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Year 3 > General > Flashcards

General Flashcards

1
Q

Define these suffixes
-otomy
-oscopy
-ectomy
-plasty
-pexy
-centesis
-ostomy
-itis
-algia
-gram

A

-otomy: surgically cutting open
-oscopy: viewing with a scope in keyhole surgery
-ectomy: refers to removal
-plasty: changing in shape
-pexy: fixing something in place
-centesis: puncturing with a needle
-ostomy: creating a new opening
-itis: inflammation
-algia: pain
-gram: recording or imaging

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2
Q

Fistula definition

A

abnormal connection between two epithelial surfaces

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3
Q

Hemicolectomy

A

removing a portion of the large bowel (colon)

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4
Q

Hartmann’s procedure

A

(proctosigmoidectomy)
removal of the rectosigmoid colon with closure of the anorectal stump and formation of a colostomy

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5
Q

Anterior resection

A

removal of the rectum

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6
Q

Whipple procedure

A

pancreaticoduodenectomy

removal of the head of the pancreas, duodenum, gallbladder and bile duct

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7
Q

what is a kocher incision

A

from an open cholecystectomy

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8
Q

What is a chevron/ rooftop incision from

A

liver transplant
Whipple procedure
pancreatic surgery or upper GI surgery

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9
Q

Mercedes Benz incision from

A

liver transplant

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10
Q

Midline incision for

A

general laparotomy

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11
Q

Paramedian incision for

A

laparotomy (midline usually instead

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12
Q

Hockey-stick incision

A

renal transplant

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13
Q

Battle incision (paramedic)

A

open appendectomy

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14
Q

Mcburney incision

A

open appendectomy

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15
Q

Lanz incision (transverse)

A

open appendectomy

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16
Q

Rutherford Morrison incision (extended version of gridiron)

A

open appendectomy and colectomy

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17
Q

Laparascopic surgery and port sites

A

several 5-10mm incisions to allow the cameras and instruments to be inserted into the abdomen via port sites. A site just above or below the umbilicus is usually used as a port site.

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18
Q

What is diathermy

A

high frequency electrical current to cut through tissues or to cauterise blood vessels to stop bleeding

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19
Q

Monopolar diathermy

A

can be used in small or large operations

A diathermy probe is used by a surgeon and produces an electrical signal. A grounding plate or grounding pad is placed under the leg or buttock. A circuit is formed in the patient’s body, where the electricity goes in through the diathermy instrument and out through the grounding plate. At the site where the electrical energy is applied, it causes localised burning and tissue damage. As the electrical signal spreads through the body to the grounding plate, it becomes less intense and does not cause damage to other tissues.

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20
Q

Bipolar diathermy

A

involves an instrument with two electrodes
current passes between electrodes affecting tissues in this area
often used in microsurgery (like operations of the hand)

helpful to prevent the electrical signals from passing through the rest of the body, for example in patients with a pacemaker.

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21
Q

Absorbable sutures

A

slowly absorbed and disappear over time
Examples: Vicryl and Monocryl

used for tissues that will heal well and remain sealed after suture had been absorbed
such as abdominal cavity and closing tissues beneath the epidermis

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22
Q

Non absorbable sutures

A

remain in place for a long time and provide support to the tissues
example: silk, nylon and polypropylene

How they might be used:
closing skin by interrupted, or mattress suture technique, removed later once skin has healed

fixing drains in place, removed later with the drain
connective tissues that heal slowly such as repairing tendons

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23
Q

5 ways to close the skin

A

staples (rapid way to close skin and need removing later)

interrupted sutures (series of individual knots)

Mattress sutures (series of individual sutures that each go from one side of the wound, under and out the other side, then back under again to the other side)

Continuous sutures (single suture that goes in and out the wound along a spiral shape)

subcuticular sutures (single absorbable suture side to side just below skin to pull skin together)

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24
Q

Chest drains

A

method of removing air and fluid from the pleural space. The external end of the drain is placed underwater, creating a seal to prevent air from flowing back through the drain into the chest. Air can exit the chest cavity and bubble through the water, but the water prevents air from re-entering the drain and chest. During normal respiration the water in the drain will rise and fall due to changes in pressure in the chest (described as “swinging”).

