Extra Flashcards
Management of childhood vulvovaginitis
Hygiene advice
Soothing creams
Topical antibiotic/antifungal
Oestrogen cream if resistant
Delayed puberty in female =
No breast development at 13y
Normal breast development but no menses 15y
Diagnosis of head lice
Live lice seen
Genital lichen sclerosis
Vulval itch, pain
Dyspareunia
White atophy
Never inside vagina
1st line for vulval lichen sclerosis
Very potent steroid OD 4 weeks
Taper to twice-weekly
2nd line for vulval lichen sclerosis
Refer gynae/derm (risk of vulval carcinoma)
All referrals for breast symptoms should be seen within
2 weeks
1st line management of cyclcical breast pain
Supportive bra
Analgesia
Consider referral of cyclical breast pain to 2 care if:
Affecting QOL/sleep
Present after 3m 1st-line measures
Blood test after vitamin D replacement
Adj calcium 1 month after starting Vit D
hyperparathyroidism
Best option for nicotine replacement in pregnancy
Gum/lozenges over patches
Congenital abnormalities seen with sodium valproate
NTD
Urinary trac malformation
Cleft palate
Congenital abnormalities seen with phenytoin
Cardiac malformation
Cleft palate
Congenital abnormalities seen with phenobarbital
Cardiac malformation
Congenital abnormalities seen with carbamazepine
Cleft palate
AEDs with lowest risks of major congenital abnormalities
Lamotrigine
Carbamazepine low-dose
In pregnancy, abdominal pain before light bleeding:
Ectopic pregnancy
Annual asthma monitoring in >=5y
Spirometry/PF variability Exacerbations Nocturnal symptoms Adherence + plan Smoking exposure
Annual asthma monitoring in <5y
Childhood asthma control test/
Asthma control questionnaire
Growth
Best psychotherapy for medically unexplained symptoms
CBT
Young schizophrenics need physical health check
Annually
Screening tool for social anxiety disorder
Mini-Social Phobia Inventory (Mini-SPIN)
DVLA + elective angioplasty
1 week off
DVLA + CABG
4 weeks off
DVLA - ACS treated successfully by angioplasty
1 week off
DVLA - ACS (not treated successfully by angioplasty)
4 weeks off
DVLA - angina
Cannot drive if at rest/at wheel
DVLA - pacemaker insertion
1 week off
DVLA - ICD implanted due to sustained ventricular arrhythmia
6 months off
Group 2 ban
DVLA - ICD implanted prophylactically
1 month off
Group 2 ban
DVLA - successful ablation
2 days off
DVLA - aortic aneurysm >6cm
Notify DVLA, annual review
>6.5cm cannot drive
DVLA - heart transplant
6 weeks off, no need to notify
CAA - Flying after MI (no complications)
after 7-10 days
Return to heavy work after MI
after 12 weeks
Accuracy of a test
(TP + TN) / (TP + FP + TN + FN)
Principle of Middle ground research
Focusing healthcare on the needs and goals of patients
Prospective observational study
Follows groups of different exposure, to monitor for disease incidence
Cohort study
Calculates relative risk
Retrospective observational study
Groups with different disease status, analysed for exposure
Case-control study
Calculates odds ratio
Crossover study
Each subject receives treatment + placebo in random order
Crossover study is appropriate for
Symptomatic treatments in chronic disease
Cross-sectional study
Describe characteristics of a population, at one point in time.
