o&G, paeds and psych

Question 1

Drugs to avoid while breast feeding

Answer 1

Lambast Mothers CCCeen taking these drugs during breastfeeding:

• Lithium
• Amiodarone
• MTX
• Benzodiazepens
• Aspirin
• Sulphonamide
• Tetracyclines

Ciprofloxacin, Chloramphenicol, Carbimazole

Question 2

2 Male

Pc: 39 degree temp 5/7, red eyes, swollen neck with generalised maculopapular rash. bilateral conjunctivitis.
Unilateral cervical lymphadenopathy.
Lips cracked and erythematous
Strawberry tongue present.

Likely diagnosis and management:

Answer 2

KAWASAKI DISEASE

Mx
–> high dose aspirin
–> IV immunoglobulin
–> ECHO to look for coronary artery aneurysms

Complications
–> coronary artery aneurysm

Aspirin usually contraindicated in children due to Reye’s syndrome

Features
high-grade fever which lasts for > 5 days. Fever is characteristically resistant to antipyretics
conjunctival injection
bright red, cracked lips
strawberry tongue
cervical lymphadenopathy
red palms of the hands and the soles of the feet which later peel

Question 3

Woman aged > 30 years with dysmenorrhoea, menorrhagia, enlarged, boggy uterus → ?

Answer 3

adenomyosis

endometrial tissue becomes embedded within the myometrium

1st Line IX –> Transvaginal USS

Management
1. Tranexamic acid
2. GnRH agonist
3. Uterine artery embolisation
4. Hysterectomy

Question 4

Patients diagnosed with this often personality disorder lack close friends other than family and can have odd or eccentric behaviour, speech and beliefs

Answer 4

schizotypal personality disorder

schizoid – odd and eccentric + lacks friends + no sexual interest, indifference to praise/criticism.
schizotypal – odd and eccentric + lacks friends + magical thinking + odd speech

Question 5

Seborrhoeic dermatitis in children: management

Cradle cap

Answer 5

Mx
–> reassurance: doesn’t affect baby will resolve w/i few weeks
–> massage topical emollient onto scalp to loosen scales
–> severe / persistent topical imidazole cream may be used

Question 6

THIS is the most common childhood leukaemia and presents with anaemia, neutropaenia and thrombocytopaenia

Answer 6

ACUTE LYMPHOBLASTIC LEUKAEMIA

Other features
–> bone pain
–> splenomegaly
–> hepatomegaly
–> fever (50% of cases)
–> testicular swelling

anaemia: lethargy and pallor
neutropaenia: frequent or severe infections
thrombocytopenia: easy bruising, petechiae

Question 7

Excema in children management

Answer 7

1. Avoid irritants
2. Simple emollients
3. topical steroids
4. wet wrapping (large amounts of emmolients applied under wet bandages)
5. severe cases: oral ciclosporin

Note
–> large quantitis of emollients
–> emmolient first, wait 30 mins before applying topical steroid
–> creams soak in faster than ointments

Question 8

is the inability to answer a question without giving excessive, unnecessary detail

Answer 8

Circumstantiality

Question 9

refers to wandering from a topic without returning to it.

Answer 9

Tangentiality

Question 10

is a severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another.

Answer 10

Knight’s move thinking

feature of schizophrenia.

Question 11

describes a placenta lying wholly or partly in the lower uterine segment

Answer 11

Placenta praevia

Clinical features
shock in proportion to visible loss
no pain
uterus not tender
lie and presentation may be abnormal
fetal heart usually normal
coagulation problems rare
small bleeds before large

Question 12

What anomaly is caused by lithium use in pregnancy:

Answer 12

EBSTEIN ANOMALY

occurs where posterior leaflets of tricuspid valve are displaced anteriorly towards apex of right ventricle
–> tricuspid regurgitation (pan systolic)

Question 13

THIS is commonly used to prevent alcohol withdrawal symptoms in patients with a history of heavy alcohol consumption.

