revision questions Flashcards
1
Q
what enzyme is involved in oestrogen production
A
aromatase
2
Q
what is the appendix epididymis a remnant of
A
proximal end of the mesonephric duct
3
Q
which part of the male duct empties into the prostatic urethra
A
the ejaculatory duct
4
Q
what conditions may result from a patent tunica vaginalis
A
cytocele, hydrocele, indirect inguinal hernia
5
Q
what constituent of ejaculate is used as a source of choline
A
glycerylphosphorylcholine formed in the epididymis
6
Q
which ligament forms the inferior border of the greater sciatic foramen
A
sacrospinous
7
Q
what is the subpubic angle of the female pelvis
A
80-85
8
Q
which area of the prostate is most likely to be affected by prostate cancer
A
peripheral zone
9
Q
what endometrial condition is most often associated with a p53 mutation
A
endometrial adenocarcinoma non endometroid
10
Q
at what positions are anal cushions present
A
3, 7, 11 o’clock
11
Q
what veins in the rectum contribute to the systemic part of the portosystemic anastomosis
A
internal pudendal
12
Q
what are the features of stage 3 male puberty
A
penal enlargement, pubic hair and testicular enlargement
13
Q
what conditions can be detected during the combined first trimester screening test which is aimed at the whole population
A
anencephaly
patau’s
down’s
edward’s
14
Q
what are the features of WPW dysrhythmia
A
short PR interval with early QRS upstroke
15
Q
what is the peak incidence of teratomas in men
A
20-30 years
alpha fetoprotein is a useful marker
16
Q
what age do yolk sac tumours occur
A
children
AFP is a marker
17
Q
what age do seminomas occur
A
30-50
no protein marker
18
Q
what is rigler’s sign
A
double wall sign
usually pneumoperitoneum due to bowel perforation
19
Q
what is the leading cause of traveller’s diarrhoea
A
enterotoxigenic e. coli ETEC
20
Q
what are the features of proliferative glomerulonephritis
A
post strep infection deposition of immune complexes Type 3 nephritic syndrome blood in urine sub epithelial
21
Q
what are the features of GI carcinoid tumours
A
large intramural masses with polypoid excavations
occur mostly in the appendix
22
Q
what are the features of adenocarcinomas in the GI tract
A
napkin ring encircling and exophytic growth
23
Q
large bulky intramural mass that may ulcerate
A
leiomyosarcoma
24
Q
clearly pedunculated with a lobar growth on the end of a stalk
A
tubular adenoma
25
3 cm velvety mass
villous adenoma
26
what cells are responsible for producing fluid that flushes sperm from the tubule to the epididymis
sertoli cells
27
describe the stepped care model
level one is self management
level 2 is multiple chronic conditions treated by a MDT
level 3 is unplanned visits to secondary care
28
what nerves might be damaged in overflow incontinence
S2-4
posterior 2/3rds of the scrotum are supplied by pudendal nerve S2,3 so would be affected
29
who is renal cell carcinoma most common in
smokers and obese people
30
what are the symptoms of renal cell carcinoma
back pain
blood in urine
pyrexia due to paraneoplastic syndrome
31
what is the five year survival rate of renal cell carcinoma
50%
32
what is the effect of phenothiazines on prolactin
phenothiazines are D2 antagonists which increase prolactin
33
what does hemizygous mean
only on chromosome is present e.g. for men with an X linked disease
34
how might a seminoma present
hard lump in young man
35
what structures secrete inhibin
CL and leydig cells
36
what substance can be used to detect neural tube defects
raised alpha fetoprotein
37
what are the features of the trophoblast
the cells of the cytotrophoblast can divide to form synciotiotrophoblast
synciotrophoblast cells are multinucleated and produces hCG. it is in contact with maternal sinusoids
38
what is trisomy 13
patau's syndrome
cleft palate, heart defects
associated with high maternal age
majority die as neonates
39
in what condition would barr bodies be absent
45 X
40
what is cyproterone acetate used to treat
