Rhodia Flashcards
(479 cards)
1
Q
Which muscle flexes the interphalangeal joint of the thumb
A
Flexor Pollicus Longus
Longus flexes the joint a LONG distance away from palm
2
Q
Which muscle flexes the metacarpophalangeal joint of the thumb
A
Flexor Pollicus Brevis
3
Q
Is apoptosis of osteoblasts a feature of Avascular Necrosis
A
No, because apoptosis is a physiological process, Avascular Necrosis is pathological
4
Q
Which nerve passes through both the greater and lesser sciatic foramen
A
Pudendal nerve
5
Q
Which foramen does the obturator nerve pass through
A
Only the lesser sciatic foramen
6
Q
Which nerve supplies the deltoid
A
Axillary nerve
7
Q
Which nerve supplies the teres minor
A
Axillary nerve
8
Q
Which nerve supplies the Supraspinatus
A
Suprascapular nerve
9
Q
Which nerve supplies the Infraspinatus
A
Suprascapular nerve
10
Q
Which nerve supplies the Subscapularis
A
Superior and Inferior subscapular nerves
11
Q
What is indicated for an intracapsular displaced femoral fracture
A
Hemiarthroplasty
12
Q
What is the nerve supply of the rectus abdomini
A
T7-12
13
Q
Which nerve roots are involved in the biceps jerk reflex
A
C5-C6
Musculocutaneous nerve
14
Q
Which nerve roots are involved in the triceps jerk reflex
A
C7-8
Radial nerve
15
Q
Which nerve is at risk due to a shoulder dislocation/fracture
A
Axillary nerve
16
Q
What is a telltale sign of axillary nerve palsy
A
numb badge patch region
17
Q
Name 2 diseases which are type V hypersensitivities
A
Grave’s Diseases
Myasthenia Gravis
18
Q
What is the Koebner phenomenon
A
Lesions at the sight of injury
Seen in psoriasis
19
Q
What is Auspitz sign
A
The appearance of small bleeding points after successive layers of scale has been removed from the surface of psoriatic papules
20
Q
What are the compartments of the thigh
A
Anterior
Medial
Posterior
21
Q
What is the nerve supply to the anterior compartment of the thigh
A
Femoral nerve
22
Q
What is the nerve supply to the medial compartment of the thigh
A
Obturator nerve
23
Q
What is the nerve supply to the posterior compartment of the thigh
A
Sciatic nerve
24
Q
What is the arterial supply to the anterior compartment of the thigh
A
Femoral artery
25
What is the arterial supply to the medial compartment of the thigh
Profunda femoris artery
| Obturator artery
26
What is the arterial supply to the posterior compartment of the thigh
Profunda femoris artery
27
What are the compartments of the lower leg
Anterior
Lateral
Posterior
28
What is the nerve supply to the anterior compartment of the lower leg
Deep fibular (peroneal) nerve
29
What is the nerve supply to the lateral compartment of the lower leg
Superficial fibular (peroneal) nerve
30
What is the nerve supply to the posterior compartment of the lower leg
Tibial nerve
31
What is the arterial supply to the anterior compartment of the lower leg
Anterior tibial artery
32
What is the arterial supply to the lateral compartment of the lower leg
Fibular (peroneal) artery
33
What is the arterial supply to the posterior compartment of the lower leg
Posterior tibial artery
34
What is the insertion of the biceps brachii
Radial tuberosity
35
What is the origin of the long head of the biceps brachii
Supraglenoid tubercle
36
What is the origin of the short head of the biceps brachii
Coracoid process of scapula
37
What kind of hypersensitivity is Scabies
Type 4
38
Which of the carpal bone is a sesamoid bone
Pisiform
39
Which tendon does the Pisiform bone sit within
Tendon of Flexor Carpi Ulnaris
40
What is the innervation of the Trapezius
Spinal accessory
41
What major neck muscle does the spinal accessory nerve innervate
Sternocleidomastoid
42
Is pruritis a feature of Acne Rosacea
Not commonly no
43
What type of hypersensitivity is Rheumatoid Arthritis
Type 3
44
How many structures are in the carpal tunnel
10
45
How many tendons are in the carpal tunnel
9
46
Which nerve is in the carpal tunnel
Median Nerve
47
Name the tendons in the carpal tunnel
Flexor Digitorum Profundus x4
Flexor Digitorum Superficialis x4
Flexor Pollicus Longus
48
Which gene is defective in Marfan's Syndrome
Fibrillin Gene
49
What is a cardiac pathology associated with Marfan's Syndrome
Aortic Dissection
50
Which ligament connects the radial head to the radial notch of the ulna
Annular Ligament
51
Which of the muscle types has nuclei located peripherally
Skeletal
52
What is the insertion of the pectoralis major
Lateral lip of the bicipital groove of the humerus
53
What is the mechanism of action of Azathioprine
Purine synthesis inhibition
54
Which arm muscle does not insert into the radius (and where does it insert)
Brachialis
| Coronoid process of ulna
55
Which nerve can be injured in small saphenous vein surgery
Sural nerve
56
Where does the psoas major insert
The lesser trochanter of the femur
57
What is the floor of the anatomical snuffbox
Scaphoid bone
58
Which nerve lies medially on the thyroid gland and in the groove between the oesophagus and trachea
Recurrent Laryngeal Nerve
59
Where does the scaphoid derive the majority of its blood supply
Distal end
60
Does alcohol inhibit glycogenolysis or gluconeogenesis
Alcohol inhibits glycogenolysis
| Hence the hypoglycaemia in the morning
61
What are the two incretins
GLP-1
| GIP
62
Where is GLP-1 secreted from
Ileum
63
Where is GIP secreted from
Duodenum
64
What are the tests for Acromegaly
IGF-1 blood test
| Oral Glucose tolerance test
65
How does Acromegaly increase risk of Type 2 Diabetes Mellitus
GH excess
| GH mobilises glucose from fat stores
66
Which layer of the adrenal cortex is Cortisol released from
Zona Fasiculata
67
What are the 3 layers of the adrenal cortex, from superficial to deep
Zona Glomelurosa
Zona Fasiculata
Zona Reticularis
68
What is released by the zona glomerulosa
Mineralocorticoids e.g Aldosterone
69
What is released by the zona fasiculata
