19/04/18 Flashcards
What type of scan should be done in stroke?
unenhanced CT
How does McArdle’s disease present?
painful muscle cramps after exercise in adulthood
What is the inheritacne of McArdle’s disease?
AR
What is a disadvantage of breast feeding?
breast milk has inadequate levels of vit K and nutrients
What is the 10% rule in phaeo?
10% are familial; bilateral; mlaignant and extra-adrenal
What conditions are associated with phaeochromocytoma?
MEN2; NF and von-Hippel Lindau syndrome
What is the characteristic pattern of clotting in liver failure?
all are low except for VIII
Why is VIII high in liver disease?
synthesised in endothelial cells thourghout the body
What artery supplies the lateral aspect of the heart?
left circumflex
What does lactase break sugar into?
glucose and galactose
Where is Gerotas fascia found?
surrounding the the kidney
What forms the trigone of the bladder?
two ureteric orificies and internal urethral orifice
How is relative risk reductino/increase calculated?
dividing the absolute risk change by the control event rate
Where is the majority of water absorbed in the GI tract?
jejunum
What is the only reason for aspiring in under 16?
Kawasaki disease
What is Reye’s syndrome?
encephalopathy and liver damage
what blood group is associatied wtih gastric cancer?
blood gorup A
What is the most common type of gastric cancer?
adenocarcinoma
What are the 4 collateral venous systems with superior vena caval obstruction?
azygous; internal mammary venous pathway; long thoracic venous system with connections to the femoral and vertebral veins
Where does the long head of biceps orginitae?
supraglenoid process
What does prompt antibiotic treatment prevent the devleopment of in suspected strep throat?
rheumatic fever- not GN
What WBC is found in granulomas?
macrophages
What stastic is used in case-control?
odds ratio
What statistic is used in a cohort study?
relative risk
When is a left sided murmur loudest?
on expiration
When is a right sided murmur loudest?
on inspiration
What innervates quadratus lumborum?
subcostal nerve
What are the actionso f quadratus lumborum?
pulls rib cage inferiorly and lateral flexion
Why is there a mixed pattern of neuro signs in MND?
damages motor cortex adn anterior horn celsl
What cancer is associated with BCL-2 oncogene?
follicular lymphoma
Whhich area of the prostate is associated with BPH?
transitional zone
How much bile enters the small bowel in 24 hours?
500-1.5L
What is the MOA of amiloride?
potassium sparing diuretic which inhibits epithelial sodium channels in the collecting ducts
Why are proximal ulnar injuries less severe than more distal ones?
causes denervation of medial half of FDP which causes decreased flexion of fingers which reduces claw like appearance
What class of hormone is insulin?
protein
What is MOA of ondansteron?
5-HT3 receptor antagonist
What ish te MOA of SUs?
block potassium ATP channels on beta cells to cause memrbaen depolarisation
Which structure of the IV disc usually herniates in dic prolapse?
nucleus pulposus
What is seen in tabes dorsalis?
degeneration of the dorsal columns
What is gravidity?
number of times a woman has been pregnnat
What is Down’s screening between 11 and 14 weeks?
combined test- US and blod test
what is the screening for Down’s between 15 and 20 weeks?
triple or quadruple test (blood tests)
When should anaemia be checked in pregnancy?
booking appointment and at 28 weeks
What is considered a positive result with down’s screening?
risk higher than 1 in 150
What are the indications of fetal echocardiography?
mothers with congenital heart disease; type 1 diabetes or epilepsy; high risk NT result or abnormal heart on anomaly scan
What does an increased NT but normal chromosomes suggest?
multiple structural abnormalities
What is secondary dysmenorrhea associated with?
endometriosis; PID; IUD; cervical stenosis after large loop exicions
How is baseline variablity calculated?
distance between the highest peak andl owest trough in a 1 minute segment
What suggests an abonrmal features with late decels?>
if present in over 50% of contractions for over 30 minutes
Aside from the classic triad; what else in associated with Reiter’s syndrome?
circinate balanitis(red lesions on penis); keratoderma blenorrhagicum (hard nodules on soles)
What is molluscum contagiosum caused by?
DNA poxvirus
What serovars of chlamydia cause infection in the eye?
