ANNOYING TOPICS Flashcards
what are the 4 developmental domains
gross motor
fine motor+vision
hearing+speech+language
social+emotional+behavioural
whats the limit age for sitting unsupported
9 months
what age do children crawl
8-9 months
whats the limit age for fixing and following
3 months
whats the limit age for reaching out for toys
6 months
when do children develop palmar grasp
4-6 months
whats the limit age for transferring toys from one hand to another
9 months
whats the limit age for mature pincer grip
12 months
when do children start drawing with crayons
16-18 months
and what age can a child build
a tower of 3
a tower of 6
a tower of 8 or train of 4
a bridge
steps after demo
a tower of 3- 18 months
a tower of 6- 2 years
a tower of 8 or train of 4- 2.5 yrs
a bridge- 3 yrs
steps after demo- 4yrs
when will a child be able to draw
a line
a circle
a cross
a square
a triangle
a line- 2 yrs
a circle- 3 yrs
a cross- 3.5yrs
a square- 4 yrs
a triangle- 5 yrs
when do babies have a polysyllabic babble
7 months
when do babies say mama and dada
7 months
when do babies say 2-3 words other than mama and dada
12 months
when do children understand 2 word commands eg name drink
12 months
when can children say 6-10 words
18 months
when can children point to body parts
18 months
whats the limit age for a child to smile
6 weeks
when can a child drink from a cup with 2 hands
12 months
when can a child successfully feed themself with a spoon
18 months
whats the limit age for symbolic play
2-2.5yrs
when should a child be dry by day
2 yrs
whats the difference between derealisation and depersonalisation
depersonalisation= when you are outside yourself and looking at your own actions/feelings/thoughts
derealisation= when you feel like the world isnt real
this are both a form of dissociative disorder
when can you use expectant management for pregnancy of unknown location
when the women is less than 6 weeks GA, not in pain
expectant management for pregnancy of unknown location
return in pain starts
do a pregnancy test in 7-10 days
return if positive
if negative pregnancy has miscarried
whats the definition of pregnancy of unknown location
positive pregnancy test but no visible pregnancy on TVUS
how to differentiate between downs and edwards on quadruple screen
in downs inhibin a will be high
in edwards it will be normal
which conditions are screened for in quadruple test
downs syndrome
what do you need to initially exclude when suspecting hyperprolactinaemia
hypothyroidism
chronic renal failure
otitis media safety net
come back if symptoms dont improve within 3 days
antibiotics given immediately when in otitis media when
sx >4 days not improving
systemically unwell
immunocompromised
<2yrs and bilateral
perforated
otitis media abx if given
amoxicillin 5-7 days
worldwide schizophrenia prevalence
1%
risk of getting schizophrenia if a parent has it
10%
when does frenotomy require general anaesthesia
when over 3 months
why do pregnant women feel breathless
tidal volume increases
minute ventilation increases
this causes breathlessness
what happens to neutrophils in pregnancy
neutrophilia
what happens to platelets during pregnancy
reduced platelets
what happens to resp rate in pregnancy
stays the same!!!
