ILAs/MISC Flashcards

1
Q

What vaccines are given at 8 weeks old? (9)

A

Diptheria/Tetanus/Pertussis/Polio/Haemophilus influeunzae type B/Hepatitis B
Pneumococcal (PCV)
Meningococcal group B
Rotavirus gastroenteritis

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2
Q

What vaccines are given at 12 weeks old? (7)

A

Diptheria/Tetanus/Pertussis/Polio/Hib/Hep B

Rotavirus

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3
Q

What vaccines are given at 16 weeks old? (8)

A

Diptheria/Tetanus/Pertussis/Polio/Hib/Hep B
Pneumococcal (PCV)
Meningococcal group B

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4
Q

What vaccines are given at 1 year old? (7)

A

Hib/Meningococcal group C
Pneumococcal (PCV)
Measles, mumps, rubella (MMR)
Meningococcal type B

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5
Q

What vaccines are given at 3 years 4 months? (5)

A

Diptheria, tetanus, pertussis and polio

MMR

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6
Q

What vaccine is given to girls age 12/13?

A

Human papillomavirus (HPV)

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7
Q

What is given at 14 years? (7)

A

Tetanus, diptheria, polio

Meningococcal A C W Y

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8
Q

Other vaccines that may be given? (3)

A

Paediatric flu vaccine
Tuberculosis if high risk - at birth
Additional pneumococcal/flu/hepatitis vaccines for those with conditions such as diabetes, CKD, haemophilia, immunosuppression, sickle cell

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9
Q

What are developmental milestones? What are the 4 groups?

A
Acquisition of important developmental skills
Gross motor
Vision and fine motor
Hearing, speech, language
Social, emotional, behavioural
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10
Q

What is the moro reflex?

A

Sudden extension of the head causes symmetrical extension then flexion of the arms

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11
Q

What is the grasp reflex?

A

Flexion of fingers when object placed in palm

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12
Q

What is the rooting reflex?

A

Head turns to the stimulus when touched near the mouth

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13
Q

What is the stepping reflex?

A

Stepping movements when held vertically and dorsum of feet touch a surface

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14
Q

What should a newborn development be?

A

Limbs flexed, symmetrical posture

Marked head lag on pulling up

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15
Q

Gross motor development? 4 with ages

A

Head control - 3 months
Sits unsupported - 6-8 months
Stands - 10 months
Walks - 12 months (worrying if not by 18)

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16
Q

Fine motor/vision development? 4 with ages

A

Fixes and follows - 6 weeks
Reaching - 4 months
Transferring - 7 months
Pincer grip - 10 months

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17
Q

Hearing/speech/language development? 3 with ages

A

Vocalises alone - 3-4 months
Mama/dada - 6-9 months
3 word sentences - 2 years

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18
Q

Social/behaviour development? 4 with ages

A

Smiles - 6 weeks
Food in mouth - 6-8 months
Feeds self - 18 months
Interactive play - 3 years

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19
Q

When should a child be able to make a tower of 3-4 bricks?

A

18 months

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20
Q

When should a child be able to make a tower of 6-8 bricks?

A

2/2.5 years

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21
Q

When should a child be able to build a brick bridge?

A

3-3.5 years

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22
Q

When should a child be able to draw a line, circle, square?

A

Line - 2-2.5
Circle - 3-3.5
Square - 4-5

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23
Q

What 6 things are included in a septic screen?

A
Bloods  (FBC, CRP/ESR, U+E, blood gas)
Blood cultures
Urine dipstick and MC+S
Stool sample
Chest X ray 
Lumbar puncture (protein, glucose, MC+S, gram stain)
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24
Q

What is seen on lumbar puncture in bacterial infection vs viral?

A

Bacterial - elevated opening pressure, turbid CSF, high WCC, positive gram stain, high protein, low glucose
Viral - normal opening pressure, clear fluid, low WCC, negative gram stain, normal/high protein, normal/low glucose

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25
Q

What does a septic screen screen for?

A

Severe infection and systemic inflammation

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26
Q

Dose of cefotaxime for meningococcal septicaemia?

A

2g IV

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27
Q

Diagnosis of Kawasaki disease?

A
Fever + 4/5 of My HEART
Mucosal involvement - lips, mouth
Hand/foot redness, swelling, peelin
Eye conjunctivitis
Adenopathy (lymph)
Red rash
Temperature >5 days
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28
Q

What is Reye’s syndrome?

