Make a Medic Mocks Flashcards
What is uterine inversion?
Complication of 3rd stage of labour
Manifests:
- Maternal shock (blood loss)
- Lump (uterine fundus) protruding from vaginal introitus
Mx:
- Uterus should be manually reduced
- If this fails, surgery
What is uterine involution?
Shrinking of the uterus back to pre-pregnancy size once the baby and placenta has been delivered
What is ground A of the abortion act?
That the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated.
What is ground B of the abortion act?
That the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman.
What is ground C of the abortion act?
That the pregnancy has not exceeded its 24th week and that continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman.
(Majority of abortions carried out under this act)
What is ground D of the abortion act?
That the pregnancy has not exceeded its 24th week and that continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing children of the family of the pregnant woman.
Ground E of the abortion act
That there is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
Ground F of the abortion act
To save the life of the pregnant woman.
Ground G of the abortion act
To prevent grave permanent injury to the physical or mental health of the pregnant woman.
How are perineal tears classified?
- 1st: Perineal skin and/or vaginal mucosa
- 2nd: Perineal muscles, no involvement of anal sphincter
- 3rd (A): <50% of external anal sphincter
- 3rd (B): >50% of external anal sphincter
- 3rd (C): External and internal anal sphincter
- 4th: Involvement of anal sphincter and anorectal mucosa
3rd and 4th associated with increased risk of faecal incontinence
Once identified, what is the next step in assessing perineal tears?
DRE to assess extent of involvement of anal canal
How are 1st/2nd perineal tears managed?
Repaired by midwives in delivery room
How are 3rd/4th perineal tears managed?
Repaired in theatre by obstetricians
Vaginal pack can be inserted to control excessive bleeding
What is the presentation of neonatal herpes infection?
Vesicles and pustules often involving the face and mouth
Three forms:
- SEM: Localised to skin, eyes and mouth
- CNS: Encephalitis
- Disseminated infection
How can neonatal varicella be differentiated from neonatal herpes?
Varicella tends to be disseminated lesions all over the body (beginning on the face) at various stages of healing
Herpes lesions tend to be clustered, mainly occurring on the face
What is the most common cause of secondary PPH?
Infection
What is the management of PPH?
- A-E
- 14g peripheral cannulae (x2)
- Lie woman flat
- Bloods (G+S, X-match)
- Crystalloid infusion - Mechanical
- Palpate and rub uterine fundus
- Catheterisation (prevent bladder distention) - Medical
- IV oxytocin injection then infusion
- IV/ IM ergometrine
- IM carboprost
- Sublingual misoprostol - Surgical
- Intrauterine balloon tamponade
- Other options: B-lynch suture, ligation or uterine arteries/ internal iliac arteries
- Hypsterectomy (life saving)
When is carboprost contraindicated?
Asthma
When is ergometrine contraindicated?
Hypertension
When is clomiphene most effective?
Between days 2-6 of cycle
What is given in oligomenorrheic patients before giving clomiphene?
Progestogen for 10 days to induce a withdrawal bleed and then clomiphene started on day 2 of the period, continued for 5 days
Check serum progesterone on day 21 to check for ovulation
How long can the cycle of clomiphene be repeated?
Max 6 times before the risk of ovarian cancer is too high
What does staining with acetic acid in colposcopy suggest?
Presence of abnormal nuclear: protein ratio within cells
What does iodine bind to when used in colposcopy?
Glycogen, present in normal cells
Abnormal cells lack glycogen so reamin yellow
Which viral strains cause roseola?
HHV6 and HHV7
Where does the rash begin in roseloa?
Chest and abdomen and spreads to the limbs over days
Which x-ray views should be ordered for Perthe’s disease?
Anteroposterior and frog leg lateral views
(shows increased density of the femoral head)
When would an MRI be indicated for Perthe’s disease?
When the x-ray is normal but there is high clinical suspicion
What is talipes equinovarus?
Club foot
(One or both feet are inverted and supinated)
What is positional talipes?
More mild form of club foot caused by compression in utero and corrected by passive manipulation
What is the management for talipes equinovarus?
Manipulation, casting and bracing with the Ponseti method
What is the management of acute chest syndrome in sickle cell?
Mechanical ventilation and urgent exchange transfusion
What is the first step in managing a sickle cell crisis?
Adequate analgesia
(then adequate oxygenation and hydration)
Which sickle cell crises will need exchange transfusion?
- Acute chest syndrome
- Priaprism
- Stroke
What is polyethylene glycol?
Movicol
(Once prescribed, GP should arrange 2 week follow up)
How long should children stay off school with mumps?
5 days following the onset of parotitis
What are the red flag symptoms of mumps?
Meningism and epididymo-orchitis
Is Turner’s syndrome associated with intellectual impairment?
No
What is the management of meconium aspiration?
- Examine oral cavity for meconium and remove using large-bore suction catheter
- IV gentamicin and ampicillin
What is the definitive treatment for biliary atresia?
Kasai procedure
Which organisms most commonly cause otitis externa?
- Staphylococcus aureus
- Psuedomonas aeruginosa
What is the presentation of vestibular neuronitis?
Inner ear infection
- Nausea
- Vomiting
- Dizziness
What is the first line treatment of dementia with lewy bodies?
Acetylcholinesterase inhibitors eg. rivastigmine
What is schizoaffective disorder?
Presence of schizophrenia symptoms for >=1 month + mood disorder (mania or depression)
Mood disorder must be present for the majority of the illness, but should be at least 2 weeks of psychosis without mood symptoms (distinguish from psychotic depression or mania with psychosis)
What is a brief psychotic disorder?
Symptoms of schizophrenia lasting <1 month
What is schizophreniform disorder?
Symptoms of schizophrenia lasting 1-6 months (mood symptoms less prominent than in schizoaffective disorder)
What is the management of schizoaffective disorder?
