31/5 Flashcards
Management of inguinal and umblicial hernias in children?
INguinal = get them IN for surgery
UMbilicial = um that can wait (till should resolve at 4/5yo)
Alongside exercise for chronic limb ischaemia
Statin and clopidrogel
How regularly is breast ca screening?
Every 3 years from 50-70
What meds are used and when, when managing breast ca?
Oesterogen-receptor +ve
Pre-menopause
- tamoxifen (selective oestrogen receptor modulator)
Post-menopause
- aromatase inhibitors e.g. anastrZOLE/letroZOLE (enzyme found in fat that converts androgens to oestrogen - maj. done there post-menopause) - do increase the risk of oestoporosis
HER2 +ve - trastuzumab/herceptin (affects heart function)
Tammy = kids toy = pre-menopause
Z = end of alphabet = post-menopause mmm,
What causes post perianal abscess?
Gold standard of imaging?
E.coli
MRI
MEN cancers
MEN1
- pituitary
- pancreatic
- parathyroid
MEN2a
- phaemochromoctyoma
- parathyroid hyperplasia
MEN2b
- phaemochromocytoma
ALMOST ALL MEN2 get medullary thyroid ca (which is otherwise v rare)
DDx for neck swellings
V
I - v inflammed lymph node, local infection, thyroiditis
N - thyroid/larynx ca, lymphoma
D - lithium, amiodarone, iodine deficency
I - sebacocous cysts, benign adneoma
C - brachial cleft cyst, thyroglossal cysts
A - Graves, hashimotos
T -
E - hyperthyroidism
What is the best way to differentiate different types of thyroid swellings?
Thyroid isotop scan
V.high uptake = graves
Focal = toxic multinodular goitre
v. low = hashimotos/de quervians
NO = thyroiditis
What antibodies in Graves and Hashimotos?
Graves = TRAb
Hashimotos = anti-TPO
ATHLETICS for levothyroxine
A - increases thyroxine levels by acting as an artifical source
T - 30 mins before brekkie (food and coffee)
H - at least 4hrs later before Fe/Ca supplemements
L - lifelong
E - reduce hypo sx e.g. weight gain, constipation, dry skin, cold intolerance
T - 4-6wks post, then 3 months till stable then yearly
I -
C - DO NOT stop/reduce dose without doc
S - too much = hyper, too little = hypo
How can you tell what is a Grave’s goitre?
Not painful and smooth
Where is the ‘station’ of the baby measured from in labour?
Ischial spines
What is a tocolytic drug?
Give an example
A drug that stops contractions
Terbutaline and nifedpine
When do you need to give IM corticosteroids in labout?
<37wks - increase lung maturation
What is the aim for no. of contractions per 10min?
3-5
How long should 2nd stage of labour go on for (post full dilation till delivery) ?
What should happen after?
Nulliparous
>3hrs if epidural
>2hrs if not
Mulitparous
>2hrs if epidural
>1hr if not
Operative delivery help e.g. forceps
Pt has used movement, NO, paracetomol for pain relief and wants more - what can be offered before epidural/pudendal nerve block?
Opiate analgesia e.g. diamorphine
Epidural reserved for active labour and those who don’t like to stay active
Can HIV +ve mothers give birth vaginally?
No - must be C-section
How raised would CK be in rhamadomyolsis?
> 10000
What nerve is responsible for tongue movement>
Hypoglossal
How do you calculate serum osmolality?
2xNa + urea + glucose
2N U G
2nuggets floating about = 2NUG for osmolality
How is trigeminal neuralgia managed?
Carbameazepine
management of scleritis?
Immediate referral to opthamologist
What is zolpidem tartrate?
Non-benzo hypnotic and sedative assoc. with postural instability and falls
