Year 3 Flashcards
Mild learning disability
50-69
Moderate learning disability
35-49
Non-epileptic fit movements
Side to side, thrusting of pelvis
Unipolar depression and dexamethasone
Dexamethasone will fail to suppress cortisol production
Mixed affective disorder
Manically depressed (high energy depression)
MSE has what
Appearance + behaviour, speech, affect, mood, thoughts, perception, cognitive function, insight
Aversive/defensive
Serotonin / NA
Depression and mania are problems with aversive/appetitive
Appetitive
Where is bipolar thought to affect?
Anterior cingulate nucleus (broadmann 24)
NA precursor
Tyrosine
5-HT precursor
Tryptophan
What metabolite is only increased in heroin?
6-monoacetylmorphine (6 hours)
Acute PTSD vs chronic
4 weeks
3 months
Hebenephric schizophrenia features
Babbles nonsense, laughs uncontrollably
Most common schizophrenia
Paranoid
Most worrying personality disorder and treatment
Group B
DBT
Schizophrenia affects white/grey matter
Grey
Schiz <1 month
Schizophreniform or acute and transient psychosis
How long to continue meds after single episode of schizophrenia?
18 m if no relapses
Schizotypal disorder
Overvalued ideas but no delusions or real hallucinations
Egodystonic
Thoughts aren’t own
Most common mental illness
Anxiety
Diagnostic tool for autism
ADOS
Disulifram does what?
Inhibits acetaldeyde dehydrogenase
What is the predict score?
Predict score = effectiveness of chemo and radiotherapy in breast caner
Where are subcutaneous glands in non-lactating breasts?
In front of deep fascia
Histology of non-lactating breast
Connective tissue and glandular epithelium
How many lobes in a breast?
15-25
What separates lobules?
Suspensory ligaments
Basic functional unit of breast
TDLU
Lactiferous sinus =
Bulge in lactiferous duct where milk concentrates
Lobules of non-lactating breast are filled with
Acinar cells, secretory epithelium (columnar and cuboidal), myoepithelial cells surround acinus
Histology of large ducts
Both stratified shamus and cuboidal
What can happen to breast during luteal?
Small secretions?
What is in lactate ?
88% water 7% carbs 3.5% lipid 1.5% protein IgA
Protein is secreted into ducts via
Eccrine transport
Lipids are secreted via
Apocrine
How deep does breast conservation surgery go?
Full thickness to chest wall
If you can’t see cancer with your eyes, how do you excise?
Wire guided wide excision
Why do you give under 35 an US?
Breast too dense for mammogram
Sterotaxis
Mammography guided biopsy
Most common breast cancer
Ductal
How is DCIS found?
Non-palpable, found on screening (pleomorphic, casting calficiations)
Invasive lobular carcinoma histology
Indian file pattern
Modified radial mastectomy preserves what?
Pec major
Fibroadenoma confirmation via
FNA and US
Phyllodes tumour looks like a ________ and is due to _______ _______
Sarcoma
Stromal overgrowth
Fat necrosis histology
Foamy macrophages
LCIS tumour markers
ER+
E-cadherin-
CDH1+ (chromosome 16)
BRCA and breast cancer risk
50%
Survival if ER positive ?
30% better
HER2+ cancer has ______ prognosis
Worse
FNA or needle core biopsy?
Needly core biopsy is more often now
Fertility treatment for poor swimmers
ICSI
First line fertility treatment
IUI
Mullerian tract makes what?
Fallopian tubes, mullein inhibiting factor in males makes them disappear
Obstructive male infertility blood
Normal
Non-obstructive male infertility blood
High LH/FSH
Low testosterone
Chlamydia treat
Doxy 7 days
What is implantation bleeding?
10 days post ovulation egg implants into uterus
What does vomiting occur in pregnancy?
First trimester
Treat hyperemesis
Cyclizine
What has a large fluid filled antrum?
Ovarian follicles
What is at the centre of the ovaries?
Hilum and medulla
Where are follicles in ovaries?
Cortex
Uterine and Fallopian tube histology
Simple columnar
Stratum of uterus endometrium undergoes monthly growth and degeneration
Functionalists
Should there be clots in normal menstruation?