A

Can be caused by aspirin in kids

Brain and liver disease - vomiting, fits, tiredness, confusion

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29
Q

Side effects of IV immunoglobulin?

A

rare - anaphylaxis

headache, nausea, wheezing/chest tightness

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30
Q

Complications of Kawasaki disease?

A

CV disease - aneurysm, heart disease, MI

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31
Q

How to work out maintenance fluid dose?

A

4ml per kilo first 10kg
2ml per kilo second 10kg
1ml per kilo after that

27kg would be 40 + 20 + 7 = 67ml hourly

67 x 24 = 1608ml daily 0.9% sodium chloride

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32
Q

How to correct fluid deficit for dehydration?

A

Dehydrated - 50mls/kg extra
Shocked - 100mls/kg extra

OVER 24 HOURS

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33
Q

Fluids for a 12kg girl 5% dehydrated?

A

Maintenance 44ml hourly x24 = 1056ml daily

Dehydrated = 50ml/kg extra over 24 hours
50 x 12 = 600

1056 + 600 = 1656ml

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34
Q

Signs of dehydration in children? (6)

A
Appears unwell
Irritable
Decreased urine output
Sunken eyes
Dry mucous membranes
Reduced skin turgor
Slightly prolonged cap refill time
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35
Q

Signs of shock? (8)

A
Decreased level of consciousness
Pale/mottled skin
Cold extremities
Prolonged capillary refill time
Hypotension
Tachycardia
Tachypnoea
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36
Q

What is usual fluid bolus given in dehydration? Exceptions?

A

20mls/kg 0.9% sodium chloride

If trauma or diabetic ketoacidosis give 10mls/kg

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37
Q

What 9 conditions are in the newborn blood spot screening test?

A
sickle cell disease (SCD)
cystic fibrosis (CF)
congenital hypothyroidism (CHT)
phenylketonuria (PKU)
medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
glutaric aciduria type 1 (GA1)
homocystinuria (pyridoxine unresponsive) (HCU)
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38
Q

Dose of thyroxine for congenital hypothyroidism?

A

10-15mcg a day per kg

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39
Q

Differentials of a sick neonate?

A
Trauma, tumour, thermal
Heart disease, hypovolaemia, hypoxia
Endocrine - CAH, DM, thyroid
Metabolic disturbance - electrolytes
Inborn errors of metabolism
Seizures of CNS metabolism
Formula dilution or over concentration leading to hypo/hypernatraemia
Intestinal catastrophe (NEC, volvulus, intussusception)
Toxins
Sepsis
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40
Q

Can congenital adrenal hyperplasia be treated antenatally?

A

Give dexamethasone to reduce virilisation

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41
Q

Biochemical presentation of a salt losing crisis?Management?

A

LOW SODIUM HIGH POTASSIUM
METABOLIC ACIDOSIS
Saline, dextrose, hydrocortisone IV

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42
Q

Management of CAH?

A
Hydrocortisone lifelong (glucocorticoid), additional if illness or injury
Fludrocortisone (mineralocorticoid) if salt wasting
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43
Q

Characteristics of respiratory acidosis on ABG?

A

Low pH

High CO2

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44
Q

Causes of respiratory acidosis?

A

Respiratory depression
Asthma
COPD

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45
Q

Characteristics of respiratory alkalosis ABG?

A

High pH

Low CO2

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46
Q

Causes of respiratory alkalosis?

A

Hyperventilation - pain, anxiety, hypoxia

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47
Q

Characteristics of metabolic acidosis on ABG?

A

Low pH
Low HCO3
Low base excess

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48
Q

Causes of metabolic acidosis?

A

Increased acid production - diabetic ketoacidosis Decreased acid excretion - addisons disease
Loss of HCO3 - diarrhoea

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49
Q

Characteristics of metabolic alkalosis on ABG?

A

High pH
High HCO3
High base excess

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50
Q

Causes of metabolic alkalosis?

A

Vomiting/diarrhoes

Renal loss - diuretics, heart failure

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51
Q

How are respiratory acidosis/alkalosis compensated?

A

Metabolically - by increasing or decreasing the levels of bicarb to correct pH

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52
Q

How are metabolic acidosis/alkalosis compensated?

