"" Flashcards
List 3 common types of dementia
Alzheimer’s
Vascular
Lewy body dementia
Name 2 blood tests that could be done to test for cognition
Thyroid, vitamin B
12, folic acid, CRP, FBC, electrolytes
Vitamin deficiency, infection, or other problems (renal failure) -> may cause confusion in the elderly
List 2 problems with the mini mental health test - one with regards to the test and one with regards to the patient
Problems: Screening tool at most Poorly administered/scored Effects of practise Effects of education, language Ceiling and floor effects Training required
Problems with the patient: Sensory/perceptual deficits – hearing and visual Deficit in attention Slow processing speed Slow reactions Less ability to use strategies
What are the most common diseases associated with obesity?
Acanthosis nigricans Diabetes type 2 Orthopaedic problems PCOS CV disease
A child’s head circumference is on the 60th centile. Write how you would
explain this to his parents in a reassuring
way
60th centile is normal; there is a lot of variation in height
Out of 100 children, there are 60 with a lower head circumference measurement than him, he is just above average
State why it would be difficult to measure the height of:
A new born baby
A 2 year old
A 5 year old with fever and leg pain
New-born:
Can’t stand on their own/straight to be measured against a wall
2 y/o:
Won’t stay still/shy
5 y/o: Can't stand straight on leg Moving around Uncooperative/ restless fatigued so poor posture
Parents are concerned their child may be undergoing pubertal growth spurt - he is 8 y/o - you look at clinical findings, height measurements and medical history. What else could you use to see if he is undergoing a growth spurt
Biochemical tests of hormones (GH, LH, FSH, test, GnRH, sex steroids)
Name and describe the 3 stages of birth
Phase 1: Contractions and cervical effacement
Phase 2: Delivery of baby
Phase 3: Delivery of placenta
Where do contractions start from and where do they spread to?
Start at fundus of uterus where the pacemaker is and spread downwards
Followed by uterine relaxation to allow blood flow to uterus
What is meant by the term ‘effacement’
The thinning and flattening of the cervix
What is menarche?
The start of mensruation - 1st period
Describe the onset of menarche. How has this changed in the past 100 years?
Current age is around 13
Evidence that age of menarche has decreased over the last 100 years
Over the last 3-4 decades it appears to have levelled off (?increasing again)
Population studies suggest that the body weight at menarche has remained relatively constant at about 47kg
When does GnRH pulsatile release occur?
Night time pulses in puberty/adrenarche up to two years before menarche
As a neonatal infant there are still pulsatile releases
Neonate = GABA and NPY are quiescent; glutamate active but negative feedback system sensitive so LH and FSH not released in large amounts
Pre-puberty = inhibitory GABA and NPY are active; glutamate inhibited, no GnRH release
Puberty = GABA and NPY are quiescent, glutamate neurones activated, GnRH release
IGF-1, leptin, ovarian steroids (peripheral signals) inhibit GABA and NPY
A 10 y/o girl is the shortest in her class
What would you look for in her PMH?
Genetic - most short children have short parents
LBW - permaturity
Events - Malnutrition due to GIT lesion, inflammatory ilness
Drugs e.g. steroids
Birth weight, prematurity, past emotional or psychological problems, childhood illness, previous malnutrition or severe GI tract disturbances
A 10 y/o girl is the shortest in her class
What would you look for in her family history?
Parental height
Inherited conditions - endocrine (GH, thyroid, IGF-1 deficiency); syndormes (Turner’s, Down’s, achondroplasia)
Skeleteal abnormality/dysplasias
A 10 y/o girl is the shortest in her class
What would you look for on physical examination?
Evidence of Turner’s syndrome: Hypoplasia of maxillary region, prominent forehead, webbed neck, high carrying angle, hypoplastic nails
Height and proportions
Malnutrition
A 10 y/o girl is the shortest in her class
What features would indicate she needed further investigation?
Plot her on a growth chart; if she is falling in centile
Evidence of genetic syndrome
Evidence of an illness e.g. malnutrition due to GIT lesion
What is height velocity?
Speed of growth = the cms grown in one year
height now–height at last visit)/(age now–age at last visit
What are the values and limitations of using predicted parental target height for a child?