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25
Q

Define guarding

A

involuntary tensing of the abdominal muscles when palpated

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26
Q

Define rebound tenderness

A

rapidly releasing pressure on abdomen creates worse pain than the pressure itself

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27
Q

what is generalised peritonitis caused by

A

by perforation of an abdominal organ releasing the contents into the peritoneal cavity and causing generalised inflammation of the peritoneum

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28
Q

What does serum lactate identify

A

indication of tissue ischaemia
product of anaerobic respiration and can also be raised in dehydration or hypoxia

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29
Q

Glasgow score

A

The criteria for the Glasgow score can be remembered using the PANCREAS mnemonic
P – Pa02 < 8 KPa
A – Age > 55
N – Neutrophils (WBC > 15)
C – Calcium < 2
R – uRea >16
E – Enzymes (LDH > 600 or AST/ALT >200)
A – Albumin < 32
S – Sugar (Glucose >10)

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30
Q

classification of haemorrhoids

A

1st degree: no prolapse
2nd degree: prolapse when straining and return on relaxing
3rd degree: prolapse when straining, do not return on relaxing, but can be pushed back
4th degree: prolapsed permanently

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31
Q

charcots triad

A

for acute cholangitis
Right upper quadrant pain
Fever
Jaundice (raised bilirubin)

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32
Q

what increases iron absorption

A

gastric acid and vitamin c

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33
Q

Transport of iron

A

carried in plasma as Fe3+ bound to transferrin

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34
Q

How is iron stored

A

as ferritin in tissures

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35
Q

How is iron excreted

A

lost via intestinal tract following desquamation

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36
Q

What is iron absorption decreased by

A

PPi
tetracycline
gastric achlorhydria
tannin (found in tea)

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37
Q

Where is iron absorbed

A

upper small intestine especially the duodenum

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38
Q

What organism causes toxic shock syndrome

A

staphylococcal aureus

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39
Q

Adrenaline dose for anaphylaxis in an adult

A

500 micrograms (o.5ml 1 in 1,000) IM

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40
Q

Scarlet fever

A

reaction to erythrogenic toxins produced by Group A haemolytic streptococci (usually streptococcus pyogenes)
peak incidence of 4yrs old
spread via respiratory route by inhaling or ingesting droplets etc.

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41
Q

What does scarlet fever present with

A

fever: lasts 24-48hrs
malaise, headache, nausea/vomiting
sore throat
strawberry tongue
rash: fine punctate erythema (pinhead) which generally appears first on the torso and spares the palms and soles, often described as having a rough sandpaper texture, dequamation occurs later in course of illness usually in fingers/toes

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42
Q

Diagnosis for scarlet fever

A

throat swab is normally taken

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43
Q

Management for scarlet fever

A

oral penicillin V for 10 days
penicillin allergy = azithromycin
it is a notifiable disease

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44
Q

Complications of scarlet fever

A

Otitis media -> most common
rheumatic fever: occurs 20 days post infection
acute glomerulonephritis : 10 days after infection

45
Q

Vitamin C deficiency

A

known as scurvy -> leads to defective synthesis of collagen resulting in capillary fragility and poor wound healing

features:
gingivitis
poor wound healing
bleeding from gums, haematuria, epistaxis
general malasie

46
Q

Vitamin K deficiency

A

increases risk of bleeding
features:
easy bruising
heavy menstrual periods
excessive bleeding from wounds

47
Q

How does PCR work

A

used to amplify desired fragments of DNS
it denatures the double helix through heating
primer hybridization and finally polymerase enzymes elongate the chain to enable analysis

48
Q

ABL oncogene category and associated cancer

A

cytoplasmic tyrosine kinase
chronic myeloid leukaemia

49
Q

c-MYC oncogene category and associated cancer

A

trnasciption factor
Burkitt’s lymphoma

50
Q

n-MYC oncogene category and associated cancer

A

transcription factor
neuroblastoma

51
Q

BCL-2 oncogene category and associated cancer

A

apoptosis regulator protein
follicular lymphoma

52
Q

RET oncogene category and associated cancer

A

tyrosine kinase receptor
multiple endocrine neoplasia (types II and III)

