Year 2 Flashcards
0
Q
What is a TIA?
A
A neurovascular even with symptoms lasting less than 24hrs
1
Q
What is a stroke/ CVA?
A
Neurological deficit related to a non- traumatic vascular event. Can be: Ischaemic Haemorrhagic
2
Q
What are the cardinal features of a stroke?
A
Sudden onset Focal clinical deficits Negative clinical phenomena (loss of function) Identifiable vascular risk factors
3
Q
Risk factors for venous stroke?
A
Pregnancy Dehydration Infection
4
Q
Risk factors for stroke?
A
HTN, smoking, diet, high alcohol, AF, diabetes, carotid artery stenosis, migraine OCP HRT Infections
5
Q
Common features of stroke?
A
Contralateral motor/sensory effects No headache- apart from ruptured aneurysm No LOC- apart from brainstem infarct
6
Q
Features of an anterior circulation stroke?
A
Contralateral hemiplegia- flaccid limbs and areflexic –> hyperreflexia Contralateral hemianaesthesia Language dysfunction Insignia Homonymous hemianopia
7
Q
Features of posterior circulation strokes?
A
Bilateral visual loss/ Diplopoda Amnesia Dysarthria Unsteadiness Dysphagia
8
Q
Features of a ruptured aneurysm?
A
Thunderclap headache Stiff neck (meningism) Raised intracranial pressure
9
Q
In what group do cerebral venous sinus thrombosis occur?
A
Younger women on the OCP
10
Q
What is the Cushing reflex?
A
Response in raised intracranial pressure –> increased BP, Irregular breathing and reduced heart rate
11
Q
What location of stroke causes ‘crossed motor signs’? I.e. Rt. CNVII with Lt. Hemiparesis
A
Brainstem strokes Opposite limb but same side of the face due to proximity to cell body of CNVII
12
Q
What scoring model is used to determine stroke and what score indicates stroke is likely?
A
ROSIER stroke scoring >0 indicates a stroke is likely
13
Q
What are the treatments for stroke?
A
Anti platelets / anticoagulants Rehab Treat risk factors Vascular surgery IV recombinant tissue plasminogen activator (thrombosis is) - patient selection is very important.
14
Q
Why would a chest x-Ray be performed when investigating a stroke?
A
Checking for cardiomyopathy and/or infection
15
Q
What is ischaemia?
A
A restriction of blood supply which leads to dysfunction and/or damage
16
Q
What is hypoxia?
A
Oxygen deprivation
17
Q
What are the 2 mechanisms for auto regulation of bloodflow?
A
Myogenic response- vasc. Smooth muscle contracts in response to raised BP Endothelial controls- increased NO release by endothelium with increased shear force
18
Q
What can cause auto regulation of blood flow to fail?
A
Age Head trauma High pCO2 Chronic hypertension SAH, CVA or cerebral hypoxia
19
Q
Why are neurons particularly sensitive to ischaemia?
A
They are obligate aerobes and mostly metabolise lactate from glial cells
20
Q
What are watershed infarcts?
A
Infarcts that occur at watersheds between arterial supplies. Due to poor blood supply from distal arteries –> increased ischaemia
21
Q
What are the main causes of ischaemic stroke?
A
Atherosclerosis Vasculitis Emboli (AF) Primary vascular disorders Hypercoagulable states
22
Q
What is puberty?
A
A series of events associated with a growth spurt and culminating in the aquisition of sexual maturity and reproductive function.
23
Q
What is the first stage of puberty in girls and boys?
A
Girls- development of breast buds Boys- testicular volume >4ml
24
What is used to measure the rate of puberty?
Tanner stages B1-5= breasts P1-5= pubic hair G1-5= male genital growth
25
What hormones are released during puberty in boys and what effect do they have?
Hypothalamus --\> GnRH --\> pituitary --\> FSH & LH FSH= stimulates Leydig cells to produce testosterone LH= promotes spermatogenesis therefore testicular enlargement
26
What effect do FSH and LH have in girls?
