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Year 2b > Day before exam > Flashcards

Day before exam Flashcards

1
Q

What is the genetic mutation in Friedreich’s Ataxia?

A

-tri-nucleotide repeat disorder GAA repeat
- frataxin’ gene

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2
Q

What is the criteria used to determine a TACS or PACS?

(total or partial anterior cerebral artery stroke)

A

Anterior stroke (either anterior or middle cerebral artery stroke)

Criteria:
1) contralateral hemiplegia
2) contralateral homonymous hemianopia
3) higher cognitive dysfunction

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3
Q

What cerebral arteries are associated with Anterior Circulation Stroke?

A

-anterior cerebral artery - lower limbs effected
-middle cerebral artery- upper limbs effected

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4
Q

What is the management of meningitis?
a) adults
b) children

A

IV cefTRIaxone + dexamethasone (adults)

IV ceFOtaxime + amoxicillin (children)

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5
Q

Facial nerve weakness and hearing loss in AICA stroke is on which side?

(Lateral Pontine Syndrome)

A

ipsilateral side

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6
Q

What are the x3 main features in Brown-Sequard Syndrome?

A

-ipsilateral motor loss
- ipsilateral loss of proprioception and vibration (DCML tract damage)
- contralateral sensory loss of pain and temperature (spinothalmic systems)

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7
Q

What are reflexes like in Brown-Sequard Syndrome?

A

-hyper-reflexia- acutely due to very stressed damaged muscle nerves

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8
Q

Sub-acute degeneration of the spine is also known as?

A

posterior cord syndrome
(b12 deficiency in vegans)

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9
Q

What is Arnold-Chiari malformation?

A

downwards displacement of the cerebellum
-associated with Syringomyelia (central cord syndrome)

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10
Q

What is Syringobulbia?

A

-fluid in the the medulla (lower brainstem)- RARE

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11
Q

What is the management of UTI in pregnancy?

A

1st trimester- nitrofuratonin (Trimethoprim is teratogenic is 1st trimester)

2nd trimester-nitrofuratonin

3rd trimester- trimethoprim

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12
Q

Split Hand syndrome is associated with?

A

-thenar wasting
-MND

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13
Q

Brisk jaw jerk reflex is associated with which type of MND?

A

-Pseudobulbar

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14
Q

‘hot potato speech’ is associated with MND

A

cortico-bulbar tract (above T6, pyramidal tract)

(associated with bulbar muscles, swallowing muscles)

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15
Q

Quadrantopias”
What are the main causes of upper and lower quadrant vision defects?

A
  • upper quadrant vision defect >= pituitary tumour
  • lower quadrant defect > = craniopharyngioma (*want to lower down a crane cos scary)
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16
Q

What is the 1st line management of Focal Seizures?

(men & women)

A

Focal Seizure:
1st line- lamotrogine or levetiricam

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17
Q

What features are associated with Posterior Circulation Strokes?

A
  • Bilateral motor/sensory deficits
  • Eye movement disorder
  • Cerebellar dysfunction
  • Isolated homonymous hemianopia
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18
Q

What is Pharmocodynamics?

A

Pharmaco-dynamics:
(dynamics- how things get on- dynamic)

  • effect the drug has on the body- receptor binding and chemical interactions
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19
Q

What is Pharmoco-kinetics (move)

A

refers to the movement of a drug through the body –ADME

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20
Q

What is ‘First’ and ‘Zero’ Order Kinetics?

A

First Order Kinetics:
- elimination rate of a drug is directly PROPORTIONATE to the drug concentration

Zero Order Kinetics:
- elimination rate of a drug is a a CONSTANT rate

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21
Q

What is the management of Prolapse?
a) cystocele
b) rectocele
c) vaginal vault prolapse

A

Prolapse Management
Cystocele:
-anterior colporrhaphy (associated with urine incontinence)

Rectocele:
-posterior colporrhaphry (associated with faecal incontinence)

Vaginal vault prolapse:
- sacrocolpexy

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22
Q

Look at herniations diagram and learn it!

(do NOT be lazy)

A
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23
Q

What is the most common type of brain herniation?

A

Sub-Falcine

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24
Q

What type of herniation is associated with Anterior Cerebral Artery damage?

A

Sub-falcine herniation

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25
Q

What type of herniation is associated with ‘ipsilateral occulomotor’ nerve palsy

A

Uncal Herniation

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26
Q

Where is ‘uncle’ herniation associated with?

(“my uncle has a temper”)

A

medial temporal lobe

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27
Q

What is Transcalverial Herniation?

A
  • bony defect change in the skull- ‘trans’
  • brain compression and herniates through this bony defect
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28
Q

What is Central Herniation?

A
  • downwards displacement of thedicephalon
  • located in central area of brain
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29
Q

What finer is damaged in ‘internuclear ophthalmoplegia?’

A

medial longitudinal fasiculus fiber

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30
Q

What are the symptoms of Inter-Nuclear Opthalmoplegia?

A
  • ISPILATERAL SIDE- impairment in ADDUCTION
  • contralateral eye- nystagmus present
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31
Q

posterior communicating anyeursim causes what palsy

A

CN 3 palsy

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32
Q

Cavernous sinus thrombosis causes which palsy?

A

CN3 palsy

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33
Q

What is the gold standard diagnostic investigation for Sub-Arachnoid Haemorrhage?

A

-diagnostic- MR angiography

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34
Q

What investigation should be completed first in GBS?

A

MOST important investigation to do first- FVC

others:
-FVC
-Nerve conduction testing
-Lumbar puncture- isolated rise in protein

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35
Q

What do nerve conduction studies show if a patient has GBS?

A

loss of F wave

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36
Q

What neurological condition is associated with better with exercise and movement?

A

Lambert eaten syndrome- pre-synaptic

(*INCREASE MUSCLE TONE AND STENGTH temporarily due to excessive contractions)

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37
Q

What is the main cause of Lambert Eaten Syndrome?

A

small cell lung cancer > hypocalcemia > waddling gait

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38
Q

What antibodies are associated with Neuromyelitis optica spectrum disorder?

A

-Aquaporin-4 antibodies

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39
Q

”ring enhancing lesions” is associated with?

A

-Cerebral Abscess
-HIV toxoplasmosis

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40
Q

What is ‘Hoffmans Sign’

A

characterized by flexion and adduction of the thumb and flexion of the index finge

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41
Q

What is Babinski’s Reflex?

A

-this is when the toes do NOT curl when the plantar foot is stroked- Multiple sclerosis

-absence of descending inhibition

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42
Q

What is the management of:
a) Premature or Prolonged Rupture of Membranes
b) Chorioamnionitis confirmed strep.b infection

A

a) 1st line- oral erythromycin
b) IV benzylpenicillin Intra-Partum

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43
Q

What is Androgen Insensitivity Syndrome?

(they are male, whereas turners are girls)

A

Androgen insensitivity syndrome is an X-linked recessive condition due to end-organ resistance to testosterone causing genotypically male children (46XY) to have a female phenotype

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44
Q

When can POP and COCP be started after child birth?

A

-Can be Started immedietley after use of emergency contraception

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45
Q

What vaccination is offered in initial dating scan at 12 weeks?

