18/04/18 Flashcards
What constitutes the corpus striatum?
lentiform nucleus (globus pallidu and putamen) and caudate nucleus
What isthe baseline HR in a CTG defined as?
average HR within a 10 minute window
What are hte causes of fetal tachycardia?
fetal hypoxia; chorioamnionitis; hyperthyroidism; anameia; tachyarrhythmia
What is mild bradycardia ?
100-120bpm
What are the causes of mild bradycardia?
postdate gestation; occiput posteiror or transverse presentation
What are the causes of severe prolonged bradycardia?
severe hypoxia- cord compression; cord prolpase; epidural and psianl anaesthesia; maternal seizures; rapid fetal descent
What is severe prolonged bradycardia defined as?
less than 80bpm for more than 3m inutes
What are the non-reassuring variabilities?
less than 5bpm for between 30-50 minutes; >25bpm for 15-25mins
What are the abnormal types of variablity?
<5bpm for >50 minutes; >25bpm >25 minutes or sinusoidal
What are hte causes of reduced variability?
fetal sleeping; fetal acidosis due to hypoxia; tachycardia; drugs; prematurity; heart abnormalities
What are the acclerations before and after a variable deceleration known as?
shoudlers of deceleration
What do shoulders of deceleration mean?
fetus is not yet hypoxic and is adapting to reduced blood flow
What is a prolonged deceleration?
> 2 minutes
What is a non-reassuring prolonged deceleration?
2-3 minutes
What is an abnormal prolonged decelration?
> 3 mins
When do late deceleraitons become abnormal?
if happens for 30minutes
What are concerning characteristics of variable decelerations?
> 60s; reduced baseline variability within decel; dailure to return to baseline; biphasic shape; no shoudlering
What are the causes of a sinusoidal pattern?
severe fetal hypoxia/anaemia; fetomaternal haemorrhage
What is an acceleration defined as?
abrupt >15bpm for >15s
What flow rate are nebulisers given at?
6-8L/min
What should be written down when prescribing oxygen/nebulisers?
drug name; flow rate; device used; target sats; indication; signature; date
What is the flow rate for non-rebreathers?
15L/min
What is the management of hypogylcaemia if concious; oriented and able to swallow?
15-20g of quick-acting carb snack eh orange juice and check blood glucose after 10-15 mins
How often can snack be repeated fro hypo?
upto 3 times
What is the treatment for hypo if conscious but uncooperative?
glucose gel between teeth and gums
What is the treatment for hypoglycaemia in an unconscious paitent?
glucose IV 10% at 200ml/hr or glucagon 1mg IV/IM
What is the management of hypo once blood gluocse is >4mmol/L?
long acting carb e.g slice of toast
What symptoms of SZ does dysregulation of mesolimbic system cause and why?
positive symptoms- dopmaine mediates the importance we place on obejects os excess mesolimbic dopmaine causes attaching salienece t oall osrtso fu nrealted phenomena
What is seen on MRI with SZ?
larger lateral ventricles, reduced frontal lobe, hippocampus and amygdala
What is the effect of dopamine on renal blood flow?
increases
What effect does phenytoin have on hair?
causes hirsutism
What xrays are needed for scaphoid fractures?
AP; lateral and oblique; PA
What is the most common cause of inherited unconjugated hyperbilirubinaemia?
gilbert syndroem
what drugs exacerbate psoriasis?
lithium; NSAIDs; beta-blockers; antimalarials; alcohol
Where is sensation lost in an UMN lesion?
sensation is lost to the level of the lesion
What is the function of alpha1 receptor stimulation?
SM of blood vessels; bronchi; uterus; bladder and iris to contract
Where are M3 receptors found?
glandular tissue and SM of lungs; GI tract and eye
What is the function of M2 receptors?
decreased heart contraction and SA node ratw
What is teh treatment for pain associated with smooth muscle spasm eg colicky abdo pain?
hyoscine butylbromide (buscopan)
What cancers are associated with von-Hippel Lindau disease?
phaeo; CNS haemangiomas; hypernephroma
What is glibenclamide?
