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Additional Flashcards

1
Q

What is Molluscum Contagiosum?

What is it caused by?

How does it appear?

A

Viral condition caused by the Molluscum Contagiosum Virus (MCV) a member of the poxviridae family

Causes pink pearly white papules with a Central umbilication

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2
Q

When should you refer if you suspect Molluscum Contagiosum?

A
  • Patients with HIV and extensive disease
  • Patients with eye lid molluscs refer to Ophthalmology
  • Anogenital lesions
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3
Q

What is the Management of Molluscum Contagiosum?

A

Clinical Diagnosis

Non-pharmacological

  • reassurance its a self limiting condition
  • Precautions to prevent spread (not sharing towels)
  • Not to scratch

Pharmacological is rarely required

  • Imiquimod cream
  • Podophyllotoxin
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4
Q

What is vulvovaginitis?
Who does it affect?

A

Inflammation and irritation of the vulva and vagina
Typically affects young girls (3-10 years)

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5
Q

What can exacerbate Vulvovaginitis?

A

Wet nappies
Use of chemicals or soaps in cleaning the area
Tight clothing that traps moisture or sweat in the area
Poor toilet hygiene
Constipation
Threadworms
Pressure on the area, for example horse riding
Heavily chlorinated pools

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6
Q

How does Vulvovaginitis present?

A

Typically presents before Puberty

Soreness
Itching
Erythema around the labia
Vaginal discharge
Dysuria (burning or stinging on urination)
Constipation

A urine dipstick may show leukocytes but no nitrites. This will often result in misdiagnosis as a urinary tract infection.

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7
Q

What is the management of Vulvovaginitis?

A

Patients have typically been treated for UTI/Thrush without improvement of Sx

General Advice:

Avoid washing with soap and chemicals
Avoid perfumed or antiseptic products
Good toilet hygiene, wipe from front to back
Keeping the area dry
Emollients, such as sudacrem can sooth the area
Loose cotton clothing
Treating constipation and worms where applicable
Avoiding activities that exacerbate the problem

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8
Q

What Helminth causes threadworms?

A

Enterobius vermicularis

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9
Q

How does threadworms present?

A

infestation is asymptomatic in around 90% of cases, possible features include:

  • perianal itching, particularly at night
  • girls may have vulval symptoms
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10
Q

How are threadworms diagnosed?

A

Apply Sellotape to the perianal area in the morning
This is sent to a lab for microscopy of eggs.

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11
Q

How is threadworms treated?

A
  • combination of anthelmintic with hygiene measures for all members of the household
  • mebendazole is used first-line for children > 6 months old. A single dose is given unless infestation persists
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12
Q

What are Head lice?

A

Pediculus humanus capitis are a parasitic infection of the scalp most commonly in school aged children.

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13
Q

What is the presentation of Head lice?

A

Infestation causes an itchy scalp. Often the nits (eggs) and even lice themselves are visible when examining the scalp.

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14
Q

What is the management of Head lice?

A

Treatment only indicated if a Live lice is identified

  • Wet combing is first line
  • Insecticides such as Dimeticone 4% and Malathion 0.5% can also be tried.

All Affected members of the household should be treated on the same day

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15
Q

What is Labyrinthitis?

A

Inflammation of the bony labyrinth of the inner ear, including the semicircular canals, vestibule (middle section) and cochlea.

The inflammation is usually attributed to a viral upper respiratory tract infection

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16
Q

How does Labyrinthitis present?

A

Labyrinthitis presents with acute onset vertigo, similarly to vestibular neuronitis.

Unlike vestibular neuronitis, labyrinthitis can also be associated with:

  • Hearing loss
  • Tinnitus

Patients may have symptoms associated with the causative virus, such as a cough, sore throat and blocked nose.

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17
Q

How is Labyrinthitis Diagnosed?

A

Clinical diagnosis

The head impulse test can be used to identify peripheral causes of vertigo

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18
Q

What is the management of Labyrinthitis?

A

Supportive care and short-term use (up to 3 days) of medication

  • Prochlorperazine
  • Antihistamines (e.g., cyclizine, cinnarizine and promethazine)
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19
Q

What is Vestibular Neuronitis?

What is the pathophysiology?

A

Vestibular neuronitis describes inflammation of the vestibular nerve. This is usually attributed to a viral infection.

Vestibular nerve is the portion of the CN VIII responsible for balance Therefore vestibular neuronitis does not involve the cochlear nerve (responsible for hearing) meaning that vestibular neuronitis does not cause hearing problems

20
Q

What are the clinical features of Vestibular Neuronitis?

A

History of recent viral URTI

  • Acute onset vertigo
  • Horizontal Nystagmus
  • Associated with nausea and vomiting

Vertigo attacks are more severe at the start lasting days but then start to resolve
They may be worsened by head movements

21
Q

What test can be used to identify peripheral causes of vertigo such as labyrinthitis and vestibular neuronitis?

How is it performed?

What are the results of normal
What results suggest vestibular system issue (peripheral vertigo)
What are the results if there was a central cause of vertigo?

A

The Head Impulse Test

  • Patient stares at examiners nose
  • Examiner twists head in one direct rapidly whilst patient remains fixated on the nose

Normal would be if their eyes remained fixed on examiners nose

Peripheral cause of vertigo the eyes will saccade (Rapidly move back and forth) before fixing on the examiners nose again

Central cause of vertigo would have a normal head impulse test

22
Q

What is the management of Vestibular Neuronitis?

