everything for summative Flashcards
(214 cards)
1
Q
define placenta praevia
A
when the placenta is over the internal cervical os
2
Q
what are the 3 main causes of antepartum haemorrhage?
A
placenta praaevia
placental abruption
vasa praevia
3
Q
management of placenta praevia?
A
corticosteroids given between 34 and 35+6 weeks gestation
planned c-section
4
Q
what is vasa praevia?
A
where the fetal vessels are within the fetal membranes and travel across the internal cervical os.
5
Q
risk factors for vasa praevia?
A
low lying placenta
multiple pregnancy
IVF pregnancy
6
Q
management of vasa praevia?
A
corticosteroids given from 32 weeks gestation to mature fetal lungs
elective c-section
7
Q
what is placental abruption?
A
when the placenta separates from the wall of the uterus during pregnancy
the site of attachment can bleed extensively after the placenta separates
8
Q
risk factors for placental abruption?
A
previous abruption
pre-eclampsia
trauma
multiple pregnancy
fetal growth restriction
multigravida
increased maternal age
smoking/cocaine use
9
Q
presentation of placental abruption?
A
sudden onset severe abdominal pain that is continuous
vaginal bleeding
shock
fetal distress on CTG
‘woody’ abdomen on palpation
10
Q
features of ectopic pregnancy?
A
- shoulder tip pain
- missed period
- constant lower abdo pain in right of left iliac fossa
- vaginal bleeding
- cervical motion tenderness
- dizziness/syncope
11
Q
how is ectopic pregnancy investigated
A
transvaginal USS - gestational sac containing a yolk sac or fetal pole may be seen in Fallopian tube
11
Q
how is ectopic pregnancy investigated
A
transvaginal USS - gestational sac containing a yolk sac or fetal pole may be seen in Fallopian tube
12
Q
what are the criteria for expectant management of ectopic pregnancy?
A
- follow up needs to be possible
- enraptured
- adnexal mass < 35mm
- no visible heart rate
- no pain
- hCG level < 1500 IU/l
13
Q
what are the criteria for management of ectopic with methotrexate?
A
- hCG must be < 5000 IU/l
- confirmed absence of intrauterine pregnancy on USS
14
Q
criteria for surgical management in an ectopic pregnancy?
A
- pain
- adnexal mass > 35mm
- visible heartbeat
- hCG levels > 5000 IU/l
15
Q
what is a polymorphism?
A
any variation in the human genome that has a population frequency of greater than 1%
OR
any variation in the human genome that does not cause a disease in its own right. It may however, predispose to a common gene.
16
Q
what is a mutation?
A
a gene change that causes a genetic disorder
OR
any heritable change in the human genome
17
Q
what is the percentage of Down syndrome recurrence if you have a child with Down syndrome?
A
approx 1% if child has primary trisomy 21
higher if caused by Robertsonian translocation
18
Q
what is the percentage of Down syndrome recurrence if you have a child with Down syndrome?
A
approx 1% if child has primary trisomy 21
higher if caused by Robertsonian translocation
19
Q
name the condition with genome 47 XY + 18
A
Edward Syndrome
20
Q
name the condition with genome 45X
A
Turner syndrome
21
Q
what is the first line chromosome test?
A
array CGH - it is genome wide and can find polymorphisms
22
Q
Which treatment is used in HER2 positive breast cancer?
A
Trastuzamab
23
Q
Which treatment is used in chronic myeloid leukaemia?
A
Imatinib - Philadelphia chromosome
24
what are Mendelian disorders?
diseases that segregate in families in the manner predicted by Mendel's Laws.
a disease that is caused by a change in a single gene.
25
name the headache:
- bilateral
- band-like pattern around the head
- pressing/tightening
- mild/moderate, non-disabling
- no nausea or vomiting
- attacks last 30 minutes to 7 days
tension headache
26
name the headache:
- unilateral (often bilateral)
- pulsating.throbbing
- moderate/severe
- disabling
- nausea/vomiting/photophobia/phonophobia
- attacks last hours to days
migraine
27
name the headache:
- always unilateral
- excruciating, stabbing, burning
- very severe
- restlessness, no aggravation by physical activity
- conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, ptosis
- attacks last 15 minutes to 3 hours
cluster headache
28
management of tension headache?
