monday 14th Flashcards
what length of time determines if its A premature rupture of membranes
> 4hr between ROM and contractions = PROM
minimum dilatation for amniotomy
2cm
what type of decelrations are bad in labour on CTG
late decelerations reduced FHR for 15 beats fro 15 secs
a foetal scalp pH of what would indicate delivery
<7.2
after how long in maternal arrest do you deliver baby
3 mins
initial mangement in any maternal collapse
left tilt
how long does puerperium last
6 weeks post partum
the three types of dicharge post birth and how long they last + colour
rubra - red -3-4 days
serosa- brown - 4-14
alba- yellow - 10-20
what hormones in hibit milk production
progesterone adn oestrogen
how long should someone breastfeed for
first 6 months exclusively then add solids +breast for up to 2 years
causes adn treatment of mastitis
staph - aureus
continue breast feed plus analgesia
if sys unwell or does not improve for 2 days oral fluclox
where do abscesses unrelated to breast feeding tend to be
sub areolar
levels of PPH
minor = 500-1L
major > 1L or shock
how to work out someones blood volume
100ml per kg
mangement of PPH uterine atony
- ABCDE
- catheterise
- bimanual massage
- syntocin
- ergometrine
-carboprost - misoprostol
-TXA ?
surgicla mangement of PPH
ballon
b-lynch sutures
artery ligation
hysterectomy
desrcibe degree of perineal tears
first - skin only
second - skin and levator ani
third- involving anal spinchter
fourth 0 involving sphincter and rectal mucosa
what level of tears require theatre
3rd and 4th
lifestsyle advice for stress incontinence
weight loss, smoking cessation, avoid constipation, heavy lifting avoid and reduce caffeine
treatment fo UTI in pregnant women
1/2 trimestetr - nitrofurantoin
3- trimepthoprim
role of sertoli cells
secrete aeminiferous fluid, androgen globuli, inhibin adn activin
role of leydig cells
secrete testpsterone
what pituitary hormone regulates spermatogeneisis
FSH
how can diabetes impact fertiliy
reduces testosetrone in men
what hormones are high in PCOS
LH and testosterone
describe duct system in breast
terminal ductules- intralobular collecting duct - lactiferous duct - lactiferous sinus - nipple
what is involved in breast triple assessment
- clinical
- imaging eg- mam, us , MRI
- biopsy
blue doems breast lump with pale fluid
fibrocystic change
treatment of kawasaki
high dose aspirin
IVIG
do an echo
complications of kawaski
cornornary artery aneurysm
management of duct ectasia
abx
stop smoking
excise
leaf breast tumout
phyloddes
what breast cancer can be seen only through screening
intraductal papilloma
what is the precursor to Ductal carcinoma in situ
intraductal papilloma
what child rash causes spots on uvula and high fever with maculopapular rash
roseola infantum
what virus casues roseola
HHV6
most common complication of chicekn pox in adults
varicella pneumonia
tx for impetigo
1% hydro peroxide
diff between lobular carcinoma in situ and atypical lobular hyperplasia
atypical lobular hyperplasia <50% of lobule involved
in situ > =50% involved
most common type of breast cancer
invasive ductal carcinoma
what type of malignant breast cancer is not palpable and seen on mammogram
lobular in situ
what type of breast cancer is more common ductal or lobular
ductal
what is a DCIS called when it involves the nipple
pagets disease of nipple
A DCIS of what size indicates mastectomy over wide local excision
> 4cm = mastectomy
risk factors for breast cancer
nulliparity
early menarche, late meno
cocp
obestity
BRCA/p53
examples fo anti oestrogen therapies
tamoxifen
aromatase inhibitors - letrozole/anastrozole
GnRh analogues - goserelin
oophrecetomy
side effects of anti-oestrogen therapy in breast cancer
hot flushes
VTE
Endometrial cancer
menstrual disturbances
side effects of aromatase inhibiots
osteoporosis
hot flushes
insomnia
What therpay is used after breast cancer wide local excision
radiotherapy
anti-oestrogen therapy used in pre and post menopausal women
pre- tamocifen
post-aromatse inhibitos (more effective so reserved for these women )
what therapy is used in HER2+ve breats cancer and when is it contraindicated
trastuzamab (HERCEPTIN)
contra in hx of heart problems
is +ve HER2 good or bad
BAD
what is the best hormone profile to have in breast cancer
OE+, PR+ HER2-ve
what therapy can be done pre-surgery in breast cancer
chemo
do breast cancers have incresaed or decresaed vascularity
increased
what is USS bad for seeing - breast cancer
DCIS
difference between partial and complete mole
partial - 3 sets of DNA - 1 egg, 2 sperm - may have foetus
completet - no maternal DNA in egg -no foestu
how long post molar pregancy before can get pregnant
12 months
risk following molar preg
choriocarcinoma
features of threatened misscariiage vs inevitble
threatened - closed os light bleeding
inevitable - open os - heavy bleed +clots
what is a missed/delayed miscarriage
gestational sac present but no foetus
what is classed as recurrent miscarriages
3 or more consec losses - screen for phosph and thrombophilia
indications for medical or surgical miscarriage managment over conservative
increased risk of haemorrhage
prev traumatic experience eg still birth
infection
medical management of miscarriage
vaginal misoprostol - see doctor if no bleeding in 24 hrs
a b-HCG of what points towards ectopic preg
> 1,500
indication for surgical management of ectopic
> 35mm
foetal heart beat
pain
hcg>5000
if b-hecg >1000 but<1500 what management is indicated
medical amangeemnt - mehtotrexate- follow up
pneumonia with hyponatraemia + deranged LFT and dx test
legionella - urine antigen test
raised antibodies in autoimmune hepatitis
ANA/SMA/LKM1 antibodies, raised IgG levels
plateelt transfusion thresholds
<30
<100 if significant bleeding
how long after acute stroke should AF meds be started
2 weeks
ECG changes in hyperkaalemis
tall t , widened QRS , flat p waves
most common organism from line infections
staph epidermidis
seizure following sleep deprivation
juvenile myoclonic epilepsy
first line screening test in those with iron deficient anaemia
anti -ttg
