Exam Flashcards
1
Q
RF for GDM
A
Family history Obesity Black ethnicity Previous GDM Previous macrosomic baby
2
Q
Screening for GDM
A
Glycosuria
Fasting plasma glucose 5.6
OGTT at 2h 7.8
3
Q
GDM plasma glucose >7 management
A
Insulin
4
Q
GDM plasma glucose <7 management
A
- Diet exercise (2 weeks)
- Metformin
- Add insulin
5
Q
GDM risks
A
Macrosomia
Neonatal hypoglycaemia
Traumatic birth
Perinatal death
6
Q
Chronic hypertension in pregnancy
A
HTN <20 weeks
7
Q
Gestational hypertension
A
> 20weeks hypertension
NO proteinuria
8
Q
Pre-Eclampsia
A
HTN >20 weeks
PROTEINURIA
Resolves 6 weeks post partum
9
Q
Urine dipstick proteinuria
A
PCR >30
ACR > 8
10
Q
Pre eclampsia risk factors
A
>40 yo Obesity Multiple pregnancy 1st pregnancy Previous pre eclampsia
11
Q
Pre eclampsia complications
A
Placental abruption
Eclampsia
HELLP
Foetal growth restriction
12
Q
Pre eclampsia medications
A
Labetalol
Nifedipine
Methyldopa
13
Q
Seizure prevention in pre eclampsia
A
IV magnesium sulphate
14
Q
VTE Management
A
LMWH (enoxaparin)
At least 3 months
At least 6 weeks post partum
At least until end of pregnancy
15
Q
Which VTE drugs to avoid in pregnancy?
A
Warfarin DOACs (rivaroxaban, apixaban)
16
Q
Obstetric cholestasis
A
No rash
Itching
Abnormal LFT (raised ALP)
17
Q
Complication of obstetric cholestasis
A
Preterm birth (check weekly LFT)
18
Q
Obstetric cholestasis management
A
Weekly LFT
Urodeoxycholic acid
19
Q
Acute fatty liver of pregnancy symptoms
A
N & V
Abdominal pain
Jaundice
-always 3rd trimester-
20
Q
HELLP
A
Haemolysis (LDH)
Elevated Liver (ALT AST)
Low Platelet
21
Q
Placenta praevia management
A
If bleed:
Admit
Steroids 24-36th week
Delivery (C section)
22
Q
Placental abruption symptoms
A
Severe abdominal pain
Vaginal bleeding
Tense rigid abdomen
23
Q
Risk factors for placental abruption
A
Hypertension
Smoking
Cocaine
Multiple pregnancy
24
Q
Placental abruption management
A
Delivery
25
Placenta praevia - where does placenta attach?
Deep into myometrium
26
1* post partum haemorrhage causes
```
4 Ts
Tone
Trauma
Thrombin
Tissue (retained)
```
27
Preventing PPH routine
Prophylactic uterotonics
1st IM Oxytocin
2nd IM Syntometrine (if high risk)
+ Tranexamic acid
28
IM Syntometrine contraindications
HTN
29
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
```
30
First stage of labour rate
1cm - 2h
31
2nd stage of labour length
Nulliparous: 3h
Multiparous: 2h
32
Membrane sweep
Trying detach the membranes from inner cervix - 40+ weeks
33
Induction of labour
```
Membrane sweep
24h later: prostaglandin pessary
Prostaglandin gel/tablet
Artificial rupture of membranes
Syntocinon
```
34
1st stage latent dilatation rate
0-3cm /6h
35
1st stage active length
3-10cm
| 1cm/hr
36
Antibodies in haemolytic disease of a newborn
IgG
37
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
38
Kleihauer test
Quantifies how much foetal blood is in maternal circulation
39
Hyperemesis gravidarum
>5% weight loss
Electolyte disturbance
Dehydration
PUQE sforę
40
Antiemetics in pregnancy
1) cyclizine, prochlorperazine, promethazine, chlorprimazine
| 2) metoclopramide, domperidone, ondasetron
41
Ectopic - expectant management
No pain
< 35mm
No heartbeat
hCG < 1000
42
Ectopic - Medical management
PAIN
< 35mm
hCG < 1500
No heart beat
IM METHOTREXATE
43
Ectopic - surgical management
PAIN
> 35 mm
hCG > 5000
Salpingectomy / salpingotomy
44
Threatened miscarriage
Heartbeat
Pain, bleeding