prostate carcinoma and BPH and male hypersexuality
| acne and PCOS
41
What effect does psychological stress have on prolactin
increases prolactin
42
what effect does hyperthyroidism have on prolactin
decreases
43
what is the function of oestrodiol
stimulates hyperplasia and hypertrophy of columnar epithelium and stroma in the endometrium and fallopian tubes
also secretion
44
what metabolic disturbance causes hyperkalaemia
acidosis
45
why does burns cause hyperkalaemia
cellular injury causing potassium release
46
how much protein is lost per day in nephrotic syndrome
3. 5 g
47
a man comes in with raised red plaque on his penis. what's the diagnosis
Bowen's disease
Squamous cell carcinoma in situ
very slow growing cancer
48
what causes invasive squamous cell carcinoma on the penis
HPV
Nodule of plaque
mets to inguinal lymph node
49
what occupation used to be at risk of carcinoma of the scrotum
chimney sweeps and arsenic workes
50
a man comes in with a nodular ulcerated mass on his scrotum. what's the diagnosis
squamous carcinoma
51
what is the most common testicular tumour
seminoma
52
a man has testicular cancer which has spread to the para aortic lymph nodes, what stage is this
2
(involves testes and paraaortic lymph nodes)
3- mediastinum/ supraclavicular region
53
what week in pregnancy do hCG levels peak
8-10
54
when is maternal circulation functional
week 10 -12
55
at what week are all steroids required for pregnancy secreted by the placenta
week 4-5
56
a woman presents with uterine bleeding in week 7 of her pregnancy. what drug do you prescribe to stop the bleeding
ergometrine
causes the uterus to contract
alpha receptor antagonist
57
what is stage 1 of male pubertal maturation
no pubic hair, no enlargement of penis or testes
58
a boy has testicular enlargement and start of pubic hair, what stage is this
2
59
a boy has penal enlargement, testicular enlargement and pubic hair, what stage is this
3
60
a boys pubic hair darkens what stage is this
4
61
what is stage 5
adult genital appearance
62
what is the venous drainage of the ovary
pampiniform plexus to the uterine plexus to the left renal vein or aorta
63
what surrounds each ovary
tunica albuginea (pressure) mesotheliun which is analogous to peritoneum
medulla consists of connective tissue and blood vessels
64
which antenatal test is usually carried out at 11-12 weeks gestation
chorionic villus sampling
65
which antenatal scan would be most appropriate to diagnose down's syndrome at 15 weeks
amniocentesis
66
what is the energy intake increase needed at the end of pregnancy
1200 kJ per day
67
why might pregnant women experience heartburn, constipation and increased transit time
reduced GI tone and motility due to relaxation of smooth muscle by progesterone
68
what causes morning sickness
ovarian steriods
69
how much does the maternal pituritary increase by
40 %
70
how much does pulmonary ventilation increase by
40%
| raised tidal volume
71
where does the inguinal ligament go to
pubic tubercle to asis
inwardly rolled inferior edge of external oblique
72
abdo pain worse after eating, weight loss, constipation, malaise, smoking, watery diarrhoea
crohns
73
where is the thorocolumbar fascia
iliac crest to 12th rib
74
cerebral calcifications, cerebral palsy
| treated with spiramycin
toxoplasmosis
75
eye defects and limb hypoplasia
| treated with iv aclivor or immunoglobulin
VZV
76
heart defect, microcephaly
rubella
77
ductal carcinoma in situ
unilateral
78
lobular carcinoma in situ
bilateral
79
mucoid diarhoea
UC
80
watery diarrhoea
crohns
81
peripheral zone
prostate cancer
82
p53
non endometroid endometrial adenocarcionoma
83
inferior rectal veins
internal pudendal veins
84
hyperparathyroidism
increased calcium levels which can lead to the production of renal calculi leading to haematurian and pain- loin and groin
85
renal tuberculosis
weight loss, night sweats, haematuria, loin pain
86
kidney disease, hearing loss, eye abnormalities