A

hep.b vaccination

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46
Q

When is higher dose of folate (5mg) given in pregnancy?

A
  • BMI >30
  • thalassemia - haemolysis > bilirubin elevated
  • Anti-epileptic meds
  • coeliac
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47
Q

Chickenpox in Pregnancy?
a) exposure
b) developed chickenpox

(*varciella zoster)

A

-exposure- oral aciclovir (7-14 days after exposure)

-develop acc chickenpox- oral aciclovir within 24 hrs!

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48
Q

What is the best contraceptive method for a trans male?

A

copper IUD

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49
Q

NIPT Testing:
What are results like in the following conditions?
a) Trisomy 21
b) Patau’s
c) Spina Bifiida
d) Edwards Syndrome

A

Trisomy 21- raised HCG and inhibin A

Patau’s- isolated rise in Inhibin A

Spina bifida, etc- Isolated elevation AFP

Edwards syndrome- ALL LOW

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50
Q

What is Mcroberts Position?

A

Mcroberts:

-Flexed and ABDUcted hips

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51
Q

What is cytology?

A

-same as cervical smear

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52
Q

Patient has confirmed HPV 16 and 18 but cytology is normal, what is next line investigation

A

repeat smear in 12 months (if still positive but normal cytology) the continue REPEATING every 12 months

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53
Q

What structure is at highest risk of damage in a C-Section?

A

uterine damage

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54
Q

What is the mechanism of these drugs:
a) mifepristone (oral)
b) misoprostol (vaginal)

A

a) mifepristone- anti-progesterone

b) misoprostol- prostaglandins- induce uterine contractions

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55
Q

What is the surgical management of:
a) Cystocele
b) Rectocele
c) Uterine prolapse

A

-Cystocele:
-anterior colporrhaphy,

-Rectocele:
-posterior colporrhaph
colposuspension

  • uterine prolapse:
    -hysterectomy
  • sacrohysteropexy
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56
Q

What type of prolapse is associated with recent hysterectomy?

A

vaginal vault prolapse

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57
Q

What criteria is associated with Lactational Ammenorea used as a contraceptive method?

A
  • complete ammenhorea (secondary)
  • nearly all feeds are breastfeeds
  • <6 months since birth of baby
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58
Q

Cervical Ectropion:
a) 1st line investigation
b) 1st line management

A

Cervical Ectropion:

1st line investigation- colposcopy

1st line management- ablation

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59
Q

What is the MOST common cause of post menopausal bleeding?
b) what must be ruled out though?

A

-most common- vaginal atrophy

b) must rule out- endometrial cancer

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60
Q

Ovarian Cancer:
a) What is the 1st line investigation
b) what is the gold standard diagnostic investigation?

A

Ovarian cancer:
1st line- CA-125 levels (calculate RMI score)

diagnostic- laparotomy

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61
Q

What are LFT results like in ‘fatty liver disease of the liver’

A

liver damage- ends with T

elevation- AST and ALT

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62
Q

What are LFTs like in Obstetric Cholestasis?

A

elevated ALT, AST and GGT
-raised bile acids

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63
Q

What deficiency is there in Fatty Liver Disease in Pregnancy?

A

-long-chain 3-hydroxyacyl-CoA dehydrogenase(LCHAD)deficiencyin the fetus, which is anautosomal recessivecondition

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64
Q

What is the definitive management of Obstetric Cholestasis?

A

definitive management- birth the baby

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65
Q

Summarise FIGO Staging System in Ovarian Cancer:

A

Stage 1: Limited to the ovaries only
stage a- limited to one ovary
stage b- both ovaries
stage c - tumour limited to ovarian surfaces and does not spread beyond

Stage 2: Involving one or more ovaries + pelvic extension
2a- extend to Fallopian tubes
2b- extends to pelvic tissues
2c- pelvic extension with malignant implants and ascites

Stage 3: involving one or more ovary + outwith pelvic extension
3a- mICROscopic metastases beyond the pelvis
3b- mACROscopic metastases beyond the pelvis
3c- peritoneal metastases

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66
Q

Summarise the Glasgow Coma Scale:
(MoVE)
6,5,4

A

Motor: (6)
-spontanous/obeys commands
-away from site of pain
-normal flexion
-abnormal flexion
-abnormal extension
-no movement

Verbal: (5)
-orientated
-confused
-words
-noises
-none

Eyes:
-spontanoeus
-responds to voice
-responds to pressure
-none

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67
Q

What is the management of a Missed Miscarriage?

A

1st line- oral mifEpristone + 24/48hrs after- misoprostol

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68
Q

When can oral medication not be given for a miscarriage?

A

-evidence of infection
-haemorrhage

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69
Q

What is Postpartum Thyroiditis?
b) what is the management?

A

Three stages

    1. Thyrotoxicosis
    1. Hypothyroidism
    1. Normal thyroid function (but high recurrence rate in future pregnancies)

management:

symptom management- beta blockers

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70
Q

What is ‘tidal volume?’

A

-volume of air that enters and exits the lungs per breath

(*Increases during pregnancy)

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71
Q

What is ‘reichters transformation?’

A

CLL > non-hodgkins lymphoma

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72
Q

WBC mature at different stages is associated with which condition?

A

CML

(Philadelphia matures- Chronic myeloid leukemia)

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73
Q

What is the management of Infective Endocarditis?
a) Native valve (do not know cause)
b) cause if staph.a
c) penicillin allergy
d) Prosthetic heart valve (staph.epidermis)

A

Native valve:
amoxicillin (+/- gentamicin)
staph.a confirmed- fluclox

Pen-allergy/MRSA:
vancomycin (+/- gentamicin)

Prosthetic valve:
vancomycin + rifampicin + gentamicin (FRG

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74
Q

Revise Radiology images!

A
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75
Q

What condition is associated with:
-murmur louder on valsalva manœuvre and quieter when squatting

A

Hypertrophic Cardiomyopathy

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76
Q

What genetic conditions are associated with:
a) ST elevation
b) Dagger Q waves

A

a). brugada syndrome
b) hypertrophic cardiomyopathy

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77
Q

What is the 1st line management of Brugada Syndrome?

A

ICD

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78
Q

What is the management of Long QT Syndrome?

A

1st line- beta blocker
2nd line- ICD

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79
Q

What are the main bacterias located in the LARGE bowel?

A

(*all the food ones)
-c.difficile
-baciluus cerus
-e.coli

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80
Q

What bacteria is located in the ‘stomach’

A

-h.pylori

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81
Q

What bacteria is located on the skin?

A

staph.a
staph.epidermis

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82
Q

What does ‘specific’ mean

A

Specific - the ability test has to detect negatives (e.g 100% specific means there would be NO false positive results

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83
Q

What does ‘sensitive’ mean?

A

Sensitive - the ability the test is able to detect people with the condition

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84
Q

What bacteria are CF patients most susceptible to?

A

Pseudomonas aeruginosa

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85
Q

What is the mechanism of ‘FluroQUINolones’ antibiotics?

(Ciprofloxacin, Moxifloxacin, Levofloxacin, Ofloxacin)

A

‘quintuplets’- inhibits DNA synthesis

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86
Q

What is the mechanism of ‘SulFOnamide’ antibiotics?

