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MD2002 > Week 10 > Flashcards

Week 10 Flashcards

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1
Q

Give the 4 routes for spread of infection to bones.

A
  • haematogenous spread
  • local spread
  • compound fracture
  • foreign body
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2
Q

Give 6 predispositions to osteomyelitis.

A
  • sickle cell disease
  • travel/ foreignborn
  • prosthesis
  • children under 5
  • UTI
  • younger people
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3
Q

Give the 5 more likely locations for osteomyelitis, from most likely to least likely.

A
  1. femur
  2. tibia
  3. calcaneum
  4. humerus
  5. fibula
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4
Q

Name the 3 most common organsims responsible for osteomyelitis in Scotland.

A

S. aureus, S. pyogenes, M. tuberculosis

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5
Q

Give 4 symptoms of osteomyelitis.

A
  • painful swollen site
  • fever
  • reduced movement
  • paraplegia
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6
Q

What are the 4 preliminary investigations to order for suspected osteomyelitis?

A
  • Fever
  • WBC
  • ESR
  • CRP
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7
Q

Which organism is most susceptible to cause spinal osteomyelitis?

A

M. tuberculosis

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8
Q

What investigations would allow a better understanding of the development of osteomyelitis?

A
  • blood culture
  • X-ray
  • MRI/T/bone scan
  • pus sample
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9
Q

What is the standard empirical treatment for osteomyelitis? What are the alternatives?

A

STANDARD
flucloxacillin + fucidin

ALTERNATIVES

  • fucidin + erythromycin or rifampicin
  • ciprofloxacin
  • isoniazid, rifampicin, pyrazinamide, ethambutol
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10
Q

Name the 3 main sites of septic arthritis.

A

knee, hip and lumbosacral spine

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11
Q

Name 3 predisposing conditions for septic arthritis.

A
  • rheumatoid arthritis
  • injection of joint
  • prosthetic joint
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12
Q

Name 6 organisms involved in septic arthritis.

A
  • S. aureus
  • S. pyogenes
  • S. epidermis
  • M. tuberculosis
  • Salmonella
  • Brucella
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13
Q

What are the investigations allowing diagnosis of septic arthritis?

A
  • blood culture
  • joint aspirate
  • joint X-ray
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14
Q

What is the standard empirical treatment for osteomyelitis? What is the alternative?

A

STANDARD
flucloxacillin + fucidin

ALTERNATIVES
fucidin + erythromycin or rifampicin

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15
Q

What are 9 post-infectious arthritides?

A
  • rheumatic fever
  • rubella
  • meningococcus
  • Yersinia
  • Salmonella
  • Shigella
  • Campylobacter
  • Mumps
  • Reiter’s syndrome
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16
Q

Give 6 symptoms associated with Reiter’s syndrome.

A
  • synovitis
  • conjunctivitis
  • sacroiliitis
  • aortitis
  • circinate balinitis
  • Keratoderma blennorrhagica
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17
Q

Define cell differentiation, potency, cell fate and competence.

A

CELL DIFFERENTIATION
process by which embryonic cells become different from one another

POTENCY
the entire repertoire of cell types a particular cell can give rise to in all possible environments

CELL FATE
what the cell will become in the course of normal development

COMPETENCE
ability of a cell to respond to chemical stimuli

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18
Q

Describe the hierarchy of stem cells.

A

totipotent –> pluripotent –> multipotent

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19
Q

What are the two stages of commitment?

A

1) reversible specification

2) irreversible determination

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20
Q

Illustrate the progress of cell during development.

A

naive –> specified (from cytoplasmic determinants or induction)
specified –> determined (from loss of competence for alternative fates)
determined –> differentiated (from cell-specific gene expression)

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21
Q

In an embryonic stem cell, how is the bivalent chromatin from master regulator genes found?

A

Poised: both open and closed

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22
Q

Give an example of use of somatic cell reprogramming.

A

Therapeutic cloning

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23
Q

Define intramembraneous ossification. Give two examples.

A

the formation of flat bones in fibrous connective tissue

  • mandible
  • skull
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24
Q

What is the mesenchyme?

