11 Flashcards
what is the vertex
area of foetal skull outlined by anterior and posterior fontanelles and parietal emninences
what is wider at pelvic outlet AP or transverse diameter
AP diameter
what is the POP-Q scale
with patient straining at 6 specific sites evaluated, at rest 3 sites, measured in relation to hymen as this is a fixed point
above hymen -ve if below hymen +ve
what is the classification of uterovaginal prolapse
1st degree= in vagina
2nd degree is at interoitus
3rd degree=outside vagina
procidentia=entirely outside vagina
what is an anterior prolapse called
cystolcele
what is a vaginal vault prolapse also known as
enterocele
what is a posterior prolapse
rectocele
where is wernickes area
superior temporal gyrus
where is brocas area
inferior temporal gyrus
where is conductive/associative area
arcuate fasciculus
what are the strongest contraindications to COCP
migraine with aura >35 and smoking more than 15 cigarettes a day history of thromboembolic disease history of stroke/IHD breastfeeding and <6 weeks postpartum uncontrolled hypertension current breast cancer majory surgery/period of immobility
what do granulosa cells produce
oestrogen
what are granulosa cells associated with
endometrial hyperplasia because they can produce oestrogen
describe the staging of ovarian cancer
stage1= confined to ovary
stage 2=outside ovary but within pelvis
stage3=outside pelvis but within abdomen
stage 4=distant metastasis
how do you treat DVT
LMWH for 5 days and warfarin for 3 months (if obvious provoking factor eg major surgery) if no provoking factor then 6 months
why do you need to give LMWH and warfarin for the first 5 days
as warfarin takes a while to work and is initially prothrombotic
what marker can be raised after seizures
prolactin
name causes of splenomegaly
myelofibrosis, CML, CLL, Hogkins, haemolytic anaemia, portal hypertension, infections eg glandular fever, hepatitis, infective endocarditis, thalassaemia
what shape is anthropoid pelvis
oval shaped with large AP diameter and smaller transvers
what is android pelvis
triangular heart shaped, narrower at the front
what are the risks of breech
placenta praevia, abnormal pelvic rim, oligohydramnios, low birth weight/prematurity, previous breech
what can myelofibrosis be caused by
hyperplasia or megakaryocytes that produce platelet derived growth factor leading to intense marrow fibrosis and myeloid metaplasia
what are hypermetabolic symptoms
weight loss, night sweats etc
what are the lab findings in myelofibrosis
anaemia, increase in wcc and platelets in early disease, tear drop poikolocytes on blood film, high urate and LDH
what is a common complication of PCP
pneumothorax
which types of shock cause cold peripheries
cardiogenic, hypovolaemic and obstructive
what happens in cardiogenic shock
decreased force of contraction leads to decrease in SV and hence CO and MAP
compensatory increase in SVP
what happens to SVR in obstructive, cardiogenic and hypovolaemic shock
it increases resulting in cool, clammy peripheries
what are the microcapillary changes in shock
capillary blood flow is reduced, intermittent or terminated
von willebrand disease affects intrinsic or extrinsic pathway
intrinsic pathway APTT and bleeding time are increased
von willebrand factor carries what factor
factor VIII (8)
von willebrnad disease affects what pathway intrinsic or extrinsic
intrinsic pathway
what is an uncal herniation
medial part of temporal lobe herniates inferior to tentorium cerebelli
what nerve can get compressed by uncal herniation
oculomotor
what does damage to oculomotor nerve by uncal herniation cause
ipsilateral fixed dilated blown pupil
what is 99% predictive of bacterial meningitis
WCC >2000 neutrophils >1180 protein >2200 glucose <34 glucose CSF/serum <0.23
activated protein C inhibits what cofactor
factor V
activated protein S inhibits what cofactor
factor VIII
what factors does heparin inhibit
2,9,10,11
which factor is not affected in liver disease
8
warfarin acts on what clotting factors
2,7,9,10
what does factor V Leiden do
means activated factor V is inactivated x10 more slowly by protein C (so clots persist for longer)
LMWH increases action of antithrombin III on what factor
Xa
Tamm-Horsfall protein is produced where
in thick ascending loop of Henle
when is a mild bradycardia more common
in occiptoposterior/transverse presentations and postdate gestation
how long does bradycardia need to be sustained for
3 minutes
what is normal variability
5-25 bpm
what is reduced variability most commonly due to
foetal sleeping
how is sickle cell disease treated
hyposplenism-reduce risk of infection with prophylactic penicillin vaccination, pneumococcus, meningococcus, haemophilus
folic acid supplementation
hydroxycarbamide can decrease severity by inducing HbF
how are haemoglobinopathies inherited
autosomal recessive
what does wertheims hysterectomy include
pelvic node clearance, hysterectomy, removal of parametrium and upper 1/3 of vagina
what does pre-eclampsia increase risk of
IUGR, prematurity, haemorrhage-intra abdominal, intracerebral, placental abruption, cardiac failure, multiorgan failure
when do you get cervical excitation
PID and ectopic pregnancy
what bloods are included in a confusion screen
glucose, vit B12, folate and thyroid function
in a well flexed foetus in OA position what is the diameter measured
sub-occipitobregmatic
with face presentation what diameter is measured
submentobregmatic
what is the bregma
anterior fontanelle
presentation in less well flexed
occipito-frontal
treatment of von willebrand
transexamic acid
desmopressin or factor VIII concentrate
steps in formation of a platelet pluf
adhesion, aggregation and activation
what happens in adhesion
platelets bind to subendothelial collagen via glycoprotein Ib and von willebrand factor
what happens in aggregation
via GPIIb and IIIa and fibrinogen
what happens in activation
platelets alter their shape to expose more phosopholipid on surface which provides increase surface area for coagulation activation and fibrin production to stabilise the clot
how does aspirin work
inhibits cyclo-oxygenase which is necessary to produce thromboxane A2
how does dipyridamole
phosphodiesterase inhibitor-reduces production of cAMP which is a second messenger in platelet activation
what does dabigatran work on
IIa
what does rivaroxaban work on
Xa
where do thiazide diuretics act
distal convoluted tubule
where do loop diuretic act
ascending loop of henle
which substances can increase dopamine release
amphetamine, cocaine, nicotine, morphine
what do fMRI studies shoe in non addicted patients when they win
increased flow to striatum
