20/04/18 Flashcards
1
Q
What are the sources of vitamin A in the diet?
A
cheese; eggs and yoghurt
2
Q
What are the srouces of vit C in the diet?
A
oranges; blackcurrants and potatoes
3
Q
What supplements should all children above 6 months who are consuming <500mls/day of infant formula be taking?
A
vitamin A, C and D
4
Q
What supplement should all breastfeeding mothers tkae?
A
vit D
5
Q
When should the transition from exclusive milk feeding to family foods b/e
A
6 months; not before 4
6
Q
When can fullt fat cows milk be used as a drink?
A
12 months
7
Q
When should semi-skimmed milk not be given before?
A
2 years
8
Q
when should skimmed milk not be given before?
A
5 years
9
Q
When should whole nuts and seeds be avoided before?
A
5 years
10
Q
When should drinking from cups or beakers be introduced?
A
6 months
11
Q
What is primary haemostasis?
A
formation of platelet plug
12
Q
what is secondary haemostasis?
A
formation of fibrin clot
13
Q
What causes the formation of prothrombin to thrombin?
A
V/Xa
14
Q
What factor binds to tissue factor?
A
VII
15
Q
What is the effect of plasmin?
A
converts fibrin to FDPs
16
Q
What muscle does the sacral plexus overlie?
A
piriformis
17
Q
What muscles make up the lateral pelvic wall?
A
obturator internus; coccygues; piriformis; levator ani
18
Q
What is the origin of the superior rectal artery?
A
IMA
19
Q
What 2 arteries of hte pelvis do not arise from the itnernal iliac artery?
A
gonadal artery and superior rectal
20
Q
What arteries arise form the posteiror division of the internal iliac?
A
gluteal arteries
21
Q
What is the inferior vesical artery in females?
A
vaginal artery
22
Q
What is the foudn in the lateral umbilical fold?
A
inferior epigastric vessels
23
Q
What is the medial umbilical fold?
A
remnant of umbilical artery
24
Q
What is the median umbilical fold?
A
urachus
25
What is the termination of the perineal artery?
posterior scrotal artery
26
what is the origin of the anterior scrotal artery?
external iliac
27
What is the uterine artery a homolog of in the male?
artery to vas defenes
28
What artery is the middle rectal artery a branch of?
internal pudendal artery
29
What is hte vaginal artery a branch of?
uterine artery
30
What supplies the inferior part of hte vagina ?
itnernal pudendal artery
31
Where do the lateral sacral veins drain?
internal vertebral venous plexus
32
Where does the right ureter normally cross?
external iliac
33
Where does the left usually corss?
more medial- common iliac
34
Which ureter is more commonly damaged in surgery?
left ( right is more constant and lateral)
35
Where does uperior pelvic viscera generally drain?
external iliac
36
Where does inferior vagina drain?
sacral nodes
37
Where does the inferior vesical artery in females branch from?
vaginal artery
38
Where should your fingers be when palpating hte uterus bimanually?
posterior fornix
39
Where is the round ligament contained proximally?
broad ligament
40
What is anteverted?
uterus tipped anteiror realtive to axis of Vagina (anteVerted= Vagina)
41
What line divides the pernieum into the urogenital and anal trigagles?
line bweteen the ischial tuberosities
42
What is the nerve to levator ani roots?
S3, 4 ,5
43
What is level I axillary nod clearance?
inferior and lateral to pec minor
44
what is level II axilalry node clearnace?
deep to pec minor
45
What is level III axillary clearance?
superior and medial to pectoralis minor
46
What muscle forms the internal urethral spinchter ?
detrusor muscle
47
What aspect of hte bladder are the ureteric orificies?
base
48
Where is the internal urethral orifice in the bladder?
floor
49
What is the conjoint tendon?
medial end of the combined aponeuroses of IO and TA
50
What type of muscle is the dartos muscle?