Answer 13

Chlordiazepoxide
- enhances action of GABA which helps calm CNS and reduce
- AGITATION
- TERMORS
- SEIZURES

Carbamazepine can also be given

Question 14

Miscarriage: management

Answer 14

Expectant
–> (7-14 days for miscarriage to complete)

Medical
1. Missed miscarriage
–> oral mifepristone
–> 48hrs later misoprostol
–> if bleeding not started 48hrs contact healthcare proffessional

2. Incomplete
–> single dose of misoprostol

anti-emetics and pain relief

pregnancy test at 3 weeks

Surgical
1. Vacuum aspiration (suction curettage) OR theatre

Question 15

Meningitis in children < 3 months: give

Answer 15

IV amoxicillin in addition to cefotaxime to cover for Listeria

Managment
1. ABX
2. Dexamethasone (>3months)
–> LP purulent, White cell >1000, bacteria on gram stain
3. FLUIDS
4. Cerebral monitoring
5. pubic health notification and ABx prophylaxis of contacts
-> ciprofloxacin

> 3 months: IV cefotaxime (or ceftriaxone)

Question 16

adhesions and fibrosis of the endometrial cavity most commonly associated with dilation and curettage procedures

Answer 16

Asherman’s syndrome

Question 17

Post partum haemorrahge: management

Answer 17

1. Life threatening: senior team!
   2. ABC
   –> lie flat
   –> 2x 14 gauge cannula
   –> G&S
   –> warmed crystalloid
   3. Mechanical
   –> rub fundus
   –> catheterise: monitor UO
   4. Medical
   –> IV oxytocin
   –> ergometrine (not in HTN)
   –> carboprost IM (not in asthma)
   –> misoprostol sublingual
   –> tranexamic acid
   5. Surgical
   –> balloon tamponade
   –> B-lynch suture, ligation of arteries (uterine or internal iliac)
   –> LAST RESORT: hysterectomy

2ndary PPh: 24-6 weeks after
due to retained placental tissue or endometriosis

Question 18

is used in patent ductus arteriosus to promote duct closure

Answer 18

Indomethacin or ibuprofen

Note
–> prostaglandin E1 would keep the duct upon if surgical repair was warranted, e.g. if associated with CHD

If left untreated:
–> pulmonary HTN or Eisenmenger’s syndrome: reversal of shunt from left-to-right (acyanotic) to right-to-left (cyanotic)

Question 19

A patient purposely causing symptoms is known as what:

Answer 19

MUNCHAUSEN’S syndrome

Others:
Conversion: loss of function with no cause

Malingering: faking symptoms for financial gain

Question 20

Expectant management of an ectopic pregnancy can only be performed for

Answer 20

1) An unruptured embryo
2) <35mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <1,000IU/L and declining

Question 21

Tricyclic antidepressants can cause what type of incontinence

Answer 21

Overflor:

TCA –> urinary retention –> frequent leaking

Question 22

Mirtazapine may be prescribed due to what useful side effects

Answer 22

Sedation and increased appetite

e.g. MMMMMirtaZZZpine

Question 23

Generally women can feel their babies move around

Answer 23

18-20 weeks

If no movements by 24 weeks then referral to maternal fetal medicine unit

Question 24

Head lice management

Answer 24

Tx IF living head lice are found

1. Malathion
2. Wet combing
3. Dimeticone
4. Isopropyl myristate
5. cyclomethicone

Question 25

The corrected age of a premature baby is

Answer 25

age minus the number of weeks he/she was born early from 40 weeks

e.g. if born at 32 weeks then they are 8 weeks premature

Question 26

Alcohol withdrawal: features and mx

Answer 26

Mechanism: decreased inhibitory GABA and increased NMDA glutamate transmission

Features:
a) 6-12 hrs: tremor, sweating, t.cardia, anxiety
b) peak incidence of seizures at 36 hours
c) delerium tremens: 48-72hrs: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

Management
1. ADMISSION
2. long acting benzo: chlordiazepoxide or diazepam (lorazepam if hepatic failure)
–> carbamazepine also effective