Counselling Flashcards

1
Q

Indications for induction of labour

A

Prolonged gestation which increases risk of still birth, LSCS etc

Prelabour rupture of membranes (>24 hrs before labour) which increases risk of infection

Maternal health conditions e.g. diabetes, hypertension or heart disease which can increase the risk of stillbirth and large baby

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2
Q

Disadvantages of induction of labour

A

Labour ward vs midwifery-led unit, no birth pool

May be more painful

Longer stay in hospital

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3
Q

Talk through the process of induction of labour

A

Most will get membrane sweep first (adjunct) to stimulate release of prostaglandins- increases chance of natural labour, can cause discomfort

Then depending on bishops score management is different:

<6 (unfavourable cervix) then PV prostaglandins or mechanical method e.g. balloon catheter is offered to increase favourability of cervix

> 6 (favourable cervix) then amniotomy +/- oxytocin infusion is recommended

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4
Q

Pros and cons of prostaglandin use in IOL

A

Hormones that mimic the ones in ur body that make contractions happen

Usually done when bishops <6 alongside ?balloon catheter

Reduces likelihood of needing mechanical methods

But can cause hyperstimulation

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5
Q

Pros and cons of amniotomy

A

Amnihook to artificially break the membranes to release prostaglandins

Must be done before oxytocin drip

But can be uncomfortable- pain relief can be provided

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6
Q

Alternative to OGD

A

Barium swallow

Non-invasive and doesnt require sedation

Shows motility problems in the oesophagus but can’t examine the mucosa or get a biopsy

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7
Q

What do you have to do before an OGD

A

Stop PPIs 2 weeks before

Not eat for 6 hours, clear fluids for 2 hours (same as surgery)

?stop anticoagulants also

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8
Q

2 options for anaesthesia during OGD

A

Throat spray- numbing back of throat, no gag reflex

IV sedation- relaxes patient but they stay awake, must be taken home

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9
Q

Side effects and risks of OGD

A

SE:
- gagging
- sore throat
- nausea/ abdominal pain
- minor bleeding

Risks:
- damage to teeth- mouthguard
- aspiration pneumonia
- perforation
- infection
- over-sedation

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10
Q

Alternative to colonoscopy

A

CT colonography (virtual colonoscopy)

Imaging test- air enema and then CT from different angle creates 3D model

Less invasive but not as detailed and no biopsies

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11
Q

How to prepare for colonoscopy

A

Bowel prep- low fibre diet for 2-3 days and increase fluids

Then take very strong laxative the day before -> diarrhoea

Eating 6 hrs, clear fluids 2 hrs

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12
Q

Pros and cons of the 2 types of dialysis

A

Haemodialysis and peritoneal dialysis (catheter into peritoneum- fluid changed either overnight or 4x a day )

Haemodialysis has a social aspect, performed by HCP, has dialysis-free days and can be done at home.
BUT diet and fluid intake are restricted, requires vascular access and can cause SE including infection, muscle cramps, itchy feeling

Peritoneal dialysis is more flexible and freeing, but is done every day, you have as permanent catheter in, and has risks e.g. hernia, infection, scarring

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13
Q

5 transfusion side effects and management

A

Anaphylaxis -> stop and IM adrenaline etc ABCDE

TACO -> stop and Tx as acute HF

TRALI -> stop and supportive care e.g. O2

Haemolytic reaction (ABO incompatibility) -> stop and supportive Mx

Febrile non-haemolytic transfusion reaction -> slow and paracetamol

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14
Q

How to differentiate between TRALI and TACO

A

Both present with SOB, hypoxaemia

TRALI more severe

TACO more likely in HF patients

TACO more of an overload picture, TRALi has CXR white out

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15
Q

How does acute haemolytic transfusion reaction present

A

Fever, hypotension, agitation, flushing, chest/ abdominal pain, DIC/ bleeding, AKI

Occurs in minutes of BT

If rigors consider bacterial contamination instead

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16
Q

What is UKMEC4 for COCP

A

<3wks p.p if not breastfeeding
<6wks p.p if breastfeeding

Breast cancer

> 35 and smoke >15 a day

VTE history
Recent immobilisation
Thrombogenic mutations
Antiphospholipid
AF

Migraine with aura

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17
Q

What percentage of women using the COCP get pregnant after a year

A

9%

Actually effectiveness is 99% but people dont use it right so it is 91% effective

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18
Q

What 2 cancers does COCP reduce chance of

A

Ovarian and endometrial

Increases cervical and breast cancer

19
Q

Four risks of COCP

A

VTE

MI / stroke

Breast cancer

Cervical cancer

20
Q

Common side effects of the POP

A

Irregular bleeding !!!!

