Week 27
Noxious stimuli will be perceived after traveling through which pathway?
Spinothalamic tract
What are the ligaments of the uterus?
round ligament of uterus = connect to anterior wall
broad ligament of uterus = connect to lateral wall
utero sacral ligament = connect to posterior wall
A patient states they could not feel the pinprick on their inner thigh. Which dermatome is affected?
L3
List four signs/changes that may indicate a doctor is impaired.
- recurrent job changes
- long periods b/w employment
- accepting jobs that are inappropriate or doctor is overqualified for
- physical deterioration
- signs of intoxication or withdrawal
- erratic mood & personality
- poor memory
- frequent medical complaints (staff and/or patient)
- persistent overwork
- absence from work
- loss of reliability
How would you define recurrent pregnancy loss?
2 or more miscarriages (explained or unexplained)
Sciatica is a cause of which type of pain?
Neuropathic (radiation from nerve irritation)
M1 receptors can achieve what type of action? (at least 1)
- salivary gland secretion
- gastric acid secretion
- autonomic ganglia
Distinguish foetal lie, presentation, and engagement.
Foetal lie = the position of the foetal vertebrae relative to mom (cephalic, transverse, oblique)
Foetal presentation = the part of the foetus that is presenting towards the pelvic outlet or closest to the mom's pelvis (cephalic/breech/shoulder)
Foetal engagement = the proportion of foetal head that has descended into the pelvis (indicated as fifths - engagement when widest part of the foetal head has descended)
Based on the cardiovascular risk calculator, outline the three categories of risk and give an example of a management suggestion.
High risk = >10% --> healthy lifestyle + anti-HTN Rx or lipid modifying Rx
Intermediate risk = 5-10% --> healthy lifestyle, consider anti-HTN Rx or lipid modifying Rx depending on context
Low risk = <5% --> healthy lifestyle, no Rx needed
Why would alteplase be given when managing ACS in the ED?
It's a fibrinolytic.
Converts plasminogen into plasmin, then plasmin breaks down fibrin to fragment the clot.
What type of pain management should be prescribed for neuropathic pain, and why?
Anti-depressant, anti-convulsants, topical anesthetics, physical therapy
Neuropathic pain doesn't respond well to opioid-like and NSAIDs pain medication as it is from a nervous system pathology, not a nociceptor pathology.
the 3 factors that promote thrombosis:
1-changes in vessel wall (injury & plaque buildup)
2-changes in blood flow (stasis)
3-changes in blood composition (hypercoagulability or increased viscosity)
If a patient presents with a positive anterior drawer test and lachman's test on their knee examination, what does that suggest?
ACL tear
List 3 recommendations into aged care quality and safety that are specific to dementia.
Any of the following:
- comprehensive, clear, accessible post-diagnosis pathway
- reviewing the specialist dementia care units to see if they are sufficient to address the needs of the areas/population they are designed to cover
- including dementia care standards in aged care quality
- improve design of aged care accommodation so that it's dementia-friendly
- enable mandatory dementia care training for employees of residential aged care & care in home
What are the five A's of smoking cessation?
Ask (about use, quitting, feelings on smoking)
Advise (attempt quitting & explaining ramifications)
Assess (willingness & motivation to attempt quitting)
Assist (attempt to quit through several methods)
Arrange (follow up to review progress)
What is the consequence of accidentally severing the superior laryngeal nerve?
Loss of innervation to cricothyroid muscle which tenses your vocal cords.
Not being able to tense vocal cords prevents ability to generate high pitch.
If someone received a blow to the pterion, what bone(s) can fracture?
Why is this injury dangerous?
Pterion= joining point between frontal, parietal, sphenoid, temporal bones
Middle meningeal A branch is just deep to the pterion. If there is a blow, can lead to epidural hemorrhage.
Analyse the following ABG results:
Respiratory acidosis with starting/partial compensation (but not full).
ph < 7.35 = acidotic
PaCO2>normal range = retaining CO2 (resp problem)
PaO2<normal range = not enough (confirms resp problem) supported by low SaO2
HCO3- >normal range slightly = suggests compensation is starting
List 4 examples of fall prevention.
- maintain strength & physical activity
- reduce use of ladders, and get support for home maintenance
- implement stepping On program to emphasize behaviour change
- stay on your feet program: community-based activities for older individuals
- increase awareness & knowledge of fall risks
- assessment, management, and rehabilitation for pts post-op
- home safety interventions by occupational therapists
A rare disorder of amino acid metabolism causes severe mental retardation if left untreated. If the disease is detected after birth a restrictive diet prevents mental abnormalities. Which of the following characteristics would be most desirable in a screening test for this disease?