A,B, C
Is jaundice seen in cholecystitis?
no
How is acute fatty liver of pregnancy differentiated from HELLP syndrome ?
acute fatty liver- hypoglycaemia and high uric acid
What is pain and discmofort in the pelvic area which can radiate to the upper thighs and perineum, worse on walking?
symphysis pubis dysfunction
What is the shape of the anteiror fontanelle?
diamond dhaped
What is the shape of hte posteiror fontanelle?
Y-shaped/triagnular
What are teh indicators of breech presentation?
ballotable head at fundus and fetal heart heard above the umbilicsu
What are the 3 types of breech?
extended; felxed and footling
what is extended breech?
feet extended near the head
What is flexed breech?
feet next to bottom
What is footling breech?
foot presents at cervix
what is the most common type of breech?
extended breech
What are the CI to exterenal cephalic version?
previous C/S; hx of APH; multiple pregnnacy; oligo/polyhydramnios and placenta praevia
What is the least common presentation?
brow- extended neck with largest diameter of fetal head presenting (chin to occiput)
How is brow nad face presentation differentiated?
can palpate the sagittal suture and anterior fontanelle in brow presentation
why is there a higher risk of cord prolapse in footling breech?
feet do not fill the pelvis like a head or buttock would- more space for cord to come down
When should cyclical combined HRT be given?
patients with a uterus and bled within the las tyear
What is prematuirty defined as?
delivery before 37 weeks
When are steroids give in preterm labour?
from 24 to 35 weeks
What is the antibiotic give for PROM?
erythromycin
What antibiotic is associated with increased incidence of fetal necrotising colitis?
co-amoxiclav
What are the features of uterine rupture?
pain; maternal shock; sudden termination of contractions and CTG abnormalities
What happens in placental abruption?
placental bed bleeds and a haematoma forms behind it lifting hte placenta away from the uterus
When is hysteroscopic resection possible for fibroids?
small, submucosal fibroids
What happens to respiratory rate in pregnnacy?
unchanged
What are the medical treatments for uterine fibroids?
GnRH analogues or low dose ulipristal acetate
What are the treatments for cervical ectropion?
diathermy or cryocautery
What do cerivcal polyps usually arise from?
endocervical mucosa
Which cancers are reduced with pill use?
colon; ovarian and endometrial
what cancers are increased with pill use?
breast
When is the COCP CI in diabetics?
only if neuropathy; nephropathy or retinopathy or other vascular disease is present
After what gestation is the Kleihauer test used?
after 20 weeks gestation
When is anti-D needed with threatened or complete miscarriage?
only afte r12 weeks unless uterine evacuation is performed
When should anti-D be given with terminations of ectopic pregnnacy?
always
What is the minimum dose of anti-D after 20 weeks gestation?
500 IU
What is the geenral meaning of stage 2 ovarian cancer?
beyond ovaries but confined to pelvis
what is the general meaning of stage 3 ovarian cnacer?
beyond pelvis but confined to abdomen
What is the general meaning of stage 4 ovarian cancer?
disease is beyond abdomen
What metastatic tumour of the ovaries has signet ring morphology?
Krukenberg tumours
How can stage 1a1 cervical cancer be treated?
cone biopsy or simple hysterectomy
What is stage 1a1 cervical cancer defiend as?
less than 3mm and width less 7mm
What is stage Ib1 cervical cacner?
tumour <4cm
what is stage 1b2 cervical cacner?
tumour >4cm
What is stage 2a cervical cancer?
invasion of upper 2/3rds of vagina
What is stage 2b cervical cancer?
invasion of parametrium
What do all other cervical cancers of stage 1 and 2 except 1a1 require fro treatment?
radical abdo hysterectoym
What is a radical abdo hysterectomy?
hysterectomy with removal of upper 1/3rd of vagina, parametrium and pelvic lymph nodes
What is the alternative for radial hysterectomy for women who wish to stay fertile?
radical trachelectomy
What is the main RF fro uterine sarcoma?
pelvic irradiation
What is the type of endometrial cancer in 90%?
adenocarcinoma
What is the management of post-dates woman who doesn’t want induced?
twice weekly CTG and US of liqour volume
What is first line in failure to progress?
amniotomy
What is uterine hyperstimulation defined as?
> 7 contractions in 15 minutes
What are the features of fetal varicella syndrome?
dermatomal skin scarring; neuro defects; limb hypoplasia; eye defects
What is the treatment for toxoplasmosis?
spiramycin
What virus causes roseola infantum?