Headaches
Nausea
Mood changes
Breast tenderness

21
Q

Missed pill times for types of POP

A

Desorgestrel= half Day= 12 hours ok

Levonorgestrel/ norethisterone= 3 hours

22
Q

Indications for double dose of levonorgestrel

A

BMI>26
Weight >70kg
Enzyme-inducing meds

No double dosing for Ella-One

23
Q

6 enzyme inducers

A

Carbemazepine (mood stabilizer, anticonvulsant)
Rifampicin (Abx)
Alcohol
Phenytoin (seizure prevention)

Griseofulvin (antifungal)
Phenobarbitone (seizure prevention)
Sulphonylureas (T2DM e.g. gliclazide)

They induce P450 which increases the amount of NAPQI which is hepatoxic which is relevant in paracetamol overdose

24
Q

Inhibitors of P450 enzyme (9)

A

SSRIs
Omeprazole
Valproate
Acute Achilles
Antibiotics e.g. ciproflox, eryth
Amiodarone
Allopurinol
Isoniazid
Zoles e.g. ketoconazole

25
Q

Can you restart hormonal contraception after emergency

A

Yes if levonorgestrel

No if EllaOne- wait for 5 days

26
Q

UKMEC4 for contraceptive implant

A

Current breast cancer

27
Q

Cons of contraceptive implant

A

Unpredictable bleeding that doesn’t necessarily get better

Procedure to fit and remove

Small increased risk of breast cancers

28
Q

UKMEC 4 for copper coil

A

P.p sepsis

PID active

STI active

Cervical/ endometrial cancer

Pelvic TB a

29
Q

Cons of copper coil

A

Heavier and more painful periods

1/20 risk of expulsion

Ectopic pregnancy

No protection vs PMS

30
Q

When do you take methotrexate

A

Once a week

Folic acid on the other days/ also once a week? But on different days

FA helps to reduce side effects

31
Q

Analgesia in copper coil insertion?

A

Yes!

Take ibuprofen/ paracetamol 1/2 hours before

Can have LA in the cervix, spray into cervix, gel into uterus or just simple analgesia

32
Q

How does IUS work

A

3 ways:

  • thins endometrium to prevent implantation of egg
  • thickens cervical mucous to prevent sperm from entering uterus
  • can prevent ovulation sometimes
33
Q

How does depot injection work contraception

A

3 ways:

  • thins lining of uterus
  • thickens cervical mucous
  • inhibits ovulation

(Same as IUS as is progesterone, POP doesn’t seem to thin uterus lining like the other two do)

34
Q

How often is depot injection given

A

Every 13 weeks (3 months)

35
Q

What is chance of anaphylaxis in vaccinations

A

1 in 1 million in UK

36
Q

Which vaccines are live

A

Measles
Mumps
Rotavirus
Rubella

37
Q

5 cautions for corticosteroid prescribing

A

Liver impairment

Stomach ulcers

Diabetes

MH problems

Pregnancy!! (Lower dose as affects growth)

38
Q

What should be avoided in those taking immunosuppressive doses of steroid

A

Live vaccines!

Polio, MMR, BCG

39
Q

Missed pill rule for steroids

A

Take as soon as remember

BUT

Don’t take 2 doses at once to compensate

40
Q

How do we monitor people on steroids

A

BP, body weight and BMI to check for weight gain i guess

Eye exam for glaucoma/ catacts

HBA1C 1 month after stating then every 3 months

41
Q

Common short and long term side effects fo steroids

A

Short-term:
Sleep disturbance/ insomnia
Weight gain
Mood changes

long term:
Cushings
Osteroporosis
HTN
Muscle weakness
Diatebetes
Peptic ulcers
Cataracts

42
Q

What not to forget in steroid counselling

A

Steroid withdrawl-> adrenal insufficiency! Do not stop a suddenly

Steroid emergency card

Double dose (hydrocortisone) during illness

43
Q

Do you stop metformin in low eGFR

A

Yes

EGFR <30

As risk of lactic acidosis