NIBBLY BITS Flashcards
what is 6CIT
a brief cognitive function test which takes less than five minutes and is widely used in primary care settings
what is the treatment of EPSEs
- ESPEs are thought to be due to relatively increased cholinergic transmission so anticholinergics are used
- procyclidine
- this works for all but tardive dyskinesia for which tetrabenazine is needed
what is the first line treatment for viral induced wheeze if the child is pretty well
salbutamol inhaler given via spacer
summarise childhood limp in ages 1-3, 3-10 and 11-16 differentiating between acute & painful and chronc & intermittent
12w vaccines
6 in 1 (DTaP, IPV, Hib, Hep B), PCV, Rotavirus.
1y vaccine
Hib/Men C, PCV booster, MMR, Men B booster
what is the following PD, what cluster does it belong to?
pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent
paranoid
belongs to cluster A (odd or eccentric disorders)
investigations for biliary atresia
UCC - double bubble scan
liver histology confirms diagnosis
what is the following PD and what cluster does it belong to?
attention seeking behaviour and excessive emotions
histrionic
cluster B (dramatic, emotional or erratic disorders
how do benzos work
they facilitate and enhance the binding of GABA to the GABA receptors
what is the threshold for diagnosis of polyhydramnios
Polyhydramnios is usually diagnosed at an AFI of >24cm (or 2000ml+). Oligohydramnios is usually diagnosed with an AFI of <5cm (or under 200ml).
typical causes of horners in an exam
Pancoast (apical) tumour which is compressing the sympathetic chain. There are other causes of Horner’s syndrome, including central causes like MS or brain tumours, and other things can press on the sympathetic chain such as a large goitre.
3y 4m vaccine
DTap/IPV, MMR.
what is flumazenil for
reverses benzo overdose
what is the cut off for macrosomia
>4.5kg
What are SNRI side effects
serotonin syndrome
sexual dysfunction
suicidality
what’s the tremor like in lithium toxicity
course
fine tremor is often recorded within therapeutic range so is considered side effect of normal treatment
what is the virus that causes hand foot and mouth
coxsackie
what is the following PD and what cluster does it belong to?
grandiosity, need for admiration and a perceived lack of empathy
narcissistic
cluster B (dramatic, emotional or erratic disorders)
features of congenital syphilis
generalised lymphadenopathy
hepatosplenomegaly
rash
skeletal malformations
what is the management of asymptomatic bacteriuria in pregnant women
Asymptomatic bacteriuria in a pregnant woman requires treatment due to risk of pyelonephritis, and association with premature labour and ROM. However contamination of a first culture is possible and so a second test should be performed to confirm.
12-13y vaccine
HPV
what is the prophylactic treatment for migrains
topirimate or propanolol
propanolol is preferred in female patients of childbearing age as topirimate is teratogenic and can cause hormonal contraceptives to be ineffective
topirimate preferred in asthma
what are the only class of abx that are safe at every stage of pregnancy
cephalosporins
e.g. cefotaxime, ceftriaxone, cefuroxime
treatment for normal pressure hydrocephalus
LP/lumbar drainage
what is the following PD and what cluster does it belong to?
a pervasice psychological need to be cared for by other people
dependent
cluster c (anxious or fearful disorders)
what are made acts, feelings and drives?
the experience being carried out by the patient is considered as alien/imposed
what type of drug is venlafaxine
SNRI
what is the following PD and what cluster does it belong to?
