CBL notes 3 Flashcards
Radiological sign seen in sigmoid volvulus
Coffee bean sign
- where portion of intestine twists around its blood supply
Lower left iliac fossa pain differential diagnoses
- diverticulitis
- crohn’s
- UC
- ovarian cyst
- ectopic pregnancy
Suspected pancreatitis investigations for diagnosis
- bloods : CRP
- bedside : ECG
- Imaging: CXR, CT, MRCP (for definitive diagnosis)
- Serum amylase: if 3x upper limit of normal then indicative of pancreatitis
This is known as:
- appearance of new skin lesions on previously unaffected skin secondary to trauma
KOEBNER PHENOMENOM
Medical management of abortion
Mifepristone - FIRST - FOETUS - terminates
Misoprostol - Second - Shedding - Contractions
When to give cyclical or continuous HRT
Cyclical in perimenopausal
Continuous in post menopausal
Management of SVT
- Valsalva, carotid massage
- Adenosine
- Transcutanoues pacing
- transvenous pacing
Antibodies in pernicious anaemia
intrinsic factor antibodies
antibodies for coeliac screening
anti-TTG
Neuroleptic malignant syndrome characterisied by
- HYPERTONIA
- HYPERTHERMIA
- AUTONOMIC INSTABILITY
- MENTAL STATE CHANGE
What type of bacteria is N. Gonorrhoea
gram negative intracellular dipolocci
can be seen under microscope unlike chlamydia
Treatment regime of N.Gonorrhoea
1st line : CEFTRIAXONE 1g IM stat or CIPRO
2nd line : Azithromycin and Gentamicin
Complications of gonorrhoea
- PID
- epididymitis
- SARA
- disseminated gonococcal infection
Syphilis is caused by what type of bacteria
Treponema Pallidum (spirochete)
Stages of syphilis
STAGE 1
- 3-4 weeks painless chancre at innoculation site
STAGE 2
- 4-8 weeks after appearance of primary chancre
Latent
- early
- late
will be latent in sensory ganglia
Teritary
- 1-10 years after
Chancre can be investigated which what technique
dark ground microscopy
What is Tabes dorsalis
slow degeneration of nerve cells and nerve fibres that carry sensory information to the brain
Normal nuchal transluceny
measures less than 3.5mm
between 11-14 weeks of pregnancy
What is measured in the combined test:
- hCG
- NT
- PAPPA
What is measured in the quad test
- bHCG
- oestroadiol
- inhibin A
- Afp
Male semen analysis
- what is measured ?
- volume 1.5mls
- Concentration 15 million per mil
- sperm count 39 mullion
- normal morphology more than 4%
- good mobility more than 32%
What might be given to try and induce ovulation
Clomiphene citrate
How to assess ovarian reserve
Anti-Mullerian hormone (2-4 days in cycle)
FSH and LH nearer to ovulation time
remember previous STI could block of tubes
What investigations are done in the booking appointment ?
FBC - anaemia
Infection screen: HIV, HEP B, SYPHILIS
Blood group
Haemoglobinopathies (only if FHx)
Screening during pregnancy summarised
ON NHS
Combined
- 10-14 weeks
- Downs, Edwards, Pataus
Quad
- 15-20 weeks
- Downs and Edwards
NOT ON NHS
NIPT
- maternal blood test for fragments of foetal DNA
Amniocentesis (15-20 weeks)
Chorionic villous sampling (11-14 weeks)
Risks of amniocentesis or chorionic villous sampling
1/200 risk of miscarriage for amnio
Infection
Risk of harm to baby
False positive (1%)
False negative
Advice given to pregnant women (what should they take and avoid?)
- 400mg Folic acid daily
(more if patient is obese, on anti epileptics or antipsychotics)
AVOID VITAMIN A - found in liver
Antiemetics for hyperemesis gravidarum
- Cyclizine, promethazine, prochlorpromazine
- Odansetron, metoclopramide, domperidone
- Hydrocortisone (IV steroids)
Management of microcytic anaemia in pregnancy
- dietary advice (red meat, leafy veg)
- iron supplementation
- if RHESUS NEGATIVE THEN NEED PROPHYLACTIC ANTI d
What is done for the 32 week appointment
- blood pressure
- urine dipstick (proteinuria)
- auscultation
- symphysis fundal height
Ix
- doppler
- then CTG
May do foetal blood sampling
What may help diagnose gestational diabetes
Fasting glucose more than 5.6
Random glucose more than 7.8
pathophysiology of gestational diabetes
Placenta produces
- human placental lactogen + progesterone + cortisol
- which causes hyperglycaemia
- and insulin resistance
Stages of labour
Stage 1
Latent (0-4cm) contractions not
continuous
Active (4-10cm) regular painful contractions
Stage 2
Passive –> Full dilatation in absence of expulsive contractions
Active –> full dilatation, maternal effort and expulsive contractions
Stage 3
Expulsion of placenta and membrane
Psychiatry: section 2
admit for 28 days for investigation
Psychiatry: section 3
treatment order, 6 months then after that every 12 months
Important physical health checks to commence before commencing antipyschotic medication
- FBC
- ECG
- U&Es
- HbA1C
- height and weight
- waist circumference
- cholesterol
- prolactin
- BP
- pulse
How often is weight checked in a patient on anti-psychotics?