- Antipsychotic (atypical)
- Mood stabiliser (lithium)
When is the onset of baby blues?
Within the first 2 weeks PP
When does post natal depression present?
6-8 weeks post partum
But any depression within 1 year post partum is considered PPD
What are the requirements for a gestational hypertension diagnosis?
blood pressure (BP) ≥140/90 mmHg on two occasions (at least 4 hours apart) during pregnancy after 20 weeks’ gestation in a previously normotensive patient, without the presence of proteinuria or other clinical features suggestive of pre-eclampsia
What is a commonly used first line tocolytic?
Nifedipine
If contraindicated, atosiban can be used
What is the first step in managing preterm labour with in-tact membranes?
Pre-term labour can be diagnosed if cervix is <15mm on TVUSS
- Tocolytics (nifedipine, atosiban)
- Corticosteroids (22-33+6 weeks), don’t give more than 2 courses
What are the risks of contractions with cervical cerclage in place?
Cervical tear
What are the symptoms of lichen planus?
Polyglonal (many sharp angles), violaceous (violet colour) macular rash on vulva and perianal region
Wikham striae on oral mucosa (cob-web like markings)
How does the surgical treatment of endometriosis differ when fertility is a priority?
Fertility:
- Laproscopic excision or ablation with adhesiolysis
Not prioritising fertility:
- Laparoscopic excision followed by hormonal treatment, as hormonal treatment can prolong the effects of surgery
Where is inflammation in Crohn’s most common?
Terminal ileum
Which extra intestinal symptoms are more present in Crohn’s over UC?
- Apthous ulcers
- Uveitis
- Ankylosing spondylitis
Which extra intestinal features are more seen in UC over crohn’s?
- PSC
- Pyoderma gangrenosum
- Enteric arthritis
What is a complication of tinea capitis?
Scarring alopecia
Oral antifungals or topical ketoconazole shampoo
What organisms cause tinea capitis?
- Trichophyton tonsurans
- Microsporum canis
What is alopecia areata?
Localised, autoimmune loss of hair which typically grows back within a year (non-scarring)
What is telogen effluvium?
Loss of hair as a result of stress (more common in adults)
What is traction alopecia?
Hair loss (usually on the side of the head) due to pulling hair back tightly
When in pregnancy would cleft lip occur?
Failure of fusion between weeks 4-7
When in pregnancy would cleft palate occur?
Failure of fusion in weeks 6-9 of pregnancy
What are the complications of cephalohaematoma?
- Jaundice
- Defective blood clotting
- Intracranial bleeding
Takes months to resolve
What are the poor prognostic factors of ALL?
- T cell markers
- Being <2yrs or >10yrs
- Male
- WCC >20x109
When are topical steroids used for eczema?
If the patient has a flare, they should be applied 30mins after emolients
What are the organic causes of Fregloi delusion?
- Treatment with levodopa
- Injury to the fusiform gyrus
- Damage to the temporo-parietal area
What is flumenazil?
A benzodiazepine receptor antagonist sometimes used to treat benzodiazepine overdose
What are the first investigations to order when intestinal malrotation is suspected?
- Upper GI contrast studies USS (any history of bilious vomiting)
- CT abdo (with contrast) (if the concern for malrotation is low)
- Abdo x-ray (ED, not as helpful as above)
- FBC (WBC should be normal in MR without volvulus, may be abnormal with prolonged volvulus)
What is the management for endometrial hyperplasia without atypia?
Continous progestogens using IUS
- Continue for 6 months
- Review with TVUSS and endometrial biopsy every 6 months
What is the management for endometrial hyperplasia with atypia?
Total hysterectomy and bilateral salingo-oophorectomy
What is the management for pre-menopausal woman with endometrial hyperplasia and atypia who wanted to preserve fertility?
Continuous progestogens and 3 monthly reviews
When is endometrial ablation used?
HMB for patients who don’t want to preserve fertility
Management of PMS?
- Symptom diary for 2 cycles
(If no no impact on the patient’s personal, social or professional life)
2. Lifestyle advice
(Otherwise)
2. COCP
- CBT
Which antimuscarinics are offered for urge incontinence?
- Tolterodine
- Oxybutynin
- Darifenacin
AVOID in elderly women with risks of falls, give:
- Mirabegron (beta-3 agonist)
What happens to the tidal volume during pregnancy?
Increases by 30-35% due to increased metabolic CO2 levels and progesterones which increase respiratory drive
Increased minute ventilation by 40%
How much does GFR increase in pregnancy?
30-60%
How long is the antibiotic regimen for UTI in pregnancy?
7 days
What should be considered if a pregnant patient has had no improvement in their UTI symptoms after 48 hours on nitrofurantoin?
Amoxicillin or cephalexin
Why is trimethoprim avoided in the first trimester?
Increases the risk of neural tube defects
How is diagnosis of genital herpes confirmed?
Viral cultures and PCR
What is a primary genital herpes infection?
4-7 days after sexual contact (can last up to 3 weeks)
What is a secondary genital herpes infection?
An infection in an individual with previously existing immunity
What is the management of primary genital herpes in pregnancy?
Presenting in 1st/2nd trimester:
- 5 days of oral acyclovir (400mg TD)
- Suppressive oral acyclovir from 36 weeks until delivery, with vaginal delivery anticipated
Presenting in the 3rd trimester:
- Oral acyclovir immediately until delivery (400mg TD), C-section recommended
When should invasive procedures be avoided with herpes in pregnancy?
When there are genital lesions eg. instrumental delivery
What is the management for recurrent herpes in pregnancy?
Oral acyclovir from 36 weeks, no C-section delivery indicated
What is the management of mastitis with prolonged symptoms?
Flucloxacillin
Why can hydrocele occur in neonates?
Failure of obliteration of the processus vaginalis
<2 years tend to resolve spontaneously as the processus vaginalis closes
What are the referral criteria for bronchiolitis?