what form of oestrogen increases in pregnancy
oestriol (E3)
what change to bowel movements is seen during pregnancy
contipation as less peristalsis
whats comes first out of metaplasia and dysplasia
whats the difference between them
metaplasia= external stressors cause change from one cell type to another
dysplasia= internal change in cell development causes transformational change
therefore metaplasia has to come before dysplasia
out of c4 and c3 what is likely to be lower in lupus
c4
c3 is low in severe disease
treatment for human tapeworms
praziquantel
when to give ganciclovir/valaciclovir
CMV
HHV6
what stain to use for fungi that arent cryptococcus
methanamine silver
how to differentiate SS and NMS
SS=hyperreflexia
NMS= slower reflexes, leadpipe rigidity
NMS mx
stop antipsychotic
hydrate
may use dantrolene
SS mx
stop SSRI
hydrate
may use benzodiazepine
in what overdose will you get
dilated pupils (mydriasis)
pinpoint pupils
nystagmus
dilated pupils (mydriasis)= TCA OD
pinpoint pupils= opiate OD
nystagmus= benzo OD
what is mydriasis
dilated pupils
how does alcohol affect GABA and NMDA
enhances GABA
reduces NMDA
in alcohol withdrawal what happens to GABA and NMDA
reduced GABA
increased NMDA
how do benzodiazepines effect GABA
increase it
peak incidence of seizures in alcohol withdrawal
36 hrs
how long after last drink do alcohol withdrawal sx start
6-12 hrs
peak incidence of delirium tremens in alcohol withdrawal
48-72hrs
what class of medication is used in alcohol withdrawal and why
benzodiazepines
they enhance GABA
when might you not use chlordiazepoxide and what will you give instead
when there is liver failure
give lorazepam
first line mx for delirium tremens
oral lorazepam
IV thiamine
first line mx for alcohol withdrawal seizure
oral lorazepam
GAD mx 1/2 line and 1/2/3 medications
1= 4-12 week course CBT
2= medical
1. sertraline
2. other SSRI/SNRI
3. pregabalin
baby blues vs postnatal depression time onset
baby blues= onset within 2-3 days of birth, resolves by day 10
postnatal depression= onset within first month of birth, 2 weeks of continual depressive symptoms
medication advice for bipolar disorder in pregancy
you cannot change or stop medication without specialist advice
sodium valproate is not recommended
mood stabiliser may be switched to an antipsychotic
non hormonal management of women with symptomatic fibroids includes
NSAIDs
tranexamic acid
what is uterine artery embolisation
a form of radiological intervention used to treat fibroids in women not desiring fertility
what to do if a pregnant women has proteinuria +1
if she has no sx of pre eclampsia and normal BP, call her back in a week to reassess
if persistent +1 on dip, quantify the proteinuria using urine albumin:creatinine or protein:creatinine ratio
what is significant proteinuria in pregnancy defined as
albumin:creatinine >8mg
protein:creatinine >30mg
if a women has +2 proteinuria what do you do
arrange urgent secondary care assessement
what are the triads for nephrotic and nephritic syndrome
nephrotic= oedema, proteinuria, hypoalbuminaemia
nephritic= oedema, haematuria, hypertension
what are the 3 causes of nephrotic syndrome
minimal change disease
membranous glomerulonephropathy
focal segmental glomerulosclerosis
what are the 5 causes of nephritic syndrome
post streptococcal glomerulonephritis
IgA vasculitis (bergers)
rapidly progressive
alports syndrome
thin basement membrane
SNRI side effect
high blood pressure
sertraline side effect
hyponatraemia
citalopram side effect
qt prolongation
tamoxifen use causes what cancer
endometrial
what therapy is useful in schizophrenia
CBT
3rd degree vs 4th degree prolapse
3rd= cervix and uterus
4th= cervix, uterus and vaginal wall, bleeding and ulceration possible
what degree of prolapse does stuff start going out of the interoitus
3rd
when to start compressions in a neonate
after 10 resus breaths and 30 seconds of effective ventilation if the HR is <60
genetic condition wherein there is a large head and relatively short limbs
achondroplasia
what does the mutation in achondroplasia affect
fibroblast growth factor 3
how often are contractions assessed in labour
every 30 mins
how often is pulse assessed in labour
hourly
what is assessed every 4 hrs in labour
temp
BP
resp rate
vaginal exam
bladder exam (output, fluid balance)
delay in the first stage of labour is
dilation <2cm in 4 hrs
if suspected do a vaginal exam in 2 hrs and if <1cm dilation diagnose delay
how long after ROM should you assess a women
2 hrs
what rate of contractions means you should stop oxytocin
more than 4 in 10 mins
second stage of labour
passive vs active
passive= when fully dilated before pushing
active= fully dilated and pushing
duration of active 2nd stage of labour in nullip vs mutlip
nullip= 3 hrs
multip= 2 hrs
offer instrumental delivery when
second stage of labour is prolonged