- basic analgesia
- reassurance
- relaxation techniques
- hot towels
29
name the headache:
- facial pain
- lasts few seconds to hours
- electricity-like shooting pain
- attacks worsen over time
- can be triggered by cold weather, spicy food, caffeine, citrus fruits
trigeminal neuralgia
30
what is the treatment for trigeminal neuralgia?
Carbamazepine
31
acute management of migraines?
- paracetamol
- triptans (serotonin receptor agonists)
- NSAIDs
- anti-emetics
32
which medications are used in the prophylaxis of migraines?
- propranolol
- topiramate (teratogenic)
- amitriptyline
33
what does normal pressure hydrocephalus show on MRI?
Ventriculomegaly without sulcal enlargement
34
why can't the COCP be taken with history of migraines?
there is a significantly increased risk of ischaemic stroke
35
what are the driving rules after a first seizure?
- must inform DVLa
- will have to be seizure free for 6 months before applying to have licence reinstated
36
what additional step needs to be considered when administering IV phenytoin for a seizure?
cardiac monitoring
37
first line management for myoclonic seizures in males?
sodium valproate
38
first line management for myoclonic seizures in females?
Levetiracetam
39
1st line investigation for MS?
MRI with contrast
40
how does normal pressure hydrocephalus present?
- urinary incontinence
- gait abnormality
- dementia
41
what is the management of an acute MS relapse?
high dose steroids - oral or IV methylprednisolone for 5 days
42
which artery has caused the stroke based on this presentation:
- contralateral hemiparesis
- sensory loss with upper extremity affected more
than lower
- contralateral homonymous hemianopia
- aphasia
Middle cerebral artery
43
general red flags for back pain?
- failure to improve after 4-6 weeks of conservative therapy
- night pain or pain at rest that won't go away
- progressive motor/sensory deficit
44
cancer red flags back pain?
- age > 50
- unintended weight loss
- history of cancer
- pain at night and in recumbency
45
what symptoms does a stroke affecting the left MCA give?
dysphasia
46
what symptoms does a stroke of the right MCA give?
sensory/visual inattention/neglect (right MCA)
47
which arteries make up the PCA?
2 vertebral arteries and a basilar artery
47
what arteries does the posterior circulation of the brain comprise of?
2 vertebral arteries and a basilar artery
48
which artery supplies the occipital cortex?
PCA
49
what symptoms does a stroke affecting the PCA give?
hemiparesis/hemisensory loss
ataxia
dysarthria
vertigo, diplopia, facial nerve palsy, tongue palsy, dysphasia
50
symptoms/signs of total anterior circulation syndrome?
Hemiplegia involving at least 2 of:
- face, arm and leg +/- hemisensory loss
- homonymous hemianopia
- cortical signs (dysphasia, neglect etc)
51
how long after a stroke can thrombolysis be used?
up to 4.5 hours after onset of symptoms
52
how is blood pressure lowered in ICH to prevent haematoma expansion?
IV labetalol or IV GTN
(BP > 150mmHg)
53
what is gliosis?
an astrocytic response to CNS injury
- astrocyte hyperplasia and hypertrophy
- nucleus enlarges and becomes vesicular and the nucleolus Is prominent
- cytoplasmic expansion with extension of ramifying processes
54
what do microglia do in response to injury?
proliferate and are recruited through inflammatory mediators
form aggregates around areas of necrotic and damaged tissues
55
what is seen macroscopically 12-24 hours after a stroke?
red neuron, oedema (cytotoxic and vasogenic) with generalised cell swelling
56
where do intracerebral haemorrhages most commonly occur?
basal ganglia
thalamus
cerebral white matter
cerebellum
57
what is the most common cause of subarachnoid haemorrhage?
rupture of a berry aneurysm
58
risk factors for subarachnoid haemorrhage?
