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DDT > Trigger 1 - spina bifida > Flashcards

Trigger 1 - spina bifida Flashcards

1
Q

when does spina bifida occur

A

when the neural tube fails to close during the first month of embryonic development

spinal cord and meningeal membranes protrude

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2
Q

common symptoms of spina bifida

A

urinary/faecal incontinence

muscle weakness

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3
Q

how many spinal/somatic nerves

A

31 pairs

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4
Q

5 locations of spinal nerves

A 
cervical
thoracic
lumbar
sacral
coccygeal
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5
Q

2 types of spinal nerves

A

sensory

motor

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6
Q

sensory nerves/neurones

A

deliver information from muscles/joints to spinal cord about body position

transmit sensations such as temperature, pressure, pain and touch from skin’s surface

information enters spinal cord via grey posterior horn

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7
Q

dermatome chart

A

maps areas of skin that relate to particular spinal nerves

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8
Q

motor nerves/neurones

A

pass info from brain to skeletal muscles through spinal tracts
direct precise voluntary movements

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9
Q

spinal nerves are linked to specific…

A

muscles

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10
Q

cervical spinal nerves

A

supply muscles of the neck, shoulders, arms, hands and diaphragm
e.g. extending elbow/fingers

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11
Q

thoracic spinal nerves

A

supply truck muscles and muscles involved with breathing

intercostal and abdominal muscles

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12
Q

lumbar and sacral spinal nerves

A

supply hip, leg, foot muscles

sacral nerves supply anal/urethral sphincters

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13
Q

major breathing muscles

A

diaphragm and intercostal muscles

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14
Q

abdominal muscles

A

help you cough and expel matter from your air passages

important in balance and posture.

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15
Q

divisions of autonomic nervous system

A

parasympathetic

sympathetic

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16
Q

what is the ANS responsible for

A

bodily functions such as digestion, urination, changing the size of blood vessels in order to regulate blood pressure, regulating body temperature and keeping your heart beating.

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17
Q

parasympathetic nervous system is responsible for…

A

slowing your heart rate
bronchial or air passage constriction
increasing gastric secretions
bladder function (e.g. bladder muscle contraction, release of urine)
bowel function
sexual function (e.g. erectile function and lubrication)

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18
Q

sympathetic nervous system

A 
increasing your heart rate
increasing blood pressure
increasing respiratory or breathing rate
regulating your temperature
pupil dilation (enlargement)
bronchial or air passage dilation
decreasing gastric secretions
bladder function (e.g. bladder muscle relaxation, storage of urine)
sexual function
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19
Q

reflex activity

A

fast and automatic responses

occur via spinal nerves

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20
Q

overview of the study design pyramid

A

case-control makes up the base
as we progress upwards, studies becomes more evidence based and less numerous
meta-analysis is at the top

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21
Q

why is meta-analysis at the top of the study design pyramid

A

can only be written after much other research has been done on a topic
fewer of them but offer strong evidence

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22
Q

case reports

A

An article that describes and interprets an individual case, often written in the form of a detailed story

lowest level/first line of evidence

can help identification of a new drug/disease/trend

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23
Q

case-control

A

compares a group of patients who have the disease (cases) with a group of patients who don’t (controls)

purely observational - study carried out after disease has occurred
no intervention
retrospective

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24
Q

advantages and disadvantages of case-control studies

A

good for studying rare diseases
can look at multiple risk factors
take less time to complete- disease already occurred
useful to initially establish an association between a risk factor and a disease

problems with data quality - rely on memory/recall bias
difficult to find suitable control group

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25
Q

cohort study

A

where one or more samples (cohort) are followed and evaluations with respect to the disease and conducted to determine which risk factors are associated with it

outcome from participants in each cohort is measured and relationships with specific characteristics determined

cohorts need to be chosen from separate but similar populations

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26
Q

risk factor

A

initial participants exposure characteristics

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27
Q

advantages of a cohort study

A

subjects in cohorts can be matched
standardisation of outcome/criteria is possible
easier/cheaper than RCT