A

Respiratory - retaining or blowing of CO2 to correct pH

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53
Q

What would respiratory acidosis with metabolic compensation look like on ABG?

A

Low pH
High CO2

High HCO3!

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54
Q

What would respiratory alkalosis with metabolic compensation look like on ABG?

A

High pH
Low CO2

Low HCO3!

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55
Q

What would metabolic acidosis with respiratory compensation look like on ABG?

A

Low pH
Low HCO3

Low CO2!

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56
Q

What would metabolic alkalosis with respiratory compensation look like on ABG?

A

High pH
High HCO3

High CO2!

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57
Q

Murmur in ASD?

A

EJECTION SYSTOLIC murmur UPPER LEFT sternal edge

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58
Q

Murmur in VSD?

A

Harsh PANSYSTOLIC murmur LOWER left sternal edge

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59
Q

Murmur in PDA?

A

CONTINUOUS murmur UPPER left sternal edge

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60
Q

How is RDS managed?

A

Surfactant through TRACHEAL TUBE
Airway + breathing - clear if needed, high flow humidified oxygen/CPAP/mechanical ventilation
Incubator

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61
Q

Neonatal antibiotics for suspected infection?

A

Benzylpenicillin and gentamicin

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62
Q

Why do preterm infants get hypoglycaemia and how is it managed?

A

Poor glycogen stores
Prevention - early frequent milk feeding
Dextrose IV given
NG feeding

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63
Q

Risk of building up fluids too quickly in neonates?

A

NEC! reflux, aspiration

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64
Q

How is adequacy of nutrition monitored in paeds?

A

Input/output fluid chart

Weight

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65
Q

Where does IVH originate from in babies?

A

IVH in the preterm brain usually arises from the germinal matrix whereas IVH in the term infants originates from the choroid plexus.

66
Q

How does IVH present?

A
Diminished/absent Moro reflex.
Poor muscle tone.
Sleepiness.
Lethargy.
Apnoea.
Tense/bulging fontanelle
Premature babies often show sudden deterioration on day two or three, with periods of apnoea, pallor or cyanosis, failure to suck properly, abnormal eye signs, shrill cry, twitching or convulsions, reduced muscle tone or paralysis
67
Q

What abnormality seen on ABG in IVH?

A

Metabolic acidosis

68
Q

Management of IVH?

A

Supportive - fluids, blooc, bicarb infusion
Anticonvulsants

Prevention - vitamin K at birth

69
Q

Prognosis of IVH?

A

25-50% may die if severe
15% need permanent CSF shunt
Motor and cognitive defects, neurodevelopmental delay

70
Q

Cause for concern with neonatal jaundice >2 weeks?

A

dark urine, pale stools
hepatomegaly
poor weight gain

71
Q

What is the direct coombs test?

A

The direct Coombs test is used to test for autoimmune hemolytic anemia—that is, a condition where the immune system breaks down red blood cells, leading to anemia
The direct Coombs test is used to detect antibodies or complement proteins attached to the surface of red blood cells

72
Q

What is the indirect coombs test?

A

The indirect Coombs test is used in prenatal testing of pregnant women and in testing prior to a blood transfusion. The test detects antibodies against foreign red blood cells

73
Q

Pain relief for neonates?

A

Paracetamol, morphine

74
Q

What does the NIPE test? When is it done?

A

Newborn infant physical examination, done within 72hrs and AGAIN at 6-8 weeks

Eyes i.e. congenital cataracts
Heart
Hips i.e. developmental dysplasia of the hip
Testes i.e. undescended

75
Q

What are Barlows and Ortolanis tests?

A

Barlows - If the hip is dislocatable — that is, if the hip can be popped out of socket with this maneuver — the test is considered positive. The Ortolani maneuver is then used, to confirm the positive finding (i.e., that the hip actually dislocated) by hearing a ‘thunk’ as it goes back in

76
Q

Vascular causes of unilateral visual loss?

A
Amaurosis fugax
Central retinal artery occlusion/retinal detachment
GCA
Optic neuritis
Vitreous haemorrhag
77
Q

What is optic neuritis?

A

Inflammation of optic nerve, may be first manifestation of MS.
Reduced visual acuity over a few days, pain on moving eye
Exacerbated by heat/exercise
Afferent pupillary defect

78
Q

What is Lhermitte’s phenomenon?

