnar styloid
characteristic appearance of a colles fracture?
dinner fork
what is a Smith’s fracture?
reverse colles fracture (ventral displacement of distal fragment)
what is a barton’s fracture?
intra-articular colles fracture
what is ventral barton’s fracture?
intra articular smiths fracture
unimpacted fractures of the femur are associated with limb shortening, true or false?
true
the proximal segment of the fractured femur is flexed by the iliopsoas and abducted by gluteus medius and minimus
the distal segment is pulled medially by the adductor muscles
this produces shortening of the limb
what is a pertrochanteric fracture and how does this produce AVN?
linear fracture through the greater and lesser trochanters
does not produce AVN as the fracture lies outwith the line of attachment of the hip capsule
what is a subcapital fracture?
type of intracapsular fracture of the femoral neck, just distal to the femoral head
associated with AVN as it is an intracapsular fracture
mechanism of action of “gliptins”?
DPP4 inhibitors
inhibits DPP4 which is an enzyme responsible for the breakdown of glucagon like peptide (GLP-1) (therefore an increased GLP-1)
this leads to a lack of glucagon and therefore a reduced blood glucose
mechanism of action of “glitazones”?
PPAR-gamma agonist
what is hammer toe?
flexed PIPs
extended DIPs
a lesion in which area of the visual pathway would cause macular sparing?
visual cortex
right homonymous hemianopia with macular sparing?
left visual cortex
right superior quadrantanopia?
left temporal lobe optic radiation
left homonymous hemianopia?
right optic tract
left inferior quadrantanopia?
right parietal lobe optic radiation
what causes a retinoblastoma?
mutation (loss of heterozygosity) of Rb gene
- Rb = tumour suppressor gene
what pre-existing diseases is scleritis associated with?
systemic diseases
- RA
- sarcoidosis
- vasculitis
how do scleritis and episcleritis differ in terms of presentation?
scleritis = more severe, boring and deep pain, also have pain on eye movement
what test can differentiate between scleritis and episcleritis?
phenylepinephrine
will cause blanching of vessels in episcleritis
how does scleritis present?
pain - severe, constant, boring, can wake up at night redness tearing photophobia injected vessels history of systemic disease
presentation of orbital cellulitis?
painful swollen eye reduced vision pain on eye movement (movements can be restricted) swollen periorbital area red and proptosed eye chemosis RAPD in affected eye
what is the first step in suspected orbital cellulitis?
CT of orbit, sinuses and brain
- may show infiltrate, orbital abscess, sinus opacity or proptosis
management of orbital cellulitis?
involve ENT
may need drainage of abscess
IV antibiotics
how does uveitis present?
painful red eye photophobia some blurred vision no discharge often have history of systemic disease (e.g inflammatory bowel disease)
management of cataract?
removal of lens via phacoemulsification
presence of inflammatory cells in the aqueous is a hallmark of what?
anterior uveitis
mainstay of therapy for anterior uveitis?
cyclopentolate (for pain)
corticosteroids (for inflammation)
what is the first and second line for bacterial conjunctivitis?
1st line = chloramphenicol
2nd line = fusidic acid
when should chloramphenicol be avoided an d why?
pregnancy
- risk of grey baby syndrome
what is lambert eaton myasthenic syndrome?
disorder of pre-synaptic calcium channels causing impaired release of acetylcholine
associated with malignancy such as lung cancer
how does lamber-eaton myasthenic syndrome present?
gradual onset weakness in arms, legs, neck and face
- improves after exercise
ptosis in eyelids
co-existent cancer
what is strabismus and what are the 2 types?
