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Adrenocorticotrophic hormone (ACTH):
-Is a peptide hormone.
The CVP is increased in:
- Tension pneumothorax
- Heart failure
- Pleural effusion
- Pulmonary embolus
- Cardiac tamponade
- Mechanical ventilation (PEEP)
- Forced exhalation
The CVP falls with
Any blood borne pathogen can be potentially transmitted via a needlestick injury including
- Ø HIV
- Ø hepatitis B, C and D
- Ø herpes simplex
- Ø herpes zoster
- Ø diphtheria.
- Regarding needlestick injuriesàrisk of transmission is higher with a
- Ø hollow needle than with a solid needle.
Regarding needlestick injuries-> risk of contracting HIV from an HIV positive source patient is
Ø between 0.2-0.5%.
Thoracic outlet syndrome involves compression of the
Ø subclavian artery and brachial plexus à they pass between the anterior scalene and middle scalene muscles at the superior thoracic aperture.
Causes of thoracic outlet syndrome include:
- Scalenus anticus syndrome
- Cervical rib syndrome
- Costoclavicular syndrome
- Pancoast tumour
Thoracic outlet syndrome àAdson's sign is the
Ø loss of the radial pulse in the arm caused by rotating the head to the affected' side with an extended neck following deep inspiration.
- Ø enhance the effects of GABA resulting in sedative, hypnotic, anxiolytic, anticonvulsant and muscle relaxant properties.
- Midazolam is a short-acting benzodiazepine à half-life
- Ø 2-6 hours
BZD + first-line drug of choice in the emergency tranquilization of violent or disturbed patients.
- Ø Oral lorazepam 1-2 mg or IM lorazepam 2-4 mg
- The dose of lorazepam in adult status epilepticus is
- Ø 4mg IV
- Regarding the neck of the femurà Anteriorly the capsule attaches at
- Ø intertrochanteric line
Regarding the neck of the femuràposteriorly the lateral half of the femoral neck is
Regarding the neck of the femurà intertrochanteric line lies
- Ø anteriorly
- Regarding the neck of the femurà intertrochanteric crest lies
- Ø posteriorly.
Intertrochanteric fractures do not disrupt the blood supply entering through the retinacula on the neck and can therefore usually be managed with the
Ø placement of a dynamic hip screw.
Atropine is a
Ø muscarinic receptor antogonist -> reduces parasympathetic activity.
Ø cycloplegic (paralyses the ciliary muscle of the eye) -> paralyses the accommodation reflex. It is also a mydriatic, causing pupillary dilatation.
Atropine causes relaxation of the
Ø smooth muscle in the gut, urinary tract and biliary tree.
The side effects of atropine include:
- Ø Nausea, dizziness, blurred vision, photophobia, dry mouth, urinary retention, confusion and hallucinations.
- Ø Confusion and CNS side effects are particularly prominent in the elderly.
In a cross-over study each patient receives treatment and placebo in a
- Ø random order.
- Ø suitable for chronic disorders that are not cured but for which treatment may give temporary relief.
Case-control studies are a type of
Ø observational study.
Cross-sectional studies are a type of
Ø observational study
The proximal convoluted tubule reabsorbs approximately:
- 100% of filtered glucose
- 100% of filtered amino acids
- 80% of filtered phosphate
- 65% of filtered potassium
- 65% of filtered sodium
- 50% of filtered urea
Pulmonary surfactant is a
- Ø mucopolysaccharide.
- Ø Decreases surface tension.
- Ø Keeps alveoli dry
- Ø Increases compliance
Gastrocnemius is innervated by the
- Ø Tibial nerve
- Ø nerve roots S1 and S2.
- Ø Sural arteries
Anatomy of the calf + frequently a sesamoid bone called the
- Ø fabella lying -> lateral head of the gastrocnemius muscle.
- Ø present in 10-30% of the population and can be mistaken for a loose body or an osteophyte.
Plantaris assists gastrocnemius in
Ø plantar-flexion of the ankle and flexion of the knee.
The sural arteries are two large branches arising from the popliteal artery that supply
- Ø gastrocnemius
- Ø soleus
- Ø plantaris.
Systolic blood pressure =
Ø 90-140 mmHg
Diastolic blood pressure =
Ø 60-90 mmHg.
The mean arterial pressure (MAP) =
Ø (diastolic blood pressure + 1/3 of the pulse pressure) and = 70-105 mmHg.
