Last min revision! Flashcards
Medication treatments for postpartum haemorrhage secondary to uterine atony
- Oxytocin
- Ergometrin (not in hypertension)
- Syntocinon 5 units slow IV
- Carboprost (not in asthmatics)
- Misoprostol 1000 micrograms
If pharmacological mx fails then surgical haemostasis should be initiated
The causes of a primary PPH can be divided into the 4 T’s:
1. Tone - problems with uterine contraction
2. Tissue - retained products of conception
3. Trauma
4. Thrombin
Anaphylaxis: treatment algorithm
Repeat every 5 mins if necessary
Refractory = resp / cvd problems persist despite 2x doses of IM adrenaline
IV fluids should be given for shock
Management following stabilisation
1. non-sedating oral antihistamine s
2. serum tryptase
3. specialist allergy clinic if new diagnosis
4. give 2 adrenaline auto-injectors and how to use it
ectopic pregnangy: mx
DVT investigation: if the scan is negative, but the D-dimer is positive →
stop anticoagulation and repeat scan in 1 week
Maintenance fluid in children
Weight dependent
100ml/kg for first 10kgs
50ml/kg for next 10 kg
20ml/kg for every subsequent kilo
Supraventricular tachycardia: mx
Acute
1. Vagal manoeuvre e.g. try blowing into empty plastic syringe, carotid sinus massage
2. IV adenosine
a) rapid IV bolus of 6mg –> if unsuccessful give 12mg –> if unsuccessful give 18mg
b) not in asthmatics –> verapamil instead
3. Electrical cardioversion
Prevention of episodes:
1. Beta-blockers
2. Radio-frequency ablation
Signs of right-sided heart failure
raised JVP, ankle oedema and hepatomegaly
which drug is contraindicated to use in ventricular tachycardia
DO NOT USE VERAPAMIL
- CCB can reduce contractility of the heart even further resulting in death
What is the most appropriate approach to screen for gestational diabetes in future pregnancies?
OGTT as soon as possible after booking and subsequently at 24-28 weeks
first-line to maintain remission in left-sided or extensive ulcerative colitis
An oral aminosalicylate
If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year they should be given either
either oral azathioprine or oral mercaptopurine to maintain remission
Essential tremor
Autosomal dominant condition
features
- postural tremor: worse if arms are outstretched
- improved by alcohol and rest
mx
- propranolol 1st line
- primidone sometimes used
Essential tremor symptoms are usually eased by alcohol.
visual field defects
The main points for the exam are:
left homonymous hemianopia means visual field defect to the left, i.e. Lesion of right optic tract
homonymous quadrantanopias: PITS (Parietal-Inferior, Temporal-Superior)
incongruous defects = optic tract lesion; congruous defects = optic radiation lesion or occipital cortex
Homonymous hemianopia
incongruous defects: lesion of optic tract
congruous defects: lesion of optic radiation or occipital cortex
macula sparing: lesion of occipital cortex
Homonymous quadrantanopias
superior: lesion of the inferior optic radiations in the temporal lobe (Meyer’s loop)
inferior: lesion of the superior optic radiations in the parietal lobe
mnemonic = PITS (Parietal-Inferior, Temporal-Superior)
Bitemporal hemianopia
lesion of optic chiasm
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour
lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma
acute progression of visual loss, metamorphopsia (wavy distortion of straight lines), and retinal haemorrhages
Wet macular degeneration is characterised by choroidal neovascularisation, whereby new, weak blood vessels are formed which are friable and prone to haemorrhage
I use PUCL to remember the difference between pituitary tumour and craniopharyngioma
Pituitary Upper, Cranio Lower
Hope this helps !
Acute angle closure glaucoma is associated with hypermetropia, where as primary open-angle glaucoma is associated with myopia
Acute angle closure glaucoma is associated with hypermetropia, where as primary open-angle glaucoma is associated with myopia
