Handbook section 2b Flashcards
Common childhood rashes, Measles
Organism: Measles virus
Rashes: starts from head, spreading downwards
Other symptoms: flu-like symptoms, koplik spots
Treatment: Supportive
Common childhood rashes, Scarlet Fever
Organism: Group A streptococcus
Rashes: Fine papules, rashes at creases
Other symptoms: strawberry tongue, lymphadenopathy, flu like symptoms
Treatment: antibiotic
Common childhood rashes, Fifth disease
Organism: Human parvovirus b19
Rashes: slapped cheek rashes, pruritc lacy rashes avoiding palms and soles
Other symptoms: flu like symptoms
Treatment: supportive
Common childhood rashes, roseola
Organism: Human herpesvirus 6
Rashes: tiny papules on trunk then spreading outward
Other symptoms: high fever prior to rash, flu like symptoms
Infectious mononucleosis(mono)
usually affects teenagers and young adults
Organism: Epstein-Barr virus
Rash: fine pink rash
Other symptoms: spleen enlargment, swollen and painful liver, sore throat
Treatment: supportive, avoid contact sports
Hypertensive disorders during pregnancy
- chronic hypertension: hypertension before 20 weeks pregnancy, without a known cause.
- gestational hypertension: new onset hypertension after 20 weeks pregnancy without any features of pre-eclampsia, followed by return to normal within 3 months after the birth
- pre-eclampsia: gestational hypertension and involvement of other organ systems and/or the fetus. Proteinuria is a common additional feature
- superimposed pre-eclampsia: pre-eclampsia with chronic hypertension
Types of bilirubin
indirect/unconjugated - blood
direct/conjugated - liver
urobilinogen - reabsorbed from the intestine
Early (<40) vs Late (>40) onset schizophrenia
LOS
- worse for affective flattening and social withdrawal
- worse for systematic delusion and hallucinations
- worse for medication side effect
EOS
- worse for negative symptoms
- worse disorganized thoughts
Preseptal (periorbital) cellulitis, definition
Preseptal cellulitis is infection of the skin and subcutaneous tissues anterior to the orbital septum.
Postseptal (Orbital) cellulitis, definition
Orbital cellulitis (or ‘postseptal cellulitis’) is infection of the soft tissues posterior to the orbital septum, and poses risk of vision and life- threatening complications.
Preseptal (periorbital) and postseptal(orbital) cellulitis, back ground and red flags
BACKGROUND
- higher frequency in children
- Often occurs with sinusitis and URTI
• Pathogens: Gram positive cocci (Staphylococcus and Streptococcus species),
Haemophilus species, anaerobes
RED FLAGS
- Urgent surgical intervention may be required in cases of orbital cellulitis with sinusitis, subperiosteal abscess, intraorbital abscess, or foreign body
- Intracranial infection should be suspected with headache, nausea and vomiting, neurologic findings
- Children <4 years of age have an incomplete orbital septum and are at risk of infection from the preseptal to orbital space.
- Children who are systemically unwell
Preseptal (periorbital) cellulitis, causes
- trauma
- chalazion (oil gland)
- dacryocystitis (tear duct)
- URTI
- conjunctivitis
- endogenous seeding
Postseptal (orbital) cellulitis, causes
- sinusitis (ethmoid)
- preseptal( periorbital) cellulitis
- trauma
- dacryocystitis, dacryoadenitis
- dental infection
- facial infection
- endogenous seeding
Preseptal (periorbital) cellulitis, signs and symptoms
- systemically well
- possible fever
- inflamed, possible fluctuance in eyelid
- normal eye (function, movement, conjunctiva)
Postseptal (Orbital) cellulitis, signs and symptoms
- possibly systemically unwell
- often febrile
- inflamed and swollen eyelids
- inflamed eye
- change in vision and eye movements
Preseptal (periorbital) and Postseptal (orbital), investigations
GENERAL
- discharge swab for microscopy, culture and PCR
PRESEPTAL (PERIORBITAL) CELLULITIS
- investigations are usually not necessary
POSTSEPTAL (ORBITAL) CELLULITIS
- blood tests (FBE, UEC, LFT, CRP)
- blood cultures (if systematically unwell)
- CT scan with contrast (orbits, paranasal sinuses and brain)
Preseptal (Periorbital cellulitis), treatment
ADULTS
- Fluocloxacillin
- Penicillin hypersensitive (Cephalexin)
- Penicillin immediate hypersensitivity (Clindamycin)