- Looking seriously unwell
- Apnoeic
- Centrally cyanosed
- O2 sats <92%
- Severe respiratory distress
- Resp rate >70
What is the management for bronchiolitis?
Supportive
May require:
- O2
- Feeding via NG tube
- Suction for significant secretions
What are the extra-pulmonary/ extra-pancreatic features of CF?
- Meconium ileus
- Short stature
- Infertility in males
How often is chest physiotherapy done for CF?
Twice daily
What are most causes of infant torticollis caused by?
Sternocleidomastoid tumour, congenital muscular torticollis
Reduced ROM and struggling to turn the head in one direction (can manifest subtly, only managing to feed from one breast)
What vaccine is given to children at 3 months old?
1st dose
- Pneumococcal conjugate vaccine
2nd dose
- 6-in-1 vaccine
- Oral rotavirus vaccine
What is included in the 6-in-1 vaccine?
- Whooping cough
- Hepatitis B
- Tetanus
- Diptheria
- Haemophilus influenzae type B
- Polio
When is the time limit for febrile status epilepticus?
30 minutes
How long is the observation period after a first episode of febrile convulsion?
4-6 hours
What is the infectious period for chicken pox?
1-2 days before the appearance of the rash until the lesions have crusted over
What are the four developmental domains?
- Social, emotional and behavioural
- Gross motor
- Vision and fine motor
- Hearing, speech and language
What are the milestones by 18 months across all domains?
Social, emotional and behavioural
- Feed themselves with a spoon
- Drink from a cup
- Play alone
- Help with dressing
Gross motor
- Take off shoes
Vision and fine motor
- Pincer grip
- Build a tower of three
- Look at and palm hit books
- Draw a scribble
Hearing, speech and language
- 6-10 words
- Follow simple instructions
- Point to 2-4 body parts
When can children use a fork?
By 3 years
When can children put on shoes?
By 2 years
When do children play with other children?
By 4 years
(Play near other children at 2)
When do children combine words?
2 years
When should mood be screened for post partum?
At 6 weeks and 4 months
Which SSRIs are recommended for breastfeeding?
Sertraline and paroxetine
(+ low dose amitryptiline)
What is the cut off score for Edinburgh scale postnatal depression?
> =10
What is the management for mild PND?
- Indirect counselling via midwife/ health visitor
- Support groups etc
What is the managment of moderate PND?
- Psychological intervention and antidepressants
How long does a 136 last?
24 hours
But can be extended 12 hours
What investigation can be performed if the diagnosis of Parkinson’s is in doubt?
Dopamine transporter scan
Visualise depletion of the dopaminergic neurones in the substantia nigra
Which complications of the varicella zoster virus are pregnant women more at risk of?
- Pneumonia
- Hepatitis
- Encephalitis
If birth occurs within 7 days of the onset of VZV rash, how long is the neonate observed for?
28 days
When is the last dose of LMWH given before C section?
24 hours before and restart 6-12 hours after birth
When do foetal movements tend to plateau?
By 32 weeks
What is the longest range between foetal movements?
50-75 minutes
(Afternoon/ evening periods are the periods of peak activity)
How long are foetal sleep cycles?
20-40 minutes
(rarely exceed 90 minutes)
How should foetal movements be assessed?
Subjective maternal perception of foetal movements
What is the advice for women who are unsure about the frequency of foetal movements after 28 weeks?
Lie on their side and focus on foetal movements for 2 hours, if 10 or more discrete movement aren’t felt contact their midwife/ maternity unit
What is the definition of recurrent miscarriage?
3 or more consecutive miscarriages
What is the threshold for vaginal delivery in an HIV positive mother?
<50 copies/mL at 36 weeks
(immediate cord clamping and no breastfeeding)
When is ECV offered for nullip and multip women?
Nullip:
36 weeks
Multip:
37 weeks
What are the risks of ECV?
- Premature ROM
- Placental abruption
What are the urine protein thresholds for PET?
- P:C >30mg/mol
- 24 urine >300mg
What are the symptoms of dislocation of the knee?
- Severe knee pain
- Sudden knee swelling
- Inability to straighten leg/ walk
- Sudden popping
What is the inheritance pattern of Becker’s muscular dystrophy?
X-linked recessive
Which conditions are associated with Talipes equinovarus?
- Neuromuscular (eg. spina bifida)
- Edward’s
- Oligohydramnios
- Arthrogryposis multiplex congenita
- Cerebral palsy
What are the five main signs for testicular torsion?
- Absent cremasteric reflex
- No relief of scrotal pain on elevation of the testicles (negative prehn’s sign)
- Deming sign - testicle in an abnormally elevated position
- Brunzel sign - horizontal testicle lie
- Ger sign - pitting at the testicle base
What is omphalitis?
Rare condition where the umbilicus and surrounding tissues become infected and inflamed
- Staphylococcus
- Streptococcus
Umbilicus appears red and warm and discharges pus
What are secondary lesions in acne?
Lesions which occur as a result of primary lesions healing
eg. excoriations or macules
What are the primary lesions in acne?
Inflammatory lesions
- Papules
- Pustules
- Nodules
Non-inflammatory lesions
- Comedones
- Pseudocysts
What would an ECG of Ebstein’s anomaly show?
Right bundle branch block
What are cannon waves on ECG?
Contraction of the atria against a closed tricuspid valve
What are rosenthal fibres a histological hallmark of?
Pilocytic astrocytomas
Which syndrome are haemangiomas associated with?
Von Hippel-Lindau
What is the inheritance pattern of congenital adrenal hyperplasia?
Autosomal recessive
How does 11-beta hydroxylase deficiency CAH present?
Virilisation of female genitalia, precocious puberty, hypertension and hypokalaemia
What is the congenital defect risked when taking fluoxetine in the first trimester?