- female
- smoking
- hyperT
- drugs
- PKD
59
what is hydrocephalus ex vacuo (seen in Alzheimer's)?
dilatation of the ventricular system and a compensatory increase in CSF volume secondary to a loss of brain parenchyma
60
what is the most common brain tumour in children?
Pilocytic astrocytoma
61
what is the definition of MS?
an autoimmune demyelinating disorder characterised by distinct episodes of neurological deficit, separated in time, and which correspond to spatially separated foci of neurological injury.
62
what does MS show in a CSF sample?
IgG oligoclonal bands
63
clinical features of MS?
optic neuritis
motor or sensory deficit in trunk and limbs
spasticity
bladder dysfunction
cranial nerve signs
ataxia
nystagmus
internuclear ophthalmoplegia
64
what are the differences between active and inactive plaques?
active plaques
- perivascular inflammatory cells
- microglia
- ongoing demyelination
- yellow/brown with an ill-defined edge
inactive plaques
- gloss
- little remaining myelinated axons
- oligodendrocytes and axons reduced in number
- grey-brown well-demarcated
- classically situated around lateral ventricles
65
which genes are linked to Alzheimer's?
- APP
- Presenilin 1 (chromosome 14) and 2 (chromosome 1)
66
macroscopic findings in Alzheimer's?
- cortical atrophy
- frontal, temporal and parietal lobe atrophy
- widening of sulk
- narrowing of gyri
- dilatation of ventricles
- brainstem and cerebellum normal
67
microscopic features of Alzheimer's?
- neurofibrillary tangles
- extensive neuronal loss with associated astrocyte proliferation
- neuritic plaques
- amyloid angiopathy
68
how does Lewy bodies dementia present?
- hallucinations
- fluctuating levels of attention/cognition
- REM sleep behaviour disorder
- memory is affected a lot later than in
Alzheimer's
- fluctuation in severity of condition on a day-to- day basis
- features of Parkinsonism may be present at onset or emerge shortly after
68
how does Lewy bodies dementia present?
- hallucinations
- fluctuating levels of attention/cognition
- REM sleep behaviour disorder
- memory is affected a lot later than in
Alzheimer's
69
what are the pathological features of Lewy bodies dementia?
degeneration of the substantial nigra
70
what are the macroscopic features of Lewy body dementia?
pallor in the substantial nigra, where pigmented dopaminergic neurones run
71
what are the microscopic features of Lewy body dementia?
- loss of pigmented neurone
- reactive gliosis
- spread of Lewy bodies from brainstem to cortex
72
How is Huntington's disease inherited?
autosomal dominant pattern
Huntington gene on chromosome 4p - mutated with increase in CAG repeats
73
what are the macroscopic findings in Huntington's disease?
Atrophy of the basal ganglia; caudate nucleus; putamen
74
what are the microscopic findings of Huntington's disease?
simple neuronal atrophy of striata neurones of the basal ganglia
pronounced astrocytic gloss
75
what are the macroscopic findings of frontotemporal dementia?
extreme atrophy of the cerebral cortex in frontal and later in temporal lobes
76
what are the microscopic findings of frontotemporal dementia?
Pick's cells (swollen neurons)
Intracytoplasmic filamentous inclusions - Pick's bodies
77
management for idiopathic tension headache?
weight loss and acetazolamide
78
which spinal columns are affected in subacute combined degeneration of the spinal cord?
dorsal columns and lateral corticospinal tracts
79
what class of medications should be avoided in patients taking SSRIs?
triptans - risk of serotonin syndrome
80
management of delirium tremens?
admit to hospital
long-acting Benzos - Chlordiazepoxide, Diazepam
81
what would a patient with bullimia's ECG look like?