A

Self limiting condition and will resolve in weeks

  • Prochlorperazine/Antihistamines can be used in severe attacks
  • Referral If Sx do not improve after 1 week or improve after 6 weeks
  • Patients may require admission if Severe nausea and vomiting/dehydration
23
Q

What is the prognosis of Vestibular Neuronitis?

What may occur following the condition?

A

Symptoms are more severe for the first few days
They gradually resolve over 2-6 weeks

Patients may develop BBPV following vestibular neuronitis

24
Q

What test is done to distinguish between peripheral and central causes of vertigo?

A

HINTS examination

  • Head Impulse Test
  • Nystagmus
  • Test of Skew (Cover test)
25
Q

What is the DVLA guidance for vertigo symptoms?

A

Patients must not drive and inform the DVLA if they get: Sudden and unprovoked episodes of disabling dizziness

26
Q

What is multimorbidity?

A

Presence of 2 or more long term health conditions

27
Q

What are the risk factors for Multimorbidity?

A
  • Increasing age
  • Female sex
  • Low socioeconomic status
  • Tobacco and alcohol usage
  • Lack of physical activity
  • Poor nutrition and obesity
28
Q

How should Frailty be assessed?

A

Through Gait speed, Self reported health status or the PRISMA-7 Questionnaire

29
Q

What is Caput Succedaneum

A

Collection of fluid between the periosteum and the scalp.

This fluid can accumulate following instrumental deliveries and Crosses suture lines

Typically it resolves within a few days

30
Q

What is Cephalohaematoma?

A

Collection of blood between the skull and periosteum due to damaged blood vessels during prolonged instrumental delivery.

Blood does not cross suture lines as it is located below the periosteum.

This blood can also haemolyse leading to increased bilirubin and prolonged jaundice

31
Q

What is Apnoea of Prematurity?

A

Apnoea is defined as periods where breathing stops spontaneously for more than 20 seconds, or shorter periods with oxygen desaturation or bradycardia.

These are very common in premature neonates

32
Q

What are apnoeas caused by in neonates?

A

Apnoea occur due to immaturity of the autonomic nervous system that controls respiration and heart rate. This system is more immature in premature neonates.

Other conditions

  • Infection
  • Anaemia
  • Airway obstruction (may be positional)
  • CNS pathology, such as seizures or haemorrhage
  • Gastro-oesophageal reflux
  • Neonatal abstinence syndrome
33
Q

What is the management for apnoea of prematurity?

A

Apnoea monitors in neonatal units

  • Tactile stimulation (vigorous rubbing stimulates breathing)
  • IV Caffeine can be used to prevent apnoea and bradycardia in recurrent episodes
34
Q

What is retinopathy of prematurity?

A

Typically affects babies born before 32 weeks gestation.

Abnormal development of the blood vessels in the retina can lead to scarring, retinal detachment and blindness.

35
Q

What is the pathophysiology of retinopathy of prematurity?

A
  • Retinal blood vessels begin developing at 16 weeks and complete by 37-40 weeks
  • This process is Driven by hypoxia
  • Premature babies often require supplemental oxygen
  • When the retina is exposed to high oxygen concentrations the Stimulation for new blood vessel development is lost
  • When the hypoxic environment re-occurs there is excessive neovascularisation which leads to scarring and retinal detachment
36
Q

How is Retinopathy of prematurity screened for?

A

Babies born before 32 weeks or under 1.5kg are screened by an ophthalmologist at

  • 30 – 31 weeks gestational age in babies born before 27 weeks
  • 4 – 5 weeks of age in babies born after 27 weeks

Screening occurs every 2 weeks until the retinal develops normally

37
Q

What is the treatment for retinopathy of prematurity?

A

First line is transpupillary laser photocoagulation to halt and reverse neovascularisation.

Other options are cryotherapy and injections of intravitreal VEGF inhibitors. Surgery may be required if retinal detachment occurs.

38
Q

What is the most accurate way to measure the gestation of a fetus?

A

Crown rump length

39
Q

what are the main causes of preterm birth?

A

Uterine Infection

  • ascending from vagina
  • Transplacental (haematogenous)
  • Retrograde seeding from peritoneal cavity
  • iatrogenic

Uterine Ischaemia

  • same process as pre-eclampsia

Overstretching of the uterus

  • Polyhydramnios
  • Multiple Pregnancy

Weakness of the Cervix/incompetence

  • Following LLETZ
40
Q

what is a screening method that can be done to screen for preterm birth?

A

TVUSS looking at cervical length

<25 mm suggests increased risk of preterm birth

41
Q

What can be done to prevent preterm birth?

A

Vaginal progesterone

Cervical Cerclage

42
Q

How can preterm birth be managed?

A
  • Tocolytics - as long as its not contraindicated such as in infection
  • Antenatal steroids - betamethasone ex IM injections
  • Magnesium Sulphate before 34 weeks
  • delayed cord clamping
  • keep baby warm with thermoregulation
43
Q

How is gestational age measured?

A

Crown Rump length

44
Q

What are the routine antenatal appointments where imaging is used?

A

12 scan for nuchal thickness
20 week anomaly scan

all other appointments where scans are used are based on clinical need

45
Q

how can you test ovarian reserve?

A

FSH
antral follicle count
Anti Mullerian hormone

46
Q

What are the initial investigations for fertility analysis?

A

Female hormone profile (day 2 FSH, day 21 Progesterone)
Tft, prolactin
Rubella testing
Smear test
Swabs
Seaman analysis

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