Obs + Gynae Flashcards
what is the management of PPROM at 30 weeks
The patient is 30 weeks pregnant and therefore it is better to prolong the gestation as much as possible. Referral/discussion with obstetrics registrar/consultant. · Initial mx: admit patient for observations for 24 hours (due to increased chance of going into labour) observations to look for ?infection, bloods such as FBC + CRP for infection – monitor for signs of chorioamnionitis, advise patient to avoid sexual intercourse and watch out for signs of infection e.g. take temperature everyday ·
Medical management: o Prophylactic erythromycin 250 mg QDS for 10 days
Corticosteroids
Aim expectant management until 34 weeks
MgSO4 - neuro protective for baby?
Advice against sex due to infection risk
PROM mx
CTG
speculum - clear liquor in fluid
reassure mum
If contractions - deliver
risk factors for placental abruption
smoking old cocaine pre-eclampsia multiparity trauma
how do you investigate abruption
abdo US to rule out placenta praevia first
clotting studies for DIC
CTG
Avoid vaginal exam
mx of abruption
A-E Counsel mum - keep calm haem stable Hb - blood not fluid - tx hypovolaemia O2 Hb above 100 Monitor UO Transexamic acid? Stable IV access CTG BDZ <36 weeks anti-D foetus in distress - C/S Maintain BP during C/S no foetal distress can induce for vaginal delivery if both stable Risk of DIC Baby dead induce and deliver vaginally
IM oxytocin following C/S
eczema
lichenification
ecsorations
hypo and hyper pigmentation
eczema managemnet
psych - stress improve it
food allergies in kids = control ]
bathing showers better than baths
soap free cleanser
avoid wool and synthetic fibre
protect skin from dust and detergent
stress reduction
avoid scratching
mittens
emollients first line - big quantities, after bath, thick layer, 30 mins before steroids
Prescribe in pumps not pots - stop dipping fingers in
topical steroids - lowest strength possible
antihistamines at night - warn about sedation
tx secondary infecton - fluclox
immunosuppresant is las line
what are the differentials for PAD?
spinal stenosis arthritis venous claudication smptomatic baker cyst venous insufficiency DVT nerve root compression
what ix should you do in pAD
Ankle brachial plexus
gold standard test for diagnosis = CT angiogram
doppler
whta is the management of chronic pad?
aggressive risk factor modification including BP, lipids, dm and smoking cessation
advice mild to moderate cases to keep walking to improve sx and may have a structured exercise programme
antiplatelet therapy recommended to all
annual follow up visits to monitor coronary, cerebrovascualr and leg ischaemic sx
symptomatic relief can be given with vasodilators such as Naftidrofuryl
referral to vasc surgery for revsacularisation if critical - monitor patency long term
what is the mx of acute limb ischameia
medical emergency - any decrease in limb perfusion urgent hx and exam urgent referal to vascular surgery emergency ABPI or duplex US once diagnosis made - systemic anticoag unless contra - pain relief - paracetamol and opoid if non viable limb = amputation if viable limb - revascularisation e.g. percutanoeus catheter directed thrombolytic therapy
what are the differentials for psoraisis
lichen planus eczema SLE pityriasis rosea seborrheic dermatitis
what is the mx of psorasis
the aim of therapy is to gain control of the disease process and achieve/maintain remission. And aim to achieve no impact on QoL.
topical tx are mainstay of tx - creams, ointments and lotions if limited start with topical corticosteroids and/or Vit D analogue (calcipotriol).
Topical tars and dithranol are no longer used as much
Systemic therapy - phototherapy, conventional systemic therapy e.g. methotrexate, ciclosporin and biological therapy
while explaining the risks e.g. etanercept
counsil pt on condition, psycosocial implications screening for depression and anxiety, psoriatic arthritis and mention of CV disease risk
how does management of guttate psoriasis differ to plaque psorasis?
1st line is phototherapy and initiate tx under specialist
what is the mx of osteoporosis?
Non-pharmacological: Educate about the diagnosis and supplement with written information, stop smoking, reduce alcohol intake, wean down or stop causative medications like steroids, regular exercise such as swimming and walking, utilise an MDT approach to tackle falls risk factors (reduce polypharmacy, physiotherapy, occupational therapy, social services assessment, optician review, hearing aid assessment), offer hip protectors.
Medical: Ensure calcium and vitamin D replete, bisphosphonates (eg: alendronate), denosumab (monoclonal antibody that acts as a RANKL inhibitor and thereby reduces osteoclast activity given subcutaneously every 6 months), strontium ranelate (looks a bit like calcium so taken up into bones etc), raloxifene (secondary prevention only, if bisphosphonate not tolerated or contraindicated; selective oestrogen receptor modulator, reduces breast cancer risk but increases VTE risk), teriparatide (parathyroid hormone peptides).
Surgical: Repair of fractures.
what ix do you do in pleural effusion
Bloods- FBC. U+E, LFT, CRP/ESR, LDH, clotting, amylase, lipid profile, TFTs, RF, ANA, ANCA, complement if suspicion of connective tissue disease
Blood cultures
Sputum gram stain, culture and sputum for AFBs
Pleural fluid analysis (USS guided aspiration):
Appearance (clear/straw, yellow/turbid, milky, blood)
Biochemistry: LDH, protein, pH, glucose, amylase, triglycerides, cholesterol
Microbiology: gram stain, cell count, culture, AFB culture
Cytology: for malignant cells
Immunology: Rheumatoid factor, ANA, complement
CXR, USS chest – loculated effusion, to insert drain/sample fluid
Contrast enhanced CT thorax: detect small effusions, look for the underlying cause
Bronchoscopy, thoracoscopy
Pleural biopsy