Congenital heart defects
What are the symptoms of olanzapine exposure to neonates in utero?
- Lethargy
- Tremor
- Hypertonia
What is the timeline required for illness anxiety disorder/ hypochondrial disorder?
6 months
How often should monochorionic diamniotic twins have growth scans?
Every 2 weeks from 16-24 weeks
Scans at 28, 32 and 34 weeks
What is the first line treatment of candidiasis in pregnancy?
Intravaginal clotrimazole
When are oral antibiotics indicated in mastitis?
When symptoms have persisted over 24 hours, despite adequate milk expression
What is the insulin regimen during labour for patients who have T1/2DM?
Variable-rate insulin infusion with the aim of maintaining BM 4-7
When can IM oxytocin be given for active management of 3rd stage of labour?
- After delivery of the anterior shoulder
- After delivery of the baby and before clamping the cord
What is the preferred mode of delivery for IUGR?
C-section
Which women are not offered IOL?
- Previous C-section
- Breech presentation
What is given for all patients with balanitis?
- Hygiene advice
- Topical 1% hydrocortisone cream
- Swabs (only if the aetiology is unclear)
What is the presentation and management of bacterial balanitis?
Painful, yellow discharge
Flucloxacillin
When would circumcision be considered in balanitis?
Severe cases with phimosis
How long is the watch and wait period for ADHD?
10 weeks
How long is methylphenidate trailled for ADHD?
6 weeks
Important to monitor height, weight and baseline ECG every 6 months
Drug free trial every year to see if the child can stop taking it
What is laryngomalacia?
Congenital softening of the supraglottic larynx
Usually grown out of by the time the child is 2
How often are height and weight monitored for coeliac disease?
Annually
Which rash is characteristic of coeliac?
Dermatitis herpetiformis (vesicular rash)
What is the treatment threshold for pneumothorax?
> 2cm immediate drainage with needle aspiration
If unsuccessful, chest drain
<2cm and not breathless, safety net and outpatient review in 2-4 weeks (repeat x-ray)
What is a secondary pneumothorax and how does management of this differ from primary pneumothorax?
Pneumothorax resulting from a chronic lung disease
> 2cm immediate chest drain
<1cm high flow oxygen and observation
What are the four types of FGM?
- Clitoridectomy
- Excision
- Infibulation
- Miscellaneous
What are the symptoms of rubella?
Maculopapular rash spreading from the face to the trunk, low grade fever, pink eyes, runny nose, headache and lymphadenopahty
Which rash causing conditions have an incubation period of 3-6 days?
- Hand foot and mouth disease
- Scarlet fever
- Viral meningitis
Which medications are indicated in Alzheimers?
Mild-moderate (Ach esterase inhibitors)
- Donepezil
- Rivastigmine
- Galantamine
Moderate-severe (NDMA receptor agonist)
- Memantine
Which alzheimer’s drugs cause nausea and vomiting?
Ach esterase inhibitors
What are the features of neonatal opiate withdrawal?
CNS
- High-pitched and continuous crying
- Tremors
- Hyperactive reflexes
- Seizures
- Increased tone
- Reduced sleep
GIT
- Feeding difficulties
- Vomiting
- Diarrhea
ANS
- Yawning/sneezing
- Increased resp rate
- Nasal flaring
How soon after birth does puerperal psychosis present?
10 days
How long do symptoms of personality disorders have to persist for a diagnosis?
2 years
What is the required timeframe for a diagnosis of delusional disorder?
3 months
What is the management for a GBS infection in pregnancy if a woman has had a previous baby infected with GBS?
Intrapartum benzylpenicillin and induction of labour
Likelihood of GBS in a subsequent pregnancy when they’ve been GBS positive in a previous pregnancy is 50%
How does vulval cancer tend to arise in young vs older patients?
Younger patients –> HPV infection
Older patients –> long standing lichen sclerosis
Which auto-antibodies are present in antiphospholipid syndrome?
- Anti-cardiolipin
- Anti-lupus anticoagulant
- Anti-beta 2 glycoprotein I
At how many weeks of pregnancy does malrotation occur?
10th week
How does duodenal atresia present?
Polyhydramnios and bilious vomiting after the first feed
Which chromosomal defect causes Hirschprung’s disease?
Chromosome 10
For how many weeks of life is the heel prick test accurate?
6 weeks
How long does immunisation from the whooping cough vaccine last?
4-12 years
Once infected, macrolides are the choice antibiotic
What is the diagnostic investigation for whooping cough?
Nasopharyngeal swab culture or PCR
What is the description of the headlice rash (pediculus humanus capitis)?
Papular, red rash, finely spread across the base of the neck and into the hairline
Most often treated mechanically with wet combing which can be combined with application of topical malathion
What is the management of pityriasis versicolor?
Ketoconazole
What is the Jones criteria for acute rheumatic fever?
2 major or 1 major + 2 minor criteria
Major:
- Carditis (may manifest as a new heart murmur)
- Polyarthritis
- Chorea
- Erythema marginatum (non-itchy macular rash)
- Subcutaneous nodules
Minor:
- Fever >38.5
- Arthralgia
- ESR >30 and/or CRP >3
- Prolonged PR interval on ECG
What is the gold standard diagnostic test for CMPA?
Double-blind placebo food challange and exclusion of causitive food from the diet
What is anakastic personality disorder?
The same as obsessive compulsive personality disorder
Which timeframe does the Edinburgh Postnatal Depression Scale measure?
The last 7 days
A score >12 indicates the patient is suffering from PND
What is the triad of Meig’s syndrome?
- Benign ovarian tumour (usually fibroma)
- Ascites
- Pleural effusion
What coinfection is an indication for C-section in HIV?
Hepatitis C
Hep C testing is offered to all women HIV positive in pregnancy
Are serial growth scans indicated in HIV?