CHILDREN
- Fluocloxacillin
- Penicillin hypersensitive (Cephalexin)
- Penicillin immediate hypersensitivity (Clindamycin)
Hib INFECTED CHILDREN
- amoxicillin- clavulanate
- Penicillin hypersensitive (Cefuroxime)
- Penicillin immediate hypersensitive (refer)
Postseptal (orbital) cellulitis, treatment
ADMISSION
- under OPAL/ENT team
- possible surgery
ANTIBIOTICS
- Adults (Ceftriaxone, Flucloxacillin)
Adult community acquired pneumonia, severity assessment
CORB
- confusion
- oxygenation
- respiratory rate
- blood pressure
Adult community acquired pneumonia, treatment
MILD (NO CORB)
- amoxicillin
- penicillin allergy (clarithromycin)
MODERATE (1 CORB / ADMITTED)
- benzylpenicillin + doxycyclin/clarithromycin
- penicillin allergy (ceftriaxone + doxycycline/clarithromycin)
SEVERE (2 CORB / ICU / HDU)
- benzylpenicillin + azithromycin + gentamicin
- penicillin allergy (ceftriaxone + azithromycin)
CORB
confusion
O2 sat <90%, pO2 <60mm
RR > 30
BP sys < 90, dias <60
Urethral injury, presentation
- blood at the urethral meatus
- gross hematuria
- inability to void
- absent/abnormal prostate position via DRE
- Ecchymosis/hematoma involving penis, scrotum or perineum
Urethral injury, investigation
- one gentle attempt at urethral catheterization is reasonable
- retrograde urethrogram (contraindicated for pelvic vascular injury as it may interfere with angiogram or CTA)
Type of scientific studies
Randomized controlled trials - the effect of the treatment is often compared with “no treatment” (or a different treatment)
Cohort studies - Two (or more) groups are exposed to different things and are compared with each other over a period of many years
Case-control studies - A generally retrospective comparison of people who have a certain medical condition with people who do not have the medical condition. The two groups are interviewed, or their medical files are analyzed, to find anything that might be risk factors for the disease.
Cross - sectional studies - The classic type is the survey: A representative group of people are interviewed or examined in order to find out their opinions or facts.
Qualitative studies - Information collected by talking to people who have a particular medical condition and people close to them. Written documents and observations are used too.
Common causes of GI Obstruction in children, Necrotizing Enterocolitis
NECROTIZING ENTEROCOLITIS (inflamed intestine)
Population - newborn
Presentation - abdominal distension, bilous vomiting, bloody stool
Treatment - NPO, NG tube, Antibiotics, Surgery referral
Common causes of GI Obstruction in children, Midgut volvulus
MIDGUT VOLVULUS (twisted intestine)
Population - Newborn
Presentation - abdominal distension, bilous vomiting, bloody stool
Treatment - NPO, NG tube, Antibiotics, Surgery Referral
Common causes of GI Obstruction in children, Pyloric stenosis
PYLORIC STENOSIS (semiblocked stomach)
Population - 0-6months
Presentation - projectile vomiting, olive mass RUQ
Treatment - Electrolyte correction, surgery consult
Common causes of GI Obstruction in children, Intussusception
INTUSSUSCEPTION (folded telescope intestine)
Population - 2m - 6 yrs
Presentation - bilous vomiting, bloody stool, sausage mass RUQ
Treatment - Air enema, surgery consult
Liver function test, interpretation
Direct (Conjugated) Bilirubin - Liver bilirubin
Indirect (Unconjugated) Bilirubin - Blood bilirubin
ALT - Liver cell injury
AST - Nonspecific, Alcohol (greater than ALT)
ALP - bone, intestine, liver, placenta
GGT - Hepatobiliary source
Hepatitis B Panel result
HBsAg - active infection
Anti-HBc - any exposure to Hep B virus (except immunization)
Anti-HBs - Immune
IgM anti-HBc - Acute infection
Congenital varicella, presentation
- History of maternal exposure
Incubation - 14-15 days
Infectious - 2 days before rash starts to 5 days after rash starts - skin scarring
- neurologic defects
- eye disease
- skeletal anomalies
Live vaccine contraindication
- pregnancy
- immunodeficiency
- clinical AIDS
- high dose corticosteroids
- previous anaphylaxis to any component
- recent treatment with IgG (within 3 months)
Prophylaxis and treatment options for varicella, pregnant women
PREGNANT WOMAN
- test for antibodies