A

Inhibits ‘FOlate’ synthesis

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87
Q

What is the management of OCD?
a) mild
b) severe OCD

A

Iffunctional impairment is mild

  • low-intensity psychological treatments: cognitive behavioural therapy (CBT) including exposure and response prevention (ERP)

moderate-severe

1st line- SSRI

2nd line- increase SSRI dose

3rd line- alternative SSRI or SNRI

4th line- tri-cyclic- clomipramine

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88
Q

What type of drug class is ‘Mirtazipine’?

A

Noradrenergic and specific serotonergic antidepressants(NaSSAs). T

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89
Q

What is the mechanism of ‘Acamprosate’ in alcohol misuse disorders?

A

Acamprosate- A-Anti-craving medication

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90
Q

What is the mechanism of Di-sulfram in alcohol misuse disorders?

A

Disulfiram (also known as Antabuse) is an irreversible inhibitor of acetaldehyde dehydrogenase (alocohol chemical).

If alcohol consumed + di-sulfram-unpleasant symptoms (vomiting will occur)

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91
Q

Lithium medication:
a) how often are lithium levels monitored
b) how often are TFT and Renal tests monitored?

A

-lithium- every 3 months once levels established after weekly monitoring for 18 wees

-TFT and renal tests- every 6 months

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92
Q

What are the steps involved in ‘Opiate Replacement Therapy?’

A
  1. Induction- starting treatment
  2. Optimisation- finding the right dose
  3. Maintenance- stability and adherence for period of time
  4. Reduction- reducing the dose
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93
Q

What does ‘left shift’ in neutrophils mean?

A

Left Shift:
- immature less lobes
- cause- acute infection

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94
Q

What does ‘right shift’ in neutrophils mean?

A
  • hypermaturity more >5 lobes caused by -

cause- chronic infection- adapted to be better

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95
Q

Where is Vitamin K absorbed?

A

Vitamin K is absorbed in the upper intestine

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96
Q

What is ‘Myelodysplasia?’

A

stem cell malignancy where these is ineffective haemopoietic stem cells (pluripotent)

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97
Q

What mucosa is damaged in pernicous anaemia

A

autoimmune disorder affecting the gastric mucosa that results in vitamin B12 deficiency

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98
Q

paroxysmal nocturnal haemoglobinurias:
a) what is the 1st line investigation?
b) what is the definitive management?

A

1st line investigation- Flow cytometry (CD59 and CD55 levels are low)
definitive management- bone marrow transplant

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99
Q

What is the gold standard diagnostic test in hereditary spherocytosis?

A

diagnostic (gold standard)- EMA binding test

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100
Q

early morning bloody urine is associated with?

A

paroxysmal nocturnal haemoglobinurias:

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101
Q

What is the underlying cause of paroxysmal nocturnal haemoglobinurias?

(early morning bloody urine)

A

Acquired mutation of PIGA on X chromosome of haematopoietic stem cells, causing loss of surface GPI proteins. Cells are vulnerable to complement system attack.

(intra-vascular haemolysis-G6PD and paroxysmal)

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102
Q

What type of haemolysis are these blood transfusions reactions?
a) acute haemolytic reaction (ABO incompatibility)
b) Delayed Haemolytic Reaction

A

a) intra-vascular haemolysis
b) extra-vascular haemolysis

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103
Q

What antibody is produced in Acute haemolytic reaction in blood transfusions?

A

IgM (mediate)

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104
Q

What is the cause of ‘febrile non-haemolytic reactions’

A

-non haemolytic cause by exCess production of cytokines

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105
Q

What is the preventative methodd for Febrile Non-haemolytic blood transfusion reaction?

A

prevention- -leukoreduction(stops wbc releasing cytokines)

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106
Q

What x2 conditions increases the risk of TACO?

A

Diagnosis of CKD or Congestive heart failure

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107
Q

What antibody is produced in an anaphylactic reaction in blood transfusions?

A

IgA

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108
Q

What type of hypersensitivity is febrile non haemolytic blood transfusion reaction?

A

Type 2 hypersensitivity(as non-haemolytic- caused by excess release of cytokines!)

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109
Q

What type of hypersensitivity are these Organ Transplant Rejections?
a) hyperacute
b) acute
c) chronic

A

Hyperacute- starts within minutes
- (**type 2 hypersensitivity)-

Acute:
type 4(mainly 4) and type 2 hypersensitivity, occurs weeks to months

Chronic- months to years after transplant,
type 4 and 2 hypersensitivity

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110
Q

What type of hypersensitivity is ‘Immune thrombocytopenic purpura (ITP)

A

Type 2

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111
Q

What type of parasites are associated with malaria?

A

parasite- plasmodium falciparim and ‘anopheles’ mosquito vecto

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112
Q

What condition is associated with a fever spiking every 48 hours?

A

malaria

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113
Q

What is the gold standard investigation for malaria?

A

Gold standard investigation- blood film (3 neg samples on 3 consecutive days)

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114
Q

What is the prophylaxis medication for Vaso-occlusive crisis?

(*also known as painful syndrome)

A

Mono-clonal antibody ‘mab’

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115
Q

‘pencil pokoloyytes’ and ‘target cells’ are associated with

A

iron deficiency anaemia

(target eat more iron)

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116
Q

Study all the blood film abnormalities

A
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117
Q

Auer rods are associated with?

A

-auer rods- acute myeloid leukemia (a cute metal rod)

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118
Q

What are the triad of symptoms in HUS?

Triad: N(Mneumonic HRT)

A

Triad of symptoms:

1) renal failure (uraemic part of HUS)

2) thrombocytopenia

3) haemolytic anaemia (hameolytic part of HUS)

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119
Q

Summarise the Ann-Arbour Staging System in Lymphoma

A

Ann-Arbour Staging System: Lymphoma

Stage 1:

  • single lymph node involvement

Stage 2:

  • 2 or more lymph node regions on the SAME side of the diaphragm

Stage 3:

  • LN regions effected are on BOTH sides of the diaphragm

Stage 4:

  • extra-lymph-organ involvement
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120
Q

What type of cancer are these conditions associated with?
a) pernicious anaemia
b) coeliac disease

A
  • pernicous anaemia- increased risk gastric cancer
  • coeliac- increased risk of T cell lymphoma
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121
Q

What is the main antibiotic to trigger G6PD

A

nitrofuratonin

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122
Q

What is the eradication management of H.pylori in MALT lymphoma?

(*same management as peptic ulcer disease)

A

a proton pump inhibitor + amoxicillin + (clarithromycin OR metronidazole

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123
Q

Study Neuro eye defect fundoscopies

A
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124
Q

optic disc cupping is associated with

A

glaucoma

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125
Q

What are the x5 criteria to be detained under the mental health act 2003

A
  • Mental disorder (anorexia included, if physical illness is as a result of mental disorder)
  • Impaired decision making ability- lack capacity
  • Significant risk to themselves or others
  • Informal or voluntary care is not appropriate
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126
Q

What criteria is used to assess capacity?

A

Capacity:

  • Unable to retain information
  • Cannot weigh up
  • Cannot understand
  • Cannot communicate their decision
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127
Q

What treatment cannot be given under detention?