Hypokalaemia - first degree heart block, flattened T waves, tall P waves
82
when should a patient under 25 who has been started on an SSRI be reviewed?
after 1 week
83
features/symptoms of mania?
lasts for at least 7 days
elevated mood, increased activity and grandiose ideas of self-importance.
causes severe functional impairment in social and work setting
likely to require hospital admission
can present with psychotic symptoms
84
features/symptoms of hypomania?
lasts for < 7 days
persistent mild elevation of mood, increased energy and activity
increased sociability, talkativeness and over-familiarity
Increased sexual energy
Decreased need for sleep
can be high functioning and doesn't impair functional capacity in social or work setting
doesn't exhibit any psychotic symptoms
85
features of anorexia nervosa?
reduced BMI
bradycardia
hypotension
enlarged salivary glands
86
physiological abnormalities associated with anorexia nervosa?
hypokalaemia
Low FSH, LH, oestrogen and testosterone
raised cortisol and growth hormone
impaired glucose tolerance
87
what are the first rank symptoms of schizophrenia?
auditory hallucinations
thought disorders
passivity phenomena
delusional perceptions
88
mechanism of action of Mirtazapine?
noradrenergic and specific serotonergic antidepressant
increases release of neurotransmitters by blocking alpha 2 adrenoreceptors
89
long-term side effects of ECT?
apathy
anhedonia
concentration difficulties
loss of emotional responses
difficulty learning new information
90
risk factors for developing BPD?`
prenatal exposure to Toxoplasma gondii
premature birth < 32 weeks gestation
childhood maltreatment
postpartum period
cannabis use
91
characteristics of bipolar I ?
the person has experienced at least 1 episode of mania
92
characteristics of bipolar II ?
the person has experienced at least 1 episode of hypomania but never an episode of mania.
they must have also experienced at least 1 episode of major depression.
93
what medication is added if lithium is not effective in the long-term management of BPD?
sodium valproate (NOT IN PREGNANCY OR WOMEN OF CHILDBEARING AGE)
94
side effects of lithium?
increased thirst
increased volume and frequency of urination
tiredness
weight gain
fine tremor
95
side effects of lithium toxicity?
confusion
drowsiness
visual problems
loss of appetite
difficulty speaking
seizures
excessive thirst + urination
(risk of toxicity is decreased by taking their dose at the same time every day and regular attending to have their blood tested)
96
what are the signs of lower motor neurone disease?
muscle wasting
reduced tone
fasciculations
reduced reflexes
97
what are the signs of upper motor neurone disease?
increased tone or spasticity
brisk reflexes
upping plantar responses
98
which medication is used in motor neurone disease to slow the progression of it?
Riluzole
99
what is the pathophysiology of Parkinson's?
Progressive reduction of dopamine in the basal ganglia (produced in the substantial migration) leads to disorders of movement.
100
what is the classic triad of features in Parkinsons?
resting tremor
rigidity
bradykinesia
101
which medications is given in Parkinson's to treat symptoms?
Levodopa - synthetic dopamine given orally to boost dopamine levels.
usually paired with Carbidopa or Benserazide
102
what are the side effects of Levodopa?
dystonia
chorea
athetosis
103
what is the mechanism of action of Entacapone?
inhibit the catechol-o-methyltransferase enzyme which metabolises levodopa in the body and the brain.
taken with levodopa.
104
what is the main side effect of dopamine gnosis's (Carbergoline, Pergolide etc)
pulmonary fibrosis
105
which type of tumour is linked to myasthenia gravis?
thymomas
106
how does myasthenia gravis present?
diplopia
ptosis
weakness in facial movements
swallowing difficulty
fatigue in jaw while chewing
slurred speech
progressive weakness with repetitive movements
107
how is myasthenia gravis diagnosed?
presence of ACh-R antibodies
presence of MuSK antibodies
presence of LRP4 antibodies
CT or MRI thymus gland - used to look for thymoma
108
name the type of aphasia:
- speech non-fluent, laboured and halting
- comprehension normal
- repetition is impaired
Broca's aphasia
due to lesion in inferior frontal gyrus - supplied by superior division of left MCA
109
when can investigations be commenced for infertility?
for couples who have been trying to conceive for 1 year after frequent (every 2 -3 days), unprotected sexual intercourse.
110
when can couples have an early referral for infertility investigations?
- if the woman is aged 36 or over
OR
- there is a known cause of infertility
OR
- there is a history of predisposing factors
111
what investigations are done in primary care to assess male infertility?
