Passmed :0 Flashcards
1
Q
estational diabeties test results and treatment plNS
A
fasting plasma glucose of <7 needs a trial of diet and excercise. if this doesn twork fr 2 week start metformin
> 7 start insulin immediatly
2
Q
perthes disease key presentaion and what is it
A
avasucalr necrosis of teh femoral head. 5x more common in boys
presents with progressive hip pain, limo and stiffness
3
Q
how long do teh different contraceptives take to become effective
A
Contraceptives - time until effective (if not first day period):
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS
4
Q
PCOS medication and treatment
A
For endometrial canre- IUS or COCP
for infertiloty:
Clomifene - increases chace of ocultion
Laparoscopic ovarian drilling
In vitro fertilisation (IVF)
spiranalactone to block angrogen conversion!!!
5
Q
menopaue ages and contraceptons
A
menopause - 12 months after no period
perimonopause - teh sime surrounding menopasue tat leds to smptoms
normal is over 45
FSH test neeed in women under 40 - this is premature
contracetio needed 1 years after menopause in over 50 and 2 years for under 50
6
Q
what is teh apgar scoring process
A
Appearance
Pulse
Grimace
Activity
Respiratory
7
Q
alchollwthdwarl sezzures onset tmes
A
symptos - 6-12 hours
sezures 36 hours
delerum tremens 72 hours
8
Q
treatment for stress and urge ncontnance
A
stress - pelvc floor excercses
urge - bladder retranng nd then oxybutynn (antmuscnarc)
9
Q
deine and name a tocolytc and one tme you may use it
A
reduces contracions
terbutalne
umblcal cord prolapse
10
Q
lst DOACs and LMWH
A
DOAC:
rvoroxban
apxaban
edoxban
LMWH:
daltaparn
enozaparn
tnzaparn
11
Q
whats fluid bolus is given in diabeties
A
Start IV fluid resuscitation in children or young people with a bolus of 10 ml/kg over less than 10 minutes
12
Q
what are teh dfferent types of psorass
A
- Plaque - most common from in adults
- Guttate - small raised papules, most commn in children and is triggerd by strep throat infection, stress or medication. Resolve in 3-4 months
- Pustular - pustules form under erythematous skin, medicla emergany
Erythrodermic - the skin comes away coepleyelt - admit emergancy
13
Q
what are the 2 signs of porass
A
- Auspitz sign- small point of bleeding when the plaueq is scraped off
- Koebner phenomenon - psoriatic lesions in area of skin affected by trauma
Residual pigmentation of eth skin once the lesion resolves
14
Q
what s teh sterod ladder names
A
Steroid ladder:
* Hydrocortisone (1)
* Eumavate (2.5)
* Betnovate (10)
Dermavate (50)
15
Q
blood marer for rheumatod arthertis
A
ant CCP - ant cyclc ctrullnated peptde
16
Q
extra astro features of chrons
A
fnger clubbng
erythema nodosum
pyoderma ganerenosm
epsclerts
nflamatry artherts
17
Q
remsson and mantndanct for UC and chrons
A
chronns - oral pred or IV hydrocortisone then zathioprine
UC - msalazine ot sulfasalazine
18
Q
When should maternal steroids be given
A
between 24-35 weeks
19
Q
what what pont whould lochia get an ultrasond
A
6 weeks
20
Q
medcal treatment for stress adn urge ncontance
A
urge:
bladder retrangn
Anticholinergic medication: for example, oxybutynin, tolterodine and solifenacin
Mirabegron (a beta-3 agonist) has no antcholngergc afects.
Stress:
pelvc floor excercse
Duloxetine is the agent of choice for stress incontinence.
