13 Flashcards
fixed flexion of DIP and hyperextension of PIP
swan neck deformity
unable to move a swollen index finger cause
tendon sheath infection
what can leflunomide cause
interstitial lung disease (need to be off for 2 years befor pregnancy)
what can sulfasalazine cause
reduced sperm, neutropenia
what can hydroxychoroquine cause
eye problems
what indicates active RA
DAS>5.1
what type of drug is allopurinol
xanthine oxidase inhibitor
what HLA is RA
HLA DR4
what are the 3 zones of the adrenal cortex
outermost-zona glomerulosa=mineralocorticoids eg aldosterone
then zona fasciculara=glucocorticoids
then zona reticularis=sex steroids and glucocorticoids
what is in the adrenal medulla
chromaffin cells which secrete catecholamines
low sodium, high potassium, palmer hyperpigmentation
addisons disease
what is bowens disease and where is it found
SCC in situ, red scaly patch on leg
describe typical features of BCC
pearly border, picket fence, slow growing, non healing ulcer, teleangectasia, these rarely metstasise
where are eccrine glands found
entire body surface except clitoris, labia minora, external ear canal, high density on soles and palms
where are apocrine glands found
in axillae, nipples, labia, glans penis
what is the angle in glaucoma
iridocorneal angle
which canal gets blocked in glaucoma
canal of schlemm
what are the features on fundoscopy for primary open angle glaucoma
optic disc cupping, cup to disc ratio >0.7, optic disc pallor, bayonetting of vessels, cup notching
mid diastolic murmur with tapping, undisplaced apex, best heard left lateral position using bell
mitral stenosis
ejection systolic murmur, radiating to neck
aortic stenosis
systolic murmur radiates to axilla
mitral regurg
best heard when patient sits up, lean forward and fully expires at left side of lower part of sternum
aortic regurgitation
what is tardive dyskinesia
repetitive involuntary purposeless movements, grimacing, sticking tongue out, lip smacking, pursing lips, blinking, may take years to develop
what is acute dystonic reaction
takes hours or days to develop-muscle spasms, treated with acetylcholine inhibitor
what are the side effects of antipsychotics
weight gain sedation metabolic syndrome-increase diabetes, increase MI, increase BP hyperprolactinaemia antimuscarinic neuroleptic malignant syndrome-pyrexia, rigidity, tachycardia decrease seizure threshold sexual dysfunction
what are the features of neuroleptic malignant syndrome
pyrexia, rigidity, tachycardia
D2 blockade in the nigrostraital area causes
Parkinsonism
D2 blockade in the ventrotegmental area causes
hyperprolactinaemia
how often does clozapine need check
weekly for first 6 months, fortnightly for next 6 months, monthly thereafter
1 month after cessation
what do you check for monitoring of unfracitoned heparin
APTT
what can myelodysplasia progress to
AML
mild learning difficulty IQ
50-69
moderate learning difficulty IQ
35-49
what is the triad in ASD
social interaction, communication impairment, rigid restricted/repetitive behaviours
what is agoraphobia
fairly well-defined cluster of phobias embracing fears of leaving home, entering shops, crowds, public places/travelling along, buses or planes
specific phobia
marked and persistent fear that is excessive or unreasonable cued by presence or anticipation of a specific object or situation
describe social anxiety disorder
fear that they will act in a way that will be embarrassing/humiliating, common symptoms=blushing/shaking, fear of vomiting, urgency or fear of micturition
describe brain changes in social phobia
increased bilateral activation of the amygdala and increase rCBF to the amygdala and related limbic areas that normalize on successful treatment
is ASD strongly inheritable
yes, commonly relatives affected (broader phenotype), 20% of siblings will meet diagnostic criteria, no single gene identified
generally considered global inherent deficit
what is the criteria for generalized anxiety disorder
needs to be severe enough to be long lasting (most days for at least 6 months), not controllable, causing significant distress/impairment in function
90% are co-morbid with another psychiatric disorder
what are the cognitive symptoms of anxiety
fear of losing control, difficulty concentraing, feeling objects are unreal-derealisation, hypervigilance, racing thoughts, metaworry, health anxiety
how do benzos work
cause hyperpolarizaiton of cells, they are GABAa agonists so they increase the inhibition actions of GABA
what is the antagonist of benzos
flumazenil
what are the positive symptoms in schizophrenia
hallucination, delusions, passivity phenomena, disorder of thought form
negative symptoms schizophrenia
decrease in speech, decreased motivation, decrease interest/pleasure, decrease social interaction, restricted range of affect (blunting)
what can be used to help with diagnosis of ADHD
school reports, screening questionairres-SDQ, DAWBA, structured diagnostic questionnaire-Conners Rating Scale, ADHD rating scale
how does ritalin work
it improves dopaminergic neurotransmission in networks involved in executive functioning-PFC
what are the side effects of ritalin
usually minor can decrease appetite and sleep
what is the diagnostic criteria for OCD
obsessional symptoms/compulsions must be present on most days for at least 2 weeks and be a source of distress and interference with activities
obsessions must be individuals own thoughts
resistance must be present
rituals are unpleasant
obsessional thoughts/images/impulses must be repetitive
name some obsessions
contamination, fear of harm (eg looking doors), order/symmetry, obsessions with body/physical symptoms, religious/blasphemous thoughts, sexual thoughts
name some compulsions
checking, cleaning and washing, repeating acts, mental compulsions eg special words in a set order, ordering,symmetrical exactness
when does OCD tend to come on
mena age 20
is there a gender bias/socioeconomic status affect on OCD epidemiology
no
difference in onset of OCD in females and males
males 13-15, females 24-25
times of onset for males and females in schizophrenia
