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What blood changes would you expect in normal pregnancy?
- Reduction in serum iron concentration with an increase in iron binding capacity to accomodate for this
- A reduced plasma viscosity would also be expected
- As a consequence of the increased metabolism there may be a small increase in urea.Usually however,urea falls due to increase in GFR and haemodilution.
What do tocolytics do and are prophylactic tocolytics of proven value in multiple pregnacies?
Tocolytics are anti-contraction meds used to suppress prem labour. No proven value in twin pregs
c-myc protein-oncogene is associated with what cancers?
Where is the lesion/problem? "... weakness and wasting of the right tibialis anterior and calf, absent right ankle jerk and extensor plantar responses; nerve conduction studies showed normal motor conduction velocity and sensory responses from the right common peroneal nerve..."
Given normal conduction velocity and sensory responses in the common peroneal nerve, and the extensor plantar response, with muscle wasting an upper motor neurone lesion is suggested e.g. compression of the conus medullaris.
where is the lesion? " ... right leg weakness of subacute onset involving ankle dorsiflexion, eversion and inversion, with depression of the ipsilateral ankle jerk and sensory loss confined to the dorsum of the foot and the anterior aspect of the leg ..."
The area of sensory loss gives the site of the lesion, the most likely cause being herniation of the intervertebral disc between L4 and L5 and compression of the L5 nerve root.
where is the lesion? "... weak left leg evolving over a few weeks with tingling in the foot and, on direct questioning, urinary urgency; examination showed increased tone in both lower limbs and bilaterally extensor plantar responses; weakness restricted to left hip flexion and ankle dorsiflexion; pain sensation reduced in the right foot but joint position sense lost in the left foot ..."
The clinical findings suggest a spastic paraparesis of gradual evolution, the lesion lying in the spinal cord e.g. multiple sclerosis.
where is the lesion? "... severe pain in the lower back and left thigh and leg in a patient on anticoagulants; marked weakness of hip flexion and knee extension on the same side with impaired sensation on the anterior aspect of the thigh..."
This history suggests a haematoma in the lumbar region with pressure effect on the lumbosacral plexus.
Blood tests that are commonly abnormal in multiple myeloma? and radiological finding?
- Common test abnormalities are
- High erythrocyte sedimentation rate (ESR)
- High urate
- Renal impairment
- Low Hb
Punched out lesions are seen on skull x ray, the so called 'pepper-pot skull'.
Plasma cell neoplasm produces infiltration of bone marrow and osteolytic deposits. Proliferation of specific immunoglobulin or light chains are noted. Presentation is with bone pain and lassitude resulting from anaemia and renal complications, as well as signs of hyperviscosity. The peak age of the disease is 70 years.
Characteristics of Waldenstrom's macroglobulinaemia?
- Visual disturbance
- Retinal haemorrhage
- Gastrointestinal bleeding.
Features of cavernous sinus thrombosis?
- Sharp and severe headache
- Swelling of the eyes
- Eye pain that is often severe
diagnosis? A 35-year-old woman presents with purpura, fever, haemolytic anaemia, microvascular thrombosis, renal failure and mild stroke. Blood film shows fragmented red cells and clotting screen is normal.
- Thrombotic microangiopathies are characterized by microangiopathic haemolytic anaemia, thrombocytopenia, microvascular thrombosis and multiple organ dysfunction. TTP has a peak incidence between 30-40 years of age, whilst haemolytic uraemic syndrome (HUS) occurs mainly in young children after a viral or gastrointestinal infection. TTP may occur following cytotoxic drugs eg mitomycin or cyclosporin, be associated with SLE, pregnancy or oral contraceptive use. However, in most cases there is no known cause. Unlike DIC, clotting screen including fibrinogen level, fibrinogen degradation products and thrombin time is almost always normal in TTP/HU
what is the cause of this ladies anaemia? A 28-year-old caucasian female with a gluten sensitive enteopathy is noted to have a haemoglobin of 8g/dl and an MCV of 105fl.
Folate deficiency due to coeliac disease
what is the cause of this womens anaemia? A 20-year-old female of Congolese origin is noted to have yellow sclerae, target cells on blood film and a haemoglobin of 5.6g/dl with a MCV of 70fl.
The target cells indicate hyposplenism associated with haemolysis as evidenced by the low Hb and jaundice in a person from central africa - Sickle cell disease.
what drug, if taken in pregnacy is most likely to cause Oligohydramnios and renal tract malformation.?
Angiotensin-converting enzyme inhibitors (ACEis) are absolutely contraindicated in pregnancy being teratogenic in the first trimester with cardiac, renal and neurological abnormalities.It is also fetotoxic in the second and third trimesters.
What drug if taken in pregnancy is likely to cause defective ossification with mid-face hypoplasia, saddle nose and cardiac abnormalities.
Warfarin is teratogenic in the first trimester and is associated with defective ossification. Beyond the first trimester, it is occasionally used but is associated with an increased risk of fetal cerebral haemorrhage.
Features of Kallmans syndrome?
- Other clinical abnormalities observed include Retinitis pigmentosa, Colour blindness, Midline cranial and intracranial defects, Hypertension, Obesity, Cryptorchidism, Osteopenia, Mild neurosensory hearing loss, Gynaecomastia, Diabetes mellitus, Cleft lip or palate, Mental retardation.
- Most cases are autosomal dominant but recessive and X linked cases are known.
What can sulphonamides in neonates cause?
Sulphonamides may cause liver damage and therefore kernicterus in neonates.
Tetracycline is associated with what in the fetus?
Tetracycline is associated with bone and dental abnormalities in the fetus. Its use is therefore contraindicated in pregnancy. Ampicillin is safer in pregnancy
Where in the kidney is the macula densa sittuated?
The macula densa is a tissue that is found on the distal convoluted tubule, and sits at the hilum of the Bowman’s capsule. Its role is to monitor blood flow into the capsule, and hence involved in blood pressure control.
Where in the Kidney is the majority of glucose reabsorbed?
95% of glucose is reabsorbed in the proximal convoluted tubule. Glucose should be completely reabsorbed from the urine in the kidneys, and if not, usually demonstrates diabetes mellitus.
Where in the kidney does glomerular filtration occur?
The Bowmans capsule.
Where in the kidney does water leave via diffusion.
Water leaves the descending thin limb of the loop of Henle by diffusion. This is because of the high solute potential around the descending limb caused by active transport of sodium and chloride from the ascending limb.
What part of the kidney does aldosterone mainly act on?
The distal convoluted tubule
What are koplik spots and what are they associated with?
White punctate lesions on the buccal mucosa pathognomic with measles. Often faid as the generalised papular rash starts