30.5.2013(obstetrics,skin) 22 Flashcards
Time between delivery of umbilicus to delivery of mouth in breech is
5-10 min
Timing of episiotomy in breech
When breech is climbing the perineum
Methods of delivery of after coming head
Marshall burns
Piper forceps
Mauriceau smellie veit
Delivery of extended leg in frank breech
Pinnard manoeuvre -popliteal pressure
Delivery of breech with extended arms
Lovset manoeuvre
Reverse mauriceau smellie veit
Prague manoeuvre
Screening of Gestational diabetes is done at
24-28wks
Amount of glucose used in glucose challenge test
50grams
Oral hypoglycaemic without fetal side effects
Glyburide
Triple drug ART for pregnant women
CD4 count< 350 or
Stage 3 and stage 4
Most common cardiac complication of gestational diabetes
1.VSD
TGA
Most specific complication of gestational diabetes
Caudal agenesis
Most common complication of gestational diabetes
CVS
During pregnancy HIV transmission occurs mostly during
Labor
Drug supplied by NACO for preventing HIV transmission to foetus
Nevirapine
Factors increasing vertical transmission
Disease factors: Maternal viral load Advanced maternal disease Seroconversion in pregnancy Low CD4 count Obstetric factors: Vaginal delivery Preterm delivery Coexistent STD Prolonged rupture of membranes Chorioamnionitis Low birth weight Antepartum invasive procedures Postpartum invasive procedures
HIV testing in pregnant women
Opt out approach
Prevention of vertical transmission
Caesarian section
ART
Women with infertility.
B/L cornual block on HSG
Next step
Confirmation by hysteroscopy and laparoscopy
False positive proximal tubal occlusion on HSG
Tubal spasm
Amorphous debris
Minimal adhesions
Extensive fibrosis or debris
Management in HIV positive mother with no prior ART
Single dose nevirapine to mother at onset of labor
Single dose to infant within 72 hours after birth
elective CS in HIV
All HIV positive women with RNA load> 1000 copies/ml
Timing of elective CS in HIV positive women
38 wks to lessen chances of premature rupture of membranes
Rx of HIV positive pregnant women who don’t meet ART criteria
Antepartum zidovudine at 14-34 wks 100mg 5 times a day IV zidovudine during labor 2mg/kg orally is given to neonate every 6 hours for 6 weeks Commencing at 8-12hrs after birth
Early cord clamping is done in
HIV positive mothers
Postpartum hemorrhage in HIV positive women
Ergometrine is avoided,interaction with Protease and reverse transcriptase inhibitors to cause severe vasoconstriction
Give oxytocin and prostaglandin
Disposal of HIV positive placenta
10% sodium hypochlorite bleach for 20min
Vaccines contraindicated in neonates born to HIV positive women
OPV
BCG
Surgery is effective in which type of tubal occlusion
Distal tubal occlusion
Distal tubal occlusion
Sx done
Fimbrioplasty
Neosalpingostomy
Treatment of choice in prenatal congenital adrenal hyperplasia
Dexamethasone
Prenatal steroid Rx for neonatal congenital adrenal hyperplasia should start at
At the time of first missed menstrual period
Type of inhibin more commonly elevated
InhibinB
Inhibin levels elevated in post menopausal women cause
Granulosa cell tumor
Mucinous cystadenocarcinoma
CK20 is associated with
Adenocarcinoma
CK 7 is associated with
Ovarian tumor
HRT in postmenopausal women is not given for
Prevention of CAD
Indications of HRT
Vaginal dryness
Hot flushes
Prevention of osteoporosis
Risk of HRT
CAD
stroke
VTE
breast cancer
Benefits of HRT
Osteoporosis
Ovarian and endometrial cancer
Colorectal cancer
Cognitive function and dementia
Prevention of postmenopausal osteoporosis
Raloxifen
Bisphosphanates
For Rx only bisphosphonates are used
Tumor markers in dysgerminoma
Placental alkaline phosphatase LDH Rarely Alpha fetoprotein hCG
Tumor markers positive in embryonal carcinoma
AFP
hCG
Benign conditions associated with increased CA125