Gives an idea of expected height
Limitations: -so long as someone is growing along their centile there is no clinical issue; likewise, if someone ends up at the predicted height but in an abnormal fashion/via dropping centiles, it might indicate a pathology -parents may overestimate their height -height also depends on environmental factors (in utero) not just genetic factors
What are the factors affecting taking accurate hegiht measurements?
Get the right equipment and make sure it is accurate Position the child carefully: relaxed (Make sure the child doesn’t move) Line up the head, standing straight Remember hair styles, headbands etc
What are the advantages of a mini-mental state exam (MMSE)?
Fairly short time to administer; takes around 30 minutes
Does attempt to cover several areas of cognitive function
Less cultural bias than tests
Widely used and translations available
What are some disadvantages of the mini-mental state exam?
Often poorly administered or scored Educational level or language may affect results Ceiling and floor effects Only a screening tool Effects of practise Training required
What are problematic aspects of giving the elderly cognitive tests?
How do the advantages and disadvantages of the MMSE relate?
Lower attentional levels
Difficult to obtain a history: sensory deficits and cognitive problems
What mistakes can be made in measuring someones height?
Incorrect set-up of equipment
Incorrect position/line up of child - child not relaxes, standing straight
Failure to remove shoes and headwear
What are the advanteages and limitation of using the predicted parental height?
Gives an idea of what height to expect
Not an accurate prediction
Child can still have normal growth even is it is significantly higher or lower than mid-parental height
Even if a chid reaches mid-parental height, there may still be abnormal growth
Other effects than genetic i.e environmental
What is height velocity and how do you calculate it?
Height velocity is the speed of growth
Height–height last visit) / (age now-age last visit
How do you ascertain whether a child growht is normal?
If growth is progressing on roughly the same centile with age
What event precedes puberty?
Adrenarche
Up to two years before menarche, there is evidence that the adrenals begin to be active and
increase the production of androgens (e.g. DHEA, DHEA-S)
What event in girls marks the start of puberty?
Menarche
What 2 hormones are released at the start of puberty?
LH
FSH
What molecule released from the hypothalamus causes puberty to begin and describe its release
GnRH (LHRH) is released in a pulsatile manner when stimulatory glutamate neurones are activated, and inhibitory GABA and
NPY neurones are inactivated (by
leptin, IGF1, peripheral stimuli, ovarian steroids
). Opioids may activate glutamate
neurones.
A new pathway in the causes of puberty has been discovered. Name the gene, the initial protein product
produced and the receptor
it acts on.
KISS-1 gene
Initial protein is kisspeptin-121
GPR54
What hormone secreted peripherally rfom adipose tissue states the body is ready to undergo puberty?
Leptin
Describe how the neural tube is formed and say when each part of the formation occurs
Development is directed by the notochord
The neural tube is formed from the neural plate
The developing notochord (from migration of the primitive streak cells) causes ectoderm to
thicken -> neural plate
On day 18: invagination of the neural plate to form the neural groove
On day 21: fusion of neural folds begins, complete by week 4
A neural crest forms between the surface epithelium and neural tube
Closure occurs from the middle outwards
Give two conditinos in which the neural tube fails to close properly and describe the most common condition
Anencephaly - failure of rostral fusion of the neural tube
Spina bifida - failure of caudal fusion of the neural tube
There are three types of spina bifida:
Occulta: defect in vertebral arches covered by skin; marked by a patch of hair overlying the dimple; no underlying tissue affected.
These two are
called spina bifida cystica, cyst-like sac is formed
Meningocele: defect in the vertebral arches, meninges protrude but not neural tissue (SC in canal still)
Myelomeningocele: defect in the vertebral arches, meninges and the SC protrude outside of the canal.
Neurological deficits: neurogenic bowel and bladder, lower limb paralysis, fractures, joint contractures, learning
impairments, hydrocephalus secondary to meningitis etc.
What substance prevents the neural tube from failing to close?
Folate
If the person takes a folate acid synthesis inhibitor, change medication
All pregnant women take folic acid 0.4mg 5 weeks prior to conception and for the first 12 weeks
What does hCG do?