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28
Q

disadvantages of a cohort study

A

cohorts difficult to identify due to confounding variables
no randomisation - imbalances in patient characteristics could exist
blinding is difficult
outcome of interest could take time to occur

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29
Q

randomised control trial

A

randomly assigns participants into an experimental/control group
the difference between the two groups should be the variable being studied

should be a study of one population only

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30
Q

advantages of RCT

A

randomisation washes out population bias
easier to blind
well known stats tools easily used for analysis
populations of participating individuals easily identified

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31
Q

disadvantages of RCT

A

time/money consuming
volunteering population may not be representative
does not reveal causation

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32
Q

practice guidlines

A

a statement outlining best practice to inform health care professionals and patients in making clinical decisions
should be updated frequently
created by panel of experts

known as ‘evidence-based’ or ‘clinical’ guidlines

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33
Q

systematic review

A

document reviewing/summarising all relevant studies on a particular clinical or health-related topic/question

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34
Q

advantages of systematic review

A

evidence based
reliable
less time consuming than making a new study

however may not be easy to combine studies into one

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35
Q

meta-analysis

A

subset of systematic reviews
combines quantitative and qualitative study data
develops single conclusion with great statistical power due to increased number/diversity of subjects

studies for review should all be of a similar type e.g. all RCT so they are comparable

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36
Q

when would you use a meta-analysis study

A

To establish statistical significance with studies that have conflicting results
To develop a more correct estimate of effect magnitude
To provide a more complex analysis of harms, safety data, and benefits
To examine subgroups with individual numbers that are not statistically significant

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37
Q

advantages of meta-analysis

A

Greater statistical power
Confirmatory data analysis
Greater ability to extrapolate to general population affected
Considered an evidence-based resource

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38
Q

disadvantages of meta-analysis

A

Difficult and time consuming to identify appropriate studies
Not all studies provide adequate data for inclusion and analysis
Requires advanced statistical techniques
Heterogeneity of study populations

39
Q

when would you carry out csf analysis

A

to diagnose a condition involved with CNS

e. g. bleeding within brain/skull, autoimmune disorder or cancer
e. g. meningitis, encephalitis (determining if it fungal, viral or bacterial)

40
Q

how do you collect a csf sample

A

lumbar puncture or spinal tap from lower back

multiple tubes may be used to improve quality of testing

41
Q

where is csf formed continually

A

choroid plexus tisssue
(has many blood vessels lining the ventricles of the brain)
500mL produced a day

42
Q

what characteristics of csf are measured

A

pressure
colour - should be clear
turbidity - cloudy/turbid could mean presence of WBC/RBC
viscosity- should be same as water

43
Q

biomarker definition

A

“a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes or pharmacological responses to a therapeutic intervention

44
Q

characteristics of a good biomarker

A

Safe and easy to measure
Cost efficient to follow up
Modifiable with treatment
Consistent across gender and ethnic groups

45
Q

anticholinergic medicines

A

used to treat urinary incontinence
relax the overreactive detrusor muscle in the bladder wall
bladder capacity increases and urinary urge decreases

46
Q

features of sympathetic ganglionic neurons

A

short pre-ganglionic
- releases ACh to nicotinic receptor

long post-ganglionic
- releases noradrenaline to muscarinic adrenoreceptor

47
Q

which nerve regulates gastric acid secretion

A

vagus nerve

48
Q

which autonomic nervous system has a long pre-ganglionic neuron

A

parasympathetic

49
Q

where does reflex signal travel through

A

spinal cord

not brain

50
Q

why does myelination increase speed of conduction

A

Na+ can only depolarise at nodes of ranvier
saltatory conduction
jump from node to node

51
Q

myotomes

A

the group of muscles that a singler spinal nerve innervates

52
Q

clinical significance of myotomes

A

can identify where spinal lesions might be

53
Q

Na+ influx via ligand-gated channels on post-synaptic membrane

A

causes end-plate potential

propagates across muscle

54
Q

calcium storage in SR

A

uptake via ATP exchange - SERCA pump
calsequestrin
important to reduce calcium conc to relax muscles

