Year 3 Flashcards
(287 cards)
1
Q
Mild learning disability
A
50-69
2
Q
Moderate learning disability
A
35-49
3
Q
Non-epileptic fit movements
A
Side to side, thrusting of pelvis
4
Q
Unipolar depression and dexamethasone
A
Dexamethasone will fail to suppress cortisol production
5
Q
Mixed affective disorder
A
Manically depressed (high energy depression)
6
Q
MSE has what
A
Appearance + behaviour, speech, affect, mood, thoughts, perception, cognitive function, insight
7
Q
Aversive/defensive
A
Serotonin / NA
8
Q
Depression and mania are problems with aversive/appetitive
A
Appetitive
9
Q
Where is bipolar thought to affect?
A
Anterior cingulate nucleus (broadmann 24)
10
Q
NA precursor
A
Tyrosine
11
Q
5-HT precursor
A
Tryptophan
12
Q
What metabolite is only increased in heroin?
A
6-monoacetylmorphine (6 hours)
13
Q
Acute PTSD vs chronic
A
4 weeks
3 months
14
Q
Hebenephric schizophrenia features
A
Babbles nonsense, laughs uncontrollably
15
Q
Most common schizophrenia
A
Paranoid
16
Q
Most worrying personality disorder and treatment
A
Group B
DBT
17
Q
Schizophrenia affects white/grey matter
A
Grey
18
Q
Schiz <1 month
A
Schizophreniform or acute and transient psychosis
19
Q
How long to continue meds after single episode of schizophrenia?
A
18 m if no relapses
20
Q
Schizotypal disorder
A
Overvalued ideas but no delusions or real hallucinations
21
Q
Egodystonic
A
Thoughts aren’t own
22
Q
Most common mental illness
A
Anxiety
23
Q
Diagnostic tool for autism
A
ADOS
24
Q
Disulifram does what?
A
Inhibits acetaldeyde dehydrogenase
25
What is the predict score?
Predict score = effectiveness of chemo and radiotherapy in breast caner
26
Where are subcutaneous glands in non-lactating breasts?
In front of deep fascia
27
Histology of non-lactating breast
Connective tissue and glandular epithelium
28
How many lobes in a breast?
15-25
29
What separates lobules?
Suspensory ligaments
30
Basic functional unit of breast
TDLU
31
Lactiferous sinus =
Bulge in lactiferous duct where milk concentrates
32
Lobules of non-lactating breast are filled with
Acinar cells, secretory epithelium (columnar and cuboidal), myoepithelial cells surround acinus
33
Histology of large ducts
Both stratified shamus and cuboidal
34
What can happen to breast during luteal?
Small secretions?
35
What is in lactate ?
```
88% water
7% carbs
3.5% lipid
1.5% protein
IgA
```
36
Protein is secreted into ducts via
Eccrine transport
37
Lipids are secreted via
Apocrine
38
How deep does breast conservation surgery go?
Full thickness to chest wall
39
If you can't see cancer with your eyes, how do you excise?
Wire guided wide excision
40
Why do you give under 35 an US?
Breast too dense for mammogram
41
Sterotaxis
Mammography guided biopsy
42
Most common breast cancer
Ductal
43
How is DCIS found?
Non-palpable, found on screening (pleomorphic, casting calficiations)
44
Invasive lobular carcinoma histology
Indian file pattern
45
Modified radial mastectomy preserves what?
Pec major
46
Fibroadenoma confirmation via
FNA and US
47
Phyllodes tumour looks like a ________ and is due to _______ _______
Sarcoma
| Stromal overgrowth
48
Fat necrosis histology
Foamy macrophages
49
LCIS tumour markers
ER+
E-cadherin-
CDH1+ (chromosome 16)
50
BRCA and breast cancer risk
50%
51
Survival if ER positive ?
30% better
52
HER2+ cancer has ______ prognosis
Worse
53
FNA or needle core biopsy?
Needly core biopsy is more often now
54
Fertility treatment for poor swimmers
ICSI
55
First line fertility treatment
IUI
56
Mullerian tract makes what?
Fallopian tubes, mullein inhibiting factor in males makes them disappear
57
Obstructive male infertility blood
Normal
58
Non-obstructive male infertility blood
High LH/FSH
| Low testosterone
59
Chlamydia treat
Doxy 7 days
60
What is implantation bleeding?
