Exam Flashcards
RF for GDM
Family history Obesity Black ethnicity Previous GDM Previous macrosomic baby
Screening for GDM
Glycosuria
Fasting plasma glucose 5.6
OGTT at 2h 7.8
GDM plasma glucose >7 management
Insulin
GDM plasma glucose <7 management
- Diet exercise (2 weeks)
- Metformin
- Add insulin
GDM risks
Macrosomia
Neonatal hypoglycaemia
Traumatic birth
Perinatal death
Chronic hypertension in pregnancy
HTN <20 weeks
Gestational hypertension
> 20weeks hypertension
NO proteinuria
Pre-Eclampsia
HTN >20 weeks
PROTEINURIA
Resolves 6 weeks post partum
Urine dipstick proteinuria
PCR >30
ACR > 8
Pre eclampsia risk factors
>40 yo Obesity Multiple pregnancy 1st pregnancy Previous pre eclampsia
Pre eclampsia complications
Placental abruption
Eclampsia
HELLP
Foetal growth restriction
Pre eclampsia medications
Labetalol
Nifedipine
Methyldopa
Seizure prevention in pre eclampsia
IV magnesium sulphate
VTE Management
LMWH (enoxaparin)
At least 3 months
At least 6 weeks post partum
At least until end of pregnancy
Which VTE drugs to avoid in pregnancy?
Warfarin DOACs (rivaroxaban, apixaban)
Obstetric cholestasis
No rash
Itching
Abnormal LFT (raised ALP)
Complication of obstetric cholestasis
Preterm birth (check weekly LFT)
Obstetric cholestasis management
Weekly LFT
Urodeoxycholic acid
Acute fatty liver of pregnancy symptoms
N & V
Abdominal pain
Jaundice
-always 3rd trimester-
HELLP
Haemolysis (LDH)
Elevated Liver (ALT AST)
Low Platelet
Placenta praevia management
If bleed:
Admit
Steroids 24-36th week
Delivery (C section)
Placental abruption symptoms
Severe abdominal pain
Vaginal bleeding
Tense rigid abdomen
Risk factors for placental abruption
Hypertension
Smoking
Cocaine
Multiple pregnancy
Placental abruption management
Delivery
Placenta praevia - where does placenta attach?
Deep into myometrium
1* post partum haemorrhage causes
4 Ts Tone Trauma Thrombin Tissue (retained)
Preventing PPH routine
Prophylactic uterotonics
1st IM Oxytocin
2nd IM Syntometrine (if high risk)
+ Tranexamic acid
IM Syntometrine contraindications
HTN
Major PPH management
Bimanual compression IV oxytocin 5U IV/IM ergometrine 0.5mg Oxytocin infusion IM Carboprost 0.25mg Sublingual Misoprostol 800ug Surgical / Balloon tamponade
First stage of labour rate
1cm - 2h
2nd stage of labour length
Nulliparous: 3h
Multiparous: 2h
Membrane sweep
Trying detach the membranes from inner cervix - 40+ weeks
Induction of labour
Membrane sweep 24h later: prostaglandin pessary Prostaglandin gel/tablet Artificial rupture of membranes Syntocinon
1st stage latent dilatation rate
0-3cm /6h
1st stage active length
3-10cm
1cm/hr
Antibodies in haemolytic disease of a newborn
IgG
Sensitising events treatment
1st term: 250 u anti-D immunoglobulin
2nd: 250 u in 72h of event + Kleihauer test
3rd: 500 u in 72h + Kleihauer test
Kleihauer test
Quantifies how much foetal blood is in maternal circulation
Hyperemesis gravidarum
> 5% weight loss
Electolyte disturbance
Dehydration
PUQE sforę
Antiemetics in pregnancy
1) cyclizine, prochlorperazine, promethazine, chlorprimazine
2) metoclopramide, domperidone, ondasetron
Ectopic - expectant management
No pain
< 35mm
No heartbeat
hCG < 1000
Ectopic - Medical management
PAIN
< 35mm
hCG < 1500
No heart beat
IM METHOTREXATE
Ectopic - surgical management
PAIN
> 35 mm
hCG > 5000
Salpingectomy / salpingotomy
Threatened miscarriage
Heartbeat
Pain, bleeding
Os closed
Inevitable miscarriage
No heartbeat
Pain, bleeding
Os Open
Incomplete miscarriage
Retained products of conception
Pain, bleeding
Os Open
Complete miscarriage
Empty uterus
Closed Os
Missed miscarriage
No heartbeat
Asymptomatic
Miscarriage Medical management
Vag misoprostol
Pain relief
Antiemetic
Surgical management of miscarriage