Current UK state pension age
66y
Qualitative study
Non-numerical data
1 finger-tip unit =
0.5g
1 finger-tip unit covers:
Both palms (adult)
Actinic keratoses self-resolve in:
25%
Treatment options for actinic keratoses - individual lesions
5-FU (+/- salicylic acid)
Cryotherapy
Treatment options for actinic keratoses - small area of field change
5-FU (+/- salicylic acid)
Imiquimod 5%
Photodynamic therapy (PDT)
Treatment options for actinic keratoses - large area of field change
3% diclofenac gel
Imiquimod 3.75%
Form for statutory paternity pay
SC3 form
CRVO
Widespread haemorrhages
Disc oedema
May be RAPD/retinal detachement
Tuberous sclerosis inheritance
Autosomal dominant
Hungtington’s Chorea inheritance
Autosomal dominant
Hunter disease inheritance
X-linked recessive
Spontaneous (neither parent has disease) X-linked recessive disorders only occur in:
Males
except Turner’s syndrome
X-linked recessive traits cannot be passed
From father to son
“25% chance of affected son”
X-linked recessive
“50% chance of affected child”
Autosomal dominant
“25% chance of affected child”
Autosomal recessive
Indication for treatment in CLL
Symptomatic
Hepatosplenomegaly
Anaemia
Lymphadenopathy
Neuropathic pain relief to avoid in severe liver disease
Amitriptyline
EOL care - oxycodone can be given down to GFR
eGFR 10
Head injury - refer to ED if:
GCS <15 LOC Focal neurology Sign of skull fracture Persistant headache Vomiting Seizure High-energy injury Previous neurosurgery Bleeding disorder/anticoagulation Intoxicated Safeguarding concern Ongoing clinical concern
Subcutaneous lump at insulin injection site
Lipodystrophy Cutaneous amyloidosis (risk of hypos when switching area)
Insulin dose in pregnancy, frequently needs:
Increase in 2nd/3rd trimesters
Refer diabetes specialist
Insulin dose in breastfeeding
Refer diabetes specialist
Insulin in hepatic impairment
May need decreased dose
Insulin in renail impairment
Greater risk of hypo
Adult on insulin - target 24-hr blood glucose range
4 - 9 mmol/l
Adult on insulin - target blood glucose range pre-meal
4 - 7 mmol/l
Adult on insulin - target blood glucose range after meals
<9 mmol/l
Child on insulin - target 24-hr blood glucose range
4 - 10 mmol/l
Child on insulin - target blood glucose range pre-meal
4 - 8 mmol/l
Child on insulin - target blood glucose range after meals
<10 mmol/l
Patient input in fixed-dose insulin regime
Regulate carb intake to match insulin regimen
Patient input in variable/multiple injection insulin regime
Adjust insulin dose according to carb intake
Can diagnose T1DM clinically in adult if random glucose >11 and 1+:
Ketosis Rapid weight loss Onset <50y BMI <25 PMH/FH AI disease
Diagnosed T1DM in adult
Same-day referral
T1DM should be suspected in child if hyperglycaemia and:
Polyuria
Polydipsia
Weight loss
Excessive tiredness
Suspect T1DM in child?
Same-day referral for diagnosis
If symptomatic, can diagnose T2DM in adult if:
HbA1c >= 48 (6.5%)
Fasting glucose >7.0
Persistent hyperglycaemia - random glucose
> 11
Humalog (insulin lispro)
Rapid-acting
Novorapid (insulin aspart)
Rapid-acting
Actrapid
Short-acting
Rapid-acting insulins
Onset 15 min
Last 2-5hr
Short-acting insulins
Onset 30-60min
Last 8hr
Humulin S
Short-acting
Intermediate-acting (Isophane) insulins
Max effects 3-12hr
Last 11-24hr
Long-acting insulins
Last up to 24hr
Humulin I
Intermediate-acting
Insuman Basal
Intermediate-acting
Insulatard
Intermediate-acting
Lantus (insulin glargine)
Long-acting
Levemir (insulin detemir)
Long-acting
Tresiba (insulin degludec)
Long-acting
Xultophy
Insulin degludec + liraglutide combo
Basal-bolus regime
Rapid/short-acting before meals
+
1+ intermediate/long-acting /day
Biphasic/mixed regime
1-3 injections/day of combo:
short/rapid + intermediate
Continuous sc insulin infusion/pump
Continuous infusion of rapid/short acting insulin
1st choice regime for T1DM
Basal-bolus with:
BD detemir
rapid-acting pre-meals
Covid anti-viral pathway criteria:
Symptoms <5d (P, S, M) or <7d (R)
LFT/PCR +ve
High-risk
No new O2 requirement
1st-line ‘anti-viral’ for high-risk covid (non-hospitalised)
nirmatrelvir/ritonavir
sotrovimab (nMAB)
2nd-line anti-viral for high-risk covid (non-hospitalised)
Remdesivir
3rd-line anti-viral for high-risk covid (non-hospitalised)
Molnupiravir
Considered high-risk in COvid
Down's Cancer Chemo <3/m Stem cell/organ transplant eGFR <30 Cirrhosis Immunodeficiency On certain immunomodulators High risk HIV MS MND Myasthenia gravis
1st-line covid ‘antiviral’ (if required) in 12-18y
Sotrovimab
1st-line covid ‘antiviral’ (if required) in pregnant
Sotrovimab
Post-covid syndrome
Symptoms develop during/after covid
Continue >12wk
Not explained by anything else
Acute covid
Symptoms up to 4wk
Ongoing symptomatic Covid
Symptoms 4wk - 12wk