Stimulate the ovary to produce Oestradiol and progesterone from the Theca Granulosa cells
27
What does consonance mean and what can deviation indicate?
Consonance means that it follows a set pattern and deviation from this can indicate an underlying abnormality
28
When is delayed puberty defined?
Girls- No breast development by 13.5 years or no menstruation within 3 years of breast formation. Boys- failure of testicular growth \>4mls by 14 years.
29
What are some causes of delayed puberty?
Disruption of the hypothalamic/ pituitary control Lack of gonadotropins (Kalman's) Chronic illness Genetic (Turner's, Kleinfeldter's) Lack of gonadal response Androgen insufficiency syndrome
30
What is precocious puberty?
Premature activation of the hypo-pituitary axis
31
What age is considered precocious puberty and what are the most common causes?
Girls= \<9 years- 60% tumours
32
What does it indicate if precocious puberty follows consonance?
It is most likely to be a problem with the hypo-pituitary axis
33
What are some causes of central (gonadotropin dependent) precocious puberty?
Idiopathic Hydrocephalus Tumours Trauma Abuse Chronic inflammatory conditions Radiotherapy
34
What is McCune- Albright syndrome and what is a characteristic sign?
A genetic cause of peripheral (gonadotropin independent) precocious puberty. It is characterised by extensive Cafe au Lait marks
35
What is Thelarche?
Onset of secondary breast development
36
What should FSH and LH levels be prepuberty?
FSH\>LH and LH \<5
37
What causes pubic and Axillary hair growth in girls?
Adrenal androgens- can occur discordantly with ovarian development
38
What is adrenache?
Discordant pattern which can occur up to ~1 year before puberty. Caused increase in adrenal hormone output = development of pubic and Axillary hair and BO.
39
What is gonadache?
Onset of puberty- secretion of GnRH = increased FSH & LH
40
What hormonal profile would you expect in constitutional delay of puberty?
Low FSH, LH and either testosterone or oestrogen
41
What would the hormonal profile be in a 16 year old girl with Turner's syndrome?
Raised FSH and LH with low oestrogen
42
What would the hormonal profile be in premature adrenache?
Normal FSH, LH and oestrogen/testosterone Mildly raised androstenedione
43
What would the hormonal profile be in a 4 year old girl with virilisation, cliteromegaly and no breast formation?
Normal FSH and LH Raised 17- hydroxyprogesterone
44
Why does Triptorelin (GnRH analogue) work for treating idiopathic central precocious puberty?
Normal GnRH release is pulsatile. High levels of GnRH inhibits the release of LH and FSH
45
What's the most common cause of congenital adrenal hyperplasia?
21- hydroxylase deficiency This prevents cortisol synthesis --\> increased 17- hydroxyprogesterone --\> androstenedione & testosterone
46
What are the clinical features of Kallman syndrome?
Delayed puberty Asos is Infertility Colour blindness Synkenesis FHx
47
What is the pathophysiology of alcoholic liver disease?
Alcohol --\> fatty liver --\> alcoholic hepatitis/fibrosis --\> cirrhosis
48
How does acetaldehyde cause liver damage?
Conjugated to glutathione depleting its stores. Hepatocytes then more at risk from free radicals
49
Why does fatty acid build up occur in the liver in alcoholic liver disease?
Ethanol consumption leads to large consumption of NAD ( --\> NADH) leaving small reserves. Decreased NAD means fatty acids not broken down & build up as globules
50
What is the presentation of alcoholic hepatitis?
Jaundice Ascites Fatigue Encephalopathy
51
What are some complications of portal hypertension?
Splenomegaly Oesophageal varices Spider naevae Caput medusae Ano-rectal varices
52
What are causes of acute hepatitis?
Alcohol Viral (A, B, C, & E) - C most common in the UK and B most common worldwide Drugs e.g. Isoniazid, Halothane Sepsis, toxins, ischaemia
53
What would indicate alcoholic hepatitis?