Os closed
45
Inevitable miscarriage
No heartbeat
Pain, bleeding
Os Open
46
Incomplete miscarriage
Retained products of conception
Pain, bleeding
Os Open
47
Complete miscarriage
Empty uterus
| Closed Os
48
Missed miscarriage
No heartbeat
| Asymptomatic
49
Miscarriage Medical management
Vag misoprostol
Pain relief
Antiemetic
50
Surgical management of miscarriage
Manual vacuum aspiration
Surgical management
51
Antiphospholytic syndrome triad
Recurrent miscarriage
Thrombocytopenia
VTE
52
Antiphospholipid syndrome screen
Lupus anticoagulant
| Anticardioliptin antibodies
53
Medical TOP
Mifepristone
Misoprostol
+ >22 feticide
54
Surgical TOP <14 w
Vacuum aspiration
55
Surgical TOP 14-24 weeks
Dilation and Evacuation
56
Complete mole
Sperm + empty egg = 46XX
57
Partial mole
2x sperm + egg = 69 XXY
58
Depot - characteristics
Weight gain
Slow return to fertility
Every 12-14 weeks
59
COCP
Prevents ovulation
Makes period lighter
Quickly reversible
60
POP
Thickens mucus
Irregular period
Small window for taking
61
Hormonal coil
Lasts 3-5 y
Thins endometrium
Lighter, less painful period
62
Copper coil
Work immediately
Makes period more heavy
5-10 y
Sterile inflammation
63
Implant
Prevents ovulation
3 years
Irregular period
64
Patch
Weekly 3 weeks, 1 week off
Skin sensitivity
Similar to COCP
65
Kallman syndrome
- hypogonadotrophic hypogonadism
| - reduced or absent sense of smell (anosmia)
66
PCOS
PCOS on USS >12 cysts in 1 ovary
Hyperandrogenism
Anovulation
67
Estrogen only
-> endometrial cancer
68
HRT
VTE
STROKE
BREAST CANCER
69
Clomiphene
Stimulates egg release in PCOS to improve fertility
| metformin also improves fertility
70
Diagnosis of premature ovarian insufficiency
2x FSH >30
| 4-6 weeks apart
71
Ovarian cancer symptoms
Bloating
Constipation
Urination trouble
PM
72
Ovarian cancer diagnosis
CA 125
73
Endometrial cancer diagnosis
TVUSS >4mm suspicious
Hysteroscopy biopsy
Mx: high dose progesterone
74
Cervical cancer symptoms
Postcoital bleeding
| Intermestrual bleeding
75
Cervical cancer diagnosis
HPV 16/18
| Check for CIN Cervical Intraepithelial Neoplasia
76
HPV -
Routine screening in 3 years
77
HPV +
| Normal CIN
Re test in 1 year
78
HPV +
| Abnormal
Invite for colposcopy
79
PID treatment
IM Ceftriaxone STAT 500mg
PO Docycycline 100mg BD 14d
PO Metronidazole 400mg BD 14d
80
PID management in penicillin allergy
PO Ofloxacin + Metronidazole 14d
81
Urge incontinence management
1) bladder retraining 6w
2) oxybutynin, tolterodine
3) mirabegron (b3 agonist)
4. SNS, botox, PTNS
82
Stress incontinence management
1. Pelvic floor exercise 3 mth
| 2. Duloxetine SNRI
83
Syphilis in pregnancy
FGR
| Mx IM Benzathine Penicillin
84
VZV in pregnancy
Neonatal varicella - cutaneous scarring, FGR, Limb hypoplasia
85
+HPV management
Cytology
Abnormal: colposcopy
Normal: 12mth test
86
If +HPV and cytology normal at 12 month follow up
Repeat in 12months
87
If +HPV and cytology abnormal at 12 month follow up
Colposcopy
88
Inadequate sample cytology
1x return in 3 mth
| 2x colposcopy
89
<20 w pregnant exposure to VZV
Check varicella antibodies
| If negative, IVIG in 10 days
90
<20 w pregnant with VZV
Aciclovir
91
>20 weeks pregnant with VZV
Acyclovir within 24h of rash
92
>20 weeks pregnant with VZV exposure
If not immune: give VZIG or acyclovir 7-14 days post exposure
93
HSV in pregnancy
1-2nd term: acyclovir from 36w
3rd term: acyclovir until delivery
1st ever episode in 3rd term: C Section
