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Revision > PBL Seen scenario 2 (integrated) > Flashcards

PBL Seen scenario 2 (integrated) Flashcards

1
Q

What does G2P1 mean?

A

Gravida 2 = two pregnancies

Para 1 = one birth

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2
Q

What would calf tenderness indicate

A

DVT, due to blood clot in the vein (ant./post. tibial vein) diverting blood flow to other veins –> increase in pressure

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3
Q

What is a CTG

A

Continual recording of foetal heart via ultrasound

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4
Q

What are the roles of a Physiotherapist

A

Specifically trained and regulated practitioners

Help those affected by injury, illness or disability through movement and exercise, manual therapy, education and advice

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5
Q

What are the roles of an Occupational Therapist

A

Provide patients practical advice and solutions to enable them to live full, satisfying and independent lives

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6
Q

Cause of R. sided pleuritic chest pain

A

Pneumonia (also be TB/pulmonary infarct/PE)

  • R. Lower lobe consolidation with mid-zone changes and intra-alveolar exudate
  • Hospital acquired: 48 hrs or more after hospital admission and no incubation at admission
  • CRB65: Confusion, resp rate >30
Treatment:
Doxycline (30s ribosomal unit)
Penicillin
Macrolides (50s) 
All for 5 days
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7
Q

What causes COVID-19

A

SARS-CoV-2 –> enveloped and stranded RNA

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8
Q

Signs of COVID-19

A

Elevated CRP, neutrophils and IgG antibodies

Low lymphocyte count (lymphopenia) as immune mediated damage
Micro thrombosis, decrease in diffusion capacity, V/Q mismatch

Bilateral airspace consolidations / hazy opacities

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9
Q

Treatment for COVID-19

A

Intramuscular Dexamethasone: corticosteroid –> inhibits phospholipid A2

Oral Prednisolone

Low molecular weight heparin:
binds to antithrombin and activates it –> inactivates factor Xa (Has a short half life)
*COVID-19 –> hypercoagulability if increased D-dimer

Tocilizumab: Competitive inhibitor of IL-6 mediated signalling

Remdesivir: Nucleoside analogue, inhibits RNA-dep RNA polymerase

Warfarain: Vit K antagonist

Streptomycin: inhibits initiation of protein synthesis by binding to 16s rRNA)

WARfARIN AND STREPTOMYCIN CONTRAINDICATED IN PREGNANCY

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10
Q

What is Virchows triad

A

Underlying physiology that drives venous thrombus formation. Consists of three factors:

Decreased blood flow

Blood Vessel pathology (decreased heparan sulphate, X platelet adhesion)

Hypercoagulable state (pregnancy, thrombophilia, factor V leiden, Protein C)

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11
Q

Wells score

A

2 or more = DVT

>4 = PE, pitting oedema, calf tenderness and swelling >3cm, cancer, increased D-Dimer (fibrinolysis product)

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12
Q

What does stagnant blood flow inhibit

A

Inhibit NO and Prostacyclin release (Vasodilators)

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13
Q

What is the critical threshold for SpO2 in oxygen therapy

A

94% SpO2

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14
Q

What happens in changes to PaO2 below the critical threshold

A

Small change in PaO2 causes a large change in SpO2 –> acute desaturation of SpO2

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15
Q

What is CPAP

A

Constant level of Pressure Above atmospheric Pressure applied

Preferred over non-invasive respiratory support, delivers higher fractions of inhaled O2, prone positioning improves V/Q mismatch

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16
Q

What is SpO2, what is it measured by and what are the disadvantages

A

Oxygen saturation in the peripheral blood, measured by oximetry

Disadvantages:
Can’t tell ventilation
Can’t tell Hb saturation in terms of carboxyhaemoglobin

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17
Q

What is SaO2/PaO2

A

Oxygen saturation in the arterial blood, measured by ABG

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18
Q

Gestational diabetes pathophysiology

A

Pregnancy causes slight insulin resistance due to secretion of anti-insulin hormones –> human placental lactogen (HPL) –> increases free fatty acid levels, cortisol, glucagon

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19
Q

What is the glucose range in Gestational diabetes

A

Glucose range = >11mm/L

20
Q

What can Gestation diabetes cause in the baby

A

Macrosomia, due to higher diffused glucose via the placenta to the baby, produces excess insulin –> excess glucose stored as fat

21
Q

Gestational diabetes vs Pre-eclampsia

A

GD: late onset of hypertension after 20 weeks WITHOUT proteinurea

Pre-eclampsia: late onset of hypertension after 20 weeks WITH proteinurea

22
Q

Treatment for pre-eclampsia

A

Labetalol (beta blocker)

Methyldopa (alpha 2 receptor agonist) –> inhibits symp neurotransmitter release and causes vasodilation

23
Q

C-section

A

from 39th week when the pregnancy is high risk

Could be used in cases of breech position, HIV positive, pre-eclampsia and the labour not progressing