Glucocorticoids e.g Cortisol
70
What is released by the zona reticularis
Androgens e.g Testosterone
71
What does PTH do to serum calcium levels
Increase
72
How does PTH increase serum calcium
Via Vitamin D to increase reabsorption of calcium in distal convoluted tubule of kidneys
73
Which cells release somatostatin
Delta cells
74
Which 3 things does somatostatin decrease
Insulin
GH
Pancreatic exocrine secretions
75
What are 4 features of Men 2b
Medullary thyroid carcinoma
Phaeochromocytoma
Mucosal Neuroma
Marfanoid features
76
What are the levels of PTH, Calcium & Phosphate in primary hyperparathyroidism
Elevated PTH
Elevated Calcium
Decreased Phosphate
77
What are the levels of PTH, Calcium & Phosphate in secondary hyperparathyroidism
Elevated PTH
Decreased Calcium
Increased Phosphate
78
What are the levels of PTH, Calcium & Phosphate in tertiary hyperparathyroidism
Grossly Elevated PTH
Elevated Calcium
Decreased Phosphate
79
What is the Pes Anserius
The conjoined tendons of the Sartorius, Gracialis and Semitendinous muscles
80
Which hormones are increased in the stress response
```
GH
Cortisol
Glucagon
Prolactin
ADH
ACTH
```
81
Which hormones are decreased in the stress response
Insulin
Testosterone
Estrogen
82
Where does the superior thyroid vein drain
Into the Internal Jugular Vein
83
Where does the middle thyroid vein drain
Into the Internal Jugular Vein
84
Where does the inferior thyroid vein drain
Into the Brachiocephalic Vein
85
What is the pneumonic for the lateral rotators of the hip
```
P-GO-Q
Piriformis
Gemilus (superior & inferior)
Obturator (internus & externus)
Quadratus femoris
```
86
Which two thumb muscles does De Quiverains tenosynovitis affect
Extensor Pollicus Brevis
| Abductor Pollicus Longus
87
Treatment for Intertrochanteric fracture of femur
Dynamic Hip Screw
| Or IM nail
88
Treatment for sub-capital femoral neck fracture
Total Hip Replacement
89
What happens to Anti-dsDNA levels when SLE is more active
They rise
90
What type of systemic sclerosis is pulmonary fibrosis more common in
Diffuse systemic sclerosis
91
What antibody is associated with diffuse systemic sclerosis
Anti-Scl70
92
What antibody is associated with limited systemic sclerosis
Anti-Centromere
93
Which autoimmune disease puts you at higher risk of lymphoma
Sjogren's Syndrome
94
Is thrombocytosis a feature of Anti-Phospholipid syndrome
Not commonly no
95
What autoimmune condition is a butterfly rash associated with
SLE
96
What autoimmune condition is a Pneumothorax associated with
Marfan's
97
What is symmetrical small joint swelling suggestive of
Rheumatoid Arthritis
98
What is one way to treat Enteropathic Arthritis apart from methotrexate
Treat the underlying IBD
99
What is a crystal arthropathy associated with erosive joint changes
Gout
100
What is the new name for Churg Strauss syndrome
Eosinophilic Granulomatosis with Polyangiitis
101
What is the triad associated with Churg Strauss syndrome
Asthma, Rhinitis, Eosinophilia
102
Which autoimmune disease which has cutaneous changes is associated with an increased chance of malignancy
Dermatomyositis
103
What are the possible starting doses of prednisolone for Polymyalgia Rheumatica
15mg
| 40mg if also Giant Cell Arteritis
104
What is the commonest benign bone tumour
Osteochondroma
105
What tumour is a bony spur growing away from the metaphysis of long bones
Osteochondroma
106
Is an osteochondroma completely benign
No
| Has a 1% chance of malignancy
107
What are two names for the kind of bone found at the epiphysis of long bones
Trabecular
| Cancellous
108
What is Osgood-Schlatter's disease
Traction osteochondritis at the tibial tubercle
109
What is Sever's disease
Traction osteochondritis at calcaneus
110
What is described as a single lucent lesion in metaphyseal regions of bones
Simple Bone Cyst
111
What is a buzzword for the appearance of a Giant Cell tumour
Soap bubble around knee usually
112
What pathology can be described as Sheperd's crook deformity
Fibrous Dysplasia
113
Where is fibrous dysplasia normally seen
Proximal femur
114
What tumour is described as a mostly lucent lesion with patchy sclerosis
Enchondroma
115
What pathology is described as a lucent multi-loculated cyst and where is it usually found
Aneurysmal bone cyst
| usually in the medulla of bones
116
What is the name given to the space which chondrocytes occupy
Lacuna
117
Which cancer arises as a result of an (11;22) translocation & how common is it
Ewing's Sarcoma
| Rare
118
Which bone tumour only arises in abnormal bone
Fibrosarcoma
119
Give an example of a disease where abnormal bone is present and could thus result in a fibrosarcoma forming
Paget's disease
120
What is the most common primary bone tumour
Osteosarcoma
121
What are osteoprogenitor cells
A reserve pool of osteoblasts
122
What are osteoblasts
Bone forming cells
123
Where are osteoblasts found
On the surface of developing bone
124
Which two antibodies are associated with Rheumatoid Arthritis
Anti-CCP
| Rheumatoid Factor
125
What is the treatment pathway for Rheumatoid Arthritis
Methotrexate
| Biologics
126
What is the timeframe within which Methotrexate should be started after a diagnosis of Rheumatoid Arthritis
3 Months
127
What is the name of the severity scale for monitoring Rheumatoid Arthritis
DAS-28
128
Which antibodies are associated with Sjogren's Syndrome
Anti-Ro
| Anti-La
129
What are two treatment options for Sjogren's Syndrome
Eyedrops
| Pilocarpine
130
What is the test used to diagnose Sjogren's called and how is it performed
Schirmer's test
| paper strips inserted into the eye for several minutes to measure the production of tears
131
What is the pathology of Systemic Sclerosis
Excess collagen deposition
132
What is limited Systemic Sclerosis also sometimes called
```
Calcinosis
Raynaud's
Esophagal dysmotility
Sclerodactyly
Telangiectasia
```