94
HIV in pregnancy
Check viral load 2-4 weeks
And at 36w
Vaginal if <50 at 36w
95
C section in HIV pregnancy
```
IV zidovudine (+ART to everyone as usual)
Avoid breastfeeding
```
96
Hep B in pregnancy
Vax + HBIG in 12h
| Vax at 1 month, 6 months
97
Core symptoms of depression
Low mood
Anhedonia (usual things don’t bring happiness)
Lack of energy
- for at least 2 weeks
98
Beck’s triad
Hopeless
Worthless
Helpless
99
High risk of suicide
```
Anticipation acts
Preventing discovery
Careful planning
Suicide note
Violent method
```
100
GAD Mx
GAD must be >6mth
High dose SSRI
Benzodiazepines
101
OCD management
Exposure and Response Prevention
Or
SSRI
or after 12 weeks, Clomipramine, or alt SSRI
102
Schizophrenia triad
Auditory hallucinations
Abnormal thoughts
Delusions
103
Auditory hallucinations
Thought echo
3rd person voice
Running commentary
104
Abnormal thoughts
Thought insertion / withdrawal / broadcasting
105
Delusions
False fixed belief held despite evidence
106
Paranoid schizophrenia
Delusions and hallucinations
107
Hebephrenic schizophrenia
Disorganised mood, inappropriate, childlish
108
Catatonic schizophrenia
Psychomotor disturbance
| Stupor, rigidity, flexibility
109
Simple schizophrenia
Only negative symptoms: social withdrawal, blunted affect
110
Typical antipsychotics SEs
Acute dystopia
Tardive dyskinesia
Akathisia
Parkinsonism
111
Typical antipsychotics examples
Haloperidol
| Chlorpromazine
112
Treatment resistant schizophrenia
2 drugs failure
At least 6 weeks
At least 1 atypical
113
Treatment resistant schizophrenia drug & SEs
Clozapine
| __AGRANULOCYTOSIS
114
Personality disorder treatments
Dialectical behavioural therapy
| SSRI, antipsychotic
115
Capacity assessment
Understand / retain / weigh/ communicate
116
Section 135
Police enters premises with social worker warrant, move to a płace of safety for 72h
117
Section 136
Police removes from public space, no warrant, 24h
118
Section 2
Assessment and treatment
28days
Can’t be renewed
2 drs (GP, AMHP) and social worker
119
Section 3
Treatment order
6m
2 doctors
Social worker needs relative approval (can disagree)
120
Section 4
Assessment in emergency
72h
1 AMPH
121
Section 5.2
Detention of inpatient for 72h
| By doctor
122
section 5.4
Detention of inpatient by nurse for 6h
123
HAD
Hospital anxiety and depression
124
PHQ9
Patient health questionnaire (screening, diagnosing, severity of depression)
125
Social anxiety disorder
Fear of being critisized and judged
126
Agoraphobia
Fear of being unable to return to safe place
127
GAD
Symptoms for 6 mth
128
OCD
Exposure and response prevention
129
Positive symptoms (schizophrenia)
Delusions
Hallucinations
Disorganised speech
Catatonic behaviour
130
Negative symptoms
Blunted affect
Alogia - can’t speak
Anhedonia - no enjoyment
Avolition - lack of motivation
131
Persecutory delusion
Persistent false belief that you are about to be harmed
132
Paranoid delusions
Fear and anxiety and can’t tell what is real and what is not
133
Delusions of reference
Unrelated external world events have significance in patient
134
Type 1 bipolar
Mania + depression
135
Type 2 bipolar
Hypomania + depression
136
Cyclothymic disorder
Hypomanic + depressive most of the time for 2 years
137
Binge eating
>1x week for 3 months
| No purging
138
Bulimia
>1x a week for 3 months binge eating with purging
139
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?