53
Q

RAS oncogene category and associated cancer

A

G-protein
many cancers including pancreatic

54
Q

erb-B2 (HER2/neu) oncogene category and associated cancer

A

tyrosine kinase receptor
breast and ovarian cancer

55
Q

Vitamin K clotting factors

A

II, VII, IX, X
prothrombin

56
Q

Helper T cells

A

involved in cell-mediated immune response
recognises antigens presented by MHC class II molecules

57
Q

what does Helper t cells express

A

CD4
CD3, TCR and CD28

58
Q

What are helper t cells a major source of

A

IL-2

59
Q

Cytotoxic t cells

A

involved in the cell mediated immune response
recognises antigens presented by MHC class I molecules
induce apoptosis in virally infected and tumour cells

60
Q

What do cytotoxic t cells express

A

CD8
CD3 and TCR

61
Q

B cells

A

major cell of humoral immune response
acts as an APC
mediates hyperacute organ rejection

62
Q

Plasma cells

A

differentiated from b cells
produces large amounts of antibody specific to a particular antigen

63
Q

What does IgG do

A

enhance phagocytosis of bacteria nad viruses
fixes complement and passes to fetal circulation
most abundant isotype in blood serum

64
Q

What does IgA do

A

predominant immunoglobulin found in breast milk - also found in secretions of digestive, respiratory and urogenital tracts
provides localised protection on mucous membranes
most commonly produced immunoglobulin in body
transported across interior of cell via transcytosis

65
Q

What does IgM do

A

first immunoglobulin to be secreted in response to an infection
fixes complement but does not pass to fetal circulation
anti-A, B blood antiboduies
pentamer when secreted

66
Q

IgD

A

role in immune system unkown
involved in activation of B cells

67
Q

IgE

A

mediates type 1 hypersensitivity reactions
synthesised by plasma cells
binds to fc receptors found on the surface of mast cells and basophils
provides immunity to parasites such as helminths
least abundant isotype in blood seurm

68
Q

Hawthorn effect

A

describes a group changing its behaviour due to the knowledge that it is being studied

69
Q

Ketamine

A

NMDA receptor antagonist
may be used for induction of anaesthesia
has moderate to strong analgesic properties
produces little myocardial depression making it suitable agent for anaestheisa in those who are haemodynamically unstable
can produce nightmares

70
Q

What part of the brain is required for converting short term memory into long term memory?

A

Hippocampus

71
Q

mechanism of action of doxycycline

A

Tetracyclines - inhibits protein synthesis by acting on the 30S subunit of ribosomes

72
Q

what is anaphylaxis

A

immediate type 1 hypersensitivity reaction characterised by widespread IgE-mediated histamine release from mast cells and basophils.

73
Q

mechanism and example of type 1 hypersensitivity

A

Antigen reacts with IgE bound to mast cells

anaphylaxis
atopy

74
Q

Mechanism and example of type 2 hypersensitivity

A

IgG or IgM binds to antigen on cell surface
* Autoimmune haemolytic anaemia
* ITP
* Goodpasture’s syndrome
* Pernicious anaemia
* Acute haemolytic transfusion reactions
* Rheumatic fever
* Pemphigus vulgaris / bullous pemphigoid

75
Q

Mechanism and example of type 3 hypersensitivity

A

immune complex
Free antigen and antibody (IgG, IgA) combine
Serum sickness
* Systemic lupus erythematosus
* Post-streptococcal glomerulonephritis
* Extrinsic allergic alveolitis (especially acute phase)

76
Q

Mechanism and example of type 4 hypersensitivity

A

T cell mediated
* Tuberculosis / tuberculin skin reaction
* Graft versus host disease
* Allergic contact dermatitis
* Scabies
* Extrinsic allergic alveolitis (especially chronic phase)
* Multiple sclerosis
* Guillain-Barre syndrome

77
Q

Mechanism and example of type 5 hypersensitivity

A

Antibodies that recognise and bind to the cell surface receptors.