No, clots are abnormal
Proliferative phase of menstruation
Oestrogen
Luteal phase of menstruation
Progesterone
Complete mole
2 sperm DNA
46 chromosomes
STI needing a proof of cure
Gonorrhea
What infections are people with AIDS at increased risk of?
Fungal, viral, parasitic, MYCObacterial
Toxoplasmosis signs
CN palsy, confusion
CMV signs
Floaters, abdo pain, PR bleed
How long after sex do you test HIV
4 weeks
How long do ovum survive?
17-24 hours
Listeria and pregnancy avoid what?
Soft cheese, shellfish, pate
Round ligament is remnant of what?
Gru vernaculum
Ribs below pec major?
2-6
Preeclampsia risk –> take
75 mg aspirin from week 12
T sign placenta with twins
Monochorionic
Lamba sign
Dichorionic
Asymmetrical IUGR suggests
Placental insufficiency
Prenatal appointment screen
Hep, HIV, syphilis, blood group, anaemia
Placenta is made of
Trophoblasts and decide
_____ stimulation releases oxytocin
Nipple
Urogenital system arises from the
Intermediate mesoderm
What helps testes descend
Gubernaculum
Are contractions under hormonal or neuro control?
Hormonal
APH
50-1000ml but no shock
1st phase of labour latent vs active
0-4cm
4-10cm
How many women experience baby blues?
Up to 50%
Treatment of overactive bladder?
Oxybutinyn and tolterodine
Demopressin
Mirabegron
What makes up levator ani?
PPI
Feeding of pre-term baby?
Supplements, give small drops of milk to encourage gut maturation
RDS is common before ____ weeks
37
XRAY in RDS
Ground glass
Normal weight of baby
2.5-4kg
c. number means
Where mutation is in mRNA
p. number mean
Which amino acid is affected
c.(number, letter>letter) meaning
Position of codon and what it has switched to
Liver in neonates is smaller/larger
Larger
Bowel loops should be _______ than vertebral column otherwise _______
Smaller
Dilated
Why does NEC happen?
Unprepared GI tract springs a leak and leads to shock
Brown fat
Produced in 3rd trimester, provides warmth after birth, between scapula and internal organs
How long can a newborn be blue and not be worrying?
5 mins
Initial rhesus of newborn
In air up to 10 mins then wrong so use oxygen
Physiological jaundice of newborn?
Fetal haemoglobin is breaking down, normal 24h-2weeks
Endometrial polyps are common when?
Around menopause
Endometroid endometrial cancer precursor
Atypia
Brachytherapy?
Intrauterine tube under GA, gets radiotherapy closer to cancer
Ovarian cancer risks
> 50, no kids, FMHx, BRCA
What divides obturator foramen?
Piriformis
Blood supply to uterus?
Uterine and ovarian
Obturator nerve roots
L2-4
Sections of uterus
Cervix
Isthmus
Corpus
Mets to ovary from (3)
GI
Pancreas
Breast
Leiomyoma cells look like
Smooth muscle, long spindle cell, cigar shape
CIN and acetic acid
Goes white
Koiliocyte
Big black nucleus, squamous cell infected by HPV
PCOS cysts are ________
Follicular
Which ovarian cancer chemo is renal function dependent?
Carboplatin
What ovarian cancer chemo drug causes hair loss
Paclitaxel
Uvula deviates
Away
Tongue deviates
Towards
Young man dizzy then collapses
Epidural - arterial
Corpus callous is _____ matter
White
What columns cross at spinal levels?
Anterior corticospinal, spinothalamic
What is in basal ganglia?
CPGSS
Lenticular nucleus
P+GP
Striatum
C+P
Glycine is where? Gaba is where?
Cortex/brainstem
Cortex/thalamus
Spatial summation =
of neurones
High threshold receptor
Pain
How are receptive fields defined
1=small
2=large
SA1
Merkel
FA1
Meissners
SA2
Ruffini
FA2
Pacinian
What are gamma motor neurones?
Maintain stretch in muscle spindles
Non-rem sleep features
Strong emotional dreams, start of night, MOST IMPORTANT
Disturbances in non-rem sleep leads to …. why?