A

Tingling ‘electrical’ sensation down spine, esp. when bending head forward

79
Q

Differential diagnosis of blackouts?

A

Syncope
Epilepsy
Non epileptic attacks

80
Q

What is syncope?

A

Syncope is an abrupt and transient loss of consciousness associated with loss of postural tone that follows a sudden fall in cerebral perfusion

81
Q

Causes of syncope?

A

Neurogenic - vasovagal, reflex i.e. cough/micturition
Cardiac - arrhythmias, valvular disease
Orthostatic - prolonged standing, heat, dehydration

82
Q

Why do focal onset seizures need imaging?

A

More likely to be a structural problem

83
Q

What are you looking for in JME on interictal EEG?

A

Normal background

Frequent polyspike and wave discharges

84
Q

3 vascular territories in stroke

A

Anterior cerebral artery
Middle cerebral artery
Posterior cerebral artery

85
Q

4 clinical syndromes in stroke

A

Total anterior circulation infarct TACI
Partial anterior circulation infarct PACI
Lacunar stroke
Posterior circulation infarct

86
Q

Benefits of thrombolysis (alteplase) in stroke?

A

If within 4.5 hours of ISCHAEMIC strokes, improves chance of independence

Risk of death the same

87
Q

When is risk of stroke after TIA highest?

A

First 48 hours

88
Q

Which personality disorders predispose to psychosis?

A
Paranoid PD
Schizotypal PD (social deficit, magical beliefs etc)
89
Q

What can borderline PDs progress to?

A

Bipolar

90
Q

What can obsessive PDs progress to?

A

OCD

91
Q

What is attachment theory?

A

Deep, enduring bond connecting one person to another across time and space
Child seeks attachment figure when upset
Early infant separation/neglect links to later maladjustment i.e. fear of abandonment, disproportionate overreactions to change in routine etc

92
Q

What is a biopsychosocial formulation?

A

Predisposing
Precipitating
Prolonging
Protective

factors of biological, psychological and social aspect of the patient to form a diagnosis/management

93
Q

What is asked about in psych history?

A
Presenting complaint
History of PC
Collateral history
Past psych history
Medical history
Drugs and allergies
Family history
Social history - substance misuse, work, housing
Personal history - birth, childhood and school, relationships etc
Forensic history
Premorbid personality
94
Q

Mental state exam components?

A
Appearance and behaviour
Mood and affect
Speech - tone/rate/volume, circumstantiality/perserveration etc, flight of ideas
Thoughts - obsessions, delusions, dissociation
Perceptions - hallucinations, illusions
Cognition
Insight
RISK
95
Q

What gene is mutated in Fragile X ?

A

FMR1 on X chromosome

96
Q

How to work out alcohol units?

A

Units = vol in litres x ABV%

97
Q

What is the main inhibitory and excitatory neurotransmitter?

A

Inhibitory - GABA

Excitatory - glutamate

98
Q

How does alcohol affect GABA/glutamate?

A

Enhances GABA which is inhibitory
Inhibits glutamate which is excitatory - that’s why withdrawal is agitated

benzodiazepines have same effect so give in withdrawal

99
Q

3 medications to help alcohol abstinence?

A

Disulfiram
Acamprosate
Naltrexone

100
Q

MASER features for bipolar?

A
Mood
Attention
Self esteem
Energy
Risk
101
Q

Causes of hyponatraemia?

A
Renal failure
Diuretics
Water loss
Heart failure
Nephrotic syndrome
102
Q

Symptoms of hyponatraemia?

A
Confusion
Seizures
Cardiac failure
Oedema
Nausea
D+V
103
Q

Causes of hypernatraemia?

A

Not enough water
Diuretics
Diabetes insipidus

104
Q

Symptoms of hypernatraemia?

A
Thirst
Confusion
Seizures
Coma
Signs of dehydration
105
Q

Causes of hypokalaemia?

A

Thiazide/loop diuretics
Cushings
D+V
Poor intake

106
Q

Symptoms of hypokalaemia?

A

Muscle weakness - rhabdomyolysis
Arrhythmias
Constipation
Paralysis, paraesthesia late

107
Q

Causes of hyperkalaemia?

A

Decreased renal excretion

Potassium sparing diuretics

108
Q

Symptoms of hyperkalaemia?

