Extras Flashcards
Function of primary stimulatory neurones
To stimulate appetite via the release of neuropeptide T and agouti-related peptide
Function of primary inhibitory neurones
To inhibit appetite via the release of POMC
Where is PYY released from
Small intestine
Function of secondary neurones in appetite
Coordinate a response to appetite via the vagus nerve
What is the cause of hyperpigmentation sent in Addison’s disease
Decreased cortisol levels
Main function of aldosterone
Control of arterial blood pressure
What does a phaeochromocytoma secrete .
This is a tumour of the chromaffin cells of the adrenal glands
Catecholamines Eg Dopamine Adrenaline Nor adrenaline
How is an Addison crisis treated
Fluid and cortisol - supports blood pressure
What hormone is released from the antihero pituitary to stimulate cortisol release
ACTH - adrenocorticotrophic hormone
How is primary hyperaldosteronism defined?
Primary hyperaldosteronism is caused by a defect in the adrenal cortex.
What is the main cause of Addison’s disease?
Destructive atrophy of the adrenal glands by an autoimmune response is the most common cause of Addisons Disease.
Which of the following is cortisol bound to in the blood?
transcortin
Common signs and symptoms of hyperaldosteronism
include high blood pressure, left ventricular hypertrophy, hypernatraemia, and the correct answer here, which is hypokalaemia.
Affects of cortisol
catabolism (like increased proteolysis), resistance to stress, anti-inflammatory effects, and depression of the immune system.
Fat redistribution
hypertension
hyperglycaemia
symptom of what disease/syndrome
symptom of Cushing syndrome
What is the main cause of Cushing’s syndrome?
Being prescribed glucocorticoids
Which of these is a symptom of a phaeochromocytoma?
severe hypertension
do renin levels decrease in primary hyperaldosteronism
yes
What is the most common cause of gigantism?
pituitary adenoma
Which of the following correctly describes the route of hormones from the hypothalamus to the pituitary?
Hypothalamus – axons – median eminence – hypophyseal portal system – endocrine cells in the anterior pituitary
can Genetics, insulin concentration and environmental factors can all influence somatic growth.
yes
A mother takes her 4 year old son for a general check-up, where the GP notices he is on the 2nd percentile for his age on the standard growth chart despite being born at the 60th percentile. The mother comments that he does seem a lot smaller than the other children at playgroup, which she couldn’t understand as her other son was the tallest in the class. After testing, the doctors diagnose the child with pituitary dwarfism. What would be the most effective form of treatment?
growth hormone
The HPA axis has the following functions:
Control of the adrenal glands
Function of the thyroid glands
Growth
most common cause of hyperprolactinaemia
prolactinoma - tumour secreting prolactin
Growth hormone deficiency can be difficult to diagnose because
the signs are often subtle, and growth hormone is released in a pulsatile manner (meaning that it can be very difficult to infer anything from the blood levels of growth hormone).
Cranial diabetes insipidus is a condition characterised by a deficiency in ADH.
true or false
true
To which structure does the thyroglossal duct connect the developing thyroid gland?
The thyroglossal duct connects the thyroid gland to the tongue. This is an important anatomical feature of the neck as a cyst can form in the thyroglossal duct.
A 35 year-old woman presents to her GP as she has started feeling ‘not right’. Upon taking a history, the GP ascertains that she has been losing her hair, is tired all the time, always feels cold, and has put on half a stone despite no change in lifestyle. Which of the following should be considered as a differential?
hypothyroidism
Iodine deficiency and Multinodular goitre are the most common cause of goitre.
true
By which form of transport is thyroglobulin containing thyroid hormones transported back into the follicular cell
pinocytosis - ingestion of liquid into a cell by the budding of small vesicles from the cell membrane
The intracellular concentration of which ion must increase to cause the release of insulin from pancreatic β cells?
calcium
Which of the following symptoms is NOT one of the classic triad of symptoms for diabetes? (1 mark)
Polyuria
Excessive thirst
Excessive sweating
Weight loss
excessive sweating
The genital thrush is caused by the presence of glucose in the urine, which encourages the growth of organisms in the genital area. true or false
true
what states can plasma calcium be found in the blood
as a free ion
bound to albumin
which hormones act to raise serum calcium levels
Calcitriol, PTHrP and PTH
Which of these hormones acts to raise serum calcium levels when there is a PROLONGED reduction in serum calcium
calcitriol
when is a cerivcal smear offered
he cervical screening program is offered to women between 25 and 49 every 3 years, and women 50 to 64 every 5 years.