10 days post ovulation egg implants into uterus
61
What does vomiting occur in pregnancy?
First trimester
62
Treat hyperemesis
Cyclizine
63
What has a large fluid filled antrum?
Ovarian follicles
64
What is at the centre of the ovaries?
Hilum and medulla
65
Where are follicles in ovaries?
Cortex
66
Uterine and Fallopian tube histology
Simple columnar
67
Stratum of uterus endometrium undergoes monthly growth and degeneration
Functionalists
68
Should there be clots in normal menstruation?
No, clots are abnormal
69
Proliferative phase of menstruation
Oestrogen
70
Luteal phase of menstruation
Progesterone
71
Complete mole
2 sperm DNA
| 46 chromosomes
72
STI needing a proof of cure
Gonorrhea
73
What infections are people with AIDS at increased risk of?
Fungal, viral, parasitic, MYCObacterial
74
Toxoplasmosis signs
CN palsy, confusion
75
CMV signs
Floaters, abdo pain, PR bleed
76
How long after sex do you test HIV
4 weeks
77
How long do ovum survive?
17-24 hours
78
Listeria and pregnancy avoid what?
Soft cheese, shellfish, pate
79
Round ligament is remnant of what?
Gru vernaculum
80
Ribs below pec major?
2-6
81
Preeclampsia risk --> take
75 mg aspirin from week 12
82
T sign placenta with twins
Monochorionic
83
Lamba sign
Dichorionic
84
Asymmetrical IUGR suggests
Placental insufficiency
85
Prenatal appointment screen
Hep, HIV, syphilis, blood group, anaemia
86
Placenta is made of
Trophoblasts and decide
87
_____ stimulation releases oxytocin
Nipple
88
Urogenital system arises from the
Intermediate mesoderm
89
What helps testes descend
Gubernaculum
90
Are contractions under hormonal or neuro control?
Hormonal
91
APH
50-1000ml but no shock
92
1st phase of labour latent vs active
0-4cm
| 4-10cm
93
How many women experience baby blues?
Up to 50%
94
Treatment of overactive bladder?
Oxybutinyn and tolterodine
Demopressin
Mirabegron
95
What makes up levator ani?
PPI
96
Feeding of pre-term baby?
Supplements, give small drops of milk to encourage gut maturation
97
RDS is common before ____ weeks
37
98
XRAY in RDS
Ground glass
99
Normal weight of baby
2.5-4kg
100
c. number means
Where mutation is in mRNA
101
p. number mean
Which amino acid is affected
102
c.(number, letter>letter) meaning
Position of codon and what it has switched to
103
Liver in neonates is smaller/larger
Larger
104
Bowel loops should be _______ than vertebral column otherwise _______
Smaller
| Dilated
105
Why does NEC happen?
Unprepared GI tract springs a leak and leads to shock
106
Brown fat
Produced in 3rd trimester, provides warmth after birth, between scapula and internal organs
107
How long can a newborn be blue and not be worrying?
5 mins
108
Initial rhesus of newborn
In air up to 10 mins then wrong so use oxygen
109
Physiological jaundice of newborn?
Fetal haemoglobin is breaking down, normal 24h-2weeks
110
Endometrial polyps are common when?
Around menopause
111
Endometroid endometrial cancer precursor
Atypia
112
Brachytherapy?
Intrauterine tube under GA, gets radiotherapy closer to cancer
113
Ovarian cancer risks
>50, no kids, FMHx, BRCA
114
What divides obturator foramen?
Piriformis
115
Blood supply to uterus?
Uterine and ovarian
116
Obturator nerve roots
L2-4
117
Sections of uterus
Cervix
Isthmus
Corpus
118
Mets to ovary from (3)
GI
Pancreas
Breast
119
Leiomyoma cells look like
Smooth muscle, long spindle cell, cigar shape
120
CIN and acetic acid
Goes white
121
Koiliocyte
Big black nucleus, squamous cell infected by HPV
122
PCOS cysts are ________
Follicular
123
Which ovarian cancer chemo is renal function dependent?
Carboplatin
124
What ovarian cancer chemo drug causes hair loss
Paclitaxel
125
Uvula deviates
Away
126
Tongue deviates
Towards
127
Young man dizzy then collapses
Epidural - arterial
128
Corpus callous is _____ matter
White
129
What columns cross at spinal levels?
Anterior corticospinal, spinothalamic
130
What is in basal ganglia?