“squint”
occurs where one eye is looking directly at the object in view while the other is misaligned
esotropia = convergent strabismus (affected eye sits looking inwards)
exotropia = divergent strabismus (affected eye sits looking outwards)
how does strabismus present?
double vision
squint
affected eye moves inwards/outward when the unaffected eye is covered
opacification can occur in the anterior or posterior capsule after cataract surgery?
posterior
most of anterior capsule removed during surgery
presents with blurring of vision
how does hypertensive retinopathy present?
cotton wool spots scattered around the retina
raised optic disc
can have reduction in visual acuity and colour vision due to optic neuropathy secondary to the hypertension
describe dual innervation of levator palpebrae superioris
oculomotor nerve
- palsy causes droopy eyelid and dilated pupil
sympathetic fibres
- innervates part pf LPS called Muller’s muscle
- palsy causes droopy eyelid and constricted pupil (Horner’s syndrome)
function of the inferior oblique muscle?
extorsion
abduction
elevation
what is a chalazion and how is it managed?
Meibomian cyst
usually self limiting
- apply warm compress and massage daily
what are the 2 most common causes of 3rd nerve palsy?
diabetes
hypertension
how does a 3rd nerve palsy present?
diplopia
ptosis
eye is abducted and slightly depressed
- as lateral rectus and superior oblique are not supplied by CN III so are function is unaffected
what are the 3 types of nerve injury?
neuropraxia
neurotmesis
axonotmesis
what is neuropraxia?
temporary loss of nerve function Nerve intact but electrical conduction is affected Full recovery Autonomic function preserved Wallerian degeneration does not occur
what is neurotmesis?
Disruption of the axon, myelin sheath and surrounding connective tissue.
Wallerian degeneration occurs
permanent?
what is axonotmesis?
Axon is damaged and the myelin sheath is preserved. The connective tissue framework is not affected.
Wallerian degeneration occurs
how is impetigo managed?
fusidic acid = 1st line retapamulin = 2nd line if severe: - oral flucloxacillin = 1st line - oral erythromycin = 2nd line
what 3 arteries supply the thyroid?
superior thyroid artery (1st branch of external carotid) inferior thyroid artery (branch of thyrocervical) thyroid ima (from brachiocephalic, only present in 10% of people)
if trendelenburg sign is positive and a patient’s hip drops to the right while walking, which muscles are weak?
left gluteus medius and minimus
what nerve supplies the posterior belly of the digastric muscle?
facial nerve
what nerve supplies the anterior belly of the digastric muscle?
mylohyoid nerve
where does each rotator cuff muscle insert on the humerous?
supraspinatous, infraspinatous and teres minor = greater tubercle
subscapularis = lesser tubercle
where does the deltoid muscle insert on the humerous?
deltoid tuberosity
which tendon passes through the intertubercular groove on the humerus?
long head of biceps tendon
what is Jobe’s test and what muscle does it test?
empty can test
tests supraspinatous
what artery supplies the femoral head and neck?
medial femoral circumflex artery
what artery supplies the ACL?
medial geniculate artery
which skin cancer is more likely in immunocompromised individuals?
SCC
how does SCC spread?
lymphatics
what are the 2 main drivers of growth in infants?
nutrition
insulin
what drives growth in childhood?
growth hormone and thyroid
what drives growth in puberty?
growth hormone and sex steroid
what are the contents of the cubital fossa from lateral to medial?
radial nerve biceps tendon brachial artery median nerve Really Need Beer To Be At My Nicest
what is the Kocher criteria?
criteria for diagnosis of septic arthritis
- fever >38.5
- non weight bearing
- raised ESR
- raised WCC
what structure articulates with the head of the radius superiorly?
capitulum
how do NSAIDs cause peptic ulcers?
inhibit prostaglandin synthesis (via inhibition of COX enzyme)
what nerve supplies the lateral dorsal aspect of the foot
sural nerve
what nerve supplies the dorsum of the foot?
superficial peroneal (fibular)
what nerve supplies the 1st web space?
deep peroneal (fibular)
what nerves supply the extremities of the toes?
medial and lateral plantar nerves
what nerves supply the plantar aspect of the foot?
proximal plantar surface = tibial nerve
medial = medial plantar
lateral = lateral plantar
