9/6/22 Flashcards
1st + 2nd line Impetigo mx?
1st line = Hygiene advice + topical fulsilic acid
2nd line = Oral Flucloxacillin (Clarithromycin - if allergic)
What are the LT complications of minimal change disease and why?
Minimal change disease -> loss of protein in urine hence
Loss of anti-thrombin -> Increased risk of THROMBOSIS
Loss of Ig -> Increased risk of INFECTIONS
Loss of albumin -> Increased choleseterol synthesis (HYPERCHOLESTERAEMIA)
Presentation of:
- Chondromalacia patellae
- Osgood schlatter
- Osteochondritis dissecans
Chondromalacia patellae:
- Anterior knee pain often in active teens (F>), grating sensation / creptius + worse when using stairs
Osgood schlatter:
- Knee pain after exercise + swelling over tibial tuberosity (M>)
Osteochondritis dissecans:
- Cracks in articular cartilage + subchondral bone due to reduce blood flow -> activity related pain w/ locking and giving way sensation
NB: subluxation of patella can also present w/ sensation of giving way and general knee instability
Mx of Chondromalacia patellae?
Referral to physio - strengthen quadriceps
Main features of:
- Spina bifida occulta
- Meningomyelocele
- Meningocele
Spina bifida occulta
- NTD + some neuro signs +back lump
Meningomyelocele:
- WORST TYPE - spinal cord protrudes through unfused spinal column causing severe neuro issues
Meningocele:
- Herniation of meninges between vertebrae - no neuro symptomsas no neural tissue inside (just csf)
What is the gold standard ix for bronchiectasis? inhaled foreign body?
CT scan
Bronchoscopy
What is the normal dose of Levorgestrel (UPSI)? When should this be changed?
- 5mg
3. 0mg if woman is 70+ kg or BMI >26
What are the short and long-term side effects of ECT?
ST: Arrythmias, headaches, nausea, muscle ache
LT: Impaired memory
How do you manage the following EPSE symptoms:
- Dystonia
- Akathisia
- Parkinsonianism
- Tardive Dyskinesia
Dystonia:
- Procyclidine
Akathisia:
- Reduce dose, change drug or propanolol
Parkinsonianism:
- Reduce dose, change drug or procyclidine
Tardive Dyskinesia:
- Stop / change drug to atypical antipsychotic, reduce dose and Tetrabenazine in moderate or severe cases
Describe the following terms:
- Extracampine hallucination
- Elemental hallucination
- Pareidolic illusion
Extracampine hallucination = Hallucination that exceeds the normal sensory fields
Elemental hallucination = Simple hallucinations such as flashes of light or noises
Pareidolic illusion = Interpretation of meaningful images from a vague stimulus (eg face in fire)
What ix for menopause and in who?
Women <45y = Day 2-5 follicular-stimulating hormone, two measurements 4-6 weeks apart
Women >45y = clinical diagnosis (provided no suggestions of organic cause)
Mx of CIN?
CIN I = Observation + F/U smear test in 12m
CIN II / III = Large loop excision of the transformation zone (LLETZ)
Biopsy results in hirschsprungs (not just absence of ganglion cells)
Absence of ganglion cells, along with presence oflarge acetylcholinesterase-positive nerve trunks
What is the Ladd procedure used to treat?
Volvulus and Malrotation
What causes most cases of epiglottitis in the UK?
Group A B-haemolytic Strep - successful vaccination programmes have reduced incidence of HiB
Mx of epiglottitis?
A to E approach to secure the airway and prevent respiratory obstruction.
Once stable, blood cultures are taken from the child, and IV ceftriaxone is administered for 7-10 days
What is WAGR syndrome?
Rare genetic syndrome seen in 10% of Wilm’s tumour pts
Presents w/ Wilms tumour + aniridia (abnormal development of the iris of the eye) + genitourinary abnormalities + mental retardation
What is another name for croup?
Laryngo-tracheo-bronchitis
How is croup severity quantified?
Westley Croup Severity Score
Mx of Croup as per severity scale?
Mild (<3) = 1 dose of dex
Moderate (3-7) = 1 dose of dex + neb adrenaline
Severe (8-11) = Admit + 1 dose of dex PO/IV/IM + repeated neb adrenaline
Impending resp failure (>11) = ICU admission + 1 dose of dex PO/IV/IM + repeated doses of neb adrenaline + intubation
First step in mx of painful vaso-occulsive crisis in sickle cell pt?
The first step in the management of a crisis is analgesia; crises are extremely painful. In children less than 12 years of age, morphine should be avoided; other opiates are suitable.
Following administration of analgesia, hydration status should be restored. This is achieved by oral and intravenous fluids
What changes can be found in neuroleptic malignant syndrome on bloods?
Metabolic acidosis
Raisd CK, ?WCC, hepatic transaminases
Can also have AKI -> deranged U+Es
What is fornication (can occur secondary to cocaine use)?
Formication is a term used to describe the feeling of insects crawling across or underneath the skin (in ekbom’s they believe this is real)
This is a paraesthesia that may present in patients withdrawing from alcohol or using recreational drugs, such as cocaine
What is CJD and how does it generally present?
Creutzfeldt-Jakob disease is a rare, prion disease and patients present with dementia along with extensive neurological signs
82y dementia pt experiences N+V whilst using donepezil, what should you do?
In older pts + generally in pts at risk of confusion best to avoid polypharmacy -> switch donepezil to suitable medication
Memantine is a dementia drug that is a different class to donepezil hence would be suitable
Describe the dysplasia and presence of aytpia in the different stages of CIN?
CIN I:
Dysplasia: Mild
Atypia: Only in lower (deepest) 1/3 of epithelium
CIN II:
Dysplasia: Moderate
Atypia: Only in lower 2/3 of epithelium
CIN III:
Dysplasia: Severe
Atypia: Occupies full thickness of the epithelium (carcinoma in situ)
How can prolapses be categorised? + what organs do they affect
Prolapse of anterior vaginal wall: - Urethrocele (urethra) - Cystocoele (bladder) - Cystourethrocoele (urethra \+ bladder)
Prolapse of posterior vaginal wall (differentiated by DRE):
- Rectocoele (rectum) bulges on DRE
- Enterocoele (bowel)