Which of the following best describes the epithelium inside the vagina?
The epithelium inside the vagina is stratified squamous epithelium. This is because the vagina needs to be able to withstand some friction during intercourse.
Which of the following structures are damaged in type two female genital mutilation
the clitoris and labia minora
which divisions of the broad ligament covers the fallopian tube?
The mesosalpinx is the portion of the broad ligament that covers the fallopian tubes (the mesofallopian does not exist). The mesometrium covers the uterus, and the mesovarium covers the ovaries.
4 divisions of the Fallopian tube
The fallopian tubes have 4 main divisions: the fimbriae are next to the ovaries, then the infundibulum, then ampulla, and the isthmus is attached to the uterus.
all the layers of the uterine wall
The endometrium has two layers: the basal layer (the layer that allows proliferation) and the functional layer (the portion that sheds during menstruation). The myometrium is the muscular component to the uterine wall.
describe the venous drainage of the ovaries
The venous drainage of the ovaries is a little complex: the right ovary drains directly into the inferior vena cava, but the left ovary drains into the left renal vein (which then drains into the inferior vena cava).
Which of the following best describes the location of the ovarian ligament?
The ovarian ligament is a fibrous band that lies within the broad ligament, and connects the ovaries to the uterus, attaching just below the join of the fallopian tubes.
Which of the ligament of the internal female reproductive tract are the remnants of the gubernaculum
The gubernaculum attaches the ovary to the labia majora and becomes fused with the uterus during development. This means that the ovarian ligament (ovary to uterus) and the round ligament (uterus to labia majora) are remnants of this.
There are many risk factors for pelvic organ prolapse
increased age, oestrogen deficiency (as occurs in the menopause), increased parity, chronically increased abdominal pressure (for example caused by obesity). The only incorrect answer here is an increased number of Caesarean sections: increased vaginal deliveries does increase the risk of pelvic organ prolapse, but Caesarean sections do not particularly increase the risk.
Which of the following pelvic organs could be prolapsed in a posterior prolapse?
bowel and rectum
An episiotomy has been performed on a woman during childbirth. Which muscles of the pelvic floor have been cut during this procedure? (2 answers, 2 marks)
The bulbospongiosus and transverse perineal muscles are cut during an episiotomy to allow delivery of a large baby or instrumental delivery. It is done to help prevent a third or fourth degree vaginal tear which affects the anal sphincter or rectum, and this is achieved by performing the cut at a slightly oblique angle.
Which pelvic organ pushes into the vaginal space in a cystocele?
the bladder
Which type of urinary incontinence is related to pelvic floor dysfunction?
Stress incontinence occurs when urine leaks from the urethra with increased intra-abdominal pressure (e.g. while coughing or laughing) because the pelvic floor is not supporting the urethra properly.
Urge incontinence is related to overstimulation of the bladder, and overflow incontinence is seen during urinary retention when the urine cannot be stored any more, and so leaks out.
what is a primary sexual characteristic
A primary sexual characteristic is one that develops before birth but is not able to perform its sexual function until after puberty. This includes the uterus (the correct answer in this case), as well as the penis, testicles and vagina. The remaining options are all examples of secondary sexual characteristics, which develop during puberty
where is inhibin produced in both females and males
Inhibin is produced by the Sertoli cells in the testicle and the granulosa cells in the ovary. The function of inhibin is to inhibit the secretion of follicle-stimulating hormone (FSH) from the pituitary gland through negative feedback
Which hormone in the body delays the fusion of epiphyseal growth plates?
Testosterone inhibits the fusion of the epiphyseal growth plates in long bones, and this, along with the fact that increased oestrogen encourages their fusion, explains why men are generally taller than women.
Which of the following types of cells are responsible for producing testosterone in the testicles?
Leydig cells in the testes are responsible for producing testosterone. Sertoli cells also exist in the testicles, but they are responsible for providing nutrition for developing sperm. Theca interna and granulosa cells exist in the ovaries to produce oestrogen and control the maturation of the oocytes.
Which of the following replenishes the stock of spermatogonia available for the production of sperm?
type A spermatogonium
The time taken for the same stage of spermatogenesis to appear in the same segment of the seminiferous tubules is called
The spermatogenic cycle is the time taken for the same stage of spermatogenesis to appear in the same segment of the seminiferous tubules.