woman requests it
how does previous perineal trauma affect future births
risk is not increased at all because of previous trauma
advice on water births nhs
no conclusive evidence to support or not support water birth
what drug is recommended for active management of third stage of labour
oxytocin plus ergometrine
when should the cord be clamped in active management of the 3rd stage of labour
after one minute
before 5 minutes
polyhydramnios diagnostic criteria
amniotic pool >8cm
amniotic fluid index >95th percentile expected at the gestational age
what can you not take on tamoxifen
SSRIs
when is anterior colporrhaphy used
cystourethrocele
when is sacrocolpopexy used
for vaginal vault prolapse in women who have had a hysterectomy
when is sacrospinous fixation used
to give support to the uterus
age for croup
6 months- 6 years
adjustment disorder time scale
doesn’t last for longer than 6 months after the stressor
how do patients react to their symptoms in conversion disorder
unbothered
what is low birth weight
<2500g
breastfeeding advice for LBW infants
start breastfeeding as soon as possible
exclusive breastfeeding for 6 months is recommended
if breastfeeding not possible, donor milk is recommended
if donor milk not possible, formula
what gynae cancers metastasise to the paraaortic nodes
endometrial
ovarian
what gynae cancers metastasise to the inguinal nodes
cervical
vulval
bicornuate or septate uterus is due to failure of fusion of what ducts
paramesonephric
low serum progesterone causes miscarriage when
first trimester
what is the embryogenic mechanism for ToF
anterosuperior displacement of the infundibular septum
complicated otitis media mx
oral antibiotics
follow up at 6 weeks in primary care
what abx are given in otitis media
amoxicllin
what cell produces androgen binding hormone
sertoli
what does NSAID use after 20 weeks GA cause
oligohydramnios
premature closure of the PDA
increases risk of persistent pulmonary hypertension
when in pregnancy is NSAID use absolutely contraindicated
after 28 weeks
what is first line analgesia in pregnancy
paracetamol
what type of nsaid is completely contraindicated throughout pregnancy
cox 2 inhibitor
smoking is protective in which gynaecological cancer
endometrial
what condition in the mother increases risk of neonatal respiratory distress syndrome?
diabetes
what 2 drugs cause foetal hyantoin syndrome
phenytoin
carbamazepine
when is meconium ileus more common
post term
when a pregnant mother is given steroids for preterm labour what might happen
hyperglycaemia- need to carefully monitor her
what might infants get after gastroenteritis transiently that also causes diarrhoea
lactose intolerance
what are maternal causes of cleft palate
anti epileptic use
benzo use
rubella infection
smoking
hep b breastfeeding rules
safe to breast feed
how does smoking affect hyperemesis gravidarum
reduces risk
when is gestational age calculated by CRL vs head circumference
head circumference if the CRL is >84mm
when questioning how can you differentiate dementia and depression
depression= patient will be less likely to answer qs or will say i dont know
dementia= patients will attempt to answer all qs
can you do ECT in pregnant women
yes
what type of memory impairment do you get with ECT
retrograde (difficulty remembering what happened before ECT)
lithium therapeutic range
0.6-1.0
what are rf for VTE in pregnancy
age over 35
smoker
parity >3
BMI >30
pre eclampsia
immobility
IVF pregnancy
multiple pregnancy
pre eclampsia
low risk thrombophilia
when is VTE prophylaxis given in pregnancy
if there are 4 or more rf immediately
if 3 start at 28 weeks
how long is anticoagulation continued for if DVT is near term
3 months after term
when is foetal fibronectin used and when is igf1/ placental alpha microglobulin used
foetal fibronectin= used if membranes are intact and preterm labour is suspected
igf1/ placental alpha microglobulin is used when membranes have reuptured to assess likelihood of progression to labour
if amniotic fluid pooling is seen in pprom what tests need to be done to confirm?
none, you manage the women as suspected going into labour
how does TGA affect pulse
causes thready/weaker pulse
what urine study uses dye
MCUG
what is done for opiate substitution therapy during pregnancy and breastfeeding
if established on buprenorphrine or methadone continue
dont encourage switch to buprenorphrine
can safely continue on these during breastfeeding
what are the recommendations on opiate detoxification during pregnancy
in small amounts can be done in second trimester
not recommended in third trimester
what is the best way for a baby to present
occiput anterior
describe occiput anterior
when the occiput (at base of skull on side of spine) is on the same side as mums tummy/front
how long do women stay in hospital for after a hysterectomy?