SM
51
What is the root of hte penis attached to?
ischium of pelvis
52
Where is the corpus cavernosum located in the penis?
psoteriorly
53
What forms the glans penis ?
corpus spongiosum
54
Where does most of the lymph from the scrotum and most of penis drain?
superficial inguinal nodes
55
Where does lymph from glans penis drain?
deep inguinal nodes
56
What forms the pelvic inlet?
sacral promontory; ilium; superior pubic ramus and pubic symphysis
57
What forms the pelvic outlet?
pubic symphysis; ischiopubic ramus; ischial tuberosities; sacrotuberous ligaments; coccyx
58
Where does the pelvic cavity lie?
between the pelvic inlet and pelvic floor
59
What is the longest diameter in the fetal head?
occipitofrontal diameter
60
What is the difference between a night terror and a nightmare?
nightmare, patietn can remember the dream
61
What causes narcolepsy?
inhibition of REM sleep
62
What are the 4 main features of narcolepsy?
irresisteible attacks of sleep at inappropriate times; cataplexy; hypnogogic/hypnopompic hallucinations and sleep paralysis
63
What is cataplexy?
sudden loss of muscle tone when intense emotion occurs leading to collapse
64
What is the annual risk of suicide in the general population?
1 in 10,000
65
What is the risk of completed suicide in the year following self harm?
1%
66
How many patients who have completed suicide have seen a GP in the last month?
66.6%
67
How many patients who self-harm have a psychiatric illness?
90%
68
What is the annual incidence of self-harm?
3 in 1000
69
What is Couvade syndrome?
male experiences symptoms similar to pregnancy
70
What is puerperium defined as?
first 6 weeks following childbirth
71
What are the effects of cannabis use?
dry cough; increased appetitie; conjunctival infection and fatigue
72
What is formication?
tactile hallucination- insects crwloing over the skin
73
What drug is formication asociated with?
cocaine
74
What is the size of pupils with cocaine use?
mydriasis
75
What are Lilliputian hallucinations?
hallucinations seeing little people
76
What are lilliputian hallucinations characteristic of?
alcohol withdrawal
77
How many grams of alcohol is one unit equal to?
10g
78
What is Ekbom syndrome?
delusional psychosis that one is infested with parasites
79
What is Cotard syndrome?
delusion that one is dea, lost all possessions and is decaying
80
What is Rett's syndrome?
neurodevelopmental disorder- developmental decline after 1-2 years, similar to autism
81
What is Pickwickian syndrome?
associated of obesity with sleep apnoea and hypersomnia
82
What is de Clerambault's syndrome?
delusional belief that soeone of higher social status is in love with them
83
What is Ganser's syndrome?
factitious disorder in which people give approximate answers to simple questions that show that they understand the underlying theem of the questions asked
84
What is Fregoli's syndrome?
persecutor is able to change into many forms and disguise themselves to look like different people
85
What is othello syndrome?
delusional intensity belief that partner is being disloyal
86
What is Capgras' syndrome?
delusional belief that a close acquantiance has been replaced by an identical double
87
What type of disorder is agoraphobia?
phobic anxiety disorder
88
What is social phobia?
fear of scrutiny and criticism from others
89
What is generalised anxiety disorder defined as?
generalised, excessive worry for more than 6 months
90
How long do symptoms need to last for a diagnosis of somatization disorder?
2 years
91
What is first line managemetn of panic disorder?
CBT
92
What does the term conversion mean in psychiatry?
unconscious change of intrapsychic anxiety into physical symptoms of symbolic significance
93
What pathway in the brain is involved in positive symptoms ?
mesolimbic pathway
94
what pathway in the brain is involved in negative symptoms?
mesocortical pathway
95
What are teh 4 dopamine pathways in the brain?
mesolimbic; mesocortical; tuberoinfundibular and nigrostriatal
96
What can be used to treat akathisia?
beta blockers and BZDs
97
What are the specific SE of chlorpromazine?
greying of the skin in response to sunlight and reduced seizure threshold
98
What type of dopamine receptor do typical antipsychotics work on?
D2 receptors
99
What dopamine receptors do clozapine and olanzapine work on?
D1 and D4
100
What is the combination of St Johns wort and fluoxetine assocaited with?
serotonin syndrome
101
Waht are the signs of serotonin syndrome?
severe HT; tachycardia; high pyrexia; myoclonus, sweating and hyper-reflexia
102
What is hypermnesia?
exaggerated retnetion of detail about past experiences
103
what is paramnesia?
distorted recall of events, such that falsification of memory occurs
104
What is confabulation?
verbal evidence of unconscious filling of gaps in memory with false memories
105
What is stupor?
state of being unresponsive, akinetic and mute but fully conscious
106
How long do symptoms need to present for a diagnosis of SZ?
