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Korsakoff's syndrome is caused by
· thiamine (vitamin B1) deficiency.
There are six main symptoms of Korsakoff's syndrome:
- · Anterograde amnesia
- · retrograde amnesia
- · confabulation
- · meagre conversation
- · lack of insight and apathy.
The symptoms of Korsakoff's can sometimes be improved by the administration of
- · thiamine
- · however Korsakoff's is a persistent and irreversible process.
Wernicke's syndrome is
· reversible by the administration of thiamine.
Tthe commonest cause of the Wernicke-Koraskoff syndrome.
· Chronic alcohol abuse
Diagnosis of acute compartment syndrome should be considered + mmHg
· Interstitial tissue pressures > 30 mmHg
acute compartment syndrome + Complications include
- · rhabdomylosis
- · renal failure
- · Volkmann's contracture.
Prolonged exercise can cause
· chronic compartment syndrome->relieved by discontinuing the exercise and is not dangerous.
Labetolol is indicated Treating hypertension in acute stroke has been shown to reduce the risk of intracranial if the
· systolic BP is > 220 mmHg or the diastolic BP is > 120 mmHg. haemorrhage.
Propranolol can be used in the prophylaxis of
- Atenolol dose
- · not cross the blood brain barrier.
Bisoprolol has a half life of
- · 10-12 hours
- There are three phases of wound healing:
- 1. inflammatory phase (up to 48 hours after injury)
- 2. proliferative phase (up to 3 weeks after injury)
- 3. maturation phase (up to 1 year after injury)
The inflammatory phase (up to 48 hours after injury)
- · Blood vessels dilate to allow antibodies, white blood cells, growth factors, enzymes and nutrients to reach the wounded area.
- · The characteristic signs of inflammation are seen.
- · The predominant cell types seen are neutrophils and macrophages, which serve to autolyse and devitalized necrotic tissue.
The proliferative phase (up to 3 weeks after injury)
- · New granulation tissue
- · comprised of collagen and extracellular matrix develops.
- · Angiogenesis occurs with fibroblasts and capillaries growing into the necrotic areas.
The maturation phase (up to 1 year after injury)
- · The final phase occurs when the wound has closed.
- · Remodeling of collagen from type I -> type III.
- · Cellular activity reduces and the number of blood vessels in the wounded area regresses and decreases.
Wound remodeling continues for
· up to 1 year.
Causes of thrombocythaemia
· low platelets.
Other disease processes that can cause a raised platelet count include:
- · inflammatory bowel disease
- · sarcomas
- · rheumatoid arthritris
- · nephrotic syndrome
- · sepsis.
Sepsis can cause both
· raised and lowered platelet counts.
- The ulnar nerve arises from the
- · medial cord of the brachial plexus.
- · a root value of C8 / T1
The ulnar nerve lies
· medial to brachial artery at the midpoint of the humerus.
- The ulnar nerve supplies
- · flexor carpi ulnaris
- · medial half of flexor digitorum profundus
- · hypothenar muscles,
- · interossei
- · adductor pollicis
- · medial 2 lumbricals.
- Regarding the paediatric airway:
- The larynx in children lies at the level of C5/C6.
- The larynx in children lies high and anterior in children at the level of
- · C2/C3.
The narrowest part of the airway in children.
· cricoid ring
Uncuffed tubes should be used during resuscitation, by those without paediatric anaesthesia experience, for children up until approximately
· 10 years of age.
Regarding traumatic aortic disruption + Survivors usually have an
· incomplete laceration near the ligamentum arteriosum of the aorta.
The ligamentum venosum is the
· fibrous remnant of the ductus venosus -> attached to the left branch of the portal vein within the porta hepatis.
The ligamentum arteriosum tends to fix the
· aorta in place during rapid deceleration and recoil-> ruptured aorta.
Regarding traumatic aortic disruption It is the
- · second leading cause of death after traumatic brain injury.
- · Approximately 18% of deaths following RTA.
Regarding traumatic aortic disruption + Helical contrast enhanced CT scanning has
· 100% sensitivity and specificity for aorta rupture, however CT scanning should be reserved
Troponin C has
· 4 binding sites.
Posterior MI is associated with the following ECG changes:
- Tall, broad R waves in leads V1-V3
- ST depression in leads V1-V3
- Dominant R wave in lead V2
- Upright T waves in leads V1-V3
The anacrotic limb is the
- · first phase of the arterial pulse cycle
- · ventricles contract ->eject blood into the arterial tree.
- · The arterial pressure rises to the end-systolic pressure at the peak of the anacrotic limb.
The dicrotic limb is the
- · second phase of the pulse cycle
- · fall in arterial pressure -> reaches end-diastolic pressure.