133
What antibody is associated with MCTD (mixed connective tissue disease)
Anti-RNP
134
Which antibodies are associated with Anti-Phospholipid Syndrome
Lupus-Anticoagulant
Anti-cardiolipin
Anti-beta2 Glycoprotein
135
What is a cutaneous manifestation of Anti-Phospholipid Syndrome
Livedo Reticularis
136
What is the diagnostic procedure for Giant Cell Arteritis
Temporal Artery Biopsy
137
Which antibodies are associated with Polymyositis
Anti-Jo1 mainly
| but also Anti-RNP
138
What three investigations can be done for suspected Polymyositis
Serum CK
EMG (Electromyograph|)
Muscle biopsy
139
What are the 3 changes seen in Dermatomyositis but not in Polymyositis
Gottron's papules
V-shaped Rash over chest
Heliotrope rash
140
What nail changed are seen in Dermatomyositis
Nail fold infarcts
141
Which antibodies are associated with SLE
Anti-dsDNA
| Anti-sm
142
Which drug is always given in SLE for symptomatic relief regardless of severity
Hydroxychloroquine (anti-malarial)
143
What is the pathology in Osteogenesis Imperfecta
Defect in type 1 collagen
144
What is a special procedure which can be done for treatment for Osteogenesis Imperfecta
Sofield procedure
145
Which gene is abnormal in Marfan's Syndrome
Fibrillin gene
146
What cardiac pathology is associated with Marfan's Syndrome
Aortic Dissection
147
What is the pathology of Ehler-Danlos syndrome
Abnormal collagen and elastin formation
148
Which disease can cause blue sclera
Osteogenesis Imperfecta
149
Which two conditions are associated with atlantoaxial instability
Down's Syndrome
| Rheumatoid Arthritis
150
Which gene is abnormal in Duchenne Muscular Dystrophy and what is it normally involved in
Dystrophin gene
| Calcium transport
151
What is the difference between Duchenne Muscular Dystrophy and Becker's Muscular Dystrophy
Becker's is milder - leads to death in 30's-40's rather than 20's
152
What are the two severities of spina bifida called and which one is more severe
Spina bifida Occulta
| Spina bifida Cystica - more severe
153
What are the two types of Spina Bifida Cystica and what is the difference
Meningocele - herniation of only meninges
| Myelomeningocele - herniation of meninges + spinal cord
154
What is a possible treatment for Poliomyelitis
Arthrodesis
155
Which spinal roots are affected in Erb's Palsy
C5+C6
156
Which muscles lose function in Erb's palsy
```
Biceps
Brachialis
Deltoid
Supraspinatus
Infraspinatus
```
157
What happens to the humerus with Erb's Palsy
Internal rotation
158
What posture is associated with Erb's Palsy
Waiter's tip
159
Which spinal roots are affected in Klumpke's Palsy
C8 + T1
160
Which muscles lose function in Klumpke's Palsy
Intrinsic hand muscles
161
Which syndrome can Klumpke's Palsy sometimes cause
Horner's
162
Which action can bring about Klumpke's Palsy
Forceful adduction of arm
163
What does Froment's Test test for
Ulnar Nerve Palsy
164
The action of which muscle is tested in Froment's test
Adductor Pollicus
165
Which type of collagen is produced in Dupuytren's Contracture
Type 3
166
What is the pathology in Dupuytren's Contracture
Nodular Hypertrophy of palmar fascia
167
Is periosteum thicker in children's bones or adult's bones
Children's
| Reason for greenstick fractures
168
What is a nightstick fracture
Isolated fracture of the ulna
169
What is Wolff's Law
Bone is laid down in areas of stress
170
What may be considered instead of a total joint replacement in a young patient with knee arthritis
Tibial Osteotomy
171
Which wrist movement is required to acquire full grip strength
10 degrees of wrist extension
172
Which fracture can result in loss of wrist extension and thus a loss in grip strength
Distal Radial Fracture
173
What is a Monteggia fracture
Fracture of the proximal third of the ulna with dislocation of the proximal head of the radius
174
What is a Galeazzi fracture
Fracture of the distal third of the radius with dislocation of the distal radioulnar joint
175
How is a Nightstick fracture treated
Conservatively
176
How is a Monteggia fracture treated
ORIF of the ulna after reduction of radial head
177
How is a Galeazzi fracture treated
ORIF of the radius after reduction of ulna
178
How is a tear of the long head of biceps tendon treated
Conservatively
179
How is a tear of the patellar tendon treated
Surgically repaired
180
What GCS score indicates a need to perform airway manoeuvres
8 or below
| because this indicates loss of airway control
181
What are the 5 types of fractures
```
Transverse
Oblique
Spiral
Comminuted
Segmental
```
182
How is a Transverse fracture described
Flat line
183
How is an Oblique fracture described
Diagonal break across bone
184
How is a Spiral fracture described
Rotational break due to twisting force
185
How is a Comminuted fracture described
3 or more pieces
186
How is a Segmental fracture described
Bone breaks in 2 places
187
What are the 3 classes of nerve injury from MOST severe to LEAST severe
Neurotmesis
Axonotmesis
Neurapraxia
188
Describe Neurapraxia
Conduction defect from compression/stretch
| Full function returns in 28 days
189
Describe Axonotmesis
Death of axons distal to point of injury
Wallerian Degeneration
Axons regrow at 1mm/day
190
Describe Neurotmesis
Complete transection of nerve
| Requires surgery for recovery
191
What is the Salter-Harris classification used for
Paediatric epiphyseal plate fractures
192
Which Salter-Harris fractures are intra-articular
Class 3 and 4
193
What is a Bumper injury and which nerve is at risk of damage
A car hitting a pedestrian side on
Blow to the lateral knee
Common Peroneal nerve at risk
194
Which nerve is at risk of injury from a posterior hip dislocation
Sciatic nerve
195
Which nerve is at risk of injury from a supracondylar fracture of the humerus
Median nerve
196
What is a Boxer's injury
Fracture of the 5th metacarpal neck
197