No, HIV does not affect the growth of the baby
What is the correct way to count the gravidity of a multiple pregnancy?
G1 (one pregnancy event)
What are the steps of assessing reduced foetal movements?
- Handheld Doppler to auscultate the heartbeat
If heartbeat is present:
2. CTG
If heartbeat is not present:
2. Ultrasound scan
What are the different time points at which an embryo divides and how does this correspond to what type of twins are produced?
Divides before day 4 after fertilisation:
- Dichorionic diamniotic
Divides between days 4-8:
- Monochorionic diamniotic
Divides between days 8-12:
- Monochorionic monoamniotic
Divides after day 13:
- Conjoined twins
When would variable rate insulin infusion be indicated for GDM?
If the mother was already receiving insulin for their treatment, treatment with metformin alone doesn’t indicate insulin infusion
What is the mechanism of Kallman syndrome?
Failure of development of the GnRH neurones within the hypothalamus
What gynaecological cause does fragile X syndrome lead to?
Premature ovarian insufficiency
What is the most common childhood arrhythmia?
Supraventricular tachycardia
What ECG finding would suggest Wolff-Parkinsons White syndrome?
Short PR interval and a slurred upstroke to the QRS complex
What is the management for SVT if vagal manoeuvres fail?
IV adenosine (blocks conduction through the AV node)
What is the management for heart failure that arises secondary to acyanotic conditions like VSD?
Diuretics and captopril (ACE inhibitor)
Which antivirals can be considered for roseola infection in immunosuppressed children?
Ribavirin or cidofovir
For which type of UTI is ultrasound always performed in the acute setting?
Atypical UTI
When is dexamethosone started for bacterial meningitis in children?
- LP reveals frankly prurulent CSF
- WCC >1000u/L
- Raised WCC with protein concentration >1g/L
- Bacteria on gram stain
What are the causitive organisms of impetigo?
Group A strep or staph aureus
How long should children with impetigo be excluded from school?
Until the lesions are dry and have scabbed over
How long is school exclusion for whooping cough?
Until 48 hours after appropriate antibiotics have been initiated
How long is school exclusion for measles or rubella?
For 4 days after the onset of the rash
What is the peak incidence of transient synovitis?
2-12 years old
What is the PHQ threshold for depression?
> 5
Which score on the AMTS would suggest cognitive impairment?
<8
<6 would indicate delirium or dementia
What is the criteria for referal to memory clinic?
Significant result on a memory test such as the AMTS
What is the criteria for treatment of paracetamol in a staggered overdose?
Treatment should be given immediately
Bloods taken to measure the paracetamol concentration, LFTs and coagulation
What is the mechanism of activated charcoal?
Reduces the absorption of paracetamol
What is the definition of persistent grief disorder?
When the symptoms persist for over 6 months
What is the criteria for persistent complex bereavement disorder?
Grief persisting for over 12 months, patients may express a desire to die to be with their loved one
What is the definition of oligomenorrhea?
Cycles >35 days or <9 cycles per year
What is acanthosis nigricans a sign of?
Insulin resistance
What is the moa of metformin in PCOS?
Biguanine
Increases insulin sensitivity and decreases circulating insulin levels which can decrease circulating androgen levels, improving anovulation and fertility
What is the mechanism of spironolactone in PCOS?
Anti-androgenic effects used in the management of hirsutism
Which pain relief is often used during the 1st stage of labour (before admission)?
- Paracetamol
- Co-dydramol
- Pethidine
Which analgesias are available for the 2nd stage of labour?
- Entonox
- Remifentanil patient controlled analgesia
- Epidural anaesthesia
What are the indications for instrumental delivery in 2nd stage of labour?
- Poor progress
- Foetal compromise
- Maternal exhausion or distress
- Need to reduce time pushing (eg. maternal cardiac disease)
What is a normal AFI?
5-25cm
How does foetal anaemia cause polyhydramnios?
Increases the cardiac output which increases urine production and therefore amniotic fluid level
When is insulin started straight away for GDM?
If fasting glucose is >7mmol/L
Patient should be reviewed within 1 week
What is the management for asymptomatic bacteriuria in pregnancy?
Immediate antibiotic prescription for 7 days
What is the management for women with hypertension at 37/40?
Delivery within 24-48 hours
How long should additional contraception be used when POP is initiated post partum?
2 days
How long should folic acid be taken for?
Conception to 12+6 weeks
Which metrics are the developmental milestones achieved by?
- Time at which 1/2 population achieves a skill (median age)
- Time at which 95% of the population achieves a skill (limit age)
When would an inferior pincer grip indicate developmental delay?
At 12 months, the child should have developed a mature pincer grip, if it is still inferior they are delayed (vision and fine motor)
What is the limit age for speaking 2 words?
18 months
What is the treatment of biliary atresia?
Hepatoportoenterostomy
What is the cause of hirschprung’s disease?
Absence of parasympathetic ganglion cells in the myenteric and submucosal plexuses of the rectum
What is the management of Hirschprung’s disease?
Bowel irrigation, broad-spectrum antibiotic coverage and surgical correction (anorectal pull-through)
In which children is labial fusion common?
Female children below the age of 7
Usually develops 1-2 years of age and often resolves by puberty
What is the management of symptomatic labial fusion?
4-6 weeks of topical oestrogen
Surgical separation can be considered if topical oestrogen is ineffective
What is the managment of reactive arthritis?
Self-resolving and often doesn’t require any active treatment
What is the initial investigation for acute appendicitis?
Abdominal USS
Which age group of children should not receive antivirals for chickenpox?
1 month to 12 years
What is the management of chickenpox in immunocompromised individuals?
IV acyclovir once symptoms have developed
Which heart condition is Edward’s associated with?
VSDs
What is the cause of guttate psoriasis?
Streptococcal infections
Tends to develop on the upper trunk and proximal upper limbs
What is the first line therapy for mild psoriasis?