- seronegative (give ZIG)
- seropositive (reassure)
- with symptoms (oral aciclovir)
Prophylaxis and treatment options for varicella, children
NEONATES (Exposed 7 days prior to delivery to within 1st month of life)
- mother has confirmed varicella (ZIG)
- uncertain maternal history/seronegative (test then if seronegative, ZIG)
- with symptoms (IV aciclovir)
PREMATURE INFANTS <28 WKS, <1KG
- ZIG
- with symptoms (IV aciclovir)
Prophylaxis and treatment options for varicella, adults
IMMUNOCOMPROMISED ADULTS
- test then if seronegative, ZIG
- with symptoms (IV aciclovir)
HEALTHCARE WORKERS
- uncertain immunity/history (test then if seronegative, Vaccine)
- if seropositive (reassign away from clinical duties if rash develops)
Early pregnancy loss, initial interventions
- resuscitate (as needed)
- speculum exam (remove any POC)
- Labs: B hCG, USS, FBC, Blood group
- as needed labs per case
Early pregnancy loss, definitive management for stable intrauterine pregnancy
EXPECTANT
INDICATIONS - patient’s choice, incomplete miscarriage
CONTRAINDICATIONS - patient instability, GTD, IUD (must remove), infection, bleeding risk
REQUIRES - 24/7 emergency contact hospital
ONGOING MANAGEMENT
- initial history and examination
- follow up after 7-10 days
repeat B - hCG (day 8)
USS (optional for possible POC retention and GTD)
Early pregnancy loss, definitive management for stable intrauterine pregnancy
MEDICAL
INDICATIONS - patient’s preference, missed/incomplete miscarriage
CONTRAINDICATIONS - patient instability, GTD, IUD(must remove), prostaglandin allergy, infection, medical contraindications
REQUIRES
- Misoprostol
- Outpatient/ Day procedure facilities
ONGOING MANAGEMENT
- follow up at days 2 and days 8
- repeat B hCG at day 1 and day 8
- USS (optional for possible retained POC or GTD)
Early pregnancy loss, definitive management for stable intrauterine pregnancy
SURGICAL
INDICATIONS - patient preference, unsuccessful prior management
CONTRAINDICATIONS - patient instability, persistent excess bleeding, infected POC, GTD
REQUIRES
- Misoprostol
- Antibiotics (optional)
- USS (optional)
ONGOING MANAGEMENT
- depend on specialist
- GP if noted ongoing concerns
JVP waveforms
A - Atrial contraction
PROMINENT - RV hypertrophy, Pulmonary stenosis/hypertension, Tricuspid stenosis
ABSENCE - Atrial fibrillation, TR
CANNON - AV block, Atrial flutter
C - Ventricular contraction
PROMINENT - TR
ABSENT - constrictive pericarditis
X - Atrial relaxation
V - Atrial venous filling
PROMINENT - constrictive pericarditis
Amaurosis fugax, definition
A painless, temporary loss of vision, in one or both eyes, that is caused by a blocked blood vessel. This is the same as having a ‘mini stroke’ or ‘transient ischaemic attack’ (TIA) in the eye.
Amaurosis fugax, investigation
- eye examination will look at the back of your eyes to check for any changes
- Blood tests to check for risk factors and to exclude inflammatory/immune disease
- Ultrasound of your carotid arteries (carotid doppler)
- Heart tracing (ECG) to look for an irregular heartbeat
- CT-scan of your brain to check for stroke
- Temporal artery biopsy if temporal arteritis is suspected.
Amaurosis fugax, treatment
- blood thinners
- cholesterol lowering medications
- no driving private (2 wks) and commercial (4 wks) vehicles
- follow up with stroke doctor, GP and eye care provider
Postpartum (postnatal/puerperal) psychosis, presentation
Onset - 2 days to 2 wks after birth (max 12 wks)
Initial symptoms
- difficulty sleeping
- restless/irritable
- feeling invincible
- strange and irrational beliefs of somebody harming the baby
Later symptoms
- combination of bipolar and psychotic symptoms
- may affect energy, thinking, behaviour and mood
Baby blues vs Postpartum depression
BABY BLUES
ONSET - 2-3days postpartum
DURATION - <10 days
SEVERITY - mild
POSTPARTUM DEPRESSION
ONSET - usually within 1 month, max 1 year
DURATION - >2 weeks
SEVERITY - moderate to severe, possible self harm
Horner Syndrome, definition
A classic neurologic syndrome whose signs include MIOSIS, PTOSIS and ANHIDROSIS. Also called oculosympathetic paresis, a Horner syndrome can be produced by a lesion anywhere along the sympathetic pathway that supplies the head, eye, and neck.
