General Questions Flashcards
Name 5 risk factors for schizophrenia
Genetics (50% identical twin chance)
Substance abuse (inc risk if start younger/ heavier)
Poor development/ low socioeconomic status
Low birth weight/ low O2 at birth
Stress
Name 3 positive symptoms of schizophrenia
Delusions (Untrue belief)- Often grandeur or paranoia
Hallucinations (False perceptions)- Mainly auditory
Thought echo/ thought broadcasting
Name 5 negative symptoms of schizophrenia
Avolition (lack of motivation- stop wash/ eat etc)
Anhedonia (inability to experience pleasure)
Flat emotion
Alogia (poverty of speech)
Asociality (lack of desire for relationships)
What are the three components of the GCS?
Motor (1-6)
Verbal (1-5)
Eyes (1-4)
Total 3 is worst, 15 is best (<8 is severe)
Which gender has a higher stroke incidence?
25% higher in men but more women due to older F population
Name 10 RF’s for a stroke
Age, raised BP, smoking, obesity, diabetes, afrocarribean, stress, alcohol, previous stroke/ TIA, cocaine, family history, high cholesterol
What are the diagnostic criteria for GAD (generalised anxiety disorder)?
Excessive worry for more days than not for >6months
Three or more of: (Restlessness, fatigue, irritability, sleep disturbance, low concentration)
What are some possible caused of GAD (generalised anxiety disorder)?
Brain area overactivity- Amygdala
NT imbalance (serotonin/ adrenaline)
Genetics
Traumatic experience/ long term illness/ substance abuse
What are some of the symptoms of depression in MDD or the depression phase of bipolar? (10)
Sad, hopeless, lack of energy, concentration difficulty, loss of interest, guilt, despair, sleep difficulty, decreased appetite, pessimism, self doubt
What are some of the symptoms of the mania phase of bipolar disorder? (9)
Elation, quick talking, full of energy, self important, new ideas + plans, spend more money, more promiscuous, drink more, increased libido
What are the two types of bipolar disorder?
I (raging)- Severe mainia (>1wk) affecting ability to function combined with severe depression
II (swinging)- Hypomania with severe depression with possible level mood periods
What is cyclothymia?
(BIPOLAR) Hypomania episodes with mild depressive episodes (mild form of bipolar)
What is rapid cycling (bipolar)?
4 or more mania/ hypomania/ depressive episodes within 12 months (can occur with any type of bipolar)
What are some of the risk factors for a foetus developing spina bifida?
Family history
Mother: Low folic acid, taking valproate/ carbamazepine, has diabetes or obesity
What % of babies are breech at a) 28wks b) 37wks c) how is this corrected?
a) 20% b) 3%
External cephalic version offered (50% success)
Then caesarean offered at 39wks (normal time)
NICE guidelines suggest long term management following a stroke should include what ‘blood thinner’ medication?
Anti-platelet (e.g. clopidogrel)
Generalised anxiety disorder is linked to which over-active brain region?
Amygdala
What area’s control a) understanding/ comprehension of speech b)motor formation of speech?
a) Wernickes - understanding of speech
b) Brocha’s - motor speech induction
The sneezing reflex is triggered by sensory stimulation of which cranial nerve?
Trigeminal
How is folic acid (Vit B9) activated?
Via enzymatic activation (Dyhydrofolate reductase- takes place in the liver)
Biologically active form is tetrahydrofolate
Folate deficiency is accelerated by consumption of what?
Alcohol
Problems with folate deficiency are often linked with what other deficiency?
Vitamin B12 (can present with megaloblastic anaemia)
If a P presents in adulthood with a congenital abnormality, they complain of headaches but were asymptomatic in childhood. They are most likely to be diagnosed with?
Chiari T1 malformation
The DNFB1 mutation is associated with what?