Manual vacuum aspiration
Surgical management
Antiphospholytic syndrome triad
Recurrent miscarriage
Thrombocytopenia
VTE
Antiphospholipid syndrome screen
Lupus anticoagulant
Anticardioliptin antibodies
Medical TOP
Mifepristone
Misoprostol
+ >22 feticide
Surgical TOP <14 w
Vacuum aspiration
Surgical TOP 14-24 weeks
Dilation and Evacuation
Complete mole
Sperm + empty egg = 46XX
Partial mole
2x sperm + egg = 69 XXY
Depot - characteristics
Weight gain
Slow return to fertility
Every 12-14 weeks
COCP
Prevents ovulation
Makes period lighter
Quickly reversible
POP
Thickens mucus
Irregular period
Small window for taking
Hormonal coil
Lasts 3-5 y
Thins endometrium
Lighter, less painful period
Copper coil
Work immediately
Makes period more heavy
5-10 y
Sterile inflammation
Implant
Prevents ovulation
3 years
Irregular period
Patch
Weekly 3 weeks, 1 week off
Skin sensitivity
Similar to COCP
Kallman syndrome
- hypogonadotrophic hypogonadism
- reduced or absent sense of smell (anosmia)
PCOS
PCOS on USS >12 cysts in 1 ovary
Hyperandrogenism
Anovulation
Estrogen only
-> endometrial cancer
HRT
VTE
STROKE
BREAST CANCER
Clomiphene
Stimulates egg release in PCOS to improve fertility
metformin also improves fertility
Diagnosis of premature ovarian insufficiency
2x FSH >30
4-6 weeks apart
Ovarian cancer symptoms
Bloating
Constipation
Urination trouble
PM
Ovarian cancer diagnosis
CA 125
Endometrial cancer diagnosis
TVUSS >4mm suspicious
Hysteroscopy biopsy
Mx: high dose progesterone
Cervical cancer symptoms
Postcoital bleeding
Intermestrual bleeding
Cervical cancer diagnosis
HPV 16/18
Check for CIN Cervical Intraepithelial Neoplasia
HPV -
Routine screening in 3 years
HPV +
Normal CIN
Re test in 1 year
HPV +
Abnormal
Invite for colposcopy
PID treatment
IM Ceftriaxone STAT 500mg
PO Docycycline 100mg BD 14d
PO Metronidazole 400mg BD 14d
PID management in penicillin allergy
PO Ofloxacin + Metronidazole 14d
Urge incontinence management
1) bladder retraining 6w
2) oxybutynin, tolterodine
3) mirabegron (b3 agonist)
4. SNS, botox, PTNS
Stress incontinence management
- Pelvic floor exercise 3 mth
2. Duloxetine SNRI
Syphilis in pregnancy
FGR
Mx IM Benzathine Penicillin
VZV in pregnancy
Neonatal varicella - cutaneous scarring, FGR, Limb hypoplasia
+HPV management
Cytology
Abnormal: colposcopy
Normal: 12mth test
If +HPV and cytology normal at 12 month follow up
Repeat in 12months
If +HPV and cytology abnormal at 12 month follow up
Colposcopy
Inadequate sample cytology
1x return in 3 mth
2x colposcopy
<20 w pregnant exposure to VZV
Check varicella antibodies
If negative, IVIG in 10 days
<20 w pregnant with VZV
Aciclovir
> 20 weeks pregnant with VZV
Acyclovir within 24h of rash
> 20 weeks pregnant with VZV exposure
If not immune: give VZIG or acyclovir 7-14 days post exposure
HSV in pregnancy
1-2nd term: acyclovir from 36w
3rd term: acyclovir until delivery
1st ever episode in 3rd term: C Section
HIV in pregnancy
Check viral load 2-4 weeks
And at 36w
Vaginal if <50 at 36w
C section in HIV pregnancy
IV zidovudine (+ART to everyone as usual) Avoid breastfeeding
Hep B in pregnancy
Vax + HBIG in 12h
Vax at 1 month, 6 months
Core symptoms of depression
Low mood
Anhedonia (usual things don’t bring happiness)
Lack of energy
- for at least 2 weeks
Beck’s triad
Hopeless
Worthless
Helpless
High risk of suicide
Anticipation acts Preventing discovery Careful planning Suicide note Violent method
GAD Mx
GAD must be >6mth
High dose SSRI
Benzodiazepines
OCD management
Exposure and Response Prevention
Or
SSRI
or after 12 weeks, Clomipramine, or alt SSRI
Schizophrenia triad
Auditory hallucinations
Abnormal thoughts
Delusions
Auditory hallucinations
Thought echo
3rd person voice
Running commentary
Abnormal thoughts
