18/04/18 Flashcards
1
Q
What constitutes the corpus striatum?
A
lentiform nucleus (globus pallidu and putamen) and caudate nucleus
2
Q
What isthe baseline HR in a CTG defined as?
A
average HR within a 10 minute window
3
Q
What are hte causes of fetal tachycardia?
A
fetal hypoxia; chorioamnionitis; hyperthyroidism; anameia; tachyarrhythmia
4
Q
What is mild bradycardia ?
A
100-120bpm
5
Q
What are the causes of mild bradycardia?
A
postdate gestation; occiput posteiror or transverse presentation
6
Q
What are the causes of severe prolonged bradycardia?
A
severe hypoxia- cord compression; cord prolpase; epidural and psianl anaesthesia; maternal seizures; rapid fetal descent
7
Q
What is severe prolonged bradycardia defined as?
A
less than 80bpm for more than 3m inutes
8
Q
What are the non-reassuring variabilities?
A
less than 5bpm for between 30-50 minutes; >25bpm for 15-25mins
9
Q
What are the abnormal types of variablity?
A
<5bpm for >50 minutes; >25bpm >25 minutes or sinusoidal
10
Q
What are hte causes of reduced variability?
A
fetal sleeping; fetal acidosis due to hypoxia; tachycardia; drugs; prematurity; heart abnormalities
11
Q
What are the acclerations before and after a variable deceleration known as?
A
shoudlers of deceleration
12
Q
What do shoulders of deceleration mean?
A
fetus is not yet hypoxic and is adapting to reduced blood flow
13
Q
What is a prolonged deceleration?
A
> 2 minutes
14
Q
What is a non-reassuring prolonged deceleration?
A
2-3 minutes
15
Q
What is an abnormal prolonged decelration?
A
> 3 mins
16
Q
When do late deceleraitons become abnormal?
A
if happens for 30minutes
17
Q
What are concerning characteristics of variable decelerations?
A
> 60s; reduced baseline variability within decel; dailure to return to baseline; biphasic shape; no shoudlering
18
Q
What are the causes of a sinusoidal pattern?
A
severe fetal hypoxia/anaemia; fetomaternal haemorrhage
19
Q
What is an acceleration defined as?
A
abrupt >15bpm for >15s
20
Q
What flow rate are nebulisers given at?
A
6-8L/min
21
Q
What should be written down when prescribing oxygen/nebulisers?
A
drug name; flow rate; device used; target sats; indication; signature; date
22
Q
What is the flow rate for non-rebreathers?
A
15L/min
23
Q
What is the management of hypogylcaemia if concious; oriented and able to swallow?
A
15-20g of quick-acting carb snack eh orange juice and check blood glucose after 10-15 mins
24
Q
How often can snack be repeated fro hypo?
A
upto 3 times
25
What is the treatment for hypo if conscious but uncooperative?
glucose gel between teeth and gums
26
What is the treatment for hypoglycaemia in an unconscious paitent?
glucose IV 10% at 200ml/hr or glucagon 1mg IV/IM
27
What is the management of hypo once blood gluocse is >4mmol/L?
long acting carb e.g slice of toast
28
What symptoms of SZ does dysregulation of mesolimbic system cause and why?
positive symptoms- dopmaine mediates the importance we place on obejects os excess mesolimbic dopmaine causes attaching salienece t oall osrtso fu nrealted phenomena
29
What is seen on MRI with SZ?
larger lateral ventricles, reduced frontal lobe, hippocampus and amygdala
30
What is the effect of dopamine on renal blood flow?
increases
31
What effect does phenytoin have on hair?
causes hirsutism
32
What xrays are needed for scaphoid fractures?
AP; lateral and oblique; PA
33
What is the most common cause of inherited unconjugated hyperbilirubinaemia?
gilbert syndroem
34
what drugs exacerbate psoriasis?
lithium; NSAIDs; beta-blockers; antimalarials; alcohol
35
Where is sensation lost in an UMN lesion?
sensation is lost to the level of the lesion
36
What is the function of alpha1 receptor stimulation?
SM of blood vessels; bronchi; uterus; bladder and iris to contract
37
Where are M3 receptors found?
glandular tissue and SM of lungs; GI tract and eye
38
What is the function of M2 receptors?
decreased heart contraction and SA node ratw
39
What is teh treatment for pain associated with smooth muscle spasm eg colicky abdo pain?
hyoscine butylbromide (buscopan)
40
What cancers are associated with von-Hippel Lindau disease?
phaeo; CNS haemangiomas; hypernephroma
41
What is glibenclamide?