Side effects: infection, blood clots

24
Q

Regular blood loss in pregnancy

A

Vaginal delivery: 500ml

Caesarean delivery: 1000ml

25
Q

How much blood loss is excessive, causes and what is it classified as

A

> 2L is excessive –> post-partum haemorrhage

Uterine contractions not strong enough to provide sufficient compression to local blood vessels where the placenta was attached to the uterus

Causes include: 4T’s
Tone, Tissue, Trauma, Thrombosis

26
Q

Risk factors and Complications of PPH

A

Risk factors:
Placental praevia, multiple gestational pregnancy, pronged labour, infection, obesity

Complications:
Organ failure, shock, death

27
Q

Treatment for PPH

A

Ergotamine (increases contraction, give oxytocin analogues), uterine massage (balloon tamponade)

28
Q

Coagulability state during pregnancy

A

During pregnancy, hypercoagulable state –> to maintain placental function and prevent postpartum bleeding

  • increase in fibrinogen and all clotting factors (except XI and Tissue factor)
  • increased platelet production and yet decreased platelet count
  • increases risk of thrombosis and thromboembolism
29
Q

Post-partum changes

A

Oxytocin release from the hypothalamus via posterior pituitary gland

  • involved in mother-infant bond
  • uterus contraction (during ferguson reflex)
  • Stimulated via suckling (spinal reflex arc) results in milk ejection (brain to milk ducts) - contraction of the myoepithelial cells
  • prolactin - simulates milk production
30
Q

Baby blues symptoms

A

Lasts only a few days

Symptoms:

  • reduced concentration
  • appetite problems
  • sleep problems
31
Q

Post natal depression symptoms

A

Post-natal depression is a DSM-4 classification of mental illness
Interferes with ability to handle baby

Symptoms:

  • Severe mood swings
  • Insomnia

Physical changes:
After childbirth, dramatic drop in hormones (oestrogen and progesterone) –> may contribute to post-natal depression.
Other hormones in the thyroid may also drop sharply - feelings of tiredness, sluggish and depressed

32
Q

Depression pathways in the brain

A

In the amygdala and can have decreased cortical thickness

33
Q

Antidepressant drugs

A

Citalopram and flouxetine are SSRIs

  • increased selectivity for serotonin uptake
  • NO anticholinergic or cardiotoxic effects
  • SSRI discontinuation syndrome –> increase insomnia, anxiety and headaches (and HYPOnatremia)
34
Q

Cancer grading system

A

TNM system
T(1-4) = Size of cancer and nearby spread
M(0-1) = Metastasis (0 = no spread, 1 = spread to distant organs)
N(0-3) = Spread to lymph nodes (0=no lymph nodes, 3 = multiple lymph nodes)

Dukes classification - colon cancer staging (based on tumour resection and depth of invasion through mucosa and bowel wall; A-D)

35
Q

What does stage 2 breast cancer mean

A

Grown cancer but no spread or metastasis

36
Q

What is HER2+ (ErbB2)

A

Proto-oncogene: gene amplification mutation (somatic genetic)

Receptor tyrosine kinase family

37
Q

Immune targeted therapy in HER2+ cancer

A

Trastuzumab (herceptin):

  • Antibody dependent cellular cytoxicity
  • Humanized MoAb: used in HER2+ positive patients
    Binds to extracellular binding domain IV on HER2, prevents cleavage of HER2 extracellular domain receptor –> supresses ligand-dependent HER2 signalling leading to cell cycle arrest
  • Risk of cardiotoxicity (HER2) - congestive heart failure –> assess every 3 months
  • If recurrent HER2+ –> pertuzumab + trastuzumab & docetaxel

Pertuzumab:

  • Binds to domain II on HER2, and HER1,3,4 (inhibits HER2-3 dimerisation) –> surpress ligand dependent HER2 signalling

Second-line –> Trastuzumab - Emtansine (Ab drug conjugate):

  • binds to anti-microtubule agent - DMI (anti-mitotic inhibition tubulin polymerisation), enters cytoplasm and delivery of toxic payload
  • for HER2+ but inoperable breast cancer
38
Q

Chemotherapy and cancers + side effects

A

Adjuvant chemotherapy, reduce micrometastases

Side effects: Nausea and vomting, tiredness, hair loss, infection and infertility

39
Q

What cancers are chemo-resistant

A

Lung, pancreatic, melanoma and gastric

40
Q

What does the COVID-19 vaccination consist of and how does it work

A

Inactivated viral vector (ebola) - whole dead virus used (polio)

RNA-mRNA in lipid shell generates viral proteins consumed by APC, to T cell, activates adaptive immune system response

41
Q

What bones form the pelvic girdle

A

Ilium, ischium and pubis

42
Q

What test can diagnose sciatica

A

Straight leg raise diagnosis

43
Q

What is the faber test

A

Abduction and external rotation of the hip

44
Q

Symphysis pubis dysfunction (front)

A

Cartilaginous symphysis joint, due to increased relaxin (surpresses myometrial contractions) causing increased ligament laxity

45
Q

Sacroiliac joint (at the back)

A

Synovial diarthrodial/planar joint between ilium and sacrum

46
Q

What can hypocalcaemia show on an ECG

A

QT prolonged vent

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