disregard for the rights of others, lack of empathy, incresed self-image, manipulative and impulsive behaviour
dissocial
cluster B (dramatic, emotional or erratic disorders)
what type of drug is paroxetine
SSRI
what is first and second line intervention for anxiety
talking therapies
common side effects of antipsychotic drugs
management of nephrotic syndrome
prednisolone
penicillin prophylaxis
pneumococcal vaccination
consider albumin infusion
causes of neonatal hepatitis syndrome
idiopathic
congenital infection
CF
alpha anti-trypsin deficienct
what types of drugs can cause a manic switch in depression
TCAs like amitryptyline
what are the COPD steps of management
- Step 1: SABA or SAMA
- if no asthmatic features or features suggesting steroid responsiveness
- Step 2: Add LABA + LAMA
- Step 3: LABA + LAMA + ICS
- if they have asthmatic features or features suggesting steroid responsiveness
- Step 2: LABA + ICS
- Step 3: LABA +LAMA + ICS
- if no asthmatic features or features suggesting steroid responsiveness
alzheimers meds
donepezil
memantine
what are the kocher criteria for and what do they include
septic arthritis
fever >38.5
non weight bearing
raised ESR
raised CRP
how long does in an interpregnancy interval need to be to increase risk of IUGR
120 months
(10 yrs)
difference between cicumstantiality and tangential speech
circumstantiality - talking at great length around the subject but returns to the topic
tangenital: does not return to the topic
what is meningococcal meningitis prophylaxis antibiotic
oral ciprofloxacin
or
oral rifampicin
or
im ceftriaxone
what is the antibiotic prophylaxis of choice in preterm prelabour ROM
PO erythromycin
prerequisites for instrumental delivery
- cervix fully effaced and dilated
- head position known to be deeply engaged in mid cavity or below
- valid indicaton
- empty bladder
- adequate analgesia
what happens if you have amoxicillin with infectious mononucleosis
maculopapular pruritic rash
what are the 5 Ms of geriatric medicine
mind
mobility
medications
multi-complexity
matters most - i.e. holistic patient centred approach
treatment for fibroids <3cm
cocp
what type of drug is duloxetine
SNRI
what is the surgery for biliary atresia and what is an important consideration
kasai procedure
success rate diminishes with age
4 complications of prematurity
retinopathy of prematurity
NEC
intraventricular haemorrhage
chronic lung disease
where is the rash normally in HSP
on the bum and extensor surfaces usually symmetrical
trunk usually spared
what is perseveration
repetition of a word or phrase (usually associated with an organic/frontal disorder)
what timings for emergency contraception
ullipristal acetate (ellaone) and copper coil: up to 120 hrs
levonelle: up to 72hrs
difference between stereotype and mannerism
Stereotype: A repetitive and bizarre movement which is not goal-directed (in contrast to mannerism). The action may have delusional significance to the patient. Seen in schizophrenia.
Mannerism: Abnormal and occasionally bizarre performance of a voluntary, goal directed activity (e.g. a conspicuously dramatic manner of walking.
buttock wasting – think:
coeliac
what would you give before fibroid surgery and why
GnRH agonists - fibroids are oestrogen dependent so temporary menopause will reduce their size and make them less likely to bleed during surgery
how do antipsychotics work
they block dopamine D2 receptors
what do you give someone with cuada equina before surgery
high dose dexamethasone to try and halt progression of compression before surgery
what is horner’s syndrome
unilateral anhidrosis (absence of sweating of the face), enophthalmos (inset eye), miosis (constricted pupil) and ptosis (drooping eyelid)
how long should a woman with premature preterm rupture of membranes be given antibiotics for
10 days or until she is in established labour - whichever is sooner
what are TCA side effects
sedation
anti-cholinergic
cardic arrhythmias
what is the following PD and what cluster does it belong to?
rigid conformity to rules, perfectionism and control to the point of satisfaction and excluson of leisurely activities and friendship
anankastic (obsessive compulsive)
cluster C (anxious or fearful disorders)
explain the two syphilis tests
VDRL - indicate active syphilis and become negative after treatment
TPHA - look for IgG which remains after treatment to confer immunity
what does egosyntonic mean
very different to the patient’s normal beliefs and values
what investigation is used to monitor treatment response in hodgkin lymphoma?
