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Y4 - Finals Edition > CBL notes 3 > Flashcards

CBL notes 3 Flashcards

1
Q

Radiological sign seen in sigmoid volvulus

A

Coffee bean sign

  • where portion of intestine twists around its blood supply
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2
Q

Lower left iliac fossa pain differential diagnoses

A
  • diverticulitis
  • crohn’s
  • UC
  • ovarian cyst
  • ectopic pregnancy
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3
Q

Suspected pancreatitis investigations for diagnosis

A
  • bloods : CRP
  • bedside : ECG
  • Imaging: CXR, CT, MRCP (for definitive diagnosis)
  • Serum amylase: if 3x upper limit of normal then indicative of pancreatitis
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4
Q

This is known as:
- appearance of new skin lesions on previously unaffected skin secondary to trauma

A

KOEBNER PHENOMENOM

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5
Q

Medical management of abortion

A

Mifepristone - FIRST - FOETUS - terminates

Misoprostol - Second - Shedding - Contractions

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6
Q

When to give cyclical or continuous HRT

A

Cyclical in perimenopausal

Continuous in post menopausal

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7
Q

Management of SVT

A
  1. Valsalva, carotid massage
  2. Adenosine
  3. Transcutanoues pacing
  4. transvenous pacing
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8
Q

Antibodies in pernicious anaemia

A

intrinsic factor antibodies

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9
Q

antibodies for coeliac screening

A

anti-TTG

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10
Q

Neuroleptic malignant syndrome characterisied by

A
  • HYPERTONIA
  • HYPERTHERMIA
  • AUTONOMIC INSTABILITY
  • MENTAL STATE CHANGE
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11
Q

What type of bacteria is N. Gonorrhoea

A

gram negative intracellular dipolocci

can be seen under microscope unlike chlamydia

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12
Q

Treatment regime of N.Gonorrhoea

A

1st line : CEFTRIAXONE 1g IM stat or CIPRO

2nd line : Azithromycin and Gentamicin

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13
Q

Complications of gonorrhoea

A
  • PID
  • epididymitis
  • SARA
  • disseminated gonococcal infection
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14
Q

Syphilis is caused by what type of bacteria

A

Treponema Pallidum (spirochete)

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15
Q

Stages of syphilis

A

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

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16
Q

Chancre can be investigated which what technique

A

dark ground microscopy

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17
Q

What is Tabes dorsalis

A

slow degeneration of nerve cells and nerve fibres that carry sensory information to the brain

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18
Q

Normal nuchal transluceny

A

measures less than 3.5mm

between 11-14 weeks of pregnancy

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19
Q

What is measured in the combined test:

A
  • hCG
  • NT
  • PAPPA
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20
Q

What is measured in the quad test

A
  • bHCG
  • oestroadiol
  • inhibin A
  • Afp
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21
Q

Male semen analysis
- what is measured ?

A
  • volume 1.5mls
  • Concentration 15 million per mil
  • sperm count 39 mullion
  • normal morphology more than 4%
  • good mobility more than 32%
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22
Q

What might be given to try and induce ovulation

A

Clomiphene citrate

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23
Q

How to assess ovarian reserve

A

Anti-Mullerian hormone (2-4 days in cycle)

FSH and LH nearer to ovulation time

remember previous STI could block of tubes

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24
Q

What investigations are done in the booking appointment ?

A

FBC - anaemia

Infection screen: HIV, HEP B, SYPHILIS

Blood group

Haemoglobinopathies (only if FHx)

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25
Q

Screening during pregnancy summarised

A

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)

26
Q

Risks of amniocentesis or chorionic villous sampling

A

1/200 risk of miscarriage for amnio

Infection

Risk of harm to baby

False positive (1%)

False negative

27
Q

Advice given to pregnant women (what should they take and avoid?)