A short systolic time represents
- · hypovolaemia
- · high systemic vascular resistance.
- Arterial lines measure systolic/diastolic blood pressure approximately than non-invasive blood pressure (NIBP) measurement
- · Systolic 5 mmHg higher
- · Diastolic 8 mmHg lower.
Sodium channels are made up of
· polypeptide chains.
The following mechanisms of injury would prompt transfer to a trauma centre:
- Fall > 20 feet for adult, > 10 feet for child
- High risk auto crash (intrusion > 12 in occupant site, intrusion > 18 in any site, ejection, death in same passenger compartment)
- Auto vs pedestrian / bicyclist (thrown, run over or > 20 mph at impact)
- Motorcycle crash > 20 mph
- · osmotic diuretic derived from sugar by reduction
- · treat raised intracranial pressure following head injury.
- · usual dose is 1 g/kg of 20% solution given as an IV bolus.
There are three major classes of second messenger:
- 1. Cyclic nucleotides (e.g. cAMP and cGMP)
- 2. Inositol triphosphate and diacylglycerol
- 3. Calcium ions
Atrial natriuretic peptide (ANP) and nitric oxide use
· cGMP as a second messenger.
C3 is important for
Deficiency in C3 results in a susceptibility to
- · infections caused by encapsulated bacteria such as
- o Streptococcus pneumoniae, Streptococcus pyogenes and Haemophilus Influenzae.
Deficiency in C5-C9 (which form the membrane attack complex) result in increased susceptibility to infection with
· Neisseria spp.
Deficiency in complement is associated with rheumatological conditions including
· systemic lupus erythematosus.
In western countries is the commonest complement deficiency (1 in 10,000 of the population)
The commonest complement deficiency in Japan and Korea.
· C9 deficiency
The blood supply to the stomach is as follows:
- Left gastric artery: derived from the coeliac trunk
- Right gastric artery: derived from the hepatic artery
- Left gastroepiploic artery: derived from the splenic artery
- Right gastroepiploic artery: derived from the gastroduodenal branch of the hepatic artery
- Short gastric arteries: derived from the splenic artery
The relations of the stomach are as follows:
- Anteriorly: diaphragm, abdominal wall, left lobe of the liver
- Posteriorly: diaphragm, aorta, spleen, left kidney, pancreas, transverse mesocolon, colon, lesser sac of peritoneum
· chimeric monoclonal antibody -> irreversibly binds glycoprotein IIb/IIIa receptors on platelets->preventing ->platelet activation and aggregation.
EPIC trial (1995) showed that abciximab reduced the risk of
· death, myocardial infarction, repeat angioplasty, CABG and balloon pump insertion for patients undergoing high-risk coronary angioplasty.
The typical urinary findings in pre-renal uraemia are:
- Urinary sodium < 20 mmol/l
- Urine: plasma osmolality ratio > 1.5:1
- Fractional sodium excretion < 1%
- Urine: plasma urea ratio > 10:1
- Urine volume < 1.5 L
Prolongation of the QT interval can be caused by:
- · Romano Ward syndrome.
- · Hypothermia
- · hypomagnesaemia
- · hypocalcaemia
- · hypokalaemia.
Romano Ward syndrome.
· autosomal dominant form of the long QT syndrome.
Other drugs that cause prolongation of the QT interval include:
- · Procainamide
- · Quinidine
- · Sotalol
- · methadone.
The horizontal fissure of the right lung is
- · incomplete in 60%
- · absent in 10%.
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.
· NOT cross the blood-brain-barrier.
Regarding Sickle-cell disease
- · Autosomal RECESSIVE
- · 1/3 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.
The mnemonic PC BRASS can be used to memorise the commonly encountered cytochrome p450 enzyme inducers-> inducers inhibit the effects of warfarin resulting in a reduced INR
- P - Phenytoin
- C - Carbemazepine
- B - Barbiturates
- R - Rifampicin
- A - Alcohol (chronic ingestion)
- S - Sulphonylureas
- S Smoking
- (Un ave Phenix tiene un Carbon en su boca que lo dispara a un Barbon Alcohólico Fumador Diabético con SULFAS que vente Rifa en una feria)
p450 enzyme inhibitor and potentiates the effects of warfarin (increases the INR).
- · Sodium valproate
- · Isoniazid
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.
digoxin toxicity 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.
The oesphagus is transmitted at the level of
The inferior vena cava is transmitted at the level of
The following structures are transmitted through the diaphragm at the level of T12:
- The abdominal aorta (strictly speaking behind the diaphragm)
- The thoracic duct
- The azygous vein
- The hemiazygous vein
The following are features of lithium toxicity:
- Nausea and vomiting
- Increased muscle tone
- Nephrogenic diabetes insipidus
- Renal failure