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1
Q

List 3 common types of dementia

A

Alzheimer’s
Vascular
Lewy body dementia

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2
Q

Name 2 blood tests that could be done to test for cognition

A

Thyroid, vitamin B
12, folic acid, CRP, FBC, electrolytes
Vitamin deficiency, infection, or other problems (renal failure) -> may cause confusion in the elderly

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3
Q

List 2 problems with the mini mental health test - one with regards to the test and one with regards to the patient

A 
Problems:
Screening tool at most
Poorly administered/scored
Effects of practise
Effects of education, language
Ceiling and floor effects
Training required

Problems with the patient:
Sensory/perceptual deficits – hearing and visual
Deficit in attention
Slow processing speed
Slow reactions
Less ability to use strategies
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4
Q

What are the most common diseases associated with obesity?

A 
Acanthosis nigricans
Diabetes type 2
Orthopaedic problems
PCOS
CV disease
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5
Q

A child’s head circumference is on the 60th centile. Write how you would
explain this to his parents in a reassuring
way

A

60th centile is normal; there is a lot of variation in height
Out of 100 children, there are 60 with a lower head circumference measurement than him, he is just above average

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6
Q

State why it would be difficult to measure the height of:
A new born baby
A 2 year old
A 5 year old with fever and leg pain

A

New-born:
Can’t stand on their own/straight to be measured against a wall

2 y/o:
Won’t stay still/shy

5 y/o:
Can't stand straight on leg
Moving around
Uncooperative/ restless
fatigued so poor posture
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7
Q

Parents are concerned their child may be undergoing pubertal growth spurt - he is 8 y/o - you look at clinical findings, height measurements and medical history. What else could you use to see if he is undergoing a growth spurt

A

Biochemical tests of hormones (GH, LH, FSH, test, GnRH, sex steroids)

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8
Q

Name and describe the 3 stages of birth

A

Phase 1: Contractions and cervical effacement

Phase 2: Delivery of baby

Phase 3: Delivery of placenta

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9
Q

Where do contractions start from and where do they spread to?

A

Start at fundus of uterus where the pacemaker is and spread downwards
Followed by uterine relaxation to allow blood flow to uterus

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10
Q

What is meant by the term ‘effacement’

A

The thinning and flattening of the cervix

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11
Q

What is menarche?

A

The start of mensruation - 1st period

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12
Q

Describe the onset of menarche. How has this changed in the past 100 years?

A

Current age is around 13
Evidence that age of menarche has decreased over the last 100 years
Over the last 3-4 decades it appears to have levelled off (?increasing again)
Population studies suggest that the body weight at menarche has remained relatively constant at about 47kg

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13
Q

When does GnRH pulsatile release occur?

A

Night time pulses in puberty/adrenarche up to two years before menarche
As a neonatal infant there are still pulsatile releases
Neonate = GABA and NPY are quiescent; glutamate active but negative feedback system sensitive so LH and FSH not released in large amounts
Pre-puberty = inhibitory GABA and NPY are active; glutamate inhibited, no GnRH release
Puberty = GABA and NPY are quiescent, glutamate neurones activated, GnRH release
IGF-1, leptin, ovarian steroids (peripheral signals) inhibit GABA and NPY

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14
Q

A 10 y/o girl is the shortest in her class

What would you look for in her PMH?

A

Genetic - most short children have short parents
LBW - permaturity
Events - Malnutrition due to GIT lesion, inflammatory ilness
Drugs e.g. steroids

Birth weight, prematurity, past emotional or psychological problems, childhood illness, previous malnutrition or severe GI tract disturbances

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15
Q

A 10 y/o girl is the shortest in her class

What would you look for in her family history?

A

Parental height
Inherited conditions - endocrine (GH, thyroid, IGF-1 deficiency); syndormes (Turner’s, Down’s, achondroplasia)
Skeleteal abnormality/dysplasias

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16
Q

A 10 y/o girl is the shortest in her class

What would you look for on physical examination?

A

Evidence of Turner’s syndrome: Hypoplasia of maxillary region, prominent forehead, webbed neck, high carrying angle, hypoplastic nails
Height and proportions
Malnutrition

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17
Q

A 10 y/o girl is the shortest in her class

What features would indicate she needed further investigation?

A

Plot her on a growth chart; if she is falling in centile

Evidence of genetic syndrome

Evidence of an illness e.g. malnutrition due to GIT lesion

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18
Q

What is height velocity?