Low transaminase levels AST\>ALT IgA antibodies Neutrophils Hepatoma gaily and portal HTN
54
What clinical findings would you expect in viral hepatitis?
Moderate transaminase values ALT\>AST IgG and IgM antibodies Leukopaenia
55
What clinical findings would you find in drug related hepatitis?
Very raised transaminase levels ALT\>AST All IGs raised Eosinophilia
56
What are causes of jaundice?
Pre-hepatic- haemolytic anaemia, malaria, sickle cell Hepatic- hepatitis, cirrhosis. Gilbert's Cholestasis- biliary obstruction
57
What causes Wernicke's encephalopathy and what are the symptoms?
Thiamine deficiency Ataxia Opthalmoplegia Confusion Short term memory loss
58
In pre-hepatic jaundice what type of bilirubin is raised?
Both conjugated and up conjugated bilirubin
59
What is raised in hepatic jaundice?
Conjugated bilirubin ALT Dark urine (contains conjugated bilirubin)
60
What are the phases of acute hepatitis?
Pre-icteric- 1-2 weeks, flu-like symptoms, fever, raised ALT & AST Icteric- 2-4 weeks, jaundice w/ pale stools and dark urine, raised ALT & AST
61
What is cirrhosis?
Replacement of liver tissue by fibrosis, scar tissue and regenerative nodules which leads to liver dysfunction.
62
What causes raised gammaGT?
Chronic excessive alcohol consumption
63
Where is ALP present and what causes raised levels?
Present in the bile ducts (and bone) Raised in cholestasis, liver tumours, cholangitis, cholecystitis
64
What is the treatment for alcoholic hepatitis?
Prednisolone Pentoxifylline- inhibits TNF synthesis
65
What will blood tests show in alcoholic hepatitis?
AST/ALT ratio is \>2 (\>3 is suggestive) Raised MCV (alcohol interferes with RBC development) Raised gGT Thrombocytopaenia Low albumin Deranged clotting Leukocytosis
66
What causes Korsakoff's syndrome?
Chronic thiamine deficiency
67
What is a phase 1 reaction in drug metabolism?
Phase 1 involve P450 enzymes, redox reactions create/expose functional groups
68
What are phase 2 reactions in drug metabolism?
Phase 2 reactions (conjugation), the products of redox and hydrolysis are coupled with endogenous substrates
69
What is ACS?
Acute coronary syndrome- umbrella term for NSTEMI, STEMI and unstable angina
70
What's the difference between NSTEMI and STEMI?
In a STEMI the coronary artery is completely occluded resulting in a transmural infarct. NSTEMI is partial occlusion leading to less of the myocardium dying
71
Where are atheroma found?
Elastic arteries and large/medium muscular arteries NOT veins
72
What are the layers of an artery wall and what do they consist of?
Tunica adventitia- fibroblasts and connective tissue with some elastic fibres Tunica media- smooth muscle, elastic fibres, collagen and some fibroblasts Tunica intima- endothelium with basal Lamina, internal elastic lamina.
73
What is the 'hallmark' of atheromatous disease?
Endothelial dysfunction
74
How does nitric oxide have an anti-atherogenic effect?
- Vasodilation - Inhibition of smooth muscle proliferation - Inhibition of monocytes adhesion to endothelium - Anti-platelet effect - Promotion of macrophage apoptosis in a plaque - Inhibition of lipid oxidation
75
What 2 drugs are used in the medical management of miscarriage?
Mifepristone and Misoptostol
76
Iron deficiency has what effect on RBCs?
They're smaller- Microcytic
77
What can cause macrocytic red blood cells?
B12 or folate deficieny
78
What is haemoglobin made up of?
haem --\> iron and protoporphyrin ring
2 alpha-chains
2 beta-chains
79
What is thalassaemia?
weakening/destruction of RBCs caused by variant/missing genes affecting haemoglobin production
--\> less Hb and RBCs therefore anaemia (microcytic)
80
What are the signs and symptoms of thalassaemia?