CPGSS
131
Lenticular nucleus
P+GP
132
Striatum
C+P
133
Glycine is where? Gaba is where?
Cortex/brainstem
| Cortex/thalamus
134
Spatial summation =
of neurones
135
High threshold receptor
Pain
136
How are receptive fields defined
1=small
| 2=large
137
SA1
Merkel
138
FA1
Meissners
139
SA2
Ruffini
140
FA2
Pacinian
141
What are gamma motor neurones?
Maintain stretch in muscle spindles
142
Non-rem sleep features
Strong emotional dreams, start of night, MOST IMPORTANT
143
Disturbances in non-rem sleep leads to .... why?
Sleep walking
| Primitive brain wakes up first
144
Disturbances in REM sleep leads to ...
Punches and kicks in sleep
145
MRI in MS is every _____ _____
3 months
146
GB syndrome exclusively affects the _______
PNS
147
Add amox in BM when?
Immunocomp
| Older than 60
148
What does through SOF?
3,4,5(1),6
149
What cranial nerve exits at the pons?
5
150
What cranial nerves leave at diencephalon
1 and 2
151
Midbrain
3 and 4
152
Pontomedullary junction
6,7,8
153
Medulla
9,10,12
154
What divides images top and bottom?
Calcarine sulcus
155
When following stroke are people at most risk of a second?
Within 10 days
156
Worst stroke
TACI
157
Best stroke
Lacunar
158
Main cause of cardioembolic stroke
AF
159
Who gets prophylactic migraine treatment?
3+ a month
160
Treat SUNCT
Gabapentin
| Lamotrigine
161
Primary brain cancer
Astrocytoma
| Meningioma
162
Cerebellopontine angle tumour
Schwannoma
163
Kids primary brain tumour and where
Medullablastoma
| Cerebellar midline
164
What happens to telemeres with age?
They shorten
165
Delirium treat
Haloperidol
166
Anticholingerics in elderly cause
Delirium
167
Gabapentin in elderly causes
Sensorineural changes
168
Modified release morphine lasts _____ hours
12
169
What % of dementias are vascular
25
170
Parkinson's dementia
>1year otherwise LBD
171
Breakthrough pain should be
1/6 of dose
172
Basic drugs example
Opioid, BZD
173
Beer's criteria
Prescribe in elderly
174
High stepping gait and Romberg's + indicates
Cervical myelopathy
175
Who gets co-arction of aorta
Tuner's
176
Marfan's features
```
Bifid uvula
FBN1 mutations
Long narrow face and fingers
High arch palate
Flexible
Pectus excavutum
Scoliosis
Near sighted
```
177
Kallman syndrome is due to
Deficiency in GnRH
178
Kartagener syndrome
Primary ciliary dyskinesia, situs inverses
AR
Neonatal distress, hearing loss, infertility
179
Abduct shoulder muscle
Supraspinatus
180
Ph in PE
Alkalosis
181
Breast cancer tumour marker
Ca15-3
182
Pancreatic cancer marker
Ca19-9
183
BNP marker for
Heart failure
184
Sarcoid granuloma
Non-caseating
185
Main source of hormones in 1st trimester
Corpus luteum
186
Placenta in 2nd and 3rd
Produces oestrogen and progesterone
187
Anterior pituitary in pregnancy
Increases in size, increased TSH
188
Main constituent of gallstones
Cholesterole
| If pigmented - bilirubin
189
Hypospadias
Congenital defect in which urethra opens on ventral side of penis instead of at the tip
190
Blood supply to greater omentum
L+R gastroepiploic arteries
191
Epigastric artery supplies
Abdominal wall and some of diaphragm
192
Treatment of seizures in eclampsia
1. MS
2. Phenytoin
3. Diazepam
193
Coarse vs fine crackles
COPD
| Fibrosis
194
Lorazepam makes delirium
Worse
195
Function of lithium
Lowers levels of inositol by inhibiting phosphatidylinositol
196
FBN1 gene on Ch
15
| Marfans
197
How are platelets formed?
Budding from megakaryocytic
198
Chains of adult Hb
2b 2a
199
Fetal Hb
2a 2g
200
Chromosomes for haemoglobin
11+16
201
Ch16 hb
2a
202
Alzheimers affects what part of brain?
Hippocampus
203
FTD aka ______ dementia
Semantic
204
Why do you avoid thiazides in elderly?