Sleep walking
Primitive brain wakes up first
Disturbances in REM sleep leads to …
Punches and kicks in sleep
MRI in MS is every _____ _____
3 months
GB syndrome exclusively affects the _______
PNS
Add amox in BM when?
Immunocomp
Older than 60
What does through SOF?
3,4,5(1),6
What cranial nerve exits at the pons?
5
What cranial nerves leave at diencephalon
1 and 2
Midbrain
3 and 4
Pontomedullary junction
6,7,8
Medulla
9,10,12
What divides images top and bottom?
Calcarine sulcus
When following stroke are people at most risk of a second?
Within 10 days
Worst stroke
TACI
Best stroke
Lacunar
Main cause of cardioembolic stroke
AF
Who gets prophylactic migraine treatment?
3+ a month
Treat SUNCT
Gabapentin
Lamotrigine
Primary brain cancer
Astrocytoma
Meningioma
Cerebellopontine angle tumour
Schwannoma
Kids primary brain tumour and where
Medullablastoma
Cerebellar midline
What happens to telemeres with age?
They shorten
Delirium treat
Haloperidol
Anticholingerics in elderly cause
Delirium
Gabapentin in elderly causes
Sensorineural changes
Modified release morphine lasts _____ hours
12
What % of dementias are vascular
25
Parkinson’s dementia
> 1year otherwise LBD
Breakthrough pain should be
1/6 of dose
Basic drugs example
Opioid, BZD
Beer’s criteria
Prescribe in elderly
High stepping gait and Romberg’s + indicates
Cervical myelopathy
Who gets co-arction of aorta
Tuner’s
Marfan’s features
Bifid uvula FBN1 mutations Long narrow face and fingers High arch palate Flexible Pectus excavutum Scoliosis Near sighted
Kallman syndrome is due to
Deficiency in GnRH
Kartagener syndrome
Primary ciliary dyskinesia, situs inverses
AR
Neonatal distress, hearing loss, infertility
Abduct shoulder muscle
Supraspinatus
Ph in PE
Alkalosis
Breast cancer tumour marker
Ca15-3
Pancreatic cancer marker
Ca19-9
BNP marker for
Heart failure
Sarcoid granuloma
Non-caseating
Main source of hormones in 1st trimester
Corpus luteum
Placenta in 2nd and 3rd
Produces oestrogen and progesterone
Anterior pituitary in pregnancy
Increases in size, increased TSH
Main constituent of gallstones
Cholesterole
If pigmented - bilirubin
Hypospadias
Congenital defect in which urethra opens on ventral side of penis instead of at the tip
Blood supply to greater omentum
L+R gastroepiploic arteries
Epigastric artery supplies
Abdominal wall and some of diaphragm
Treatment of seizures in eclampsia
- MS
- Phenytoin
- Diazepam
Coarse vs fine crackles
COPD
Fibrosis
Lorazepam makes delirium
Worse
Function of lithium
Lowers levels of inositol by inhibiting phosphatidylinositol
FBN1 gene on Ch
15
Marfans
How are platelets formed?
Budding from megakaryocytic
Chains of adult Hb
2b 2a
Fetal Hb
2a 2g
Chromosomes for haemoglobin
11+16
Ch16 hb
2a
Alzheimers affects what part of brain?
Hippocampus
FTD aka ______ dementia
Semantic
Why do you avoid thiazides in elderly?
Hyponatremia
Postural hypotension
Why avoid PPI in elderly
Hypomag
Increased risk of fractures
B12 anaemia
Increased Cdiff infection
Telemeres are at the ________ of the chromosome
End
What happens when chromosome gets too short?
Sesence
Hayflick limit?
Number of times human cell can divide before stops
4AT
Alertness
AMT (age, date, place, year)
Attention
Acute change / fluctuate
Sedation in delirium manage
Haloperidol
Quetipine - Parkinsons /Lewy body
BZD - alc withdrawal
Pain manage mild pain
Paracetamol
NSAID
What is cocodomol
Codeine+paracetamol
What bone is the supraorbital ridge found on?
Frontal
Where does blood supply to skin originate from?
Hypodermal layer
Most caudal of brainstem?