A

Treatment that cannot be given under detention:

  • ECT
  • Vagus nerve stimulation
  • Neurosurgery
  • Any medication intentionally which would reduce their sex drive
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128
Q

What genetic mutations is haemochromatosis associated with?

A
  • HFE gene defect and chromosome 6
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129
Q

What bacteria is associated with ‘petting zoos small animals’

A

salmonella - ciprofloxacin

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130
Q

What bacteria is associated with bbqs?

A

Campylobacter.jejuni

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131
Q

What cranial nerves are damaged in pseudo bulbar MND?

A

9,10,12

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132
Q

What system activates the anti gravity extensor muscles- balance activated when fall.

A

Extra-pyramidal- vestibule-spinal

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133
Q

REM sleep disorders and BAD nightmares are associated with?

A

Lewy body dementia

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134
Q

Where does blood collect in Splenic rupture > haematoperitoneum?

A

hepatorenal recess

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135
Q

Where does the facial nerve exit the skull?

A

internal acoustic meatus (patronius part of the bone)

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136
Q

Forced contraction of what part of the leg causes an avulsion fracture?

A

ilipsoas muscle

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137
Q

How long must panic disorder be present to be diagnosed

A

panic disorder must be present > 1 month

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138
Q

What is the 1st line management of duct papilloma?

A

1st line- microrchoidectomy

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139
Q

What part of the lungs are most likely to be effected in aspiration pneumonia?

A

Theright middle and lower lung

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140
Q

What is the best anti-psychotic to give a patient with hypertension?

A

Aripiprazole- lowest side effect profile

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141
Q

What is the best SSRI to give a patient who has had recent MI?

A

sertraline- most cardio-protective SSRI

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142
Q

What is Transmural pressure gradient?

A

difference between intra-pleural and intra-alveolar pressure

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143
Q

What neurons are effected in MND?

A

-only motor
-no sensory deficits

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144
Q

What type of loss is associated with Charcot Marie tooth disease>

A

motor loss: (marie-m)

muscle atrophy, recurrent ankle sprains, -foot drop-strork leg deformity, pes cavus (high arched feet)

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145
Q

What type of neuronal loss is associated with Lambert eaten syndrome?

A

motor loss

-symmetrical asscending weakness, reduced motor reflexes
***-temporary increased muscle strength due to repeated muscle contractions

(better with exercise)

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146
Q

What is the management of a brain abscess?
(*ring enhancing lesion)

A

1st line- Ceftriaxone + metronidazole

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147
Q

What is the 1st and 2nd line anti-emetic management for Hyperemesis Gravidarum?

A

1st line antihistamines: oral cyclizine or promethazine
2nd line- oral ondansetron

148
Q

NIPT in neural tube defects and Edwards syndrome, what level is inhibit A?

A

inhibin A-normal

149
Q

thickened Nuchal Translucency is associated with?

A

Trisomy 21

150
Q

What is the ‘quadruple’ NIPT testing used to screen of Trisomy 21?

A

1) AFP
2) HCG
3) Inhibin A
4) UE3 (unconjugated estriol)

151
Q

what are key features of stage 3 lymphoma?

(Ann-Arbor staging)

A

lymph nodes on neck and groin

152
Q

Obstetric cholestasis increases your risk of

A

still birth

153
Q

Name a type of tocolytic drug

A

terbutaline- reduces contractions

154
Q

What drug can be given alongside managing umbilical cord prolapse?

A

tocolytics- terbutaline (reduces contractions)

155
Q

How many points out of Rotterdam Criteria can a PCOS diagnosis be made?

A

2/3

(associated with elevated LH:FSH)

156
Q

When MUST genital mutilation (infibulation) be reported

A

under 18 years old- report to the police!

157
Q

chorioamnionitis is associated with what foetal symptom

A

foetal tachycardia

158
Q

Psammoma bodies is “buzzword” feature of which ovarian cancer tumour?

A

Epithelial- serous cystadenocarcinoma

159
Q

“schiller-duval bodies” present on which type of ovarian germ cell tumour?

A

yolk sac tumour (germ cell tumour)

160
Q

What is the triad of symptoms in Thrombotic Thrombocytopenic Purpura?

A

microangiopathic haemolysis, thrombocytopenia, and neurological abnomalities

(Deficiency in metalloproteases enzymes- usually breaks down VWB multimers-stciky VWB- excessive adhesion and increases risk of thrombosis)

161
Q

What is the most common bacterial cause of gastroneteritis?

A

e.coli

162
Q

What is the most common cause of travellers diarrhoea?

(*buzzword)

A

e.coli

163
Q

What is the most common bacterial cause of neonatal jaundice

A

strep.b

(*associated with pathological Janice, <24hrs after birth)

164
Q

What is the management of life threatening C.difficle

A

1st line- oral vancomycin + IV metronidazole

165
Q

Patient had recent C.diff infection less 12 weeks ago what is the management?

A

-do not give oral vancomycin if been given for previous c.diff infection within 12 weeks

1st line- oral fixdaxomicin

166
Q

What drug increases risk of iron deficiency anaemia and c.difficile

A

PPIs (omeprazole)

167
Q

What bacterial infections are associated with the following incubation periods:
a) 1-6 hours
b) 12-48 hours
c) 48-72 hours

A

a) staph.a, bacillus cereus
b) salmonella, e.coli
c) campylobacter

168
Q

What is the management of Chlamydia in pregnancy?

A

1st line- azithromycin or erythromycin

(doxycycline contra-indicated)

169
Q

What is the management of PID

A

Oral ofloxacin + oral metronidazole

OR
intramuscular ceftriaxone + oral doxycycline + oral metronidazol

170
Q

What is the management for Lymes Disease?

A

1st line- oral doxy

(*bullseye lesions)

171
Q

When condition does dynamic airway compression occur alongside?

A

Dynamic airways compression- makes active expiration harder in patients with COPD.

this is because:
intra-pleural ressure rises during expiration compressing the airways more.

172
Q

What effect does inspiration and expiration have on the trans-mural pressure gradient?

A

During Inspiration: (*opposite what i think)
-intra-pleural pressure falls

During Expiration:
-intra-pleural pressure rises

173
Q

What effect can giving excess O2 have on patients with COPD?

A

lead to hypercapnaeic respiratory failure in COPD patients with chronic CO2 retention.

174
Q

What condition is associated with a very high V/Q mismatch?

A

PE

mismatch and/or dead-space ventilation. (very mismatched between rate of air delivery and and gas exchange)

175
Q

What is the more extensive list of Accessory respiratory muscles?

(*Mneumonic)

A

More Extensive list: (mneunonic 3SEP)

X3s:

-scalene

-sternocleidomastoid

-serratus anterior

E-Erector Spinae

P-Pectoralis Major and Minor muscle

176
Q

In what condition do patients have ‘high pulmonary compliance?’

A

COPD patients- damaged elastic recoil

177
Q

What is the FEV1:FVC ratio % in obstructive and restrictive airways disease?

A
  • [ ] asthma FEV1:FVC- less 70%
  • [ ] restrictive more than 70%
178
Q

What ligaments does a Laminectomy go through?