Hyponatremia
| Postural hypotension
205
Why avoid PPI in elderly
Hypomag
Increased risk of fractures
B12 anaemia
Increased Cdiff infection
206
Telemeres are at the ________ of the chromosome
End
207
What happens when chromosome gets too short?
Sesence
208
Hayflick limit?
Number of times human cell can divide before stops
209
4AT
Alertness
AMT (age, date, place, year)
Attention
Acute change / fluctuate
210
Sedation in delirium manage
Haloperidol
Quetipine - Parkinsons /Lewy body
BZD - alc withdrawal
211
Pain manage mild pain
Paracetamol
| NSAID
212
What is cocodomol
Codeine+paracetamol
213
What bone is the supraorbital ridge found on?
Frontal
214
Where does blood supply to skin originate from?
Hypodermal layer
215
Most caudal of brainstem?
Medulla
216
Structure that runs through transverse process of cervical vertebrae
Vertebral artery and vein
217
Dermatome of belly button
T10
218
Medal 2/3 of external acoustic meatus
Temporal
219
Nerve to cricothyroid
External laryngeal
220
Medial border of sartorious makes of lateral border of what triangle
Femoral
221
Hip joint is
Synovial
222
Lesser momentum attaches to
Lesser curve of stomach and liver
223
Right brachiocephalic artery branches into
Right common carotid and subvlacian
224
Vertebral level is pancreas
L1
225
Function of orbiculares oculi
Closes eyelid
226
Transumbilical plane
L3
227
Cribriform plate
Ethmoid
228
How many cervical nerves
8
229
Which part of duodenum is major paillae found
Descending
230
Which muscle elevates pharynx
Sapinophaygneus
231
What artery does the small cardiac vein travel with?
Right coronary
232
Tympanic cavity is where?
Middle ear
233
How many vertebrae
33
234
Second rib tuberosity for
Serratus anterior
235
Action of medial rectus
Adducts eye
236
How much milk for infant is normal ?
150ml/kg/day
237
ECG showing asystole management
IV adrenaline/epinephrine
238
Unprovoked DVT manage
CT abdomen and pelvis
239
What airway device provides protection for the lungs from regurgitation?
Tracheal tube
240
Saturation for haemachromatosis
Transferrin
241
30 year old has severe headache 24 hours after spinal anaesthetic
Low pressure
242
Fasting times for surgery
2h clear liquids
| 6h solids
243
Abnormally high potassium out of blue
Repeat - could be due to spurious degeneration in tube
244
Appropriate test to monitor respiratory function
FVC
245
Dorsiflex nerve
Common perineal
246
Cyclical pain in breasts with brown fluid
Fibrocystic disease
247
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
248
Ovarian cancer nodes
Para aortic
249
Symptomatic gallstone disease
Laparoscopic cholecystectomy
250
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
251
Nephrotic syndrome diagnosis via
Renal biopsy
252
Recurrent falls, reduced pinprick, brisk reflexes
B12 deficiency
253
Venous ulcer presentation
Hyperpigmented, lipodermatosclerosis
254
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
255
Lung cancer investigation
CXR
| CT
256
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)
257
Treat malignant spinal cord compression
Dexamethasone
258
Triple assessment of breast lump
Clinical exam, breast image, core biopsy
259
Lithium toxicity features
Confusion, coarse tremor, jerky leg movements
260
How can lithium toxicity be precipitated?
Dehydration
261
IV fluid resuscitation is with what?
0.9 NaCl
262
If VF/VT persists after third shock, what do you do?
Amiodarone
263
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
264
Person on clozapine with severe sore throat
FBC
265
Meningitis on LP
High pressure, raised protein, excess neutrophils
266
Normal HCO3- excludes a _________ cause of acidosis/alkalosis
Metabolic
267
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
268
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
269
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
270
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
271
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
272
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
273
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
274
How do you confirm norovirus?
PCR stool
275
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
276
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
277
AF long term stroke prevention
Apixaban
278
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
279
Endocarditis diagnosis
Trans-oesophageal echo
| Blood cultures
280
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
281
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
282
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
283
Duodenal vs gastric ulcers
Duodenal relieved by eating
| Gastric is worse by eating
284
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
285
In which part of the brain are changes most likely to be found in early Alzheimer’s disease?
Temporal lobe
286
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
287
Amiodarone can cause what in lung?
Pulmonary fibrosis