SU
42
What are signs of significant ischaemia with non-proliferative diabetic retinopathy?
engorged tortuous veins; cotton wool spots and large bloot haemorrhages
43
What is Lowenstein-Jensen medium used for ?
culture of mycobacteria
44
give na example of a gram positive alpha haemolytic diplocci ?
strep. pneumoniae
45
How are streptococci differentiated?
haemolysis
46
How are staphylococci differentiated?
coagulase positive or negative
47
What is a coag negative staph?
staph epi
48
What is an alpha haemolytic strep?
strep pneumoniae and strep viridans
49
What are the beta haemolytic streps?
group a and b strep
50
What is a group A strep?
strep. pyogenes
51
What is non-haemolytic strep?
entercoccus
52
When are attacks with cluster HA more common?
at night
53
Why would cirrhosis cause hyponatraemia?
hypervolaemia
54
What contraceptive shouldn't be used in a IDDM with microalbuminuria or hypertension?
COCP
55
What does a high stepping or stamping gait indicate?
dorsal column loss
56
what are the causes of dorsal column loss?
tabes dorsalis or subacute combined degeneration of the cord
57
What is the appearnce of acute leukaemia in the retina similar to?
Roth spots in infective endocarditive
58
How do roth spots appear?
circular retinal haemorrhages with a central pale core
59
What are dot haemorrhages on teh retina pathognomic of?
DM
60
Why would a thiazide precipitate digoxin toxicity?
cause hypokalaemia which increases the risk of digoxin toxicity
61
When should a patietn be referred for not being able to sit unsupported?
10 months
62
when should a patietn be referred for not being reliably dry at night?
6 years
63
When should a patient be referred for not being able to speak in intelligible short sentences?
3 years
64
How are X and Y chromosomes paired in speramtogeneiss?
end to end
65
What does a base deficit mean?
acidosis
66
What is seen on ECG with hypokalaemia?
ST segment depression; U waves; inverted T wabes; prolonged PR interval
67
What is the inheritance of acute intermitten phorphytia?
AD
68
What artery origintes from the left posterior aortic sinus?
LCA
69
Who gets pseudomonas osteomyleitis ?
haemodialysis and IV drug addicts
70
What is the enzyme deficiency in prophyria cutanea tarda?
uroporphinogen decarboxylase
71
What are the factors contributing to PCT?
alcohol; excess iron and excess oestrogens
72
What happens when sulphonamides and methotreaxate are combined?
sulphonamide displaces methotrexate from its plasma protein binding site
73
What is the most atherogenic lipid particle?
small dense LDL
74
What enzyme is carried on LDL?
Lp-PLA2
75
What is Lp-PLA2 associated iwth?
development of necrotic core
76
What blood vessels ahve the biggest impact on BP?
arterioles
77
What is Charcot's triad?
RUQ pain; jaundice; fever with rigors
78
What is the pain in cholecysitis?
constant
79
What is the most common site of pancreatic cancer?
head of the pancreaas
80
What artery supplies the body and tail of pancreas?
SMA- mid gut
81
What is a positive correlation mean?
direction of relationship
82
What is the best assay to determine if there is PROM in vaginal fluid?
AFP
83
What type of renal stone are seen with hypercalciuria?
calcium phosphate
84
How many feeds would a 2 month old infant be expected eachday?
3/4 stools a day
85
How many wet nappies should an infant produce a day?
5/6
86
How many stools should an infant have per day?
3/4
87
What is seen histoloigcally in Sjogren's syndrome?
lymphocytic infiltration and fibrosis of exocrine galnds esp lacrimal and salivary
88
What does the SMA supply?
second half of the duodenum to the first 2/3rds of the transverse colon
89
What is aphse 1 study?
conducted in healthy volunteers
90
What is a phase 2 study?
conducted in patietns across a ragne of doses
91
What is the cause of characteristic watermelon appearance on endoscopy?
gastric angiodysplasia
92
What is the cause of achalasia?
degeneration of Auerbach's myenteric plexus
93
Aside from Hodgkins lymphoma when else are owls eye inclusions seen?
CMV
94
What is a true aneurysm?
involves all three layers of aortic wall
95
What is the effect of St Johns wort on heptic enzymes?
inducer
96
Where should labour at 42 weeks gestation take place and why?
consultant unit as increased perinatal mortliaity and morbidity
97
What happens to the amniotic fluid at 42 weeks gestation?
decreased
98
What translocation commonly causes Down's?