Stroke volume =
Ø 60-100 ml/beat
Partial pressure of oxygen =
Ø 80-100 mmHg
The complete hepatitis B virion is referred to as the
Ø Dane particle.
- Ø acute infection and high infectivity
- Regarding hepatitis B % become chronic carriers
- Ø 5-10% become chronic carriers.
AntiHBc IgM signifies
- Ø recent acute infection
- Ø only present for less than 6 months.
Neutrophils defend against
Ø bacterial and fungal infections.
Basophils release histamine as part of an
Ø allergic response.
Eosinophils primarily deal with
Ø parasitic infections.
Monocytes share the phagocytic function of neutrophils but live
Ø much longer.
Posterior myocardial infarction-> vessel involved is the
- Ø right circumflex artery.
- Ø Usually occurs as part of an inferior or lateral myocardial infarction.
- Ø Tall R wave in lead V1 + ST depression in leads V1-V3.
Regarding antipsychotic drugs + Extrapyramidal side effects occur most commonly with
- Ø piperazine phenothiazines
- o (fluphenazine, prochlorperazine and trifluoperazine)
- Ø butyrophenones
- o (benperidol and haloperidol).
Regarding antipsychotic drugs + renal impairment
Ø Reduce dosis->increased cerebral sensitivity
Haloperidol is the first-line drug for dementia-related psychosis
Ø NO-> increased risk of mortality in elderly pt-> increased risk of cardiovascular events and infections such as pneumonia.
Rescue breathing (expired air ventilation) can only deliver an expired oxygen concentration of
Ø approximately 16-17%.
10 L/min of oxygen via a mask with a reservoir bag can deliver an inspired oxygen concentration of
High inflation pressures tend to cause gastric inflation thereby
Ø reducing lung compliance.
Regarding magnesium + normal range is
- Ø 0.75-1.2 mmol/l.
- Regarding magnesium + body contains between
- Ø 21-28 g of magnesium.
- Regarding magnesium + primarily absorbed in the
- Ø duodenum.
Magnesium is an effective treatment both in
Ø eclampsia and acute asthma.
Regarding the femoral nerve lies
Ø lateral to the femoral artery and vein.
Regarding the femoral nerve + nerve roots
The femoral nerve is formed in the abdomen
- Ø within the psoas major muscle and descends through the fibres of it and emerges at the lower part of its lateral border.
- Ø It overlies the iliacus muscle.
Regarding the femoral nerve + anterior division gives off the
- Ø anterior cutaneous branches
- Ø branches to pectineus and sartorius.
Regarding the femoral nerve + posterior division gives off
- Ø rectus femoris
- Ø vastus lateralis
- Ø vastus medialis
- Ø vastus intermedius.
- Ø absorbable
- Ø synthetic suture made primarily of polyglactin.
- Ø its tensile strength for 3-4 weeks.
- Ø braided suture
Regarding the small intestine:
- · It averages 6-7 metres in length.
- · pain ->referred to the T9-T10 dermatomes.
The wall of the jejunum is
· thicker due to its thick circular folds (the plicae circularis).
Peyers patches are organized lymphoid nodules that are present in the
Regarding meningococcal septicaemia in children The commonest causative agent UK
- · Neisseria meningitidis.
- · The choice of fluid in septic children is debated but 4.5% human albumin should be given after an initial 2 boluses of crystalloid have been administered.
- · dose of IV Ceftriaxone is 80 mg/kg.
The most common inherited coagulation disorder
· Von Willebrand disease
Haemophilia A is due to a
· factor VIII deficiency.
Haemophilia B is due to
· factor IX deficiency.
Acquired vWD occurs in patients with
· aortic stenosis -> gastrointestinal bleeding (Heyde's syndrome).
Regarding membrane receptors for hormones: They are often
Catecholamines, glucagon and luteinizing hormone are examples of hormones that uses
· cAMP as a second messenger.
Atrial natriuretic peptide (ANP) and nitric oxide use
· cGMP as a second messenger.
Chronic myeloid leukaemia (CML): Philadelphia chromosome
- · 90% of cases
- · Almost all patients with CML eventually progress to blast crisis.
- · low neutrophil alkaline phosphatase score
- · serum B12 is typically high due to the production of a B12 binding protein by white cells.
Philadelphia chromosome is a balanced translocation between
· chromosomes 9 and 22.
The injection of 100,000 units/ml of tuberculin purified protein derivative into the skin using a Sterneedle gun is the
· Heaf test.