HHV6
What is made up of mesovarium?
broad ligament
What is the suspensory ligament of the ovary?
part of hte broad ligament- lateral mesovarium
What is the anatomy of the ligament of the ovary?
atttaches to the medial aspect of the ovary and passes to the lateral edge of the uterus- medial mesovarium
What is a fundal placenta a risk for?
uterine inversion
What in the mx of the third stage of labout can cause uterine inversion?
excessive cord traction or rapid decompression of the uterus
What does large for gestational age mean?
> 90th centile
What is macrosomia?
fetuses with a weight >4.5kg
How is the diagnosis of cord prolapse made?
signs of fetal distress and cord can be palpated in the vagin
Which emergency contraception cannot be used alongisde hormonal contraception?
ulipristal acetate- will affect progesterone-containing contraceptives for the rest of hte cycle
What information should be given to patients with EC?
return if vomit within 2 hours of taking hte pill; next period may be early or late; barrier protection should be used for 7 days and to seek medical attention if she gets symptoms suggesting pregnancy
Waht is the most common cause of secondary PPH?
infection
What is the initial management of an atonic uterus?
emptying the bladder and rubbing up uterine contractions
What is first line medical mx of atonic uterus?
ergometrine adn oxytocin
What is 2nd line medical mx of atonic uterus?
carboprost IM thigh or the myometrium
What is the surgical mx of atonic uterus?
B-lynch suture; insertion of a uterine balloonm over-sewing of the placental bed
What is the cervical screening for HIV positive patietns?
yearly
When does the active stage of labour start ?
4cm dilated
How can tearing of perineum as the head is delivered by reduced?
shorter, smaller, active pushes and applying support to the perineum with a pad or swab
What is Mendelson’s syndrome?
aspiration pneumonitis - acute lung injury after sterile gadtric contents are inglated into the lung
What other name is Mayer-Rokitansky-Kuster-Hauser syndrome known as?
mullerian agenesis
What is seen in mullerian agenesis?
congential absence of the uterus; cervix adn upper 2/3rds of the vagina
What is hte maximum number of contractions with instrumental deliveries?
3
What is 3c perineal tear?
both external and internal anal sphincters are torn
How long should PT for UI be carried out?
3 months
What is the MOA of mirabegron?
beta-3 agonist
When is PTU preferred in pregnnacy?
early pregnnacy and in breastfeeding
When is carbimazole used in pregnnacy? why?
in latter stages due to lvier toxicity with PTU
What is first line anti-emetic in pregnnacy?
promethazine
how do primordial germ cells divide?
mitosis
How do spermatogonia divide?
mitosis into primary spermatocytes
How many chromosomes do primary spermatocytes contain?
46
What are primary spermatocytes which have undergone meiosis 1 called?
secondary spermatocytes
What are secondary spermatocytes called once they have undergone meiosis 2?
spermatids
How do spermatids become spermatozoa?
undergo spermiogenesis
What organism causes chancroid?
haemophilus ducreyi
What type of twins result if division ovccurs between days 4 and 8?
monozygotic monochorionic diamniotic twins
What is the best reliable indicator of gestational age after 14 weeks?
head circumference
What is the most sensitive parameter to assess fetal grwoth and detect IUGR
abdo circumference
Where are Pick’s bodies typically found in Pick’s disease?
substantia nigra
What is somatic passivity?
patient feels that they are receiving bodily sensations from an outside agency
What is mild depression?
4 symptoms in total
What is moderate depression?
5 or 6 symptoms in total
what is severe depression?
7 symptoms in total including all 3 core symptoms
What are the 3 core symptoms?
low mood; anhedonia and anergia
What is atypical depression?
hyperphagia; weight gain adn hypersomnia
what is somatic syndrome?
at least 4/8 biological symptoms of depression
What is perseveration?
mental operations are continued beyond when they are relevant- e.g repeating a whole word or last syllable of a word
What is dysprosody?
loss of hte normal melody of speech
What does perseveration suggest?
organic brain disease
What is Knight’s move thinking?
speech jumps from one subject ot another with no link
What is flight of ideas?
accelerated thorughts with abrupt incidental changes of subject and no central direction
What is hypnagogic?
wake to sleep
what is hypnopompic ?
sleep to wake
What is pseudocyesis?
development of symptoms and many of hte signs of pregnancy in a woma nwho is not pregnant.