SU
What are signs of significant ischaemia with non-proliferative diabetic retinopathy?
engorged tortuous veins; cotton wool spots and large bloot haemorrhages
What is Lowenstein-Jensen medium used for ?
culture of mycobacteria
give na example of a gram positive alpha haemolytic diplocci ?
strep. pneumoniae
How are streptococci differentiated?
haemolysis
How are staphylococci differentiated?
coagulase positive or negative
What is a coag negative staph?
staph epi
What is an alpha haemolytic strep?
strep pneumoniae and strep viridans
What are the beta haemolytic streps?
group a and b strep
What is a group A strep?
strep. pyogenes
What is non-haemolytic strep?
entercoccus
When are attacks with cluster HA more common?
at night
Why would cirrhosis cause hyponatraemia?
hypervolaemia
What contraceptive shouldn’t be used in a IDDM with microalbuminuria or hypertension?
COCP
What does a high stepping or stamping gait indicate?
dorsal column loss
what are the causes of dorsal column loss?
tabes dorsalis or subacute combined degeneration of the cord
What is the appearnce of acute leukaemia in the retina similar to?
Roth spots in infective endocarditive
How do roth spots appear?
circular retinal haemorrhages with a central pale core
What are dot haemorrhages on teh retina pathognomic of?
DM
Why would a thiazide precipitate digoxin toxicity?
cause hypokalaemia which increases the risk of digoxin toxicity
When should a patietn be referred for not being able to sit unsupported?
10 months
when should a patietn be referred for not being reliably dry at night?
6 years
When should a patient be referred for not being able to speak in intelligible short sentences?
3 years
How are X and Y chromosomes paired in speramtogeneiss?
end to end
What does a base deficit mean?
acidosis
What is seen on ECG with hypokalaemia?
ST segment depression; U waves; inverted T wabes; prolonged PR interval
What is the inheritance of acute intermitten phorphytia?
AD
What artery origintes from the left posterior aortic sinus?
LCA
Who gets pseudomonas osteomyleitis ?
haemodialysis and IV drug addicts
What is the enzyme deficiency in prophyria cutanea tarda?
uroporphinogen decarboxylase
What are the factors contributing to PCT?
alcohol; excess iron and excess oestrogens
What happens when sulphonamides and methotreaxate are combined?
sulphonamide displaces methotrexate from its plasma protein binding site
What is the most atherogenic lipid particle?
small dense LDL
What enzyme is carried on LDL?
Lp-PLA2
What is Lp-PLA2 associated iwth?
development of necrotic core
What blood vessels ahve the biggest impact on BP?
arterioles
What is Charcot’s triad?
RUQ pain; jaundice; fever with rigors
What is the pain in cholecysitis?
constant
What is the most common site of pancreatic cancer?
head of the pancreaas
What artery supplies the body and tail of pancreas?
SMA- mid gut
What is a positive correlation mean?
direction of relationship
What is the best assay to determine if there is PROM in vaginal fluid?
AFP
What type of renal stone are seen with hypercalciuria?
calcium phosphate
How many feeds would a 2 month old infant be expected eachday?
3/4 stools a day
How many wet nappies should an infant produce a day?
5/6
How many stools should an infant have per day?
3/4
What is seen histoloigcally in Sjogren’s syndrome?
lymphocytic infiltration and fibrosis of exocrine galnds esp lacrimal and salivary
What does the SMA supply?
second half of the duodenum to the first 2/3rds of the transverse colon
What is aphse 1 study?
conducted in healthy volunteers
What is a phase 2 study?
conducted in patietns across a ragne of doses
What is the cause of characteristic watermelon appearance on endoscopy?
gastric angiodysplasia
What is the cause of achalasia?
degeneration of Auerbach’s myenteric plexus
Aside from Hodgkins lymphoma when else are owls eye inclusions seen?
CMV
What is a true aneurysm?
involves all three layers of aortic wall
What is the effect of St Johns wort on heptic enzymes?
inducer
Where should labour at 42 weeks gestation take place and why?
consultant unit as increased perinatal mortliaity and morbidity
What happens to the amniotic fluid at 42 weeks gestation?
decreased
What translocation commonly causes Down’s?