Topical corticosteroids or vitamin D analogues
What is the presentation of hyperkeratotic eczema?
Eczema characterised by dry, thickened hyperkeratotic plaques involving the palmar surfaces
What is the mainstay in treating vascular dementia?
Modifying the cardiovascular risk
What do the blood tests of NMS demonstrate?
Raised WCC and raised CK
Which type of vaginal swab will detect trichomonas vaginalis?
High vaginal swab
What is Naegele’s rule?
LMP+9 months+1 week (+ difference in the cycle)
What are the critera for pregnant women being offered OGTT at 28 weeks? (BIG PE)
B - BMI >30kg/m2
1 - 1st degree relative with GDM
G - GDM previously
P - Previous pregnancy with birth weight >4.5kg
E - Ethnicity eg. south asian, black or middle eastern
What are the threasholds for the PUQE score?
- Mild 3-6 points
- Moderate 7-12 points
- Severe >=13 points
What is the management for undescended testes?
If asymptomatic, review at 6 week check and if still undescended, review at 4-5 months, if still undescended refer to paeds urology and they should be seen before 6 months
What is the management for bilateral undescended testes?
Urgent referral to paediatrician within 24 hours for genetic and endocrine testing
What is the main finding on an xray for inhaled foreign body?
Increased volume and translucency of the affected lung
Diagnosis usually confirmed by bronchoscopy which can be used to remove foreign body
What is a Blalock-Taussig shunt?
Surgical procedure creating an artificial shunt between the subclavian and pulmonary artery used in TOF
Used to stabilise patients ahead of elective intracardiac repair
What is the name of the procedure to correct transposition of the great arteries?
Arterial switch
What is tethered spinal cord syndrome?
A complication of spina bifida
- Lower back pain
- Gait disturbance
- Scoliosis
- High-arched feet
- Neurological dysfunction (bladder and bowel)
What is a myelomeningocele?
Severe form of spina bifida
Spinal cord protrudes through an opening in the spinal column
Withdrawal of which drug can cause lacrimation?
Opiates
Increased salivation is a side effect of which antipsychotic?
Clozapine
What is couvade syndrome?
A condition in which the expectant father may experience the same symptoms as their pregnant partner
What does active managment of the third stage of labour involve?
Administration 10IU oxytocin, delayed cord clamping (depending on maternal choice) and controlled cord traction
For active management of the 3rd stage, the cord should be clamped within 5 minutes to allow for controlled cord traction
What is the most common STI in the UK?
Chlamydia
100mg doxycycline PO BD for 1 week OR (if worried about compliance)
1-2g azithromycin stat dose
In which patients are prostaglandin pessaries usually avoided in?
Previous C sections due to the risk of uterine rupture
What is placenta accreta?
Attachment of the placenta to the myometrium, with no invasion into the myometrium
Placenta increta is invasion into the myometrium
What is the mechanism of levonorgestrel?
Inhibits ovulation, therefore if a patient is day 15-28 it’s likely they have already ovulated
What is the mechanism of tranexamic acid?
Anti fibrinolytic drug acting to decrease the transformation of plasminogen to plasmin
At what glucose level in DKA is 5% dextrose added to the treatment regimen?
<14mmol/L
At how many weeks in utero does the vitelline duct obliterate?
7 weeks
What is Peutz-Jegher syndrome?
An autosomal dominant condition characterised by development of hamartomas throughout the GI tract, hyperpigmented spots on the lips, hands and genitalia
Associated with increased risk of breast and GI cancer
Where is the mutation in familial adenomatous polyposis?
APC tumour suppressor
What is Gardner syndrome?
FAP with osseous and soft tissue tumours
Until how many months of age is strabismus common?
3 months
Refractive errors are the most common cause
Any child >3 months should be referred to an opthalmologist
Why are young children more likely to develop acute otitis media than adults?
Their Eustachian tubes are shorter and more horizontal
What is a cholesteatoma?
A benign growth behind the eardrum that can occur in the context of recurrent ear infections
How long can it take for molluscum contagiosum to heal?
18 months
What is the corneal light reflex test?
Light is shone at the eyes from a distance to produce reflections on both corneas simultaneously
What is sturge-weber syndrome?
A neurocutaneous syndrome characterised by presence of haemangiomatous facial lesions in the distribution of the trigeminal nerve, abnormal intracranial blood vessels and eye abnormalities
What are the features of neurofibromatosis type 1?
Autosomal dominant
- Cafe-au-lait spots
- Neurofibromas
- Auxillary freckling
- Optic glioma
- Lisch nodules
- First degree relative with NF1
What are the features of neurofibromatosis type 2?
Autosomal dominant (less common than NF1)
- Bilateral acoustic neuromas (deafness)
- Multiple inherited schwannomas, meningiomas and ependymomas
How long is the watch and wait period for ADHD?
10 weeks
What is the regimen for checking lithium levels?
Initially checked weekly (12 hours after last dose), then every 3 months, thyroid and renal function checked every 6 months
What is the dose of MgSO4 given in pre-eclampsia?
4mg loading dose and continuous infusion until 24 hours after the surgery
In which urogenital infection are pinkish blue inclusions seen?
Chlamydia
What are the absolute contraindications for the COCP?
SAILBOAT
- Smoking >15 cigarettes a day and >35
- Aura
- Immobility or recent surgery
- Liver disease
- Blood pressure >140/90
- Obesity BMI >30
- Any oestrogen dependent tumour or unexplained PV bleed
- Thromboembolism or stroke history, CVD or family history of VTE <45 years
When is the most appropriate time to measure serum progesterone to get an idea of ovulation?
7 days before the end of the cycle, therefore if their cyle is 28 days - day 21, if 30 days - day 23
What can cause the uterus to be in a fixed retroverted position in endometriosis?