Medulla
Structure that runs through transverse process of cervical vertebrae
Vertebral artery and vein
Dermatome of belly button
T10
Medal 2/3 of external acoustic meatus
Temporal
Nerve to cricothyroid
External laryngeal
Medial border of sartorious makes of lateral border of what triangle
Femoral
Hip joint is
Synovial
Lesser momentum attaches to
Lesser curve of stomach and liver
Right brachiocephalic artery branches into
Right common carotid and subvlacian
Vertebral level is pancreas
L1
Function of orbiculares oculi
Closes eyelid
Transumbilical plane
L3
Cribriform plate
Ethmoid
How many cervical nerves
8
Which part of duodenum is major paillae found
Descending
Which muscle elevates pharynx
Sapinophaygneus
What artery does the small cardiac vein travel with?
Right coronary
Tympanic cavity is where?
Middle ear
How many vertebrae
33
Second rib tuberosity for
Serratus anterior
Action of medial rectus
Adducts eye
How much milk for infant is normal ?
150ml/kg/day
ECG showing asystole management
IV adrenaline/epinephrine
Unprovoked DVT manage
CT abdomen and pelvis
What airway device provides protection for the lungs from regurgitation?
Tracheal tube
Saturation for haemachromatosis
Transferrin
30 year old has severe headache 24 hours after spinal anaesthetic
Low pressure
Fasting times for surgery
2h clear liquids
6h solids
Abnormally high potassium out of blue
Repeat - could be due to spurious degeneration in tube
Appropriate test to monitor respiratory function
FVC
Dorsiflex nerve
Common perineal
Cyclical pain in breasts with brown fluid
Fibrocystic disease
A 70 year old man has a brief episode of twitching that starts in his left hand and spreads up the arm over 2 minutes, then stops. His arm feels weak for an hour afterwards.
Partial stroke
Ovarian cancer nodes
Para aortic
Symptomatic gallstone disease
Laparoscopic cholecystectomy
A 56 year old woman develops vertigo, nausea, vomiting and intense occipital headache of sudden onset. She is unable to walk without falling. She has a history of hypertension treated with ramipril.
Cerebellar stroke
Nephrotic syndrome diagnosis via
Renal biopsy
Recurrent falls, reduced pinprick, brisk reflexes
B12 deficiency
Venous ulcer presentation
Hyperpigmented, lipodermatosclerosis
An 82 year old woman has constipation and passes infrequent, hard stools. She has hypertension, overactive bladder symptoms and type 2 diabetes mellitus. She takes amlodipine, doxazosin, gliclazide, metformin and oxybutynin.Whats causing her constipation?
Oxybutinyn
Lung cancer investigation
CXR
CT
A 45 year old man with pain caused by cancer has been using opioids to control his pain very successfully. He is taking a regular dose of MST Continus® 60 mg 12-hourly orally. He has been using three breakthrough doses (oral morphine 20 mg) per day for the past week. How should his opioid prescription be adjusted?
90 12 hourly and 30 as required 4 hourly (4 hourly should be 1/6 of total day dose)
Treat malignant spinal cord compression
Dexamethasone
Triple assessment of breast lump
Clinical exam, breast image, core biopsy
Lithium toxicity features
Confusion, coarse tremor, jerky leg movements
How can lithium toxicity be precipitated?
Dehydration
IV fluid resuscitation is with what?
0.9 NaCl
If VF/VT persists after third shock, what do you do?
Amiodarone
A 17 year old boy has repeated episodes characterised by a funny ‘racing’ sensation in his abdomen, followed by loss of awareness. His girlfriend describes that he has a vacant stare and waves his left arm around in a writhing manner during these attack
Right temporal
Person on clozapine with severe sore throat
FBC
Meningitis on LP
High pressure, raised protein, excess neutrophils
Normal HCO3- excludes a _________ cause of acidosis/alkalosis
Metabolic
A65yearoldwomanhasaweekofdisorientationanddizziness.Shealso has headaches that are worse when bending over and associated with vomiting. She had a non-small cell lung cancer that was treated with radical radiotherapy two years ago
Cerebral mets
An66yearoldwomanwithadvancedbowelcanceristakingmorphinesulfate (modified release, 30 mg twice daily) for abdominal pain. She is in the last days of life and is now unable to swallow oral medications. She has not needed any doses for breakthrough pain
Continuous infusion required, how much over 24 hours?