positron emission tomography PET
which nerve roots are affected by erb’s palsy
c5-c6
what are the geriatric giants
immobility
instability
incontinence
impaired intellect
What is the initial blood monitoring for clozapine
minimum of 1 blood test per week for the first 18 weeks
then fortnightly for 1 year
after one year it’s monthly
Haemophilus influenzae type b disease: prevention of secondary cases
rifampicin
what are the schneiderian 1st rank symotoms
- 3rd person auditory hallucinations
- passivity phenomena
- thought alienation
- insertion
- withdrawal
- broadcast
- delusional perception
what is the most common cause of meningitis in neonates
GBS
8w vaccines
6 in 1 (DTaP, IPV, Hib, Hep B), Men B, Rotavirus
what type of drug is fluvoxamine
SSRI
what is the first line treatment for faecal impaction in children
macrogol laxative e.g. polyethylene glycol and electrolytes (movicol paediatric plain)
what checks should be done with lithium and how often
Thyroid and renal function should be checked every 6 months, as lithium can cause hypothyroidism and is nephrotoxic
Lithium has a narrow therapeutic index. Lithium levels are therefore checked every 3 months
remember that a fine tremor is fine and a course tremor indicates toxicity
what is the nephrotic syndrome triad
proteinuria >1g/m2/24hrs
serum albumin <25
peripheral oedema
what’s the first line medical treatment for delirium if it is required
haloperidol 0.5mg PO
or
haloperidol 0.5mg IM
if a child is in 10% fluid deficit (shocked) what would you give them
maintenance + extra 100ml/kg/day
NSAID for heavy menstrual bleeding
mefanemic acid
what is a liver biopsy with giant cell hepatitis and rosette formation in a neonate indicative of
neonatal hepatitis syndrome
what is the following PD and what cluster does it belong to?
mood swings, insability in relationships, self-image/identity, behaviour and affect, often leading to self harm and impulsivity
EUPD
cluster B (dramatic, eomotional or erratic disorders)
if a child is in 5% fluid deficit what would you give them
maintenance + extra 50ml/kg/day
what is methylphenidate
ritalin
used for adhd
what is the following PD and what cluster does it belong to?
social inhibition and inadequacy, extreme sensitivity to negative evaluation
anxious avoidant
cluster C (anxious or fearful disorders)
what is thought echo
it is a form or auditory hallucination where a patient hears their thoughts spoken aloud
what is protamine sulphate
treats heparin overdose
5 drugs that cause falls in the elderly and how they do it
- senna: urgency to go to toilet
- painkillers (co-codamol or amitryptyline) : cause confusion
- diuretics: postural hypotension
- sertraline: low sodium
- benzos: sedation
managment of DDH
pavlik harness if <5 months
if 6 months or older then closed reduction and fixation
what is the delirium screen
calcium
TFT
B12
infection (CRP, WCC and MSU)
exclude strokes
exclude constipation
identify and treat pain
some causes of stephen johnson syndrome
- drugs
- allopurinol
- penicillin
- phenytoin
- lamotrigine
- infections
- mumps
- flu
- HSV
- EBV
what is becks questionaire for
depression
what medication for stress incontinence
1st line is 3 months of pelvic floor training
then duloxetine or surgery
which drugs typically cause extrapyramidal side effects
1st generation (typical) antipsychotics such as haloperidol
what is natrexone
long-acting opioid receptor antagonist that can be used in opioid and alcohol maintenance regimes, but is not considered first line
describe extrapyramidal side effects and their treatment
- acute dystonic reaction
- Rx: benzos
- akanthasia - extreme restlessness
- Rx: beta blockers or benzos
- pseudoparkinsonism
- tardive dyskinesia
- associated with chronic antipsychotic use
- lip smacking and tongue protrusion
- Rx: switch antipsychotic
what is the 1 yr mortality of a NOF fracture
30%
30 day mortality is 7%
name four 2nd generation antipsychotics
clozapine
olanxapine
risperidone
quetiapine
what is clozapine and what can it cause
2nd generation antipsychotic
can cause neutropenia
14y vaccine
Tetanus, diphtheria, polio. Men ACWY
16w vaccines
6 in 1 (DTaP, IPV, Hib, Hep B), Men B
what are the sanctuary sites for chemo
testes and CNS
what is the only absolute contraindication for ECT
raised ICP
which drugs can cause parkinsonism
Typical antipsychotics (e.g. haloperidol) are known to be dopamine antagonists and can cause parkinsonism. The atypical antipsychotics (e.g. clozapine, olanzapine, quetiapine, risperidone) often do not have extrapyramidal side effects including parkinsonism.