A
First nothing
Weakness
Paralysis
Heart arrhythmias
SoB, death
109
Q

Causes of hypocalcaemia?

A
Para/thyroid surgery
Chronic renal failure
Pancreatitis
Respiratory alkalosis
Osteomalacia
110
Q

Symptoms of hypocalcaemia?

A

Tetany
Depression
Neuromuscular excitability - - muscle twitching

111
Q

Causes of hypercalcaemia?

A

Hyperparathyroidism
Cancer
Lithium use

112
Q

Symptoms of hypercalcaemia?

A
Bones - pain, fractures
Stones - renal stones
Groans - confused
Thrones - constipation
Psychic moans - depression
113
Q

How often is breast screening done?

A

Mammograms every 3 years from age 50 to 70 (trial of 47-73)

114
Q

What is cervical screening?

A

Checks for cervical intraepithelial neoplasia (CIN) - precancerous dysplasia using a brush to collect cells

115
Q

How often is cervical screening done?

A

aged 25 to 49 – every 3 years
aged 50 to 64 – every 5 years
over 65 – only women who have recently had abnormal tests

116
Q

What does the infectious diseases programme in pregnancy screen for?

A

HIV
Syphilis
Hepatitis B

117
Q

What is the combined test for Downs/Edwards/Patau? When is it done?

A

Nuchal translucency at dating scan
Serum b-HCG
Pregnancy associated plasma protein A (PAPP-A)

Between 11-13+6 weeks

118
Q

What is quadruple maternal serum screening for Downs? When is it done?

A

hCG
alpha fetoprotein
uE3
inhibin A

14-20 weeks

119
Q

How is screening for Edwards/Patau done if over 14 weeks?

A

Mid pregnancy anomaly scan 18-20+6 weeks

120
Q

What condition does the mid pregnancy scan look for? (11)

A
anencephaly
open spina bifida
cleft lip
diaphragmatic hernia 
gastrochisis 
exomphalos 
serious cardiac abnormalities 
bilateral renal agenesis
lethal skeletal dysplasia
Edwards' syndrome, or T18
Patau's syndrome, or T13
121
Q

How gets tested for gestational diabetes?

A

Any woman with 1 or more risk factors - BMI above 30, previous baby over 4.5kg, prev gestational diabetes, parent/sibling with diabetes, south asian

122
Q

When is OGTT done?

A

women who’ve previously had gestational diabetes: oral glucose tolerance test (OGTT) should be performed as soon as possible after booking and at 24-28 weeks if the first test is normal.

women with any of the other risk factors should be offered an OGTT at 24-28 weeks

123
Q

When is booking visit? What is done?

A

8-12 weeks
General info about lifestyle, BMI
Bloods - HIV, syphilis, hep B, haemoglobinopathies, rhesus status, anaemia, red cell antibodies
urine dipstick

124
Q

When is first dating scan?

A

10-13+6

125
Q

When is anti-D given for rhesus negative women?

A

First - 28 weeks
Second - 34 weeks

Whenever sensitisation i.e. bleeding, amniocentesis

126
Q

Describe the HPG axis

A

Hypothalamus produces gonadotrophin releasing hormone
Anterior pituitary releases follicle stimulating and luteinising hormones
Ovary releases oestrogen

127
Q

What part of the embryo is the urogenital system from?

A

Intermediate mesoderm

Genital system develops from gonadal ridges from primordial germ cells

128
Q

What is the SRY gene?

A

SRY gene induces testes development, lack of results in ovaries

129
Q

What is the Mullerian duct?

A

Develops into uterus, fallopian tubes and upper vagina

Wolffian duct regresses

130
Q

Investigations of amenorrhoea?

A

Hormone tests - bhcG, FSH, LH, prolactin, thyroid, testosterone
Chomosome analysis
US pelvis
CT/MRI head

131
Q

Treatment of amenorrhoea?

A

Surgery if treatable congenital anomaly
Weight loss/stop exercising as much/less stress
Gonadal dysgenesis/pof - HRT
PCOS - treat i.e. with the pill
High prolactin - dopamine agonists
Cervical stenosis/Ashermans - surgery to remove adhesions

132
Q

Causes of acute pelvic pain?