alport syndrome
87
nephrotoxic mechanism of aminoglycosides
accumulates in the lysosomes of the PCTs
88
early distal tubules to block the sodium chloride co transporter
thiazide
89
decreases active reabsorption in the TAL by blocking the sodium chloride potassium co transporter
loop diuretric
| e.g. furosemide
90
directly inhibits entry of sodium and secretion of potassium in the collecting ducts
soidum channel blocker
| e.g. amiloride
91
competes with aldosterone for receptors in the cortical collecting ducts leading to retention of potassium
potassium sparing diuretic
| e.g. spironolactone
92
inhibits water and solute reabsorption by increasing the osmolarity of tubular fluid
osmotic diuretc e.g. mannitol
93
inhibits H+ secretion and bicarbonate reabsorption which reduces sodium reabsorption in the PCT
Carbonic anhydrase inhibitors
94
secreted by parietal cells
intrinisic factor and hydrochloric acid
95
released by p'symp stimulation it excites peptic cells, parietal cells and mucous cells
acetyl choline
96
stimulates ECL cells and acid secretion
gastrin
97
intestino intestinal reflex
inhibition of contractions in the adjacent regions of the small intestine
98
left iliac fossa is palpated causing pain in the right iliac fossa due to movement of inflammed parietal peritoneum
rovsing's sign - appendicitis
99
cannot be made directly
vitamins
100
copper deposition
wilson's disease
101
acute hepatitis
toxoplasmosis
102
histamine 2 and muscarinic 3 and prostaglandins and gastrin receptors
increases gastric acid secretion from parietal cells
103
normal temp
36-37.5
104
anterior fibres of temporalis
elevation of the mandible
105
posterior fibres of temporalis
retraction of the mandible
106
ranitidine
targets h2 receptors in order to reduce gastric acid secretion
107
chemoreceptor trigger zone
D2 receptors
e.g. metoclopramide and domperidone
108
ondansetron
serotonin antagonist 5HT3
109
what are the different types of antiemetic
antimuscarinics
histamine 1 antagonists
serotonic antagonists
dopamine 2 antagonists
110
what is the surface marker for the femoral pulse
midway between the asis and the pubic symphysis
111
villous atrophy, increased lymphocytes, increased crypt cell
coeliac disease
112
non bloody diarhoea
crohns
113
inflammation always starts at rectum and never spreads beyond ileocaecal valve, no inflammation beyond submucosa
uc
114
increases the volume and alkalinity of pancreatic juice
secretin
115
increases peristalsis
substance p
116
osmotically active substance is secreted into the tubules which retains water causes diuresis
mannitol
117
what hormone is involved in the milk let down reflex
oxytocin
118
what hormone leads to a rise in HDL cholesterol levels
oestrogen
119
what hormone is involved in galactorrhoea
prolactin
120
level of the coeliac trunk, superior mesenteric and inferior mesenteric
t12, L1 and L3
121
which unpaired artery arises just above the aortic bifurcation at L4, posteriorly
median sacral
122
what vitamin deficiency may alcoholism cause
B1- thiamine
(amino acid and energy production and muscle action potentials)
found in wheat, oats and yeast products
may lead to beriberi / Korsakoffs syndrome
123
what is the most serious consequence of hypomagnesium
arrythmias and cardiac arrest
124
where is aldosterone (mineralocorticoid) produced
zona glomerulosa (outer layer)
125
what is the function of aldosterone
Aldosterone promotes sodium retention and loss of potassium and hydrogen ions. regulates blood pressure
126
where is cortisol made, and other glucocorticoids
zona fasciculata (middle)
127
what is the function of cortisol
increased blood sugar levels, helps to stabilise membranes, stimulates appetite and suppresses the immune/ hypersensitivity response.
128
where are adrenal androgens made
zona reticularis (inner layer)
129
where is renin made
juxtaglomerular apparatus
| also regulates the glomerular filtration rate to control sodium excretion.
