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Revision > PBL seen scenario 1 > Flashcards

PBL seen scenario 1 Flashcards

1
Q

Metformin MoA and side effects

A

Decreases hepatic gluconeogenesis
Decreases intestinal absorption of glucose
Inhibits lipolysis
Increases muscle utilisation and uptake of glucose - increasing insulin sensitivity

Side effects: Nausea and vomiting

DURING PREGNANCY: crosses placenta but safe during pregnancy and breastfeeding (not teratogenic)

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2
Q

Antenatal schedule

A 
Dating scan (8-14 weeks):
Determine due date and screen for possible conditions - Down Syndrome, Edwards and Patau syndromes

20 week scan:
HIV, syphilis and hepatitis B screening
Detailed USS of baby (organ development)
Sex of baby

28 weeks:
Offer screening tests

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3
Q

Polycystic Ovarian Syndrome Pathophysiology

A

Insulin resistance –> hyperinsulinaemia –> increased androgen synthesis by theca cells

Hyperinsulinaemia reduces liver production of sex hormone binding globulin (binds to free testosterone) –> free testosterone might increase

Increased androgen synthesis by theca cells can increase LH secreted by anterior pituitary

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4
Q

Polycystic Ovarian Syndrome Diagnosis

A

Rotterdam criteria:
Hyperandrogenism, oligomenorrhea, polycystic ovaries on ultrasound

PCOS Blood screen:
Raised LH, normal fSH –> raised LH:fSH ratio (>3:1)
Glucose due to raised insulin resistance
Day 21 progesterone - should be high (ovulatory phase). Released by corpus luteum; low –> no ovulation

Differential Diagnoses:
Thyroid function test, prolaction levels, Cushing’s

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5
Q

Polycystic Ovarian Syndrome Presentation

A 
Hirsutism and acne
Acanthosis nigricans (due to insulin resistance)
Central obesity
Menstrual disturbance
-  Oligomenorrhea
-  Amenorrhea
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6
Q

Polycystic Ovarian Syndrome Treatment

A

Lose weight

Treatment:

  • 1st line: Clomiphene - selective oestrogen receptor blocker (brain thinks oestrogen is low –> more fSH = ovulation)
  • 2nd line: Metformin (combat insulin resistance)

Laparoscopic drilling - destroys androgen producing theca and granulosa cells

Injectable Gonadotropins (fSH)

COCP - restore menstrual regularity

Surgery to remove cysts

Anti-androgens - to treat acne/hirsutism

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7
Q

Polycystic Ovarian Syndrome Complications

A

Infertility
T2D
CVD

Pregnancy complications:
Increased risk of gestational diabetes (Pregnant with PCOS –> 24-28 week test for GD) pre-eclampsia, premature labour

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8
Q

How is risk measured

A

Incidence is used as a measure of risk

number of new cases (or deaths) per 100,000 people per year

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9
Q

Relative risk

A

Incidence of disease in exposure population / incidence of disease in unexposed population

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10
Q

What does 95% CI represent

A

95% of a sample relative risk contains the population relative risk with a probability of 95%

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11
Q

What is a confounder

A

A confounder is a factor that is associated both with the exposure and the disease

Adjusting for confounders:
RR for heavy drinkers dying from lung cancer compared to non-drinkers = 2
RR for smoking (heavy drinkers dying from lung cancer compared to non-drinker) = 1

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12
Q

Reasons for illegitimate association between exposure and disease

A
  • Bias
  • Recall Bias
  • Selection Bias
  • Reverse Causality
  • Confounding
  • Incorrect analysis
  • Chance
  • Causal
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13
Q

Bradford Hill Criteria for Causation

A
  • Strength of association
  • Dose response
  • Time sequence
  • Consistency of findings
  • Similar studies on different populations
  • Biological plausibility
  • Coherent of the evidence: other types of studies
  • Reversibility
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14
Q

How can consultations improve adherence

A

Patient-centred, decision making is shared

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15
Q

What is adherence influenced by

A

Illness perception, background beliefs, concerns (perceived needs)

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16
Q

Self-regulatory model of illness behaviour

A

Identify, time-line, consequences

17
Q

Influences on beliefs

A

Medical establishment
family/friends
Culture
Media

18
Q

Health belief model

A

Depends on perceived susceptibility/severity/benefits/barriers and cues to action and self-efficacy

19
Q

Theory of planned behaviour

A
  • Confidence in performing behaviour

- Intentions (important indicator whether people will take action), depends on attitude and subjective norm

