Week 3 - Core clinical problems Flashcards
In a patient presenting with acute abdominal pain, what is the 1st line investigation?
US
What method of imaging is useful for finding mets?
CT
For what imaging techniques would you use for endometrial cancer (and why)?
TVUS - 1st line. Good for looking for thickened endometrium
CT - Good for looking for mets
MR - Assessing the myometrium invasion
If a patient presents with an unknown pelvic mass, what imaging technique should be used 1st line
US
When assessing fertility issues, what mode of imaging should be used
MR
MR should be used to image for Ovarian cancer - T/F
F
US used to diagnose & CT should be used to stage
What imaging method should be used for assessing response to cancer treatment?
CT
What imaging is used to find nuchal thickness?
US
What general tests can be used to screen for down’s syndrome?
Nuchal thickness
HCG (human chorionic gonadotropin)
AFP (alpha fetoprotein)
What specific diagnostic tests can be used for testing for down’s syndrome?
Amniocentesis
Chorionic villus sampling
What is the placenta made from?
Trophoblast and Decidual tissue
What is pre-eclampsia
Pregnancy induced hypertension & proteinuria
What causes pre-eclampsia?
Increased secretion of placental hormones
Immune response to fetus
Insufficient blood supply to placenta
What is eclampsia?
Extreme pre-eclampsia without treatment
What causes the uterus to contract and become excitable?
Oestrogen : Progesterone ratio altering
Oxytocin
Mechanical stretch of uterine
Stretch of cervix
Strong neurogenic contractions + Pain from birth canal cause what kind of reflex?
A neurogenic reflex from the spinal cord that induce abdo muscle contractions
What inhibits milk production
Oestrogen and Progesterone - there is a sudden drop once baby is born
Give the reason for asymmetrical intrauterine growth restriction
Normal head & small body.
Suggests the baby is preserving brain growth instead of abdomen
Major risk factors for a SGA baby
Smoker (10+) Maternal age 40+ Antiphospholipid syndrome Hypertension Renal problems Cocaine use BMI >35 Daily vigorous exercise
How to diagnose SGA
Measure fetal AC (abdominal circumference)
Combine with head circumference +/- femur length
How can you tell if a MCA doppler ultrasound is normal in a placenta?
Should have a forward flow
When is it indicated that you should deliver baby early (before 37 weeks) by C-section?
If growth becomes static
Abnormal umbilical artery doppler
Abnormal MCA doppler
Abnormal venosus ductus doppler
What is polydramnios?
Excess amniotic fluid
Investigations for polydramnios
Oral glucose tolerance test
Serology
Antibody screen
USS
Management for gestational diabetes in pregnant mother
Advise avoid getting pregnant if HbA1c = 86 mmol or more
Give 5mg folic acid 3 months before conception
What could be a cause of polydramios
Maternal diabetes
Fetal infection
If a mother has diabetes, what risks does this pose to the fetus?
Shoulder dystocia
Pre-eclampsia
Neonatal hypoglycaemia
Macrosomia (LGW)
What nerve fibre types are in the pelvis (body cavity) vs perineum (body wall)?
Pelvis = parasympathetic/sympathetic & visceral afferents Perineum = Somatic motor & Somatic sensory
In what region do you inject an epidural?
L3/L4 region
Where does spinal cord end and cauda equina begin?
L2 vertebra
What does the pudendal nerve supply?
structures of the perineum
what branches does the pudendal nerve form from?
S2-S4
What are the 3 male accessory glands?
Prostate gland
Bulbourethral gland
Seminal vesicle
Will female development occur in the presence of SRY transcription factor?
NO. SRY transcription factor needs to be absent
Leydig cells = males
____ cells - females?
Thecal
At what stage can you determine sex of baby?
Week 7
What is hypospadias?
External urethral opening lies in an abnormal position along the ventral aspect of the penis