A

supraspinous ligaments
interspinous ligaments
ligamentum flavum

179
Q

What injury would cause ‘foot drop’

A

fibular fracture (common ‘fibular’ nerve)

180
Q

What is Toxic Shock Syndrome

A

excess release of staphylococcal exotoxins from tampons

management:
IV fluids
IV antibiotics

181
Q

What is 2nd order kinetics

(harder not same as first and zero order)

A

Second order kinetics is where doubling the concentration of the reagents quadruples the reaction rate

whereas
first order-elimination rate is DEPENDENT on the concentration of the durg
zero order- drug is eliminate at a CONSTANT rate

182
Q

What are the x3 key symptoms in thrombotic thrombocytopenia purpura?

A

-microangiopathic haemolysis
-neurological impairment
-thrombocytopenia (low platelets)

183
Q

In Immune thrombocytopenia purpura what is the pathophysiological process

A

antibodies are produced against glycoprotein IIb-IIIa or Ib complex

184
Q

What is the mechanism of LMWH? (‘rin’ drugs’)

A

activates anti-thrombin III and factor Xa

185
Q

What deficiency is veganism and pervious anaemia associated with

A

B12 deficiency

186
Q

What types of haemorrhage are these features associated with?
a) labial periods
b) fluctuating consciousness, recent head trauma, alcoholics and old

A

a) extra-dural
b) sub-dural

187
Q

State the x2 antibodies present in Anti-phospholipid syndrome?
b) What blood test is prolonged?

A

anticardiolipin antibodies
anti-beta2 glycoprotein I (anti-beta2GPI) antibodies

b) APTT- this is when increased due to the antibodies interacting with the clotting factors during blood test

188
Q

What do antibodies in Anti-Phospholipid Syndrome target?

A

glycoprotein IIb/IIIa

189
Q

Polycythaemia Rubra, essential thrombocythaemia and myelofibrosis is at risk of transformation into what type of leukaemia

(Myelodysplatic syndromes)

A

AML

190
Q

Name the X2 preventative medications for Tumour Lysis Syndrome

A

allopurinol or rasburicase

(before chemo always give allopurinol and fluids)

191
Q

Name x3 conditions associated with Howell-jolly bodies

A

1) sickle cell anaemia
2) coeliac
3) hyposplenism (Post splenectomy)

192
Q

What autoimmune condition can cause neutropenia?

A

SLE

193
Q

What drug causes neutrophillia, and increased neutrophil distribution?

A

prednisone (steroids)

194
Q

What are bloods like in DIC

A
  • ↓ platelets
  • ↓ fibrinogen
  • ↑ PT & APTT
  • ↑ fibrinogen degradation products
195
Q

increased fibrinogen degradation products and d-dimer is associated with?

A

DIC

196
Q

how long should prophylactic DVT therapy be continued for?

A
  • provoked (e.g. recent surgery): 3 months
  • unprovoked: 6 months
197
Q

What are hb and reticulocyte levels like in sickle cell anaemia

A

-low hb and high reticulocyte

198
Q

What is the gold standard definitive diagnostic investigation used in Sickle Cell Anaemia?

A

definitive diagnosis of sickle cell disease is byhaemoglobin electrophoresis

199
Q

How does acute chest syndrome present on an CXR?

A

pulmonary infiltrates on chest x-ray, l

200
Q

What is the most common type of Hodgkins Lymphoma?

A

-nodular sclerosing- most common type- lacunar cell

201
Q

What type of Hodgkins lymphoma has best and worst prognosis?

A

best and worst prognosis:

lymphocyte predominant- best type

lymphocyte depleted - worst type (depleted and feel sad)

202
Q

What is the most common cause of thrombophillia (DVT etc)

A
  • factor V Leiden (activated protein C resistance):most common cause of thrombophilia

(**Protein C not S resistance)

203
Q

What excess cell proliferation is associated with myelofibrosis?

A

myelofibrosis- abnormal megakaryocytes

204
Q

Aquagenic itch is mainly associated with which one condition?

A

polycythaemia vera

205
Q

What is molecule do antibodies target in Immune Thrombocytopenia Purpura (ITP)

(*characterised by isolated thrombocytopenia)

A

-antibodies produced against glycoprotein IIb/IIIa or Ib-V-IX complex
type 2 hypersensitivity

206
Q

What is the management of major bleeding in a patient on warfarin?

A

Stop Warfarin
Give IV vitamin K + pro-thrombin complex

207
Q

What is the management if INR is <8?

<8 (between 5-8)

A

Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose

208
Q

What is the management if INR is >8

A

STOP warfarin
IV Vitamin K

209
Q

What is the prophylaxis of Vaso-occlusive crisis? (Pain syndrome)

A

‘mab’

210
Q

What type of haemolysis is Paroxysmal Nocturnal Haemoglobinuria

A

intra-vascular haemolysis

211
Q

What is the 1st line investigation of Paroxysmal Nocturnal Haemoglobinuria

(what cells does it detect)

A

-flow cytometry-CD59 abd CD55

212
Q

What is the management of Paroxysmal Nocturnal Haemoglobinuria?

A

1st line- Blood replacement

213
Q

dar urine in the morning is a buzzword for?

A

Paroxysmal Nocturnal Haemoglobinuria

214
Q

What are bloods like in G6PD deficiency?

A

-low gluathione
low NADPH (as not converted back)
-low G6PD enzyme

215
Q

Why is intravascular haemolysis associated with G6PD deficiency?

A

-G6PD is not there to convert NADP > NAPDH so glutathione (anti-oxidant) cannot bind to the free radicals.
-therefore RBCs are exposed to oxidative stress > intravascular haemolysis

216
Q

What defects are associated with microcytic anaemia and microcytic anaemia

A

microcytic anaemia- cytoplasmic defect
microcytic anaemia- delayed DNA maturation and defective DNA synthesis

217
Q

What is the underlying pathology of Pernicious Anaemia?

A

autoimmune damage to the gastric mucosa. results in B12 deficiency

218
Q

What is the most common cause of B12 deficiency

A

Pernicious Anaemia

219
Q

What type of mutation is present:
a) alpha thalassemia
b) beta thalassemia

A

alpha- deletion mutation
beta-point mutation (codon 6-defectibe beta globulin production)

220
Q

What is Spurious (false macrocytosis)

A

-cold agglutinins causes the RBCs to clump together > high MCV

221
Q
A
222
Q

What are sex hormone levels like in anorexia?

A

Hypothalamic axis Failure
-low FSH and Low LH
-low oestrogen and progesterone

223
Q

What is the main symptom of mania

A

flight of ideas

224
Q

What level are WBCs in anorexia?

A

low

225
Q

What are CT scan features if Normal Pressure Hydrocephalus?

A

Enlarged ventricles
Absent sulci

226
Q

What are the CT scan features of Alzheimers?

A

Enlarged ventricles and prominent sulci seen on CT brain scan

(alzheimers has prominent sulk and normal pressure hydrocephalus they are absent)

227
Q

How does Huntingtons present on a CT scan

A

flattening of the convex walls of the lateral ventricles.

228
Q

Bipolar like mood swings within 2 weeks after childbirth is most likely?]

