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PACES > Management > Flashcards

Management Flashcards

1
Q

How would you prevent preterm labour?

A

Vaginal progesterone
Prophylactic Cervical Cerclage

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2
Q

How would you manage preterm labour?

A

Admit
Steroids
Administer Tocolytics
Magnesium Sulfate

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3
Q

How would you manage PPROM?

A

Admit, sterile speculum
Erythromycin
Mg Sulfate
CTG

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4
Q

What are the risk factors for preterm labour?

A

Smoking, multiple pregnancy , previous

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5
Q

How do you manage PROM?

A

IOL after 24 h
IOL if meconium

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6
Q

What are the risks of ECV?

A

50% success
Placental Abruption
Foetal Distress needing c section

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7
Q

Risks of breech vaginal birth?

A

40% c section

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8
Q

How would you induce labour?

A

Membrane sweep
vaginal prostaglandins
Amniotomy
Syntocinon

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9
Q

VBAC risks

A

Uterine rupture
75% successful, need for emergency c-section in 25%

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10
Q

How would you manage uterine rupture?

A

Senior
ABCDE (group and save)
Expedite delivery
Urgent surgery to repair the uterus

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11
Q

How would you manage PPH?

A

ABCDE
Senior, haemorrhage protocol
Massage uterus
Syntocinon
Ergometrine

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12
Q

How would you manage Hypertension in pregnancy?

A

Aspirin
Labetalol
Serial growth scans every 4 weeks

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13
Q

How would you manage diabetes in pregnancy?

A

Folic Acid
Monitor glucose
Foetal abnormality scan
Serial growth scans every 4 weeks
Elective birth between 37-38+6 weeks
Sliding scale during labour

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14
Q

When should you check thyroid function in pregnancy?

A

Every 2-4 weeks

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15
Q

How would you manage hsv in pregnancy?

A

Oral aciclovir & vaginal if 1/2 trimester
c section if birth within 6 weeks

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16
Q

HIV counselling pregnancy?

A

Joint clinic every 2 weeks
Monitor viral load and at delivery, might need c section.
Don’t breastfeed

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17
Q

When should a patient with pre-eclampsia be admitted?

A

>160/110
Symptoms of severe disease
Foetal compromise
Biochemical abnormalities

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18
Q

How should pre-eclampsia be monitored antenatally?

A

Deliver at 37 weeks
BP 4x a week
Bloods 2x a week
Growth scans every 2 weeks

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19
Q

Risk factors for pre eclampsia

A

Young/Old
Previous HTN disorder
Diabetes
Kidney Disease
Obesity

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20
Q

What are the risks of gestational diabetes?

A

Maternal: HTN, trauma, stillbirth
Foetal: big baby, neonatal hypo, congenital abnormalities

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21
Q

How would you counsel on obstetric cholestasis?

A
  • Risk Factors: personal or family history of OC, history of liver disease, multiple pregnancy
  • Explain diagnosis and risks (stillbirth and premature birth)
  • Explain need for early delivery (37 weeks)
  • Explain regular monitoring with weekly LFTs
  • Advise paying close attention to foetal movements
  • Symptomatic treatment with ursodeoxycholic acid and emollients (and maybe vitamin K)
  • High recurrence rate (up to 90%)
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22
Q

How is acute fatty liver of pregnancy managed?

A

Supportive in ITU
Expedite delivery as soon as stable

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23
Q

How is IUGR managed?

A

Growth scans every 2 weeks
Dopplers twice a week
Monitor movements
Delivery by 37 weeks as a consultant led decision

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24
Q

Placenta praevia counsel

A

PACES TIPS
• Risk Factors: previous placenta praevia, multiple pregnancy, previous C-section, smoking and drug use, advanced maternal age
• Presenting with Asymptomatic Low-Lying / Placenta Praevia
o Explaintheimportanceofthefinding(increasesriskofbleeding) o Explainthat90%ofplacentaswillmoveawayfromtheos
o Rescanat32weeksandthengofromthere
o Advisetoavoidhavingsex
• Presenting with Symptomatic Placenta Praevia (with bleeding)
o Admituntilbleedinghasstoppedandforafurther48hours
o Explaintheimportanceofthefindingandthatthefoetusneedstobemonitored o Explainthatpromptdeliveryneedstobediscussed(basedongestation)
o Explaintherisksofdelivery:
Major blood loss
May require a blood transfusion May require a hysterectomy

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25
Q

How would you manage placental abruption?

