10 Flashcards
what drugs are contraindicated in breast feeding
ciprofloxacin, tetracycline, chloramphenicol, sulphonamides (eg co-trimaoxazole), aspirin, carbimazole, methotrexate, sulphonylureas, cytotoxic drugs (eg some chemo drugs) amiodarone
what is the hoffmans reflex
shows UMN dysfunction and points to a disease of central nervous system
to elicit, examiner should flick patients distal phalynx (usually middle finger) to cause momentary flexion, a +ve sign is exaggerated flexion of thumb
which demographic is neuroleptic malignant syndrome more common in
young males
when is neuroleptic malignant syndrome most common
in patients who have just commensed treatment-within first 10 days
what are the symptoms of neuroleptic malignant syndrome
renal failure-secondary to rhabdomyloysis pyrexia rigidity tachycardia increased CK in most cases leucocytosis may also be seen
what is the management for neuroleptic malignant syndrome
stop antipsychotic
IV fluids to prevent renal failure
dantrolene-may be useful
dopamine agonists eg bromocriptine
what are the examination findings in neuroleptic malignant syndrome
decreased reflexes, lead pipe rigidity, normal pupils
what can trigger a cluster headache
alcohol
what tool is used to screen for post natal depression
Edinburgh Postnatal depression score
what happens in the secretory phase of endometrial cycle
progesterone is released this usually lasts 14 days
increased tortuosity and luminal secretions
TVUS thickness of how much is indication for biopsy in premenopausal women
> 16 mm
what is DUB mostly due to
anovulatory cycles
when is anovulatory DUB most commone
at either end of reproductive life
corpus luteum doesn’t form so continued growth of functionalis layer
when are endometrial polyps most common
usually asymptomatic but may present with bleeding or discharge often around and after menopause
almost always benign
what does a complete mole only contain
paternal DNA
what type of DNA is contained within a partial mole
maternal and paternal DNA
69XXY-triploid
is GBS picked up on an incidental swab in pregnancy a cuase for concern
no this is a commensal in 20-40% of women
when should you give abx for GBS
maternal IV antibiotic prophylaxis should be offered to women with previous baby with GBS
maternal IV antibiotics in preterm labour regardless of GBS status
women with pyrexia in labour >38 degrees given IV abx
BENZYLPENICLLIN
describe discharge after delivery
this is called lochia
in the first 3-4 days it is red rubra
then up to 10 days it is brown-serosa
then up to 4 weeks white-alba
what about discharge after birth is concerning
large clots-about size of golf balls
reddining in colour after lightening
needing to change your pad every hour
abdominal pain and fever
describe what can happen to fibroids in pregnancy
sensitive to oestrogen and can therefore grow in pregnancy, if growth outstrips blood supply, they can undergo red or carneous degeneration
get low grade fever pain and vomit
condition usually managed conservatively with rest and analgesia and resolve within 4-7 days
what is retinopathy of prematurity
disorder of developing retina
abnormal fibrovascular proliferation or retinal vessels may lead to retinal detachement and visual loss
large fluctuations in PaO2 thought to cause this
treatment of retinopathy of prematurity
diode laser therapy
what is PAF
population attributable risk
proportion of disease caused by a particular risk factor
what does PAF measure
burden of disease
what percentage of breast cancers are thought to be preventable
42%
the 42% of preventable breast cancers are because of
lack of physical activity 12%, alcoholic drinks 22%, body fatness 16%
what is the increase of breast cancer and weight
5% increase of breast cancer with every 2kg/m2 increment eg a woman weighing 30kg/m2 has a 12.5% increased risk compared to a woman with a BMI 25kg/m2
what are some of the risk factors for preterm labour
x9 if multiple pregnancy
if 2 previous preterm deliveries 70%
if abnormally shaped uterus increase 19%
hypertension, IUGR, IVF, smoking, <6 months between previous pregnancy
how long do depressive symptoms need to be present for
at least 2 weeks for most of day