15-25 for men, 25-35 for women
what are bad prognostic indicators for schizophrenia
early age of diagnosis male poor premorbid adjustment insidious onset cognitive impairment enlargement of ventricles
what are the 3 categories of SZ
paranoid, hebephrenic, catatonic
what is paranoid SZ
commonest type, hallucinations and or delusions prominent
what is hebephrenic SZ
age of onset 15-25, poor prognosis, fluctuating affect, prominent with fleeting fragmented delusions and hallucinations
what is catatonic SZ
characterised by stupor, posturing, waxy flexibility and negativism
describe juvenile myoclonus epilepsy
onset in teenage years of myoclonic jerks and generalized seizures
typical precipitants-alcohol and sleep deprivation
symptoms tend to be worse in mornings
EEG shows characteristic 3-5Hz polyspike and wave pattern
treatment of juvenile myoclonus epilepsy
sodium valproate and levetriacetam
what is dystonia
prolonged muscle contractions causing abnormal posture or repetitive movements
what is the most common type of dystonia
torsion dystonia=dystonia musculorum deformans which is a generalised dystonia
describe the features of generalized/tonic dystonia
onset typically in childhood, dystonia in one leg, spreading to that side of the body over 5-10 years
autosomal dominant inheritance deletion in DYT1
what is the gene involved in dystonia
DYST1 deletion
how do you treat generalized dystonia
deep brain stimulation-a surgical procedure
how do you treat focal dystonia
botulin toxin
what is myotonia
failure of muscles to relax
myotonia is due to a channopathy where
in the chloride channel
describe features of smooth muscle
cells not striated, single cell nucleus, gap junctions between cells, significant CT around them, no sarcomere, actin myosin ratio 10:1
where are the antibodies against in myasthenia gravis
to the acetylcholine receptors
what do the antibodies in myasthenia gravis do
block binding of Ach but also trigger inflammatory cascade that damages the fold of postsynaptic membrane
how do you treat myasthenia gravis
acetylcholinesterase inhibitor, pyridostigmine
changes to breast tissue in menstrual cycle (luteal phase)
increase in height of epithelial cells, secretions lining ducts increase and lumina of ducts enlarge
changes to breast tissue in first trimester
elongation and branching of smaller ducts combined with proliferation of epithelial cells of the glands and myoepithelial cells
changes to breast tissue 2nd trimester
glandular tissue increase and secretory alveoli increase
plasma cells and lymphocytes infiltrate nearby connective tissue
breast tissue changes 3rd trimester
secretory alveoli continue to mature, development of extensive rER,
how does connective tissue and adipose tissue change in pregnancy
adipose tissue and connective tissue decreases
how are lipids transported
apocrine secretion
how are proteins transported
merocrine secretion
breast tissue after menopause
secretory cells of TDLU degenerate leaving only ducts. In CT there are fewer fibroblasts, decreased collagen and elastic fibres
what is the proposed pathophysiology for MND
decreased activity of excitatory amino acid transported EAAT2 which mops up glutamate so get excess glutamate that’s toxic
what are the 4 types of MND
amyotrophic lateral sclerosis
primary lateral sclerosis
progressive bulbar palsy
progressive muscular atrophy
describe ALS
this is the most common type, with UMN and LMN features
disease of lateral corticospinal tracts
describe primary lateral sclerosis
least common, causes only UMN symptoms, due to loss of Betz cells, there is no cognitive decline
describe progressive muscular atrophy
only LMN signs, tends to affect mostly men, develops into ALS
describe progressive bulbar
more common in women, always generalization into ALS
what is kennedys syndrome
X linked bulbar and spinal muscular atrophy, no UMN, also develop sensory loss in feet and hands, may have enlargement of male breasts/develop non insulin dependent DM
what is another name for RAPD
Marcus Gunn pupil
what happens in RAPD
on swinging light to the affected eye it dilates
what are the causes of RAPD
large retinal detachment, central retinal artery/ optic nerve ischaemia, optic neuritis, compression, asymmetrical glaucoma
where does the base of stapes fit into
oval window
what can spontatneous intracranial hypotension be caused by
rare cause of headache that results from CSF leak
risk factors eg CTD, marfans
headache generally worse when upright
what can an increase in nuchal translucency be due to
downs, abdo wall defects, congenital heart defects
what are the SE of ECT
headache, nausea, short term memory impairment, memory loss prior to ECT, cardiac arrhythmia
what foods do you need to avoid in pregnancy
unpasteruised milk, ripened soft cheeses eg camembert, brie, blue cheese, pate/undercooked meat
avoid raw/partially cooked eggs and no liver as high in vit A which is teratogenic
when is booking visit
8-12 weeks
describeinternuclear opthalmoplegia
due to lesion in medial longitudinal fasciculus for conjugate eye movement
impairment of ADDuction of ipsilateral eye, contralateral eye abducts but with nystagmus
describe eye in CN VI palsy
eye doesn’t abduct, innervation of lateral rectus
gaze naturally in esotropia
medially rotated eye which cannot be abducted past the midline
25 year old male with PCKD presents with headache and dilated left pupil unreactive to light and opthalmoplegia
CN III due to posterior communicating artery aneursym
what is the synctiotrophoblasts
the outer cells of the trophoblast that are multinucleate and invade decidua to break down capillaries to from cavities filled with maternal blood
what are the drugs used in non Hogdkin lymphoma
rituiximb cyclophosphamide doxorubicin (hydroxydaunomycin) vincristine (oncovin) prednisolone
what are triptans
specific 5-HT1 agonists used in the acute treatment of migraine
should be taken asap after onset of headache rather than onset of aura
side effects of triptans
tingling, heat, tightness eg throat, chest, heaviness, pressure
contraindications to triptans
history of IHD
