Pass medicine learning points Flashcards
Antipsychotic side effects
Parkinsonism
Acute dystonia
Akathisia (restlessness)
Tardive dyskinesia (involuntary movements)
Charles bonnet risk factors
Peripheral visual impairment Advanced age Social isolation Sensory impairment Early cognitive impairment
How long before a PTSD diagnosis
2 months
Depression in winter
Seasonal affective disorder
Schizophrenia first rank symptoms
auditory hallucinations, thought disorders, passivity phenomena and delusional perceptions
Second rank symptoms of schizophrenia
impaired insight incongruity/blunting of affect (inappropriate emotion for circumstances) decreased speech neologisms: made-up words catatonia negative symptoms
What should you do if there are symptoms of mania in primary care
Urgent referral to community mental health team
How is mania different to hypomania
Mania is persistently elevated mood state with psychotic symptoms (hypomania is normally 7-10 days)
Describe schizotypal personality disorder
Patients diagnosed with schizotypal personality disorder lack close friends other than family and can have odd or eccentric behaviour, speech and beliefs
What is the difference between schizoid and schizotypal personality disorder
Both loners but schizoid don’t want sex whereas schizotypal are eccentric
Histiroinic personality disorder
Crave attention and are inappropriate
What is clozapine
Atypical antipsychotic
Clozapine side effects weight gain
weight gain excessive salivation agranulocytosis neutropenia myocarditis arrhythmias
Hyperkalaemia, low chloride, alkalotic
Bulimia nervosa
Rapid speech and topics but no connection
Knights move, schizophrenia
Rapid speech and topics but with a connection
Flight of ideas, bipolar, mania
SSRI SE
GI symptoms
Drug interactions
QT elongation
TCA SE
drowsiness dry mouth blurred vision constipation urinary retention lengthening of QT interval
After you’ve changed the lithium dose when do you need to recheck the levels
7 days and 12hours later
What class of antidepressant is venlafaxine
Serotonin and noradrenaline reuptake inhibitors
Clozapine life threatening SE
Agranulocytosis
Hand foot and mouth disease
Viral infection in a child. Mouth ulcers, rash on hands and feet. Sometimes legs and buttocks. Fever, anorexia, sore throat
Group B strep prophylaxis
BenPen IV
4 year constipation in child
Diet and exercise, osmotic laxative.
What is a red flag for hirschprungs disease
Passage of meconium after 48 hours, MEN2
Hip dysplasia red flags
Female Breech Family History Oligohydramnios Birth weight over 5kg
Which contraceptive can cause a delay in fertility returning
Progesterone only injection
What is the most effective form of emergency contraception
Copper intrauterine device (not affected by BMI)
Ovarian cyst early in pregnancy
normal
25-49 cervical screening frequency
3 years
50-65 cervical screening frequency
5 years
65+ cervical screening frequency
If they havent since 50
Child needs treatment for life and parents refuse what do you do
Have to give as best interests
Torticollis
wry neck, tight on one side, can be from haloperidol, example of acute dystonia
Paediatric life support how many compressions a minute
100-120
How does a threatened miscarriage present
painless per vaginal bleeding and a closed cervical os
Woman wants to concieve and has large fibroids treatment
Myomectomy
vomiting, dry skin, tiredness and raised B-hCG. Foetus large for date
Molar pregnancy
Meningitis in under 3 month olds what do you need to give in addition to cefotaxime to cover for listeria
Amoxicillin
menstrual disorders, infertility, acne, hirsutism, and metabolic syndrome.