what is pyridostigmine for
it is a long-acting acetylcholinesterase inhibitor for myasthenia gravis
how is the diagnosis of necrotising enterocolitis made
colonoscopy
describe neuroleptic malignant syndrome
what is the management for acute otitis media
- watch and wait is suitable for majority of children as it will resolve within 4 days
- treat if:
- AOM in only hearing ear
- cochlear implant
- perforated TM
- both ears if they’re <2yrs
- treat if:
- first line treatment for a patient you need to treat is 5 days of amoxicillin
how should sfh correlate with gestation
- fundus not obvious before 12 wks
- at 16wks it’s half way beteen symphysis and umbilicus
- 16-26wks height in cm = gestational age
- 26-36wks height in cm +/- 2cm = gestational age
- from 36 wks you’re allowed +/- 3cm
what is somatic passivity
delusional belief that the bodily sensations are from an external agency
name 5 1st generation antipsychotics
sulpiride
haloperidol
flupentixol
zuclopennthixol
chlorpromazine
investigation results that would diagnose gestational diabtes
OGTT: 2hr plasma glucose >7.8mmol/l
fasting glucose >5.6mmol/l
difference between dissociation, derealisation and depersonalisation
- depersonalisation: pt. feels that they are unreal
- derealisation: pt. feels that the world has become unreal
- dossociation: The separation of unpleasant emotions and memories from consciousness awareness with subsequent disruption to the normal integrated function of consciousness and memory.
- dissociative fugue
can lithium be used in pregnancy
Lithium is teratogenic and is therefore contraindicated in pregnancy. It is associated with Ebstein’s anomaly, a congenital heart defect characterised by an enlarged right atrium, shrunken right ventricle, and a pansystolic murmur caused by a defective tricuspid valve
why do you get raised CK in NMS
because of muscle rigidity
what is the following PD and what cluster does it belong to?
lack of interest and detachment from social relationships, apathy and restricted emotional expression
schizoid
cluster A (odd or eccentric disorders)
what are the safest anti-epileptics in pregnancy
carbemazepine and lamotragine
what can you add if lithium alone isn’t working for BPD
valproate
what type of drug is trazodone
TCA
phenlazine side effects
hypertensive crises associated with cheese and wine
summarise the pregnancy appt timeline
booking: 8-12 wks
dating scan 12-14 wks
anomaly scan 18-20wks
fortnightly midwifery checks from 34wks
what type of drugs must you avoid eating cheese with and why
MAO inhibitor antidepressants such as phenelzine
tyramine rich foods such as cheese and wine can lead to a build up of tyramine and hypertension
what is loosening of association
lack of association between thoughts
what are anticholinergic side effects
urinary retention
constipation
dry mouth
dry eyes
blurred vision
dizziness
unsteadiness
confusion
what is carbimazole switched to in pregnancy
propylthiouracil
lewy body dementia meds
rivastigmine
three most common causes of neonatal bacterial meningitis
GBS
E.coli
listeria monocytogenes
SSRIs side effects
abdo upset
suicidality
sexual dysfunction
when does peak incidence of delerium tremens occur
48-72hrs following alcohol withdrawal
what is belle indifference
an apparent lack of concern at symptoms/disability
compare gilbert and crigler nijjar syndrome
3 things screened for at dating scan
down’s
edward’s
patau’s
first second and third line antipsychotics
- first line: 2nd gen
- second line: 1st or 2nd gen
- third line: clozapine
- has increased efficacy but more hazardous side effect profile