Thought insertion / withdrawal / broadcasting
Delusions
False fixed belief held despite evidence
Paranoid schizophrenia
Delusions and hallucinations
Hebephrenic schizophrenia
Disorganised mood, inappropriate, childlish
Catatonic schizophrenia
Psychomotor disturbance
Stupor, rigidity, flexibility
Simple schizophrenia
Only negative symptoms: social withdrawal, blunted affect
Typical antipsychotics SEs
Acute dystopia
Tardive dyskinesia
Akathisia
Parkinsonism
Typical antipsychotics examples
Haloperidol
Chlorpromazine
Treatment resistant schizophrenia
2 drugs failure
At least 6 weeks
At least 1 atypical
Treatment resistant schizophrenia drug & SEs
Clozapine
__AGRANULOCYTOSIS
Personality disorder treatments
Dialectical behavioural therapy
SSRI, antipsychotic
Capacity assessment
Understand / retain / weigh/ communicate
Section 135
Police enters premises with social worker warrant, move to a płace of safety for 72h
Section 136
Police removes from public space, no warrant, 24h
Section 2
Assessment and treatment
28days
Can’t be renewed
2 drs (GP, AMHP) and social worker
Section 3
Treatment order
6m
2 doctors
Social worker needs relative approval (can disagree)
Section 4
Assessment in emergency
72h
1 AMPH
Section 5.2
Detention of inpatient for 72h
By doctor
section 5.4
Detention of inpatient by nurse for 6h
HAD
Hospital anxiety and depression
PHQ9
Patient health questionnaire (screening, diagnosing, severity of depression)
Social anxiety disorder
Fear of being critisized and judged
Agoraphobia
Fear of being unable to return to safe place
GAD
Symptoms for 6 mth
OCD
Exposure and response prevention
Positive symptoms (schizophrenia)
Delusions
Hallucinations
Disorganised speech
Catatonic behaviour
Negative symptoms
Blunted affect
Alogia - can’t speak
Anhedonia - no enjoyment
Avolition - lack of motivation
Persecutory delusion
Persistent false belief that you are about to be harmed
Paranoid delusions
Fear and anxiety and can’t tell what is real and what is not
Delusions of reference
Unrelated external world events have significance in patient
Type 1 bipolar
Mania + depression
Type 2 bipolar
Hypomania + depression
Cyclothymic disorder
Hypomanic + depressive most of the time for 2 years
Binge eating
> 1x week for 3 months
No purging
Bulimia
> 1x a week for 3 months binge eating with purging
SCOFF for eating disorders
S - make yourself sick C - lost control over eating O - lost 1 stone in 3 months F - believe you are fat? F - food dominates life?
Alcohol units
Litres x %
Alcohol withdrawal
Early - agitation sweating nausea
Late 24-48h confusion diarrhoea
Seizures peak at 36h
48h-72h delirium
Wernicke - triad and Mx
Nystagmus/ophthalmolegia, ataxic gait, confusion
Mx Thiamine
Korsakov syndrome
Wernickes triad + amnesia, confabulation
Paranoid personality disorder
Sensitive to criticism
Suspicion and conspiracy
Schizotypical personality disorder
Magical thinking
Odd speech
Schizoid personality disorder
Lack of emotion
Lack of interest in others
No relationships and friends
Antisocial personality disorder
Going against social norms and law
Lying/fighting/ running naked
Borderline personality disorder
Unstable relationships
Self harm
Mood swings
Switching from ideal to devalued
Histrionic personality disorder
Needs attention
Shallow
Dramatising
Sexually inappropriate
Narcissistic personality disorder
Grandiose self importance
Takes advantage of others
Arrogant
Need for attention
Avoidant personality disorder
Fear of criticism or embarrassment
Social isolation but wanting acceptance
Dependent personality disorder
Needs to be cared for
Other need to take control of their lives
Desperate need for relationships
Obsessive compulsive personality disorder
Vs OCD- OCPD seek pleasure in tasks
