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11 Flashcards

1
Q

what is the vertex

A

area of foetal skull outlined by anterior and posterior fontanelles and parietal emninences

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2
Q

what is wider at pelvic outlet AP or transverse diameter

A

AP diameter

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3
Q

what is the POP-Q scale

A

with patient straining at 6 specific sites evaluated, at rest 3 sites, measured in relation to hymen as this is a fixed point
above hymen -ve if below hymen +ve

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4
Q

what is the classification of uterovaginal prolapse

A

1st degree= in vagina
2nd degree is at interoitus
3rd degree=outside vagina
procidentia=entirely outside vagina

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5
Q

what is an anterior prolapse called

A

cystolcele

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6
Q

what is a vaginal vault prolapse also known as

A

enterocele

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7
Q

what is a posterior prolapse

A

rectocele

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8
Q

where is wernickes area

A

superior temporal gyrus

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9
Q

where is brocas area

A

inferior temporal gyrus

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10
Q

where is conductive/associative area

A

arcuate fasciculus

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11
Q

what are the strongest contraindications to COCP

A 
migraine with aura 
>35 and smoking more than 15 cigarettes a day 
history of thromboembolic disease 
history of stroke/IHD
breastfeeding and <6 weeks postpartum 
uncontrolled hypertension 
current breast cancer 
majory surgery/period of immobility
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12
Q

what do granulosa cells produce

A

oestrogen

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13
Q

what are granulosa cells associated with

A

endometrial hyperplasia because they can produce oestrogen

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14
Q

describe the staging of ovarian cancer

A

stage1= confined to ovary
stage 2=outside ovary but within pelvis
stage3=outside pelvis but within abdomen
stage 4=distant metastasis

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15
Q

how do you treat DVT

A

LMWH for 5 days and warfarin for 3 months (if obvious provoking factor eg major surgery) if no provoking factor then 6 months

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16
Q

why do you need to give LMWH and warfarin for the first 5 days

A

as warfarin takes a while to work and is initially prothrombotic

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17
Q

what marker can be raised after seizures

A

prolactin

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18
Q

name causes of splenomegaly

A

myelofibrosis, CML, CLL, Hogkins, haemolytic anaemia, portal hypertension, infections eg glandular fever, hepatitis, infective endocarditis, thalassaemia

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19
Q

what shape is anthropoid pelvis

A

oval shaped with large AP diameter and smaller transvers

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20
Q

what is android pelvis

A

triangular heart shaped, narrower at the front

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21
Q

what are the risks of breech

A

placenta praevia, abnormal pelvic rim, oligohydramnios, low birth weight/prematurity, previous breech

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22
Q

what can myelofibrosis be caused by

A

hyperplasia or megakaryocytes that produce platelet derived growth factor leading to intense marrow fibrosis and myeloid metaplasia

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23
Q

what are hypermetabolic symptoms

A

weight loss, night sweats etc

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24
Q

what are the lab findings in myelofibrosis

A

anaemia, increase in wcc and platelets in early disease, tear drop poikolocytes on blood film, high urate and LDH

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25
Q

what is a common complication of PCP

A

pneumothorax

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26
Q

which types of shock cause cold peripheries

A

cardiogenic, hypovolaemic and obstructive

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27
Q

what happens in cardiogenic shock

A

decreased force of contraction leads to decrease in SV and hence CO and MAP
compensatory increase in SVP

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28
Q

what happens to SVR in obstructive, cardiogenic and hypovolaemic shock

A

it increases resulting in cool, clammy peripheries

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29
Q

what are the microcapillary changes in shock

A

capillary blood flow is reduced, intermittent or terminated

30
Q

von willebrand disease affects intrinsic or extrinsic pathway

A

intrinsic pathway APTT and bleeding time are increased

31
Q

von willebrand factor carries what factor

A

factor VIII (8)

32
Q

von willebrnad disease affects what pathway intrinsic or extrinsic

A

intrinsic pathway

33
Q

what is an uncal herniation

A

medial part of temporal lobe herniates inferior to tentorium cerebelli

34
Q

what nerve can get compressed by uncal herniation

A

oculomotor

35
Q

what does damage to oculomotor nerve by uncal herniation cause

A

ipsilateral fixed dilated blown pupil

36
Q

what is 99% predictive of bacterial meningitis

A 
WCC >2000
neutrophils >1180
protein >2200
glucose <34 
glucose CSF/serum <0.23
37
Q

activated protein C inhibits what cofactor

A

factor V

38
Q

activated protein S inhibits what cofactor

A

factor VIII

39
Q

what factors does heparin inhibit

A

2,9,10,11

40
Q

which factor is not affected in liver disease

A

8

41
Q

warfarin acts on what clotting factors

A

2,7,9,10

42
Q

what does factor V Leiden do

A

means activated factor V is inactivated x10 more slowly by protein C (so clots persist for longer)

43
Q

LMWH increases action of antithrombin III on what factor

A

Xa

44
Q

Tamm-Horsfall protein is produced where

A

in thick ascending loop of Henle

45
Q

when is a mild bradycardia more common

A

in occiptoposterior/transverse presentations and postdate gestation

46
Q

how long does bradycardia need to be sustained for

A

3 minutes

47
Q

what is normal variability

A

5-25 bpm

48
Q

what is reduced variability most commonly due to

A

foetal sleeping

49
Q

how is sickle cell disease treated

A

hyposplenism-reduce risk of infection with prophylactic penicillin vaccination, pneumococcus, meningococcus, haemophilus
folic acid supplementation
hydroxycarbamide can decrease severity by inducing HbF

50
Q

how are haemoglobinopathies inherited

A

autosomal recessive

51
Q

what does wertheims hysterectomy include

A

pelvic node clearance, hysterectomy, removal of parametrium and upper 1/3 of vagina

52
Q

what does pre-eclampsia increase risk of

A

IUGR, prematurity, haemorrhage-intra abdominal, intracerebral, placental abruption, cardiac failure, multiorgan failure

53
Q

when do you get cervical excitation

A

PID and ectopic pregnancy

54
Q

what bloods are included in a confusion screen

A

glucose, vit B12, folate and thyroid function

55
Q

in a well flexed foetus in OA position what is the diameter measured

A

sub-occipitobregmatic

56
Q

with face presentation what diameter is measured

A

submentobregmatic

57
Q

what is the bregma

A

anterior fontanelle

58
Q

presentation in less well flexed

A

occipito-frontal

59
Q

treatment of von willebrand

A

transexamic acid

desmopressin or factor VIII concentrate

60
Q

steps in formation of a platelet pluf

A

adhesion, aggregation and activation

61
Q

what happens in adhesion

A

platelets bind to subendothelial collagen via glycoprotein Ib and von willebrand factor

62
Q

what happens in aggregation

A

via GPIIb and IIIa and fibrinogen

63
Q

what happens in activation

A

platelets alter their shape to expose more phosopholipid on surface which provides increase surface area for coagulation activation and fibrin production to stabilise the clot

64
Q

how does aspirin work

A

inhibits cyclo-oxygenase which is necessary to produce thromboxane A2

65
Q

how does dipyridamole

A

phosphodiesterase inhibitor-reduces production of cAMP which is a second messenger in platelet activation

66
Q

what does dabigatran work on

A

IIa

67
Q

what does rivaroxaban work on

A

Xa

68
Q

where do thiazide diuretics act

A

distal convoluted tubule

69
Q

where do loop diuretic act

A

ascending loop of henle

70
Q

which substances can increase dopamine release

A

amphetamine, cocaine, nicotine, morphine

71
Q

what do fMRI studies shoe in non addicted patients when they win

A

increased flow to striatum

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