The Mantoux test involves the injection of
· 5 Tuberculin units (0.1mL) intradermally.
The boundaries of the posterior triangle of the neck are:
- Superiorly (apex): the union of sternocleidomastoid and trapezius at the occiput
- Inferiorly (base): middle third of clavicle
- Anteriorly: posterior border of sternocleidomastoid
- Posteriorly: anterior border of trapezius
The contents of the posterior triangle of the neck include:
- Muscles: Inferior belly of omohyoid, the scalenes, splenius and levator scapulae
- Veins: terminal part of external jugular vein
- Arteries: third part of subclavian, transverse cervical and suprascapular arteries
- Nerves: spinal root of accessory nerve (CN XI), branches of cervical plexus, root and trunks of brachial plexus, phrenic nerve
- Other structures: lymph nodes
The ansa cervicalis is a loop of nerves that form part of the cervical plexus. It lies within the
· anterior triangle of the neck.
- · caseating granulomas -> Langhan's giant cells.
- · lacks an outer cell membrane.
- · NAAT is a rapid method for the detection
- · Culture on Lowenstein-Jenson medium takes 4-6 weeks
Regarding acute phase proteins: facilitate the
· phagocytic uptake of bacteria
Ferritin acts by
· binding iron and preventing microbial iron uptake.
CRP binds phosphocholine expressed on the
· surface of dying cells and certain bacteria in order to activate the complement system.
CRP is synthesized in the
An FEV1/FVC ratio normal values
· approximately 80%.
In restrictive lung disease the FEV1and FVC ratio are
· equally reduced, therefore the FEV1/FVC ratio is usually normal.
suggestive of respiratory muscle weakness
- · A reduction in vital capacity, FEV1, FVC and FEV1/FVC ratio
- · Arterial blood gases are usually only abnormal in late and severe impairment of respiratory muscles and are less helpful in the evaluation of respiratory muscle weakness.
Pulse oximetry gives
- · NO information about ventilation
- · only provides information about oxygenation.
Levator palpabrae superioris is innverated by the
· oculomotor nerve.
The inferior oblique muscle
· rotates the eye away from the nose (extorsion), moves the eye upwards (elevation) and outwards (abduction).
The relations of the descending colon are:
- Anteriorly: small intestine
- Posteriorly: left kidney, iliacus, quadratus lumborum
Type 1 renal tubular acidosis
- · hypokalaemia
- · low bicarbonate level
- · high urinary pH
- · normal anion gap
The normal range for chloride is
· 95-105 mmol/l
Type 1 renal tubular acidosis is associated with
· nephrocalcinosis ->of calcium stones to develop at alkaline urinary pHs. -> renal colic.
The anion gap is calculated using the following formula:
· Anion gap = (Na + K) (Cl + HCO3)
The normal anion gap is
· 8-16 mmol/l
Heinz bodies are inclusions within red blood cells composed of denatured haemoglobin. They can be caused by oxidant damage or inherited mutation. Causes include:
- G-6-PD deficiency
- NADPH deficiency
- Chronic liver disease
Howell-Jolly bodies are basophilic nuclear remnants that are seen in
- · asplenia.
- · haemolytic anaemias
- · megaloblastic anaemias
- · hereditary spherocytosis
- · myelodysplastic syndromes.
Tear drop cells, or dacrocytes, are associated with
Basophilic stippling is seen in
- · lead poisoning
- · sideroblastic anaemia.
Ecstasy is a
phenylethylamine compound with similarities to amphetamines and mescaline.
Ecstasy + Recognised side effects include:
- · fulminant hyperthermia
- · convulsions
- · rhabdomylosis
- · inappropriate ADH secretion
- · DIC
- · liver failure
- · cerebrovascular accidents.
Medical emergency team (MET) calling criteria
- · A respiratory rate of < 5 per minute or > 36 per minute
- · A heart rate of < 40 per minute or > 140 per minute
- · A systolic blood pressure < 90 mmHg
- · A decrease in GCS of > 2 points
TB Pulmonary infection accounts for
-> 70% of cases of post-primary tuberculosis.
Graves disease is caused
- - thyroid autoantibodies that activate the TSH receptor stimulating thyroid hormone synthesis.
- -Approximately 30-50% ->Graves ophthalmopathy.
- - catechol (a 1,2-dihydroxybenzene group) and an amine side-chain.
- - have a half-life of a few minutes.
