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Explain fetal circulation
The fetal circulation is designed such that oxygenated blood from the umbilical vein is directed via the ductus venosus to the inferior vena cava and via the foramen ovale to the left side of the heart and then to the head and neck of the fetus.The less well oxygenated blood from the superior vena cava enters the right ventricle and then enters the aorta via the ductus arteriosus distal to the left subclavian artery. The less well oxygenated blood is therefore diverted to the trunk and lower body of the fetus.
Causes of secondary ammenorrhoea?
- Pelvic TB
- Exercise, anorexia
- Anxiety, emotional distress
- Premature ovairan failure
NOT hypothyroid although this can cause menorrhagia
A raised neutrophil count ma be seen in?
- Acute infection
- Acute stress, trauma
- Myelocytic leukemia
- Rheumatoid arthritis, Rheumatic fever
A low neutrophil count may be seen in?
- Pernicious anaemia
- Is frequently due to drug therapy such as carbimazole (hyperthyroid) or cytotoxics.Aplastic anemia
- Influenza or other viral infection
- Widespread bacterial infection
- Radiation therapy or exposure
A 64-year-old park attendant is referred with a slow growing ulcerated lesion on the dorsum of his hand. On closer inspection it has a raised everted edge. What is it.
- An ulcerated lesion with an everted edge is typical of an SCC, a malignant skin lesion that typically arises on sun-exposed areas of the body. The lesions grow slowly and locally destroy tissue but may also metastasise to lymph nodes.
- Other predisposing factors include: radiation exposure; pre-malignant conditions (Bowen's, senile keratosis, lupus vulgaris, Paget's disease); inherited (xeroderma pigmentosum, albinism); chronic irritation (Marjolin's ulcer, leukoplakia, varicose veins, osteomyelitis sinus); infection (HPV 5 & 8).
A 23-year-old woman is seen with a 1 x 2 cm brown-purple lesion on the back of her calf. On closer inspection it is uniform in colour, has a smooth surface and edges and is slightly elevated from the surrounding skin. What is it?
A dermatofibroma is a benign skin lesion. No treatment is required but there is often patient anxiety over the presence of a pigmented lesion and many request their removal which can be done under local anaesthetic.
What condition is associated with midline defects including hypotelorism (eyes close together), cleft palate, microphthalmia (small eye) and cyclopia
Patau syndrome (trisomy 13)
What condition is associated with Acrocephaly and syndactyly.
Apert's syndrome is one of the craniosynostoses (premature fusion of the cranial sutures). It is characterised by syndactyly of fingers and toes.
What is c-myc? and what carcinomas has it been associated with?
C-myc, a proto-oncogene, is involved in the regulation of cell proliferation and DNA synthesis. It has been implicated in the development of carcinoma of the breast, colon, cervix, lung and stomach.
What is Peutz-Jeghers syndrome?
- An autosomal dominant condition.
- The circumoral pigmented lesions are a characteristic feature of this condition.
- Small intestinal polyps are hamartomas and not adenomas. Recent data suggest that Peutz-Jeghers syndrome is a premalignant condition but the risk is low
- It can present as anaemia in childhood. The anaemia is a hypochromic microcytic anaemia resulting from iron deficiency.
What things increase your risk of getting gallstones?
- Cholelithiasis is associated with any process that would increase bile production or produce sludging. Increased risk is associated with
- Oral contraceptive therapy
- Octreotide therapy (somatostatin)
Statins inhibit cholesterol synthesis by inhibiting 3HMG-CoA and do not predispose to biliary stasis.
Hyperparathyroidism predisposes to renal calculi.
What drugs can be used for hypertension in pregnancy?
- Drugs useful in hypetension in pregnancy include:
- Nifedipine (calcium channel blocker)
Drugs that cannot be used to treat hypertension in pregnancy?
- Drugs to be avoided in pregnancy include:
- ACE inhibitors (enalipril) and angiotensin receptor antagonists
- Sodium nitroprusside.
Spontaneous pre-term delivery is associated with?
- Placenta Previa
- STI (ie bacterial vaginosis but NOT HIV)
What congenital heart defect is associated with Turners syndrome?
Coarctation occurs in 10% of patients with Turner's syndrome and 15% of patients with this condition have a bicuspid aortic valve.
What anticonvulsant is associated with hyperammoniaemia?
Sodium valproate has many side effects including gastric irritation and nausea as well ashyperammonaemia (interferes with the urea cycle, reducing carnitine concentrations and has been associated with hyperammonaenic encephalopathy), decreased appetite and weight gain in 6% of cases and transient hair loss.
What anti-convulsant is associated with visual field defects?
- Vigabatrin is used for treatment of partial epilepsy with or without secondary generalisation usually in combination with other antiepileptic drugs although it can be used as monotherapy in the management of infantile spasms. Side effects include drowsiness and confusion and visual field defects, increased appetite in 10% of cases and weight gain in 12% of cases.
Describe sebaceous cyst?
- Closed sac under the skin containing chees-like oily material. Often arise from hair follicles, found on face, hair, neck and trunk.
- They have a central punctum, dermal topography (arise form dermis), fluctuance with the dermis (tethered to the skin) and contents of sebaceous material.
What is a neavus flammeus? and when does it normally present.
- Port-wine stain/ capillary malformation
- usually present at birth but may not present until later in life
- Treatment is by laser or tattooing at a much later date as the lesions may regress spontaneously. The majority occur in the regions supplied by the fifth cranial nerve
possible drug treatment for infuenza A?
Drug used to treat pseudomonas auruginosa?
- Ciprofloxacin is a quinolone antibiotic most active against gram negative organisms such as pseudomonas aeruginosa.
Drug suitable for tx of legionella pneumophilia?
- Clarithromycin is a macrolide antibiotic active against atypical organisms in community acquired pneumonia such as Legionella pneumophila.
Drug treatment for Candida albicans?
nystatin or amphotericin (antifungals)
Drug tx for MRSA?