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1
Q

what is the vertex

A

area of foetal skull outlined by anterior and posterior fontanelles and parietal emninences

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2
Q

what is wider at pelvic outlet AP or transverse diameter

A

AP diameter

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3
Q

what is the POP-Q scale

A

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

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4
Q

what is the classification of uterovaginal prolapse

A

1st degree= in vagina
2nd degree is at interoitus
3rd degree=outside vagina
procidentia=entirely outside vagina

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5
Q

what is an anterior prolapse called

A

cystolcele

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6
Q

what is a vaginal vault prolapse also known as

A

enterocele

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7
Q

what is a posterior prolapse

A

rectocele

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8
Q

where is wernickes area

A

superior temporal gyrus

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9
Q

where is brocas area

A

inferior temporal gyrus

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10
Q

where is conductive/associative area

A

arcuate fasciculus

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11
Q

what are the strongest contraindications to COCP

A 
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
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12
Q

what do granulosa cells produce

A

oestrogen

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13
Q

what are granulosa cells associated with

A

endometrial hyperplasia because they can produce oestrogen

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14
Q

describe the staging of ovarian cancer

A

stage1= confined to ovary
stage 2=outside ovary but within pelvis
stage3=outside pelvis but within abdomen
stage 4=distant metastasis

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15
Q

how do you treat DVT

A

LMWH for 5 days and warfarin for 3 months (if obvious provoking factor eg major surgery) if no provoking factor then 6 months

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16
Q

why do you need to give LMWH and warfarin for the first 5 days

A

as warfarin takes a while to work and is initially prothrombotic

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17
Q

what marker can be raised after seizures

A

prolactin

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18
Q

name causes of splenomegaly

A

myelofibrosis, CML, CLL, Hogkins, haemolytic anaemia, portal hypertension, infections eg glandular fever, hepatitis, infective endocarditis, thalassaemia

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19
Q

what shape is anthropoid pelvis

A

oval shaped with large AP diameter and smaller transvers

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20
Q

what is android pelvis

A

triangular heart shaped, narrower at the front

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21
Q

what are the risks of breech

A

placenta praevia, abnormal pelvic rim, oligohydramnios, low birth weight/prematurity, previous breech

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22
Q

what can myelofibrosis be caused by

A

hyperplasia or megakaryocytes that produce platelet derived growth factor leading to intense marrow fibrosis and myeloid metaplasia

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23
Q

what are hypermetabolic symptoms

A

weight loss, night sweats etc

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24
Q

what are the lab findings in myelofibrosis

A

anaemia, increase in wcc and platelets in early disease, tear drop poikolocytes on blood film, high urate and LDH

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25
what is a common complication of PCP
pneumothorax
26
which types of shock cause cold peripheries
cardiogenic, hypovolaemic and obstructive
27
what happens in cardiogenic shock
decreased force of contraction leads to decrease in SV and hence CO and MAP compensatory increase in SVP
28
what happens to SVR in obstructive, cardiogenic and hypovolaemic shock
it increases resulting in cool, clammy peripheries
29
what are the microcapillary changes in shock
capillary blood flow is reduced, intermittent or terminated
30
von willebrand disease affects intrinsic or extrinsic pathway
intrinsic pathway APTT and bleeding time are increased
31
von willebrand factor carries what factor
factor VIII (8)
32
von willebrnad disease affects what pathway intrinsic or extrinsic
intrinsic pathway
33
what is an uncal herniation
medial part of temporal lobe herniates inferior to tentorium cerebelli
34
what nerve can get compressed by uncal herniation
oculomotor
35
what does damage to oculomotor nerve by uncal herniation cause
ipsilateral fixed dilated blown pupil
36
what is 99% predictive of bacterial meningitis
``` WCC >2000 neutrophils >1180 protein >2200 glucose <34 glucose CSF/serum <0.23 ```
37
activated protein C inhibits what cofactor
factor V
38
activated protein S inhibits what cofactor
factor VIII
39
what factors does heparin inhibit
2,9,10,11
40
which factor is not affected in liver disease
8
41
warfarin acts on what clotting factors
2,7,9,10
42
what does factor V Leiden do
means activated factor V is inactivated x10 more slowly by protein C (so clots persist for longer)
43
LMWH increases action of antithrombin III on what factor
Xa
44
Tamm-Horsfall protein is produced where
in thick ascending loop of Henle
45
when is a mild bradycardia more common
in occiptoposterior/transverse presentations and postdate gestation
46
how long does bradycardia need to be sustained for
3 minutes
47
what is normal variability
5-25 bpm
48
what is reduced variability most commonly due to
foetal sleeping
49
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
50
how are haemoglobinopathies inherited
autosomal recessive
51
what does wertheims hysterectomy include
pelvic node clearance, hysterectomy, removal of parametrium and upper 1/3 of vagina
52
what does pre-eclampsia increase risk of
IUGR, prematurity, haemorrhage-intra abdominal, intracerebral, placental abruption, cardiac failure, multiorgan failure
53
when do you get cervical excitation
PID and ectopic pregnancy
54
what bloods are included in a confusion screen
glucose, vit B12, folate and thyroid function
55
in a well flexed foetus in OA position what is the diameter measured
sub-occipitobregmatic
56
with face presentation what diameter is measured
submentobregmatic
57
what is the bregma
anterior fontanelle
58
presentation in less well flexed
occipito-frontal
59
treatment of von willebrand
transexamic acid | desmopressin or factor VIII concentrate
60
steps in formation of a platelet pluf
adhesion, aggregation and activation
61
what happens in adhesion
platelets bind to subendothelial collagen via glycoprotein Ib and von willebrand factor
62
what happens in aggregation
via GPIIb and IIIa and fibrinogen
63
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
64
how does aspirin work
inhibits cyclo-oxygenase which is necessary to produce thromboxane A2
65
how does dipyridamole
phosphodiesterase inhibitor-reduces production of cAMP which is a second messenger in platelet activation
66
what does dabigatran work on
IIa
67
what does rivaroxaban work on
Xa
68
where do thiazide diuretics act
distal convoluted tubule
69
where do loop diuretic act
ascending loop of henle
70
which substances can increase dopamine release
amphetamine, cocaine, nicotine, morphine
71
what do fMRI studies shoe in non addicted patients when they win
increased flow to striatum

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