Hypothyroidism and dyslipidmeia
In hypothyroidsim there is a decrease in lipoprotein lipase activity which leads to hypertriglyceridemia. Similarly, a decrease in hepatic low density lipoproteins (LDL) receptors cause elevated LDL levels.
CPK elevation in hypothyroidism
Creatine phosphokinase (CPK) levels can be elevated in hypothyroidism. Often there is assocated generalised aches and pains, localised rhabdomyolysis, proximal myopathy and Hoffman syndrome – a pseudo muscle hypertrophy with weakness, usually affecting the calf. Statins can aggravate the rhabdomyolysis in hypothyroidism leading to generalised rhabdomyolysis which may lead on to renal failure.
Large pituitary in hypothyroidism
Large pituitary or …

Sibai regimen is an intravenous magnesium sulphate regimen for treatment of eclampsia
It was introduced by Sibai et al in 1990
Loading dose – 6g IV given over 20 minutes
Maintenance dose – 2-3g IV every hour

Maternal and fetal outcome after treatment with Sibai regimen:

In a study published by Sibai et al in 1990, treatment of eclampsia with Sibai regimen had a maternal mortality of 0.5% and a perinatal mortality of 5%.

Zuspan regimen is a treatment regimen using Magnesium sulphate for the treatment of eclampsia
Magnesium sulphate 4g is given as IV bolus dose in the beginning
This is followed by intravenous infusion of Magnesium sulphate at the rate of 1g/hour till 24 hours have elapsed after the last seizure
Other regimens using MgSO4 for treatment of eclampsia are

Pritchard’s regmimen
Sibai regimen

HELLP stands for:

Hemolysis, Elevated Liver enzymes, and Low Platelets

The hour following delivery of placenta  is termed Fourth stage of labour
Monitoring of the patient’s Blood pressure and pulse rate during this stage is important
The episiotomy site should be checked for bleeding or development of any hematoma
Check whether the bladder is distended, if so encourage patient to pass urine
If the patient is stable after one hour and has passed urine, she can be transferred to the post natal ward

Oxytocin is a polypeptide hormone synthesised by the supraoptic and paraventricular nuclei of hypothalamus
It is secreted by the posterior pituitary into the blood stream

Actions of oxytocin

Main action is on uterine myometrium

It promotes uterine muscle contraction
The action is greater on pregnant uterus as it has increased number of oxytocin receptors

Contraction of myoepithelial cells in breast cause expression of breast milk
Smooth muscle relaxation and vasodilation
ADH (Anti Diuretic Hormone) like effect in large doses, causes water intoxication

Mechanism of action on uterine myometrium:

It acts by releasing cAMP
This in turn results in the release of …

Blount’s disease is a growth disorder of the tibia characterised by bowing of legs
Also called pathologic tibia vara, non rachitic bowlegs, Blount Barber disease
Clinical features

Presents with progressive bowing of legs in a child
There is varus angulation and internal rotation of tibia
Usually seen in children if African origin
Associated with obesity, early walking and short stature

Clinical types

Infantile – early onset (<3 years of age)
Juvenile – 4-10 years
Adolescent – >11 years

Pathology

There is disordered bone ossification in the medial part of proximal tibial epiphysis, physis and metaphysis
Presumed to be caused by excessive compressional forces on the …

KAFO stands for :

Knee Ankle Foot Orthosis (used in orthopedics)

Partogram is a graphical representation of the progress of labour depicting cervical dilatation and station of head plotted against time
The concept of partogram was first introduced by Friedman

Data recorded in a partogram are:

Patient data – Name, Age, Parity, Hospital identification number, Date of admission, Time of admission
Dilatation of cervix
Station of fetal head
Fetal heart rate
Number of uterine contractions in 10 minutes
Moulding (+ / ++ )
Liquor amni

Intact membranes – I
Clear liquor – C
Meconium staining – M

Oxytocin units, drops/min
Drugs
Oral and IV fluids
Blood pressure, pulse, temperature
Urine for acetone

How to use a partogram in active management …

Waldeyer’s lymphatic ring is a collection of lymphoid tissue present in the neck (Waldeyer’s outer ring) and pharynx (Waldeyer’s inner ring /  Waldeyer’s tonsillar ring)
It plays an important role in protection against pathogens
It was named after the nineteenth century German anatomist Heinrich Wilhelm Gottfried von Waldeyer-Hartz.

Waldeyer’s inner ring

It is located in the nasopharynx and oropharynx
The components are:

Adenoids (nasopharyngeal tonsil)
Tubal tonsil
Palatine tonsil
Lingual tonsil

It helps protect the body against inhaled and ingested pathogens

Waldeyer’s outer ring

It is composed of various lymph nodes in the neck – mostly cervical lymph nodes
The component lymph nodes are:

Occipital
Post …