21
Q
what s teh SSRi of choce n those wth recent myocardal nfarcaton
A
Sertralne
22
Q
when should an ectopc be managed surgcally
A
All ectopic pregnancies >35 mm in size or with a serum B-hCG >5,000IU/L should be managed surgically
or heartbeat presatn
heamodynamcally unstable
23
Q
wbat s frst lne SSR n chldren and young people
A
Fluoxetne
24
Q
what are teh red nce guodlines
A
blue
not responding or doesnt wake
grunting
tachyopnea >60
chest indrawing
reduced skin turgour
age <3 with temp >38
non blanching rash
bulgign fontanelle
neck stiffness
status epilepticus
focal neurological signs
focal seizures
25
risk factors for PPH
Previous PPH
Multiple pregnancy
Obesity
Large baby
Failure to progress in the second stage of labour
Prolonged third stage
Pre-eclampsia
Placenta accreta
Retained placenta
Instrumental delivery
General anaesthesia
Episiotomy or perineal tear
26
what are teh the mechanical and surgical treatment for PPH
Mechanical treatment options involve:
Rubbing the uterus through the abdomen to stimulates a uterine contraction (referred to as “rubbing up the fundus”)
Catheterisation (bladder distention prevents uterus contractions)
Intrauterine balloon tamponade – inserting an inflatable balloon into the uterus to press against the bleeding
B-Lynch suture – putting a suture around the uterus to compress it
Uterine artery ligation – ligation of one or more of the arteries supplying the uterus to reduce the blood flow
Hysterectomy is the “last resort” but will stop the bleeding and may save the woman’s life
27
medcnla management of PPH
Oxytocin (slow injection followed by continuous infusion)
Ergometrine (intravenous or intramuscular) stimulates smooth muscle contraction (contraindicated in hypertension)
Carboprost (intramuscular) is a prostaglandin analogue and stimulates uterine contraction (caution in asthma)
Misoprostol (sublingual) is also a prostaglandin analogue and stimulates uterine contraction
Tranexamic acid (intravenous) is an antifibrinolytic that reduces bleedi
28
defne antepartm and postpartum heammorage
a - bleedng from the gental tract after teh 24th wee of pregnancy
p - greater than 500 mls blood loss from teh gental tract (1000 s c sectons)
(wthn 24 hours fr prmar y and 12 wees for secondary)
29
what is HELLP syndroem
complication of preeclampsia
Heamolysis
Elevated Liver enzymes
Low Platelets
30
what are the timmings for alcoho withdawsl
6-12 - tremor, sweating, headache, craving, anxuety
12-24- hallucinaions
24-48 - seizures
24-72 - delerium tremenes
31
what crusttams mae up gout and dney stones
gout - monosodum urate
S - calcum oxelate
32
what bloods are taen at a a pregancy boong appontment
blood group and rhesus d status
FBC - for anaeam
screenn for thalaseama (some women also screended for scle cell dsease)
HV
hepatts B
syphylss
33
colposcopy stans
acetc acd and iodene
acetic acid makes teh cells white
then add iodene and the healthy ones will turn brown
punch biopsy or large loop excision of teh ransformational zone
34
what cervcal cancer type causes
squamous cell
adenoarcnoma
35
what are the gudlnes for smear testng tmeframes
25-49 every 3 years
50-64 evey 5 years
f nadequate seample - repeast after 3 months
HPV postve and abnormal cytology- refer for colposcpy
HPV potetve - repeat HPV after 12 months
- if after 12 months HPV s negatve return to normal screening
- if after 12 onths its posirive and cytology normla screen again in 12 months
- once at 24 months if its still potiivet refer to colposcopy
36
treatment of aacute dystona
procycldnie
37
treatment of tardve dyskinesia
tetrabenzine
38
treatment of akathia
propanalol
39
what medicaton for meningitis in under 3 months and over 3 months
under - cefotaxime
over - cefriaxone
40
presentation of compartement syndreom
* Pain
* Paresthesia
* Pale
* Pressur e
* Paralysis
Pain is out of proportion with the injury!!!!!