Weight
- weekly for first 6 weeks
- then at 12 weeks
- then at 1 year
- then annually
Features of metabolic syndrome
DIG ET
- dyslipidaemia
- insulin resistance
- glucose tolerance decreased
- essential hypertension
- truncal obesity
Early intervention team
14-65
patient can remain under their care for 3 years
Describe a community treatment order
Lasts 6 months but can be extended
- patient treated at home
- they were previously sectioned and discharged
- need to engage with care coordinator
- need to make themselves available for medical examinations
If they don’t comply can be brought back and detained for 72 hours
Prothrombin time indicates what pathway?
Extrinsic pathway –> coagulation
Partial thromboplastin time indicates what pathway?
Intrinsic –> platelet plug formation (initiates platelet adhesion)
Von Willebrand is protective of what factor:
factor 8 protective
- extrinsic coagulation
Carb counting rule in diabetes
500 rule
500 / by total daily dose of insulin
For example if patients total daily dose of insulin was 25 –> then 500/25 = 20
1 unit of insulin will cover 20g of carbohydrate in the meaL
How to calculate correction dose?
100 rule
100/ total daily dose of insulin = sensitivity factor
If patients total daily dose as 25
then 100/25 = 4
1 unit will lower blood glucose by 4mmol/L
What effect do ketones have on insulin
Ketones make insulin less effective
If ketones present then need multiplication factor of 1.5
Puberty initiated due to:
nocturnal pulsatile secretions of LHRH which cause LH and FSH release from anterior pituitary.
Most important test in puberty
bone scan
- because sex hormones cause growth plates to fuse
heart condition associated with Turners syndrome
coarcation of aorta
Scoring system for septic arthritis
KOCKER score
1. inability to weight bear
2. fever > 38.5
3. ESR over 40
4. WCC over 12
What type of fever is seen with malaria and JIA?
Quotidian fever
- cyclical fever
Risk factors for neoplasia in kids
- petechia or purpura without cause
- hepatosplenomegaly
- pallor
- generalised lymphadenopathy
- bone pain
Compare and contrast sJIA with Kawasaki disease
sJIA
- > 6 weeks fever
- 39 degrees
- salmon pink rash
- generalised lymphadenopathy
- hepatosplenomegaly
Kawasaki
- > 5 days fever
- 38 degrees
- polymorphic rash
- cervical lymphadenopathy
Complications of JIA
- psychological
- uveitis
- stunted growth
- leg length discrepancy
- side effects of NSAIDs
- macrophage activation syndrome
Treatment of sJIA
- paeds rheumatology
- test for other causes
- rule out infection
- school progress monitorinng
- look for uveitis signs
Medical
- high dose NSAID plus intraarticular steroid
- if not effect in 1 week then given IV steroids
- then oral steroids until CRP returns to normal
What is macrophage activation syndrome?
Systemic inflammation which is lethal
- increased ferritin
- hepatosplenomegaly
- DIC
- liver dysfunction
Treatment
- high dose steroids and ciclosporin (for immunosuppression)
If a patient w/ SJIA had bacterial tonsilitis what will you do in terms of teir medication?
stop methotrexate
increase steroid
What viral infections may cause ventriculomegaly
> 10 mm in lateral ventricle is abnormal
may be caused by viral infections such as CMV or toxoplasmosis
Staging used in twin to twin transfusion syndrome
Quintero score stages
1. both visible bladder
2. one lost bladder
3. no bladder no doppler pulse
4.one or both show hydrops (abnormal fluid)
5. one or both fetuses have died
MRC Dyspnoea scale in COPD
1 - Health: not troubled by breathlessness except on strenuous exercise
2 - Hill: breathless up slight hill
3 - Has to stop when walking at own pace
4- stops for breath at 100m
5- too breathless to leave house