55
Q

thin filaments in sarcomeres

A

actin
tropomyosin
troponin

56
Q

thick filament

A

myosin

57
Q

H band

A

just mysoin

58
Q

I band

A

just actin

59
Q

A band

A

length of myosin with some actin overlap

60
Q

Z line

A

vertical line between adjacent sarcomeres

61
Q

what makes up limbic system

A

thalamus

hypothalamus

62
Q

normal CSF composition

A 
no RBC
few WBC
water
few small proteins
some glucose
63
Q

hydrocephalsu

A

build up of CSF in the brain

icnreases intracranial pressure

64
Q

chairi malformation

A

cerebellum too larger
blocks ventricles in brain
CSF builds up
intracranial pressure increases

65
Q

if CSF is cloudy

A

WBC or RBC present

microorganisms or proteins present

66
Q

proteins in CSF

A

disease

67
Q

reciprocal innervation

A

when contraction of muscles is accompanied by simulatous inhibition of antagonistic muscles

68
Q

when do stretch receptors in the bladder signal to sacral nerves (parasympathetic NS)

A

when it fills to 400ml

69
Q

which sacral nerves are involved in micturition

A

S2-S4

70
Q

receptor and signalling causing contraction of bladder detrusor muscle

A

M3

Gaq

71
Q

effect of cAMP on smooth muscle contraction

A

G alpha s increases cAMP which inhibits MLCK so inihbits smooth muscle contraction

72
Q

opening of external sphincter

A

voluntary
somatic
allows you to wee

73
Q

sympathetic control of bladder

A

filling
B3 adrenoreceptor stimulated
relaxation of bladder detrusor muscle

74
Q

contraction of internal sphincter

A

closes sphincter

alpha 1 adrenoreceptor

75
Q

most rigorous study design

A

meta-analysis

76
Q

major regions found in temporal lobe

A

primary auditory cortex

wernickes area

77
Q

lateral fissure

A

between temporal and frontal lobe

78
Q

wernickes area

A

responsible for comprehension of speech

temporal loebe

79
Q

middle cerebral artery (MCA)

A

largest branch on internal carotid artery
common stroke site
lenticulostriate arteries branch off

80
Q

difference between cerebral arteries and systemic arteries

A

cerebral arteries have no external lamina

and fewer elastic fibres

81
Q

anterior cerebral artery

A

supplies frontal lobes

82
Q

posterior cerebral artery

A

supplies temporal/occipital lobes

83
Q

common carotid arteries

A

external and internal

84
Q

cause of haemorrhagic stroke

A

when a weakened blood vessel ruptures in the brain
blood spills causing swelling and pressure
tissue damage

85
Q

why are strokes on left side of brain worse

A

effects seen on right side of body

e..g speech and language problms

86
Q

2 types of haemorrhagic stroke

A

intracerebral - blood leaks to surrounding brain

subarachnoid - blood leaks into subarachnoid space

87
Q

circle of willis

A

arterial loop at the base of the brain

carotid and vertebrobasilar arteries

88
Q

collateral circulation

A

circle of willis ensures that if blood flow is obstructed to one vessel, blood can still be delivered to all regions of the rbain
methods to avoid aschaemia

89
Q

stents are used to treat

A

narrow or weak arteries

90
Q

percutaneous coronary intervention (PCI)

A

stent implantation method

  • insertion of catheter with collapsed balloon inserted into bronchial artery
  • balloon inflated to compress plaque against artery wall and expand stent
  • balloon deflated, catheter removed
  • cells grow over to cover stent
91
Q

drug-eluting stent

A

coated with medicine which releases slowly over time

often immunosuppressants

92
Q

reason for drug-eluting stent

A

prevent re-stenosis

93
Q

re-stenosis

A

too much tissue growth around stent can lead to more blockage

DDT (12 decks)

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