Deformity in which plane is tolerated in a Boxer's fracture and up to what angle
Up to 45 degrees of flexion is tolerated
198
Deformity in which plane is not well tolerated in a Boxer's fracture
Rotational deformity
199
Which direction is shoulder dislocation most common in
Anterior
200
What is the 1-year mortality post-hip fracture
30% wtf
201
What is the most common site for a proximal humerus fracture
Surgical neck
202
What is the management of a minimally displaced proximal humerus fracture
Conservative
203
What is the pathology behind Mallet Finger and what does this result in
Avulsion of extensor tendon at DIPJ
| Inability to extend at DIPJ
204
Describe hammer toe
Flexion at PIPJ
205
Describe mallet toe
Flexion at DIPJ
206
Describe claw toe
Flexion at DIP & PIP joints
207
Which structure is at risk after a displaced Colles Fracture
Median nerve
208
What is a thoracolumbar wedge type fracture
A single column spinal fracture
209
Where does the sphenoid sinus drain
Sphenoethmoidal recess
210
Which cranial nerve has the longest course
CN VII - Facial
211
Which structure does the facial nerve pass into
Parotid Salivary gland
212
Which meatus, canal and foramen does the facial nerve pass through
Internal Acoustic Meatus
Facial canal
Stylomastoid foramen
213
Which sinuses drain to the middle meatus
Frontal
Ethmoidal
Maxillary (antra)
214
What drains into the inferior meatus
Nasolacrimal duct
215
Which cranial fossa does the Internal Acoustic Meatus sit in
Posterior
216
Which two structures can a Le Fort 1 fracture damage
Maxillary sinus
| Opening of the nasolacrimal duct
217
Which opening can mastoiditis affect
Additus of mastoid air cells
218
Which 4 structures pass through the jugular foramen
CN IX - Glossopharyngeal nerve
CN X - Vagus
CN XI - Spinal accessory
Internal Jugular Vein
219
Which structure prevents anterior dislocation of the jaw
Zygomatic arch
220
Which nerve has a geniculate ganglion part to it, in the petrous part of the temporal bone
Facial Nerve
221
What pathology could be suspected with recurrent falls
Vestibular nerve pathology
222
What makes up the skeleton of the external ear
Elastic cartilage
223
What is Hordeolum Externa
Stye- inflammatory focus centred on a lash follicle
224
Is a flame-shaped haemorrhage superficial or deep in the retina
Superficial
225
Which cranial nerves carry parasympathetic outflow
CN 3, 7, 9, 10
226
What types of axons does the long ciliary branch contain
Sympathetic and Sensory
227
What types of axons does the short ciliary branch contain
Sympathetic and Parasympathetic
228
Which branch of which cranial nerve supplies the Lacrimal gland
Parasympathetic fibres supplied by Greater Petrosal nerve
| Branch of CN VII
229
What is a scotoma
A gap in visual field
230
What is amaurosis fugax
```
Transient CRAO (central retinal artery occlusion)
Lasts around 5 mins
```
231
What is a synechia
Irregular pupil shape
232
What is Rubeosis Iridis and what does it indicate
Blood vessel growth on iris
| suggests severe ischaemia
233
What is a Symblepharon
Palpebral conjunctiva becomes stuck to bulbar conjunctiva
| Causes turning in of the eyelid
234
Which epilepsy medication can cause constriction of the visual field
Vigabatrin
235
What is the tee-pee sign and what condition is it seen in
Eyelashes stick together due to oil and sebaceous matter
| seen in Seborrhoeic Anterior Blepharitis
236
What is chemosis
Conjunctival Oedema
237
What does redness around the limbus suggest
Anterior Uveitis
238
What is trichiasis
When the eyelashes grow abnormally and touch the eyeball
239
Why is there pain in the presence of light when a patient has uveitis
The muscles of the iris are inflamed and cause pain when they try to constrict the pupil
240
What is the Trousseau sign and what does it indicate
Inflation of the BP cuff causes flexion of wrist and fingers
| Indicates hypocalcaemia
241
What is the Chovstek sign and what does it indicate
Tapping on the parotid gland causes twitching of the mouth
| Indicates hypocalcaemia
242
What is Waterhouse-Freiderichson syndrome
Adrenal hypofunction due to bleeding into the gland
| usually caused by a N. meningitidis infection
243
What is Sheehan syndrome
Hypopituitarism due to ischaemic necrosis of the gland postpartum
244
What is the 2nd line treatment for Hyperthyroidism and when is 1st line
PTU is 2nd line after Carbimazole
| The 1st line drug only in the 1st trimester of pregnancy
245
Why is carbimazole not used in the 1st trimester of pregnancy
Risk of aplasia cutis in early pregnancy
246
What is the difference between a vocal chord and a vocal fold
Vocal fold has mucosal covering (squamous epithelium)
| Vocal cord does not
247
What kind of cartilage is the laryngeal inlet (aditus)
Elastic
248
Which muscle is being tested when you ask a patient to stick their tongue straight out
Genioglossus
249
Which nerve is being tested when you ask a patient to stick their tongue straight out
Hypoglossal CN XII
250
How can you tell which nerve (right or left) is injured when you ask a patient to stick their tongue straight out
The tongue tip will point to the side which is damaged/non-functional
251
Which two muscles are being tested when you ask a patient to say "ahh" and what is their innervation
Tensor Veli Palatini (CN V3)
| Levator Veli Palatini (CN X)
252
How can you tell which nerve (right or left) is injured when you ask a patient to say "ahh"
The uvula is pulled away by the functioning side
| i.e points away from the injured side
253
During a Laryngoscopy, which space is the laryngoscope placed into
Vallecula (space between epiglottis and tongue)
254
Which nerve supplies the Circular (constrictor) muscles of the pharynx
CN X (Vagus)
255
What do the longitudinal muscles of the pharynx do
Elevate pharynx & larynx
256
Where do all the longitudinal muscles of the pharynx insert
