papaer 2 Flashcards
what is the commonest cause of respiratory distress in the newborn period? and the biggest risk factor
Transient tachypnoea of the newborn.
It is caused by delayed resorption of fluid in the lungs
more common following c-sections (lung fluid not ‘squeezed out’ during labour)
Chest x-ray may show hyperinflation of the lungs and fluid in the horizontal fissure.
Management
observation, supportive care
supplementary oxygen maybe
settles within 1-2 days
imaging for osteomyelitis
mri
how to calculate absolute risk reduction
(Number who had particular outcome with the control)/ (Total number who had the control) - (MINUS) -
(Number who had particular outcome with the intervention) / (Total number who had the intervention)
how to calculate The positive predictive value (PPV)
dividing the number of true positives by the total number of individuals who tested positive
how to calculate the sensitivity?
Sensitivity is determined by dividing the number of true positives (78) by the sum of true positives and false negatives
Typically starts with a high grade fever which resolves before the onset of the rash. starts on the trunk before spreading to the limbs. Maculopapular rash
not itchy. - diagnosis
Roseola infantum
femoral vs inguinal hernia
a femoral hernia will pass below and lateral to the pubic tubercle, whereas an inguinal hernia will be seen above and medial to it.
strangulated hernia - open or laparoscopic repair?
open
Chlamidyma vs Gonorrhea cell type and management
gonorrhea- gram negative diplicocci
Chlamidya- gram negative eukaryotic cells
clammy dogs - chlamydia/doxycycline
‘the Gunner was accused of Ceft’ - gonnorhoea/ceftriaxone (or cefixime)
when to monitor a blood tranfusion?
-
spinal cord compression give what before starting tranfusion
dexamethasone
inactivated vaccines
rabies
hepatitis A
influenza (intramuscular)
category of c sections and timings
Category 1
an immediate threat to the life of the mother or baby
examples indications include: suspected uterine rupture, major placental abruption, cord prolapse, fetal hypoxia or persistent fetal bradycardia
delivery of the baby should occur within 30 minutes of making the decision
Category 2
maternal or fetal compromise which is not immediately life-threatening
delivery of the baby should occur within 75 minutes of making the decision
Category 3
delivery is required, but mother and baby are stable
Category 4
elective caesarean
when is a platelet transfusion appropriate
Platelet transfusion is appropriate for patients with a platelet count < 30 x 109 and clinically significant bleeding
treatment of neutapenic sepsis after chemo
Piperacillin with tazobactam (Tazocin)
hints test: abnormal head impulse and unilateral nystagmus
peripheral cause (Vestibular neuronitis)/
when not to fly in pregnancy
37 weeks plus singleton
32 weeks plus twins +
most common headache in children
migraine without aura
most common cause of puerperal pyrexia
puerperal pyrexia
seretonin syndrome vs malignant …
how many weeks can you diagnose pre eclampsia by
20 weeks
rheumatoid arthirits x ray findings
Early x-ray findings
loss of joint space
juxta-articular osteoporosis
soft-tissue swelling
periarticular erosions
subluxation
osteoarthritis hand changes
Heberden’s nodes (in the DIP joints)
Bouchard’s nodes (in the PIP joints)
Squaring at the base of the thumb (CMC joint)
swan neck deformity vs Boutonniere deformity
Swan neck deformity (hyperextended PIP and flexed DIP)
Boutonniere deformity (hyperextended DIP and flexed PIP)
1st and second line treatment for osteoarthritis
topical nsaids
oral nsaid w ppi cover
ankylosing spondylitis pelvic x ray finding
sacro-ilitis
A 9-year-old boy is diagnosed as having Attention Deficit Hyperactivity Disorder and started on methylphenidate. Which one of the following should be monitored during treatment?
Growth
due to appetite suppression
gout vs pseudogout
accelerations decelerations
Why should NSAIDS not be given to kids w chicken pox
NSAIDs can increase the risk of necrotising fasciitis in patients with chicken pox
Turner’s syndrome is associated with which heart condition
Turner’s syndrome is associated with aortic
what is the normal folic acid intake vs high risk intake and who is high risk?
all women should take 400mcg of folic acid until the 12th week of pregnancy
women at higher risk of conceiving a child with a NTD should take 5mg of folic acid from before conception until the 12th week of pregnancy
either partner has a NTD, they have had a previous pregnancy affected by a NTD, or they have a family history of a NTD
the woman is taking antiepileptic drugs or has coeliac disease, diabetes, or thalassaemia trait.
the woman is obese (defined as a body mass index [BMI] of 30 kg/m2 or more).
when should pregnant women take folic acid till
12 weeks
ds 4 test 3 test
Inflammatory arthritis involving DIP swelling and dactylitis points to a diagnosis of
psoriatic arthritis
Adjuvant hormonal therapy is offered if tumours are positive for hormone receptors. which are used for who?