This either stimulating them or blocking ligand binding

graves disease
myasthenia gravis

78
Q

Mechanism of action of macrolides

A

Macrolides - inhibits protein synthesis by acting on the 50S subunit of ribosomes

79
Q

What is amiloride and what does it do

A

blocks the epithelial sodium channel in the distal convoluted tubule

weak diuretic, usually given with thiazides or loop diuretics as an alternative to potassium supplementation (remember that thiazides and loop diuretics often cause hypokalaemia)

80
Q

Indications for aldosterone antagonists e.g. spironolactone

A

ascites: patients with cirrhosis develop a secondary hyperaldosteronism. Relatively large doses such as 100 or 200mg are often used
heart failure
nephrotic syndrome
Conn’s syndrome

81
Q

where are T cells developed

A

thymus

82
Q

consequences of vitamin B12 deficiency

A

macrocytic megaloblastic anaemia
peripheral neuropathy

83
Q

Where does dormant tuberculosis most frequently reactivate?

A

apex of lung

84
Q

what is co-trimoxazole a combination of

A

sulfamethoxazole + trimethoprim

85
Q

where is dopamine made

A

substantia nigra pars compacta

86
Q

genetic inheritance of mitochondrial disease

A

none of the children of an affected male will inherit
all children of affected female will inherit

87
Q

Histology of mitochondrial disease

A

muscle biopsy classically shows ‘red, ragged fibres’ due to increased number of mitochondria

88
Q

first immunoglobulin secreted in response to an infection

A

IgM

89
Q

weird side effect of rifampicin

A

Rifampicin is know for causing a red-orange discoloration of bodily fluids including urine, tears, and sweat.

90
Q

adrenaline Actions on α adrenergic receptors:

A

inhibits insulin secretion by the pancreas
stimulates glycogenolysis in the liver and muscle
stimulates glycolysis in muscle

91
Q

adrenaline Actions onβ adrenergic receptors:

A

stimulates glucagon secretion in the pancreas
stimulates ACTH
stimulates lipolysis by adipose tissue

92
Q

where does levothyroxine bind

A

acts via nuclear receptors

93
Q

allopurinol mechanism of action

A

Allopurinol inhibits xanthine oxidase

94
Q

What does lidocaine act on

A

ion channels

95
Q

Falciparum malaria

A

the commonest, and most severe, type of malaria.

96
Q

Features of falciparum malaria

A

schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia

97
Q

Complications of falciparum malaria

A

cerebral malaria: seizures, coma
acute renal failure: blackwater fever, secondary to intravascular haemolysis, mechanism unknown
acute respiratory distress syndrome (ARDS)
hypoglycaemia
disseminated intravascular coagulation (DIC)

98
Q

first line management for cellulitis

A

Flucloxacillin

99
Q

What is penetrance

A

describes the proportion of a population of individuals who carry a disease-causing allele who express the related disease phenotype

100
Q

Allograft

A

transplant of tissue from genetically non identical donor from the same species

101
Q

Isograft

A

graft of tissue between two individuals who are genetically identical

102
Q

Autograft

A

Transplantation or organs or tissues from one part of the body to another in the same individual

103
Q

Xenograft

A

tissue transplanted from another species

104
Q

What should be considered in patients with portal hypertension and lower Gi bleeding

A

rectal varices

105
Q

Neurogenic shock

A

Occurs most often following a spinal cord transection usually at a high level
Result is either decreased sympathetic tone or increased parasympathetic tone

Results in decreased preload and thus decreased caridac output
decreased peripheral tissue perfusion
in contrast with other types of shock peripheral vasoconstrictors are used to return vascular tone to normal

106
Q

Dumping syndrome

A

occurs post gastrectomy
occurs as a result of a hyperosmolar load rapidly entering proximal jejunum
osmosis drags water into the lumen
this results in lumen distention and then diarrhoea
excessive insulin release also occurs and results in hypoglycaemic symptoms

107
Q

Boas’ sign

A

in acute cholecystitis there is hyperaestheisa beneath the right scapula

108
Q

Boehaaves syndrome

A

spotaneous rupture of oesophagus
caused by repeated episodes of vomiting often in association with alcohol
Typically episode of reptitive vomiting followed by severe chest and epigastric pain

Year 3 (14 decks)

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