5/6 Flashcards
Ignore what you learnt before - what do you do with pregnant women with chickenpox
> 20 weeks give aciclovir if unsure of chickenpox status/ no previous exposure regardless of symptoms
How do you manage cord prolapse?
Conservative
Push THE PRESENTING PART (BABY) back inside mum - so it doesnt compress the umblicial cord
DO NOT TOUCH THE UMBILICAL CORD
Insert a urinary catheter and fill bladder with saline
Go on all 4s
Medical
Tocolytics e.g. nifedpine, terbutaline
Surgical
Immediate C-section
What kind of contraception can women not have if they are on epilpesy meds?
COCOP and POP
POP can be taken if they are on lamotrogine
If clopidogrel is not tolerated what med should be used instead long-term post stroke?
Just aspirin 75mg
What is a further organic cause of almost all psych presentations?
Neurosyphilis
Explain syphilis testing
How is each stage managed?
Non-treponemal tests - +ve if active
Treponemal - +ve if active/past infection
If early latent or before = IM benzylpenicillin
If late latent or after = IM benzylpenicillin weekly for 3 weeks
Contact tracing for chlamydia, gonorrohoea, trichomonias vaginalis and syphilis
Gonorrohea
2wks back from symptoms for symptomatic men
3mnths for women and asymptomatic men
Chlyamdia (double above)
4wks back from symptoms for sympomatic men
6mnths for women and asymptomatic men
Trichomnias
- current sexual partners
Syphilis
- primary = 3mnth
- secondary + = 2 years
How long post-exposure can you take PrEP?
What is used to test for HIV?
CD4 level below what is dangerous?
What medication is given alongside ART?
72hrs
p24 and HIV Ig
<200
Prophylatic co-trimaxazole for pneumocystis jirovecii pneumonia
Why does a pt need a tetanus jag if exposed to dirty/punctuating wound?
full course = 5 vaccines
full course w/ last dose <10yrs ago = no vaccine or tetanus Ig
full course w/ last dose >10yrs ago = booster (if high risk e.g. heavy contamination, extensive deviatlised tissue, surgical intervention) = booster + Ig
vaccine hx unknown/incomplete = booster regardless of severity
if prone/high risk = booster + Ig
Match each of the following presentations to their genetic cause:
1. single palmar crease, upward sloping palpebral fissures, brachycephaly
2. Tall height, wide hips, small testicles, reduced libido, appear as male until puberty
3. Short stature, webbed neck and widely spaced nipples
4. Constant insatiable hunger, hypotonia
- Downs syndrome - trisomy 21
- Klinefelter syndrome 47 XXY
- Turner’s syndrome 45 XO
- Prader-Willi syndrome
What testing would indicate down’s?
USS - increased nuchal translucency
b-HCG - high
PAPPA - low
Treatment for Prader-Willi syndrome?
Conservative
- keeping food locked away and dietican help
Medical
- Growth hormone
Management for DKA
IV fluids
IV fixed rate insulin 0.1unit/kg/hr
Monitor K+
LWMH - thromboembolism risk
Management of thyroid storm
HIPP - busted out ur HIPP during the storm
Hydrocortisone IV (reduces inflam of thyroid)
Iodine (4hrs post PTU)
Propylthiouracil (blocks conversion)
Propranolol IV (symptom control - give digoxin if asthmatic/low BP)
What differentiates DKA from HHS?
How do you manage HHS?
No ketones and no acidosis
Glucose >/= 30mmol/L
IV fluids
If thats not enough 0.05units/kg/hr fixed rate insulin
LWMH
What are the different ways you will bring a patients glucose levels back up with a hypo
Concious with swallow = 15-30grams of short-acting glucose e.g. 150ml of OJ followed by long acting e.g. toast or biscuit
Concious with no swallow = 1.5-2 tubes of glucose gel
Unconcious = IV 200ml of 10% glucose OR 1mg/kg glucagon IM
4Hs and 4Ts of MI
Treatment of ACS
How does this differ for STEMI vs NSTEMI?
Hs
- Hypothermia
- Hypo/hyper electrolytes
- Hypovolemia
- Hypoxia
Ts
- tension pneumothorax
- tamponade
- toxins
- thrombus
MMONA+T
Morphine (if in extreme pain)
Metroclopramide
Oxygen (sats <94%)
Nitrates (GTN spray unless hypotensive)
Aspirin 300mg
Ticagrelor
STEMI
<2hrs to PCI
- no a/c previous - aspirin + prasgurel
- a/c previous - aspirin + clopidogrel
>2hrs - fibrinolysis
NSTEMI
- fondapurinaux if no signifcant bleeding risk
- if immediate angioplasty to take place LWMH
What bug causing pneumonia is associated with erythema multiforme?
Mycoplasma
OSHITMAN is same for acute flare of COPD.
What is different in terms of ventilation and O2 delivery?
CPAP - if type 1
BiPAP - if type 2
24% O2 (BLUE) venturi mask 88-92%
How can you tell if pt has had a true episode of anaphlyaxis?
Tryptase levels
Pneumonia with lymphopenia, hyponatraemia & deranged LFTs?
Legionella
Describe the differences in lithium tremors
Fine tremor with chronic use
Coarse tremor in acute toxicity
What are the contraindications to the following airways
- oropharygeal
- nasopharnygeal
What airway support should be used if significant trauma has happened affecting potentially spine?
Oropharngeal = concious - can cause gagging and aspiration in semi-concious pts
Nasopharngeal = potential base of skull factures as small but v dangerous risk of perforation
Jaw thrusts
What should be done in addition to OSHITMAN for acute asthma?
How is response monitored?
SIT UP
Multiple peak flow measurement
What should you do if pt not responsive to first dose of adrenaline?
How much and what dose again?
0.5mg of 1:1000 IM in anterolateral aspect of middle thigh
6-12 years old = 0.3mg
<6years old = 0.15mg
Repeat after 5 minutes -> still no response -> HELP -> IV adrenaline from consultant
How would you manage each of the following electrolyte imbalances:
- Hyperkalaemia
- Hypokalaemia
- Hypercalcemia
- Hyponatremia
- IV insulin and dextrose
Calcium gluconate to protect the heart
Calcium resonium (to prevent reabsorption - move long term) - IV K+
Check Mg+ - K+ cannot rise without it and telemtery - IV FLUIDS
Biphosphates too - 1.8% saline but be careful - low to high - pons might die (central pontine demylineation)
What ECG finding can be seen in HYPERcaleamia?
Short QT interval
How would you describe asthma to a pt?
Chronic inflammatory response of the windpipe
Stays tightened and can struggle to get air in
Blue inhaler helps to open up the airways in the short term
Steroid inhaler helps to reduce the inflammation overall
We call it a reversible obstructive inflammation