A
Menstruation/ovulation
Sex
PID
UTI
Miscarriage/ectopic
Torsion/cyst rupture
Premature labour/placental abruption/uterine rupture
Fibroids, pelvic tumour
Appendicitis, IBS
133
Q

Assessment of pelvic pain?

A

Acute - urinalysis, MSU, high vaginal and endocervical swabs, pregnancy test, USS if suspected ectopic
Chronic - STI screen, Ca125, urinalysis, transvaginal USS, laparoscopy

134
Q

Management of pelvic pain? (3)

A

Pain relief
COCP/GnRH agonist if cyclical
Diagnostic laparoscopy

135
Q

Favourable position for normal vaginal delivery?

A

Occipito-anterior

136
Q

Normal head position at engagement?

A

Occipito-transverse

137
Q

Lie with increased risk of cord prolapse?

A

Footling breech

138
Q

Symptoms of primary and secondary post partum haemorrhage?

A

Primary - blood loss, collapse, enlarged uterus, trauma

Secondary - blood loss, enlarged uterus, tender, open internal os

139
Q

What are the 4 T’s of post partum haemorrhage?

A

Tone
Trauma
Tissue
Thrombus

140
Q

Definition of low birth weight?

A

2.499kg or less

Less than 10th centile

141
Q

Define IUGR

A

Fetuses failing to reach their OWN growth potential (not just constitutionally small as in sfd, may not even be small)
May be related to placental dysfunction

142
Q

What is fetal macrosomia? Causes?

A

Baby over 4kg at birth

Caused by maternal diabetes, prolonged pregnancy, excessive weight gain

143
Q

Risks of macrosomic babies?

A
Shoulder dystocia
Obstructed labour
Instrumental/c section
PPH
Hypoglycaemia - RDS (breastfeed)
144
Q

Risks of IUGR babies?

A
Stillbirth
Cerebral palsy
Preterm delivery
Convulsions
Meconium aspiration
145
Q

Why should you not give ACEi with NSAIDs?

A

High risk of renal failure

146
Q

community support for heart failure?

A
GP and specialist centres
community nurses, home visits
Social care
palliative care
rehabilitation
patient groups
pharmacy deliveries
147
Q

What is Qrisk score?

A

Score for predicting cardiovascular risk - risk of a person developing CVD over next 10 years for people between 35 and 74

148
Q

At risk groups to miss vaccinations?

A
Looked after children
Children with physical/learning difficulties
Children of single or teenage parents
Not registered with GP
In hospital
Travellers, asylum seekers
149
Q

Signs of respiratory distress in children?

A
Nasal flaring
Accessory muscles use
Stridor, wheeze
Tracheal tug
Chest recession
150
Q

Red light NICE indicators for a sick child?

A
Pale/mottled/blue
No response, appears ill
High pitched cry
Grunting
Tachypnoea >60
Chest recession
Reduced skin turgor
Bulging fontanelle
Non blanching rash
Stiff neck
Seizures
AGE 3 MONTHS
TEMP >39
FEVER >5 days
151
Q

What 3 things are needed for consent?

A

Voluntarily
By an individual with capacity
Fully informed

152
Q

When can confidentiality be breached?

A

With consent
If clinically relevant/needed
Risk to patient or someone else
Health risk to others - DVLA

153
Q

What are the Fraser guidelines regarding contraception under 16? UPSSI

A

Understanding of advice
Parents will not be informed despite asking
Sex will continue either way
Suffering mentally/physically if no treatment given
In her best interest

154
Q

Tools for dementia screening in primary care?

A

Mini mental state examination
GP-COG
6-CIT

155
Q

Depression screening tool?

A

PHQ-9

156
Q

Risk factors for TB?

A
HIV/immunosuppression
Diabetes
Malnutrition
Smoking
Alcohol
Overcrowding
Low socioeconomic status
157
Q

Prevention of TB?

A
BCH vaccine for high risk newborns
Symptom education
Medication education
Contact tracing
Limit overcrowding
158
Q

Symptoms of TB?

A
Weight loss
Fever
Night sweats
Fatigue
Cough - phlegm/blood
Breathlessness
If disseminated - abdo pain, bone pain, headache
159
Q

Causative agent in TB?

A

Mycobacterium tuberculosis

160
Q

Treatment of TB?

A

Isioniazid
Rifampicin
Pyrazinamide
Ethambutol