What elevation of only alpha-fetoprotein alone may mean?
Break in a fetal skin → neural tube defect (e.g. spina bifida) or anencephaly
*further testing/imaging is needed to confirm spina bifida
What age of gestation do we perform:
b) chorionic villus sampling
a) amniocentesis →15 weeks and above
b) chorionic villus sampling → 11- 14 weeks
*both tests are diagnostic - they will give definitive answer if a condition is present
What's a 'low risk 'ovarian cyst and what to do?
- USS: unilateral, simple, <5 cm
- normal Ca 125
Conservative management, if an asymptomatic patient
Repeat scan in 3-4 months (as 50% ill resolve)
*high risk cysts -> opposite to above -> manage by surgical excision
Patient >60 y old and new iron-deficiency anaemia. What to do?
Urgent colorectal cancer pathway referral
Examples of live attenuated vaccines (7)
- oral polio
- yellow fever
- oral typhoid
- oral rotavirus
- intranasal influenza
These to be avoided if a patient is on immunosuppressive treatment / immunocompromised
What are adverse features of patients with tachycardia?
Following ABC assessment, patients are classified as stable/unstable according to the presence of aby adverse signs:
-shock: BP <90, pallor, sweating, confused/impaired consciousness, cold. clammy extremities
- heart failure
- myocardial ischaemia
If any of the above signs are present → give DC synchronised shock (synchronised cardioversion)
What levels of fasting glucose indicate impaired glucose regulation/pre-diabetes?
What's Lemmiere's syndrome?
- infective thrombophlebitis of the internal jugular vein
- caused by Fusobacterium necrophorum
- it is a complication of a throat infection when it spreads through the tissues in the neck to cause an infected blood clot
- this can cause sepsis as well as embolism to the lungs
Hypertension treatment - 4 steps
What's recommendation of Rx of DKA (dose)?
A fixed rate IV insulin infusion of 0.1 units/kg/hour
What symptoms can deficiency of each vitamin ADEK cause?
Vitamin A: poor night vision and general vision
Vitamin D: poor bone and muscle strength
Vitamin E: myopathies, neuropathies, ataxia
Vitamin K: easy bruising
1st line Rx for:
- generalised seizures
- focal seizures
Generalised: Sodium Valproate
Treatments (1st and 2nd line) for general tonic-clonic seizures
1st line: sodium valproate
2nd line: lamotrigine, carbamazepine
Drug treatment for absence seizures
Absence seizures* (Petit mal)
- sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy
What anti-convulsive (1) drug may exacerbate absence seizure and myoclonic seizures?
When in gestation can CTG be used?
From 32 weeks gestation
*measures foetal HR and uterine activity
What's normal range of foetal HR?
The labour triad of passages
- power → uterine contractions
- passage → birth canal
- passenger → the foetus
When is the pregnant uterus palpable?
From 12 weeks
Anatomical location of the pregnant uterus in:
- 20 - 22 weeks
- by 36 weeks
- 20 - 22 weeks → reaches the umbilicus
- by 36 weeks → lies under the ribs
What elements must be determined in obstetric palpation?
- number of foetuses
- lie (longitudinal, oblique or transverse)
- presentation (cephalic or breech)
- measure symphysis-fundal height (from 16 weeks, this will increase approx 1cm/week)
- auscultate the heart (Doppler USS from 12 weeks, Pinard stethoscope from 24 weeks)
If the SROM (spontaneous rupture of membranes) is suspected, do we do vaginal examination?
No, it is better to do speculum exam (to avoid the infection)
What's an absolute contraindication to the manual vaginal exam?
What's the most preferable position of baby's presentation at labour?
How do face and brow presentation (labour) look like?
brow is the least common presentation (1 in 2000) → it may delay 2nd stage of labour (head is required to rotate - otherwise its diameter is too large to pass through pelvis)
- face occurs 1 in 500 → it can delay engagement and progress; also it may lead to facial oedema
Risk factors for breech presentation
- bony pelvic abnormalities
- uterine abnormalities
- fetal prematurity (insufficient time to rotate)
- multiple pregnancies
- fetal abnormality
- extended legs
- placenta previa
External Cephalic Version (ECV)
- when can be performed
- contraindications to ECV
- performed at 37 weeks
- contraindications: previous CS, Hx of antepartum haemorrhage, multiple pregnancies, oligo/polyhydroamnios, placenta previa