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12 Flashcards

1
Q

what is the pelvic diaphragm made up of

A

levator ani and coccygeus

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2
Q

is there a gap in pelvic diaphragm muscles and if so why

A

yes in the anterior gap between medial borders

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3
Q

what is the gap in pelvic diaphragm called

A

urogenital hiatus

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4
Q

what is the layer superficial to pelvic diaphragm

A

endo-pelvic fascia

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5
Q

name some pelvic ligaments

A

uterosacral, transverse cervical=cardinal, lateral ligament of bladder and lateral ligmaents of rectum

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6
Q

what is superficial to pelvic diaphragm layer

A

deep perineal puch

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7
Q

what is contained within deep perineal pouch

A

contains part of urethra and vagina in females, bulbourethral glands in males, NVB for penis, clitoris, extensions of ischioanal fat pads and muscles

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8
Q

where is the bulbourethral gland found in males

A

deep to deep transverse perineal muscle in deep pouch

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9
Q

where is bulbourethral glands found in females

A

superficial perineal pouch

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10
Q

where is perineal membrane located

A

between deep and superficial pouch

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11
Q

what is perineal membrane

A

thin sheet of tough, deep fascia

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12
Q

where does perineal membrane attach

A

laterally to sides of pubic arch, closing the urogenital triangle

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13
Q

what is contained in superficial perineal pouch male

A

root of penis, bulb-corpus spongiosum, crura, corpus caverosum, proximal penile uretha, superficial transverse perineal muscle and branches of internal pudendal vessels and pudendal nerve

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14
Q

where is superficial perineal pouch female

A

below perineal membrane
contains female erectile tissue and associated muscle
clitoris and crura-corpus cavernosum
bulb of vestibule-paired
associated muscles bulbospongiosus and ischiocavernosus
also contains greater vestibular glands, superficial transverse perineal muscles and branches of internal pudendal vessels and pudendal nerve

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15
Q

where are branches of internal pudendal and pudendal nerve found

A

in superficial perineal pouch

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16
Q

what are the vestibular glands in females called

A

bartholins glands

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17
Q

what are vestibular glands in males called

A

Kowpers glands

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18
Q

which drugs are absorbed in an acidic environment

A

phenytoin, aspirin, penicillin

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19
Q

acidic drugs bind to what

A

albumin

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20
Q

alkaline drugs bind to what

A

A1-AG

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21
Q

which drugs are absorbed in basic environment

A

diazepam, mrophine

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22
Q

elderly tend to have a more acidic or alkaline stomach environment

A

alkaline

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23
Q

what happens to 1st pass metabolism in elderly

A

it is decreased

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24
Q

what is pharmacodynamics

A

drug action on the body, including adverse drug reactions

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25
Q

what is pharmacokinetics

A

ADME-absorption, distribution, metabolism,excretion

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26
Q

describe some drug/drug interactions

A 
theophylline and macrolide
statin and macrolide 
TCA and anti-arrhythmic drugs type I
warfarin and multiple 
ACE increases hypoglycaemic effects of SU
clopidogrel and PPI
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27
Q

what can constipation be worsened by

A

calcium, calcium channel blocker, antimuscarinics

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28
Q

which gene encodes achondroplasia

A

FGFR3

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29
Q

how is achondroplasia inherited

A

autosomal dominant (although 80% of time its due to a new mutation)

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30
Q

when do symptoms of neck swelling typical of Hodgkins get worse

A

on alcohol

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31
Q

how are macrolides excreted

A

via the liver

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32
Q

describe cephalosporins

A

cephs/cef, they inhibit cell wall synthesis and are bactericidal, broad spectrum so can cause c diff, urine excretion

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33
Q

fluroquinolone examples

A

ciprofloxacin, levofloxacin (nb bactericidal)

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34
Q

which antibiotics are bacteriostatic

A

macrolides and tetracyclines

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35
Q

name some glycopeptides

A

vancomycin nb they have no activity against gram negative

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36
Q

replication of DNA happens in what phase

A

S phase

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37
Q

describe features of viral lymphadenopathy

A

tender, hard consistency, smooth surface, no skin inflammation, no tethering

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38
Q

describe features of bacterial lymphadenopathy

A

tender, hard, smooth surface, skin inflammation no tethering

39
Q

lymphoma lump features

A

non tender, soft, smooth, no inflammation , no tethering

40
Q

metastatic

A

non tender, hard, irregular, no inflammation but tethering

41
Q

what is number needed to treat

A

average number of patients who need to be treated to prevent one additional bad outcome

42
Q

what is absolute risk

A

risk of developing disease over a time period

43
Q

what is relative risk

A

used to compare risk in 2 different groups of people eg smokers and non-smokers

44
Q

what does degenerative cervical myelopathy cause

A

loss of fine motor function in both upper limbs

45
Q

causes of hyperkalaemia

A

AKI, potassium sparing diuretics, ACEI, ARB, spironolactone, ciclosporin, heparin

46
Q

how is sodium controlled

A

mineralocorticoid activity

47
Q

what is water controlled by

A

ADH

48
Q

explain what happens in diabetes insipidus

A

too little water cause by disruption of pituitary stalk, cant excrete ADH, lots of water lost in urine, urine v large quantities, so patients sodium is high