2-4 days
how long do women have a catheter in after hysterectomy
24hrs
what PV bleeding might occur after hysterectomy
light PV bleeding
1-2 weeks
how soon after hysterectomy can someone have sex
4-6 weeks
how long after hysterectomy can you shower
24hrs
how long after hysterectomy can someone go back to work
usually around 6-8 weeks
when should women with single pregnancies be offered IOL if they havent gone into labour
41+0 weeks
what is klinefleters syndrome
when a boy has an extra chromosome (47 XXY)
how does klinefelters syndrome present
taller than average
small testes
infertile
lack of secondary sexual characteristics
gynaecomastia
what are gonadotrophin and testosterone levels in klinefelters
gonadotrophin= high
testosterone=low
lymph nodes in what location are more likely to be malignant
supraclavicular and posterior triangle of neck
where is a branchial cyst found
lateral aspect of neck at the anterior border of sternocleidomastoid
what are the 2 midline cysts in a child
branchial
thyroglossal
what is lymphadenitis
swelling of lymph nodes due to infection
what is left shift
increased number of immature neutrophils which occurs in infection
the neutrophils will be hypogranular and hypolobulated
when is chlordiazepoxide not given and whats given instead
if they have liver impairment
give lorazepam
if a child has congenital heart disease and is cyanosed what are the 2 conditions they could have? how do you differentiate them
ToF= they will have a murmur
TGA= they will not have a murmur
what congenital heart condition in a child will lead to lack of femoral pulse but normal other pulses
coarctation
what congenital heart condition in a child will lead to lack of femoral pulse and absent left carotid
interrupted aortic arch
what congenital heart condition in a child will lead to lack of all pulses
hypoplastic heart or critical aortic stenosis
what congenital heart condition in a child will lead to carotid thrill
aortic stenosis
how does assisted vaginal birth affect risk of tears
increases
how does IOL affect risk of shoulder dystocia in macrosomic babies
reduced risk
when is placenta praevia/low lying placenta usually picked up
at foetal anomaly scan 18-20+6 weeks GA
what scans are done for placenta praevia/low lying placenta
picked up at anomaly scan (18-20+6 GA)
rescan at 32 weeks to check
if still low lying rescan at 36 weeks
when should you aim for delivery in placenta praevia/low lying placenta?
36-37 weeks GA
how does placenta praevia/low lying placenta affect chances of preterm birth?
increased
give steroids at 34-35 weeks GA
What is diffuse white out and air bronchograms on a CXR
Acute real distress syndrome
What is diffuse white out and air bronchograms on a CXR
Acute resp distress syndrome
MMSE dementia
o Mild AD: 21-26
o Moderate AD: 10-20
o Severe AD: < 10
wernickes triad
opthalmoplegia/nystagmus
ataxia
confusion
wernickes encephalopathy mx
IV thiamine urgent replacement
PTSD cardinal features
- traumatic event
- intrusion sx (flashbacks/nightmares etc)
- avoidance sx
- hyperarousal
- negative association
- exclusion (not drugs/alcohol etc)
- functional impairment
present for 1 month
naloxone vs naltrexone
naloxone= used to reverse opioid overdose
naltrexone= used long term to prevent opioid relapse as reduces craving
what is 99 technetium used for
meckels diverticulum
surgery options for cytsocele
anterior colporrhapy
colposuspension
surgery options for uterine prolapse
hysterectomy
sacrohysteropexy
surgery options for rectocele
posterior colporrhapy
what is each part of the bishop score score out of
3
accept position (0=posterior, 1=intermediate, 2=anterior) and consistency (0=firm, 1=intermediate, 2=soft) which are score out of 2
how do you identify meningococcal septicaemia?
non blanching rash
(sign of DIC)
