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PBL Seen scenario 2 (integrated) Flashcards

(46 cards)

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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

Study These Flashcards
A

Glucose range = >11mm/L

20
Q

What can Gestation diabetes cause in the baby

Study These Flashcards
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

Study These Flashcards
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

Study These Flashcards
A

Labetalol (beta blocker)

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

23
Q

C-section

Study These Flashcards
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

Study These Flashcards
A

Vaginal delivery: 500ml

Caesarean delivery: 1000ml

25
How much blood loss is excessive, causes and what is it classified as
>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
Risk factors and Complications of PPH
Risk factors: Placental praevia, multiple gestational pregnancy, pronged labour, infection, obesity Complications: Organ failure, shock, death
27
Treatment for PPH
Ergotamine (increases contraction, give oxytocin analogues), uterine massage (balloon tamponade)
28
Coagulability state during pregnancy
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
Post-partum changes
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
Baby blues symptoms
Lasts only a few days Symptoms: - reduced concentration - appetite problems - sleep problems
31
Post natal depression symptoms
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
Depression pathways in the brain
In the amygdala and can have decreased cortical thickness
33
Antidepressant drugs
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
Cancer grading system
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
What does stage 2 breast cancer mean
Grown cancer but no spread or metastasis
36
What is HER2+ (ErbB2)
Proto-oncogene: gene amplification mutation (somatic genetic) Receptor tyrosine kinase family
37
Immune targeted therapy in HER2+ cancer
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
Chemotherapy and cancers + side effects
Adjuvant chemotherapy, reduce micrometastases Side effects: Nausea and vomting, tiredness, hair loss, infection and infertility
39
What cancers are chemo-resistant
Lung, pancreatic, melanoma and gastric
40
What does the COVID-19 vaccination consist of and how does it work
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
What bones form the pelvic girdle
Ilium, ischium and pubis
42
What test can diagnose sciatica
Straight leg raise diagnosis
43
What is the faber test
Abduction and external rotation of the hip
44
Symphysis pubis dysfunction (front)
Cartilaginous symphysis joint, due to increased relaxin (surpresses myometrial contractions) causing increased ligament laxity
45
Sacroiliac joint (at the back)
Synovial diarthrodial/planar joint between ilium and sacrum
46
What can hypocalcaemia show on an ECG
QT prolonged vent

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