A- High Sensitivity
B- High specificity
C- High positive predictive value
D- High cut-off value
E- High accuracy
A- High sensitivity
Want to confirm it's a truly positive and minimize false negatives because it can have detrimental effects if missed.
High positive predictive value = proportion of ppl who test positive and actually have the disease
Cut-off value = values of a screening test that distinguish positive vs negative
Explain the steps of an action potential (including the channels involved).
Bonus: What is the difference b/w absolute & relative refractory period?
1. Stimulus causes local depolarization towards threshold membrane potential at about 55mV (this can be graded potentials that eventually lead to the threshold). This is dependent on ligand-gated Na+ or Ca2+ channels.
2. When threshold is reached, voltage-gated Na+ channels open and are active (inactivation gate is open). This enables an influx of Na+ INTO the cell (initiating an AP), causing a depolarization of the membrane potential until 30mV. (Absolute refractory)
3. At 30mV, the Na+ channels inactivate and begin to close, whilst K+ channels are fully open to allow an efflux OUT of the cell. This causes repolarization of the membrane potential.
4. K+ channels remain open longer causing a slight hyper polarization of the membrane potential to about -90mV. Meanwhile, Na+ channels reset to starting position (closed but active b/c inactivation gate is open - relative refractory).
5. Na+/K+ ATPase pump helps to rectify the hyperpolarization and re-establish resting membrane potential at -70mV.
Absolute refractory = due to inactivation of Na+ channels (inactivation gate is closed), no amount of stimulus can generate another AP until the channels reset. (during depolarization & repolarization)
Relative refractory = channels maybe closed but they are not inactive, so with a strong enough stimulus, an AP can be generated (during hyperpolarization & re-establishment of resting membrane potential)
Describe the pathway of lipid metabolism starting in the stomach to the liver.
Large fat globules are emulsified by bile acids and lecithin into smaller globules.
Pancreatic lipase can further digest the lipid into monoglycerides (MGS) & free fatty acids (FFA).
Bile salts create micelles of the MGS and FFA that can absorb on the apical side of the enterocyte.
Inside enterocyte, the MGS, TGS, and FFA combine with cholesterol to form a chylomicron with a protein coat. The chylomicron is tagged w/ ApoC, ApoE, and ApoB48. ApoB48 sends it to the lacteal.
After the lacteal (& rejoin circulation), the ApoC sends the chylomicron to capillaries of the tissues (fat/muscle).
Lipoprotein lipase breakdown the chylomicron to use up the FAs and cholesterol. Remnant chylomicron goes to liver due to presence of ApoE.
Analyze the following ECG:
R-R = about 100 bpm
Rhythm = sinus rhythm
Cardiac Axis = potential LAD (left axis pathological) (I is pos; II is more neg; III is more neg)
P wave = small but w/in 0.08 sec (bifid in aVF suggestive of LAD)
PR interval = normal, about 0.12 sec
QRS = normal, about 0.08-0.12 sec
R wave progression = normal
ST = elevation in V1-V4 (anteroseptal infarct) due to J pt elevation (matched w/ slight ST depression in leads II and aVF)
T wave = normal (elevates w/ ST segment)
QT interval = normal, 0.4 sec
This is an ECG for Kevin Ghost, a 256 yo M, taken on the 13/10/1904 due to the patient presenting with tight chest pain that radiates. The ECG represents a normal singus rhythm with normal intervals except for ST-elevations seen in leads V1 – V4. This is indicative of the patient presenting with anteroseptal infarct, likely L ant. Descending A, which is supported by the cardiac axis indicating a pathological left axis.
Define statute and case law.
Statute law = law made by parliament (legislation); could be state or federal
Case law = law made by judges based on precedent (principles of past decisions); aka common law
How should advanced care directives be approached in a patient consultation?
- Establish clear communication w/ patient and entire healthcare teams.
- Set up care coordinator roles (e.g. nurse) to help manage complex needs of patients w/ chronic diseases.
- Develop integrated health plans w/ all health providers to ensure all aspects of patient's care are aligned.
- Engage patient in decision-making to ensure patient-centered care is reinforced.
- Use technology to increase efficiency and enhance communications to streamline communication (e.g. EHR, telemedicine etc.)
- Provide ongoing education and training for all healthcare professionals involved in chronic disease management to improve collaboration & stay up-to-date on best practices