Last minute specialties Flashcards
1
Q
how can you confirm a miscarriage on TVUSS?
A
no FH and CRL >7mm
GS > 25m + no foetus
2
Q
C-section layers
A
- superficial fascia
- deep fascia
- anterior rectus sheath
- rectus abdominis muscle
- transversalis fascia
- extraperitoneal connective tissue
- peritoneum
- uterus
3
Q
frequent maternal risks of C-section
A
- wound/abdo discomfort in first few months
- inc risk of repeat C-section
- readmission to hosptial
- haemorrhage
- infection
4
Q
what do theca cells respond to? what do they produce?
A
respond to LH
produce androgen
5
Q
what do granulosa cells respond to? what do they produce?
A
respond to FSH
produce aromatase (convert androgen to oestriol)
produce progesterone
6
Q
management of children depression
A
self help = “youngminds.org”
mild = IPAT 6-8 sessions, psychoeducation
2nd line: CBT
needs not met = referral to CAMHS
7
Q
investigations in biliary atresia
A
USS: triangular cord sign
gold standard: TIBIDA isotope scan, ERCP +/- biopsy
8
Q
fluid given in paeds maintenance
A
5% dextrose and 0.9% NaCl
9
Q
features of androgen sensitivity
A
S/S: feminisation, no internal male or female organs
XY genotype
10
Q
17-alpha hydroxylase
A
S/S: feminisation, hypertensive
XY genotype
11
Q
gene involved in achrondroplasia and hypochondroplasia
A
FGFR3 gene
12
Q
unique features of congenital hypothyroidism
A
coarse features
macroglossia
umbilical hernia
13
Q
cause of OS disease
A
osteochondritis of patellar tendon
insertion at knee
14
Q
mutation in tuberous sclerosis
A
TSC1 or 2
15
Q
neuro features of tuberous sclerosis
A
infantile spasm
developmental delay
epilepsy
intellectual disability
16
Q
drug for recurrent Ovarian Ca
A
Bevacizumab
Ab against VEGF to inhibit angiogenesis
17
Q
what ovarian tumours is chemo not useful?
A
sex cord stromal
surgery mainstay
18
Q
investigation not to forget in ovarian torsion
A
urinalysis to exclude ureteric colic
19
Q
urge incontinence management
A
- conservative: lifestyle advice, avoid fizzy drinks, bladder training (6 weeks)
- 2nd: oxybutyrin
20
Q
overflow incontinence management
A
refer to urogynaecologist
1st treatment = timed voiding
21
Q
3 structural causes of infertility in men
A
cryptochordism
CF
varicocele
22
Q
extracampine hallucination
A
sense of presence in absence of stimulus
23
Q
when can’t you have an Independent Mental Health Advocate?
A
4, 5, 135, 136
24
Q
investigations in NMS
A
FBC (leucocytosis)
U&Es (high CK and AKI)
25
how is rapid tranq monitored?
