Misc 2 Flashcards
A 35-year-old woman comes to see you in clinic with a 12 month history of heavy periods with clots and flooding. She does not experience any pelvic pain.
On examination she has a palpable bulky uterus.
You book her in for a transvaginal ultrasound scan and decide to start her on some treatment in the interim.
What is the most appropriate first line management?
Tranexamic acid
A 3-year-old boy from a Turkish family is referred to the local paediatric unit due to recurrent lethargy and pallor. His parents report no other symptoms such as fever, pain or poor feeding. He had been treated with a course of ciprofloxacin for otitis externa two weeks ago. Admission bloods show:
Hb 5.2 g/dl
WBC 10.7 *109/l
Platelets 346 *109/l
Reticulocytes 5%
What is the most likely underlying diagnosis?
Glucose-6-phoshate dehydrogenase deficiency
Ciprofloxacin is a common cause of haemolysis in patients with glucose-6-phoshate dehydrogenase deficiency
When is the peak incidence of delirium tremens following alcohol withdrawal?
72h
Alcohol withdrawal
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours
Which one of the following tricyclic antidepressants is most dangerous in overdose?
Dosulepin Citalopram Clomipramine Nortriptyline Lofepramine
Dosulepin - avoid as dangerous in overdose
TCA SE
Common side-effects drowsiness dry mouth blurred vision constipation urinary retention
More sedative Amitriptyline Clomipramine Dosulepin Trazodone*
Less Sedative
Imipramine
Lofepramine
Nortriptyline
A 27 year old woman attends her GP with breast pain. She is 2 weeks postpartum and is exclusively breastfeeding. She complains of a 3 day history of worsening right sided breast pain, which has not improved with continued feeding and expressing. On examination, she appears well, her temperature is 38ºC. There is a small area of erythema superior to the right nipple, which is tender to touch. She has no known allergies.
Oral flucloxacillin & encourage to continue breastfeeding
A 56-year-old lady reports incontinence mainly when walking the dog. A bladder diary is inconclusive.
Urodynamic studies
Urodynamic studies are indicated when there is diagnostic uncertainty or plans for surgery.
Overflow?
A 34-year-old woman from Zimbabwe presents with continuous dribbling incontinence after having her 2nd child. Apart from prolonged labour the woman denies any complications related to her pregnancies. She is normally fit and well.
Urinary dye studies
Vesicovaginal fistulae should be suspected in patients with continuous dribbling incontinence after prolonged labour and from a country with poor obstetric services. A dye stains the urine and hence identifies the presence of a fistula.
Progestogen-only pill (excluding desogestrel)
Thickens cervical mucus
desogestrel
Primary: Inhibits ovulation
Also: thickens cervical mucus
Infantile Spasms (west)
typically presents in the first 4 to 8 months of life and is more common in male infants
characteristic ‘salaam’ attacks: flexion of the head, trunk and arms followed by extension of the arms
this lasts only 1-2 seconds but may be repeated up to 50 times
progressive mental handicap
Investigation
the EEG shows hypsarrhythmia in two-thirds of infants
CT demonstrates diffuse or localised brain disease in 70% (e.g. tuberous sclerosis)
Management
poor prognosis
vigabatrin is now considered first-line therapy
ACTH is also used
A 9-year-old boy is diagnosed as having Attention Deficit Hyperactivity Disorder and started on methylphenidate. Which one of the following should be monitored during treatment?
Growth
Moro
Head extension causes abduction followed by adduction of the arms
Present from birth to around 3-4 months of age
Grasp
Flexion of fingers when object placed in palm
Present from birth to around 4-5 months of age
Rooting
Assists in breastfeeding
Present from birth to around 4 months of age
Stepping
Also known as walking reflex
Present from birth to around 2 months of age
A 5-year-old girl started to feel unwell two days ago, sore throat and headache. Overnight, temperature and vomited once. This morning rash all over her body, this has spread from her chest where it started. On examination, 38.5ºC, heart rate 130 beats per minute, she looks flushed and has an erythematous rash over her body which feels like sandpaper and blanches with pressure. There are palpable cervical lymph nodes when you examine her neck and her tongue has a white coating over it. What is the most likely diagnosis?
Scarlet fever
CF Mx
Key points
regular (at least twice daily) chest physiotherapy and postural drainage. Parents are usually taught to do this. Deep breathing exercises are also useful
high calorie diet, including high fat intake*
vitamin supplementation
pancreatic enzyme supplements taken with meals
heart and lung transplant
You are considering prescribing a selective serotonin reuptake inhibitor for a patient with depression. Which class of drug is most likely to interact with a selective serotonin reuptake inhibitor?
Beta-blocker Thiazolidinediones Tetracycline Statin Triptan
Interactions
NSAIDs: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor
warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
aspirin: see above
triptans: avoid SSRIs
A 32-year-old man with a longstanding moderate depression comes to see his GP after recently being started on a new medication by his psychiatrist. He complains that his appetite has increased hugely and as a result he has put on a significant amount of weight. He is also constantly tired and is struggling to concentrate at work.
Which of the following medications has most likely been started?
Sertraline Mirtazapine Lithium Carbamazepine Selegiline
Mirtazapine
Some of the most potent side effects of mirtazapine are a large increase in appetite (and subsequent weight gain) and drowsiness. These side effects are so pronounced that mirtazapine has been known to be used as an appetite stimulant and sleep aid off-formulary.
Selegiline is a monoamine oxidase inhibitor which are an older class of antidepressant which have been largely phased out due to their side effects which leaves mirtazapine as the most likely answer.
Mastitis Mx
First-line conservative management includes analgesia and encouraging effective milk removal (continue breastfeeding or expressing from affected side) in order to prevent further milk stasis. It is also important to ensure that there is correct positioning and attachment when feeding.
If symptoms do not improve after 12-24 hours of conservative management then antibiotics should be prescribed. First-line choice is oral flucloxacillin (500mg four times a day for 14 days) or erythromycin if penicillin allergic. Second-line choice is co-amoxiclav.
Anaphylaxis Adrenaline
< 6 months 150 micrograms (0.15ml 1 in 1,000)
6m - 6y 150
6-12y 300
12+ 500mg
Anaphylaxis Hydrocortisone
0-6m 25mg
6m-6y 50mg
6-12 100mg
12+ 200mg