PCOS
Obstetric cholestasis treatment
Ursodeoxycholic acid and vitamin K. Then delivery at 37 weeks to prevent still birth
When is the COCP contraindicated
before 6 weeks post partum
First rank schizophrenia symptoms
auditory hallucinations, thought disorders, passivity phenomena and delusional perceptions
ADHD treatment
Methylphenidate
Bronchiolitis peak incidence
3-6 months
Main bronchiolitis causative organism
RSV
Someone hasnt gone into labour and has had a sweep, whats next
Vaginal prostaglandin gel
What type of ovarian cancer causes endometrial hyperplasia
granulosa cell tumours
Akathesia
Severe restlessness
Ascending infection, back ache, losing cloudy liquid, slightly open os
Chorioamnionitis
Breech at 36+ weeks
External cephalic version
Initial management of hirschprungs
Bowel irrigation
What is the best measure of ovulation
28 day progesterone
Severe preeclampsia near term treatment
IV magnesium sulphate and plan immediate delivery
infants with symptoms of breathlessness worse on exertion (e.g. feeding), sweating, poor feeding and recurrent chest infections
Heart failure
Preceding infection, mild effusion, pain, stats normal
Transient synovitis, rest and analgesia
How do your cancer risks change with COCP
Higher breast and cervical rates
Lower ovarian and endometrial rates
How are depression and dementia different
Depression has a shorter and more rapid history
Common cause of microcephaly
Fetal alcohol syndrome
Lots of vomiting leads to what blood gas
Elevated bicarbonate, low K+, low Cl-
Fever, itchy. Face and trunk then spreads. Macular then papular then vesicular
Chicken pox
Prodrome, Koplik spots, rash starts behind ears then whole body. Discrete then becomes confluent
Measles
Fever, muscle pain. Parotitis (ear ache and pain on eating) unilateral then bilateral
Mumps
Face then body. Pink maculopapular. Facial lymphadenopathy
Rubella
Erythema infectiosum
Slapped cheek, Parvovirus B19, slapped cheek distribution spreads to proximal arms and extensors
GABHS, rash spares mouth, strawberry tongue
Scarlet fever
Coxsackie A16, vesicles in mouth and on palms and soles
Hand foot and mouth
Pulmonary hypoplasia can lead to
congenital diaphragmatic hernia
Fragile X head size
Larger than normal
Congential diaphragmatic tell tale sign on examination
Bowel signs on resp exam, intubate and ventilate
Most common causes of cyanotic heart disease
Tetralogy of fallot, transposition of the great arteries, tricuspid atresia
Acyanotic heart disease
VSD, ASD, PDA, Coarctation, AS
Turners syndrome heart sign
Ejection systolic as bicuspid aortic valve
Lithium overdose leads to which heart defect
Ebstein anomaly, atrialisation of right ventricle
APGAR
Pulse, Respiratory effort, colour, muscle tone, reflex irritability
Hypernatraemic dehydration
jittery movements increased muscle tone hyperreflexia convulsions drowsiness or coma
Abdo pain, draws knees up to chest, vomitting, blood in stool, sausage shaped mass RUQ
Intussusception (US Ix, target)
Cleft palate risk factors
Mothers benzo, antiepileptic, smoking or rubella. Childs trisomy 13, 15, 18
Fragile X
Neurodevelopmental delay, long face, protruding ears, recurrent ottitis media
Obesity in children
growth hormone deficiency hypothyroidism Down's syndrome Cushing's syndrome Prader-Willi syndrome
Jaundice but otherwise fine baby management
Urgent serum bilirubin
What injections at 2 months
6 in 1
Men B
PCV
What injections at 3 months
6 in 1
First line treatment in PPH (800ml) due to uterine atony
Uterine atony
When is croup most common
Autumn
Indications for CTG in labour
Suspected sepsis HTN >160/110 Oxytocin Significant meconium Fresh vaginal bleeding in labour
Triad of shaken baby syndrome
Retinal haemorrhages
Subdural haematoma
Encephalopathy
First sign of puberty in boys
Testicular growth. >4ml
First sign of puberty in girls
Breast development
What is the most common explanation for less variability and movements of a baby for less than 40 mins
Foetus is sleeping
Pregnant woman exposed to chickenpox who hasnt had it before
Varicella immunoglobulin
When is a nuccal down syndrome scan done
12 weeks
What happens at your booking appointment (before 12 weeks)
Booking visit
general information e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
BP, urine dipstick, check BMI
Booking bloods/urine
FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
