Maternal Hypoglycaemia is a sign of gestational diabetes, a condition associated with increased risk of still birth, macrosomi and post

natal hypoglycaemia in the infant. Placenta previa is a term that descirbes the placenta being implanted over the cervical os, it is a common cause of vaginal bleeding during pregnancy. Maternal hypertension and proteinuria indicate pre-eclampsia, pre-eclampsia can progress to eclampsia (seizures) or HELLP syndrome. Maternal megaloblastic anaemia can be caused be B12 deficiency or folate deficiency. Folate deficiency within the first trimester, is associated with fetal neural tube defects.

Rubella presents with mild fever and a discrete maculopapular rash that resolves in 3-5 days. Occipital and posterior cervical lymphadenopathy is characteristic, the characteristic rash with rubella is a maculopapular rash spreading from the head inferiorly to the trunk and then the extremities. Scarlet fever is a GAS(Beta haemolytic) infection, it presents with fever, sore throat and an erythematous maculopapular sand paper like rash. Roseola infantum is caused by herpes virus type 6, affects children 6-15 months old, and is the 6th common child exanthem. It manifests as high fever that lasts 35 days, and then resolves after appearance of a maculopapular rash that starts on the trunk and spreads peripherally. Hand-foot and mouth disease is caused by Coxsackie A virus, it presents with fever and ulcers on the tongue and oral mucosa as well as a maculopapular rash/and or vesicular rash with the palms and soles.

Hypoglycaemia initially manifests with pallor and sweaty skin, as the hypoglycaemia worsens, bizarre behavior, convulsions and unconsciousness can develop. If caught early, mild to moderate hypoglycaemia can be self treated with the consumption of 15-30mg of fast acting carbohydrates (e.g. glucose tablets, sweetened fruit juices, milk, soft drinks or hard candy). But when the hypoglycaemia becomes severe enough to induce unconsciousness parenteral treatment is required, In a non medical setting glucagon can be injected intramuscularly or subcutaneously by an informed relative or friend. Hypoglycaemia can be corrected by increasing hepatic glycogenolysis and gluconeogenesis, and will typically cause a return to consciousness 10-15 minutes after administration. This can be treated by IV dextrose in the medical setting.

The coronary sinus serves as the end point of venous drainage from the coronary blood supply. Since it contains deoxygenated blood it drains into the right atrium. The coronary sinus is usually not visible by echocardiography in most normal, healthy patients, The most common cause of coronary sinus dilatations evident on echocardiography is elevated right sided heart pressure secondary to pulmonary artery hypertension . Since the coronary sinus communicates freely with the right atrium, it will become dilated by any factor that causes dilatation of the right atrium. Coronary artery disease typically results in less coronary artery blood flow, meaning less blood in the coronary sinus and hence a smaller size, the only reason where coronary sinus dilatation would result from coronary artery disease is if myocardial ischaemia culminated in pulmonary artery hypertension and thus elevated right heart pressures. Complications of hyptertrophic cardiomyopathy often stem from left ventricular outflow obstruction. Coronary sinus dilatation should not occur unless there is superimposed heart failure. Longitudenal muscosal tears and the oesophagogastric squamocolumnar junction describe Mallory Weiss syndrome. These tears can be secondary to raised intraabdominal or intraluminal gastric pressures, as when happens during retching and vomiting, other factors include, coughing, repeated straining and abdominal trauma, also hiatus hernias are found in half the people with Mallory Weiss tears and are considered a strong predisposing factor. Mallory Weiss syndrome is very commonly associated with alcoholism. Trsansference is the unconscious shifting of emotions or desires assosciated with one person (e.g. sibling, parent spouse) to another (e.g. therapist, psychiatrus). Transference reactions often arise from childhood parent-child relationships Transference reaction occurs when the physician (or therapist) reminds the patient of the person associated with the original emotion. E.g. stop treating me as a child, my father used to treat me as a child and ive never been confident because of it, transference reactions can be positive where patient idolizes the doctor, or negative when the patient devalues the doctor. Acting out is an immature defense mechanism, where unconscious wishes or impulses are expressed through actions, temper tantrums are an example. Regression is an attempt to return to an earlier level of functioning to avoid conflict, for example; childlike patterns may emerge under