Onto posterior border of thyroid cartilage
257
Where do all the Circular (constrictor) muscles of the pharynx insert
All insert onto the midline raphe
258
Name the 3 longitudinal muscles of the pharynx
Palatopharyngeus
Salpingopharyngeus
Stylopharyngeus
259
What is the innervation of the longitudinal muscles of the pharynx
CN X supplies Palatopharyngeus & Salpingopharyngeus
| CN IX supplies Stylopharyngeus
260
Which muscle does the parotid duct pierce to emerge into the oral cavity
Buccinator
261
Which of the vocal cord muscles are not involved in whispering
Arytenoid muscles
262
Names the muscles of the floor of the mouth
Digastric (anterior belly)
Mylohyoid
Geniohyoid
263
Which vertebral level is the hyoid bone found at
C3
264
What is the lymphatic drainage for the tip of the tongue
Submental nodes
265
What structure is pressed on to compress the oesophagus to allow ventilation
Lamina of the cricoid cartilage
266
What is Dacrocystitis
Infection of the lacrimal sac
267
How would Dacrocystitis typically present
Watery eye + swelling/erythema at inner canthus of eye
268
What is the most common reason for revision surgery of of THR
Aseptic loosening of implant
269
Which diabetes drug is contraindicated in heart failure and why
TZD's
| Cause fluid retention
270
Treatment for infective conjunctivitis
Topical Chloramphenicol
271
What are tatty's 4 T's of Type 1 Diabetes
Tired
Thin
Thirsty
Toilet
272
Describe MODY
Symptoms of Type 2 diabetes in a young patient
273
1st line treatment for lower back pain
NSAID (e.g Naproxen) rather than just paracetamol alone
274
When is the commencing of uric acid lowering (uricosuric) drugs indicated
2 or more gout attacks in 12 months
275
What is the alternative to Allopurinol
Febuxostat
276
What is the mechanism of action of Allopurinol & Febuxostat
Inhibition of Xanthine Oxidase (enzyme)
277
Which investigation must be carried out with a diagnosis of SLE and why
```
Urine analysis (look for proteinuria) -> Renal Biopsy
To check for Lupus Nephritis
```
278
Which thyroid condition is strongly associated with smoking
Grave's
279
Which antibody can be seen in Grave's disease
TSH receptor antibody
| (TRAb) stimulating*
280
Which antibody can be seen Hashimoto's thyroiditis
Anti-TPO
| Thyroperoxidase
281
Name the 3 longitudinal muscles of the pharynx
Stylopharyngeus
Salpingopharyngeus
Palatopharyngeus
282
What is the innervation of the longitudinal muscles of the pharynx
CN X apart from Stylopharyngeus which is CN IX
283
Name the 2 soft palate muscles
Tensor veli palatini
| Levator veli palatini
284
What is the innervation of the soft palate muscles
Levator veli palatini - CN X
| Tensor veli palatini - CN V3
285
Which muscles open (abduct) the vocal cords and what effect does this have
Posterior crico-arytenoid muscles
| Makes voice louder
286
Which muscles relax the vocal cords and what effect does this have
Thyroarytenoid muscles
| Makes voice lower (lowers pitch)
287
Which muscles close (adduct) the vocal cords and what effect does this have
Lateral crico-arytenoid & Arytenoid muscles
| Makes voice quieter
288
Which muscles tense the vocal cords and what effect does this have
Cricothyroid muscles
| Makes voice higher (increases pitch)
289
Name the 4 strap muscles
Sternothyroid
Thyrohyoid
Omohyoid
Sternohyoid
290
Which fracture typically caused by a FOOSH always requires ORIF
Smith fracture
291
Name the muscles which make up the floor of the mouth
Mylohyoid
Anterior belly of Digastric
Geniohyoid
292
What gene mutation is linked to retinoblastoma
Rb-1 gene on chromosome 13
293
Which marker is very high in Paget's disease and why
Alkaline Phosphatase
| Marker for bone destruction
294
What does the JESS mnemonic stand for and what disease is it for
```
Joint space loss
Erosion of joint
Synovial thickening
Subluxation
X-ray changes in rheumatoid arthritis
```
295
What period of morning stiffness is associated with rheumatoid and osteoarthritis
OA - less than 30mins
| RA - more than 30mins
296
What is thyrotoxicosis factitia
Hyperthyroidism caused by ingestion of exogenous thyroid hormone
297
What stimulates a salty taste
Chemical salts (esp. NaCl)
298
What stimulates a sour taste
Free H+ ions
299
What stimulates a sweet taste
A configuration of glucose
300
What stimulates a bitter taste
Alkaloids
Toxic plant derivatives
Poison
301
What stimulates a umami (meaty/savoury) taste
Amino acids
| in particular glutamate
302
Conn's syndrome typical biochemistry and presentation
Relatively young patient with hypertension
Hypokalaemia and Hypernatraemia
(Aldosterone causes Na retention)
303
Men1 is associated with which 3 tumours
Parathyroid gland
Islet cells of the pancreas
Pituitary gland
304
What medications can exacerbate psoriasis
Anti-malarials
| Beta-blockers
305
What does the PCOS PAL mnemonic stand for, with regards to polycystic ovarian syndrome
Polycystic on ultrasound
Cycles erratic (menstrual)
Obesity + Hirsutism
Subfertility
Prolactin elevated
Androgens very elevated
LH grossly elevated
306
What is the incretin effect and what causes it
Oral glucose triggers a greater insulin release than IV
| This occurs due to oral glucose causing the release of GLP-1 and GIP (from Ileum & duodenum)
307
What are the 2 ketones commonly measured and where are they found
Beta-hydroxybutyrate - in blood
| Acetoacetate - in urine
308
What are the two types of differentiated thyroid cancers
Papillary
| Follicular
309
How does papillary thyroid carcinoma spread
Tends to spread via lymphatics
310
How does follicular thyroid carcinoma tend to spread
Via blood (haematogenous)
311
Name an endocrine, cardio & MSK condition that Acromegaly is associated with
Diabetes Mellitus
Left Ventricular Hypertrophy
Carpal tunnel syndrome
312
Is Psoriatic arthritis more similar to osteoarthritis or rheumatoid arthritis
Rheumatoid arthritis