21 and 14
99
What is a sub-viral satellite?
virus that can exist only alongisde another
100
What drugs can be given for PROM?
oxytocin receptor antagonist or nifedipine
101
What drugs should not be used for tocolysis?
betamimetics
102
What anticonvulsant can cause a PCOS syndrome in women?
valproate
103
What type of renal stone is only caused by inherited condition?
cystine
104
In which condition are Perls' Prussian blue positive deposits found in the liver?
haemochromatosis
105
What clearance equal to?
urine conc. x urine volume/ plasma conc.
106
When is choriocarcinoma more common?
extremes of reproductive age
107
What is seen on pathology with choriocarcinoma?
sheets of syncytiotrophoblasts and cytotrophoblasts with evidence of necoris; haemorrhage and intravascualr grwoth
108
What cytokines act on bone marrow to increase the production of leucocytes?
colony stimulating factor
109
What cancer are aflatoxins assocaited with?
hepatocellular carcinoma
110
What is vaginal clear cell carcinoma associated with?
exposure to diethylstilbestrol in-utero
111
What cancer is actinic keratosis assocaited with?
SCC
112
What is the commonest form of sarcoma?
GI stromal trumours
113
Which chromosome has a point mutation in beta thal?
11
114
What chromsome has a deletion in alpha thal?
16
115
How are the BRCA genes inherited?
AR
116
What is karyorrheixis?
fragmentation of the nuclei
117
What are apoptotic bodies?
cytoplasmic blebs
118
Is there release of inflammatory mediators in apoptosis?
no
119
What is karyolysis?
complete dissolution of the nucleus secondary to the action on DNAase
120
Why might mycoplasm penumonia cause a positive DAT?
cold AIHA
121
What antibiotic can cause a positive DAT?
cephalosporins
122
Is dysplasia irreversible?
no
123
What is heteroplasia?
replacement of normal tissue by abnormal tissue or malpositioned normal tissue (growing in the wrong place)
124
What is a bicornuate uterus assocaited with?
recurrent miscarriage; breech presentation; preterm delivery
125
Waht is the typical genotype of complete molar pregnnacy?
diploid 46 XX ( single sperm combining with an egg devoid of DNA and undergoing mitosis)
126
What is the typical genotype of a partial molar pregnancy?
69 XXy or quadrapolid XXXY- two sperm or one which duplicates
127
When are neutrophils typically replaced by macrophages in cutenaoue wound healing?
48-92 horus
128
What happens to the kidneys in pre-eclampsia?
hypertrophy of the glomerulus as a result of hypertrophy of intracapillary cells- reduced pergusion----glomerular capillary endotheliosis
129
What is the most common cause of acute renal failure?
acute tubular necrosis
130
What type of GN is seen in DM?
nodular glomerulosclerosis
131
What is seen in affected vessels with PAN?
necrotising transmural inflammation
132
What virus is assocaited iwth PAN?
chronic hep B
133
What cancers is CA-125 assocaited with?
ovarian and priamry peritoneal
134
What cancers is raised CA19-9 associated with?
colorectal cancer and pancreatic cancer
135
What cancer is CA15-3 assocaited with?
breast
136
What other name as endotoxins?
bacterial wall lipopolysaccharides
137
What is clomiphene citrate used for in IVF?
ovarian hyperstimulation
138
How does clomiphene citrate work
blocks oestrogen receptors in the hypothalamus and pituitary , inhibiting the oestorgen levels
139
What is the mechanism of cyproterone acetate?
antiandrogen
140
What are hte SE of cyproterone acetate?
hepatotoxicity; gynaecomastia; low cortisol; low aldosterone and osteoporosis
141
What is the MOA of mifeprositone?
competitive progesterone receptor antagonist
142
What is danazol?
synthetic testosterone
143
Why should sulphonaemides and trimethoprim be avoided in the third trimester?
cause neonatal haemolysis and methaemoglobinaemia
144
Why should trimethorpim be avoided in the first trimester?
folate antagonist
145
What antibiotics should be used for UTIs in pregnnacy>
nitrofurantoin
146
What is first line treatment for ovarian cancer?
total abdominal hysterectomy with bilateral salpingo-oophorectomy
147
What is an important complication of femal sterilisation?
ecoptic pregnnacy