Iron overload
Increased risk of infectio
bone deformation (face & skull) due to bone marrow expansion
Splenomegaly
Slowed growth
Arrythmias & congested heart failure
81
What 'crisis' can occur as a result of Sickle-cell anaemia?
**Vaso-occlusive crisis**- sickles occlude microvessels = ischaemia
**Spleni****c sequestration crisis**- spleen is infarcted by blockages of small vessels
**Acute chest syndrome**- increased pulmonary infiltrate = SOB and tachypnoea
**Aplastic crisis**- acute worsening of baseline anaemia = pallor, tachy, dyspnoea
**Haemolytic crisis**- increased breakdown of RBCs
82
Where is the typical site for a TB infection and why?
In the lung apex where O2 is highest (it's an aerobic bacillus)
83
What are the classical signs and symptoms of TB?
Fever and night sweats
Chest pain
Pleural effusion
Erythema nodosum
Phlyctenular conjunctivitis
84
What is Brock's syndrome?
Rt. midle lobe collapse secondary to lymphadenopathy.
Many lymph nodes around slit-like opening- easily closed off.
Can occur during TB
85
What leads will show an inferior infarct on an ECG?
Leads II, III & aVF
86
What leads will show anterior infarcts on an ECG?
Leads V1 and V2
87
What leads will show a septal infarct on an ECG?
Lead V3 and V4
88
What ar the different types of fibroids occur?
**Submucous**- fibroids grow towards the uterus (bleed the most)
**Subserous**- grow outwards
**Intramural**- within the wall
**Pedunculated**- grow on a stalk
89
What is exostoses?
A.K.A. Surfers ear
Bony growths into the ear canal thought to be caused by reated exposure to cold water
90
What is presbyacusis?
Degenerative hearing loss that gets worse with age
Loss of high frequency therefore background noise gives more interferace as is mostly low frequency
91
What is cholesteatoma?
Cholesteatoma is a destructive and expanding growth consisting of keratinizing squamous epithelium (skin) in the middle ear and/or mastoid process.
92
What are the 2 parts of the tympanic membrane?
Pars tensa
Pars flaccida
93
What is vertigo and what is the most common cause?
Vertigo is the illusion of movement
Most common cause is benign paroxysmal positional vertigo (BPPV)
94
What would a 'strawberries & cream' appearance of the tonsils indicate?
Glandular fever
95
What is quinzy?
unilateral swelling due to a large volume of pus inside the tonsil
96
What is the name of this condition?
Atresia if the pinna
97
What are the other names for glue ear?
Otitis media
Otitis media with effusion
Serious otitis media
98
Why can an ear drum perforation cause hearing loss?
It exposes the round window
This allows incident sound to move the fluid in the ear and affect/cancel out the movement from the ossicles via the oval window
99
What type of hearing loss can be caused by retraction of the tympanic membrane and why?
Conductive deafness
The movement of the ossicles is dampened down
100
Name the three ossicles in order
Malleus
Incus
Stapes
101
What causes a cholesteatoma?
Negative middle ear pressure pulls the pars flaccida inwards
Migrating epithelium becomes trapped and thi is the start of a cholesteatoma
102
Signs and symptoms of a cholesteatoma?
Conductive hearing loss
Scanty, foul smelling discharge
Painless
Complications: mastoiditis, facial nerve paralysis, brain abscess
103
What is otosclerosis?
Thickening of the bone by the stapes footplate that spreads across the oval window and prevents articulation and transmission of sound
--\> Conductive hearing loss \<--
104
What are the treatment options for otosclerosis?
Hearing aid
Surgery- ankylosed area is excised or a piston is fitted to transmit the sound
105
What i the usual treatment for glue ear?
A grommit
Falls out on its own after ~9months
106
Give some examples of iatrogenic causes of hearing loss
Aminoglycosides
Loop diuretics
chemotherapy drugs
Surgical
107
What is the pathophysiology of presbyacusis?
Hair cells and spiral ganglion cells deteriorate with increasing years and do not repair. Hearing loss follows.