49
Q

where do loop diuretics work

A

ascending loop of henle

50
Q

where do thiazides work

A

distal convoluted tubule

51
Q

describe cryoglobulinemic vasculitis

A 
type II and III mixed cryoglobulins
immune complex mediated disease
type III nypersensitivty 
depositied at temperatures less than 37
membranoproliferative glomerulonephritis 
decrease in C3 AND C4 rheumatoid factor
52
Q

anti PR3 with cANCA

A

granulomatosis with polyangiits -suspect this when lesions in lungs, sinuses and kidneys

53
Q

anti MPO with pANCA

A

eosinophilic granulomatosis with polyangiits (EGPA), lat eonset asthma, nasal polyps

54
Q

which interleukin is key regulator of allergic disease

A

il5

55
Q

thick white vaginal discharge-cottage cheese like

A

candida albicans

56
Q

myotomes for hip flexion

A

L2.L3 (mostly l2)

57
Q

hip extension myotomes

A

L5,S1

58
Q

ankle dorsiflexion

A

l4,l5 TIBIALIS ANTERIOR

59
Q

inversion

A

L4-tibialis anterior and posterior

60
Q

eversion

A

L5,S1 fibularis longus and brevis

61
Q

how can BPH be treated

A

a1-antagonists eg tamsulosin and alfuzosin which decrease muscle tone in prostate and bladder 1st line but can cause dizziness, postural hypotension, dry mouth, depression

62
Q

second line treatment for BPH

A

5a reductase inhibitors eg finasteride
they block the conversion of testosterone to dihydrotestosterone which is known to increase BPH
side effects-erectile dysfunction, decrease libido, ejaculation problems, gynaecomastia

63
Q

a faint due to sight of blood is what type of syncope

A

vasovagal

64
Q

what is a bell clapper deformity

A

tunica vaginalis joins high on spermatic cord which predisposes to testicular torsion

65
Q

describe nutcracker syndrome

A

left renal vein becomes compressed in between superior mesenteric artery and aorta

66
Q

what does the development of the zona pellucida signify

A

transformation of primordial follicle-primary follicle

67
Q

what is the aim of the direct pathway

A

to allow thalamus to be activated

68
Q

how does duct ectasia present

A

dilation and shortening of major lactiferous ducts, common presentation in menopausal women, often presents with green/yellow discharge, palpable mass and symmetrical slit like nipple retraction
identified on mammography by dilated calcified ducts without any other features of malignancy

69
Q

what are the cardinal movements

A

change in position of babys head in pelvis described in relation to vertex presentation

70
Q

describe atlanto-occipital joints

A

between occipital condyles and superior articular facets of atlas

71
Q

where does supraspinous connect between

A

tips of spinous processes

72
Q

where does infraspinous connect between

A

connect superior and inferior surfaces of adjacent spinous processes

73
Q

what are supraspinatous joints like

A

strong, fibrous

74
Q

what are interspinous ligaments like

A

weak, membranous

75
Q

what muscles allow for flexion of spine

A

psoas major and rectus abdominis

76
Q

describe erector spinae muscles

A

3 vertical muscle groups located lateral to spine

77
Q

where do erector spinae attach

A

inferiorly common tendon attaches to sacrum and iliac crest

78
Q

where does the transversopinalis attach

A

located within grooves between transverse and spinous processes, individual muscle fibres attach between vertebra and skull, vertebra and rib and one vertebra and another
sacrum and vertebra

79
Q

what are intrinsic back muscles supplied by

A

posterior rami branches

80
Q

what is removed in laminectomy

A

one or more spinous processes and the adjacent lamina

81
Q

what does the facial canal connect

A

internal acoustic meatus to stylomastoid foramen

82
Q

describe the cardinal movements in order

A

engagement, descent, flexion, internal rotation, extension, external rotation/restitution, expulsion
pneumonic-EVERY DAY FINE INFANTS ENTER EAGER AND EXCITED

83
Q

what muscles mediate plantarflexion

A

soleus and fibularis longus

84
Q

what myotomes used in plantarflexion

A

L5,S1

85
Q

what muscles used in dorsiflexion

A

tibialis anterior

86
Q

what myotomes used in dorsiflexion

A

L4,L5

87
Q

describe visceral afferents that are tpuching peritoneum

A

visceral afferents run alongside sympathetic fibres, enter spinal cord between T11-L2 pain perceived as suprapubic

88
Q

describe visceral afferents not touching peritoneum

A

visceral afferents run alongside parasympathetic fibres, enter spinal cord at S2,3,4, perceived in perineum

89
Q

visceral afferents from organs touching peritoneum run alongside sympathetic or parsympathetic fibres

A

sympathetic

90
Q

where do autonomic nerves of pelvis come from

A

sacral sympathetic trunks, T11-L2, superior hypogastric plexus

91
Q

where do parasympathetics come from

A

sacral outflow (S2,3,4), pelvic splanchnic nerves, emerge from spinal roots, mixes with sympathetics in inferior hypogastric plexus

92
Q

what are the articulations in atlanto-axial joint

A

3 articulations
2 between inferior articular facets of atlas and superior articular facets of axis
1 between anterior arch and odontoid process of axis

93
Q

describe the path of the pudendal nerve

A

enters the pelvis via greater sciatic foramen, passes posterior to sacrospinous ligament
enters perineum via lesser sciatic foramen

94
Q

what is the portal triad

A

hepatic artery, portal vein and common bile duct

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