A

Speed of growth = the cms grown in one year

height now–height at last visit)/(age now–age at last visit

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19
Q

What are the values and limitations of using predicted parental target height for a child?

A

Gives an idea of expected height

Limitations:
-so long as someone is growing
along their centile there is no clinical issue; likewise, if someone ends up at the
predicted height but in an abnormal fashion/via dropping centiles, it might indicate a pathology
-parents may overestimate their height
-height also depends on environmental
factors (in utero)
not just genetic factors
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20
Q

What are the factors affecting taking accurate hegiht measurements?

A 
Get the right equipment and make sure it is accurate
Position the child carefully: relaxed
(Make sure the child doesn’t move)
Line up the head, standing straight
Remember hair styles, headbands etc
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21
Q

What are the advantages of a mini-mental state exam (MMSE)?

A

Fairly short time to administer; takes around 30 minutes
Does attempt to cover several areas of cognitive function
Less cultural bias than tests
Widely used and translations available

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22
Q

What are some disadvantages of the mini-mental state exam?

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A 
Often poorly administered or scored
Educational level or language may affect results
Ceiling and floor effects
Only a screening tool
Effects of practise
Training required
23
Q

What are problematic aspects of giving the elderly cognitive tests?

How do the advantages and disadvantages of the MMSE relate?

Study These Flashcards
A

Lower attentional levels

Difficult to obtain a history: sensory deficits and cognitive problems

24
Q

What mistakes can be made in measuring someones height?

Study These Flashcards
A

Incorrect set-up of equipment
Incorrect position/line up of child - child not relaxes, standing straight
Failure to remove shoes and headwear

