OSCE practise Flashcards
Adrenaline amount for anaphylaxis?
1 in 1000, 5 mg
paeds question I always forget to ask?
are they hitting all of their developmental milestones
what makes a febrile seizure complex?
when they consist of partial or focal seizures,
last more than 15 minutes
or occur multiple times during the same febrile illness.
risk of epilepsy after febrile seizure
Children who have had a febrile seizure have a slightly increased chance of having epilepsy later in life.
1 in 100 - 1 % extra chance
what is coeliacs disease?
an autoimmune condition triggered by eating gluten.
It can develop at any age
blood tests for coeliacs
total immunoglobulin A levels
anti-TTG and anti-EMA antibodies
what happens in coeliacs if u continue eating gluten even in tiny amounts?
It can lead to:
Nutritional deficiencies
Anaemia
Osteoporosis
Hyposplenism (with immunodeficiency, particularly to encapsulated bacteria such as Streptococcus pneumoniae)
Ulcerative jejunitis
Enteropathy-associated T-cell lymphoma (EATL)
Non-Hodgkin lymphoma
Small bowel adenocarcinoma
food with gluten
oats, bread, pasta, cereal, and pizza.
GORD managment babies
In simple cases some explanation, reassurance and practical advice is all that is needed. Advise:
Small, frequent meals
Burping regularly to help milk settle
Not over-feeding
Keep the baby upright after feeding (i.e. not lying flat)
More problematic cases can justify treatment with
Gaviscon mixed with feeds
Thickened milk or formula (specific anti-reflux formulas are available)
Proton pump inhibitors (e.g., omeprazole) where other methods are inadequate
when does pyloric stenosis present
first few weeks of life, with a hungry baby that is thin, pale and generally failing to thrive.
investigation and management of pyloric stenosis
Diagnosis is made using an abdominal ultrasound to visualise the thickened pylorus.
Treatment involves a laparoscopic pyloromyotomy (known as “Ramstedt’s operation“). Prognosis is excellent following the operation.
what is the criteria for giving ultrasounds for children with UTIs
All children under 6 months with their first UTI should have an abdominal ultrasound within 6 weeks, or during the illness if there are recurrent UTIs or atypical bacteria
Children with recurrent UTIs should have an abdominal ultrasound within 6 weeks
Children with atypical UTIs should have an abdominal ultrasound during the illness
what structural abnormality predisposes children to UTIs
Vesicoureteric reflux
investigation for children with Vesicoureteric reflux
Micturating Cystourethrogram (MCUG)
Micturating cystourethrogram (MCUG) should be used to investigate atypical or recurrent UTIs in children under 6 months. It is also used where there is a family history of vesico-ureteric reflux, dilatation of the ureter on ultrasound or poor urinary flow. A MCUG is used to diagnose VUR.
It involves catheterising the child, injecting contrast into the bladder and taking a series of xray films to determine whether the contrast is refluxing into the ureters. Children are usually given prophylactic antibiotics for 3 days around the time of the investigation.
management of placental abruption
Urgent involvement of a senior obstetrician, midwife and anaesthetist
2 x grey cannula
Bloods include FBC, UE, LFT and coagulation studies
Crossmatch 4 units of blood
Fluid and blood resuscitation as required
CTG monitoring of the fetus
atenatal steroids are offered between 24 and 34 + 6 weeks gestation to mature the fetal lungs in anticipation of preterm delivery.
Rhesus-D negative women require anti-D prophylaxis when bleeding occurs. A Kleihauer test is used to quantify how much fetal blood is mixed with the maternal blood, to determine the dose of anti-D that is required.
Emergency caesarean section may be required where the mother is unstable, or there is fetal distress.
when to do emergency c section in placental abruption
Emergency caesarean section may be required where the mother is unstable, or there is fetal distress.
what are the 3 causes of antepartum haemorrhage to remember
The three causes of antepartum haemorrhage to remember are placenta praevia, placental abruption and vasa praevia
causes of spotting in pregnancy
Causes of spotting or minor bleeding in pregnancy include cervical ectropion, infection and vaginal abrasions from intercourse or procedures.
risk of placental previa
Antepartum haemorrhage
Emergency caesarean section
Emergency hysterectomy
Maternal anaemia and transfusions
Preterm birth and low birth weight
Stillbirth
management of placenta previa
ultrasound scan at:
32 weeks gestation
36 weeks gestation (if present on the 32-week scan, to guide decisions about delivery)
Corticosteroids are given between 34 and 35 + 6 weeks (Lungs) given the risk of preterm delivery.
Planned delivery is considered between 36 and 37 weeks gestation. planned early to reduce the risk of spontaneous labour and bleeding. Planned cesarean section is required with placenta praevia and low-lying placenta (<20mm from the internal os).
Emergency caesarean section may be required with premature labour or antenatal bleeding.
