Part B 03 Flashcards
Monteggia #
Description
# distal ulnar Dislocation radial head
Whooping cough
Organism
Bordatella pertussis
Whooping cough
Tx
Erythromycin
Or
Clarithromycin
FB in airway
Tx
Bronchoscopy
Asthma Tx Paeds
1) Bronchodilator
- 10 puff salbut in spacer
- Neb salbut 2.5-5mg
+ ipratropium 250mcg
Sara<92% add Mg sulphate (150mg neb)
2) Steroids
- 2-5y: 20mg
- >5y: 30-40mg
3) second line Tx
IV salbut (15mcg/kg over 10m)
Paeds asthma
Bronchodilator Tx
1) Bronchodilator
- 10 puff salbut in spacer
- Neb salbut 2.5-5mg
+ ipratropium 250mcg
Sats<92% add Mg sulphate (150mg neb)
Paeds asthma
Steroid Tx
2) Steroids
- 2-5y: 20mg
- >5y: 30-40mg
Paeds asthma
Second line Tx
IV salbut (15mcg/kg over 10m)
Amiodarone
APLS dose
5mg/kg
Alternative to amiodarone
APLS drug and dose
Lidocaine 1mg/kg (max100mg)
Croup
Organism
Parainfluenza virus
Croup
Tx
Oral Dex: 0.15mg/kg
Neb budesonide if too unwell: 2mg
Neb adrenaline
Croup
Scoring system called
Westley croup score
Westley croup score
Stridor (0-2) -None, agitated, rest Retractions - nil, mild, mid, severe Air entry - normal, mild, severe SaO2<92% - nil, agitation (4), rest (5) Consciousness - normal, decreased (5)
AAA
Defined
> 3cm
>1.5 x normal
AAA
Elective surgery
> 5.5cm
Or >4.5 and increasing >0.5cm/6m
Inguinal hernia
Comp
Pain
Incarceration
Strangulation
Salicylate levels
Mild
Mod
Severe
Mild <450mg/L
Mod 450-750
Severe >700
Salicylate OD
Tx
Severe cases >750mg/L
IV fluids and 1.26% na bicarbonate
MetHb
Define
> 1%
MetHb
When to
Tx
> 25%
Or symptomatic
MetHb
Tx
IV fluids
IV methylene blue 1% (1mg\kg)
Refer to ITU
Salicylate OD
Sx
Tinnitus, hearing loss
Sweating, high RR
Flushing, high T (esp Paeds)
Thin profuse yellow green discharge PV
Dx
Trichomonas Vaginalis
Strawberry cervix
Dx
Trichmonas vaginalis
Trichmonas vaginalis
pH discharge
> 4:5
Trichmonas vaginalis
Associated with
PID
HIV
Preterm delivery
Trichmonas vaginalis
Tx
Metronidazole
Missed COCP
Plan
<72h
- take pill immediately and continue as normal
>72h
- emergency contraception, continue as normal, add in barrier until next cycle?
TRALI
Define
Sx
Transfusion related lung injury Hypoxia & bilateral p edema W/i 6h transfusion
TRALI
Tx
Stop trans
O2
Resp support: NIV, int&vent
Pre eclampsia
RF
1st pregnancy Multiple preg Obesity >35yo DM HTN Kidney ds
Pre eclampsia
Define
Pregnancy induced HTN
And
Proteinuria (>0.3g/24h)
Severe pre eclampsia
Define
BP>160/110 Severe proteinuria Oliguria Headache and clonus Plt<100 Epigastric pain Deranged LFT
Pre eclampsia
Complications
Eclampsia HELLP ARDS Cerebral haemorrhage Stroke P edema Renal failure DIC
Biochem teat to predict complications of pre eclampsia
Uric acid level
Pre eclampsia
Tx
Labetolol
Calcium gluconate
Used to Tx
Low K
Low calcium
CCB OD
APLS calcium gluconate
Dose
0.3ml/kg
10% sol
APLS fluid bolus
Shock
20ml/kg
APLS
Maintenance fluids
(Daily vol)
1st 10kg : 100ml/kg
2nd 10kg: 50ml\kg
Subsequent kg: 20ml/kg
Estimate % paediatric
Dehydration
Clickable signs dehydration w/o shock ~5%
With shock~ 10%
Otitis media
Most common organism
Streptococcus pneumoniae
Paeds DKA
Tx
Fluid bolus to reverse shock (20ml\kg) Rehydrate over 48h Insulin after 1h fluids — 0.1unit/kg/h Check electrolytes
Emergency contraception
Types
Levonorgestrel
Ulipristal acetate
Copper IUD
Levonorgestrel aka
Levonelle
Dose of
Levonorgestrel
1.5mg
Levonorgestrel
Hour many hours after unprotected
Up to 72h
Ulipristal acetate
Up to how many hours after unprotected
Up to 120h
Copper IUD
Up to how many days after unprotected sex
5 days
Mitral stenosis
Most commonly due to
Rheumatic heart disease
Mitral stenosis
Signs
Malar flush AF Tapping apex beat (palpable 1st heart sound) Loud 1st HS Left parasternal heave Mid diastolic murmur (best at apex)
B blocker OD
Atropine 500mcg
Glucagon 2mg
ALS bradycardia algorithm
Stable
1st and 2nd line Tx
1st line Atropine 500mcg up to 3mg 2nd line Transcutaneous pacing Isoprenaline 5mcg/min Adrenaline 2-10mcg/min
Glucagon
Used to Tx which ODs
B blocker
CCB