1 month
107
What is waxy flexibility?
patient remains motionless but allow their limbs to be moved be someone els
108
What is a schizoid personality?
preference for theri own company over other , lack emotional expression
109
what is a paraphilia?
disorder of sexual preference
110
What is first line treatment for mild depression?
CBT
111
What is the absolute CI to ECT?
raised ICP
112
what is SSRI withdrawal syndrome?
transient dizziness; lethargy; nausea and HA
113
What is the problem thing in MAOs?
tyramine
114
Why should there be a washout period before starting an MAO?
risk of serotonin syndrome- highest when MAOI is combined with otehr antidepressants
115
What is anankastic PD?
inflexible preoccupation with rules; order adn attention to detail
116
What are cluster A personality disorders?
paranoid; schizoid; schizotypal : odd/eccentric
117
what are cluster B personality disorders?
emotional or dramatic- antisocial; borderline; histrionic; narcisstic
118
What are cluster C personality disorders?
anxious/fearful- avoidant; dependent; anankastic
119
What are Brodmann's areas 1,2 and 3?
primary somatosensory cortex
120
What is Brodmann's area 4?
primary motor cortex
121
What is Brodmann's area 5?
somatosensory association cortex- superior parietal lobe
122
What is Brodmann's area 6?
premotor cortex and supplementary motor cortex
123
what is the treatment for paroxysmal hemicrania?
indomethacin
124
What tumour is a dural tail associated iwth?
meningiomas
125
How do visceral afferents of pelvic organs touching the peritoneum reach the spinal cord?
run alongside sympathetics
126
what spinal levels do visceral afferents from the pelvis accompanying sympathetics enter?
T11-L2
127
Where do visceral afferents from organs not touching the peritoneum enter the spinal cord?
alongside parasympathetics
128
Where does spinal cord become cauda equina?
L2
129
Where does the subarachnoid sapce end?
S2
130
what space is anaesthetic injected into in a spinal?
subarachnoid
131
What is the direction of incision in episiotomy?
posterolateral/mediolateral
132
Which abdominal mucles attach into the thoracolumbar fascia?
internal oblique and transverse abdominus
133
What plane does the nerve supply to the anterolateral abdo wall travel in?
between IO and TA
134
Where do the epigastric arteries lie?
psoterior to rectus abdominus
135
What is the blood supply to the lateral abdominal wall continuations of?
psoterior intercostal arteries
136
What should be avoided in a lateral port ?
inferior epigastric artery
137
Where does the inferior epigastric artery emerge?
medial to the deep inguinal ring
138
where is the deep inguinal ring located?
half way between ASIS and pubic trubercle
139
What are the 3 layers of the pelvic floor?
pelvic diaphragm; muscles of perineal pouches and perineal membrane
140
Where does the deep perineal pouch lie?
below the pelvic diaphragm and above the perineal membrane
141
What muscles are found in the deep perineal pouch?
external urethral sphincter; compressor urethrae and deep transverse perineal muscle
142
What does the perineal membraen atttach to laterally?
sides of the pubic arch
143
What muscles are found in the superficial perineal muscle of the male?
bulbospongiosus; ischiocavernous; superifical transverse perineal muscle
144
what is the difference between the bulb in males and females?
paired in females; single structure in males
145
what muscle is most invovled in maintaining faecal continence?
puborectalis
146
What do the 4 rectal muscles and superior oblique originate from?
common tendinous ring
147
What is the lacunar ligament?
joins the inguinal ligament to the pectineal ligament
148
What is the pectineal ligament?
extension of hte lacunar ligament which runs along the pectineal line
149
What forms the anterior wall of the inguinal canal?
aponeuroses- EO and IO
150
What forms the roof of the inguinal canal?
muscles- TA and IO
151
What forms the lower wall (floor) of hte inguinal canal?
