MLA paper 2 Flashcards
What does the audiogram show:
- Is there anything below 20dB
yes = move to step 2
no = normal hearing
- If there a gap
yes = conductive or mixed
no = sensorineural hearing loss
- One below or both below 20db line
one = conductive
both = mixed
Left mixed hearing loss.
- air bone gap in left ear = conductive component
- decrease in bone conduction thresholds suggests a sensorineural component too
Methotrexate prescribing:
- weekly rather than daily
- Monitor: FBC, U&Es and LFTs (weekly until therapy stabilised then 2-3 months thereafter)
- Folic acid 5mg weekly co-prescribed
- starting dose = 7.5mg weekly
Methotrexate: interactions
Avoid trimethoprim or co-trimoxazole –> increase risk of marrow aplasia
High dose aspirin increases risk of methotrexate toxicity
Tx of methotrexate toxicity = FOLINIC ACID
the classical presentation of this condition involves:
abdominal: abdominal pain, vomiting
neurological: motor neuropathy
psychiatric: e.g. depression
hypertension and tachycardia common
Acute intermitten porphyria
- rare
- autosomal dominant
- defect in enzyme involved in biosythesis of haem
- toxic accumulation of delat aminolaevulinic acid and porphobilinogen
Management:
- avoid triggers
- IV haematin/haem arginate
- IV GLUCOSE if the above not immediately available
Polycythaemia vera: management
- Myeloproliferative disorder (clonal proliferation of marrow stem cell –> increase in red cell volume)
Key features
- hyperviscosity
- pruritus
- splenomegaly
Management
1. Aspirin: reduce VTE risk
2. Venesection
3. Chemotherapy
a) hydroxyurea
b) phosphorus 32 therapy
Prognosis
1. Thrombotic event
–> 5-15% of patients progress to myelofibrosis
–> 5-15% of patients progress to acute myeloid leukaemia
JAK 2 mutatio
Lower back pain: prolapsd disc management
- physio
- NSAIDS + PPI
If symptoms persist after 4-6 weeks then referral for consideration of MRI is appropriate
Site of compression and features
Bite and blister cells are typical of the blood film in
G6PD deficiency
Associations of G6PD deficiency:
Have a Bite of Heinz Fava beans.
=>
Bite cells. Heinz bodies. Fava beans.
Absent or weak femoral pulses are suggestive of a major defect such as
coarctation of the aorta
Cancer patients with VTE mx
6 months of a DOAC
is a risk factor for endometrial hyperplasia
tamoxifen
Management of endometrial hyperplasia: high dose progestogens w/ repeat samply in 3-4 months.
IUS
Atypia: hysterectomy advised
this is the most effective antipsychotic for dealing with negative symptoms of schizophrenia
CLOZAPINE
drug used for prophylaxis of sickle cell crises
hydroxycarbamide
Sickle cell crisis management
oxygen with IV analgesia and IV fluids
Cervical cancer screening: if 1st repeat smear at 12 months is still hrHPV +ve →
repeat smear 12 months later (i.e. at 24 months)
Referred to colposcopy if still HrHPV positive at 24 months
is a suitable method for contraception in breastfeeding mothers from 4 weeks and is the most appropriate option in this case.
The progesterone-only pill
Breast feeding is an absolute UKMEC contraindication for combined hormonal contraception
Nerve damage and clinical features
- femoral
- lumbosacral
- sciatic
- obturator
Glue ear treatment options
otitis media with an effusion
If child w/ first presentation of otitis media w/ effusion –> active observation for 3 months , no intervention required
or
–> grommet insertion (allow air to pass through middle ear)
–> majority stop functioning after 10 months
–> adenoidectomy
Cervical cancer management based on staging
Stage 1A tumours
–> gold standard = hysterectomy +/- lymph node clearance
–> fertility maintained? cone biopsy w/ negative margins
Stage A2
–> nodal clearance
–> radical trachelectomy
Management of stage IB tumours
–> radiotherapy (brachy or external beam) w/ concurrent chemo (cisplatin)
B2 tumours
–> radical hysterectomy w/ pelvic node dissection
Stage II and III tumours
–> radiation w/ concurrent chemo
–> Hydronephrosis? nephrostomy consideration
Management stage IV
–> radiation and/or chemo
Stage IVB
–> palliative chemo
Management of recurrent disease
–> surgical: chemo or radiotherapy
–> radiation: surgical therapy
SSRI discontinuation syndrome
- increased mood change
- restlessness
- difficulty sleeping
- unsteadiness
- sweating
- gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
- paraesthesia
Paroxetine increased risk of congenital malformations, particularly in the first trimester
Surgery / diabetes:
these drugs can be continud on day of surgery
DPP IV inhibitors (-gliptins)
and GLP-1 analogues (-tides)
Hyperemesis gravidarum: management
1st line:
–> antihistamines: oral cyclizine or promethazine
–> phenothriazine: prochlorperazine or chlorpromazine
–> combination: doxylamine/ pyridoxine (vitamin B6)
2nd line
–> odansetron: CLEFT/LIP palate risk
–> oral metoclopramide or domperidone: EPSe w/ metoclopramide not more than 5 days
ADMISSION –> IV HYDRATION
typically involves loss of motor or sensory function
Functional neurological disorder (conversion disorder)
the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
present with a shortened and internally rotated leg
Posterior dislocation (everything goes INto the hip) - internally rotated, adducted, flexed and shortened
Anterior dislocation (everything goes out of the hip) - Externally rotated, abducted, normal/lengthened leg
Femoral neck fracture (the muscles of the hip pull the shaft of the femur up and out) - Externally rotated, and shortened limb
Posterior hip dislocations
ECLAMPSIA: management
Magnesium sulphate!