30
A44yearoldwomanhasshootingpaininherleftleg.Shehasanadvanced rectal cancer compressing the sciatic nerve. As part of her end of life care, she is taking morphine sulfate modified release (20 mg twice daily) but requests further medication for the pain
Amitriptyline
A67yearoldmanpresentstotheEmergencyDepartmentfeelinggenerally unwell with no specific symptoms. He is being treated with neoadjuvant chemotherapy for bowel cancer. He underwent the third cycle 8 days ago.
His temperature is 38.6°C, pulse rate 97 bpm, BP 132/68 mmHg, respiratory rate 12 breaths per minute and oxygen saturation 95% breathing air. Examination is otherwise unremarkable. Blood tests have been taken, but results are not yet available
Diagnosis and treatment
NEUTROPENIC SEPSIS
BROAD SPEC ANTIBIOTICS
A 33 year old man is found collapsed on the medical ward. He was admitted 3 days ago with urosepsis and is being treated with intravenous antibiotics. He has a history of type 1 diabetes and has been taking his usual doses of subcutaneous insulin
Needs glucose, what do you give?
75mL 20% glucose by IV infusion
A 36 year old man has recurrent episodes of collapse over 4 months. When laughing, his muscles feel limp and he falls to the floor but remains conscious. He has a history of anxiety and depression and takes citalopram. His father died from an ischaemic stroke aged 59 years
Cataplexy
A 25 year old man has taken an overdose of 16 paracetamol tablets. He became very sad earlier that day after an argument with a friend. His mood changes between being happy and sad several times per week. He struggles with concentration and gets angry easily. He has frequently been excessively drunk on nights out with friends. He has never experienced psychotic symptoms
Borderline
How do you confirm norovirus?
PCR stool
A 78 year old woman has back pain and bilateral leg weakness. She had surgery for breast cancer 14 years ago. She had a minor fall at home a few days ago
Spinal cord compression
A 28 year old man is investigated for polyuria and polydipsia. He has bipolar disorder for which he has taken lithium for 2 years. What is most useful diagnosis test?
Serum calcium first
AF long term stroke prevention
Apixaban
A 92 year old woman has severe neck, chest and back pain and tingling in her left hand following a mechanical fall. She has bruising around her right eye. Diagnosis and management
Cerivcal spine fracture
CT neck
Endocarditis diagnosis
Trans-oesophageal echo
Blood cultures
A 47 year old woman has 1 year of increased urinary frequency, urgency and nocturia. She finds that she leaks urine if she is unable to get to the toilet promptly. She had three normal pregnancies with no complications. The perineum appears normal and there is no uterine prolapse. Incontinence is not provoked by coughing or straining. Urinalysis is negative. A post-micturition ultrasound scan of bladder shows minimal residual urine volume
Treatment?
Oxybutynyn
A 23 year old man attends the sexual health clinic with a painful swelling in his groin and pain when opening his bowels. He had unprotected anal sex with a new male partner 4 weeks ago. He has a perianal ulcer and tender inguinal lymphadenopathy
Diagnosis?
Lymphogranuloma venereum
A 75 year old man is admitted with weakness in his legs. He has a squamous cell lung cancer treated by radiotherapy 18 months previously. He is cachetic. He has 4 out of 5 power in hip flexion and knee flexion bilaterally. Sensation and reflexes are normal, and sphincter function is preserved. His BMI is 17 kg/m2. MR scan of spine shows destructive bony lesions of T12 and L2–L4 vertebral body
Treatment?
Too frail for surgical decompression
Radiotherapy is best treatment option
Duodenal vs gastric ulcers
Duodenal relieved by eating
Gastric is worse by eating
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
Treatment?
Midazolam
In which part of the brain are changes most likely to be found in early Alzheimer’s disease?
Temporal lobe
A researcher is seeking to examine whether long-term mobile phone use is linked to acoustic neuroma risk. The information on mobile phone usage is collected from participants with acoustic neuroma and a comparable group of participants without acoustic neuroma, selected from the general practice register
What kind of study is this?
Case-control
Amiodarone can cause what in lung?
Pulmonary fibrosis