21 and 14
What is a sub-viral satellite?
virus that can exist only alongisde another
What drugs can be given for PROM?
oxytocin receptor antagonist or nifedipine
What drugs should not be used for tocolysis?
betamimetics
What anticonvulsant can cause a PCOS syndrome in women?
valproate
What type of renal stone is only caused by inherited condition?
cystine
In which condition are Perls’ Prussian blue positive deposits found in the liver?
haemochromatosis
What clearance equal to?
urine conc. x urine volume/ plasma conc.
When is choriocarcinoma more common?
extremes of reproductive age
What is seen on pathology with choriocarcinoma?
sheets of syncytiotrophoblasts and cytotrophoblasts with evidence of necoris; haemorrhage and intravascualr grwoth
What cytokines act on bone marrow to increase the production of leucocytes?
colony stimulating factor
What cancer are aflatoxins assocaited with?
hepatocellular carcinoma
What is vaginal clear cell carcinoma associated with?
exposure to diethylstilbestrol in-utero
What cancer is actinic keratosis assocaited with?
SCC
What is the commonest form of sarcoma?
GI stromal trumours
Which chromosome has a point mutation in beta thal?
11
What chromsome has a deletion in alpha thal?
16
How are the BRCA genes inherited?
AR
What is karyorrheixis?
fragmentation of the nuclei
What are apoptotic bodies?
cytoplasmic blebs
Is there release of inflammatory mediators in apoptosis?
no
What is karyolysis?
complete dissolution of the nucleus secondary to the action on DNAase
Why might mycoplasm penumonia cause a positive DAT?
cold AIHA
What antibiotic can cause a positive DAT?
cephalosporins
Is dysplasia irreversible?
no
What is heteroplasia?
replacement of normal tissue by abnormal tissue or malpositioned normal tissue (growing in the wrong place)
What is a bicornuate uterus assocaited with?
recurrent miscarriage; breech presentation; preterm delivery
Waht is the typical genotype of complete molar pregnnacy?
diploid 46 XX ( single sperm combining with an egg devoid of DNA and undergoing mitosis)
What is the typical genotype of a partial molar pregnancy?
69 XXy or quadrapolid XXXY- two sperm or one which duplicates
When are neutrophils typically replaced by macrophages in cutenaoue wound healing?
48-92 horus
What happens to the kidneys in pre-eclampsia?
hypertrophy of the glomerulus as a result of hypertrophy of intracapillary cells- reduced pergusion—-glomerular capillary endotheliosis
What is the most common cause of acute renal failure?
acute tubular necrosis
What type of GN is seen in DM?
nodular glomerulosclerosis
What is seen in affected vessels with PAN?
necrotising transmural inflammation
What virus is assocaited iwth PAN?
chronic hep B
What cancers is CA-125 assocaited with?
ovarian and priamry peritoneal
What cancers is raised CA19-9 associated with?
colorectal cancer and pancreatic cancer
What cancer is CA15-3 assocaited with?
breast
What other name as endotoxins?
bacterial wall lipopolysaccharides
What is clomiphene citrate used for in IVF?
ovarian hyperstimulation
How does clomiphene citrate work
blocks oestrogen receptors in the hypothalamus and pituitary , inhibiting the oestorgen levels
What is the mechanism of cyproterone acetate?
antiandrogen
What are hte SE of cyproterone acetate?
hepatotoxicity; gynaecomastia; low cortisol; low aldosterone and osteoporosis
What is the MOA of mifeprositone?
competitive progesterone receptor antagonist
What is danazol?
synthetic testosterone
Why should sulphonaemides and trimethoprim be avoided in the third trimester?
cause neonatal haemolysis and methaemoglobinaemia
Why should trimethorpim be avoided in the first trimester?
folate antagonist
What antibiotics should be used for UTIs in pregnnacy>
nitrofurantoin
What is first line treatment for ovarian cancer?
total abdominal hysterectomy with bilateral salpingo-oophorectomy
What is an important complication of femal sterilisation?
ecoptic pregnnacy