Adhesion formation
How is lichen sclerosis usually managed?
Short course of topical steroids with an antimicrobial agent eg. betnovate and fusidic acid
What % of molar pregnancies a) become invasive b) procress to choriocarcinoma?
a) 10%
b) 2.5%
What is the referral pathway if low grade dyskaryosis is detected on cytology?
Colposcopy within 6 weeks
(If high grade colposcopy within 2 weeks)
What is the inheritance pattern of Marfans?
Autosomal dominant
What are the symptoms of osteochondritis dissicans?
Caused by disrupted blood supply to the cartilage
- Knee pain
- Swelling
- Locking following exercise
What would an x-ray of necrotising enterocolitis show?
Distended loops of bowel
What is the first step if whooping cough is diagnosed?
The patient should be isolated in the hospital to prevent any further spread and the health protection unit should be alerted
Which heart sounds are heard with TGA?
No abnormal heart sounds
- Prostaglandin infusion
- Emergency balloon atrial septostomy
- Arterial switch operation
What is the difference in heart sounds between ostium secundum and ostium primum?
Both have ejection systolic murmur with fixed splitting of the S2 sound, but primum also causes an apical pansystolic murmur due to AV valve regurgitation
What is the management for ASDs?
Closure in the cath lab at 3-5 years
What are the two phases of cocaine withdrawal?
- Crash phase (several hours after last use)
- Depression
- Exhuastion
- Agitation
- Irritability - Continual withdrawal phase
- Increased cravings
- Irritability
- Anergia
- Poor concentration
- Insomnia
What is the difference between early and delayed cord clamping?
Early is within 60s and delayed is 1-5 minutes
Which dementia has alpha-synuclein involved?
Lewy body dementia
Steven has been brought to A&E by his family with concerns that he might harm himself. He has a 3 week history of intermittent agitation and distress, stating that he needs to go to find his uncle in Yorkshire because “they’re trying to get me”. This morning, he ran out of the house into the road. He has been medically cleared. The psychiatry trainee thinks that he may need admission to a mental health unit, however, steven attempts to abscond from A&E whilst waiting for the assessors to arrive. What should the psychiatry trainee advise?
The A&E team should stop him leaving under the mental capacity act
What is the mental capacity act?
Gives any adult with capacity the right to make advance decisions and lasting power of attorney
- Says how to decide if someone has capacity
For any adult without capacity it tells professionals to
- Act in their best interests
- Consult family/friends about decisions
- Appoint IMCA for important decisions
- Apply Deprivation of liberty safeguards (DOLS) to anyone deprived of liberty
What are inconsolable cry and fever classic signs of in a child?
Meningism
When is it common for infants to lose weight?
In the first few days of life, weight loss tends to cease between days 4-5
Which health care professionals can aspirate a hip joint?
This must be done by orthopaedics, because it is an inaccessible joint
What are some gonadotrophin-independent cause of precocious puberty?
- McCune Albright syndrome
- CAH/ Cushings
- Obesity
What are the doses for prednisolone management of nephrotic syndrome?
60mg/m2/day for 4 weeks, then reduce to 40mg/m2/day
You review a lady in A&E. She is 8 weeks pregnant and very confident of the dates. She attended A&E because she had some PV bleeding at home after intercourse, which has now resolved. She has no pain. Normal observations. On a bedside scan the uterus is empty. What is the diagnosis?
And why can this not be diagnosed as a miscarriage?
Pregnancy of unknown location
Because the pregnancy needs to have been previously visualised on USS
Which is the competency relating specifically to contraception?
Fraser competence
You see a 16 year old girl in Paediatric and Adolescent Gynaecology Clinic. She presents with primary amenorrhoea. Upon further history taking you elicit that she experiences lower abdominal pain every 28 days and suffered with recurrent UTIs as a child. The patient consents to examination and you note that she has undergone female genital mutilation. What is your immediate professional obligation under the FGM act 2003?
Report to the police regardless of consent
A 32 year old woman presents to you at 16wks with elevated BP without proteinuria on urine dip. Which of the following is the most appropriate with regards to her need for aspirin?
A She requires weekly measurement for proteinuria and her management will depend on whether she develops proteinuria
B She requires formal PCR to determine whether there is proteinuria and
C She needs a full history to assess risk factors for pre-eclampsia and if she has enough risk factors she will need aspirin for pre-eclampsia
D She needs aspirin from 12wks regardless of risk factors from her history
E She needs to start an ACE inhibitor
She needs aspirin from 12 weeks regardless of the risk factors from her history
What is the mechanism of smoking increasing the risk of cervical cancer?
Impairs the immun system’s ability to control infection by HPV, resulting in dysplasia and malignant change in the cervical cells
How is premature ovarian failure diagnosed?
By FSH levels, measured at 2-5 days of cycle
Two FSH levels taken 4-6 weeks apart significantly elevated, a diagnosis of POF is made
What is the mechanism of ulipristal acetate?
Selective progesterone receptor modulator
What is the threshold for Ca125 for TVUSS?
35IU/ml or greater
How does AVSD present in a newborn?
Typically with cyanosis and heart failure, heart murmur will often not be audiable
What is the murmur in tricuspid atresia?
Pansystolic
Which genetic syndromes is interrupted aortic arch associated with?
DiGeorge
What is the organism causing scabies?
Sarcoptes scabiei
What are the symptoms of primary ciliary dyskinesia?
- Recurrent upper and lower respiratory tract infections
- Infertility
- Pancreatic insufficiency
- Situs intersus (cilia play an important role of the movement of organs into their correct positions)
How long does a section 4 last for?
72 hours
When can whooping cough patients be given antibiotics?
If they are diagnosed within 21 days of the onset of symptoms
School exclusion until 48 hours after antibiotics or 21 days after onset of symptoms
What are the three main complications of minimal changes disease?