Perfectionist
Occupied by rules and rituals
Serotonin syndrome
Too much serotonin
Fever, HYPER reflexes, myoclonus, DILATED PUPILS
- HOURS -
Neuroleptic malignant syndrome
- DAYS-
Fever, HYPO reflexia, RIGID
CK high
Septal haematoma mx and risk
Incise and drain in 24h
-> saddle shaped deformity
BPPV
Examination and Mx
Episodic <30s on head movement
Dix-Hallpike manoeuvre
Epley manouvre
Otitis externa
Accitic acid
Fusidic acid
Otitis media
Amoxicillin
Cystic hygroma
Posterior triangle
<2 yo
Fluctunant
Branchial cyst
Anterior triangle
Young people & children
Fluctuant
Radiating
Most common thyroid cancer
Papillary - orphan cells, lymphatic spread
Follicular - >50yo, haematology
Medullary - calcitonin, Men 2a/ 2b
Laryngeal cancer
SCC
HPV 16, 18
Abnormal voice, sore throat, ulceration and cancer
Chalezion
Painless eyelid cyst of meibomian gland
Hordeolum
Infected cyst of meibomian gland
PAINFUL
Tx chloramphenicol
Blepharitis
Mild bacterial eyelid margin, erythematous and crusty eyelid margins, uncomfortable
Tx warm compress, chloramphenicol
Viral conjunctivitis cause
Adenovirus
Bacterial conjunctivitis
Staph aureus
Bacterial keratitis
Staph aureus
Viral keratosis
HSV
rf: immunosuppressive
Dendritic ulcer on fluorescent stain
Acanthamoeba
Contact lenses
Ring infiltrate
Disproportional pain
Diabetic retinopathy
Gradual vision loss
Micro aneurysm, hard exudate, blot haemorrhage, cotton wool spots
Ectopic pregnancy risk
Previous ectopic
PID
assisted conception
Previous pelvic surgery
DCML
Ascending
Fine touch, propritocention
Nephritic syndrome
Increased PCR IgA Nephropathy Post Strep Glomerulonephritis Haemolytic Ureamic Syndrome Henoch-Schonlein Purpura SLE
Nephrotic syndrome
Proteinuria, hypoalbuminaemia, oedema
Minimal Change Disease
FSGS
Membranous Glomerulonephritis
Tetralogy of fallot
Pulmonary stenosis
VSD
overriding aorta
Right ventricular hypertrophy
Onset of cyanosis in bebos
In days: TGA
in months: TOF
TGA Xray
Egg on a string
TOF Xray
Boot shaped heart
ASD
Ejection systolic murmur
Left sternal edge
VSD
Pansystolic murmur
Left sternal edge
AVSD
pulmonary hypertension
Down syndrome
PDA
machinery murmur below left clavicle
Indamethasin/ Nsaid
Anaphylaxis
IM adrenaline 1:1000
5 min later IM adrenaline 1:1000
Adrenaline infusion
DKA and dehydration pH
pH > 7.1 = 5% loss
pH < 7.1 = 10% loss
Total fluid deficit volume
%deficit x weight x 10
Over 48h
Maintenance fluids paediatrics
0-10kg 100mL/kg
10-20kg 50mL/kg
>20kg 20mL/kg
Status epilepticus
IV lorazepam /rectal diazepam, buccal midazolam
10min IV lorazepam
Phenytoin infusion
GA
Generalised seizure mx
Sodium valproate
Lamotrigine
Focal seizure mx
Lamotrigine
Absence seizure
Ethosuximide
ADHD Mx
Methylphenidate
Lisdexamphetamine
-> may impair growth (hight weight ecg)
Pyloric stenosis treatment
Ramstedt pylorymyotomy
Constipation paeds
Movicol (draw water into intestine)
Senna (stimulant laxative, intestine contractions)
If impaction:
Movicol on 2 week escalation dose + Senna
Bulk forming laxative
Fybrogel
Osmotic laxative - draws water to intestine
Movicol
Lactulose
Stool softener
Glycerol
Docusate
Stimulant laxative - augment contractions
Senna
Bisacodyl
Intussuception
red currant jelly stool
Sausage shaped mass
Dx USS, AXR
Mx Rectal air insuflation, surgery
Jaundice 24h - 14d
Breast milk
Bruising / traumatic birth
RBC breakdown
Jaundice <24h
Rhesus incompatibility
ABO incompatibility
G6DP deficiency
Pyruvate Kinase deficiency
Jaundice >14d
Biliary atresia
Congenital hypothyroidism
Neonatal hepatitis
Transcutaneous bilirubin
Jaundice >24h
Born >35w
Serum bilirubin
Jaundice <24h
Born <35w
Hearing tests
Otoacoustic test
Adutiroty brainstem response test
Meningitis in HIV
Cryptococcus neoformans- india ink stain