Mutation in the GJB2 gene
Most common form of congenital deafness
Define pharmacokinetics
(What the body does to the drug)
The branch of pharmacology concerned with the movement of drugs within the body
Define pharmacodynamics
(What the drug does to the body)
The branch of pharmacology concerned with the effects of drugs and the mechanism of their action
What are the fraser guidelines?
Guidelines set out saying a doctor could provide treatment (contraception) for an under 16 providing they met conditions (such as understanding
What are dermatomes?
Form from the lateral wall of each somite in the embryo. They are a region of skin supplied by nerves from a single spinal root
Intramuscular injections in the gluteal region should only be given in what quadrant?
Upper lateral
Describe the path of the needle from skin to CSF in a lumbar puncture
Skin > ligamentum flavum (1st give) > dura mater (2nd give) > now in subarachnoid space
Where is a lumbar puncture performed?
Lumbar cistern region (from conus medularis at L1/2 to around S2). Oftern performed at L4/L5. Cistern is a swelling of the subarachnoid space
What is the prevalence, most common diagnosis age/ ethnicity and M/F ratio in MS?
1 in 1200
M1:3F
White (Near the equator lowest risk)
Presents most commonly between 20 and 40
What are the most commonly seen plaque sites in MS?
Optic nerves, brain stem, corpus callosum, periventricular region
What genetic area is linked to MS?
MHC complex on chromosome 6
What are the most common MS symptoms?
Limb weakness/ numbness and tingling
Blurred/ double vision/ no colour/ pain (Optic neuritis)
Ataxic gait/ nystagmus/ (tremor- later on)
How would you diagnose MS?
Any two lesions in two or more places
(dissemination in time and space)
MRI to confirm
Slow evoked potentials/ oligoclonal banding
What are oligoclonal bands?
Bands of immunoglobulins in CSF (indicative of MS)
Could be monoclonal (just one band) can show other disease or be normal
What are the three types of MS?
RRMS (90%, average 1 relapse per year) Secondary progressive (late stage, gradually worsening diability) Primary progressive (no relapses/ remittance)
What is a teratogen?
Any agent which can affect the development of an embryo or foetus
What is the most common diagnostic age for schizophrenia?
15-35
M often early 20’s
F often late 20’s
On what conditions can Schizophrenia be diagnosed?
1st rank sympt for >1mth (Hallucination/ delusion/ though echo/ broadcasting)
2nd rank symp for >1mth
The theraputic effect of blocking D2 receptors comes from blocking which brain area?
Limbic striatum
Which two dopaminergic pathways are involved in schizophrenia and how?
Nigrostriatal (SNpc to striatum)- RAISED DA
Mesocortical (VTA in midbrain to dorsolateral prefrontal cortex)- LOW DA
In schizophrenia, dopamine dysregulation is secondary to what?
NMDA receptor hypofunction
Glutamate
Action of antipyschotics on which receptor causes side effects of dry mouth and tachycardia?
M1
Action of antipyschotics on which receptor causes side effects of orthostatic hypotension?
Alpha adrenoreceptor
Action of antipyschotics on which receptor causes side effects of sedation?
H1
What is an autoreceptor?
Receptor stimulated upon release of neurotransmitter from the same cell
What type of drug could be given to treat alzheimers?
Acetylcholinesterase inhibitors
What are the central effects of cannabinoids?
Impaired short term memory/ motor coordination
Analgesia
Increased appetite
What are the peripheral effects of cannabinoids?
Tachycardia, vasodilation, bronchodilation
What is akathisia?
Can’t keep still
What are the symptoms of hyperprolactinemia?
Raised hCG, breast enlargement, diminished libido, amenorrhea, galactorrhea and acne
What is the pathophysiology of tonsillitis causing otitis media?
Enlarged adenoids block eustachian tube so block mucus removal from middle ear
Name the risk factors for otitis media (5)
Nursery or day care centre, exposure to smoking, formula not breast milk, using dummy, downs/cleft palate
Who is most commonly affected by otitis media?
75% are under age 10. Most common 15mths-6years
What treatment is given for otitis media?