```
140
Alcohol units
Litres x %
141
Alcohol withdrawal
Early - agitation sweating nausea
Late 24-48h confusion diarrhoea
Seizures peak at 36h
48h-72h delirium
142
Wernicke - triad and Mx
Nystagmus/ophthalmolegia, ataxic gait, confusion
| Mx Thiamine
143
Korsakov syndrome
Wernickes triad + amnesia, confabulation
144
Paranoid personality disorder
Sensitive to criticism
| Suspicion and conspiracy
145
Schizotypical personality disorder
Magical thinking
| Odd speech
146
Schizoid personality disorder
Lack of emotion
Lack of interest in others
No relationships and friends
147
Antisocial personality disorder
Going against social norms and law
| Lying/fighting/ running naked
148
Borderline personality disorder
Unstable relationships
Self harm
Mood swings
Switching from ideal to devalued
149
Histrionic personality disorder
Needs attention
Shallow
Dramatising
Sexually inappropriate
150
Narcissistic personality disorder
Grandiose self importance
Takes advantage of others
Arrogant
Need for attention
151
Avoidant personality disorder
Fear of criticism or embarrassment
| Social isolation but wanting acceptance
152
Dependent personality disorder
Needs to be cared for
Other need to take control of their lives
Desperate need for relationships
153
Obsessive compulsive personality disorder
Vs OCD- OCPD seek pleasure in tasks
Perfectionist
Occupied by rules and rituals
154
Serotonin syndrome
Too much serotonin
Fever, HYPER reflexes, myoclonus, DILATED PUPILS
- HOURS -
155
Neuroleptic malignant syndrome
- DAYS-
Fever, HYPO reflexia, RIGID
CK high
156
Septal haematoma mx and risk
Incise and drain in 24h
-> saddle shaped deformity
157
BPPV
| Examination and Mx
Episodic <30s on head movement
Dix-Hallpike manoeuvre
Epley manouvre
158
Otitis externa
Accitic acid
| Fusidic acid
159
Otitis media
Amoxicillin
160
Cystic hygroma
Posterior triangle
<2 yo
Fluctunant
161
Branchial cyst
Anterior triangle
Young people & children
Fluctuant
Radiating
162
Most common thyroid cancer
Papillary - orphan cells, lymphatic spread
Follicular - >50yo, haematology
Medullary - calcitonin, Men 2a/ 2b
163
Laryngeal cancer
SCC
HPV 16, 18
Abnormal voice, sore throat, ulceration and cancer
164
Chalezion
Painless eyelid cyst of meibomian gland
165
Hordeolum
Infected cyst of meibomian gland
PAINFUL
Tx chloramphenicol
166
Blepharitis
Mild bacterial eyelid margin, erythematous and crusty eyelid margins, uncomfortable
Tx warm compress, chloramphenicol
167
Viral conjunctivitis cause
Adenovirus
168
Bacterial conjunctivitis
Staph aureus
169
Bacterial keratitis
Staph aureus
170
Viral keratosis
HSV
rf: immunosuppressive
Dendritic ulcer on fluorescent stain
171
Acanthamoeba
Contact lenses
Ring infiltrate
Disproportional pain
172
Diabetic retinopathy
Gradual vision loss
| Micro aneurysm, hard exudate, blot haemorrhage, cotton wool spots
173
Ectopic pregnancy risk
Previous ectopic
PID
assisted conception
Previous pelvic surgery
174
DCML
Ascending
| Fine touch, propritocention
175
Nephritic syndrome
```
Increased PCR
IgA Nephropathy
Post Strep Glomerulonephritis
Haemolytic Ureamic Syndrome
Henoch-Schonlein Purpura
SLE
```
176