-anti-d in rhesus negative mothers
The main complication of placenta praevia is haemorrhage. When this occurs, urgent management is required and may involve:
Emergency caesarean section
Blood transfusions
Intrauterine balloon tamponade
Uterine artery occlusion
Emergency hysterectomy
what is vasa praevia?
usually the babies blood vessels are tucked into the placenta or umbilical cord. Vasa praevia is when The fetal vessels travel through the chorioamniotic membranes, and pass across the internal cervical os (the inner opening of the cervix). These exposed vessels are prone to bleeding, particularly when the membranes are ruptured during labour and at birth. This can lead to dramatic fetal blood loss and death.
investigation and management of vasa praevia
Ideally, Vasa praevia may be diagnosed by ultrasound during pregnancy. However, ultrasound is not reliable, and it is often not possible to diagnose antenatally.
It may present with antepartum haemorrhage, with bleeding during the second or third trimester of pregnancy.
It may be detected by vaginal examination during labour, when pulsating fetal vessels are seen in the membranes through the dilated cervix.
Finally, it may be detected during labour when fetal distress and dark-red bleeding occur following rupture of the membranes. This carries a very high fetal mortality, even with emergency caesarean section.
management
For asymptomatic women with vasa praevia, the RCOG guidelines (2018) recommend:
Corticosteroids, given from 32 weeks gestation to mature the fetal lungs
Elective caesarean section, planned for 34 – 36 weeks gestation
-anti-d in rhesus negative mothers
Where antepartum haemorrhage occurs, emergency caesarean section is required to deliver the fetus before death occurs.
After stillbirth or unexplained fetal compromise during delivery, the placenta is examined for evidence of vasa praevia as a possible cause.
two main risk factors of GD
big baby- shoulder dystocsia
post partem hypogylcaemia
screening test for GD
oral glucose tolerance test
An OGTT should be performed in the morning after a fast (they can drink plain water). The patient drinks a 75g glucose drink at the start of the test. The blood sugar level is measured before the sugar drink (fasting) and then at 2 hours.
Normal results are:
Fasting: < 5.6 mmol/l
At 2 hours: < 7.8 mmol/l
Results higher than these values are used to diagnose gestational diabetes.
TOM TIP: It is really easy to remember the cutoff for gestational diabetes as simply 5 – 6 – 7 – 8.
managment for GD
-Fasting glucose less than 7 mmol/l: trial of diet and exercise for 1-2 weeks, followed by metformin, then insulin
-Fasting glucose above 7 mmol/l: start insulin ± metformin
-Fasting glucose above 6 mmol/l plus macrosomia (or other complications): start insulin ± metformin
After how many weeks does pre eclampsia present
20 weeks
what can be given as phrophylaxis for pre-eclampsia
Aspirin is used for prophylaxis against the development of pre-eclampsia. It is given from 12 weeks gestation until birth to women with risk factors
management for pre eclamsia
Medical management of pre-eclampsia is with:
Labetolol is first-line as an antihypertensive
Nifedipine (modified-release) is commonly used second-line
Blood pressure is monitored closely (at least every 48 hours)
Ultrasound monitoring of the fetus, amniotic fluid and dopplers is performed two weekly
Treating to aim for a blood pressure below 135/85 mmHg
Admission for women with a blood pressure above 160/110 mmHg
IV magnesium sulphate is given during labour and in the 24 hours afterwards to prevent seizures
Fluid restriction is used during labour in severe pre-eclampsia or eclampsia, to avoid fluid overload
Planned early birth may be necessary if the blood pressure cannot be controlled or complications occur. Corticosteroids should be given to women having a premature birth to help mature the fetal lungs.
at what blood pressure does someone with pre-eclampsia/hypertension need to be admitted
Treating to aim for a blood pressure below 135/85 mmHg
Admission for women with a blood pressure above 160/110 mmHg
treatment of Eclampsia
IV magnesium sulphate
affects of pre-eclampsia/eclampsia on the baby
pre-eclampsia: Fetal growth restriction
eclampsia: poor fetal perfusion/fetal destress
Amniocentesis vs cvs
Cvs before 15 weeks
downs syndrome testing
The combined test is the first line and the most accurate screening test. It is performed between 11 and 14 weeks gestation and involves combining results from ultrasound and maternal blood tests.
Ultrasound measures nuchal translucency, which is the thickness of the back of the neck of the fetus. Down’s syndrome is one cause of a nuchal thickness greater than 6mm.
Maternal blood tests:
Beta‑human chorionic gonadotrophin (beta-HCG) – a higher result indicates a greater risk
Pregnancy‑associated plasma protein‑A (PAPPA) – a lower result indicates a greater risk
Triple Test
The triple test is performed between 14 and 20 weeks gestation. It only involves maternal blood tests:
Beta-HCG – a higher result indicates greater risk
Alpha-fetoprotein (AFP) – a lower result indicates a greater risk
Serum oestriol (female sex hormone) – a lower result indicates a greater risk
Quadruple Test
The quadruple test is performed between 14 and 20 weeks gestation. It is identical to the triple test, but also includes maternal blood testing for inhibin-A. A higher inhibin-A indicates a greater risk.
Jaundice in the first ??? hours of life is pathological.
24 hrs
prolonged jaundice?