hepatitis B, syphilis, rubella
HIV test is offered to all women
urine culture to detect asymptomatic bacteriuria
What can you do at 12 weeks
Downs screening
Scan to confirm dates and exclude multiple pregnancy
What happens at your 20 week appointment
Anomaly scan
If someone is a primip how is their scan storyline different
They get a 25 week scan
What happens at 28 week appointment
Routine care: BP, urine dipstick, SFH
Second screen for anaemia and atypical red cell alloantibodies. If Hb < 10.5 g/dl consider iron
First dose of anti-D prophylaxis to rhesus negative women
What happens at 34 week appointment
Routine care as above
Second dose of anti-D prophylaxis to rhesus negative women*
Information on labour and birth plan
What happens at 36 week appointment
Routine care as above
Check presentation - offer external cephalic version if indicated
Information on breast feeding, vitamin K, ‘baby-blues’
Diet advice for CF
High calorie, high fat, pancratic enzyme replacement for every meal
Gestational hypertension over 150/90 treatment
Oral labetalol
Describe transient synovitis child
Acute onset
Usually accompanies viral infections, but the child is well or has a mild fever
More common in boys, aged 2-12 years
Describe osteomyelitis child
Unwell child, high fever
Describe JIA child
Painless limp
Who gets developmental dysplasia of the hip
Girls, detected neonatally
What is perthes disease
Due to avascular necrosis of the femoral head
Describe slipped upper femoral epiphysis
10-15 years - Displacement of the femoral head epiphysis postero-inferiorly
What to do if a kid is getting nose bleeds
Short course of topical chlorhexidine and neomycin and discourage the child from picking his nose
High fever lasting >5 days, red palms with desquamation and strawberry tongue
Kawasaki disease
What if the person is under 13 having sex
They are unable to consent and you must break confidentiality
When should a baby smile
6-8 weeks
What disease is neonatal hypotonia associated with
Prader Willi (hypothyroidism, neonatal sepsis and spinal muscular atrophy)
Can haemophilia be passed male to male
No
Severe preeclampsia at 39 weeks management
IV labetalol, aim for diastolic 80-100mmhg
Asthma: on saba, nighttime symptoms and using more than 3 times a week =
Paediatric low dose inhaled corticosteroid
Medical management of an ectopic drug
Methotrexate
Can you accept gifts from patients
You should not accept substantial gifts from patients or gifts which could be seen to affect how you prescribe, treat or refer patients
COCP IMB and PCB
Cervical ectropian
Kawasaki disease
Echocardiogram to exclude coronary artery aneurysms
Ectopics in which place have an increased risk of rupture
Isthmus
What is the most common cause of respiratory distress in a newborn
Transient tachypnoea of the newborn
Methotrexate and trying for a baby
Both men and women should stop it for 6 months before trying for a baby
Painful bleeding in a pregnant lady
Placental abruption?
Painless bleeding in a pregnant lady
Placenta praevia?
What is a specific clinical sign in preeclampsia
Brisk tendon reflexes
Do children with downs syndrome snore
Yes
Which drugs cause hyponatraemia
SSRIs
Painless bleeding after 24 weeks
Placenta praevia
If a newborn has abnormal hearing test, which test are they offered
Auditory brainstem response test
A baby is born with micrognathia, low-set ears, rocker bottom feet and overlapping of fingers
Edwards syndrome (trisomy 18)
Microcephalic, small eyes
Cleft lip/palate
Polydactyly
Scalp lesions
Patau (trisomy 13)
Learning difficulties Macrocephaly Long face Large ears Macro-orchidism
Fragile X
Webbed neck
Pectus excavatum
Short stature
Pulmonary stenosis
Noonan syndrome
Hypotonia
Hypogonadism
Obesity
Prader willi syndrome
What does a bishops score under 5 suggest
Labour wont happen without induction (needs vaginal prostaglandin)
Risk factors for placenta praevia
ivf
Multiparity
Previous pregnancies
HTN before 20 weeks
Chronic hypertension
HTN after 20 weeks
Preeclampsia
Easiest way to visualise pyloric stenosis
Abdominal ultrasound
How long should a child be drowsy for after a simple febrile seizure
1 hour
Clang associations
Words/ trails of thought are linked together by rhymes or similar sounding words
Neologism
Patient makes up a word or uses a word incorrectly
Echolalia