(*always answer this for bipolar post pregnant mum)

A

Puerperal psychosis

Features include severe swings in mood (similar to bipolar disorder) and disordered perception (e.g. auditory hallucinations)

management:
-emergency admission to mother and baby unit + anti-psychotics

229
Q

What is the 1st line management for Acute Stress Disorder?

A

1st line- trauma-focused cognitive-behavioural therapy (CBT) is usually used first-line

230
Q

What is 1st and 2nd line management of alzheimers?
b) what is the drug class of 2nd line

A

1st line- ACH inhibitors ((donepezil, galantamine and rivastigmine)

2nd line- memantine (NDMA receptor antagonist)

231
Q

What x2 parameters must be monitored when starting an SSRI or SNRI

A

-urea and electrolytes (can cause hyponotremia)
-blood pressure

232
Q

What is the most common cause of meningitis in unvaccinated children?

A

h.influenza

233
Q

What is the underlying cause of botulism?

A

-exotoxin (chemical released) acts on the motor neurone terminals blocking the pre-synaptic membrane and release of ACH
-bulbar palsy

234
Q

What chemical is released in botulism?

A

exotoxin

235
Q

What is the most likely cause of brain abscesses from recent sinus infections?

A

haematogenous spread

236
Q

What is the management of Kawasaki Disease?
b) what are the main features

A
  • Kawaski diease- immunoglobulins + aspirin (risk of coronary artery anyeurism)

b) bilateral conjunctivitis and unexplained fever >5 days

237
Q

What are lumbar puncture signs of Aseptic Meningitis?

(seems like there is no infection)

A

*A low number of WBC
*A minimally elevated protein
*A normal glucose

238
Q

What chromosome abnormalities are associated with:
-Downs Syndrome
-Edwards Syndrome
-Patau’s Syndrome

A

Trisomy 21- chromosome 21
Edward’s Syndrome- chromosome 18
Patau’s Syndrome- chromosome 13

239
Q

How does an amniotic fluid embolism present on a CXR?

A

pulmonary oedema

240
Q

What is the 1st line management of Renal Colic?

A

diclofenac (NSAIDs)

241
Q

What does the Broad Ligament Connect to

A

Uterus, fallopian tubes and ovaries to the pelvic wall
-double layered

242
Q

What does the round ligament connect to?

A

Uterine fundus to the labia majora
-embryological remnant

243
Q

What ligament attached Cervix to the lateral pelvic wall

A

cardinal ligament

244
Q

When does puberty occur in boys and girls

A

girls- between 8-14 years old
boys- between 9-15 years

245
Q

When are girls investigation for failure to menstruate or develop secondary characteristics

A

-no period by 15
-no breast or secondary seal characteristics by 15

246
Q

How can uterine cancer spread and can this condition spread and therefore present with superficial inguinal node swelling?

A

round ligament- connects uterine funus and labia majora

247
Q

What is the risk of vertical transmission from a HIV positive mother to baby?

A

risk of HIV transmission is reduced to less than 2%, this is if treatment is taken and correct advice is followed

248
Q

pus cells on swabs from the vagina or endocervix is associated with

A

PID

249
Q

what type of cellularity is Reed-Sternberg Hodgkins Lymphoma

A

mixed cellularity

250
Q

‘coffee bean’ nuclei’ is associated with

A

Brenners Tumour (transitional cell epithelium)

-epithelial ovarian tumour

251
Q

What hormones does sex cord tumours release?

A

Fibroma- produces oestrogen
Sertoli Leydig- produces progesterone

252
Q

What hormones does germ cell tumours release

A

AFP and HCG

253
Q

When is surgical excision required for fibroadenoma?

A

> 3cm

254
Q

What number of placentas and amniotic sacs are associated with identical twins?

A

Monochorionic diamniotic
(one placenta separate amniotic sacs)

if was monochorionic monoamniotic- mean baby’s would be co-joined attached

255
Q

what type of cause for Large for gestational date is associated with vaginal bleeding?

A

molar pregnancy

*If patient been treated for molar pregnancy and experiences vaginal bleeding > indicates molar pregnancy

256
Q

When is IV potassium chloride required for an abortion

A

> 22 weeks

257
Q

Ovarian Cancer:
a) what is the 1st line investigation
b) what is the gold standard diagnostic investigation

A

a) CA-125 glycoprotein
b) gold standard diagnostic- tissue laparotomy

258
Q

PCOS increases the risk of which cancer

A

endometrial cancer- excess oestrogen

259
Q

What is the 1st line investigation of patient complaining of heavy periods?

A

1st line-FBC (detects iron deficiency anaemia)

260
Q

What is the management of atrophic vaginitis?

A

vaginal oestrogen cream (not ring

261
Q

What are the clinical features of a patient with androgen insensitivity syndrome?

A

little or no axillary and pubic hair
undescended testes causing groin swellings
-short vagina
-pelvic masses (Undescended testes)
-high androgens

(man -XY chromosomes but with a female phenotype)

262
Q

Endometrial Cancer:
a) What is 1st line investigation
b) what is the diagnostic investigation, and excludes a diagnosis too

A

a) TV US
b) endometrial biopsy and hysteroscopy

263
Q

What are the X4 stages of Female Genital Mutilation:

A

stage 1- cliterodiectomy
stage 2- excision
stage 3- infibulation
stage 4- jewellery and piercings

MUST report to police if under 18 years when it was carried out

264
Q

What is the main clinical feature associated with Ovarian Cyst Rupture or Uterine Hyperstimulation Syndrome?

A

hypotension/hypotensive crisis

265
Q

‘erythematous’ cervix is associated with what STI

A

strawberry cervix - trichiomonas vaginalis (parasitic infection)

266
Q

yellow/green, frothy discharge colour is associated with?

A

Trichiomonas vaginalis

267
Q

What type of biopsy in Triple Assessment for Breast Cancer is used?

A

Core needle biopsy

268
Q

How do you distinguish between fibroadenoma and phyllodes tumour?

A

both- firm mobile masses

phyllodes tumour - much more rapidly growing

269
Q

What is Sclerosing Breast Lesion

A

· Sclerosing lesion- disorderly proliferation of acini and stroma

(benign breast conditon)

270
Q

What are the x2 main components of breast tissue?

A

-fibroglandular and adipose tissue

271
Q

Bloody discharge from the nipple which can present with/without a palpable mass, is known as

A

Intra-ductal papilloma

272
Q

patient reports breasts to be “lumpy” breasts, most commonly in the upper outer quadrant.
Breast pain.

A

fibrocystic change

metaplasia- squamous cells >apocrine cells

273
Q

What time is used to monitor LMWH? (e.g heparin)

A

Activated partial thromboplastin time (APTT)

274
Q

What artery is at risk when draining bartholins cyst?

A

Internal pudendal artery

275
Q

What is a key feature which suggest congenital abnormality in a newborn?

A

delay in femoral pulses- coarction of the aorta

276
Q

What chemical is low in depression

A

5 HT is low in depression (5-hysroxytryptamine)

277
Q

What chemical causes a seizure in a patient with drug withdrawal?

A

withdrawal from sedatives-GABA (slows brain)

delirium trements- 36hrs peak seizure- lack of GABA as no longer drinking alcohol

278
Q

What should be assessed before starting the COCP?