- semen analysis
- chlamydia screen
112
what investigations are done in primary care to assess female infertility?
- mid-luteal progesterone - to assess whether the woman is ovulating
- FSH and LH - to assess ovarian function
- chlamydia screen
113
what are the 2 types of urinary incontinence?
stress and urge
114
how is urge incontinence caused?
overactivity of the detrusor muscle of the bladder
(AKA overactive bladder)
115
describe urge incontinence
suddenly feeling the urge to pass urine, having to rush to the bathroom and not arriving before urination occurs.
116
how is stress incontinence caused?
weakness of the pelvic floor and sphincter muscles which allows urine to leak at times of increased pressure on the bladder.
117
describe stress incontinence
urinary leakage when laughing, coughing or surprised
118
what is overflow incontinence?
when there is chronic urinary retention due to an obstruction to the outflow of urine.
results in an overflow of urine and the incontinence occurs without the urge to pass urine.
more common in men
119
risk factors for urinary incontinence?
- increased age
- post-menopausal
- increased BMI
- previous pregnancies and vaginal deliveries
- pelvic organ prolapse
- pelvic floor surgery
- neuro conditions such as MS
- cognitive impairment and dementia
120
how is urinary incontinence investigated?
- bladder diary
- urine dip
- post-void residual bladder volume
- urodynamic testing
121
management of stress incontinence?
avoid caffeine, diuretics and overfilling bladder
avoid excessive or restrictive fluid intake
weight loss
pelvic floor exercises - for at least 3 months before surgery
- surgery
- duloxetine
122
management or urge incontinence?
bladder retraining - for at least 6 weeks
anticholinergic medication - oxybutynin, tolterodine and solifenacin
mirabegron
invasive procedures where medical treatment fails
123
how does the combined oral contraceptive pill work?
mimics the luteal phase of the menstrual cycle, leading to inhbiition of the hypothalamic-pituitary-gonadal axis.
this prevents the release of LH and FSH needed for ovulation.
thickens the cervical mucus and thins the endometrium
124
how often is the contraceptive injection given?
every 12 weeks
125
how does the IUS work?
thins the endometrium to prevent implantation
thickens the cervical mucus to prevent sperm passage
126
what are the most common reasons for he insertion of the Mirena coil?
contraception (5 years)
menorrhagia (5 years)
endometrial protection for women on HRT (4 years)
127
how many days after unprotected sex can the copper coil be used?
5 days
128
how long after taking levonorgestrel for emergency contracpetioncan the COCP or OCP be taken?
immediately after
129
how long after unprotected sex can levonorgestrel be used as emergency contraception?
72 hours
130
how long after taking Ulipristal (EllaOne) for emergency contraception can the pill be taken?
5 days after
131
in which patient groups should Ulipristal be avoided in?
patients with severe asthma
132
management of bacterial vaginosis?
Metronidazole orally or by vaginal gel
(clindamycin is the alternative)
133
what investigations are done for BV?
- vaginal pH using swab and pH paper
- charcoal vaginal swab for microscopy - shows 'clue cells' on microscopy
134
which organism normally causes BV?
gardnerella vaginalis
135
how does trichomoniasis present?
50% asymptomatic
frothy, yellow-green vaginal discharge - may have fishy smell
itching
dysuria
dyspareunia
balanitits
examination of cervix - strawberry cervix
136
management of trichomoniasis?
Metronidazole
137
management of gonorrhoea?
single dose of IM ceftriaxone 1g - if sensitivities unknown
single dose of oral ciprofloxacin 500mg - if sensitivities are known
138
how does gonorrhoea present?