The spermatogenic wave is the wave-like motion across the seminiferous tubules that occurs with different stages of spermatogenesis occurring simultaneously.
The spermiogenic cycle and spermiogenic wave do not exist.
Which of the following equations is the most correct representation of spermiogenesis? (1 mark)
Primordial germ cells -> spermatogonia -> primary spermatocytes
Primary spermatocytes -> secondary spermatocytes
Secondary spermatocytes -> spermatids -> sperm cells
Spermatids -> sperm cells
Spermiogenesis is the final stage in producing sperm, so the correct answer is “Spermatids -> sperm cells”. All of the other equations indicate parts of spermatogenesis.
what stage of maturation of an oocyte best described the period in which the granulosa cells secrete the zona pellucida? (1 mark)
The preantral stage is the stage in which the granulosa cells secrete the zona pellucida. This is the glycoprotein layer that surrounds the oocyte.
When does oogenesis begin in the female?
Oogenesis begins in utero in the female, arresting at prophase I. The continuation of oogenesis occurs at ovulation (which occurs monthly at puberty), and the completion of oogenesis occurs only at fertilisation.
When does oogenesis permanently cease in females?
Oogenesis ceases at the menopause, as this mahttps://www.brainscape.com/l/study?classes=17029960-9879089rks the end of the fertile period of the woman.
When does oogenesis permanently cease in females?
Oogenesis ceases at the menopause, as this the end of the fertile period of the woman.
Which of the following processes involves making sperm cells mobile?
Spermiation is the maturation stage of sperm cells that creates their motile capacity.
Spermatogenesis creates the spermatids from primordial germ cells, spermiogenesis creates sperm cells from spermatids (then spermiation occurs), and finally sperm capacitation occurs to allow the sperm to bind to the zona pellucida of the egg and begin fertilisation.
How many polar bodies are produced in total by oocyte division following fertilisation
Polar bodies are the smaller daughter cells of oocyte division which are produced only so the division of chromosomes is even. They serve no purpose, and there are three of them produced.
The corpus luteum is made up of which two types of cells?
The corpus luteum is made up of granulosa and theca interna cells and secretes progesterone and oestrogen in preparation for implantation.
If β-hCG is released by the implanted zygote, the corpus luteum persists until the fourth month of pregnancy.
If no β-hCG is released (ie if implantation was not successful and no pregnancy occurs), the corpus luteum will survive 14 days and then turn into the fibrotic corpus albicans.
In which stage of the maturation of the oocyte does the first division of meiosis occur
In the preovulatory stage, FSH and LH increase, which induces growth and causes meiosis I to divide into two haploid daughter cells.
treatments are given commonly during pregnancy for physiological anaemia of pregnancy?
ferrous sulphate and vitamin C
what hormone decreases during pregnancy
Thyroid stimulating hormone (TSH) decreases during pregnancy because hCG and TSH have a similar structure, so the hCG stimulates the TSH receptors, increasing T4 levels, which through negative feedback, reduced TSH levels. Progesterone, oxytocin and prolactin increase during pregnancy.
Which of the following conditions would be improved by pregnancy? (1 mark)
HIV
Psoriasis
Eczema
Reflux disease
Pregnacy results in a reduction in TH1 cytokine production, so will improve TH1 mediated conditions like psoriasis. It is important to know at least one example of a condition improved by pregnancy. Eczema and reflux disease will be worsened by pregnancy. HIV is not affected by pregnancy.
Even though blood volume increases during pregnancy, blood pressure decreases. Why is this?
Progesterone causes dilation of blood vessels in pregnancy, which means that blood pressure reduces (despite the increased plasma volume)
A 28 year old asthmatic patient presents to the GP for her annual asthma check. She is at the time 7 months pregnant. Which of the following changes might you expect in the asthma review?
Peak flow values should not alter during pregnancy, because the FEV1 (amount of air breathed out in one second) is a representation of the actual lung tissue, which will not change during pregnancy. If it does alter, this is an indication for a review of asthma medications.