313
What is arthritis mutilans
A severe and highly destructive form of psoriatic arthritis
314
Why cant testosterone be given IV
Is only available with an oily base, therefore, risk of embolus if given IV
315
What condition is this a classic presentation of :
| Halo around lights, 'Frosted glass appearance', pain & decreased visual acuity
Acute Angle Closure Glaucoma
316
What are the Rotterdam criteria for Polycystic Ovarian Syndrome
2 out of 3 of :
Polycystic ovaries on ultrasound
Evidence of elevated androgens (hirsutism)
Menstrual irregularity
317
What part of the body can Bisphosphonates cause side effects in
Oesophagus
318
What is the most common cause of vertigo
Benign Paroxysmal Positional Vertigo
| BPPV
319
What is thought to be the cause of BPPV
Otolith material (calcium carbonate) displaced from utricle into semi-circular canals (usually posterior)
320
What is the test to diagnose BPPV
Dix-Hallpike test
| Classic Nystagmus is seen
321
What manoeuvre is used to treat BPPV
Epley manoeuvre
| Relocates displaced material to utricle
322
What is the shawl sign and which disease is it seen in
Red Rash on back of neck like a shawl
| Dermatomyositis
323
What are the 3 endocrine receptor types
G-Protein coupled receptor
Receptor kinase
Nuclear receptors
324
What are the 3 classes of hormones
Protein & peptide
Steroid
Tyrosine derivatives
325
What is preproinsulin and what is it broken down into
Insulin precursor
| Broken down into insulin + c-peptide
326
Does insulin inhibit or stimulate lipolysis
Inhibit lipolysis
327
Which glucose transporter is in pancreatic beta cells
GLUT2
328
Which glucose transporter is in skeletal muscle cells
GLUT4
329
Does water follow Na or the other way round
Water follows Na as a rule of thumb
330
What does mineralocorticoid activity mean
Na retention in exchange for K+/H+ ions
331
Concentrated urine has a high/low osmolarity
High osmolarity
332
What is the HbA1c level in a normal person
Below 41mmol/L
333
What HbA1c level diagnoses diabetes
48mmol/L and above
334
What is the onset and peak action time of rapid-acting insulin
15min onset, 1-2 hour peak
335
Give examples of rapid-acting insulin
Novorapid, Humalog
336
What is the onset and peak action time of short-acting insulin
30-60min onset, 2-4 hour peak
337
Give examples of short-acting insulin
Actrapid, Humulin S
338
What is the onset of basal insulin
1-3 hour onset
339
Give examples of basal insulin
Insulatard, Humulin I
340
Give examples of long-acting insulin
Lantus (Glargine)
| Levemir (Detemir)
341
What are the pre-meal blood glucose targets
3.9 - 7.2mmol/L
342
What are the 1-2 hour post-meal blood glucose targets
< 10mmol/L
343
What effect does GLP-1 have on alpha-cells of the pancreas
Decreases glucagon release
344
What 2 factors can be mutated in MODY
Transcription factor
| Glucokinase
345
Which type of MODY presents at birth
Glucokinase mutation
346
Which type of MODY can sulphonylureas be useful for
Transcription factor MODY
347
What level of ketonaemia is diagnostic of DKA
>3mmol/L
348
What level of blood glucose is diagnostic of DKA
>11mmol/L
349
What level of bicarbonate & pH is diagnostic of DKA
Bicarbonate < 15mmol/L
| pH < 7.3
350
What type of breathing is associated with DKA
Kussmaul breathing
351
What is the normal range of lactate
0.6-1.2
352
What is the normal range of osmolality
285-295
353
What is stored in thyroid colloids and released by follicular cells
Thyroglobulin
354
What is the definitive test for Cushing's
Low dose dexamethasone suppression test overnight
| Cortisol < 50 = normal
355
What are the Hypophysis and Neurohypophysis
Hypophysis - Anterior pituitary
| Neurohypophysis - Posterior pituitary (extension of hypothalamus)
356
What kind of cells does the adrenal medulla contain
Chromaffin cells
357
Which two chemicals does ACTH mediate the release of from the adrenal cortex
Cortisol from Zona Fasiculata
| Androgens from Zona Reticularis
358
What does cortisol do to libido and proteins in the body
```
Loss of libido
Protein loss (muscle wasting & osteoporosis)
```
359
Why is Addison's associated with dark/pigmented skin
Adrenal failure causes high ACTH
| ACTH causes melanocytes to produce more melanin
360
What are the levels of K+, Na+, ACTH, Renin & Aldosterone like in Addison's
```
High K+
Low Na+
High ACTH
Very High Renin
Low Aldosterone
```
361
What is the diagnostic test for Addison's
Short SYNACTHEN test
| Cortisol > 550 = normal
362
What is the treatment for Addison's
Hydrocortisone (cortisol replacement)
| Fludrocortisone (aldosterone replacement)
363
What tests can be done to diagnose Conn's syndrome
Aldosterone: Renin ratio
Saline suppression test
(failure to suppress aldosterone by 50% with 2L saline)
364
Treatment for Conn's syndrome
Adrenalectomy
| Spironolactone if bilateral
365
What are the cortisol, aldosterone & androgen levels like in congenital adrenal hyperplasia
Low cortisol
Low aldosterone
Very high androgens
366
Which adrenal condition can present with ambiguous genitalia
Congenital Adrenal Hyperplasia
367
What is the classic triad of symptoms for phaeochromocytoma
a headache
sweating
palpitations
368
What is the treatment ladder for Phaeochromocytoma
Alpha blocker
Beta|-blocker
fluid replace
Surgical excision
369
How is hypercalcaemia treated
Fluid replacement, loop diuretic, bisphosphonate
370
What bone mineral density is considered normal
Within 1 standard deviation of the young adult-reference mean
371
What bone mineral density is considered osteopenic
1-2.5 standard deviations below the young adult-reference mean
372
What bone mineral density is considered osteoporotic
2.5 standard deviations or more below the young adult-reference mean
373
How do bisphosphonates work
They are ingested by osteoclasts and cause cell death
| This decreases bone resorption
374
What are some side effects of bisphosphonates