Nephrotic syndrome
Proteinuria, hypoalbuminaemia, oedema
Minimal Change Disease
FSGS
Membranous Glomerulonephritis
177
Tetralogy of fallot
Pulmonary stenosis
VSD
overriding aorta
Right ventricular hypertrophy
178
Onset of cyanosis in bebos
In days: TGA
| in months: TOF
179
TGA Xray
Egg on a string
180
TOF Xray
Boot shaped heart
181
ASD
Ejection systolic murmur
| Left sternal edge
182
VSD
Pansystolic murmur
| Left sternal edge
183
AVSD
pulmonary hypertension
| Down syndrome
184
PDA
machinery murmur below left clavicle
| Indamethasin/ Nsaid
185
Anaphylaxis
IM adrenaline 1:1000
5 min later IM adrenaline 1:1000
Adrenaline infusion
186
DKA and dehydration pH
pH > 7.1 = 5% loss
| pH < 7.1 = 10% loss
187
Total fluid deficit volume
%deficit x weight x 10
Over 48h
188
Maintenance fluids paediatrics
0-10kg 100mL/kg
10-20kg 50mL/kg
>20kg 20mL/kg
189
Status epilepticus
IV lorazepam /rectal diazepam, buccal midazolam
10min IV lorazepam
Phenytoin infusion
GA
190
Generalised seizure mx
Sodium valproate
| Lamotrigine
191
Focal seizure mx
Lamotrigine
192
Absence seizure
Ethosuximide
193
ADHD Mx
Methylphenidate
Lisdexamphetamine
-> may impair growth (hight weight ecg)
194
Pyloric stenosis treatment
Ramstedt pylorymyotomy
195
Constipation paeds
Movicol (draw water into intestine)
Senna (stimulant laxative, intestine contractions)
If impaction:
Movicol on 2 week escalation dose + Senna
196
Bulk forming laxative
Fybrogel
197
Osmotic laxative - draws water to intestine
Movicol
| Lactulose
198
Stool softener
Glycerol
| Docusate
199
Stimulant laxative - augment contractions
Senna
| Bisacodyl
200
Intussuception
red currant jelly stool
Sausage shaped mass
Dx USS, AXR
Mx Rectal air insuflation, surgery
201
Jaundice 24h - 14d
Breast milk
Bruising / traumatic birth
RBC breakdown
202
Jaundice <24h
Rhesus incompatibility
ABO incompatibility
G6DP deficiency
Pyruvate Kinase deficiency
203
Jaundice >14d
Biliary atresia
Congenital hypothyroidism
Neonatal hepatitis
204
Transcutaneous bilirubin
Jaundice >24h
| Born >35w
205
Serum bilirubin
Jaundice <24h
| Born <35w
206
Hearing tests
Otoacoustic test
| Adutiroty brainstem response test
207
Meningitis in HIV
Cryptococcus neoformans- india ink stain
208
HIV diarrhoea
Cryptosporidium
209
Fever followed by maculopapular rash
Roseola infantum
| HHV6
210
Itchy red papular lesions between toes and fingers
Scabies
| Sarcoptes scabies
211
Bilateral malar erythrema
Slapped cheek syndrome / fifth disease
| Parvovirus B19
212
Widespread erythrema and tenderness, desquamation
Scalded skin syndrome
| Staphylococcus
213
Painful lesions on hands, foot, month
Coxsackie virus
214
Erythrematous pustules with yellow crust
Impetigo
| Staph aureus
215
Blueberry muffin rush
Rubella
216
Cancer that metastasises to bone
```
BLT Kocher Pickle
Breast
Lung
Thyroid
Kidney
Prostate
```
217
Homonymous hemianopia - congruous defect
Optic radiation or occipital cortex
218
Homonymous hemianopia - incongruous defect
Optic tract
219
Homonymous hemianopia - macula sparing
Occiptial cortex
220
PPROM sign
Pooling of water in posterior vault
| Do FIBRONECTIN test
221
Praeder Willi
```
