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Flashcards in Year 2 Mix Deck (90)
1

how is congenital adrenal hyperplasia inherited and what causes it?

autosomal recessive
deficiency of one of the enzymes in the cortisol synthesis pathway

2

what is hypogonadotrophic hypogonadism?

AKA Kallmann's syndrome
isolated deficiency of LHRH or LH/FSH

3

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

4

endocrine test results of PCOS?

raised serum LH and prolactin
normal FSH
low SHBG

5

what is the most common cause of septic arthritis?

staph aureus

6

when might E coli cause a septic arthritis?

IV drug users
very old or very young
immunocompromised

7

when might salmonella cause a septic arthritis?

sickle cell anaemia

8

describe general presentation of Conn's syndrome

hypertension and hypokalaemia with no specific symptoms

9

what is Conn's syndrome?

primary hyperaldosteronim

10

what is Pott's disease?

crush fracture of the thoracic spine as a result of tuberculosis osteomyelitis

11

what are charcots joints and what typically causes this?

severely deformed joints which result from neuropathic injury
causes = diabetic neuropathy and syringomyelia

12

which 2 hormones regulate calcium levels?

PTH
calcitonin

13

how does ACTH affect glucose levels?

ACTH stimulates cortisol release which stimulates gluconeogenesis

14

useful examination for suspected PCOS?

pelvic ultrasound

15

first line investigation for all cases of amenorrhoea?

pregnancy test (HCG test)

16

what hormones levels are associated with PCOS?

high testosterone
low sex hormone binding globulin
raised LH:FSH ratio

17

name a recognised treatment for head lice

dimeticone gel

18

what is permethrin used to treat?

scabies

19

what type of shampoo can be used for fungal infections of the scalp?

ketoconazole shampoo

20

a colles fracture occurs within what distance of the wrist?

2.5 cm

21

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

22

characteristic appearance of a colles fracture?

dinner fork

23

what is a Smith's fracture?

reverse colles fracture (ventral displacement of distal fragment)

24

what is a barton's fracture?

intra-articular colles fracture

25

what is ventral barton's fracture?

intra articular smiths fracture

26

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

27

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

28

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

29

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

30

mechanism of action of "glitazones"?

PPAR-gamma agonist

31

what is hammer toe?

flexed PIPs
extended DIPs

32

a lesion in which area of the visual pathway would cause macular sparing?

visual cortex

33

right homonymous hemianopia with macular sparing?

left visual cortex

34

right superior quadrantanopia?

left temporal lobe optic radiation

35

left homonymous hemianopia?

right optic tract

36

left inferior quadrantanopia?

right parietal lobe optic radiation

37

what causes a retinoblastoma?

mutation (loss of heterozygosity) of Rb gene
- Rb = tumour suppressor gene

38

what pre-existing diseases is scleritis associated with?

systemic diseases
- RA
- sarcoidosis
- vasculitis

39

how do scleritis and episcleritis differ in terms of presentation?

scleritis = more severe, boring and deep pain, also have pain on eye movement

40

what test can differentiate between scleritis and episcleritis?

phenylepinephrine
will cause blanching of vessels in episcleritis

41

how does scleritis present?

pain - severe, constant, boring, can wake up at night
redness
tearing
photophobia
injected vessels
history of systemic disease

42

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

43

what is the first step in suspected orbital cellulitis?

CT of orbit, sinuses and brain
- may show infiltrate, orbital abscess, sinus opacity or proptosis

44

management of orbital cellulitis?

involve ENT
may need drainage of abscess
IV antibiotics

45

how does uveitis present?

painful red eye
photophobia
some blurred vision
no discharge
often have history of systemic disease (e.g inflammatory bowel disease)

46

management of cataract?

removal of lens via phacoemulsification

47

presence of inflammatory cells in the aqueous is a hallmark of what?

anterior uveitis

48

mainstay of therapy for anterior uveitis?

cyclopentolate (for pain)
corticosteroids (for inflammation)

49

what is the first and second line for bacterial conjunctivitis?

1st line = chloramphenicol
2nd line = fusidic acid

50

when should chloramphenicol be avoided an d why?

pregnancy
- risk of grey baby syndrome

51

what is lambert eaton myasthenic syndrome?

disorder of pre-synaptic calcium channels causing impaired release of acetylcholine
associated with malignancy such as lung cancer

52

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

53

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)

54

how does strabismus present?

double vision
squint
affected eye moves inwards/outward when the unaffected eye is covered

55

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

56

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

57

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)

58

function of the inferior oblique muscle?

extorsion
abduction
elevation

59

what is a chalazion and how is it managed?

Meibomian cyst
usually self limiting
- apply warm compress and massage daily

60

what are the 2 most common causes of 3rd nerve palsy?

diabetes
hypertension

61

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

62

what are the 3 types of nerve injury?

neuropraxia
neurotmesis
axonotmesis

63

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

64

what is neurotmesis?

Disruption of the axon, myelin sheath and surrounding connective tissue.
Wallerian degeneration occurs
permanent?

65

what is axonotmesis?

Axon is damaged and the myelin sheath is preserved. The connective tissue framework is not affected.
Wallerian degeneration occurs

66

how is impetigo managed?

fusidic acid = 1st line
retapamulin = 2nd line
if severe:
- oral flucloxacillin = 1st line
- oral erythromycin = 2nd line

67

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)

68

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

69

what nerve supplies the posterior belly of the digastric muscle?

facial nerve

70

what nerve supplies the anterior belly of the digastric muscle?

mylohyoid nerve

71

where does each rotator cuff muscle insert on the humerous?

supraspinatous, infraspinatous and teres minor = greater tubercle
subscapularis = lesser tubercle

72

where does the deltoid muscle insert on the humerous?

deltoid tuberosity

73

which tendon passes through the intertubercular groove on the humerus?

long head of biceps tendon

74

what is Jobe's test and what muscle does it test?

empty can test
tests supraspinatous

75

what artery supplies the femoral head and neck?

medial femoral circumflex artery

76

what artery supplies the ACL?

medial geniculate artery

77

which skin cancer is more likely in immunocompromised individuals?

SCC

78

how does SCC spread?

lymphatics

79

what are the 2 main drivers of growth in infants?

nutrition
insulin

80

what drives growth in childhood?

growth hormone and thyroid

81

what drives growth in puberty?

growth hormone and sex steroid

82

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

83

what is the Kocher criteria?

criteria for diagnosis of septic arthritis
- fever >38.5
- non weight bearing
- raised ESR
- raised WCC

84

what structure articulates with the head of the radius superiorly?

capitulum

85

how do NSAIDs cause peptic ulcers?

inhibit prostaglandin synthesis (via inhibition of COX enzyme)

86

what nerve supplies the lateral dorsal aspect of the foot

sural nerve

87

what nerve supplies the dorsum of the foot?

superficial peroneal (fibular)

88

what nerve supplies the 1st web space?

deep peroneal (fibular)

89

what nerves supply the extremities of the toes?

medial and lateral plantar nerves

90

what nerves supply the plantar aspect of the foot?

proximal plantar surface = tibial nerve
medial = medial plantar
lateral = lateral plantar