- Increased risk of thrombosis (loss of antithrombin III)
- Increased risk of infection (loss of immunoglobulins)
- Hypercholesterolaemia (decreased osmotic pressure)
What causes spina bifida occulta?
Failure of fusion of the vertebral arch
What is tethered spinal cord syndrome?
A complication of spina bifida, fixation of the inelastic tissue of the caudal spine causing abnormal movement of the spinal cord as the child grows
What are the neurological findings in meningocele?
Neurology is normal because the sac dosen’t contain neural tissue, only the meninges
What is the most severe form of spina bifida?
Myelomeningocele
Spinal cord protrudes through an opening
Which head deformity is common in neonates born via instrumental delivery?
Cephalohaematoma
Doesn’t cross suture lines
What is the inheritance pattern of Marfan’s?
Autosomal dominant
When would an ENT referral for otitis media be made?
- Child hasn’t responded to 2 courses of antibiotics
- Suspected glue ear
- Unexplained recurrent AOM
- Associated with complications or craniofacial abnormalities eg. down syndrome
What is the management for DDH?
- <6 months: Pavlik’s harness
- 18 months - 6 years: Open surgical reduction
- > 6 years: salvage osteotomy
Where is the lesion in dyskinetic cerebral palsy?
Basal ganglia
Where are the lesions in mixed cerebral palsy?
More than one location in the brain
What is the prodrome for Guttate psoriasis?
Strep throat infection or other URTI
What is the most common cause of delayed puberty in males?
Hypogonadotrophic constitutional delay
What is the presentation of infantile colic?
Inconsolable crying/ screaming, accompanied by drawing the knees up and passage of excessive flatus >3 hours/day for >3 days/week for >3 weeks
What is the presentation of rotavirus?
Fever and vomiting, followed by diarrhea lasting 3-8 days
What is the inheritance pattern of fragile x syndrome?
X-linked dominant
Which catecholamines will be elevated in neuroblastoma?
Urinary homovanillic acid (HVA) and vanillylmandelic acid (VMA)
Biopsy required for definitive diagnosis
What is the median age a baby is able to roll over?
4 months
Which diarrhea causes are notifiable?
- Campylobacter jejuni
- Listeria monocytogenes
- E.coli 0157h7
- Shigella
- Salmonella
When should topical hydrocortisone be prescribed for nappy rash?
If the child is symptomatic eg. the rash is inflamed and causing discomfort
Only give hydrocortisone if children are >1 month
What does bilateral testicle enlargement in a child suggest?
A gonadotrophin-dependent cause of precocious puberty
When would hydroxycarbamide be used for an acute sickle cell crisis?
- Recurrent hospital admissions for painful crises
- Acute chest syndrome
Takes 6-8 weeks to cause improvement, not appropriate for the acute setting
How long after an enuresis alarm should children be followed up?
4 weeks
Alarm should be continued a minimum of 14 nights
What are the features of eczema herpeticum?
Widespread blisters and punched out lesions
If present around the eyes, an opthalmological review is indicated
What is the inheriance pattern of CAH?
Autosomal recessive
How long after delivery does gestational hypertension resolve?
6 weeks
What is the BMI in which ulipristal acetate is preferred over levonorgestrel?
26
Which cells produce anti-mullerian hormone?
Granulosa cells
What is the FSH level in premature ovarian insufficiency?
High
What is the risk of fibroids during pregnancy?
They can undergo red degeneration, foetus using up the blood that supplied the fibroids resulting in ischaemia and necrosis
Presents with significant abdominal pain typically during the mid-second trimester
A 34-year-old woman on the labour ward, who is 38 weeks’ pregnant, has
started having regular, painful contractions. She suddenly experiences
a heavy gush of fresh red vaginal bleeding. On questioning, she has
not experienced any pain aside from the contractions. The CTG shows
late decelerations and foetal bradycardia. She had one previous
delivery by emergency caesarean section. What is the most likely
diagnosis?
Vasa praevia
Placenta praevia unlikely to cause pathological CTG trace as the bleeding is from the maternal circulation
How long should progestogens be continued in endometrial hyperplasia?
Minimum 6 months
How long before delivery should the last dose of LMWH be taken?
24 hours before
When is IV unfractionated heparin preferred for PE in pregnancy?
In cases of massive PE with cardiovascular compromise
What is the most common first step in induction of labour?
Prostaglandin E2 pessary
How long is emergency contraception recommended for one missed POP?
Take the missed pill (one only) and the next pill at the usual time, additional contraception for 48 hours (as the cervical mucous thickens)
How long is symptom diary for PMS recommended?
2 cycles
What is the management for candida nipple infection?
Topical miconazole for the mother and oral nystatin for the baby
What are Call-Exner bodies pathognomonic for?
Granulosa cell tumours
What is the mechanism of the progesterone only pill?
Thickens the cervical mucous
What is the mechanism of action of the implant and depot injection?
Inhibits ovulation and thickens the cervical mucous
What are the indications for foreceps delivery?
FORECEPS
F - fully dilated
O - occipito-anterior position
R - ruptured membranes
C - cephalic position
E - engaged presenting part
P - pain relief
S - sphincter (empty bladder)
At what BHCG level are intrauterine pregnancies visible?
> 1000 IU/L
What is contained in epidural anaesthesia?
Local anaesthetic eg. bupivacaine and opioid eg. fentanyl
What is the mechanism of epidural induced urinary retention?
Blockage of the output to the bladder from the spinal cord, losing the sensation of needing to urinate
What is the mechanism of a post-dural headache?
Entering into the subarachnoid space leading to leakage of the CSF
What is the advice for a mother with high BMI?
Healthy, balanced diet with at least 30 minutes of moderate intensity exercise daily
At what BMI should women be referred to an obstetric anaesthatist?
> =40kg/m2
More likely to need instrumental delivery and may be more difficult to administer epidural anaesthesia