- odourless purulent discharge, possible green or yellow
- dysuria
- pelvic pain (females)
- testicular pain/swelling in males
139
which results are typically seen in PCOS?
raised testosterone
low sex hormone binding globulin (SHBG)
raised LH
normal FSH
140
what is the management of atrophic vaginitis?
topical oestrogen cream
141
what is the first line management of uterine prolapse?
vaginal pessary
142
where is progesterone produced?
corpus luteum
143
what are the three phases of the uterine cycle?
proliferative phase
secretory phase
menstrual phase
144
management of eclampsia?
magnesium sulphate
145
what is the management of placental abruption when the foetus is alive, < 36 weeks and not showing signs of distress?
admit and administer steroids
146
first line management of nausea and vomiting in pregnancy?
cyclizine
147
how long after giving birth do women need to start using contraception again?
21 days
148
which type of cancer causes pain on drinking alcohol?
Hodgkin's lymphoma
149
what is the most common cause of vitamin B12 deficiency?
presence of anti-intrinsic factor antibodies
150
how is a definitive diagnosis of sickle cel disease made?
haemoglobin electrophoresis
151
what is seen on a blood film with DIC?
schistocytes
152
what does the Factor V Leiden mutation result in?
resistance to action of protein C
153
what are some causes of immune-mediated decreased platelet survival?
- idiopathic thrombocytopenia purpura
- SLE
- rheumatoid arthritis
- sarcoidosis
- anti-phospholipid syndrome
154
what are some non-immune causes of decreased platelet survival?
- medications - heparin, carbamazepine, ibuprofen etc
- splenomegaly
- haemolytic uraemic syndrome
- HELLP syndrome
-thrombotic thrombocytopenic purpura
155
symptoms of thrombocytopenia?
spontaneous bruising or excessive bruising as a result of minor injury
bleeding gums
epistaxis which may be excessive, frequent and prolonged
GI bleeding
genitourinary bleeding
menorrhagia
156
what are the clinical findings of thrombocytopenia?
petechiae (< 2mm)
purpura (0.2-0.1mm)
found on skin and oral mucosa
157
what are the 3 layers of the cerebellar cortex?
molecular layer (outer)
Purkinje cell layer (middle)
granule cell layer (inner)
158
what side of the body will signs appear in a cerebellar hemisphere lesion?
ipsilateral side
159
which symptoms does a unilateral cerebellar hemispheric lesion cause?
disturbance of limb coordination
intention tremor
unsteady gait
160
which symptoms do bilateral cerebellar lesions cause?
slowed, slurred speech
bilateral incoordination of the arms
staggering, wide bed gait
161
what symptoms does a midline lesion of the cerebellum present with?
disturbance of postural control
162
which 3 arteries supply the cerebellum?
superior cerebellar artery
anterior inferior cerebellar artery
posterior inferior cerebellar artery
163
what are the functions of the basal ganglia?
facilitate purposeful movements
inhibit unwanted movements
help maintain posture and muscle tone
164
what symptoms do lesions of the basal ganglia cause?
affect the contralateral side of the body
changes in muscle tone
dyskinesias
tremor
chorea
myoclonus
165
what is the pathology behind Huntington's disease?
progressive degeneration of the basal ganglia and cerebral cortex
166
what are the signs/symptoms of normal pressure hydrocephalus?
- abnormal gait
- urinary incontinence
- dementia
167
investigations for normal pressure hydrocephalus?
Lumbar puncture
lumbar drain test
168
management of normal pressure hydrocephalus?
VP shunt
medium-low or low-pressure valve
169
management of idiopathic intracranial hypertension?
weight loss
carboanhydrase inhibitors - Actetazolamide, Topiramate
diuretics
CSF diversion
interventional radiology
170
pathway of CSF secretion?
choroid plexus (lateral ventricles) > ventricular system > subarachnoid space (Magendie and Luschka) > venous system (arachnoid granulations)
171
how is CPP calculated?
MAP - ICP = CCP
172
what effect does CO2 have on arterioles?
increased CO2 - vasodilation
decreased CO2 - vasoconstriction
173
what is the normal ICP for adults?