Is mild hypertrophy of the heart normal during pregnancy
yes
The two correct answers here are linked: the mild hypertrophy of the heart stems from the heart having to work harder to pump the increased volume of plasma round the body. This can cause a physiological S3 heart sound as the hypertrophy prevents the tricuspid and mitral valves to close at different times. Neither oesophageal varices or aortic stenosis would be normal in pregnancy, and would indicate that the mother has associated risks.
during anaemia what happens to red blood cells and plasma volume levels
In pregnancy, blood volume increases, meaning that haematocrit decreases (because the number of red blood cells does not increase fast enough to keep the concentration the same). This is normal, but because of the reduced haematocrit, is called physiological anaemia of pregnancy.
signs of pre-eclampsia
Signs of pre-eclampsia include: headache, oedema, seizures, hyperreflexia, visual disturbances and right upper quadrant pain.
what is bells palsy
dysfunction of the facial nerve
what is effective treatment for pre-eclampsia
Immediate delivery of the fetus and placenta is the most effective treatment for pre-eclampsia. While antihypertensives can be an option, labetalol is the only one indicated for pre-eclampsia, as the other two can be potentially harmful to the fetus. This is not expected knowledge at this point, as delivery is the best option.
Which of the following patients would be classified as having pre-eclampsia? (1 mark)
A 32 year old woman with blood pressure of 135/87 and proteinuria
A 26 year old woman with blood pressure of 153/94 and glycosuria
A 17 year old woman with blood pressure of 146/92 and proteinuria
A 45 year old woman with blood pressure of 157/105 and proteinuria, previously diagnosed with hypertension
Pre-eclampsia is defined as hypertension of over 140/90 and proteinuria arising de novo after 20 weeks gestation in a previously normotensive woman. This makes the correct answer the 17 year old with hypertension of 146/92 and proteinuria.
The 32 year old woman does not have high enough blood pressure to diagnose pre-eclampsia. The 26 year old woman does not have proteinuria. The 45 year old woman has had previously diagnosed hypertension, so this does not count as pre-eclampsia.
Which of the following definitions of the post-partum period is correct?
The period of 6 weeks following the delivery of the placenta
Which of the following would be described a primary post-partum haemorrhage?
Primary post-partum haemorrhages are defined as a loss of over 500ml within the first 24 hours post-birth. They are commonly caused by the 4 T’s (tone, trauma, tissue and thrombus), e.g. lack of uterine tone, trauma, retained placental tissue or coagulopathy.
Any haemorrhage that occurs after 24 hours is described as a secondary post-partum haemorrhage, and any bleeding that occurs before birth is not ‘post-partum’.
Which of the following reasons explains why breastfeeding mothers may go longer without having a menstrual period than a mother who is not breastfeeding?
Prolactin release during breastfeeding which inhibits FSH, so no egg can be matured
High levels of prolactin release during breastfeeding disrupt the hypothalamus-pituitary-gonadal axis, causing levels of FSH to decrease. This can disrupt the ovulatory cycle, causing a delay in the return of menstruation.
However, it is important to remember that this is not 100% effective as a contraceptive, because ovulation may occur without the shedding of endometrium (ovulation occurring without a period),which means that the woman could be fertile without knowing.
Which of the following definitions describes a lactogenic hormone?
Lactogenic hormones promote milk production (this can be worked out by remembering that ‘lacto’ relates to milk, and ‘genic’ relates to the production of something).
Which organism commonly causes mastitis
staphylococcus aureus is the most common cause of mastitis, because it is a common skin commensal, which can enter the breast tissue through a crack on the nipple as a result of breastfeeding.
It is possible for the other organisms to cause mastitis, but these are often infections in the upper respiratory tract of the baby which pass to the breast tissue through direct contact during breastfeeding.
A 17 year old mother is out in the park with her partner and their 3 week old baby. The mother expresses concerns that she thinks someone is following her, and that she needs to get them away from the people who are trying to steal the baby. She is extremely anxious, and is holding the baby very tight to her chest in a protective measure.
Post-partum psychosis is a serious condition that can be characterised by hallucinations, delusions, mania and anxiety. It is important that it is recognised early and help is given, because the condition is associated with increased risks of maternal suicide or infanticide. It would be appropriate in this case to ring an ambulance, because the mother is deteriorating and may pose a risk to herself or the baby.
The suckling action inhibits the release of chemical X that normally acts to inhibit prolactin release. What is the name of chemical X?