20
Q

Diagnosis of intrauterine growth restrictions and types

A

Diagnosis:
Lag in symphysiofundal height of 4 weeks or more –> symphysiofundal height should increase 1cm/week in weeks 14-32
Amniotic fluid 5-25cm range (<5cm = Oligohydramnios)

Types:
Physiological foetal growth

Symmetrical/type I IUGR

Asymmetrical/type II IUGR

21
Q

Physiological foetal growth

A

Conception - 28 weeks:
hyperplasia (increase in number of cells)

Weeks 28 - 34:
hypertrophy (increase in size of cells)

22
Q

Symmetrical/type I IUGR

A

Aetiology: Genetics, Infection, Multiparity

Inhibition of growth in hyperplastic stage –> baby has overall less cells

Head + abdo circumference, height, width, weight all below 10th percentile

NORMAL HC:AC Ratio (1)

23
Q

Asymmetrical/Type II IUGR

A

Aetiology: anything that causes uteroplacental insufficiency (maternal hypertension, pre-eclampsia, vasculopathies, smoking, diabetes)

Inhibition of growth in hypertrophic stage –> normal cell numbers, but cell size reduced

foetus has to redistribute cardiac output = brain and heart receive normal flow at expense of splanchnic vessels –> small abdomen

Smaller foetal kidneys –> Oligohydramnios

REDUCED/normal HC:AC Ratio (< or = 1)

24
Q

folic acid and metabolism

A

400mg/day 3 months before conception and till 12 weeks of pregnancy (to increase chance of conception/successful preg.)

Converted to 5-MTf –> required for re-methylation of homocysteine to methionine
Methionine converted to S-adenosylmethionine (SAM), methyl donor for DNA, neurotransmitter production

Lack of folate –> homocysteine build up, CVD risk
Lack of folate also causes B12 deficiency –> macrocytic anaemia

25
Q

Types of Neural tube defects

A

Spina Bifida Occulta - some vertebrae don’t close –> exposed spinal column

Meningocoele - meninges bulge out and form a fluid-filled cyst coming out from gap in the spinal column

Myomeningocoele - SC + spinal nerve roots grow into the bulging cyst

Anancephaly - lack of skull vault –> exposed top part of brain

26
Q

Causes of PV bleeding in early pregnancy

A

Implantation bleeding - 10-14 days after conception (could be mistaken as period)

Ectopic pregnancy (e.g. caused by PID)

Miscarriage

STI - chlamydia, gonorrhoea, herpes

Preparation for birth - mucous plug sometimes contains a bit of blood

27
Q

Expected hormone levels during pregnancy

A

hCG levels double every 48-72 hours until peak at week 8-11, then falls

Oestrogen - steadily increases throughout

Progesterone - corpus luteum (early pregnancy) then placenta
- Luteal placental shift–> point when the corpus luteum no longer needed to make progesterone as placenta big enough to produce its own

28
Q

Signs of miscarriage (spontaneous loss of pregnancy before 20th week)

A

Loss of foetal heartbeat on ultrasound

Decreasing hCG levels on blood test

Cervix dilation (pelvic exam), closed cervical OS

Woman experiences: cramping, spotting/bleeding, no more pregnancy symptoms (e.g. morning sickness)

29
Q

Premature labour

A

Before 37 weeks

Tocolysis: delays preterm labour

Stress, uterine bleeding and twins

Complications:
Necrotising enterocolitis (breastfeed to lower risk)
Rotavirus

30
Q

How do you calculate corrected age

A

Chronological/calendar age - number of weeks premature

e.g.
Born at 30wks, calendar age 28
40 - 30 = 10 weeks premature
28 - 10 = 18 (corrected age)

31
Q

Signs and symptoms of labour

A

Regular contractions - interval of less than 10 mins
Mucus show plug
Water breaking

32
Q

Stages of labour

A 
1st Stage of Labour
Latent Phase: 0-3cm cervical dilatation.
Active Phase: 3-10cm cervical dilatation. 
•	Primigravida: 1-3cm/hr.
•	Multigravida: 3-6cm/hr.

2nd Stage of Labour
Primigravida: 40 minutes
Multigravida: 20 minutes.
• Propulsive phase: from full dilation to present part reaching pelvic floor.
• Expulsive Phase: from reaching the pelvic floor to delivery of the baby

3rd Stage of Labour
• From delivery of the baby to expulsion of the placenta (30 mins)

33
Q

Failure to progress

A

20+ hrs in 1st pregnancy
Otherwise 14+ hours

Give:
Oxytocin, misoprostol and surgery

Breech = forceps
Otherwise Ventouse

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