Osteonecrosis of jaw
| Oesophageal cancer
375
Which hormone increases to cause follicle formation in the menstrual cycle
FSH
376
Which cells around the leading follicle release which chemical
Granulosa cells release oestrogen
377
Which hormone spikes just before the ovulation stage of the menstrual cycle
LH surge
378
How is oligomenorrhoea defined
Less than 9 periods a year
379
Define primary and secondary amenorrhoea
Primary - Failure to have the first period by 16
| Secondary - Cessation of periods for 6 months with previous periods
380
Can high prolactin cause oligomenorrhoea or amenorrhoea
Amenorrhoea
381
What is Kallman's syndrome
Loss of GnRH secretion from hypothalamus
| Accompanied by loss of smell
382
Where is preproinsulin synthesised
Rough endoplasmic reticulum
383
What do diazoxides do
Stimulate the K+ channel in beta cells
Cause repolarisation
Inhibit insulin release
384
What are the subunits of the insulin receptor and how are they linked
2 extracellular alpha subunits
2 transmembrane beta subunits
Linked by disulfide bonds
385
How does insulin have an effect on cells
Binds to extracellular alpha subunits
causes autophosphorylation of beta subunits
Causes gene expression via MAPkinase pathway
Causes uptake of glucose via GLUT4 -> glycogen synthesis
386
Where and how are ketone bodies formed
In liver mitochondria vis beta-oxidation of acetyl-CoA
387
What is smoky red urine caused by
Caused by intact red blood cells
388
What is seen on the iodine uptake scan with acute thyroiditis
Reduced/ no uptake
389
What are the two surgical approaches to the pituitary fossa
Trans-sphenoidal
| Trans-cranial
390
Describe the three Le Forte fractures
Le Forte 1 - Maxilla seprates from hard palate
Le Forte 2 - Maxilla seperates from zygoma + nasal bones
Le Forte 3 - Nuerocranium seperates from viscerocranium
391
What is type 3 diabetes
Diabetes secondary to other disease/ cause
| e.g. Cushing's, Turner's
392
What are the two types of lactic acidosis and what are they associated with
Type A - Hypoxaemia of tissues
| Type B - Diabetes
393
What 4 pathologies does Wolfram syndrome give you
Diabetes mellitus
Diabetes Insipidus
Optic Atrophy
Deafness
394
What is Type 4 diabetes and what causes it
```
Gestational diabetes (in 3rd trimester)
Caused by placental hormones
```
395
Which malignancy is associated with Hashimoto's Thyroiditis
Papillary carcinoma
396
When are T3 and T4 stopped before a full body iodine scan and why
T3- 2 weeks before T4- 4 weeks before
| Stopped to allow TSH to be high
397
Which two things does TRH stimulate the secretion of
TSH & Prolactin
| That's why hypothyroidism can also cause hyperprolactinaemia
398
Does iodine deficiency cause hypothyroidism
yes, commonest cause in developing countries
399
Why does goitre occur in hypothyroidism
Increased TSH causes gland enlargement
400
How can a medullary thyroid carcinoma cause diarrhoea or Cushing's
Paraneoplastic production of VIP or ACTH
401
What is the Guthrie test and when is it done
Done on day 5 to screen for congenital thyroid disease
402
What is Whipple's triad and what does it indicate
Symptoms of hypoglycaemia
Documented low blood sugar
Symptomatic relief by glucose
Indicates an insulinoma
403
What do the Centor criteria consist of
Fever (over 38)
Absence of a cough
Tonsilar exudate
Tender anterior cervical lymphadenopathy
404
What does a Centor score of 3 or above indicate and what is the next step
Indicates Bacterial Tonsilitis
| Penicillin V or Clarithromycin if allergic
405
What is an Adie pupil
Tonically dilated pupil with a slow reaction to light
Seen in females with absent knee/ ankle jerk
occurs due to damage to parasympathetics of eye
406
What is a Marcu-Gunn pupil
Relative afferent pupil defect
| usually due to optic nerve damage
407
What is a Hutchinson pupil
Unilateral dilated pupil with no reaction to light
| usually due to oculomotor nerve damage
408
What is an Argyll-Robertson pupil
Bilaterally small pupils
Accommodation reflex but no reaction to light
Seen in syphilis -> prostitute's pupil
409
What is the sensory organ of hearing and how does it work
Organ of Corti
| Hair cells convert mechanical bending force into electrical impulses
410
The basilar membrane is tonotopically arranged - what does this mean
The apex picks up low frequency sound
| The base picks up high-frequency sound
411
What does impedance matching refer to
The pressure gain of x22 from the tympanic membrane to the oval window
412
Where is the auditory cortex located
Superior temporal gyrus
| Broadmann area 41/42
413
What is the lifespan of taste receptor cells and where are they renewed from
10 days
| renewed from basal cells
414
What are the three types of cell in the olfactory mucosa
Olfactory receptor cells
Supporting cells
Basal cells
415
What are the early complications of Strep Throat
Quinsy
Otitis media
Scarlet fever
416
What are the late complications of Strep Throat
Rheumatic fever
| Glomerulonephritis
417
What is the treatment for oral candidiasis
Topical nystatin suspension
418
What antibiotics are given for complicated/ unresolving sinusitis
Penicillin
| Doxycycline if allergic (Not in children)
419
What is the treatment ladder for otitis externa
Topical aural toilet
Clotrimazole for fungal causes
Gentamicin for chronic (Pseudomonas)
420
What is the classic triad of symptoms for glandular fever
Fever
Pharyngitis
Lymphadenopathy
421
Name 4 complications of glandular fever
Splenic rupture
Thrombocytopenia
Lymphoma
Upper airway obstruction
422
What 3 investigations can be done for glandular fever
IgM test
Paul-Bunnell test
Monospot test
(CRP will also be low)
423
What actually is a cholesteatoma
The presence of keratin producing squamous epithelium in the middle ear
424
What is a vestibular schwannoma and where are they typically found