Scrotal lumps, common differential diagnosis
- HYDROCELE - build up of fluid, positive transillumination
- VARICOCELE - dilated veins, bag of worms look
- EPIDIDYMITIS - inflamed area above/behind the testicle, scrotal inflammation
- ORCHITIS - inflamed testicles, scrotal inflammation
- TESTICULAR CANCER - painless abnormality
- TESTICULAR TORSION - twisted spermatic cord, cutting off testicular blood supply
- GENITAL WARTS - a group of small bumps
Osteoarthritis
POPULATION - Both men and women, Over 60 years
SPEED - Slow duration (years)
PROCESS - degenerative, wear and tear
PRESENTATION - Asymmetric joint (weight bearing joint) pain without swelling or systemic symptoms
PHYSICAL - herberden’s nodes, bouchard’s nodes
TREATMENT - Analgesics
Rheumatoid arthritis
POPULATION - More women, 35-45 years
SPEED - within 1 year
PROCESS - chronic, autoimmune
PRESENTATION - Painful swollen symmetric small joints, with remissions, pain decreased by movement, Systemic symptoms (fatigue, joints, muscle, bone problems)
PHYSICAL - rheumatoid nodules, anemia
TREATMENT - immune suppressant, analgesics
Gout
POPULATION - 35 yr old Men and postmenopausal women
SPEED - Sudden
PROCESS - metabolic disease (uric acid)
PRESENTATION - Asymmetrical swollen and extremely painful (big toe>ankle>heel..others), systemic symptoms (fatigue, chills, fever)
PHYSICAL - tophi
TREATMENT - analgesics, colchicine, steroids, urocosuric
Psoriasis
DEFINITION - A usually familial Inflammatory condition of the skin, nails and joints that produces red scaly itchy patches
TRIGGERS - infection, lithium, beta blockers, NSAID and antimalarial medication
TREATMENT - coal, immune suppressants, UV light
Hearing loss and dizziness, differentials
Acoustic Neuroma - Hearing loss (initial)
Meniere’s diseases/Otosclerosis - Dizziness, Hearing loss
Labirinthitis - Dizziness, Hearing loss, History of infection
Vestibular neuritis - Dizziness, History of infection
BPPV - Dizziness
Shingles
Systemic symptoms 2 days prior to the localized painful rash lasting 10-15 days.
Diagnosis is based primarily on the history and physical findings. In most cases, confirming the diagnosis via laboratory testing has no utility.
Treatment
CONSERVATIVE
dressing, lotion, pain relief (Analgesic, neuroactive agents, anticonvulsants)
OPTIONAL
within 72 hrs of symptom onset only- antiviral
no solid proof - steroid
Small vs Large bowel obstruction, common presentation
SMALL BOWEL OBSTRUCTION
- upper abdomen or periumbilical cramping
- vomiting
- no BM
- diarrhea (partial)
LARGE BOWEL OBSTRUCTION
- cramps in lower abdomen
- constipation
- bloating
Bowel obstruction, causes
- adhesions
- tumours
- hernias
- inflammatory bowel disease
- volvulus (twisted bowel)
- intussusception (telescoping bowel)
- foreign body
- severe constipation
Factors that require urgent (2 wks) referral for chest CT scan and lung cancer specialist
- persistent unexplained hemoptysis
- signs of superior vena cava obstruction
- high clinical suspicion of lung cancer
- imaging findings suggestin lung cancer
GP investigations for lung cancer
- History and physical exam
- Chest xray - for persistent symptoms more than 3 wks, for high risk patients, If 3rd wk chest xray is normal but symptoms persist then repeat chest xray at wk 6
- Chest CT scan with contrast
- if strong clinical suspicion of lung cancer
- unexplained and persistent hemotysis
- superior vena cava obstruction
- other imaging studies suggestive of lung cancer
Morning after pill
LNG-ECP
- single dose levonorgestrel
- used up to 3 days after sex, follow up after 3 weeks
- contraindicated in pregnancy, vaginal bleeding, breast cancer, hypersensitivity to the drug
UPA (Ellaone)
- single dose ulipristal actetate
- used up to 5 days after sex
- contraindicated in pregnant, allergic to the drug
SIDE EFFECTS
- nausea
- sore breasts
- headache
- abdominal pain
- dizziness
Alcoholic hallucinosis, presentation
- history of chronic alcohol abuse
- auditory hallucinations (third person, derogatory, command)
- paranoid symptoms
Common causes of dysphagia
NEUROLOGIC
Stroke
Head Trauma