A

blood pressure and BMI

279
Q

How fast should RBCs be transfused in non emergency scenario

A

non-urgent scenario, a unit of RBC is usually transfused over 90-120 minutes

280
Q

What type of translocation is associated with Burketts Lymphoma?

A

Translocation between chromosomes 8 and 14 is associated with which type of lymphoma

281
Q

c-myc gene translocation is associated with

A

burketts lymphoma (non Hodgkins)

282
Q

What is the name for the staging system used in lymphoma?

A

Lugano staging

283
Q

What does low haptoglobulin indictate?

A

Decrease
intravascular haemolysis

(G6PD deficiency and paroxysmal nocturnal haemoglobinuria)

284
Q

What condition is also known as ‘Christmas Disease?’

A

haemophilia B

285
Q

How long do RBCs in G6PD deficiency last?

A

30 days

286
Q

Chronic Leukemia:
a) Chronic Lymphocytic Leukemia
b) Chronic Myeloid Leukemia (philidelphia)

What is the management?

A

a) Watch and wait (*trick question)
b) CML-tyrosine kinase inhibitors

287
Q

Myeloproliferative disorders, give examples
b) are these malignancies

A

-polycythaemia vera
-essential thrombocythmeia
-myelofibrosis

288
Q

What are Myelodysplastic disorders?

A

Myelodysplastic syndromes (MDSs) are clonal hematopoietic stem cell (HSC) malignancies that are characterized by ineffective hematopoiesisand immature cells in the bone marrow that do not mature

289
Q

What gene codes for the philidelphia chromosomes?

A

BCRABL gene (BRA and ABL gene combined)

290
Q

What types of haemolysis is warm and cold autoimmune haemolysis?

(*think location)

A

Warm- extra-vascular (Antibodies- SLE)-MORE COMMON

Cold- intra-vascular

291
Q

What is the difference between intra-vascular an extra-vascular haemolysis?

A

Intra-vascular- intra-vascular - haemolysis occurs in the blood stream

Extra-vascular extra-vascular - in the spleen in the liver

292
Q

Question states the father has the condition, what do you think?

A

biological father
- In exam- X-linked recessive

(G6PD, haemophilia)

293
Q

What is elevated in anaemia of chronic disease?

A

Hepcidin

294
Q

What is the most common blood type?
b) what is the universal blood donor

A

a) O positive
b) O negative (as no anti-d for patient to react to)

295
Q

What is the management of Myelofibrosis?

A

1st line- JAK2 inhibitor

296
Q

What is the Polycythaemia Vera management?

A

1st line- venesection + JAK2 inhibitor

prophylaxis- aspirin

297
Q

What chromosome are antigens A and B on in blood types?

A

chromosome 9

298
Q

What chromosome is effected in beta thalassemia and sickle cell anaemia?

A

chromosome 11

(As sickle cell- beta globulin is damaged)

299
Q

What type of lymphoma is worse when drinking alcohol

A

Hodgkins

300
Q

What symptoms are associated with tumour lysis syndrome?

A

increased serum creatinine (1.5 times upper limit of normal)
cardiac arrhythmia or sudden death
seizure-important (due to hypocalcemia and hyPERkalemia)

301
Q

What type of haemolysis is associated with cold and wam weather?

A

cold haemolysis- 4 degrees- IgM antibody most active

warm temp (body temp)- warm haemolysis - IgG

blood is stoed at 4 degrees celcius

302
Q

a) What is the most common type of plasma?
b) What is the most common blood type
c) what is the universal blood donor type

A

a) AB neg
b) O positive
c) O neg

303
Q

What are the symptoms of Parkinsonism as an Extra-Pyramidal Side effect?

A

Slowness of movements (bradykinesia)
Muscle stiffness (rigidity)
Tremor that appears when the limb is at rest
Impaired postural reflexes (imbalance and falls)
Stooped posture (camptocormia)
Freezing of movements (short lasting episodes during which movements are blocked – e.g. legs feel like they are “glued” to the ground

304
Q

What is the management of Secondary PPH?

(24hrs after-6 weeks)

A

management: 1st line- co-amoxiclov
penicillin allergy- co-trimoxazole + metronidazole

cause- endometritis or retained placenta
investigation required- Endocervical and high vaginal swabs for infection

305
Q

What is the management of Neuroleptic Malignancy Syndrome?

A

Neuroleptic malignancy syndrome- caused by dopamine blockade
Management- IV fluids and dantrolene

306
Q

Retrospective and Prospective studies ate sub-types of which study?

A

Cohort Study

307
Q

What is the mechanism of the Tomato-Sensory System?

(NEED TO KNOW DO NOT BE LAZY)

A

system mediates pain (noiception) and itch (pruriception)?

308
Q

Is there metabolic compensation in Panic Attacks Acid-Base disorders?

A

no metabolic compensation with panic attacks as resolves fast

309
Q

What genes are defective in:
a) Wilsons Disease
b) Haemochromatosis

A

a) ATP-7B
b) HFE

310
Q

Kayser flesher rings are associated with?

A

(excessive copper)
-Wilsons Disease

311
Q

What are investigations and the associated levels in Wilsons Disease?

(excess copper)

A

-low serum caeruloplasmin
-reduced serum total copper
-HIGH copper urinary secretion

312
Q

What is the management of Wilson’s disease?

A

Management- Penicillamine

313
Q

What is the 1st line investigation for haemochromatosis?

A

1st investigation- transferrin saturation

314
Q

What is the management of Haemochromatosis?

A

1st line- venesection
2nd line- iron chealtors (as required)

315
Q

What are the x3 main clinical features of Brown-Sequard Syndrome?

A

ipsilateral motor loss and hyperreflexia (BELOW Level of lesion)
ipsilateral DCML damage

contralateral sensort loss (SPINOTHALMIC system)-(**know this)

316
Q

What are the spinal level landmarks for the nipple and umbilicus?

(*T8-T10 regions overlap, pain in T9 could be caused by t10)

A

nipple-T4
umbilicus- T10

317
Q

What are the clinical features of Erbs and Klumpe’s palsy?

A

Erbs: (‘waiter’s tip)
-shoulder AdDuction
-wrist flexion

Klumpe’s Palsy:
-weakness in the intrinsic muscles in the hands

318
Q

What type of sleep is associated with ‘dreaming’

A

REM Sleep

319
Q

What is the difference between:
a) Non-REM sleep
b) REM sleep

A

Non-REM:
-Start of the night
-relaxation of the muscles and reduced cerebral perfusion

REM: (this is where dreams occurs)
-increased cerebral blood flow
-dreaming occurs here

320
Q

What is Circadian Rhythm?

A

-refers to sleep-wake pattern over a 24hr day
-controls your daily schedule for sleep and wakefulness

321
Q

What is Sleep Latency Test?
b) what conditions is this the 1st line investigation for?

A

4 twenty five minute naps are scheduled about two hours apart

b) sleep disorders- narcolepsy, parasomnias, cataplexy

322
Q

low hypocretin levels on lumbar puncture indicates?

A

narcolepsy - chronic sleep disorder tiredness

323
Q

Carbemazipine is a sodium channel blocker, does it increase or reduce their refractory period?