108
What are the types of hearing loss and where do they occur?1
Sensoryneural- Inner ear
Conductive- outer/ middle ear
109
What is nystagmus?
A disorder of ocular posture
–Characterised by rhythmic jerky movements
110
What is included in the vestibular apparatus?
The semicircular canals, the utricle and saccule.
111
What do the semi-circular canals do?
Detect rotational movement
112
What part of the ear detects linear movement and gravity?
The utricle and saccule
113
Where is the likely origin of isolated vertigo?
The inner ear
114
Why is the name acoustic neuroma a misnomer?
It rarely affects the auditory nerve and is actually a schwannoma
- Vestibular schwannoma
115
What are the 3 main nerves that supply the inner ear?
Superior vestibular nerve
Inferior vestibular nerve
Cochlear nerve
116
What are the signs and symptoms of BPPV?
Isolated vertigo
No- tinnitus, deafness, otalgia, otorrhoea
Lasts for seconds
Occurs after specific movesments (rolling over in bed)
117
What is the treatment for BPPV?
Dix-hallpike test is diagnostic and the Epley manouver is curative
118
What causes BPPV?
Displacement of some of the otoconia from the macular
These migrate to one of the semicircular canals where they are trapped and exert and effect on the cupula giving a sensation of movement --\> vertigo
119
120
What is the difference between BPPV and Meniere's disease?
BPPV only affects the otoconia
Meniere's affects the whole endolymphatic space so there are cochlear symptoms as well
121
What is the theory for the cause of Meniere's disease?
* Excess endolymph volume arises
* Natural drainage to endolymphatic sac hindered
* Endolyphatic distends and stretches normal neuroepithelia causing malfunction
122
How does a typical attack of meniere's disease present and how long does it last?
It lasts for hours
–Aural pressure
–Tinnitus
–Hearing loss
–Vertigo
–Nausea, vomiting, sweating
123
How is Meniere's diagnosed?
It is mainly a clinical diagnosis by exclusion
MRI must be performed to exclude an acoustic neuroma
124
What is vestibular neuritis and how does it present?
It is inflammation of the vestibular nerve that presents with vertigo, nausea and vomiting for a few days that gradually subsides within 6 weeks
125
What is important in the diagnosis of MS?
signs and symptoms separated in time and space and supported by MRI and CSF electrophoresis
126
In what quadrant of the tympanic membrane is the light reflex usually found?
Anterior- inferiorr quadrant
127
What is the Chorda tympani?
It's a nerve from the taste buds in the anterior of the tongue that runs through the middle ear and joins to the facial nerve (CNVII)
128
What connects the middle ear with the nasopharynx?
The eustacian tube
129
What is the purpose of the middle ear?
Amplication of sound (by ~20x)
130
What nerves travel within the internal acoustic meatus?
Facial, vestibular (superior and inferior), cochlear
131
132
What do chylomicrons do?
Carry fats from the intestine and release them in the liver
133
What are foam cells?
Fat laden macrophages
Can indicate atheromatous disease
134
What is atherosclerosis?
Deposits of fatty material coat the walls of arteries leading to reduced blood flow
135
How does aspirin work as an anti-platelet drug?
irreversible acetylation of platelet COX-1 (This converts arachidonic acid into thromboxane A2 --\> a potent vasoconstrictor and platelet agonist)
The effect lasts for the 10 day lifespan of the platelet
136
What signs indicate familial hypercholesterolaemia?
Tendon xanthomata
Xanthelasma
Corneal arcus
137
What is now the first choice statin?
Atorvastatin
138
139
What is Charcot's triad and what does it indicate?
Pyrexia
RUQ pain
Jaundice
Indicates **cholangitis**
140
141
What are 2 types of autoimmune conditions that affect the large bowel?
Collagenous colits (left) and Lymphocytic colitis (right)
142
What pathological findings characterise Crohn's disease?
'**skip-lesions**'
Shallow aphthoid ulcers
Then later - longitudinal ulcers and fissures
**Cobblestone appearance**
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