Parkinson’s Disease - dopamine decrease leading to systemic slowdown
Motor neurone disease (MND)
Dementia
Cerebral palsy
ANATOMIC
Achalasia
Tumors
Facial Trauma
OESOPHAGEAL PROBLEMS
GERD
Dysphagia investigations
- Barium swallow
- Endoscopy
- Muscle testing (Manometry)
- CT scan
- MRI scan
Oesophageal achalasia, treatment
- Botox Injection – works in about 60% of patients, but only works temporarily and it creates scarring (last temporary resort)
- Pneumatic (Balloon) Dilation – usually needs repeating 2-3 times. Each time there is a 1% chance of rupturing the oesophagus, therapy is not as effective beyond 3-5 years as other procedures
- Laparoscopic Heller Myotomy – takes about 1 1/2 hrs and requires a 2 day hospital stay, best known results (15-20 years)
- Per Oral Endoscopic Myotomy (POEM) – takes longer to perform, Long term outcomes are not as well known, preferred therapy in patients with a very complex disease and recurrent or persistent symptoms
Common causes of upper gastrointestinal haemorrhage
- peptic ulcer disease
- gastric erosions
- Varices
- emetogenic injury (Mallory-weiss tear)
- Malignancy
- Angiodysplacia (tortuous dilated small blood vessels)
Giant cell arteritis (temporal arteritis), presentation
- An ocular emergency, it is a systemic vasculitis affecting medium and large arteries
- systemic inflammation symptoms
- Acute vision loss
- Amaurosis fugax
- Diplopia
- Ocular pain
Giant cell arteritis (temporal arteritis), management
INVESTIGATION
- ESR, CRP, FBE, UEC, LFT (initial
- biopsy ( per consultant)
TREATMENT
- if highly suspected initiate treatment as other eye may become involved with 1-7 days
- steroids
Deep vein thrombosis, definition
A blood clot that occurs in a deep vein that causes pain and swelling in the affected area; It can occur anywhere, but is most often seen in the leg.
Deep vein thrombosis, red flag
- short of breath
- chest pain
- tachycardia
- feel dizzy or faint
- cough up blood
Deep vein thrombosis, management
INVESTIGATIONS
- ultrasound
- D-dimer
- CT scan
TREATMENT
- anticoagulant medication
Menstrual cycle hormones and sources
Luteinizing hormone (pituitary) - stimulates egg growth and release, increase with pregnancy
FSH (pituitary) - stimulates egg growth and release, decrease with pregnancy
Estrogen (ovary/adrenals/fat) - stimulates egg release, builds up uterine lining, increase with pregnancy
Progesterone (corpus luteum/open egg sac) - builds up uterine lining, increase with pregnancy
Pneumothorax, investigation
- Bedside ultrasound
- Standard erect inspiratory PA CXR
- Ct scan
Pneumothorax, treatment
PRIMARY
1. Observation (small/asymptomatic)
2. needle aspiration (large/symptomatic)
3. repeat cxr
SECONDARY
1. needle aspiration (small/asymptomatic)
2. small bore chest drain (large/symptomatic)
Small - <2cm, <25%
Polymyositis vs Polymyalgia rheumatica
Polymyositis is an inflammatory, destructive, autoimmune muscle disease, usually with WEAKNESS but unusually with pain.
Polymyalgia rheumatica is an inflammatory disease of muscle that always causes symmetrically PAINFUL muscles. Polymyalgia rheumatica is not destructive to muscles.
Anticoagulant antidotes
Heparin - protamine
Warfarin - Vit K
NOAC - pro-haemostatic agents, dialysis
Pathologic correlate of respiratory distress syndrome
Hyaline membrane disease
Melanotic freckle of hutchinson, definition
Otherwise known as lentigo maligna melanoma, when left untreated it can eventually metastasize, so early diagnosis and intervention are crucial.
Spinal innervation landmarks
C2- back of the head
C3 - clavicle
C4 - shoulders
C5 - anterior upper arm
C6 - anterior lower arm
T1 - strip of upper and lower arm
T2 - strip of upper back to upper arm
T10 - level at umbilicus
S1 - lower back leg, little toe
S2 - upper back leg
S3 - outer ass/ dick
S4 - inner ass/ scrotum
L1 - strip with inguinal triangle
L2 - Anterior thigh
L3 - knee
L4 - medial lower leg
L5 - Anterior foot
Acute rheumatic fever, epidemiology
Predominantly affects
Aboriginal and Torres Strait Islander
children aged 5–14 years
living in regional and remote areas of central and north Australia.