Dopamine normally acts to inhibit prolactin release. Suckling inhibits dopamine, so prolactin release may occur. This maintains milk production, which is important when breastfeeding.
does an oophorectomy cause premature menopause
yes
Which hormone change causes the symptoms of menopause?
oestrogen
While follicle stimulating hormone (FSH) increases, and progesterone and oestrogen decrease during the menopause, it is the low levels of oestrogen cause most of the symptoms. This is why hormone replacement therapy contains oestrogen to replace that which is lost during menopause. Thyroid stimulating hormone (TSH) levels are not routinely affected by the menopause, but hypothyroidism can present with similar symptoms to the menopause
What is the term for the initial development of the breasts during puberty
Thelarche is the term given for an increase both number of lobules and the volume of the interlobular stroma in the breast – one of the first stages of puberty in girls.
What is peau d’orange a sign of?
oedema
The cooper’s suspensory ligaments restrict the swelling caused by the oedema and pull the skin back at their attachments, causing lots of little dimples like an orange skin.
algia
pain
In a 30-year-old woman presenting with a lump in her breast, what is the preferred first line choice of imaging?
In younger women, an ultrasound scan is used as the first line imaging for breast masses. Mammograms are not used as their breasts are much denser, meaning it is more difficult to differentiate any pathology from the normal breast tissue on the radiograph.
Which of these descriptions matches that of a fibroadenoma?
Fibroadenomas present as small, round and hypermobile masses in the breast.
Which of these conditions presents as a firm mass in the breast? (1 mark)
Gynaecomastia
Cysts
Fat necrosis
Duct ectasia
Fat necrosis presents as an irregular, firm, palpable mass. It usually follows a history of trauma to the breast. Further investigations are required to differentiate it from a carcinoma. The other conditions do not present as a firm mass.
As fat necrosis cannot be distinguished from a breast tumour it should be investigated using the full triple assessment technique with examination, imaging and tissue analysis.
A 25-year-old woman presents to her GP with a unilateral painful swelling in the introitus of her vagina. She was recently diagnosed with gonorrhoea. Blockage of the ducts which normally drain which structure is responsible for this presentation?
Bartholin’s glands. (1 mark). This is a Bartholin cyst.
in child birth which muscle is put under the most stress
Pubococcygeus, (1 mark), part of the levator ani, undergoes the most stretching during childbirth.
What branch of the internal iliac artery is the main arterial supply to the penis and perineum?
Internal pudendal artery. The internal pudendal artery is a division of the internal iliac artery that supplies the external genitalia and perineum. It feeds the penile arteries which will be sustaining this presentation
Which nerve fibres, trigger the contraction of the cremaster muscle?
The genitofemoral nerve arises from L1-L2 and innervates the cremaster.
A motorcyclist is in a traffic collision and severs their spinal cord, amongst other injuries. MRI scanning reveals the spinal cord to be transected at L2, damaging their parasympathetic supply to the bladder. What effect will this injury have on the activity of the detrusor muscle?
Paralysis of detrusor/detrusor unable to contract, leading to overflow incontinence.
Damaging the spinal cord below T12 inhibits the parasympathetic fibres controlling the bladder (S2-S4). The detrusor muscles stays constantly relaxed. (1 mark).
cervix drains t what lymph nodes
internal iliac
A 35 year old woman presents with a few week’s discomfort in her vulva upon intercourse. Examination reveals a small Bartholin’s gland cyst in her right labia majora. What layer of the urogenital triangle are these glands located in?
Superficial perineal pouch. (1 mark). The superficial perineal pouch is located above the superficial perineal fascia and below the perineal membrane It is a space that contains erectile tissues, blood supply to the external genitalia and the Bartholin’s glands.
what clinical sings are seen in polycystic ovarian syndrome ?
The increased ratio of LH:FSH along with oligomenorrhoea and BMI in the overweight
range indicates PCOS is most likely. A mild elevation in prolactin is sometimes seen in
PCOS.
Which clinical feature is most specific for inflammatory back pain?
Inflammatory back pain (IBP) is typically improved with activity and not relieved by rest,
as opposed to mechanical pain which is worse with activity and is relieved by rest.
IBP can wake the patient in the early hours of the morning and sacroilieitis can radiate to the
thigh, but these features are much less specific.
Morning stiffness is specific for inflammatory back pain but not persistent daytime stiffness.
IBP can occur at any age although mechanical pain is less common in young people.
A 65 year old woman with advanced carcinoma of the breast with cerebral
and liver metastases is rapidly deteriorating and is recognised to be dying.
She becomes confused and agitated.
Which is the most suitable initial treatment?
terminal restlessness should be managed with
Midazolam by prn subcutaneous injections
already said she was dying