ensure baseline taken
- oral PRN: monitor hourly for minimum one hour on NEWS form
- IM: monitor every 15 minutes for min 1 hour on rapid tranq form
26
role of noradrenaline
mood
| energy
27
role of serotonin
sleep
appetite
memory
mood
28
role of dopamine
psychomotor activity
| reward
29
depression treatment in children (5-11)
family therapy
IAPT/ individual CBT
referral made to CAMHS
30
depression treatment (12-18)
- individual CBT
- if bad = fluoxetine
- CAMHS
31
manage BPAD with comorbid depression
1. fluoxetine and olanzapine
| 2. quetiapine
32
rating scale in Schizophrenia
brief psychiatric rating scale
33
possible symptoms of GAD
```
restlessness
irritability
fatiguability
muscle tension
sleep disturbance
poor concentration
```
34
panic disorder
recurrent attacks of severe anxiety
| not restricted to any particular circumstance and so are unpredictable
35
part of the brain implicated in OCD
basal ganglia
36
seizure in alcohol withdrawal syndrome
grand-mal
37
symptoms of Korsakoff's
- anterograde amnesia
- confabulation
- peripheral neuropathy
- cerebellar degeneration
38
length of opiate substitution therapy as outpatient
12 weeks min
39
opiate substitution therapy treatmetns
methadone, buprenorphine
| offer naloxone to take home
40
recreational stimulant drug that can cause dependence
amphetamines
41
length of cocaine in urine
5-7 days
42
MoA of varenicline
partial nicotine receptor agonist
43
MoA of bupropion
selective DA and NA reuptake inhibitor
44
dissocial personality disorder
```
fights but cannot maintain relationships
irresponsible
guiltless
heartless
temper easily lost
someone else's fault
```
45
axious/avoidant personality disorder
```
avoids social contact
fears rejection/criticism
restricted lifestyle
apprehensive
inferiority
```
46
dissociation
immature ego defence
| one assumes different identity to deal with situation
47
displacement
defence mechanism
| someone takes out their emotions on neutral person
48
when should pharmacological management be used in AN?
physical symptoms
rapid weight loss
BMI <13.5
49
electrolytes low in refeeding syndrome
low K, P, Mg
50
trance and posession disorders
temporary loss of personal identity and full sense of awareness
51
4 subtypes of somatisation disorder
undifferentiated somatoform
hypochondrial disorder
somatoform autonomic dysfunction
persistent somatoform pain disorder
52
short term anti-psychotic in Alzheimer's
risperidone
53
med management in Alzheimer's
1 (mild-mod): anticholinesterases e.g. donezepil
| 2 (mod-severe): NMDA partial receptor agonist e.g. memantine
54
Lewy body distribution in LBD vs PD
LBD: brainstem, cingulate gyrus, neocortex
PD: just brainstem
55
how long should symptoms persist for diagnosis of conduct
6 months
56
MMSE no cognitive impairment
24-30
57
MMSE mild cognitive impairment
18-23
58
MMSE severe cognitive impairment
0-17
59
how do bromocriptine and dantrolene work to treat NMS?
Bromocriptine: reveres dopamine blockade
Dantrolene: reduced muscle spasm
60
what patients need anticoag in pregnancy?
CHD
pulmonary HTN
artificial valves
inc risk of AF
61
HTN in pregnancy / severe
HTN: 140/90
severe: >160/110
62
major risk factors to give aspirin for
- previous pre-eclampsia
- CKD
- AI disease
- DM
- Chronic HTN
63
give if aspirin is have 2 of:
- primigravida
- age >40
- preg interval >10 years
- BMI >35
- Pos FHx
- Multiple pregnancy
64
complications of delivery during viraemic period in VZV infection?