Occurs 10 days - 6 weeks after the streptococcal infection
Initial episode of Acute rheumatic fever, criteria
2 major
or
1 major + 2 minor
evidence of group a streptococcus infection
Recurrent attack of acute rheumatic fever, criteria
2 major
or
1 major + 2 minor
or
3 minor
evidence of past GAS infection
ARF major manifestations
Carditis (including subclinical evidence of rheumatic valve disease on echocardiogram)
Polyarthritis or aseptic mono-arthritis or polyarthralgia
Sydenham chorea
Erythema marginatum
Subcutaneous nodules
ARF minor manifestations
Fever
ESR ≥30 mm/hr or CPR ≥30 mg/L
Prolonged P-R interval on ECG
Polyarthralgia or aseptic mono-arthritis
Oesophagogastric cancer, risk factors
Generally - Smoking, increasing age
Oesophageal adenocarcinoma - Male gender, obesity, gastro-oesophageal reflux, Barrett’s oesophagus, alcohol consumption
Oesophageal squamous cell carcinoma -
Heavy alcohol consumption, caustic injury and achalasia
Gastric cancer - Helicobacter pylori bacteria, previous partial gastrectomy (especially more than 20 years ago), tobacco smoking, pernicious anaemia and family history of gastric cancer
Red flag stomach symptoms
- New onset or rapidly progressive dysphagia
- Progressive/new epigastric pain persisting for more than 2 weeks
refer immediately to be seen within 2 weeks.
Gout, treatment
Goals:
1. lower to serum urate target
without tophi (<0.36mg/dl)
with tophi (<0.30mg/dl)
2. start allopurinol in acute attacks
(start low then titrate)
3. NSAIDs for adequate time periods
ACUTE FLARE TREATMENT
1st line (NSAIDs/indomethacin, colchicine 2-3 days)
2nd line (corticosteroids 5-10 days, then reduce gradually)
PROPHYLAXIS
Moderate dose of NSAIDS
- 6 months duration generally
- 3 months after reaching target urate, nontophi patients
Wilm’s tumour, definition and epidemiology
- also called nephroblastoma it is a type of kidney cancer usually found in children aged 2-3 years old, this result from nephrogenic rest cells (which usually disappear at birth)
Only causes of diastolic murmurs
APT M
AR
PR
TS
MS
Developmental milestone (shortcut)
6 weeks - social smile, eye follows objects
4 months - cooing, turns to voice, sits with support
9 months - babble, first word, standing, first tooth
1 yr - 1 word sentences, walking
11/2 yr - climb stairs
2 yr - 2 word sentences, uses spoon, dresses
When to consider ECT
- not responsive to medications and psychotherapy
- when rapid clinical improvement is required such as in:
- inadequate oral intake
- high suicide risk
- high patient distress - as prophylaxis/maintenance
- major depressive disorder
- bipolar disorders
- schizophrenia
Types of ovarian cyst
Functional - egg cells, common, disappears in 2-3 months
Endometrioma - endometriosis attaching to the ovary
Dermoid cyst - slow growing random tissue on the ovaries
Cystadenoma - watery/mucus filled benign cyst
Ovarian cancer - usually after menopause
Ovarian cyst, symptoms
- lower abdominal fullness (feeling bloated)
- needing to urinate more often
- discomfort with bowel motions
- pelvic pain, usually mild
- irregular periods
- pain during sexual intercourse
Amniocentesis miscarriage risk
1:1000 - 1:200
Perthes’ disease, definition
A disorder of the hip joint (usually only 1) in children. Perthes’ disease usually affects children between the ages of 3-11 years. It is more common in boys than in girls.
In the early phase of Perthes’ disease, the child will have an occasional limp which may become worse as the disease progresses.
Slipped upper femoral epiphysis (SUFE), definition
Occurs when the femoral head slips posteriorly and inferiorly through the physeal plate, usually with no recollection of any trauma. Peak incidence in girls is between 10 – 13years while in boys most are between 12 to 15 years. Many patients are overweight or obese.
An unstable slip more likely to present as an inability to weight bear. Most stable SUFE will present with an insidious hip, groin, thigh or knee pain.
Patient will walk with an antalgic or Trendelenburg gait, will have limited flexion and internal rotation. The limb may also appear shorter and will naturally fall into an external rotation.