A
  • 400mg Folic acid daily
    (more if patient is obese, on anti epileptics or antipsychotics)

AVOID VITAMIN A - found in liver

28
Q

Antiemetics for hyperemesis gravidarum

A
  1. Cyclizine, promethazine, prochlorpromazine
  2. Odansetron, metoclopramide, domperidone
  3. Hydrocortisone (IV steroids)
29
Q

Management of microcytic anaemia in pregnancy

A
  • dietary advice (red meat, leafy veg)
  • iron supplementation
  • if RHESUS NEGATIVE THEN NEED PROPHYLACTIC ANTI d
30
Q

What is done for the 32 week appointment

A
  • blood pressure
  • urine dipstick (proteinuria)
  • auscultation
  • symphysis fundal height

Ix
- doppler
- then CTG

May do foetal blood sampling

31
Q

What may help diagnose gestational diabetes

A

Fasting glucose more than 5.6

Random glucose more than 7.8

32
Q

pathophysiology of gestational diabetes

A

Placenta produces
- human placental lactogen + progesterone + cortisol
- which causes hyperglycaemia
- and insulin resistance

33
Q

Stages of labour

A

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

34
Q

Psychiatry: section 2

A

admit for 28 days for investigation

35
Q

Psychiatry: section 3

A

treatment order, 6 months then after that every 12 months

36
Q

Important physical health checks to commence before commencing antipyschotic medication

A
  • FBC
  • ECG
  • U&Es
  • HbA1C
  • height and weight
  • waist circumference
  • cholesterol
  • prolactin
  • BP
  • pulse
37
Q

How often is weight checked in a patient on anti-psychotics?

A

Weight
- weekly for first 6 weeks
- then at 12 weeks
- then at 1 year
- then annually

38
Q

Features of metabolic syndrome

A

DIG ET

  • dyslipidaemia
  • insulin resistance
  • glucose tolerance decreased
  • essential hypertension
  • truncal obesity
39
Q

Early intervention team

A

14-65

patient can remain under their care for 3 years

40
Q

Describe a community treatment order

A

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

41
Q

Prothrombin time indicates what pathway?

A

Extrinsic pathway –> coagulation

42
Q

Partial thromboplastin time indicates what pathway?

A

Intrinsic –> platelet plug formation (initiates platelet adhesion)

43
Q

Von Willebrand is protective of what factor:

A

factor 8 protective
- extrinsic coagulation

44
Q

Carb counting rule in diabetes

A

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

45
Q

How to calculate correction dose?

A

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

46
Q

What effect do ketones have on insulin

A

Ketones make insulin less effective

If ketones present then need multiplication factor of 1.5

47
Q

Puberty initiated due to:

A

nocturnal pulsatile secretions of LHRH which cause LH and FSH release from anterior pituitary.

48
Q

Most important test in puberty

A

bone scan
- because sex hormones cause growth plates to fuse

49
Q

heart condition associated with Turners syndrome

A

coarcation of aorta

50
Q

Scoring system for septic arthritis

A

KOCKER score
1. inability to weight bear
2. fever > 38.5
3. ESR over 40
4. WCC over 12

51
Q

What type of fever is seen with malaria and JIA?

A

Quotidian fever
- cyclical fever

52
Q

Risk factors for neoplasia in kids

A
  • petechia or purpura without cause
  • hepatosplenomegaly
  • pallor
  • generalised lymphadenopathy
  • bone pain
53
Q

Compare and contrast sJIA with Kawasaki disease

A

sJIA
- > 6 weeks fever
- 39 degrees
- salmon pink rash
- generalised lymphadenopathy
- hepatosplenomegaly

Kawasaki
- > 5 days fever
- 38 degrees
- polymorphic rash
- cervical lymphadenopathy

54
Q

Complications of JIA

A
  • psychological
  • uveitis
  • stunted growth
  • leg length discrepancy
  • side effects of NSAIDs
  • macrophage activation syndrome
55
Q

Treatment of sJIA

A
  • 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

56
Q

What is macrophage activation syndrome?

A

Systemic inflammation which is lethal

  • increased ferritin
  • hepatosplenomegaly
  • DIC
  • liver dysfunction

Treatment
- high dose steroids and ciclosporin (for immunosuppression)

57
Q

If a patient w/ SJIA had bacterial tonsilitis what will you do in terms of teir medication?

A

stop methotrexate

increase steroid

58
Q

What viral infections may cause ventriculomegaly

A

> 10 mm in lateral ventricle is abnormal

may be caused by viral infections such as CMV or toxoplasmosis

59
Q

Staging used in twin to twin transfusion syndrome

A

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

60
Q

MRC Dyspnoea scale in COPD

A

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

Y4 - Finals Edition (40 decks)

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