- haematological: bleeding, DIC, thrombocytopaenia
- hepatitis
- VZV infection of new born
65
management of maternal CMV
- do not treat but if evidence of CNS damage to foetus = offer TOP
- foetal USS every 2w following diagnosis
- foetal MRI at 28 weeks
66
2 milestones that should be reached by 2 years
link 2 words in sentences
| understand 2 step commands
67
milestones reached by 3 yeard
gross motor: hop on one foot, walk upstairs 1 foot per step, down 2 feet per step
fine motor: draws circle bricks in bridge
speech/language: understands negatives and adjectives
social: begin to share toys, eats with fork and spoon
68
what age should children babble polysyllabically
5 months
69
later complications of Down syndrome
secretory otitis media
OSA
learning difficulty
VI joint laxity
70
metabolic diseases in Guthrie test
```
PKU
MCABB
Maple syrup urine disease
isovaleric acidaemia
glutaric aciduria type 1
homocysteinuria
```
71
first investigations in neonatal jaundice
1. check transcutaenous or serum BR levels
2. do split BR (check uBR/cBR)
3. blood film analysis
72
investigation in baby over 2 weeks
direct and indirect serum BR (split BR in over 2 week old)
73
CXR in RDS
ground glass appearance
74
important investigation in billous vomiting
AXR:
double bubble = duodenal atresia
Air fluid level = jejunal/ileal atresia
dilated bowel loops = NEC
75
GOR cause
functional immaturity of LOS (inappropriate relaxation)
76
intusseption investigations
Abdo USS = donut sign
| AXR
77
sign of volvulus on abdo exam
scaphoid abdo
78
3 most common causative organisms in otitis media
H. influenzae
S. pneumonia
RSV
79
complication of chronic otitis media
mastoiditis
80
Ebstein's heart abnormality
split 1st and 2nd heart sounds
81
mangement of rheumatic fever
high dose aspirin (suppress inflammatory response)
Abx (if evidence of infection)
steroids (if not resolved rapidly)
82
S/S of BXO
```
haemtauria
painful erections
recurrent UTI
weak stream
swelling
```
83
paraphimosis
emergency
foreskin becomes trapped in retracted position
= restriction of blood flow to head of penis
84
2 most common causes of ARF in children
HUS ATN
85
what syndrome is associated with pilocystic astrocytoma?
Neurofibromatous 1
86
Ewing's translocation
11;22
87
tissue that neuroblastoma arises from
neural crest tissue in adrenal medulla and SNS
88
benign tumour of same tissue as neuroblastoma
ganlioneuroma
89
treatment of acute crises in sickle cell disease
```
analgesia
hydration
Abx
oxygen
exchange transfusion
```
90
treatment of chronic problems in SCD
hydroxycarbamide
| HSCT if severe
91
deficiency in Gaucher's disease
beta - glucosidase
92
management of Gaucher's disease
splenectomy
bisphosphonates (due to BM suppression)
enzyme replacement
treat anaemia
93
sepsis monitoring is 2+ risk factors or 1 red flag
abx (cefotaxime, amikacin, ampillicin) and septic screen
94
what are the red flag symptoms?
seizure
resp distress
shock
95
what is Rubin's manoevure?
push anterior shoulder toward baby chest
96
what is Wood Screw?
Rubin's + push posterior shoulder towards baby back = rotation
97
biggest risk factors for SGA
```
previous stillbirth,
ALPS,
renal disease
chromosomal abnormalities
infection
multiple pregnancy
placental insufficiency
```
98
identifying pregnancy on USS
1. look for foetal heart beat
2. find foetal poles for CRL
3. if not foetal pole, look for gestational sac
99
2 placenta and 2 amniotic sacs
25%
| lambda scan
100
oligohydramnios
<5th centile
| deepest pool <2cm
101
type 1 vasa praevia
velamentous cord insertion in a single/bilobed placenta
102
type 2 vasa praevia
foetal vessels running between lobes of placenta with at least 1 accessory lobe
103
secondary endometritis
24 hours to 12 weeks PP
104
what medication in managing PPH to avoid in HTN/asthmatics?
ergometrine
105
how can baby be monitored when a mother has anti-D Abs?
middle cerebral artery dopplers
106
skin conditions of pregnancy
```
pemphygoid gestationis
PUPPP
Prurigo of pregnancy
Pruritis follicultitis A
atopic eczema
```
107
prurigo appearance
excoriated papules on extensor limbs, abdomen and shoulder
108
how does smoking affect pregnancy?
damaged umbilical cord structure
| increased risk of ectopic/placental abruption/miscarriage
109
treatment of hyperthyroidism
propylthiouracil - 1st TM
| carbimazole - 2nd/3rd
110
most likely causative organism in asymptomatic bacteruria
GBS - streptococcus agalactiae
111
foetal blood sampling
blood withdrawal from umbilical vein
112
late decelerations
lags onset of contraction and dose not return to normal until after 30s following end of contraction
113
indications for immediate CS
- terminal bradycardia : FHR < 1000bpm for more than 10 mins
| - terminal deceleration: FHR drops and does not recover for more than 3 mins
114
what gets done at the booking visit?
