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.