A

• ABCDE approach
o Gain2xIVaccess
o Bloods(FBC,Rhesusstatus,cross-matchandclottingscreen)
o Continuousfoetalmonitoring
o Fluid,antifibrinolytics,blood,orblood-productreplacement,asindicated
• Give anti-D immunoglobulin in Rh-negative women
• Decide on delivery:
o Ifmotherishaemodynamicallyunstableorthereisevidenceoffoetaldistress→
Expedite delivery (irrespective of gestation)

o Ifmotherishaemodynamicallystable,andthereisnoevidenceoffoetaldistress→
If >37 weeks gestation → induction of labour
If <37 weeks gestation → give steroids and admit to antenatal ward for close monitoring
• If bleeding settles, consider discharging home with weekly serial growth scans until term

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26
Q

Miscarriage counselling

A

Risk Factors: advanced maternal age, previous miscarriages, chronic conditions (e.g. uncontrolled diabetes), uterine or cervical anomalies, smoking, alcohol and illicit drug use, underweight or overweight
• Breaking bad news
o Explain the diagnosis
o Reassure that thisiscommonandunder-reported(1in5pregnancies) Explain that risk increases with age
If asked about cause: explain that most of the time there is no cause o Explainthemanagementoptions(expectant,medicalandsurgical)
If medical: explain what to expect (pain, bleeding, nausea)
Antiemetics and pain relief will be given o Advisetodoapregnancytestafter3weeks
• Safety net: return if symptoms get worse, bleeding persists after 7-14 days

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27
Q

ectopic counselling

A
28
Q

How would you manage gestational trophoblastic disease?

A

Anti-D

Suction curettage

Pregnancy test after 3 weeks.

29
Q

How would you manage PCOS?

A

Rotterdam Criteria

COCP/POP

Co-cyprindol for hirsutism

Clomifene if fertility needed

Weight loss

30
Q

Counsel PCOS

A
31
Q

Counsel TOP

A
32
Q

Counsel HRT

A
33
Q

Counsel PID

A
34
Q

Counsel Incontinence

A
35
Q

Endometriosis Counsel

A
36
Q

Counsel Fibroid

A
37
Q

How might you manage lichen sclerosus?

A

Good skin care, emollients

steroid

biopsy if persistent

38
Q

How might you manage PMS?

A
39
Q

CIN management

A

A1 Conservative

Radical hysterectomy and lymphadenopathy

Chemo/radio if more severe

40
Q

Counsel CIN

A
41
Q

Counsel Endometrial hyperplasia

A
42
Q

Counsel Ovarian cancer

A
43
Q

Counsel Down’s Syndrome

A
44
Q

Counsel Neonatal jaundice

A
45
Q

Counsel asthma

A
46
Q

How is croup managed?

A

Mild = Dexamethasone

Moderate = Dexamethasone Oxygen

Severe = Dexamethasone Oxygen Nebulised Adrenaline

47
Q

CF counsel

A
48
Q

Viral induced wheeze counsel

A
49
Q

Coeliac counsel

A
50
Q

Counsel Constipation

A
51
Q

GORD counsel

A
52
Q

Intussusception counsel

A
53
Q

Counsel meningitis

A
54
Q

How would you investigate a fever in a child with red flag symptoms?

A

Immediate transfer to A&E

FBC, CRP, Culture

XCR, LP, Electrolytes, VBG

55
Q

How would you manage an AKI?

A

STOP AKI

Sepsis Screen

Toxins

Optimise volume/BP

Prevent harm

56
Q

Counsel ITP

A

Benign, acute

6-8 weeks

IVIG and steroids if severe

57
Q

What are the x ray findings of SUFE?

A

Trethowan’s sign

Klein line asymmetry

58
Q

Counsel ADHD

A
59
Q

Counsel Autism

A
60
Q

Counsel cerebral palsy

A
61
Q

How would you manage status epilepticus?

A

ABCDE

IV lorazepam

Senior Help

Phenytoin

62
Q

How is anaphylaxis managed?

A

IM adrenaline

Oxygen

IV fluids

IV chlorphenamine + IV steroids

63
Q

Counsel anaphylaxis

A
64
Q

Counsel NAI

A
65
Q

How would you assess cognition?

A

AMTS

MMSE

Addenbrokes Cognitive Exam

Frontal Lobe testing

Depression Screening

PACES (8 decks)

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