12 Flashcards
what is the pelvic diaphragm made up of
levator ani and coccygeus
is there a gap in pelvic diaphragm muscles and if so why
yes in the anterior gap between medial borders
what is the gap in pelvic diaphragm called
urogenital hiatus
what is the layer superficial to pelvic diaphragm
endo-pelvic fascia
name some pelvic ligaments
uterosacral, transverse cervical=cardinal, lateral ligament of bladder and lateral ligmaents of rectum
what is superficial to pelvic diaphragm layer
deep perineal puch
what is contained within deep perineal pouch
contains part of urethra and vagina in females, bulbourethral glands in males, NVB for penis, clitoris, extensions of ischioanal fat pads and muscles
where is the bulbourethral gland found in males
deep to deep transverse perineal muscle in deep pouch
where is bulbourethral glands found in females
superficial perineal pouch
where is perineal membrane located
between deep and superficial pouch
what is perineal membrane
thin sheet of tough, deep fascia
where does perineal membrane attach
laterally to sides of pubic arch, closing the urogenital triangle
what is contained in superficial perineal pouch male
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
where is superficial perineal pouch female
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
where are branches of internal pudendal and pudendal nerve found
in superficial perineal pouch
what are the vestibular glands in females called
bartholins glands
what are vestibular glands in males called
Kowpers glands
which drugs are absorbed in an acidic environment
phenytoin, aspirin, penicillin
acidic drugs bind to what
albumin
alkaline drugs bind to what
A1-AG
which drugs are absorbed in basic environment
diazepam, mrophine
elderly tend to have a more acidic or alkaline stomach environment
alkaline
what happens to 1st pass metabolism in elderly
it is decreased
what is pharmacodynamics
drug action on the body, including adverse drug reactions
what is pharmacokinetics
ADME-absorption, distribution, metabolism,excretion
describe some drug/drug interactions
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
what can constipation be worsened by
calcium, calcium channel blocker, antimuscarinics
which gene encodes achondroplasia
FGFR3
how is achondroplasia inherited
autosomal dominant (although 80% of time its due to a new mutation)
when do symptoms of neck swelling typical of Hodgkins get worse
on alcohol
how are macrolides excreted
via the liver
describe cephalosporins
cephs/cef, they inhibit cell wall synthesis and are bactericidal, broad spectrum so can cause c diff, urine excretion
fluroquinolone examples
ciprofloxacin, levofloxacin (nb bactericidal)
which antibiotics are bacteriostatic
macrolides and tetracyclines
name some glycopeptides
vancomycin nb they have no activity against gram negative
replication of DNA happens in what phase
S phase
describe features of viral lymphadenopathy
tender, hard consistency, smooth surface, no skin inflammation, no tethering
describe features of bacterial lymphadenopathy
tender, hard, smooth surface, skin inflammation no tethering
lymphoma lump features
non tender, soft, smooth, no inflammation , no tethering
metastatic
non tender, hard, irregular, no inflammation but tethering
what is number needed to treat
average number of patients who need to be treated to prevent one additional bad outcome
what is absolute risk
risk of developing disease over a time period
what is relative risk
used to compare risk in 2 different groups of people eg smokers and non-smokers
what does degenerative cervical myelopathy cause
loss of fine motor function in both upper limbs
causes of hyperkalaemia
AKI, potassium sparing diuretics, ACEI, ARB, spironolactone, ciclosporin, heparin
how is sodium controlled
mineralocorticoid activity
what is water controlled by
ADH
explain what happens in diabetes insipidus
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
where do loop diuretics work
ascending loop of henle
where do thiazides work
distal convoluted tubule
describe cryoglobulinemic vasculitis
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
anti PR3 with cANCA
granulomatosis with polyangiits -suspect this when lesions in lungs, sinuses and kidneys
anti MPO with pANCA
eosinophilic granulomatosis with polyangiits (EGPA), lat eonset asthma, nasal polyps
which interleukin is key regulator of allergic disease
il5
thick white vaginal discharge-cottage cheese like
candida albicans
myotomes for hip flexion
L2.L3 (mostly l2)
hip extension myotomes
L5,S1
ankle dorsiflexion
l4,l5 TIBIALIS ANTERIOR
inversion
L4-tibialis anterior and posterior
eversion
L5,S1 fibularis longus and brevis
how can BPH be treated
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
second line treatment for BPH
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
a faint due to sight of blood is what type of syncope
vasovagal
what is a bell clapper deformity
tunica vaginalis joins high on spermatic cord which predisposes to testicular torsion
describe nutcracker syndrome
left renal vein becomes compressed in between superior mesenteric artery and aorta
what does the development of the zona pellucida signify
transformation of primordial follicle-primary follicle
what is the aim of the direct pathway
to allow thalamus to be activated
how does duct ectasia present
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
what are the cardinal movements
change in position of babys head in pelvis described in relation to vertex presentation
describe atlanto-occipital joints
between occipital condyles and superior articular facets of atlas
where does supraspinous connect between
tips of spinous processes
where does infraspinous connect between
connect superior and inferior surfaces of adjacent spinous processes
what are supraspinatous joints like
strong, fibrous
what are interspinous ligaments like
weak, membranous
what muscles allow for flexion of spine
psoas major and rectus abdominis
describe erector spinae muscles
3 vertical muscle groups located lateral to spine
where do erector spinae attach
inferiorly common tendon attaches to sacrum and iliac crest
where does the transversopinalis attach
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
what are intrinsic back muscles supplied by
posterior rami branches
what is removed in laminectomy
one or more spinous processes and the adjacent lamina
what does the facial canal connect
internal acoustic meatus to stylomastoid foramen
describe the cardinal movements in order
engagement, descent, flexion, internal rotation, extension, external rotation/restitution, expulsion
pneumonic-EVERY DAY FINE INFANTS ENTER EAGER AND EXCITED
what muscles mediate plantarflexion
soleus and fibularis longus
what myotomes used in plantarflexion
L5,S1
what muscles used in dorsiflexion
tibialis anterior
what myotomes used in dorsiflexion
L4,L5
describe visceral afferents that are tpuching peritoneum
visceral afferents run alongside sympathetic fibres, enter spinal cord between T11-L2 pain perceived as suprapubic
describe visceral afferents not touching peritoneum
visceral afferents run alongside parasympathetic fibres, enter spinal cord at S2,3,4, perceived in perineum
visceral afferents from organs touching peritoneum run alongside sympathetic or parsympathetic fibres
sympathetic
where do autonomic nerves of pelvis come from
sacral sympathetic trunks, T11-L2, superior hypogastric plexus
where do parasympathetics come from
sacral outflow (S2,3,4), pelvic splanchnic nerves, emerge from spinal roots, mixes with sympathetics in inferior hypogastric plexus
what are the articulations in atlanto-axial joint
3 articulations
2 between inferior articular facets of atlas and superior articular facets of axis
1 between anterior arch and odontoid process of axis
describe the path of the pudendal nerve
enters the pelvis via greater sciatic foramen, passes posterior to sacrospinous ligament
enters perineum via lesser sciatic foramen
what is the portal triad
hepatic artery, portal vein and common bile duct