A

generalised embryonic connective tissue derived from mesoderm

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25
Which group of genes pattern the body axis? What are the three axes?
Hox genes - proximo-distal axis - antero-posterior axis - dorso-ventral axis
26
When and where do upper and lower limb buds respectively appear in limb development?
UPPER LIMBS day 24, between somites C5 and T1 LOWER LIMBS day 28, between somites L1 and S2
27
When and how do limbs rotate in limb development?
UPPER LIMBS week 7 rotate 90 degrees laterally LOWER LIMBS week 7 rotate 90 degrees medially
28
What is the apical ectodermal ridge? How does it influence body axes patterning?
AER = thickened ectoderm at the apex of the developing limb induces underlying tissue to remain as a population of undifferentiated, rapidly proliferating cells --> progress zone, so limbs can grow away from the body As cells move further away from the AER they differentiate (cartilage and muscle) --> proximo-distal development
29
Which genes are involved in proximo-distal limb development, and how?
Hox-8 controls position of limb on the long axis of body TBX5 and FGF-10 initiate outgrowth of forelimb FGF4 and FGF8 maintain the progress zone
30
Which protein is involved in control of the antero-posterior axis? Explain the mechanism.
Sonic hedgehog (SHH) protein expressed by the zone of polarizing activity (ZPA), a cluster of cells near the posterior border of the limb ensures thumb grows on the anterior side of the limb bud
31
How is the dorso-ventral axis controlled?
BMPs in the ventral ectoderm induce EN1 In ventral limb ectoderm --> EN1 represses WNT7 In dorsal limb ectoderm --> EN1 induces LMX1 --> specifies the cells to be dorsal
32
How do HOX genes determine the shape of bones?
Variations in combination: - upper limb TBX5, lower limb, TBX4 - different patterns for proximal, middle and distal parts of limb
33
Define amelia, meromelia, phocomelia, micromelia.
AMELIA complete absence of the limbs MEROMELIA partial absence of the limbs PHOCOMELIA absence of long bones MICROMELIA segments are abnormally short
34
When do limb defects usually start to develop?
Week 4 and 5
35
Which defects were associated with Thalidomide use in pregnancy?
- phocomelia (or amelia) - intestinal atresia - cardiac abnormalities
36
What mutations can cause Holt Oram Syndrome?
TBX5
37
Name 4 defects in finger development.
- brachydactyly - syndactyly - polydactyly - cleft foot
38
Which vein can be found next to the lateral malleolus?
small saphenous vein
39
Which muscles merge to form the calcaneal tendon?
- gastrocnemius - soleus - plantaris
40
What is the proportion of people who do not have a plantaris muscle?
5-10%
41
What are the structures that pass posteriorly to the medial malleolus, from most anterior to most posterior?
tibialis anterior, flexor digitorum longus, neurovascular bundle, flexor hallucis longus
42
What are the three branches of the popliteal artery?
- posterior tibial artery - anterior tibial artery - fibular artery
43
What is the boundary that changes the posterior tibial vein into the popliteal vein?
lower border of popliteus
44
Give 8 risk factors for sepsis.
- elderly or very young - impaired immune system - surgery in the last 6 weeks - breach of skin integrity - IV drug users - indwelling lines or catheters - pregnancy, given birth or miscarriage/termination of pregnancy in last 6 weeks - diabetes - asplenic
45
Define colonisation, infection and septicaemia.
COLONISATION presence of a microbe in the human body that does not cause infection or a specific immune response INFECTION occurrence of inflammation due to the presence of a microbe SEPTICAEMIA presence of viable microbes in the blood
46
How is sepsis diagnosed?
``` documented infection site + 2 of: - temperature <36 or >38 - heart rate >100bmp - respiration >20/min - leukocyte count <4000/mm3 or >16000/mm3 ```
47
What are the three mechanisms involved in the pathophysiology of sepsis.
- vasodilation - activation of coagulation - increased endothelial permeability
48
Describe the sepsis 6.
- take blood cultures - measure accurate hourly urine input - give IV fluids - give broad-spectrum antibiotics - measure serum lactate and haemoglobin - administer high flow oxygen
49
What investigations would be ordered to diagnose sepsis?
- blood tests: CRP, WCC, platelets, clotting - microbiology: culture of blood, stool, urine, wound swab, tissue, CSF or sputum - viral studies: NAAT/PCR - serology: antibodies
50
Who should be called when diagnosing a case of sepsis?
Infection Control and/or Infectious disease unit and sometimes Public Health
51
Give 3 theories that explain stress.
- stress as a stimulus - stress as a response - stress as a transaction
52
Define stress.
the perceived discrepancy between demands of the situation and the resources of the person that they appraise in a stressful situation
53
Describe the model for stress appraisal.
stimulus --> primary appraisal If benign, irrelevant or positive appraisal, no further coping if stimulus appraised as harm/loss/threat --> perceived as a stressor --> secondary appraisal coping
54
What systems do stressors impact on?
- physiological - psychological - social
55
Differentiate between the fight or flight response and the general adaptation syndrome.
FIGHT OR FLIGHT - physiological reaction to emergencies (acute, short-lived stress) - increased physiological arousal GENERAL ADAPTATION SYNDROME - response to chronic/long-term stress - leads to exhaustion by depletion of resources
56
What are the two steps of physiological response to stress?
1. sympathetic activation | 2. hypothalamic-pituitary-adrenocortical (HPA) activation
57
Give 5 categories of typical signs of stress.
- biochemical - physiological - behavioural - cognitive - emotional
58
Why do responses to stress vary?
Stress moderators
59
Explain why stress has an indirect effect on health.
stress affects health-related behaviours (diet, smoking...)
60
Which movements will be assessed for power in a neurovascular examination of the lower limb?
- hip flexion - hip extension - knee flexion - knee extension - ankle dorsiflexion - great toe dorsiflexion - ankle plantarflexion
61
Which two reflexes will be assessed in a neurovascular examination of the lower limb?
- knee jerk (L3/4) | - ankle jerk (S1)
62
What are the 3 tests for coordination in a neurovascular examination of the lower limb?
- heel-shin - heel to toe - Romberg's test
63
Define coping.
process by which people manage the perceived discrepancy between demands of the situation and the resources of the person that they appraise in a stressful situation
64
What are the two types of coping?
- problem-focused coping | - emotion-focused coping
65
Name 11 coping strategies.
- planning - active coping - seeking social support - distancing - escape-avoidance - denial - distraction - self-control - substance use - accepting responsability - positive reappraisal
66
Give 4 examples of ways of coping with illness.
- normalising - denial - resignation - accommodation
67
Give 8 coping resources.
- money - health - sense of control - personality - beliefs and attitudes - become informed - exercise - social support
68
Name 2 ways to assess coping.
- Ways of Coping checklist | - COPE rating scale
69
Name the two personalities for coping.
- monitors | - blunters
70
What 4 components of social support are important in coping?
- networks - types - quantity - quality/satisfaction

MD2002 (10 decks)

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