25
What are the advanteages and limitation of using the predicted parental height?
Gives an idea of what height to expect Not an accurate prediction Child can still have normal growth even is it is significantly higher or lower than mid-parental height Even if a chid reaches mid-parental height, there may still be abnormal growth Other effects than genetic i.e environmental
26
What is height velocity and how do you calculate it?
Height velocity is the speed of growth | Height–height last visit) / (age now-age last visit
27
How do you ascertain whether a child growht is normal?
If growth is progressing on roughly the same centile with age
28
What event precedes puberty?
Adrenarche Up to two years before menarche, there is evidence that the adrenals begin to be active and increase the production of androgens (e.g. DHEA, DHEA-S)
29
What event in girls marks the start of puberty?
Menarche
30
What 2 hormones are released at the start of puberty?
LH | FSH
31
What molecule released from the hypothalamus causes puberty to begin and describe its release
GnRH (LHRH) is released in a pulsatile manner when stimulatory glutamate neurones are activated, and inhibitory GABA and NPY neurones are inactivated (by leptin, IGF1, peripheral stimuli, ovarian steroids ). Opioids may activate glutamate neurones.
32
A new pathway in the causes of puberty has been discovered. Name the gene, the initial protein product produced and the receptor it acts on.
KISS-1 gene Initial protein is kisspeptin-121 GPR54
33
What hormone secreted peripherally rfom adipose tissue states the body is ready to undergo puberty?
Leptin
34
Describe how the neural tube is formed and say when each part of the formation occurs
Development is directed by the notochord The neural tube is formed from the neural plate The developing notochord (from migration of the primitive streak cells) causes ectoderm to thicken -> neural plate On day 18: invagination of the neural plate to form the neural groove On day 21: fusion of neural folds begins, complete by week 4 A neural crest forms between the surface epithelium and neural tube Closure occurs from the middle outwards
35
Give two conditinos in which the neural tube fails to close properly and describe the most common condition
Anencephaly - failure of rostral fusion of the neural tube Spina bifida - failure of caudal fusion of the neural tube There are three types of spina bifida: Occulta: defect in vertebral arches covered by skin; marked by a patch of hair overlying the dimple; no underlying tissue affected. These two are called spina bifida cystica, cyst-like sac is formed Meningocele: defect in the vertebral arches, meninges protrude but not neural tissue (SC in canal still) Myelomeningocele: defect in the vertebral arches, meninges and the SC protrude outside of the canal. Neurological deficits: neurogenic bowel and bladder, lower limb paralysis, fractures, joint contractures, learning impairments, hydrocephalus secondary to meningitis etc.
36
What substance prevents the neural tube from failing to close?
Folate If the person takes a folate acid synthesis inhibitor, change medication All pregnant women take folic acid 0.4mg 5 weeks prior to conception and for the first 12 weeks
37
What does hCG do?
During early pregnancy the high concentrations of gonaldal steroids (oestriol and progesterone) inhibit the release of LH and FSH via negative feedback. hCG is produced by the blastocyst; binds to LH receptors to stimulate + maintain the corpus luteum, can continue to produce progesterone (enriches uterus with BVs and capillaries so it can sustain the fetus)
38
What are the risk factors for pre-eclampsia?
``` Poor obstetric hx Afro-Caribbean/African Strong FH Thrombophilias Renal disease Systemic vascular disease Diabetes Obesity Essential hypertension ```
39
What are the clinical features of pre-eclampsia?
Hypertension 140/90 on two separate occasion >4hrs apart Oedema Proteinuria
40
What is the treatment for pre-eclampsia?
``` Regular blood pressure check up Dipstick analysis of urine for proteinuria Foetal surveillance - measure SFH etc. Antihypertensives Timely delivery Easy acces to maternal care unit ```
41
Describe the current theory for the pathogenesis of pre-eclampsia
Impaired trophoblast differentiation and invasion during 1st trimester Failure to destroy muscularis layer of spiral arterioles -> reduced flow, high resistance, poorly perfused placenta + ischaemia; to compensate the BP is raised in placenta
42
Define labour
The onset of regular, fundally-dominated uterine contractions accompanies by the progressive effacement and dilation of the cervix
43
When does labour happen after sexual intercourse
37 to 42 weeks after
44
Describe the 3 stages of labour
Stage 1: 5–16+ hours Regular contractions start, cervical effacement, dilation, and thinning until full dilation at 10cm Stage 2: 30mins–2hours (active pushing for 1 hour) Full dilation, delivery of the baby Stage 3: 10-30mins Delivery of the placenta and membranes
45
Define fetal growth restriction
Failure of foetus to achieve the predermined growth potential for various reasons
46
What precautions are take to detect FGR
Screen obstetric history of mother Moniter growth of foetus Monitor foetal wellbeing
47
What precautions are take to detect FGR
Screen obstetric history of mother Moniter growth of foetus Monitor foetal wellbeing Bio chemistry: PAPP-A Past obstetric history of PET or FGR Maternal systemic disease– renal, HT, sickle Uterine artery Doppler 1st/2nd trimester identify high resistance flow through the uterine arteries Monitor size and movement
48
Differentiate between foetal growth restriction and low birth weight
Babies with fetal growth restriction will have altered growth i.e. fall away from their centile on the growth chart to a centile below normal. Low birth weight is when a baby is weighing <2500g and there is no pathology to worry about.
49
What does pre-eclampsia cause?
Foetal syndrome or early delivery
50
List 2 main sites of oestrogen production during pregnancy and the stages of pregnanct when they are produced
First 8 weeks - maternal ovary via corpus luteum From day 40 - placenta Luteo-placental shift
51
What is the name of the steroid producing tissue pre-implant of the embryo?
Corpus luteum
52
Define 'lutoe-placental shift' and briefly outline the process
The shift from the corpus luteum to the placenta as the site of production of estrogen and progesterone in amounts that are sufficient to maintain pregnancy in humans. During the first 5-6 weeks: the corpus luteum produces high levels of progesterone and oestrogens so that there is high negative feedback on the hypothalamus and pituitary -> low levels of LH and FSH. Beta hCG is needed to bind to LH receptors on the corpus luteum to stimulate steroid production. Day 40: the placenta takes over the production of oestrogen and progesterone once significant production of hormones is underway (needs foetal adrenals and liver)
53
Name the foetal tissue which aids in oestrogen production during pregnancy and how this is achieved
The foetal adrenals and liver The foetal adrenals convert cholesterol to DHEA-S The foetal liver conjugates the DHEA-S into 16 alpha DHEA-S which makes oestriol, the main pregnancy oestrogen Oestriol con only be made by the foetus
54
Name the 3 requierments essential to a successful first trimester
Implantation of the conceptus in to the uterus at day 8/9 Syncytiotrophoblast invading to produce blood supply for the developing fetus (day 12/13) Decidualisation of the endometrium to produce uterine secretions for nutrition of the embryo Low oxygen tension environment –3% to allow essential structures to develop Week 10: change of fetus blood supply from uterine to placental as placental blood enters the intervillous spaces Formation of the bilaminar disc – week 2 (day 9) Absence of teratogens whilst the fetus develops Week 3: trilaminar disc forms

RDA Past paper questions (1 decks)

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