21 prem
14 days in term baby
When writing out a prescription for a blood transfusion, each unit of blood should be prescribed as
Packed red cells
how long should you infuse the blood over
4 hours
how to check blood tranfusion
Once the blood transfusion arrives, you will need to check it with a colleague to ensure it is safe for administration:
- Wash your hands and don appropriate PPE.
- Request a colleague (nurse or doctor) to assist you with checking the blood transfusion.
- Ask the patient to tell you their name and date of birth and then compare this to their bracelet, medical notes and blood compatibility report to ensure they all match exactly.
- Check the blood group and serial number on the blood bag matches the compatibility report.
- Check the expiry date and time on the unit of blood to ensure it has not expired.
- Inspect the blood bag for:
Signs of tampering
Leaks
Discolouration
Clots
Do not administer blood if any of these are noted.
when to check blood tranfusion
The patient’s baseline observations should be checked at 0, 15 and 30 minutes from the onset of the transfusion.
What to remember for hand and wrist
Pulse
Cap refill
Palpate anatomical snuff box
Potentially sensation in tips of fingers, anatomical snuff box, hypthenar and hypo eminence
Back of the hand including anatomical snuff box is supplied by
Radial nerve
Osteoarthritis nodes
Heberden’s nodes (in the DIP joints)
Bouchard’s nodes (in the PIP joints)
X ray changes seen in rheumatoid vs osteoarthritis
Loss of joint space
Subchondral
sclerosis
Subchondral
cysts
Osteophytes
forming at joint margins
Loss of joint space
Juxta-
articular osteoporosis
Periarticular erosions
Subluxation
Management for carpal tunnel syndrome
Management options for carpal tunnel syndrome are:
Rest and altered activities
Wrist splints that maintain a neutral position of the wrist can be worn at night (for a minimum of 4 weeks)
Steroid injections
Surgery
What’s the one thing not to forget in lumbar spine
Reflexes
Apparent vs true length
Apparent leg length
Scoliosis
Pelvic tilt
True leg length
Fracture
Perthes
SUFE
Congenital difference
Postive Thomas test
Fixed flexion deformity
Ilioposas stiffness
Cystic fibrosis management
Chest physio 2 x times a day
Deep breathing exercises
High calorie diet
Pancreatic enzymes if insufficiency
Advice on refraining from other children with cystic fibrosis
Prophylactic antibiotics
Genetic counselling
Vaccinations
Rubella
Start face and moves down to chest
Pro drone low grade fever
Blanching manucolopaular rash
5 days off school
Measels
Koplik spots
Starts behind the ear associated with otitis media
Pneumonia most common cause of death
NOTIFIABLE disease
Supportive management
Mumps
Ear ache pain
Pain on eating
Swelling of face glands
No rash
Supportive management
NOTIFIABLE disease
Kawasaki
Crash and burn
Conjunctivitis
Red eyes
Adenopathy
S- strawberry tongue
H- hands and feet desqumanation
Burn-
High dose aspirin
Iv immunoglobulins
Regular echos - risk of coronary aneurysm
Pathological 24 hrs jaundice
Within 2
ABO haemolytic reaction
Resus haemolytic disease
G6PD deficiency
Hereditary spherocytosis
pulmonary odema, hypertension
TACO
Furosemide/oxygen
hypoxia, pulmonary infiltrates on chest x-ray, fever, hypotension
TRALI
O2 and supportive care
fever abdominal pain hypotension
ABO incompatible, acute haemolytic reaction
stop transfusion
confirm diagnosis
-check identity of patient/name on blood product
-send blood for direct coombs test, repeat typing and cross matching
supportive care
- fluid resuscitation
fever chills
Non-haemolytic febrile reaction
slow or stop the transfusion
paracetamol
monitor
pruritis, urticaria
minor allergic reaction
Temporarily stop the tranfusion
antihistamine
monitor
hypotension, dysponea, wheezing, angiodema
Anaphylaxis
hypotension, dyponea, wheezing, angiodema
Treatment of gbs in pregnancy
Antibiotics
Investigations for ankolysing spondylitis
Investigations
Key investigations include:
Inflammatory markers (e.g., CRP and ESR) may rise with disease activity
HLA B27 genetic testing
X-ray of the spine and sacrum
MRI of the spine can show bone marrow oedema early in the disease before there are any xray changes
Anyokokysing spondylitis management
The rheumatology multidisciplinary team will manage patients. Treatment aims to control symptoms and preserve function.
Medical management may involve:
Non-steroidal anti-inflammatory drugs (NSAIDs) are first-line
Anti-TNF medications are second-line (e.g., adalimumab, etanercept or infliximab)
Secukinumab or ixekizumab are third-line (monoclonal antibodies against interleukin-17)
Upadacitinib is another third-line option (JAK inhibitor)
Intra-articular steroid injections may be considered for specific joints.
Additional management:
Physiotherapy
Exercise and mobilisation
Avoiding smoking
Bisphosphonates for osteoporosis
Surgery is occasionally required for severe joint deformity