130
where are catecholamines made
adrenal medulla
131
at what level is the head of the pancreas
L2
132
what structures does the head of the pancreas overlie
IVC, renal veins and common bile duct
133
what is the lymph drainage of the testes
para aortic
134
what is the lymph drainage of the upper third of the rectum
inferior mesenteric
135
what is the lymph drainage of the vulva
superficial inguinal
136
what is the lymph drainage of the scrotum
superficial inguinal
137
what is the lymph drainage of the cervix
internal iliac
138
what is the lymph drainage of the upper anal canal
inferior mesenteric
139
what is the lymph drainage of the lower anal canal
inguinal nodes
140
what nerves are inferior/posterior to the left kidney
ilioinguinal nerve, iliohypogastric and subcostal
141
what is the vertebral level of the left kidney
t12 to L3
142
what are the anterior relations of the left kidney
stomach, spleen, pancreas, jejunum and descending colon
143
what hormone enhances insulin release, reduces glucagon and promotes satiety
glucagon like peptide
| GLP1
144
what hormone is raised in patients with chronic renal failure
parathyroid hormone
| due to the body attempting to conserve calcium
145
metabolic acidosis is associated with decreased levels of bicarbonate
respiratory acidosis is increased levels of CO2
146
why does SIADH cause decreased sodium
results in fluid overload and dilutional hyponatraemia
147
what structure is responsible for absorbing 60 % of all solute
PCT
148
Which limb is impermeable to water
ascending
149
what might be a symptom of B6 deficiency
sensory neuropathy
150
what is the function of PTH
promotes loss of phosphate in the urine and and prevents the loss of calcium in the urine
causes bone release of calcium
activates vitamin D
151
what can be used to treat pre eclampsia
magnesium
152
what are the features of hypermagnesemia
```
neuromuscular depression
depressed respiratory function
nausea and vomiting
hypotension
cardiac arrest
```
153
give an example of a paraneoplastic syndrome
pyrexia due to kidney cancer
154
what mediates the efferent limb of the gastrocolic reflex
gastrin and CCK
155
what mediates the efferent limb of the vagovagal reflex
VIP
156
what structures does the sigmoid mesocolon cross in the left iliac fossa
birfurcation of the common iliac
| ureter
157
where does the base of the mesentery begin
Left of L2
158
which artery enters the rectus sheath between the sternal and costal ends of the diaphragm
superior epigastric
159
what drug has its absorption slowed by ingesting food
paracetamol
160
how do ductal cells modify saliva
absorb sodium and chloride
| secrete potassium and bicarb
161
what embryonic tissue gives rise to the liver
endoderm
162
how much is life expectancy reduced in obesity
7
163
which antiemetic causes sedation
haloperidol
164
which drug increases permeability to calcium ions and is used to treat schistomes
praziquantel
165
what substance is a risk factor for adenocarcinoma
smoking
166
what part of the duodenum does the SMA start at
second part
167
what nerves are carried with the IMA
least splanchnic and p'symp from S2-4
168
what is omphalocele
physiological herniation fails to return to normal
169
what two structures does the ventral mesentery form
falciform ligament and lesser omentum
170
what structures form the stomach bed
central tendon
left colic flexure
spleen
171
how much rotatation of the bowel around the SMA occurs
270 anticlockwise
172
where is the swallowing centre
medulla and lower pons
173
what factors decrease action potential frequency
gastrin
GIP
sympathetic NS
secretin
174
what is the location of the second part of the duodenum
anterior to the hilum of the right kidney, right of L2-3 vert
175
what is the best marker of acute hepatocellular injury
ALT
176
What is a metabolic consequence of acute pancreatitis
low serum calcium
177
how does CCK affect the pancreas
reduces exocrine secretions
178
what are the features of the exocrine pancreas secretion
high bicarbonate
| isotonic
179
what is the blood supply to the lower pharynx
inferior thyroid
180
what does the falciform do in the developing embryon
connects the liver to the anterior abdo wall
181
what embryonic tissues form the anus
endoderm and ectoderm marked by the pectinate line
182
what does the cloaca develop into
anteriorly the urogenital system
| posteriorly the anorectum
183
what congenital abnormalities of the GI system can arise
```
abnormal rotation
Meckel's diverticulum
vitelline cyst
patent vitelline fistula
gastroschisis
umbilical hernia
omphalocele
failure of recanalisation
```
184
where does the caecum and appendix migrate
from the right hypochondrium to the left iliac fossa
185
how much rotation happens in the physiological hernia
90 degrees
| then another 180 as it drops back into the abdomen and 10 weeks
186
what does the midgut form from
the primary intestinal loop on a mesentery
187
what connects the midgut to the yolk sac
vitelline duct
188
what causes herniation of the intestine into the umbilical cord
rapid growth
189
what are the boundaries of the lesser sac
```
caudate lobe of liver
lesser omentum
stomach
pancreas
left kidney
adrenal gland
epiploic foramen
```
190
what is pringles manouver
compressing the hepatic artery and portal vein between the fingers to control bleeding
191
what are the borders of the epiploic foramen
free border of lesser omentum
inferior vena cava
caudate process of the caudate lobe
first part of the duodenum
192
where is the umbilical vein
free edge of the falciform ligament
193
what forms the pancreas
dorsal and ventral endodermal buds from the duodenum. rotation of the duodenum causes them to fuse
194
when does CVS happen
10 weeks