Often viral so clears up alone, only AB’s if >4days sympt or very severe or younger than 3 months
What are the symptoms of otitis media?
Earache (pulling ear if young)
Hearing loss
Fever
Irritability/ lack of feeding
What is glue ear?
What is the treatment?
Otitis media with effusion- 80% incidence before age 10
Fluid prevents ossicles from moving freely (hearing loss)
No treatment for 3months then consider grommits or adenoidectomy
What is tonsillitis?
What is the most common cause?
Inflammation of MALT palatine tonsils
Most commonly viral cause (adenovirus, rhinovirus)
85% spontaneous recovery in 1 week
What are the symptoms of tonsillitis?
Sore throat, headache, fever, cough, fatigue, swollen LN’s in neck, voice change
Signs of bacterial: High fever, white spots on tonsils, swollen LN’s
What are the criteria for a tonsillectomy?
How is it done?
5 or more episodes in 1yr or >1yr disabling symptoms
Use diathermy or cold ablation
Where are the adenoids?
What happens to them as you grow up?
Back of nasal cavity (can block eustachian tube- cause of otitis media)
They atrophy by teenage years
What is SPECT?
Single positron emission computed tomography
Releases positrons which annihilate with electrons and release gamma waves (which the SPECT scanner detects)
What is PET scanning?
Position emission tomography
Radiotracer (flurodeoxyglucose) releases gamma waves which are detected by the scanner
What is the name for the infoldings of the cerebellum which increase its surface area?
Folia
Transversely orientated
Name two proposed mechanisms of the placebo effect?
1) Reduce stress allowing normal bodily function
2) Cause brain to release its own analgesics
What is the main blood supply to the anterior scalp?
Frontal and parietal branches of superficial temporal artery (a branch of the external carotid)
What is the main blood supply to the posterior scalp?
Occipital artery (Branch of external carotid)
What is the difference between rigidity and spasticity?
Rigidity is equal in both flexors and extensors, spasticity is not
Rigidity is the same through full range of movement, spasticity is velocity dependant
What is prosopagnosia?
Can’t recognise faces
Type of agnosia
How could spasticity be treated?
Baclofen
How do cocaine and methamphetamines act on dopamine?
Block re-uptake channels
Increase synaptic conc
What type of fibre carries all outputs from the cerebellum?
Purkinje
What is leadpipe rigidity?
Increased muscle tone causes resistance through whole range of movement
Define spasticity
Combination of partial paralysis with hypertonia
Caused by loss of motor neuron inhibition
What makes up the lentiform nucleus?
Putamen and Globus Pallidus
What is the most common triad of parkinsons symptoms?
Tremor, rigidity, bradykinesia
Spasticity and rigidity are each seen in which Sem 3 diseases?
Spasticity: MS
Rigidity: Parkinsons
What is the stria terminalis and what is it’s function?
Connects amygdala to ant hypothalamus and septal nuclei
What is DVLA guidance following a stroke?
Can’t drive for 1 month
After can drive when medically fit
What causes the lemon sign (often seen in pre24 week scans indicating spina bifida)?
Low CSF volume in ventricles
What is the difference between emissary veins and normal veins?
Emissary have no valves
Name three things that travel in the subarachnoid space ?
CSF, veins, arteries
What is the confluence of sinuses?
Joining of superior sagital, straight sagital and occipital sinuses
Drains to transverse sinuses
Located deep to occipital protuberance
What is a sagittal and coronal section?
Sagittal: (mid sagittal) slice through nose to back
Coronal: Ear to ear slice
What is the adams apple?
Prominence on thyroid cartlidge in neck
What is the epiglottis?
A flap of elastic cartlidge which when larynx is pulled up during swallowing it is pulled down to block food going into the larynx
What is indicated by the babinski sign?
Upper motor neuron lesion
What is the cause of rigidity?
Involuntary state of continuous muscle contraction due to loss of basal ganglia control
What causes hyperprolactinaemia?
Decreased dopamine in the tuberoinfundibular pathway