Monitor: UO, reflexes, RR, o2
If respiratory depression: calcium gluconate!
Tx continues for 24 hours after last seizure or deliver
> 20 weeks gestation, proteinuria
acute otitis media: management
No improvement symptoms w/i 3 days –> medical help
Antibiotics prescribed immediately if:
–> symptoms more than 4 days
–> immunocompromise , neuromuscular disease
–> UNDER 2 w/ bilateral OM
–> OM w/ perforation and/or discharge
1st Line = 5-7 days AMOXICILLIN
if pen allergic: erthromycin / clarithromycin
is defined as perforation of the tympanic membrane with otorrhoea for > 6 weeks
chronic suppurative otitis media (CSOM)
Complications:
* mastoiditis
* meningitis
* brain abscess
* facial nerve paralysis
Hand, foot and mouth disease caused by:
Coxsackie A16 and enterovirus 71
Clinical features
- mild systemic upset: sore throat, fever
- oral ulcers
Management
–> symptomatic: hydration and analgesia
–> no school exclusion
Developmental milestones: fine motor and vision
Palm, point, pincer: 6,9,12
3 months –> reaches for opens
Cervical cancer screening: if two consecutive inadequate samples then →
colposcopy
The thyrotoxicosis phase of postpartum thyroiditis is generally managed with
Propranolol
In the hypothyroid phase treated with thyroxine
Three stages
1. Thyrotoxicosis
2. Hypothyroidism
3. Normal thyroid function (but high recurrence rate in future pregnancies)
Shoulder dystocia management
HELPERR
Help: call for help
e: evaluate for episiotomy
l: Legs (hyper flex, abduct hip), also known as mcroberts’
p: pressure (suprapubic pressure)
e: enter (rotational manoeuvre), Rubin, woodscrew
r: remove posterior arm
r: roll patient (all four position)
other: zavanelli, symphysiotomy
Diagnosis:
Bulging natuer of the tympanic membrane –> acute otitis media
Glue ear –> retracted ear drum
Post pregnancy: contraception
POP
–> breastfeeding and non-breast feeding
–> can start POP at any time
COCP
–> CONTRAINDICATED if breast feeding <6 weeks
–> not for first 21 days
IUD/IUD
–> w/i 48 hrs of birth
–> or after 4 weeks
Premature rupture of membranes
Confirming PPROM
–> speculum (look for pooling of amniotic fluid in posterior vaginal vault)
Management
* admission
* regular observations
* oral erythromycin 10 days
* antenatal corticosteroids –> reduce foetal RSD
* delivery @ 34 weeks !
12 Male
pc: hip pain , fever and faitgue
pain on palpation of R hip, restricted RoM
SLIPPED CAPITAL FEMORAL EPIPHYSIS
Management: internal fixation
SALTER HARIS FRACTURES
SALTEr
1 S-Straight
2 A-Above
3 L-Lower
4 T-Through (above and below)
5 Er-Everything (Crush)
Scaphoid fracture: management
Initial management
1) immobilisation with a futuro splint or below-elbow backslab
2) refer to ORTHOPAEDICS
Orthopaedic management
1) undisplaced fractures of scaphoid –> cast 6-8 weeks
2) Displaced wait –> surgical fixation
3) Proximal scaphoid pole fracture –> surgical fixation
Complications
non-union → pain and early osteoarthritis
avascular necrosis
most common cause of neutropenic sepsis
Staphylococcus epidermidis
tx –> piperacillin w/ tazobactam (Tazocin)
Woman aged > 30 years with dysmenorrhoea, menorrhagia, enlarged, boggy uterus →
adenomyosis
Isolated fever in well patient in first 24 hours following surgery?
physiological systemic inflammatory reaction
Isolated fever in well patient in first 24 hours following surgery?
Wind: day 1-2 - pneumonia, aspiration, atelectasis
Water: day 3-5 - UTI (especially if the pt was catheterised)
Wound: day 5-7 - infection at surgical site or abscess formation
Walking: day 5+ - DVT, PE
Treatment of Ramsay Hunt syndrome
- oral aciclovir
- corticosteroids
- eye protection
House-brackmann classification!
- grading facial weakness
premature ovarian insufficieny:
Before age of 40.
Features
–> rasied FSH > 30
Elevaed FSH should be shown on 2 blood samples taken 4-6 weeks apart
–> low oestradiol <100
Management
1) HRT or Combined oral contraceptive
Measles : key symptoms
Measles = 3cs = Cough, coryza, conjunctivitis, koplik spots
Slapped cheek syndrome caused by
parvovirus b19
Lethargy, fever, headache
‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces
painless vaginal bleeding and fetal bradycardia
vasa praevia
Diagnosis of ankylosing spondylitis can be best supported by
sacro-ilitis on a pelvic X-ray
is a condition characterized by splenomegaly and neutropenia in a patient with rheumatoid arthritis.
Felty’s syndrome
Hodgkin lymphoma staging system
ANN ARBOUR
I: one node
II: two nodes, they live together in a semi-detached house on the same side of the diaphragm
III: more than 2 nodes but 3 is a crowd so they crowd all around the diaphragm
IV: to inVInity and beyond, the lymphoma has spread everywhere
chicken pox exposure in pregnancy
IgG: G = Got antibodies
IgM: M = Met someone with the virus
antivirals day 7-14 post exposure
oral aciclovir > 20 weeks & w/i 24 hrs of rash