41
what s the koebner phenomenon
when there id damage to the skin adn after its healed a psoriatic plaque forms ontop
42
treatement for gout
initial - allopurinol + colchaine for 4 weeks
then allopurinol and diet changes
43
prophyacis for menieres
betahistine
44
define and list causes of multiple miscarrage
>3 miscarrges
SLE
antiphospholypid syndrome
diabtties
thyroid issues - especialy high TSH
malformed uters - unicornate, bicornate
fibroids
PCOS
chromosoal abnormalaties
45
how to wor out GCS
eyes -
4 - alert
3- respone to speech
2 - pain
speech
5 - oriantated
4 - confused
3 - inaproptiate
2- incomprehensible
Movemnt
6 - obeys comans
5 - moves to pain
4- withdraws from pain
3 - abnorml felxtion
2 - abnormla extention
46
what is lhermitts sign
ms
electric shock on felxtio of neck
47
what is the treatment for personality disorders
dialectical behaviour therapy
48
stroke in basialr artery
locked in sndroem
49
middle cereberal artery stroke
contralateral hemipareseis and sensorhy loss
homynous hemianopia
50
posterior cereberal artery
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
51
webbers syndrome
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
52
wallenburgs syndrome
ipsilater fiacila paib and temp loss
contralateral limb and tors pain and temp loss , ataxia and nystagmus
- decussates in the medula??
53
classification of stroke
oxford -
54
triad of shaken babay
encephalopathy
subdural heamatom a
retinal heamoorage
55
brain scan of acute and chronic subdural heamoatoma
chonic - hypodense
acute - hyperdense
56
treatment for chornic subdural heamatoma
decompression with burr holes
57
treatment of extradual hemoatoma
observation
craniotomy and evaculation
58
medications for palliative care
analegesia - morphine sulphate
antiemetic - haloperidol
anxiotyliti - midazolam
antisecretory - hyoscien butylbromide
59
heart faliure calssifications
new york heart assocaition classifiaction
1 - normal
2 - symtpms on acitiity
3 - symotoms with eerything
4 symptoms at rest -
60
what dugs cause idopathc ntracranal hypertenton
combined oral contraceptive pill
steroids
tetracyclines
retinoids (isotretinoin, tretinoin) / vitamin A
lithium
61
Antemetcs n chemo
For patients at low-risk of symptoms then drugs such as metoclopramide may be used first-line. For high-risk patients then 5HT3 receptor antagonists such as ondansetron are often effective, especially if combined with dexamethasone
62
anti emetics for hypermesis gravidum
1. cycclzine or promethazine
2 chlorpromazine
3. ondansetron
4. metoclopramide
63
what medication is given in subarachnodi heamorage
nimodipine
64
where is teh damae nomally with an extradural heamorage
pterion - frontal, temoporal, pariatal and sphenoid
65
what are teh signs for meningitis
kernigs - knee externtion form 90 degrees causes pain
brudinski - neck felxtion causes knee flextion
66
what medicationi for idiphatic intrecranial hyperentison
acetazolamide - carbonc anhydrase inhibitor
67
68
gllick competancfraser guidelines
UPSII
understand the conseauences,
paretns - encourage to tell them
Suffer if you dont [rescribe
Intercourse anyway
Interes - best interests of eth child
69
testing for down syndrome
Combined test - betweenn 11-13+6 weeks
HCG up
pregancy associated plasma protien down
Nuchal translucnecy - increased
if beyong this gestation offer teh quadruple test
HCG up
Inhibin A up
AFP donw
uncinjugated oestriol down
70
quadruple test results for downs, edwads and neural tube defect
DOWNS:
HCG, inibin A up
AFP
unconjucages oestriol down
HCG, AFP, oestiol down
inhibin a normal
NT:
AFP up
all rest normla
71
what s the bran scan and resulrs for parnsons
DAT scan - atropgy of teh basal gangla - dots nto commas
72
what are etn frstran symsotms of sczphrena
auftory hallucnnatons
passvty phenomenn
thought dsorder
delusotnal perceptonn
73
neagtove symtpms of schozp[hrena
incongruity/blunting of affect
anhedonia (inability to derive pleasure)
alogia (poverty of speech)
avolition (poor motivation)
social withdrawal
74
nactvated vaccne
Inactivated virus
Killed version of the pathogen
* Polio
* Flu
* Heppatitis A
* Rabies
75
subunt and conjugated vaccne
Subunit and conjucaged
Only the part of the orgausm used to stimulate an immue respone hence are safe for imunocompramised patients
* Pneimococcus
* Meningiococcus
* Hep B
* H influenzae B
* HPV
* Herpes-zoster (shingles)
76
lve attunated vaccne
Lve attenuated vaccines
Weakened live pathogen
* MMR
* BCG
* Chicempox
* Nasal influenza
* Rotavirus
77
toxn vaccne
Toxin vaccines
Cause immunity to the txin and not the pathogen
* Diptheria
* Tetnus
78
wbat are teh bases taht affect screenng programs
length tome - slower growng cancer are more lely to be pced up so peole beeb taht thye have a better prognss due to screengn bt just becasue ther dsease s lessa greessve
lead tme bas - screegng can pc up non curabe dsease earler whch gves the mpressron taht pepe ahev survved longer form dsase todeath but really they were just dagnosed earler - for examoe n dementa.
