Other Flashcards
(100 cards)
1
Q
What is observer bias?
A
Information is collected differently from cases vs. Controls because the examiners know which is which
2
Q
What is attrition bias?
A
Due to loss of participants during a study
3
Q
What is selection bias?
A
Certain groups can be over or under represented in research
Can fix by randomising who is chosen
4
Q
What is observation bias?
A
Participants are aware they are being studied so they may alter how they act or what they say
5
Q
What is confirmation bias?
A
During interpretation of results, researchers may look for patterns to confirm beliefs they already have
6
Q
What is sensitivity?
A
How well a test can detect a disease
= true positives / total diseased
7
Q
What is specificity?
A
How well a test detects NOT having the disease
= no. Of true negatives / total non-diseased
8
Q
What is a positive predictive value?
A
Percentage of truly diseased people out of those who tested positive
Affected by prevalence
9
Q
What is a negative predicted value?
A
Percentage of truly non-diseased people who tested negative
Affected by prevalence
10
Q
Cost effectiveness ratio
A
Costs / benefits
11
Q
Incremental cost-effectiveness ratio (ICER)
A
Difference in cost between two things / difference in effect
12
Q
Cost utility analysis
A
Like cost effectiveness but measured in QALYs
ICER - extra cost per QALY gained
13
Q
What is a cohort study?
A
Like case-control but over time
14
Q
What does double-blind study mean?
A
Neither participants nor the examiners know who is getting what treatment
15
Q
Which ecg leads help determine the axis of the heart?
A
I and aVF
16
Q
What on an ecg shows a normal axis?
A
I and aVF are both positive
17
Q
What on an ecg shows left axis deviation?
A
I positive
aVF is negative
18
Q
What on an ecg shows right axis deviation?
A
I negative
aVF positive
19
Q
What on an ecg shows extreme right axis deviation?
A
I and aVF both negative
20
Q
6 stages to analysing an ECG
A
- Verify name and DOB
- Check date and time it was taken
- Calibration of paper (25mm/sec, 10mm is 1mV aka. 10 small boxes
- Determine the axis (I and aVF)
- Rate and rhythm
p waves present? Regular? HR? PR interval? QRS duration - Any other changes? e.g. ST elevation
21
Q
Which ecg leads are septal and which artery?
A
V1 and V2
LAD
22
Q
Which ecg leads are anterior? Which artery do these correspond to?
A
V3 and V4
Distal LAD
23
Q
Which ecg leads are lateral and what artery?
A
I, aVL, V5 and V6
Circumflex artery
24
Q
Which ecg leads are inferior and which artery?
A
II, III and aVF
Right coronary artery
25
What areas does the right coronary artery supply?
Right atrium and ventricle
| SA and AV nodes
26
What areas does the left anterior descending artery supply?
Right and left ventricles and the ventricular septum
27
What areas does the left circumflex artery supply?
Left atrium and ventricle
28
What areas do the right and left marginal arteries supply?
Right supplies the right ventricle and apex
| Left supplies the left ventricle
29
Describe aortic stenosis
Ejection systolic murmur (crescendo-decrescendo)
Heard loudest over aortic valve but commonly radiates to carotid arteries
May help if patient is sitting forwards
30
Describe mitral regurgitation
Pansystolic murmur
| Loudest over the mitral area and radiates to axilla
31
Describe aortic regurgitation
Early diastolic murmur
Loudest at left sternal edge
May have a collapsing pulse
Heard louder with them leaning forward and holding an out breath
32
Describe mitral stenosis
Mid-diastolic murmur that’s low pitched and rumbling
Heard loudest over the apex
Associated with A. Fib
33
PR interval
3-5 small boxes
0.12-0.2 sec
AV nodal delay
34
How to determine HR from ECG
If regular, 300/no.of large squares between beats
| If irregular, number of QRS in 30 large squares and times by 10
35
What does ST depression on an ECG indicate?
Ischaemia
36
Treatment for C.Diff
Vancomycin
| Metronidazole
37
What are the 4 C causes of C.Diff
Co-amoxiclav
Clindamycin
Cephalosporins
Ciprofloxacins
38
Treatment for H.Pylori
PPI twice a day plus penicillin plus metronidazole/clarithromycin
If penicillin allergic, PPI plus metronidazole plus clarithromycin
39
Which arteries make up Little’s area?
Anterior and posterior ethmoidal
Splenopalantine
Greater palantine
Superior labial
40
What is the Chorda Tympani
Branch of facial nerve that runs through middle ear and is needed for taste signals to get back to brain
41
Tensor Tympani
Muscle in middle ear connecting malleus to tube wall
Innervated by CNV3
Dampens noise from chewing and shouting etc.