->cannot cross the blood-brain-barrier.
Regarding Sickle-cell disease
- - Autosomal RECESSIVE
- - One third of all indigenous inhabitants of Sub-Saharan Africa carry the gene.
- -Symptoms usually don't occur until after 4 months of age.
- -painful crises typically affect -> long bones, back and chest.
Normal cerebral blood flow is
- - 50 ml of blood per 100 g brain tissue per minute.
- - 750 ml per minute,
- - 15% of the cardiac output.
- - 20% of total body oxygen consumption. (approximately 3.3 mls of oxygen per 100 g of brain tissue per minute)
Cerebral perfusion pressure
- -(CPP) = mean arterial pressure (MAP) intracranial pressure (ICP).
- -Mean arterial pressure is usually around 90 mmHg and intracranial pressure is normal when less than 13 mmHg, therefore a normal CPP is -> 80 mmHg.
response to hypercarbia
-> Cerebral blood vasodilation
Helicobacter pylori is
- -Gram-negative, helix shaped (curved rod), microaerophilic bacterium.
- -outer membrane -> phospholipids and lipopolysaccharide
- -typically has 4-6 lophotrichous flagella->highly motile.
Cytochrome p450 enzyme inducers inhibit the effects of warfarin resulting in a reduced INR. The mnemonic PC BRASS can be used to memorise the commonly encountered cytochrome p450 enzyme inducers:
- P - Phenytoin
- C - Carbemazepine
- B - Barbiturates
- R - Rifampicin
- A - Alcohol (chronic ingestion)
- S - Sulphonylureas
- S - Smoking
Sodium valproate and Isoniazid are a
->cytochrome p450 enzyme inhibitor ->potentiates the effects of warfarin (increases the INR).
Haemophilia A affects
- - 1 in 5000 males.
- - X-linked RECESSIVE disorder.
Haemophilia B affects
- 1 in 50,000 males.
Factor IX has a
· longer half life than factor VIII.
- - mild form of haemophilia that occurs in both sexes.
- - It predominantly affects in Ashkenazi Jews.
Regarding Starling's law of the heart:
- -energy released during contraction depends on the initial fibre length.
- - the stroke volumes of the left and right ventricles are matched.
- -Peripheral vasoconstrcition -> increased systemic vascular resistance-> increases afterload ->decreases the velocity of fibre shortening->shifts the curve down and to the right.
Dandy-Walker syndrome (cerebellum and the ventricular system)
- Enlargement of the 4th ventricle
- Complete or partial absence of the cerebellar vermis
- Cyst formation near the base of the skull
- Raised intracranial pressure may be present
leucoerythroblastic blood picture -> 2 main causes:
- 1. Bone marrow infiltration e.g. metastatic cancer, leukaemia, myeloma, lymphoma, myelofibroma, osteopetrosis and storage diseases such as Gaucher's disease.
- 2. Acute severe illness e.g. severe haemolysis, massive trauma and sepsis.
oxygen saturation of 50% the PaO2 is approximately
-> 3.5 kPa.
Right shift indicates
->decreased oxygen affinity of Hb allowing more Oxygen to be available to the tissues.
The medical and lateral collateral ligaments are
The anterior and posterior cruciate ligaments are
The physiological effects of high altitude
- -Blood pressure is usually unchanged in normal individuals but can rise slightly in hypertensive
- -Cardiac output rises initially and returns to normal after acclimatization.
- -increased erythropoietin production.
- -initial fall in plasma volume at altitude that is gradually corrected with acclimatization.
Most aortic aneurysms are
Regarding electrical shock injuries:
- -Cardiac arrhythmias are more common when electrical energy passes transthoracically.
- -Massive tissue necrosis -> rhabdomyolysis and myoglobinuria.
- -Lichtenberg figures are feathery
- -branching skin lesions seen most commonly after lightning strikes.
- -Approximately 2/3 of patients struck by lightning have perforated eardrums.
Lung abscess is a rare complication of lobar pneumonia occurring in approximately
-> 2% of patients.
thrombocytopenia of ITP is caused by
-> IgG anti-platelet antibodies
Regarding digoxin toxicity: Xanthopsia is a
-> rare feature of digoxin toxicity.
Risk factors for digoxin toxicity include:
- Age over 55
- Male gender
- Underlying heart disease
- Pre-existing renal failure
Therapeutic range of digoxin is
- · 1-2 µg/l.
- · Severe toxic -> levels greater than 4.0 µg/l.