what is the most effective way of screening for downs, Edwards and patau
combined test
looks fluid from back of fetus neck using nuchal translucency
blood test-free hcG and PAPP-A
between 10 and 14+1 weeks
what is done in first booking visit
maternal BMI,
general info about diet, alcohol, smoking, folic acid, vitamin D, antenatal class,
BP, urine
Bloods-FBC, blood group, rhesus status, red ell antibodies, haemoglobinopathies, syphilis, rubella
HIV offered
urine culture for asymptomatic bacteraemia
in antenatal care when is the first scan done
between 10-13+6 weeks
to confirm dates and exclude multiple pregnancy
how is pregnancy usually dated
crown-rump length between 6-12 weeks
14-20 weeks can use biparietal diameter
in terms of blood markers what has an increased risk of downs
low aFP and increased HcG
what is the receptor field of an afferent neurone
the region that when stimulated with an adequate stimulus causes a response in that neurone
for primary afferent neurones the receptor field is location of what
peripheral terminal
a patch of skin contains many overlapping RFs innervated by
primary afferent fibres
describe the 2 point discrimination in finger tip, palm and forearm
2mm, 10mm, 40mm
what trisomy is in Edward syndrome
trisomy 18
what features are present in Edward syndrome
heart problems, unusal head and facial features, unable to stand and walk
what is trisomy in patau syndrome
trisomy 13
what problems are present in patau
heart problems, cleft lip and palate, growth problems, poorly formed eyes and ears, problems with kidneys, unable to stand and walk 2 in 10,000
below above what is classed as low risk for chromosomal abnormalities
1 in 150
what is a robertsonian translocation
2 acrocentric chromosomes stuck end to end
what does aCGH locate
an imbalance
if think there is a balanced chromosomal abnormality what would you do
full karyotype of FISH
how is DNA testing in pregnancy usually done
PCR
what can DNA in maternal serum help with
X linked diseases-if no Y chromosome then can reassure if Y chromosome then can proceed to more invasive testing
if already diabetic and get pregnant what do you need to check
RETINA
why do you get GORD in pregnancy
progesterone mediated pyloric sphincter relaxation
what is the usual cause of hyperemesis gravidarum
increased hcg from multiple pregnancy or mole
what is the treatment for hyperemesis gravidarum
aggressive fluid replacement
glucose can precipitate Wernicke’s encephalopathy
what happens to D2 receptors in addiction
they are decreased
how do addictive drugs affect PFC
potent signal that disrupts normal dopamine related learning in PFC
what is the orbitofrontal cortex
key creator of motivation to act
addicts get increase activation when they see drugs
what are the resp physiological changes in pregnancy
resp rate increase, tidal and minute volume increase by 50%, vital capacity and po2 don’t change, pco2 decreases
physiological cardio changes in pregnancy
HR increases up to 90min to increase CO
CO is increased by 30-50% and increased by 30% in labour
BP decreases until 2nd trimester as circulation expands and peripheral resistance decreases
where does lower visual field project to
gyrus superior to calcarine sulcus
where does upper visual field project to
gyrus inferior to calcarine sulcus
where does macula project to
posterior pole of visual cortex
describe how fibres of geniculocalcarine tract work
the fibres of geniculocalcarine sulcus form part of internal capsule, those carrying visual info from upper 1/2 of visual field first loop anterior around temporal part of lateral ventrile in Meyers loop ending below calcarine sulcus
does visual cortex or frontal eye fields track moving objects
visual cortex tracks moving objects-this tends to be smooth
what do frontal eye tracts do
movements of command-independent of moving visual stimuli
name 3 types of fibres in white matter
association, commissural and projection
what do association fibres do
connect cortical sites in the same hemisphere
what do commissural fibres do
connect one hemisphere to the other-usually have similar function
what do projection fibres do
connect hemispheres to deeper structures including thalamus, corpus striatum, brainstem and spinal cord
