Distal Ulnar Fracture

distal ulnar oblique fracture

Stages of Labor (USMLE)

Stages of Labor:

First stage of Labor: 0-10 cm dilation of cervix
                    1. Latent phase : 0-6cm dilation
                    2.Active phase : 6-10cm dilation

Active phase divided into : 
Protraction : < 2cm dilation in 2hrs (meaning if only 0-1cm cervical dilation in 2hrs, then its protraction) Tx = Oxytocin and Amniotomy
Arrest : No cervical change for greater than or equal to 4hrs with Adequate contraction Or Greater than or  equal to 6 hrs with inadequate contraction Tx = CS

Second Stage of Labor : 10cm dilation to delivery of the baby
                      Second stage arrest : No fetal descent (no change in station) in Nulliparous woman for > or equal 3hrs without epidural and > or equal to 4 hrs with epidural. Arrest in Multiparous is no fetal descent for > or equal to 2hrs without epidural and > or equal 3 hrs with epidural Tx = CS

Thrid Stage of Labor : Delivery of the baby to the delivery of the placenta

*Adequate contractions : 4 contraction in every 20-30 min or 8 contractions every hour. 200 or more Montevideo units is adequate.
*For Second stage of Labor just remember to add 1hr if they are on epidural*
                      

Intrapartum Fetal Heart Rate Monitoring (Usmle)

OBGYN: Intrapartum Fetal Heart Rate Monitoring (Usmle)

Mnemonic to remember : VEAL CHOP

Variable     Cord compression
Early          Head compression
Acceleration OK
Late         Placental Insufficiency

Early Deceleration: Head compression. Fetus deceleration is symmetrical to mother's contraction. Tx = No treatment

Late Deceleration : Placental insufficiency : Fetal deceleration is after the mother's contraction Tx= test fetal blood from scalp sample to diagnose hypoxia or acidosis.

Variable Deceleration : Cord compression. Fetal deceleration can be symmetric or after mother's contraction (Onset of fetal deceleration to the nadir should be < 30 sec.)
Tx = 1. Change the mother's position
     2. Amnioinfusion

Parkinson plus syndromes

There are number of  ''Parkinson plus'' Syndromes, which are characterized by their relative lack of response to therapy with levodopa/carbidopa

1.Parkinsonism + Vertical gaze palsy = Supranuclear palsy
2.Parkinsonism + prominent ataxia = olivopontocerebellar palsy
3. Parkinsonism + prominent orthostatic hypotension = Shy-Drager syndrome (now called multiple- system atrophy)

A useful mnemonic is to think of Mr. Parkinson as fine BRITish gentleman

Bradykinesia
Rigidity (cogwheel)
Instability (postural)
Tremor (resting)

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