Extra Flashcards by Jessica Radford

Management of childhood vulvovaginitis

Hygiene advice
Soothing creams
Topical antibiotic/antifungal
Oestrogen cream if resistant

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Delayed puberty in female =

No breast development at 13y

Normal breast development but no menses 15y

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Diagnosis of head lice

Live lice seen

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Genital lichen sclerosis

Vulval itch, pain
Dyspareunia
White atophy
Never inside vagina

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1st line for vulval lichen sclerosis

Very potent steroid OD 4 weeks
Taper to twice-weekly

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2nd line for vulval lichen sclerosis

Refer gynae/derm (risk of vulval carcinoma)

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All referrals for breast symptoms should be seen within

2 weeks

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1st line management of cyclcical breast pain

Supportive bra
Analgesia

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Consider referral of cyclical breast pain to 2 care if:

Affecting QOL/sleep
Present after 3m 1st-line measures

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Blood test after vitamin D replacement

Adj calcium 1 month after starting Vit D
(hyperparathyroidism)

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Best option for nicotine replacement in pregnancy

Gum/lozenges over patches

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Congenital abnormalities seen with sodium valproate

NTD
Urinary trac malformation
Cleft palate

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Congenital abnormalities seen with phenytoin

Cardiac malformation
Cleft palate

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Congenital abnormalities seen with phenobarbital

Cardiac malformation

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Congenital abnormalities seen with carbamazepine

Cleft palate

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AEDs with lowest risks of major congenital abnormalities

Lamotrigine
Carbamazepine low-dose

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In pregnancy, abdominal pain before light bleeding:

Ectopic pregnancy

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Annual asthma monitoring in >=5y

Spirometry/PF variability
Exacerbations
Nocturnal symptoms
Adherence + plan
Smoking exposure

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Annual asthma monitoring in <5y

Childhood asthma control test/
Asthma control questionnaire

Growth

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Best psychotherapy for medically unexplained symptoms

CBT

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Young schizophrenics need physical health check

Annually

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Screening tool for social anxiety disorder

Mini-Social Phobia Inventory (Mini-SPIN)

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DVLA + elective angioplasty

1 week off

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DVLA + CABG

4 weeks off

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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