Ligaments- lacunar and inguinal
152
what forms the posterior wall of the inguinal canal?
conjoint tendon; transversalis fascia
153
Where do direct inguinal hernias occur?
medial to inferior epigastric vessels
154
What arteries make up the coeliac trunk?
common hepatic; left gastric and splenic arteries
155
What is the function of the ciliary muscle?
accomodates the lens
156
What side of hte thorax is the azygous vein?
Right side
157
What is the version of hte azygous vein on the left side of hte thorax?
hemi-azygous vein
158
Where does the hemi-azgyous vein drain?
left brachiocephalic vein
159
Where does the azygous vein drain?
SVC
160
How many bronchopulmonary segments does each lung have?`
10
161
How many subunits are there in Hb?
4
162
What is ferritin?
storage form of iron
163
What other name is transferrin known as?
total iron binding capacity
164
What is the triad of plummer-vinson syndrome?
WID- webs; IDA and dysphagia
165
What is sideroblastic anaemia?
abnormality of heme production in the porphyrin pathway
166
What are the causes of siderblastic anaemia?
ALA synthetase deficiency; isoniazid; lead poisoning
167
Why does isoniazid cause sideroblastic anaemia?
inhibits B6 which is a cofactor for ALA synthetase
168
How does lead poisoning cause sideroblastic anaemia?
inhibits ferrochetalase- can't prudce haem
169
What is prussian blue stain for?
iron
170
Waht does deletion of 2 alpha genes result in?
mild anaemia
171
what does deletion of 4 alpha genes result in?
hydrops fetalis
172
What are the 2 types of deletion in alpha thalassaemia?
cis and trans
173
Which type of alpha deletion do asian people get?
cis deletion
174
Which type of alpha deletion do african pateitns get
trans deletion
175
What does one deletion of beta gene?
beta thal trait
176
What is seen with beta thalassaemia?
high Hb A2
177
What is the typical facial appearance of patietns with beta thal major?
chipmunk facies
178
What is the cause of mutation in beta thal?
point mutation
179
What inflammatory product is implicated in anaemia of chronic disease?
hepcidin
180
What is the function of hepcidin?
hides iron (infection uses iron to multiply)- reduce iron absorption and increase ferritin
181
What happens to transferrin in anaemia of chronic disease?
decreased
182
What gene is defected in paroxysmal nocturnal haemoglobinuria?
PIGA
183
What does PIGA gene procue?
CD55 (decay accelerating factor )and CD59
184
What is seen in PNH?
Pancytopenia; Negative direct coombs and Hibernating( occurs when sleep)
185
What are the function of CD55 and CD59?
inhibits C3 convertase- stops complement breakdown of RBC
186
What mediates glutathione being reduced?
NADPH
187
What is the function of reduced glutathione?
inhibits free radicals
188
what is the function of G6PD?
changes NADP to NADPH
189
What shunt is the G6PD enzyme involved in?
hexone monophosphate shunt
190
What are the causes of oxidative stress?
D-dapsone
six-sulfa drugs
Primaquine
(fava beans) (G6P= D6P)
191
What is seen on blood film with G6PD deficiency?
Heinz bodies and bite cells
192
What is hereditary spherocytosis caused by?
dysfunctional RBC skeleton proteins- spectrin; ankyrin; bands
193
What type of haemolysis is seen in hereditary spherocytosis?
extravascular haemolysis
194
What is seen on blood film with hereditary spherocytosis?
howell-jolly bodies
195
What are Howell-Jolly bodies?
DNA nuclear remnants usually removed by the spleen
196
Where is B12 absorbed?
terminal ileum
197
What is seen on labs with B12 deficiency?
increased homocysteine and increased MMA (methylmalonic acid)
198
What happens to neutrophils in B12 or folate deficiency?
hypersegmented neutrophils
199
Where is the thymus usually found?
posterior to the manubrium
200
What is found in the anterior chamber of hte eye?
aqueous humour
201
What canal does aqueous humour drain from the eye?
trabecular meshwork and then through the canal of Schlemm
202
What is the area of the eye bounded anteriorly by the iris and posteirorly by the zonular fibres?
posteiror chamber
203
What nerves are found in the side wall of the cavernous sinus?
III; IV; V1; V2
204
What nerve traverses the cavernous sinus?
VI
205
What is the relation of the ascending and descending colons to the peritoneum?
secondarily retroperitoneal