Tamoxifen is still used in pre- and peri-menopausal women. In post-menopausal women, aromatase inhibitors such as anastrozole
how do you decide about whether to revmove lymph nodes in breast cancer surgery?
women with no palpable axillary lymphadenopathy at presentation should have a pre-operative axillary ultrasound before their primary surgery
if negative then they should have a sentinel node biopsy to assess the nodal burden
in patients with breast cancer who present with clinically palpable lymphadenopathy, axillary node clearance is indicated at primary surgery
this may lead to arm lymphedema and functional arm impairment
who mastectomy vs wide local excision breast cancer
Mastectomy Wide Local Excision
Multifocal tumour Solitary lesion
Central tumour Peripheral tumour
Large lesion in small breast Small lesion in large breast
DCIS > 4cm DCIS < 4cm
when is radiotherapy used in breast cancer?
Whole breast radiotherapy is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds.
For women who’ve had a mastectomy radiotherapy is offered for T3-T4 tumours and for those with four or more positive axillary nodes
when is biological theraphy used for breast cancer?
The most common type of biological therapy used for breast cancer is trastuzumab (Herceptin). It is only useful in the 20-25% of tumours that are HER2 positive.
Trastuzumab cannot be used in patients with a history of heart disorders.
when is chemo used fore breast cancer
Cytotoxic therapy may be used either prior to surgery (‘neoadjuvanant’ chemotherapy) to downstage a primary lesion or after surgery depending on the stage of the tumour, for example, if there is axillary node disease - FEC-D is used in this situation.
case control studies are always…
retrospective
what do these tumour markers relate to?
CA 125
CA 19-9
CA 15-3
Alpha-feto protein (AFP)
Carcinoembryonic antigen (CEA)
what do these tumour markers relate to?
CA 125
CA 19-9
CA 15-3
Alpha-feto protein (AFP)
Carcinoembryonic antigen (CEA)
what treatments can be offered for endometriosis before establishing a definitive diagnosis with laparoscopy?
Cyclical pain can be treated with hormonal medications that stop ovulation and reduce endometrial thickening. This can be achieved using the combined oral contraceptive pill, oral progesterone-only pill, the progestin depot injection, the progestin implant (Nexplanon) and the Mirena coil.
GnRH agonists- to induce menopause but you also get menopause sympotoms e.g. hot flushes and risk of osteoperosis
investigation for adenomyosis?
Transvaginal ultrasound of the pelvis is the first-line investigation for suspected adenomyosis.
MRI and transabdominal ultrasound are alternative investigations where transvaginal ultrasound is not suitable.
The gold standard is to perform a histological examination of the uterus after a hysterectomy. However, this is not usually a suitable way of establishing the diagnosis for obvious reasons.
what is the treatment for adenomyosis?
NICE recommend the same treatment for adenomyosis as for heavy menstrual bleeding.
When the woman does not want contraception; treatment can be used during menstruation for symptomatic relief, with:
* Tranexamic acid when there is no associated pain (antifibrinolytic – reduces bleeding)
* Mefenamic acid when there is associated pain (NSAID – reduces bleeding and pain)
Management when contraception is wanted or acceptable:
Mirena coil (first line)
COCP
Cyclical oral progestogens
Progesterone only medications such as the pill, implant or depot injection may also be helpful.
Other options are that may be considered by a specialist include:
GnRH analogues to induce a menopause-like state
Endometrial ablation
Uterine artery embolisation
Hysterectomy
what is the most accurate marker of ovarian reserve?
Anti-Mullerian hormone can be measured at any time during the cycle and is the most accurate marker of ovarian reserve. It is released by the granulosa cells in the follicles and falls as the eggs are depleted. A high level indicates a good ovarian reserve.
Testosterone is necessary for sperm creation. The hypothalamo-pituitary-gonadal axis controls testosterone. Hypogonadotrophic hypogonadism (low LH and FSH resulting in low testosterone), can be due to:
pathology of the pituitary gland or hypothalamus
Suppression due to stress, chronic conditions or hyperprolactinaemia
Kallman syndrome which is a condition characterized by delayed or absent puberty and an impaired sense of smell. (genetic condition)
what are some causes of Hypergonadotropic Hypogonadism?