- · Repeated doses of activated charcoal can be used and are thought to be of value in increasing elimination.
Cushing's syndrome can be confirmed by
- either a dexamethasone suppression test or 24-hour urinary free cortisol collection
Regarding afterload: It is closely related to
- -> both aortic pressure and ventricular wall stress.
- - increase in afterload shifts the Frank-Starling curve down and to the right as it decreases the velocity of fibre shortening
BTS guidelines for the management of acute severe asthma are:
- High flow oxygen
- Short acting beta2 agonist via large-volume spacer or nebuliser
- PO Prednisolone or IV hydrocortisone
Monitor response for 15-30 minutes and if response poor:
Inhaled ipratropium bromide via nebuliser
Refer those who fail to respond and require ventilatory support to intensive care / HDU and consider:
- IV beta2 agonist or;
- IV aminophylline or;
- IV magnesium sulphate->If required the dose of IV magnesium sulphate is 1.2-2 g IV given over 20-30 minutes.
- ->Alcohol hand gel is ineffective against Clostridium difficile spores
- -Clostridium difficile 027 is a hyper-virulent strain that is increasing in incidence mainly in North America and is also becoming more prevelant in the UK.
- -The main infecting strain in the UK remains Clostridium difficile 001.
Mycoplasma pneumoniae infection is not associated with infective endocarditis. It is associated with the following extra-pulmonary sequelae:
- 1. Skin: Erythema multiforme, Stevens-Johnson syndrome
- 2. CNS: Guillain-Barre syndrome, menegitis, encephalitis, optic neuritis, cerebellar ataxia and cranial nerve palsies
- 3. GIT: Anorexia, nausea, diarrhoea, hepatitis and pancreatitis
- 4. Haem: Cold agglutinins, haemolytic anaemia, thrombocytopenia and DIC
- 5. CVS: Pericarditis and myocarditis
- 6. Rheum: Arthralgia and arthritides
- 7. Renal: Acute glomerulonephritis
The arterial supply to the thymus is derived from
- ->the internal thoracic artery
- ->the superior and inferior thyroid arteries.
Regarding ABO blood grouping:
- -The majority of Caucasian men -> rhesus positive.
- -Anti-A and anti-B antibodies -> usually IgM type.
->AB rhesus positive
Anti-Kell antibodies play an important role in
->the development is autoimmune haemolytic anaemias and haemolytic disease of the newborn.
gram negative cocci:
- -Neisseria menigitidis.
- -Moraxella catarrhalis.
The pharynx becomes the oesophagus at
The oblique fissure of the lung lies at
The origin of the celiac axis lies at
The renal arteries arise at
The trachea bifurcates at
->T4/T5. The statement is true.
The larynx becomes the trachea at
- -> C6.
- The union of the common iliac veins occurs at
- -> L5 (This is the formation of the inferior vena cava).
The origin of the inferior mesenteric artery occurs at
Openings in the diaphragm:
- ->for the inferior vena cava lies at T8.
- ->for the aorta lies at T12.
- ->for the oespohagus lies at T10.
- -> the thoracic duct at T12.
following structures lie at the vertebral level of T4/T5:
- - Sternal angle
- -The start of the arch of the aorta lies at T4/T5.
- -Bifurcation of the trachea
The top of the arch of the aorta lies at
The superior angle of the scapula lies at
following structures lie at the vertebral level of L1:
- -Transpyloric plane of Addison
- -Origen superior mesenteric artery
- -fundus gallbladder
- -hiia kedney
The area over the deltoid
The symphysis pubis
The medial aspect of the calf
The webspace between the 1st and 2nd toe
The lateral border of the foot
The ischial tuberosity area
S4 and S5 The perianal region
normal range for serum albumin is
-> 35-50 g/l.
normal range for creatinine in an adult male is
-> 60-110 µmol/l.
anion gap is calculated using the following formula:
-> Anion gap = (Na) (Cl + HCO3)
normal range for the anion gap (when potassium is excluded) is
-> 8-16 mmol/l.
The anion gap is reduced by
-> about 2.5 mmol/l for every 10 g/l fall in albumin concentration.
plasma osmolality is calculated using the following formula:
-> Plasma osmolality = 2(Na + K) + Urea + Glucose
he platelet count needs to fall to less than before spontaneous bleeding will occur.