```
FBC
MSU
blood group and ab screen
rhesus status and atypical abs
haemaglobinopathy screen
infection screen (Hep B, syphillis, HIV)
```
115
what is hPL?
homologue to GH
- decreases insulin sensitivity
- increases lipolysis to increase glucose availability for baby
- decreases glucose utilisation
116
mechanism of atosiban
inhibits oxytocin and vasopressin
117
1st and 2nd degree tear
1: superficial damage with no muscle involvement
| 2. injury to perineal muscle, no anal sphincter involvement
118
conversion disorder
typically involves loss of motor/ sensory function
119
dissociative disorder
dissociation is a process of "separating off" certain memories from normal consciousness
in contrast to conversion disorder involves pyshiatric symptoms e.g. Amnesia, fugue, stupor
120
localised non-bullous impetigo treatment
topical hydrogen peroxide
121
moderate erythema nappy rash treatment
hydrocortisone 1% cream
122
2nd line treatment in seborrhoeic dermatitis
if scalp is affected = topical imidazole cream
123
treatment of non-capitits types of tinea
mild: topical terbinafine
mod: hydrocortisone 1%
severe: oral terbinafine
124
brachial cleft/throglossal abnormality surgery
Sistrunk's procedure
125
cap glucose fasting and after meals
fasting: 4-7
| after meals: 5-9
126
2 biochemical definitions of DKA
1. acidosis and bicarb < 15
| 2. pH < 7.3 and ketones > 3
127
volume of fluid resus in DKA emergency
shocked: 20mls/kg bolus over 15 mins
| if not shocked: 10mls/kg bolus over 60 mins
128
deficit volume
weight x 10 x deficit %
129
fluid maintenance in DKA specifically
<10kg: 2 ml/kg/hr
10-40kg: 1 ml/kg/hr
40+kg: 40 ml/kg/hr
130
congenital causes of hypergonadotrophic hypogonadism
cryptoorchidism (absence of 1 or both testes from scrotum)
Kleinfelter's
Turner's
131
premature thekarce
isolated breast development before 8 years
132
what does small testes and precocious puberty indicate?
tumout of CAH (adrenal cause)
133
medical treatment for gonadotrophin dependent precious pubertyy
GnRH agonist + GH therapy
134
medical treatment for gonadotrophin-independent precious puberty
testotoxicosis: ketoconazole
CAH: hydrocortisone + GnRH agonist
135
symptoms of achondroplasia (other than short stature)
hydrocephalus
depression of nasal bridge
marked lumbar lordosis
trident hands
136
centiles for severely obese, obese and overweight
severely obese: 99th
obese: >95th
overweight: 85-94th
137
what is the roll test?
patient supine
roll affected hip internally and externally
guarding or spasm in Perthe's
138
osteochondritis dissecans
reduced blood flow = avascular necrosis
results in fragmentation of bone and cartilage
= activity related joint pain
139
septic arthritis vs osteomyelitis
infectious arthritis of synovial joint
| vs osteomyelitis of bone
140
septic arthritis vs osteomyelitis
infectious arthritis of synovial joint
| (vs osteomyelitis of bone)type
141
antiepileptic exacerbates myoclonic seizures
lamotrigine
142
first line treatment of retinopathy of prematurity
laser photocoagulation
143
germ cell ovarian tumours
- teratoma
- dysgerminoma
- endodermal sinus tumour
- choriocarcinoma
144
sex-cord stromal tumours
fibroma
thecoma
granulosa cell tumour
sertoli-leydig cell tumour
145
MOA of POP
thickens cervical mucous
146
calculating a unit
volume x (% alcohol/1000)
147
features of periventricular leukomalacia (PVL)
bilateral multiple cysts
periventricular white cell matter damage
80-90% risk of spastic diplegia
