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14 Flashcards

1
Q

tear drop poikolytes

A

myelofibrosis

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2
Q

1st line for neutropenic sepsis

A

piperacillin with tazobactam

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3
Q

which SSRI do you use post MI

A

Sertraline-also give PPI for gastric protection as likely to be on aspirin and that with SSRI can cause bleeding

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4
Q

what is risk of SSRI in first trimester

A

small risk of congenital heart defects

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5
Q

risk of SSRI in third trimester

A

persistent pulmonary hypertension of newborn

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6
Q

which SSRI can be used in adolescents

A

fluoxetine

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7
Q

when is progesterone level measured

A

7 days before end of cycle

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8
Q

how does methyldopa work

A

centrally acting alpha agonist

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9
Q

how does labetalol work

A

B and a antagonist

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10
Q

how does nifedipine work

A

Ca channel antagonist

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11
Q

hydralazine

A

vasodilator

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12
Q

what class of drug is lidocaine and how does it work

A

Na channel antagonist so it causes inhibition

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13
Q

what are ionotropic and metabotrophic glutamate receptors important in discriminating between

A

ON and OFF retinal pathways

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14
Q

what do metabotrophic GABA tend to do

A

modulate synaptic actions because their slow action is insufficient to trigger an action potential

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15
Q

how do metabotrophic GABA modulate

A

presynaptically modulate transmitter release
transmitter gated channels to regulate size of post synaptic potential
resting and voltage gated ion channels in neuronal soma to alter eg resting Em and AP firing pattern

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16
Q

what does cholinergic transmission in autonomic ganglia display

A

both direct and indirect transmitter actions

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17
Q

what is fast EPSP cholinergic

A

due to activation of nicotinic (ionotrophic) Ach receptors, channels conduct na and k

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18
Q

what is slow EPSP cholinergic

A

activation of muscarinic (G protein coupled) Ach receptors, Ach closes K+ channel (M type)

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19
Q

what is a graded potential

A

a change in the rmp caused by an EPSP or IPSP but the magnitude of neurotransmitter release is not of a magnitude large enough to cross threshold and result in an AP

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20
Q

what does an interneurone do and release

A

locally acting, typically releases GABA and so brings about an IPSP and inhibition, function is local processing of information

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21
Q

what does a projection neuron do

A

neuron responsible for conveying signals to other parts of the brain, typically releases glutamate and so brings about an EPSP

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22
Q

what is the basis of vision

A

the dark current

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23
Q

what is the dark current

A

in dark the Vm is between the Ena and EK

in response to light PNa is decreases outer channels close), PK>Pna therefore hyperpolarises

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24
Q

what happens in light in terms of retinol

A

11-cis retinal is converted to all trans-retinal

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25
Q

what does trans-retinal do

A

molecular cascade that decreases cGMP, closure of cGMP-gated na channel, lowered na entry causes hyperpolarization

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26
Q

in terms of glutamate what happens in light

A

light less glutamate

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27
Q

what is receptive field

A

part of retina that needs to be stimulated to elicit APs from a ganglion cell

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28
Q

what is a horizontal cell

A

connects between photoreceptors and project to other photoreceptors and bipolar cells

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29
Q

describe the convergence with rods

A

high convergence (large spacing, lower density) this increases sensitivity and decreases acuity

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30
Q

describe features of rods

A 
achromatic 
peripheral retina 
high convergence 
high light sensitivity 
low visual acuity
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31
Q

describe features of cones

A 
chromatic 
central retina 
low convergence
low light sensitivity 
high visual acuity
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32
Q

off pathway uses what type of glutamate receptor

A

ionotropic

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33
Q

on pathway uses what type of glutamate receptor

A

metabotropic

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34
Q

which cells produce action potentials

A

only ganglion and some amacrine cells produce action potentials (all other cells produce graded changes in membrane potential)

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35
Q

what is lateral inhibition and why is it helpful

A

it exaggerates the difference in stimulus intensity detected by adjacent neurons, aids with localization

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36
Q

lateral inhibition modifies the receptive fields of ganglion cells to have what type of organization

A

centre-surround
on centre-off surround
off center-on surround

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37
Q

does our visual system dtect differences in light intensity or amounts of light

A

light intensity

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38
Q

colour of short wave cone

A

blue

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39
Q

colour of middle wave cone

A

green

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40
Q

colour of long wave cone

A

red

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41
Q

what is the duplex theory of vision

A

rods and cones (rods=photopic) (cones=scotopic)

42
Q

if CT is negative and you strongly suspect SAH how soon can you do lumbar puncture

A

no sooner than 12 hours after onset of symptoms

43
Q

why do you need to wait 12 hours

A

to see if the spinal fluid is xanthrochromic (yellow) from the breakdown of blood in CSF

44
Q

why do you give nimodipine in SAH

A

decrease in vasospasm to decrease cerebral ischaemia

45
Q

what can carbamazepine be used to treat

A

trigeminal neuralgia, bipolar, temporal lobe epilepsy, complex partial seizures

46
Q

what are features of anorexia nervosa

A

decrease in BMI, bradycardia, hypotension, enlarged salivary glands
hypokalaemia, low FSH, LH, oestrogen and testosterone
increased cortisol and growth hormone, impaired glucose tolerance
hypercholesterolaemia
dental carriers, dry skin, brittle hair, languo hair