A

increases refractory period

324
Q

A) What glial cells are damaged in MS?
b) what glial cell provides physical support

A

-oligodendrocytes- damaged in MS

-astrocytes- provides physical support

325
Q

What is the mechanism of mesenchymal cells?

A

develop into the tissue cells such as bone marrow and adipose tissue

326
Q

What glial cell undergoes phagocytosis?

A

Microglia

327
Q

What ell produces the lining of the lateral ventricles where CSF is produced (choroid plexus)

A

produced the CSF and forms the lining of the ventricle

328
Q

What are the x3 main components of the neuron?

A
  • Dendrites
  • The cell body
  • Axons
329
Q

What is the myelination and speed of conducion like in A, B and C fibres?

A
  • A fibres are wide and heavily myelinated with fast conduction. They are both sensory and motor fibres of the somatic nerves. (FASTEST CONDUCTION)
  • B fibres are moderately myelinated with moderate conduction speed and form fibres of the autonomic nervous system.
  • C fibres are unmyelinated and have the slowest conduction and narrowest diameter. They are sensory only and conduct pain and temperature sensation.
330
Q

What is the mechanism of the messier and paciniaan mechanoreceptor cells?

A
  • meissners- vibration
  • Paciniaan- pressure (P_Pie many layers in shape)
331
Q

Alpha neurones are also known as?

A

LMNs

332
Q

What is the order of organisation of muscle?

A

Myofibrils make up muscle fibers

1)Sarcomere-smallest functional unit (located between x2 Z lines)

2)Myofibrils

3)Muscle fibers

4)Motor units

5)Muscle

333
Q

What is the route of CSF fluid?

(*need to known this)

A

Route of CSF Fluid:

-choroid plexus (lateral ventricles) 3rd venricle > cerebral aquaduct > 4th ventricle > sub-arachnoid space (this is where CSF fluid is stored)

CSF is produced by the lateral ventricles (choroid plexus) and stored in the sub-arachnoid plexus.

334
Q

What type of weakness is GBS associated with?

A

-bilateral weakness in lower limbs

(could be confused with lower anterior cord transection below the lesion)

335
Q

What is the mechanism of cerebellar layers?

A

vestibulo-cerebellum- balance and vestibulo-occular reflexes

Spino-cerebellum- maintains muscle and posture

Cerebro- cerebellum- coordination betwen movements and corrects them

336
Q

What side should carotid endarterectomy be carried out on?

A

carotid stenosis must be >70%
-carry out on the CONTRALATERAL side of symptoms in the stroke or TIA

337
Q

empty delta sign is a CT sign indicates

A

dural venous sinus thrombosis

338
Q

a) What antibodies are present in Neuromyelitis Optica Spectrum Disorder?

A

anti-aquaporin antibodies

condition-

339
Q

What is the process of Neuromyelitis Optica Spectrum Disorder?

A

autoimmune disorder where there is de-myelination of the spinal cord and optic nerve

340
Q

What is the management of Myelofibrosis, and give an example of the drug given?

A

jakinib (JAK 2 inhibitors)

341
Q

What is the management of Listeria and pregnant?
b) what antibiotics are given if patient has a penicillin allergy?

A

a) Ampicillin and gentamicin
b) Trimethoprim and sulfamethoxozole

342
Q

What is the 1st line investigation and management of a dural venous sinus thrombosis?

A

1st line- MR venogram
management- LMWH (pregnant is best option, DVT, PE swap from warfarin to LMWH)

343
Q

What is the management of Atypical Pneumoniae?

A

1st line-doxycyline

344
Q

What beta blocker is used 1st line in Long QT syndrome?

A

Nadolol (preferred) Propranolol. Metoprolol.

345
Q

What is the management of Hypertrophic Cardiomyopathy?

A

1st line- Beta blockers
2nd line- ICD

346
Q

What is the gold standard investigation for Alpha and Beta Thalassemia?

A

1st line investigation- electrophoresis
(*identifies abnormal alpha and beta globulin chains)

347
Q

What is the gold standard investigation for Multiple Myeloma?

A

1st line- electrophoresis (identifies bench jones proteins and m paraprotein)

348
Q

What do ‘schistocyte’/helmet cells indicate?
b) what type of hameolysis and give x2 examples

A

-intra-vascular haemolysis
x2 associated conditions- G6PD deficiency and Paroxysmal nocturnal haemoglobinuria

349
Q

low haptoglobulin indicates what process?

A

G6PD or Paroxysmal nocturnal haemoglobinuria
(indicates intra-vascular haemolysis is taking place)

350
Q

What do “Burr cells (echinocytes)” on blood film indicate?

A

Uraemia
Pyruvate kinase deficiency

351
Q

What do ‘Acanthocytes’ on blood film indicate?

A

Abetalipoproteinemia

352
Q

Aplastic anaemia:
a) what is the 1st line investigation
b) what is the 2nd line investigation

A

Full Blood Count (FBC): Reveals pancytopenia.
Bone Marrow Aspiration and Biopsy

353
Q

What does FBC show in the presence of Aplastic anaemia?

A

panytopenia- hypo cellular bone marrow
-low hb and low reticulocytes

354
Q

Name the specific prophylactic treatment used to prevent episodes of vaso-oclusive crisis

A

Crizanlizumab I(mab-cry)

355
Q

What type of drug is Hydroxycarbamide?

A

Ribonucleotide reductase inhibitor that increases the levels of FOETALhaemoglobin (Hb F)

foetal hb- has higher affinity for O2 than HBA
(left curve shift on dissociation curve)

356
Q

Bone marrow in leukemia is ……..

A

hypercellular- high WBC and panocytopenia other cells

357
Q

The ……. pathway is activated when blood comes into contact with collagen on an injured vessel wall

A

intrinsic- damaged vessel wall

358
Q

How does Acute Chest Syndrome present on a CXR?

A

CXR-pulmonary infiltrates

359
Q

What is the Acute Management of a Sickle Cell Crises?

A

General management
analgesia e.g. opiates
rehydrate
oxygen
consider antibiotics if evidence of infection
blood transfusion

360
Q

How to differentiate between VWB and Haemophillia?

A

both have prolonged APTT
(factor 8 is reduced in VWB)

symptoms- bruising is ONLY present in VWB disease

361
Q

What are clotting levels and factor 8 levels like in VWB?

A

APTT prolonged but factor VIII is actually normal

362
Q

What is the best diagnostic investigation for haemophilia A or B?

A

factor VIII/IX assay/factor IX

363
Q

What is the mechanism of desmopressin in VWB?

A

Releases von Willebrand factor from its storage sites in endothelial cells

364
Q

a) what is the most common inherited bleeding disorder
b) what is the most common thrombophillic disorder

A

a) Von Willebrand disease is the commonest inherited bleeding disorder
b) protein-c resistance (factor v Leiden)

365
Q

what is the 1st line management of VWB?

A

1ST LINE-Desmopressin (released VWB factor from endothelial storage cells)

2nd line- tranaexemic acid and factor VIII

366
Q

What is the management of haemophilia?
a) acute disease
b) severe disease

A

acute:
1st line-desmopressin- increases release of VWB
2nd line- replace clotting factors

367
Q
A

Year 2b (3 decks)

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