Anatomy
What type of joint allows for least movement of adjacent structures? Where would you find this type of joint?
Fibrous joints. Can be found in sutures, tibiofibular joint, radio-ulnar joint
Explain affinity and efficacy with respect to agonists and competitive antagonists
Affinity: strength of binding
Efficacy: effect upon binding
Agonist has affinity and efficacy
Competitive antagonist has affinity but no efficacy
Describe the general steps in a physical examination
1. Introduction
2. Inspection
3. Vital signs
4. Palpation
5. Percussion
6. Auscultation
7. Conclusion
List 6 clinical features of Down Syndrome
Brushfield spots, short neck, slanted eyes with prominent epicanthal fold, single palmar crease, short stature, folding of ear helix, small flattened nose, hypotonia, hyperglossia, clinodactyly
What are the 4 components of the Public Health Framework/Model?
1. Surveillance
2. Risk Factor Identification
3. Development and Evaluation of Interventions
4. Implementations
Order the contents of the femoral sheath (5)
Nerve, Artery, Vein, Empty space (femoral hernia), Lymph
NAVEL
Name 3 types of drugs that can be used in a patient with hypertension
ACE inhibitors (prils)
Angiotensin II Receptor Inhibitors (sartans)
Beta Blockers (lols)
Diuretics (e.g. frusemide)
Describe 3 abnormalities involving the chest wall (relevant to respiratory examination)
Barrel chest - increased anteroposterior diameter
Funnel chest (pectus excavatum) - localised depression at lower end of the sternum
Pigeon chest (pectus carinatum) - localised prominence of the sternum and costal cartilages
Harrison's sulcus - linear depression of the lower ribs just above costal margins (can result from severe asthma in childhood, or rickets)
List the 5 different immunoglobulins and briefly describe
IgM (pentamer - 10 Ag binding sites) - primary Ab produced in response to initial Ag exposure
IgG (most abundant) - involved in long term immunity and Ab-mediated defense, can cross placenta to protect foetus
IgA (dimer - allows it to cross epithelial cells) - predominates in mucosal areas and body secretions (e.g. breastmilk), low concentration in plasma
IgD - on the surface of B cells, function not clear
IgE - involved in allergic reactions and defense against parasitic infections
What are the 4 criteria in obtaining patient consent?
Voluntary, Informed, Specific, Capacity
VISC
What are the structures at the sternal angle (angle of Louis)?
Rib (2nd costal cartilage), Aortic arch, Tracheal bifurcation, Pulmonary trunk bifurcation, Ligamentum arteriosum, Arch of azygos vein, Nerve (left recurrent laryngeal), Thoracic duct (crosses thorax)
What are 5 factors involved in oral absorption of a drug?
Lipid solubility, Molecular size (if water soluble), Full/Empty stomach, Taken with or without food, Stability of drug, Type and Properties of the form of administration (tablet vs liquid), First pass metabolism
FILMS GF
What is Dupuytren's contracture? (GIT)
A visible and palpable thickening and contraction of the palmar fascia causing permanent flexion, most often of the ring finger (often bilateral, associated with alcoholism)
Explain the 4 classes of shock (Class 1 to Class 4)
Class 1: HR<100, RR=14-20, BP normal, Blood loss <750mL (<15%), PP norm/incr, Urine output >30mL/hr
Class 2: HR>100, RR=20-30, BP norm, Blood loss =750-1500 (15-30%), PP decr, Urine output =20-30mL/hr
Class 3: HR>120, RR=30-40, BP decr, Blood loss =1500-2000 (30-40%), PP decr, Urine output =5-15mL/hr
Class 4: HR>140, RR>35, BP decr, Blood loss >2000 (>40%), PP decr, Urine negl
What is Gillick competence?
What are the factors?
'Gillick competence' refers to a young person under 16 with capacity to make any relevant decision
Name the 11 structures in the transpyloric plane
Hila of kidneys, Hepatic portal vein, L1 vertebra, Pancreatic neck, Pylorus of Stomach, Transverse mesocolon, 9th costal cartilage, Fundus of gallbladder, Duodenojejunal flexure, Origin of SMA, Spinal Cord termination
Why does St John’s wort reduce the effectiveness of the oral contraceptive pill?
St John's Wort is an inducer of the CYP3A4 enzyme (which metabolises the active ingredients in the OCP - ethinyloestradiol and levonorgestrel). Therefore St John's Wort will speed up the inactivation of the OCP and reduce its efficacy.
What are 3 high-yield questions to ask a patient presenting with constipation?
What is the colour/consistency/odour of your stool?
Any pain or straining?
Has your bowel habits changed recently?
Is there any blood in the stools?
Have you experienced any recent weight loss?
Do you have a history of colon polyps or cancer?
Is there a family history of colon cancer?
Describe the three phases of the menstrual cycle
1. Proliferative (follicular) - endometrium thickens, follicle grows and oocyte develops, LH surge triggers ovulation
2. Secretory (luteal) - fate of the oocyte and developing corpus luteum decided, progesterone predominates
3. Menstruation - stratum functionale degenerates and is sloughed off, coiled arteries undergo cell death, progesterone withdrawal
List the 5 criteria for mandatory reporting for children and young adults
1. Emotional abuse
2. Sexual abuse
3. Physical abuse
4. Neglect
5. Family violence
What is the uncinate process of the pancreas? What are the anterior and posterior anatomical relations?
Bonus points for clinical significance
The uncinate process is an extension of the head of the pancreas
Anteriorly: Lies posterior to the superior mesenteric vessels (artery/vein)
Posteriorly: Adjacent to the inferior vena cava (IVC) and sometimes the abdo aorta
Clinical: Whipple procedure (pancreaticoduodenectomy) - wary of superior mesenteric vessels
Describe the Penicillin mechanism of action
Penicillin is a beta-lactam antibiotic class of drugs that interferes with cell wall synthesis. The β-Lactam is a D-Alanine analogue, which competitively binds to penicillin-binding protein (PBPs) to prevent peptidoglycan synthesis
Where is McBurney's point and what is its clinical significance?
McBurney's point lies 2/3 of the way from the umbilicus to the anterior superior iliac spine.
It corresponds to the location of the base of the appendix
Describe the stages of haemoglobin metabolism
Haemoglobin from old RBCs is broken down into globin (degraded to amino acids) and haem.
Haem is first oxidised to biliverdin by haem oxygenase-1 with the release of iron.
Biliverdin is oxidised to unconjugated bilirubin by biliverdin reductase.
Bilirubin is released into plasma where it is largely bound to albumin
Bilirubin is conjugated in the liver by GDP glucoronyl transferase and excreted as bile
The GIT bilirubin is catabolised by gut microflora to urobilinogen (most is reabsorbed and returns to liver, some reaches the kidneys and is excreted as urobilin (orange), some is oxidised further to stercobilin and excreted in faeces)
Name the 9 Bradford Hill criteria
Strength of association, Coherence, Specific, Biological Gradient, Plausibility, Consistency, Analogy, Experimental Evidence, Temporal
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