Eating everything
Overweight
Short stature
Hypotonia
Delay
```
222
Eosinophilic granulomatosis with polyangitis
Asthma
Bilateral nasal polyps
Nasal obstruction
223
Painless red eye in autoimmune conditions
Episcleritis
224
Painful red eye in ankylosing spondylitis
Anterior uveitis
225
Ewing sarcoma
MRI large mass with necrosis
| Small blue round cells on E&H
226
Frontal lobe seizure
Jacksonian movement
227
Limited systemic sclerosis ab
Anti centromere
228
Doffuse systemic sclerosis ab
Anti scl 70
229
Brocas area
EXPRESSIVE
230
Wernickes area
Receptive
231
Turner syndrome Heart problem
1st Bicuspid valve
| 2nd is coarctation of aorta
232
Hearing tests in newborn
Evoked otoacoustic emission
| Automated auditory brainstem resoinse
233
NEC
Ceftriaxone and Vancomycin
234
Neonatal jaundice bilirubin check
Serum bilirubin in jaundice >24h and born <35 weeks
Transcutaneous bilirubin in jaundice >24h and >35 weeks
235
Bebo sepsis abx and cause
Benzyloenicillin + gentamycin
<72h leisteria monocytogenes, GBS
>72h staphylococcus epidermis
236
Neonatal meningitis tx
Penicillin + cegtriaxone/cefotaxime
237
GBS
Mother; benzylpenicillin
| Bebo: benzylpenicillin + gentamycin/ceftriaxone
238
Hep B treatment
Tenifovir
239
Threadworms tx
Mebendazole
240
Drug for induction of ovulation
Clomiphene
241
When is anaemia checked in pregnancy?
Booking and 28w
242
Hb levels in pregnancy
1st 110
2nd 105
3rd 100
243
Ovarian cancer risk factors
many ovulations
Early menarche
Late menopause
Nullparity
244
Endometrial cancer
```
Many ovulations
Obesity
Early menarche
Late menopause
Nullparity
```
245
DCML
ascending
| Fine touch and proprioception
246
Corticospinal
Descending
| Motor
247
Spinothalamic
Ascending
| Pain and temperature
248
TIA onset <1w
Refer same day
| 300mg aspirin
249
TIA onset >1w
1 week wait referral
| 300mg aspirin
250
TIA pharmacotherapy
300 mg aspirin for 14 days
| 75mg aspirin + clopidogrel + statin later
251
Bell’s palsy
HSV1
252
Ramsey Hunt Syndrome
HZV
253
Post seizure management
2ww Neurology
6m No driving & DVLA notification if idiopathic
12 m if diagnosis or abnormality
254
Focal seizure
Carbamazepine
| Lamotrigine
255
Generalised seizure
Sodium valproate
| Lamotrigine
256
Absence seizure
Ethosuxamide
257
Subarachnoid haemorrhage
Berry aneurysm
258
Extradural haemorrhage
Trauma to pterion
| Convex not crossing sutures
259
Subdural haemorrhage
Concave
Crossing sutures
Bridging veins
260
Syphilis
```
Painless ulcers
1* chancre
2* condylomata lata
3* gummatous lesions
Tx IM benzylphenicillin
```
261
Genital herpes
Flu-like symptoms dysuria fever PAINFUL ulcers
HSV 1 oral
HSV 2 genital
Mx: Acyclovir
262
Genital warts HPV strain
6,11
263
Genital warts tx
Multiple - topical podophyllum
| Single - cryotherapy
264
HPV cancer
16, 18, 33 - cervical cancer
265
Alzheimer mx
Mild-Moderate: donezepil, gantamine, rivastigmine
| Severe: memantine
266
Dobezepil SE
Do not give in bradycardia
| Causes insomnia and weight gain
267
SLE Derm involvement
Oral ulcers
268
Glioblastoma multiformae
Young person
Space occupying lesion
Crosses midline
269
Prosthesis septic arthritis
Staph epidermidis