· < 20 x109/l
Cortisol is produced in the
· zona fasciculata
The main functions of cortisol are:
- Increasing blood glucose levels via stimulating gluconeogenesis
- Fat, protein and carbohydrate metabolism
- -average age 25.
- -Drugs such as chloramphenicol, phenytoin, quinine and benzene
- -Associated with connective tissue disease ->SLE.
Drugs that cause gynaecomastia include:
- -Cimetidine-> resolve when it has been substituted with ranitidine.
- -some anti-pyschotics.
Marijuana usage has been linked with
->The complete hepatitis B virion
-> 5-10% become chronic carriers.
AntiHBc IgM signifies
-> recent acute infection and it usually is only present for less than 6 months.
causes of a raised amylase level:
- Infections e.g. mumps
- Inflammation e.g. acute pancreatitis, hepatitis, peritonitis
- Metabolic e.g. renal failure, DKA
- Neoplasia e.g. pancreatic carcinoma
- Vascular e.g. mesenteric ischaemia
- Drugs e.g. opiates, ciprofloxacin
Tibialis anterior is innervated by the
-> deep fibular nerve.
The calcaneus is the
->largest bone in the tarsal region. The talus is the second largest.
antibodies are associated with the following gastrointestinal and liver diseases:
- Anti-mitochondrial antibodies primary biliary cirrhosis
- Anti-smooth muscle antibodies auto-immune hepatitis, cryptogenic cirrhosis
- Anti-gliadin antibodies coeliac disease
- Anti-endomysial antibodies coeliac disease
- Intrinsic factor antibodies pernicious anaemia
- Gastric parietal cell antibodies pernicious anaemia, gastric atrophy
The gallbladder is related inferiorly to the
-> duodenum and the transverse colon.
-95% of bile salts that enter the small intestines in bile are recycled and reabsorbed into the portal circulation by active transport mechanisms in the distal ileum.
Hepatocytes metabolise cholesterol to
-> cholic acid and chenodeoxycholic acid.
The total bile salt pool in a healthy adult is
- -> approximately 5 g.
- -> 20-30 mg of bile pigment is reabsorbed/day in a healthy adult.
Scarlet fever has an incubation period of
average 70kg adults at normal resting state:
- -circulating volume would be approximately 5000ml.
- -Approximately 15% of the blood is in the arterial system.
- -venous system contains approximately 3000ml of blood.
- - pulmonary circulation.25% (1250ml) of the blood volume is in the
The classical pathway is activated by
- -> antibody-antigen complexes.
- The MAC is formed on
- ->the surface of pathogenic bacterial cells as a result of the activation of the ALTERNATIVE pathway->transmembrane channels -> disrupt the phospholipid bilayer of target cells ->cell death.
- An opsonin is a molecule that targets an
- -> ANTIGEN for an immune response.
following are causes of eosinophilia:
- Allergy e.g. asthma and hayfever
- Parasitic infections e.g. filariasis, ascariasis and toxocariasis
- Skin disease e.g. eczema and psoriasis
- Hodgkins disease
- Tropical eosinophilia
- Polyarteritis nodosa
Aspirin is a non-competitive cyclo-oxygenase antagonist. It works by
-> covalently acetylating the cyclo-oxygenase active site in both COX-1 and COX-2.
At low doses (75 mg per day) aspirin only inhibits
-> COX-1, the enzyme responsible for making thromboxane A2, and therefore principally exhibits an anti-thrombotic effect.
At medium to high doses (500-5000 mg per day) aspirin inhibits
-> both COX-1 and COX-2. COX-2 is responsible for the production of prostaglandins and therefore has an anti-inflammatory effect at these doses.
The effects of a single dose of aspirin last
-> 7-10 days, the time required for the bone marrow to generate new platelets.
is classified as follows:
- Mild 32-35°C
- Moderate 30-32°C
- Severe < 30°C
- -J waves may be seen between the QRS complex and the T wave. The statement is true.
- -AF and bradycardias are the commonest rhythm disturbances seen on ECG.
-Defibrillation is appropriate at normal energy levels if VF or VT are present. If 3 shocks are unsuccessful then further shocks should be deferred until core the core temperature is > 30°C. Defibrillation is often ineffective below 30°C.
- -> produced by the S-cells in the mucosa of the duodenum and jejunum
- -> in response to increased acidity.
- -> increases bicarbonate ion production and release from the exocrine pancreas, bile ducts and from the Brunner's glands in the duodenum-> bicarbonate ions act to neutralize the acid and establish a pH conducive to the action of other digestive enzymes.