NAC anaphylactic reaction
% patients
20%
NAC anaphylactic reaction
RF
Female
Low paracetamol levels
Brittle asthma
NAC anaphylactic reaction
Tx
Stop infusion
Restart at slower rate (once controlled)
10mg piriton IV
5mg salbutamol
Koplick spot
Seen in which ds
Measles
Buccal mucosa
Incubation period
Measles
~10d
Measles
Ix
Salivary swab - measles IgM - RNA detection Serum sample - measles IgM
Measles
Complications
Febrile convulsions Pneumonia Meningitis/encephalitis Subacute sclerosing panencephalitis Otitis media Death
Paeds DKA
Fluid deficit Assumptions
~5% in mild-mod DKA
~10% in severe DKA
Paeds <5yo
Signs of UTI
Frequency, abdo pain
Irritable, lethargic
Vomiting
Poor feeding
Paeds
Sign of impacted FB in oesophagus
Pain Drooling Gagging Retching Vomiting
Intravascular volume
Infant
Older child
Infant = 80ml/kg
Older child - 70ml\kg
Philadelphia chromosome
Associated which ds
CML
Philadelphia chromosome
Translocation
T 9:22
CML
Complications
Splenic infarction
Gout
CVA
priapism
CML
Stages
Chronic
Accelerated
Blast crisis
CML
Tx
Tyrosine kinase inhibitors
Eg imatinib
Febrile convulsions
Tx
Strip down
Paracetamol 20mg/kg
Ibuprofen 5mg/kg
Complex febrile convulsions
Define: features
Focal seizure
Seizure >15min
>1 convulsion per febrile illness
Post ictal focal neuro deficit
Inhaled FB
(Paed)
Ix
CXR Inhalation And exhalation: exaggerates diff Effected lung is hyperlucent
Inhaled FB
Complications
Pneumonia Atelectasis Bronchospasm Pneumothorax Broncho oesphageal fistula Bronchiectasis
Hyperkalaemia
Salbutamol Nebs
Act w/i:…
Drops K+ by…
Acts w/i: 30mins
Drops K+ by ~1mmol
APLS algorithm
High K
> 6.5
With arrhythmia
-> 10% Ca gluconate (0.1mmol/kg)
W/O arrhythmia -> Neb salb (2.5-10mg) If improved give calcium resonium If not improved and acidotic - sodium bicarb If not improved (normal ph) - insulin and dextrose If no improvement -> dialysis
Discitis
Most common pathogen
S aureus
Or
Strep viridans in IVDU/ immuno comp
Discitis
Complications
Sepsis
Epidural abscess
Neuro deficit ~50%
Discitis
RF
Spinal surg Immuno deficiency DM Malignancy IVDU <8yo
Discitis
Ix
MRI whole spine
(Often at multiple levels)
3x cultures
Discitis
Tx
IV fluclox
+/- gent (IVDU)
IV Vanc if hospital acquired
IV magnesium sulphate
Dose in adult asthma
2g over 30mins
Lithium OD
High and toxic lithium levels
> 1 is high
>1.5 is toxic
Types of lithium OD
Acute - GI upset, tremor, ataxia, confusion, coma
Acute on chronic
Chronic - precipitated by new medication. Primarily neuro sx
Free NHS services
For oversees visitors
A&E Family planning Tx infectious ds Tx STI Tx torture, FGM, IDSVA Except when specifically travelled for Tx
GMC
Good medical practice domains
- Knowledge, skills, performance
- safety and quality
- communication, partnership and teamwork
- maintaining trust
Infantile hypertrophic pyloric stenosis
VBG finding
Hypochloraemic metabolic alkalosis
Tx
Infantile hypertrophic pyloric stenosis
Ramstedt pyloromyotomy
Testicular torsion
Ddx
Torsion testicular appendage Epididymitis Orchitis Epididymo-orchitis Appendicitis
Testicular torsion
Exam signs.
Tender
High riding
Loss cremasteric reflex
Opposite testis in horizontal lie
Prehns sign
NEG = Testicular torsion
Lift affected testicle
Relieves pain epididymitis
It by torsion
Testicular torsion
Irreversible ischaemia in how many hours
> 6h
APLS
Anaphylaxis adrenaline dose
Per age
<6yo = 150mcg
(0.15ml of 1:1000)
6-12yo = 300mcg
>12 = 500mcg
APLS
Anaphylaxis
Chlorphenamine dose
Per age
1-6yo =2.5-5mg IM
6-12yo = 5-10mg IM
>12yo = 10-20mg IM
APLS
Anaphylaxis
Hydrocortisone
Dose per age
<6m = 25mg
6m-6yo = 50mg
6-12yo - 100mg
>12yo - 200mg
Mumps
Complications
Meningitis Encephalitis Orchitis Pancreatitis Sensorineural hearing loss
Paeds
Most common non arrest rhythm
SVT
Paeds
SVT (stable)
Tx
Vagal manoeuvres Adenosine - 100mcg/kg -> 200mcg/kg -> 300mcg/kg -> 400-500mcg/kg -> sync DC shock -> Amiodarone (5-10mg/kg over 30mins)
Paeds
SVT (unstable)
Tx
Sync DC shock
1J/kg
-> 2J/kg for all subsequent shocks