HIV diarrhoea
Cryptosporidium
Fever followed by maculopapular rash
Roseola infantum
HHV6
Itchy red papular lesions between toes and fingers
Scabies
Sarcoptes scabies
Bilateral malar erythrema
Slapped cheek syndrome / fifth disease
Parvovirus B19
Widespread erythrema and tenderness, desquamation
Scalded skin syndrome
Staphylococcus
Painful lesions on hands, foot, month
Coxsackie virus
Erythrematous pustules with yellow crust
Impetigo
Staph aureus
Blueberry muffin rush
Rubella
Cancer that metastasises to bone
BLT Kocher Pickle Breast Lung Thyroid Kidney Prostate
Homonymous hemianopia - congruous defect
Optic radiation or occipital cortex
Homonymous hemianopia - incongruous defect
Optic tract
Homonymous hemianopia - macula sparing
Occiptial cortex
PPROM sign
Pooling of water in posterior vault
Do FIBRONECTIN test
Praeder Willi
Eating everything Overweight Short stature Hypotonia Delay
Eosinophilic granulomatosis with polyangitis
Asthma
Bilateral nasal polyps
Nasal obstruction
Painless red eye in autoimmune conditions
Episcleritis
Painful red eye in ankylosing spondylitis
Anterior uveitis
Ewing sarcoma
MRI large mass with necrosis
Small blue round cells on E&H
Frontal lobe seizure
Jacksonian movement
Limited systemic sclerosis ab
Anti centromere
Doffuse systemic sclerosis ab
Anti scl 70
Brocas area
EXPRESSIVE
Wernickes area
Receptive
Turner syndrome Heart problem
1st Bicuspid valve
2nd is coarctation of aorta
Hearing tests in newborn
Evoked otoacoustic emission
Automated auditory brainstem resoinse
NEC
Ceftriaxone and Vancomycin
Neonatal jaundice bilirubin check
Serum bilirubin in jaundice >24h and born <35 weeks
Transcutaneous bilirubin in jaundice >24h and >35 weeks
Bebo sepsis abx and cause
Benzyloenicillin + gentamycin
<72h leisteria monocytogenes, GBS
>72h staphylococcus epidermis
Neonatal meningitis tx
Penicillin + cegtriaxone/cefotaxime
GBS
Mother; benzylpenicillin
Bebo: benzylpenicillin + gentamycin/ceftriaxone
Hep B treatment
Tenifovir
Threadworms tx
Mebendazole
Drug for induction of ovulation
Clomiphene
When is anaemia checked in pregnancy?
Booking and 28w
Hb levels in pregnancy
1st 110
2nd 105
3rd 100
Ovarian cancer risk factors
many ovulations
Early menarche
Late menopause
Nullparity
Endometrial cancer
Many ovulations Obesity Early menarche Late menopause Nullparity
DCML
ascending
Fine touch and proprioception
Corticospinal
Descending
Motor
Spinothalamic
Ascending
Pain and temperature
TIA onset <1w
Refer same day
300mg aspirin
TIA onset >1w
1 week wait referral
300mg aspirin
TIA pharmacotherapy
300 mg aspirin for 14 days
75mg aspirin + clopidogrel + statin later
Bell’s palsy
HSV1
Ramsey Hunt Syndrome
HZV
Post seizure management
2ww Neurology
6m No driving & DVLA notification if idiopathic
12 m if diagnosis or abnormality
Focal seizure
Carbamazepine
Lamotrigine
Generalised seizure
Sodium valproate
Lamotrigine
Absence seizure
Ethosuxamide
Subarachnoid haemorrhage
Berry aneurysm
Extradural haemorrhage
Trauma to pterion
Convex not crossing sutures
Subdural haemorrhage
Concave
Crossing sutures
Bridging veins
Syphilis
Painless ulcers 1* chancre 2* condylomata lata 3* gummatous lesions Tx IM benzylphenicillin
Genital herpes
Flu-like symptoms dysuria fever PAINFUL ulcers
HSV 1 oral
HSV 2 genital
Mx: Acyclovir
Genital warts HPV strain
6,11
Genital warts tx
Multiple - topical podophyllum
Single - cryotherapy
HPV cancer
16, 18, 33 - cervical cancer
Alzheimer mx
Mild-Moderate: donezepil, gantamine, rivastigmine
Severe: memantine
Dobezepil SE
Do not give in bradycardia
Causes insomnia and weight gain
SLE Derm involvement
Oral ulcers
Glioblastoma multiformae
Young person
Space occupying lesion
Crosses midline
Prosthesis septic arthritis
Staph epidermidis