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1

Bishop Scoring

Rates the favourability of the cervix (10 is good). Based on dilatation, position in vagina, effacement

2

Partogram

Measures progress in labour.
-dilatation of cervix
-vital signs
-liquor colour
-Fetal heart rate

3

Cardiotocography

Measures FHR and uterine contactions (you expect variability and accelerations), FHR 110-160, no decelerations. Not useful antenatally unless daily in high risk

4

Fetal scalp samples

Amnioscope to get blood sample. pH below 7.2 needs delivery as acidotic and hypoxic

5

Amniocentesis

Fine gauge needle and US. (15 weeks) Chromosomal abnormalities, CMV and toxoplasmosis, Sickle cell, CF and Thallasaemia. 1% miscarry

6

Chorionic villus sampling

Biopsy of trophoblast. (11 weeks (quicker)) Higher miscarriage rates than amniocentesis. PCR and FISH for results.

7

Sperm sample boundaries of viability

5-15 million/mL=oligospermia
<32% motile= asthenospermia

8

Causes of male subfertility

Idiopathic
Drug exposure (alcohol, smoking, steroids)
Varicocele
Antisperm antibodies
Infections
Kleinfelters
CF
Kallmans
TURP

9

APGAR score

HR
RR
Muscle tone
Colour
Reflex
/10. At 1 and 5mins.
Resuscitation? Neuro outcome?

10

Assisted conception

Intrauterine insemination (IUI) if mild sperm problems.
Intracytoplasmic sperm injection (ICSI) if severe.

IVF
-mulitple follicular development
-ovulation and egg collection
-fertilisation and culture
-embryo transfer.
Multiple pregnancy and ovary overstimulation risks

11

Combined oral contraceptives

Exert negative feedback on gonadotrophin release, inhibiting ovulation. Thin endometrium and thicken cervical plug. Withdrawal bleeds if 1 week break, if not then spotting

12

Progesterone side effects

Depression
Bleeding
Amenorrhoea
Acne
Breast discomfort
Weight gain
Reduced libido

13

Oestrogen side effects

Nausea
Headaches
Increased mucus
Fluid retention and weight gain
Breast tenderness and fullness
Bleeding

14

Hormonal contraceptive negatives

Major complications (venous thrombosis, venous thromboembolism, migraine, stroke)
Minor side effects

15

Depoprovera

IM injection every 3 months, reduced bone density. Progesterone

16

Emergency contraception

IUD
Morning after pill

17

Barrier contraceptives

Male condom
Female condom
Diaphragms
Caps
Spermicides

18

What is the difference between IUDs and IUSs

IUD copper- toxic to sperm
IUS(system)- mirena (progestogen) hormonal.

19

General advantages and disadvantages

User dependence
Complications
Contraceptive
Protects from STIs

20

Other contraceptives

Male and female sterilisation

21

Pneumonia

Fever, tachypnoea, malaise, RDS.
CXR, O2 sats
Amoxicillin
Pneumococcus, mycoplasma, haemophilus, staphylococcus, TB, viral

22

Croup

Viral laryngotracheobronchitis
6 months to 6 years (2yo)
Upper airway obstruction (=stridor, barking cough, hoarse)
Pred

23

Epiglottitis

Caused by H. influenza B so went down cos of vaccine. Very acute, no preceding symptoms. Silent. Cant drink. Drooling. Soft stridor

24

Asthma

Inflammation, hyperresponsiveness, narrowing
Wheeze, cough, breathless, chest tight
Worse at night, triggers, symptoms between exacerbations
Peak flow diary, sleep? exercise?
Salbutamol (ipratropium bromide if young)
Salmeterol
Refer

25

Viral induced wheeze

Increased risk in preterm and maternal smoking, Small airways more likely to narrow and obstruct due to inflammation. Resolves by 5

26

Bronchiolitis

1-9 months
Poor feeding, apnoea, dry cough, laboured breathing
Respiratory syncytial virus
PCR analysis of nasal secretions
Supportive: humidified oxygen

27

Cystic fibrosis

CTFR chromosome 7
Meconium ileus, pancreatic enzyme deficiency, malabsorption, atypical pneumonia
Hyperinflation, nasal polyp, sinusitis, failure to thrive
Sweat test 60-125
MDT
Physio, Dornase Alpha, pancreatic enzymes, high calorie diet, ICSI

28

Otitis media

6-12 months
Eustachian tubes short, horizontal and dont work
Examine tympanic membrane in all fever infants (bright red, bulging)
RSV, rhinovirus, pneumococcus
Regular anaesthesia
(can lead to with effusion, glue ear)

29

Grommets

Tympanostomy tubes, for ottitis media with effusion. Adenoidectomy can be more effective

30

Glue ear

2-7 years old
Caused by recurrent ear infections
Decreased hearing
Ear drum dull and retracted with fluid level
Flat trace on tympanometry
Conductive hearing loss, speech and language problems.
Grommets and adenoidectomy