Hypergonadotrophic hypogonadism is the result of abnormal functioning of the gonads. This could be due to:
* Previous damage to the gonads (e.g. testicular torsion, cancer or infections, such as mumps)
* Congenital absence of the testes or ovaries
-Kleinfelter’s Syndrome (XXY)
-Turner’s Syndrome (XO)
how often are women offered a cervical smear test?
Every three years aged 25 – 49
Every five years aged 50 – 64
There are some notable exceptions to the program:
-Women with HIV are screened annually
-Women over 65 may request a smear if they have not had one since aged 50
-Women with previous CIN may require additional tests (e.g. test of cure after treatment)
-Certain groups of immunocompromised women may have additional screening (e.g. women on dialysis, cytotoxic drugs or undergoing an organ transplant)
-Pregnant women due a routine smear should wait until 12 weeks post-partum
What is the management based on these smear results?
-Inadequate sample
-HPV negative
-HPV positive with normal cytology
-HPV positive with abnormal cytology
Inadequate sample – repeat the smear after at least three months
HPV negative – continue routine screening
HPV positive with normal cytology – repeat the HPV test after 12 months
HPV positive with abnormal cytology – refer for colposcopy
what are the typical examination findings for someone with pelvic inflammatory disease?
Examination findings may reveal:
Pelvic tenderness
Cervical motion tenderness (cervical excitation)
Inflamed cervix (cervicitis)
Purulent discharge
Patients may have a fever and other signs of sepsis.
how does bacterial vaginosis change the pH of the vagina?
increases pH
Above 4.5
what is the most common bacteria causing BV?
Mycoplasma hominis
Prevotella species
Prevotella
Peptostreptococcus
Bacteroides spp.
Gardnerella vaginalis
Gardnerella vaginalis
what age does menopause become purely a clinical diagnosis and for those under this age which blood test is used to make a diagnosis?
over 45 and FSH
what age do women need to use contraception until?
Two years after the last menstrual period in women under 50
One year after the last menstrual period in women over 50
what are the two main side effects of the pogesterone depot injection and who is it unsuitable for?
weight gain and reduced bone mineral density (osteoporosis).- only in depot
Reduced bone mineral density makes the depot unsuitable for women over 45 years.
What to co-prescrige in non-hodgkins lymphoma for better outcomes?
Rituximab
What type of cells are characteristic for hodgkins lymphoma?
Reed-sternberg cells
Pain in lymph nodes after drinking alcohol? diagnosis
Hodgkin’s lymphoma
Risk factor for MALT lymphoma?
H pylori
What to give if vacomycin didn’t work first time in C.diff?
ORAL vancomycin and IV metronidazole
what malignancy is linked to mysthethenia gravis linked to?
Thymoma
Prevention of motion sickness
Hycosine>cyclizine
Test for autoimmune haemolytic anemia
Coombs test
Management of neonatal hypoglycaemia:
Asymptomatic:
* encourage normal feeding (breast or bottle)
* monitor blood glucose
symptomatic or very low blood glucose:
* admit to the neonatal unit
* intravenous infusion of 10% dextrose
what histological finding would you find in lung cancer causing hypercalcemia?
squamous cell carinoma
how does Recurrent laryngeal nerve palsy present and what is it caused by?
horse voice
a tumour pressing on or affecting the recurrent laryngeal nerve as it passes through the mediastinum.
Limbic encephalitis is a paraneoplastic syndrome where the immune system makes antibodies to tissues in the brain, specifically the limbic system, causing inflammation in these areas. This causes symptoms such as hallucinations, confusion and seizures. short-term memory impairment- this is caused by which type of lung cancer
Limbic encephalitis is a paraneoplastic syndrome where the immune system makes antibodies to tissues in the brain, specifically the limbic system, causing inflammation in these areas. This causes symptoms such as hallucinations, confusion and seizures. short-term memory impairment- this is caused by which type of lung cancer
2 things that cause hypotension in blood transfusion
anaphylaxis, abo incompatibitlty
if only fever and chills in bloo dtransfusion
Slow or stop the transfusion
Paracetamol
Monitor
Transfusion-associated circulatory overload (TACO)
vs
Transfusion-related acute lung injury (TRALI)
taco Pulmonary oedema, hypertension - stop transfusion and diuretic
TRALI Hypoxia, pulmonary infiltrates on chest x-ray, fever, hypotension - stop tranfusion and maybe oxygen
Downs syndrome tripple test vs quadruple 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
antenatal downs test
Combined Test
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.