During early pregnancy the high concentrations of gonaldal steroids (oestriol and progesterone) inhibit the
release of LH and FSH via negative feedback.
hCG is produced by the blastocyst; binds to LH receptors to stimulate + maintain the corpus luteum, can
continue to produce progesterone (enriches uterus with BVs and capillaries so it can sustain the fetus)
What are the risk factors for pre-eclampsia?
Poor obstetric hx Afro-Caribbean/African Strong FH Thrombophilias Renal disease Systemic vascular disease Diabetes Obesity Essential hypertension
What are the clinical features of pre-eclampsia?
Hypertension 140/90 on two separate occasion >4hrs apart
Oedema
Proteinuria
What is the treatment for pre-eclampsia?
Regular blood pressure check up Dipstick analysis of urine for proteinuria Foetal surveillance - measure SFH etc. Antihypertensives Timely delivery Easy acces to maternal care unit
Describe the current theory for the pathogenesis of pre-eclampsia
Impaired trophoblast differentiation and invasion during 1st trimester
Failure to destroy muscularis layer of spiral arterioles -> reduced flow, high resistance, poorly perfused placenta +
ischaemia; to compensate the BP is raised in placenta
Define labour
The onset of regular, fundally-dominated uterine contractions accompanies by the progressive effacement and dilation of the cervix
When does labour happen after sexual intercourse
37 to 42 weeks after
Describe the 3 stages of labour
Stage 1: 5–16+ hours
Regular contractions start, cervical effacement, dilation, and thinning until full dilation at 10cm
Stage 2: 30mins–2hours (active pushing for 1 hour)
Full dilation, delivery of the baby
Stage 3: 10-30mins
Delivery of the placenta and membranes
Define fetal growth restriction
Failure of foetus to achieve the predermined growth potential for various reasons
What precautions are take to detect FGR
Screen obstetric history of mother
Moniter growth of foetus
Monitor foetal wellbeing
What precautions are take to detect FGR
Screen obstetric history of mother
Moniter growth of foetus
Monitor foetal wellbeing
Bio
chemistry: PAPP-A
Past obstetric history of PET or FGR
Maternal systemic disease– renal, HT, sickle
Uterine artery Doppler 1st/2nd trimester
identify high resistance flow through the uterine arteries
Monitor size and movement
Differentiate between foetal growth restriction and low birth weight
Babies with fetal growth restriction will have altered growth i.e. fall away from their centile on the growth chart to a centile
below normal. Low birth weight is when a baby is weighing <2500g and there is no pathology to worry about.
What does pre-eclampsia cause?
Foetal syndrome or early delivery
List 2 main sites of oestrogen production during pregnancy and the stages of pregnanct when they are produced
First 8 weeks - maternal ovary via corpus luteum
From day 40 - placenta
Luteo-placental shift
What is the name of the steroid producing tissue pre-implant of the embryo?
Corpus luteum
Define ‘lutoe-placental shift’ and briefly outline the process
The shift from the corpus luteum to the placenta as the site of production of estrogen and progesterone in amounts that are
sufficient to maintain pregnancy in humans.
During the first
5-6 weeks:
the corpus luteum produces high levels of progesterone and oestrogens so that there is
high negative feedback on the hypothalamus and pituitary -> low levels of LH and FSH. Beta hCG is needed to bind
to LH receptors on the corpus luteum to stimulate steroid production.
Day
40:
the placenta takes over the production of oestrogen and progesterone once significant production of
hormones is underway (needs foetal adrenals and liver)
Name the foetal tissue which aids in oestrogen production during pregnancy and how this is achieved
The foetal adrenals and liver
The foetal adrenals convert cholesterol to DHEA-S
The foetal liver conjugates the DHEA-S into 16 alpha DHEA-S which makes oestriol, the main pregnancy oestrogen
Oestriol con only be made by the foetus
Name the 3 requierments essential to a successful first trimester
Implantation of the conceptus in to the uterus at day 8/9
Syncytiotrophoblast invading to produce blood supply for the developing fetus (day 12/13)
Decidualisation of the endometrium to produce uterine secretions for nutrition of the embryo
Low oxygen tension environment –3% to allow essential structures to develop
Week 10: change of fetus blood supply from uterine to placental as placental blood enters the intervillous spaces
Formation of the bilaminar disc – week 2 (day 9)
Absence of teratogens whilst the fetus develops
Week 3: trilaminar disc forms