Patient repeats words or phrases of the person they are talking to
Aphasic speech
Patient loses the ability to form language
Where to check pulse in an under 1
Brachial and femoral
Where to check pulse in an over 1
Carotid and femoral
What drugs can cause benign leucocytosis (benignly raised WBC)
Lithium, corticosteroids and beta blockers
Age play near other children
2 years old
Age play with other children
4 years old
Treatment of uterine atony
IV oxytocin and or ergometrine
then carboprost
Zopiclone
Increased risk of falls
Folic acid doses
Normally 400mg, 5milligrams if reasons
Who can make decisions for a child without capacity
when a child lacks capacity, consent from one parent is sufficient to administer treatment as long as it is in the best interests of the child
Does absence of bleeding rule out placental abruption
No
First step in neonatal resuscitation
Dry the baby
What at birth can lead to increased bilirubin levels
Bruising
Whats the difference between schizoid and schizotypal personality disorders
Schizoid has negative symptoms, no delusions
Schizotypal has positive symptoms, odd thoughts not psychotic but odd
Treatment and a risk factor for transient tachypnoea of the newborn
Observation
C section a risk factor
What follow up does a breech baby need
USS for Developmental dysplasia of the hips at 6 weeks
Treatment of hand food and mouth disease
Symptomatic only
Whats the first line new born hearing test
automated otoacoustic emissions test
Whats the second line new born hearing test
automated auditory brainstem response test
Heel prick test for CF, whats tested
Immunoreactive tripsinogen
What depot can be given of antipsychotic
Olanzapine
Most common ovarian cancer
Serous carcinoma
Chocolate cysts
Endometriotic cysts
Simple cysts aka
Follicular cysts
Progressive loss of fine motor control
Degenerative cervical myelopathy
Whats the proper name for frozen shoulder
Adhesive capsulitis
What do you call a stroke that only causes either motor or sensory/ specific symptoms
Lacunar stroke
Can you do surgery on a child without consent
If it is emergency
What is indirect coombs test
Looks for autoimmune haemolytic anaemia
What is direct coombs test
Done antenatally to test for antibodies which could pass to baby
Should you give antiD after an ectopic is managed surgically
Yes
Which heart defect do fragile x kids get
Mitral valve prolapse
Describe fragile x face
Big everything: enlarged mandible, long face, low set ears
What is most common complication of measles
Ottitis media
When do people get neuroleptic malignant syndrome
As soon as they are started on medication
Sinusitis, fever and focal neurology
Brain abscess
What can precipitate a myasthenic crises
Beta blockers
Times you can break confidentiality
Required by law With consent In the public interest To protect the patient To protect others
Atypical endometrial hyperplasia postmenopausal
Total hysterectomy with bilateral salpingo oophrectomy
Biconvex shape on imaging
Extradural haematoma
Convex shape on imaging
Subdural, old people have glasses
Definition of a TIA
Transient and reversible episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia without acute infarction
When should a chickenpox kid go back to school
When the lesions have crusted over
Who should tell the DVLA if the patient has dementia and cant
You should
Preterm PROM, maternal and fetal tachycardia and maternal pyrexia
Chorioamniotiis
Which diet for epilepsy
Ketogenic
What type of drug is pyridostigmine
Long acting acetylcholinesterase inhibitor
How to investigate post menopausal bleeding
TVUSS then pipelle biopsy then hysteroscopy with biopsy
Vomiting causes what electolyte changes
Hypokalaemic, hypocholoric metabolic alkalosis
Urge incontinence first line
Bladder retraining
Stress incontinence first line
Pelvic floor exercises
Endometriosis symptoms
Pelvic pain, dysmenorrhoea, dyspareunia and subfertility
Symptoms of sexual abuse
Anal fissures and recurrent UTIs
Continous blowing noise below the clavicles
Venous hum
Strep B infection management
Intrapartum antibiotics
Most common type of MS
Relapsing and remitting
How to undo a psychotic psychotic induced EPS
Procyclidine
Billious vomiting
Intussusception
?ovarian cancer
CA125 and US
Vertigo, hearing loss, tinnitus and absent corneal reflex
Acoustic neuroma- vestibular schawnnoma