Pregnancy PID endometriosis Uterine fibroid About 1% of normal females
Malignant conditions
Endometrial Ca Ca pancreas Ca colon Ca cervix Ca Fallopian tube Breast ca Lung ca Ovarian epithelial ca
Contraindications for forceps
Above +2 station
Rotation is more than 45 degrees
Presentations for which forceps delivery is applicable
Vertex
Face where chin is anterior
After coming head in breach
Prerequisites for forceps delivery
Delivery must be mechanically feasible Presentation must be suitable Head should be engaged and less than 1/5th palpable per abdomen Cervix must be fully dilated Bladder and rectum must be empty Uterine contractions should be present Membranes should have ruptured
Most common age of atopic dermatitis
5-7 yrs
Areas affected in infantile atopic dermatitis
Face
Extensor aspect
Diff between Infantile atopic dermatitis and scabies
Palms and soles are involved in scabies
Antigen in paraneoplastic Pemphigus
Desmoplakin
Factors deposited in Pemphigus vulgaris and Bullous pemphigoid
IgG
C3
Linear BM deposits
Bullous pemphigoid
Epidermolysis bullosa acquisita
Bullous SLE
Network pattern in IF
P.vulgaris
IgA Pemphigus
Paraneoplastic Pemphigus
Antigen in epidermolysis Bullous acquisita and Bullous SLE
Collagen 7
Granular deposit along BM
SLE
Granular papillary tip deposits along BM
Dermatitis herpetiformis
Ovoid bodies with ragged fibrin band along BM
Lichen planus
Peri vascular and basement membrane deposits
Porphyria
Globular deposits in tip of papillary dermis
Amyloid
Fibrin deposition is seen in which Bullous lesions
Porphyria
Lichen planus
Indications of steroids in psoriasis
Impetigo herpetiformis
Impetigo herpetiformis is associated with
Pregnancy
Impetigo herpetiformis
Pustular psoriasis of pregnancy
Sites not involved in impetigo herpetiformis
Face
Hands
Feet
Topical therapy for psoriasis
Emollients TOPICAL steroids VitD analogues calcipotriene,calcitriol Tar Tazarotene Calcineurin inhibitors (tacrolimus,pimecrolimus) Uv light
Systemic Rx of psoriasis
Methotrexate Retinoids Calcineurin inhibitors Hydroxy urea Azathioprine Paclitaxel Ethanercept Infliximab
Rx of psoriatic arthritis
mild-NSAID
severe-methotrexate
Rx of inverse psoriasis
Topical steroids alone
Don’t use high potency steroids
Rx of guttate psoriasis
Streptococcal infection should be treated first
Later uv light
Hypoxia on EEG
Early hypoxia- excitatory
Late hypoxia- depression
Hypercapnia shows similar changes
Effect of hypocarbia on EEG
Slowing
Monophasic EEG depression seen with which anaesthetic agent
Opioid
Monophasic EEG excitation is seen with which anaesthetic agent
N2O
Ketamine
Somatic passivity is a feature of
Paranoid schizophrenia
Associated with panic disorders are all except Serotonin GABA CCK glutamate
Glutamate
Amygdala and panic attacks
Reduced activity of Amygdala
Panic disorder reduction in size of which brain structure
Right Anterior cingulate cortex
Neurotransmitters associated with panic disorders
Noradrenaline Endogenous opioids Serotonin GABA CCK Orexin
Panicogens
CCK Yohimbine Beta carboline Co2 Sodium bicarbonate Sodium lactate Caffeine
Type D personalities are at increased risk for
CAD
Bipolar 1 disorder
Atleast one episode of mania
Type 2 bipolar disorder
Atleast one episode of hypomania and one episode of depression
Unipolar mania
Type VI
Hypomania or mania precipitated by antidepressant drugs
Type IV
Depressed pts with family history of bipolar illness
Type V
Cyclothymic disorder
Type III
Functional somatic disorders
Somitization
Chronic fatigue syndrome
IBS
Fibromyalgia is not included
Substance elevated in CSF of pts with fibromyalgia
Substance P
cis atracurium is preferred over atracurium
No histamine release,less laudanosine
4times more potent
Longer duration of action
Laudanosine causes
Seizures
Hypotension
Bradycardia