7-15 mmHg
174
early signs of raised ICP?
decrease level of consciousness
headache
pupillary dysfunction +/- papilloedema
changes in vision
nausea and vomiting
175
late signs of raised ICP?
coma
fixed, dilated pupils
hemiplegia
bradycardia
hyperthermia
increased urinary output
176
medical management of raised ICP?
diuretics (mannitol, hypertonic saline, furosemide)
barbiturate coma
anti-epileptics
177
which type of visual defect would a lesion in the left temporal lobe present with?
right superior homonymous quadrantinopia
(PITS)
178
which type of visual field defect would a lesion of the right parietal lobe present with?
left inferior homonymous quadrantinopia
179
management of cluster headache?
subcutaneous sumatriptan
100% oxygen
180
clinical features of brown-sequard syndrome?
ipsilateral hemiplegia
ipsilateral loss of proprioception and vibration
contralateral loss of pain and temperature sensation
181
what does the CSF in encephalitis show?
lymphocytosis
elevated protein
HSV, VZV or enteroviruses
182
management of encephalitis?
IV acyclovir
183
when should a CT scan be requested in head trauma?
skull fracture
GCS less than 15
focal neurological signs
taking warfarin
184
which protein, when stained, can help detect Lewy body Dementia?
ubiquitin
185
what happens to the caudate nucleus in huntington's diseas
atrophy of caudate nucleus and loss of neurones
186
what are the histopathological landmarks of frontotemporal dementia?
swollen neurons - Pick's cells
filamentous inclusions - Pick's bodies
187
describe the morphology of Alzheimer's disease on the brain
cortical atrophy
widened sulci
narrowed gyri
dilated ventricles
188
which protein the brain can become tangled in Alzheimer's?
tau protein
189
which medication is used to treat cerebral oedema in patients with brain tumours?
Dexamethasone
190
which deficits would you expect to find in subacute combined degeneration of the spinal cord?
loss of proprioception and vibration sensation
muscle weakness
hyper-reflexia
191
which medication is used in the long term prophylaxis of cluster headaches?
Verapamil
192
what would the investigation findings be in neuroleptic malignant syndrome?
raised CK
raised WCC
193
how does neuroleptic malignant syndrome present?
hyperthermia
muscle rigidity
autonomic instability
altered mental status
194
list some precipitants of a sickle crisis
hypoxia
dehydration
infection
cold exposure
stress
fatigue
195
management of sickle crisis?
opiate analgesia
hydration
rest
Oxygen
antibiotics if infection
red cell transfusion if severe
196
what are the 3 parameters that contractions are based on?
frequency
duration
intensity
197
what are the 3 stages of labour?
cervical dilation (8-24 hours)
passage through birth canal (0-30 mins)
expulsion of placenta
198
what are Braxton Hicks contractions?
tightening of the uterine muscles to aid body to prepare for birth
not usually felt until 2nd/3rd trimester
199
what 5 parameters are assessed under the Bishops's score?
effacement
dilation
firmness
position
level of presenting part
200
which blood pressure reading would infer hypertension in pregnancy?
systolic > 140 mmHg
OR
diastolic > 90 mmHg
201
what is a first degree tear?
tear within vaginal mucosa only
202
what is a second degree tear?
tear into subcutaneous tissue
203
what is a third degree tear?
laceration extends into external anal sphincter
204
what is a 4th degree tear?
laceration extends through external anal sphincter into rectal mucosa
205
what are the SSRIs of choice in breastfeeding women?
Sertraline or Paroxetine
206
non-pharmacological management of ADHD?
parent training
social skills training
classroom strategies
sleep and diet changes
207
pharmacological management of ADHD?
1st line = Methylphenidate (Ritalin)
2nd line = atomoxetine 0
3rd line = anti-depressant, anti-psychotics
208
mechanism of action of methylphenidate?
CNS stimulant that works by improving dopamine signalling in the networks associated with executive functioning
side effects = headache, poor appetite, insomnia
209
in the central dogma, which process is most likely to be affected by a mutation that changes the first base in an intron?
splicing
210
which type of genetic sequence variant is the one most likely to cause long QT syndrome?
a premature stop codon in the exon 2 of a gene.
211
which piece of evidence would most strongly suggest that the genetic variant in long QT syndrome is pathogenic?
the variant is a deletion of a single base in the exon of a gene