47
Q

what is first line for treatment of stroke and TIA

A

clopidogrel

48
Q

name some screening tools for depressions

A

HAD and PHQ-9

49
Q

antimuscarinics for urge incontinence

A

oxybutynin, tolterodine, darifenacin

50
Q

what can precipitate an aplastic crisis in hereditary spherocytosis

A

parovirus

51
Q

what is the other name for multisystem atrophy

A

shy dragger syndrome

52
Q

what is contained in cryoprecipitate

A

plasma containing factor VIII, fibrinogen, vWF and Factor XIII

53
Q

risk factor for bells palsy

A

pregnancy

54
Q

what are the risk factors for cervical cancer

A

smoking
HIV
early age of first intercourse, many sexual partners, high parity, lower socioeconomic status, COCP, HPV 16 and 18

55
Q

how does HPV 16 work

A

E6 which inhibits p54

56
Q

how does HPV 18 work

A

E7 inhibits RB suppressor gene

57
Q

what happens in cervical ripening

A

decrease in collagen fibre alignment, decrease in collagen fibre strength, decrease tensile strength of cervical matrix, increase in cervical decorin

58
Q

what does anterior leg do

A

dorsiflex

59
Q

what nerve is anterior leg supplied by

A

deep fibular

60
Q

what are the ligaments of the hip joint

A

ishiofemoral, iliofemoral, pubofemoral

61
Q

what is the blood supply to the hip

A

lateral and medial circumflex arteries from the deep femoral artery
artery to head of femur from obturator artery

62
Q

which muscle externally rotates knee

A

biceps femoris

63
Q

what type of injury is likely to cause a foot drop

A

fracture of neck of fibula

64
Q

what does the latissimus dorsi do

A

adducts the shoulder joint, extends and medially rotaes shoulder

65
Q

where is the confluence of the venous sinuses

A

at internal occipital protruberance which is in midline and deep to external occipital protruberance

66
Q

what does the anterior longitudinal ligament do

A

prevents against over extension

67
Q

what does posterior longitudinal ligament do

A

prevent against over flexion

68
Q

what does the cauda equine consist of

A

all the L2-co spinal nerve roots descending towards their respective intervertebral foraminae (arranged with motor roots anteriorly, sensory roots posteriorly)

69
Q

describe the path of the internal carotid

A

becomes internal to cranial cavity via carotid canal to supply the brain

70
Q

describe vertberbal arteries path

A

pass through transverse foramina in cervical vertebrae then through foramen magnum to enter cranial cavity

71
Q

how is haemophilia inherited

A

X linked recessive

72
Q

what is the fibrinolytic system

A

causes fibrin dissolution and acts via generation of plasmin, Process starts with release of tissue plasminogen activator fro endothelial cells which is stimulated by fibrin formation

73
Q

what is the combined test in pregnancy

A

hcg, PAPP-A, nuchal translucency

74
Q

what is the triple/quadruple test

A

hcg, AFP, ( unconjugated estriol and inhibin-A) after 16 weeks

75
Q

what blood results would you expect for downs mother

A

decrease in AFP, decrease in oestriol, decrease in PAPPA, increase in HCG and thickened nuchal translucency

76
Q

when are triptans used `

A

for the treatment of migraine

77
Q

what are the side effects of triptans

A

tingling, heat tightness in throat and chest

78
Q

describe the symptoms of guillian barre

A 
sensory symptoms proceed weakness
pain is v common 
progressive paraplegia 
peak symptoms are 10-14 days into onset of symptoms 
association with campylobacter 
symmetrical symptoms 
autonomic dysfunction 
distal then ascending to proximal
79
Q

where does botulism affect

A

presynaptic disorder

80
Q

what classification describes some movement if gravity removed but none against gravity

A

2

81
Q

what is rhobencephalon

A

hindbrain

82
Q

what is a chorionic haematoma

A

common cause of bleeding in the first trimester
pooling of blood between endometrium and embryo due to separation
bleeding cramping, threatened miscarriage
symptoms and course follow size and perpetuation
usually self limiting and resolve
large haematoma may be source of infection, irritability and miscarriage

83
Q

what nerve passes through the superficial inguinal ring

A

ilioinguinal

84
Q

what is tumour lysis syndrome caused by

A

high potassium and phosphate and low calcium

85
Q

how does body of uterus drain lymph and to where

A

lymphatics within braod ligament to iliac nodes

86
Q

where is 4th ventricle

A

between cerebellum and pons

87
Q

which type of SSRI do you avoid in breastfeeding an d hwy

A

fluoxetine because of its long half life

88
Q

personality disorder associated with recurrent suicidal behaviour

A

borderline

89
Q

what is postpartum haemorrhage defined as

A

> 500mls of blood loss

90
Q

how do you treat B 12 deficiency due to pernicious anaemia

A

3 monthly IM hydroxocobalamin injections

91
Q

where is B 12 absorbed from

A

ileum

92
Q

how long do B12 stores last for

A

2-4 years

93
Q

how long do folate stores last for

A

4 months

94
Q

where is folate absorbed form

A

duodenum and jejunum

95
Q

what is the MAC formed by

A

C5b and C6-C9

96
Q

subcortical dopamine hyperactivity lead to

A

psychosis

97
Q

mesocortical dopamine hypoactiivty leads to

A

negative cognitive symptoms

98
Q

alteration in clotting factor levels induced by EE maybe thrombogenic are

A

decrease in antithrombin III and protein S

99
Q

what is hysteroscopic sterelisation

A

insert implant into each fallopian tube with a hysteroscope, scar tissue forms around them and hence sterilised

100
Q

side effects of SSRIs

A

GI upset, anxiety, agitation, insomnia, sexual dysfunction, hyponatraemia in elderly

101
Q

describe why alcohol withdrawal is bad

A

leads to excess glutamate activity and decreased GABA

excess glutamate is toxic to the nerve cell

102
Q

what are the major dopinergic pathways and what do they do

A

nigrostriatal-Extra pyramidal
tuberoinfundibular-prolactin release
mesolimbic/cortical-motivation and reward

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