Secretin stimulates the release of:
- Pancreatic polypeptide
-> + myeloperoxidase and Sudan black , - negative for PAS.
Codeine phosphate and dihydrocodeine have
-> similar potencies.
At rest the blood in the coronary vein is
-> 25% saturated with oxygen.
Pain sensation is transmitted to the CNS via
-> small unmyelinated C fibres.
Wound healing is impaired by the following:
- Poor blood supply
- Superimposed wound infection
- Foreign material in the wound
- Nutrient deficiency e.g. vitamin C deficiency
- Drugs e.g. corticosteroids
The common digital nerves are derived from
- - median and ulnar nerves.
- -They divide in the DISTAL palm -> paired volar branches.
- -run with the digital vessels on either side of the flexor tendon sheath of each finger.
dorsal digital nerves are derived from the
-> ulnar and radial nerves.
Following result in a raised Troponin:
- -Cardiac contusion causes raised cardiac troponins.
- -Desfibrillator shock
- -Non-cardiac diseases: critically ill patients, high dose chemotherapy, primary pulmonary hypertension, pulmonary embolism, renal failure, subarachnoid haemorrhage, sepsis, stroke, ultra endurance exercise.
The median eminence is
->part of the inferior boundary of the hypothalamus-> Regulatory hypophysiotropic hormones collect -> before entering the hypophyseal portal system->connects the hypothalamus with the anterior lobe of the pituitary gland.
management of anaphylaxis in an 6-12 year old
- · IM adrenaline in 6-12 year olds is
- · 300 mcg (0.3 ml of 1:1000).
- · Crystalloid 20 ml/kg.
- · IV Adrenaline 1 mcg/kg/min.
- · IV Hydrocortisone in 6-12 year olds is 100 mg.
Platelets will be present in Whole blood but they will have lost function after
-> approximately 24 hours.
Fresh frozen plasma must be used within
-> 1 hour of thawing.
the neck of the femur:
- -> Capsule->Anteriorly the capsule attaches at the intertrochanteric line, posteriorly the lateral half of the femoral neck is extracapsular.
- - The intertrochanteric line -> anteriorly
- - intertrochanteric crest ->posteriorly.
The descending colon passes
->along the lateral border of the left kidney.
Causes of cranial diabetes insipidus include:
- Pituitary surgery
- Infiltrative processes e.g. sarcoidosis, histiocytosis X
- Lymphocytic hypophysitis
U waves occur in
->hypokalaemia, hypercalcaemia, thyrotoxicosis, digitalis exposure, in patients taking anti-arrhythmics and in long QT syndrome.
Inverted U waves may represent
Lamellar corpuscles (Pacinian corpuscles)
->vibration and pressure sense.
Bulbous corpuscles (Ruffini's corpuscles)
Free nerve endings
-> pain sensation (nociception).
-> light touch.
-> glutamic acid ->is replaced by valine.
Ad fibres are
- ->velocity of approximately 20 m/sec.
- -terminate in the upper laminae of the dorsal horn.
C fibres are
- ->velocity of approximately 2 m/sec.
- - transmit temperature sensation.
Facultative anaerobic bacteria make ATP via aerobic respiration and are also capable of switching to fermentation. Examples include:
- Escherichia coli
- Staphylococcus spp
- Listeria spp
- Shewanella oneidensis
- -half-life of 5-30 hours
- -used as an adjunct in alcohol withdrawal. Diazepam is a suitable alternative and also commonly used.
- -should be reduced in patients with renal impairment.
the only benzodiazepine with predictable intramuscular absorption.
following are the relations of the inguinal canal:
- Anteriorly skin, Camper's fascia, Scarpa's fascia, aponeurosis of external oblique, superficial inguinal ring (medial 1/3 of canal)
- Posteriorly transversalis fascia, conjoint tendon, deep inguinal ring (lateral 1/3 of canal)
- Superiorly internal oblique, tranversus abdominis, medial crus of external oblique
- Inferiorly inguinal ligament, lacunar ligament (medial 1/3 of canal), iliopubic tract (lateral 1/3 of canal)
The sternal angle is located
- -> opposite the second pair of costal cartilages.
- The manubrium lies at
- -> T3 and T4 vertebrae.
A size 4 LMA requires
-> 30 mls of air to inflate the cuff.
The PLMA has an additional
-> POSTERIOR cuff and a gastric drain tube.