A benign tumour of Schwann cells
| usually found at the cerebellopontine angle
425
What is the Battle sign and what does it suggest
Bruising behind the ear
| Suggests a temporal bone fracture
426
What are the two types of temporal bone fracture
Longitudinal (conductive hearing loss)
| Transverse (sensorineural hearing loss)
427
When is a barium swallow more useful than endoscopy
To visualise oesophageal dysmotility, an oesophageal stricture or a pharyngeal pouch
428
What scans are done to investigate the two types of hearing loss
Conductive - CT scan
| Sensorineural - MRI scan
429
Which virus is associated with nasopharyngeal carcinoma
Epstein Barr virus
430
Where is there a high incidence of Nasopharyngeal carcinoma
In the far east
| associated with nitrosamines in food
431
What is the histology of the palatine tonsils
Stratified squamous epithelium with crypts and a collagen hemi-capsule
432
What is the histology of the adenoid tonsils
Respiratory epithelium with folds and a transition layer (antigen processing)
433
Where is the infection in quinsy
In between the tonsil and the underlying muscle
434
What type of cartilage makes up the nasal cartilage
Hyaline cartilage
435
Which bones make up the septum of the nose
Perpendicular plate of the ethmoid
| Vomer
436
The nasal cavity is supplied by which three arteries
Facial
Maxillary
Ophthalmic
437
What is Kisselbach's area
Arterial anastomoses on nasal septum
438
Which bone are the conchae a part of
Superior and middle are part of ethmoid
| Inferior is a bone on its own
439
What proportion of the external acoustic meatus is bone
1/3 cartilage 2/3 bone
440
What structure forms the connection between the epitympanic recess and the mastoid process
Aditus
441
What is the promontory in the middle ear
Bony swelling on the medial wall of the middle ear cavity due to the cochlea
442
What is the origin of the thyroid gland
Foramen caecum
443
Where does the hypoglossal nerve lie in relation to the lingual artery
Lies lateral to the loop of the lingual artery
444
Lymph drainage of the lateral surface of the superior half of the ear
Parotid
445
Lymph drainage of the cranial surface of the superior half of the ear
Mastoid (& deep cervical)
446
Lymph drainage for majority of the ear
Superficial cervical
447
What do the terms anotia and microtia mean
Anotia is the absence of an ear
| Microtia is an ear which is not fully developed
448
What are the ducts called in correspondence to the scala media, tympani and vestibuli
Scala media - cochlear duct
Scala vestibuli - vestibular duct
Scala tympani - tympanic duct
449
What does tinnitus indicate damage to
Damage to the outer hair cells (modulate sound)
450
What is sialolithiasis
Stones within the salivary glands
451
What is herpetic whitlow
Herpes infection of the junction between nail and skin
452
What is Carhart's notch
A notch present at 2000 Hz on an audiogram
| Otosclerosis
453
What is the commonest cause of adult subglottic stenosis
Vasculitis
454
What is the classic presentation of a thyroglossal cyst
Midline swelling which moves upwards on protrusion of the tongue
455
What pathology can be described as a collection of dilated lymphatic sacs which are transilluminable
Cystic Hygroma
456
How long must a mouth ulcer be present to warrant being referred to oral surgery
3 weeks
457
What disease can present as a 'flamingo tinge' and what is this caused by
Otosclerosis
| Caused by hyperaemia
458
What 5 classes of drugs can be used to treat glaucoma
```
Prostaglandin analogue
Beta blocker
Sympathomimetics
Carbonic anhydrase inhibitor
Miotics
```
459
What is a side effect of prostaglandin analogues
Brown pigmentation of iris
460
When can beta blockers not be used to treat glaucoma
When the patient has asthma or heart block
461
What is a side effect of sympathomimetics
Hyperaemia
462
What is a side effect of CA inhibitors
Systemic Absorption
463
What is a side effect of Miotic drugs
Blurry vision and headache due to constriction of pupil
464
Which class of drug, also used for hypertension, can cause gingival hyperplasia
Calcium channel blockers
465
What symptoms can a vestibular schwannoma cause in relation to cranial nerves
CN V - Absent corneal reflex
CN VIII - Vertigo, tinnitus, HL
CN VII - Facial nerve palsy
466
What diagnosis would be suggested by night blindness and tunnel vision
Retinitis Pigmentosa
467
What are the two tuning fork tests
Rinne's test
| Weber test
468
What is the mnemonic for branches of the facial nerve
To Zanzibar By Motor Car
| Temporal, Zygomatic, Buccal, Mandibular, Cervical
469
What are the different types of Cerebral Palsy
one limb (monoplegic),
one ipsilateral upper and lower limb (hemiplegic)
both legs only (diplegic)
4 limbs usually with learning difficulties (Quadriplegic)
470
What are the names of the ducts which drain the submandibular and parotid glands
Submandibular -> Wharton's duct
| Parotid -> Stensen's duct
471
Name 2 anti-folate antibiotics which shouldn't be used with methotrexate and why
Trimethoprim
Co-Trimoxazole
(risk of severe bone marrow suppression)
472
What is Pott's disease
Tuberculosis in a site other than the lungs
| often vertebrae
473
Which TB drug can induce lupus
Isoniazid
474
What can happen to ligaments in osteoarthritis
Ligament hypertrophy
475
Which organism causes 'walking pneumonia' and why is it called this
Mycoplasma Pneumoniae
| Called this because patients often seem fine
476
What is the only organism which is not a virus but is tested for using PCR
Mycoplasma Pneumoniae
477
How is legionella pneumonia tested for
Urine sample
478
What is the ideal treatment for someone with sepsis/ severe disease
IV Bacteriocidal antibiotics
479
When should a baby be introduced to full fat, semi-skimmed and skimmed milk
Full fat - 1 year onwards
Semi-skimmed - 2 years onwards
Skimmed - 5 years onwards