42
Stapedius
Smallest muscle in the body connecting the temporal bone to the neck of stapes
Innervated by CN VII
Protects the ear from loud sounds
43
What level is the hyoid?
C3
44
What level is the laryngeal prominence of the thyroid cartilage at?
C4
45
At what level does the cricoid cartilage end?
C6
46
At what level is the thyroid?
C5 to T1
47
Symptoms of hypercalcaemia
Bones, stones, groans and moans
Polyuria and polydipsia
Decreased QT interval on ECG
Constipation and vomiting
If urea is also high it could just be dehydration
48
Causes, Signs and treatment of hypokalaemia
Causes: diarrhoea, duiretics, insulin
Signs: Weakness, cramping, twitches
ECG: T wave depression, ST sagging, Prolonged P wave interval
Treat with K supplements
49
Causes, signs and treatment of hyperkalaemia
Causes: ACE inhibitors, B-blockers, NSAIDS, addisons, rhabdomyolysis, burns
Signs: Tall tented T waves, small P waves, wide QRS, V. Fibb
Treatment is URGENT is any ECG changes: Calcium gluconate (stabilises heart), Insulin and glucose (drives K+ into cells), salbutamol
50
Type of kidney stones if rhomboid shaped crystals
Uric Acid
| Cant be seen on CT or x-ray
51
Type of kidney stones if envelope-shaped crystals
Calcium oxalate
| Most common
52
Type of kidney stone with hexagonal shaped crystals
Cysteine
53
Type of kidney stone with wedge-shaped prism crystals
Calcium phosphate
| 2nd most common after oxalate
54
Describe thyroid hormone synthesis
Iodide taken up by follicle cells and oxidised to iodine
Iodine attaches to tyrosine residues on thyroglobulin to form MIT and DIT (mono- and di- iodotyrosine unit)
MIT+DIT = T3
DIT+DIT = T4
Hormones are stored in colloid until required
55
ENT sinuses and innervation
Frontal, Ethmoidal and Sphenoidal all CNV1
| Maxillary CNV2
56
What is consequentialism
And action can either be right or wrong, it depends on the consequences
57
What is Utilitarianism
Acting to maximise the greatest happiness to the most people
| E.g. triage
58
What is communitarianiam
Acting for everyone not just individuals
| E.g. notifiable diseases and vaccination programmes
59
What does SMART goals stand for?
```
Specific
Measureable
Achievable
Realistic
Time-limited
```
60
What does contraction of the posterior cricoarytenoid do?
Widens the rima glottidis
| E.g. gives more air for forced respiration
61
What does contraction of the arytenoids and lateral cricoarytenoids do?
Closes the rima glottidis
| Adducts for protection
62
What does contraction of the thyroarytenoids do?
Relaxes the vocal ligaments decreasing pitch
63
Contraction of which muscle decreases the pitch of voice?
Thyroarytenoid
64
Contraction of which muscle increases pitch of voice?
Cricothyroid
65
What does contraction of the cricothyroid do?
Tenses the vocal ligament increasing pitch
66
What does contraction of just the lateral cricoarytenoid do?
Whispers
67
What are the three big branches of the aorta?
Brachii cephalic artery which splits into right subclavian and right common carotid
Left common carotid
Left subclavian
68
At what level is the coeliac trunk?
T12
69
At what level is the superior mesenteric artery?
L1
70
At what vertebral level is the inferior mesenteric artery?
L3
71
Bullous pemphigus (vulgaris) and bullous pemphigoid differences
Pemphigus = younger, desmogelin 3, intraepidermal, rupture easily, nikolskys sign positive, mucosal involvement, net-like IgG on immunofluorescence
Pemphigoid = older, hemidesmosomes, subepidermal, tense and firm, nikolskys sign negative, linear IgG on immunofluorescence
72
Difference between UVA and UVB
UVA causes longterm skin damage as it penetrates deeper into collagen, causes wrinkles
UVB doesn’t penetrate as deeply, responsible for sunburn
73
Breslow’s Thickness
Deepest part of the tumour from the granular cell layer in mm
<1mm, 5yr survival of >95%
>4mm, 5 yr survival of 50%
74
Which skin cancers are related to what type of sun exposure
Basal Cell and Malignant Melanoma is due to peak sun exposure, where youve been burned
Squamous Cell is due to cumulative sun exposure
75
Type of excisions for what type of skin cancer
```
MM = primary excision with clear margins
BCC = wide excision with histology to ensure clear margins
SCC = Complete surgical excision with a minimal margin of 5mm
```
76
Treatment for A. Fibb
Rate control: Digoxin, beta blockers, verapamil/diltiazem
| Cardioversion with amiodarone
77
Treatment for sinus bradycardia
Atropine
78
Treatment for acute supraventricular tachycardia
Manouvres
IV Adenosine
IV verapamil
79
Phases of ventricular muscle action potential
Phase 0: big upstroke caused by fast Na+ influx
Phase 1: slight downstroke caused by closure of Na+ channels and transient K+ efflux
Phase 2: Plateau caused by Ca++ influx
Phase 3: Sharp downstroke caused by closure of Ca++ channels and K+efflux
Phase 4: Resting membrane potential
80
Symptoms specific to Crohns Disease and treatment
```
No blood of mucus
Entire GI tract
“Skip lesions”
Terminal ileum most effected
Transmural inflammation
Smoking is a risk factor
```
Also weight loss, strictures and fistulas
Treatment: prednisolone and immunosuppressants e.g. azathioprine
81
Symptoms specific to ulcerative colitis
```
Continuous inflammation
Limited to colon and rectum
Only superficial mucosa is effected
Smoking is protective
Excrete blood and mucus
Use aminosalicylates (mesalazine)
Primary Sclerosing Cholangitis
```
82
Describe Torsades de Pointes.
