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