| How it happens and symptoms
Long QT syndrome (usually inherited) and shows no symptoms but if theres too much sympathetic stimulation like from adrenaline then Torsades de Pointes can happen
Looks like scribble zig zag just up and down on ECG
Torsades de Pointes can cause fainting, seizures and sudden death
A problem with early after depolarisation
83
Brugada Syndrome
Symptoms: sudden death, syncope, chest pain, SOB
Most likely at rest or after a meal, when feverish, or after alcohol
Predisposes to V. Tach or V. Fibb
ECG: ST elevation (though no plateau part) and with T wave inversion
84
Wolff-Parkinson-White Syndrome
```
Accessory Pathway (Bundle of Kent) that doesn’t have as much atrial delay
ECG: Short PR interval, Slanted/wide QRS, T wave inversion
Predisposes to atrial tachyarrhythmias
```
85
Strange Situation: Child is distressed when mother leaves, scared of stranger when alone but will play with mum there, happy when mum returns and uses mum as a safe base to explore.
What type of attachment style is this?
Secure Attachment
86
Strange Situation: Child is sad when mum leaves, avoids stranger always, in a huff when mum returns, cries a lot and doesnt explore.
What type of attachment is this?
Ambivalent attachment
87
Strange situation: Child is fine when mum leaves, plays with stranger, doesnt care when mum comes back, is equally happy with both mum and stranger.
What type of attachment is this?
Avoidant attachment
88
Teenager: self-reliant, doesn’t form relationships, has a negative view of other people.
What type of attachment?
Insecure-avoidant attached - Type A
89
Teenager: anti-social behaviour, unpredictable, complains.
| What type of attachment?
Insecure-ambivalent attached - Type C
90
6 week milestones
Head control
Follows torch
Responsive to voice
Social smile
91
6 month milestones
Rolls over, push up and weight bear on legs
Palmar grasp, puts things in mouth
Babbles and screams
Friendly with strangers, plays with feet
92
12 month milestones
Crawls, may take first steps
Fine grip, bangs toys together
Responds to name, jargon words
Drinks from cup and waves goodbye
93
18 month milestones
Runs and climbs
Tower of 3-4 bricks, picture books
5-20 words, points to body parts
Feeds with spoon, imitates adult behaviour
94
2 year milestones
Stairs 2 feet a step
Tower of 6-7 bricks
50+ words, understands simple instructions
Puts on hat and shoes
95
3 year milestones
Stairs with alternating feet
Copies circle, cuts with scissors
Simple conversation, asks lots of questions
Imaginative play, shares and plays with others
96
4 year milestones
Runs stairs, kick, throw and catch
Copies cross, draws stick man
Tells stories, counts to 20
Dresses self, can take turns
97
Developmental Red Flags
```
Asymmetry of movement
Not reaching for object by 6 months
Not sitting unsupported by 12 months
Not walking by 18 months
No speech by 18 months
Regression
```
98
Endocarditis in a ‘normal’ person or someone who’s recently been to dentist.
Most likely organism and empirical treatment
Strep. Viridans
| Amoxicillin and Gentamicin (IV)
99
Endocarditis in someone with a prosthetic heart valve
| Most likely organism and empirical treatment
If <2months then staph. Epidermis. If >2 months then staph. Aureus
Vancomycin and gentamicin (IV) then on day 3/5 add oral rifampicin
100
Endocarditis in an IVDU.
| Most likely organism and empirical treatment
Staph. Aureus or epidermis
| Flucloxacillin IV