79
80
what are the tests for syphls
non treponemal - not specfc for symphylss may result n false postve (rapid plasma reagin and venereal dsease rearch laboratory)
trepnoemal - specffc for syphyls - TP enzyme inmunoassay
81
what bactera csues syphylss
treponema palldum
82
what are the symptoms and stges of syphlss
ncubaton of 9-90 days
prmary - chancre (panless lesons at sght of contact) local nn tender lymphadenopathy
secondary - 6-10 wees after nfecton
fever lymphadenopath
rash on plams tun and soles
buccal snal trac ulcers
panless warty lesons on gental- condylomata lata
terray -
gummas
ascendng aortc lesosn
general paralyss
neurosyphyluss - (argyll robertson pupl -accomedates but does react prottutes pupl)
83
treatment for syphls
deep im njecton of bezathne benzylpeniciillin
84
unweel after syphls antbotcs cuases
Within 24 hours after antibiotic treatment of the spirochetal infections syphilis, Lyme disease, leptospirosis, and relapsing fever (RF), patients experience shaking chills, a rise in temperature, and intensification of skin rashes known as the Jarisch–Herxheimer reaction (JHR) with symptoms resolving a few hours late
85
breast cancer screenng age groups
mamogram every 3 years 50-70
hgh ris every year from 30
frst dgreerealev under 40
frst degree male reltov e
frs degree wth blateral under 50
2 frst degree relatves wth be
86
what s the fever pan score n tonsllts
* Fever pain score - . A score of 2 – 3 gives a 34 – 40% probability, and 4 – 5 gives a 62 – 65% probability of bacterial tonsillitis:
* Fever during previous 24 hours
* P – Purulence (pus on tonsils)
* A – Attended within 3 days of the onset of symptoms
* I – Inflamed tonsils (severely inflamed)
N – No cough or coryza
87
endometrosis on examination findings
reduced organ mobility
tender nodularity of posterr vaginal fornix
visible vaginal endoetriotic lesisons
88
uterine and non utierne symptoms of endometriosis
uterine - chronic pelciv pain - yclical
deep sydparanuria
subfertility
non uterine -
dysuria
heamaturia
frequancy
dyschezia - painful bowel movements
89
invasive options for urge and stress incontinance
urge:
Botulinum toxin type A injection into the bladder wall
Percutaneous sacral nerve stimulation involves implanting a device in the back that stimulates the sacral nerves
Augmentation cystoplasty involves using bowel tissue to enlarge the bladder
Urinary diversion involves redirecting urinary flow to a urostomy on the abdomen
stress:
Tension-free vaginal tape (TVT) procedures involve a mesh sling looped under the urethra and up behind the pubic symphysis to the abdominal wall. This supports the urethra, reducing stress incontinence.
Autologous sling procedures work similarly to TVT procedures but a strip of fascia from the patient’s abdominal wall is used rather than tape
Colposuspension involves stitches connecting the anterior vaginal wall and the pubic symphysis, around the urethra, pulling the vaginal wall forwards and adding support to the urethra
Intramural urethral bulking involves injections around the urethra to reduce the diameter and add support
90
surgical management of prolapse
Surgical options
cystocele/cystourethrocele: anterior colporrhaphy, colposuspension
uterine prolapse: hysterectomy, sacrohysteropexy
rectocele: posterior colporrhaphy
91
what are ten cervcla screengn age bracets
Every three years aged 25 – 49
Every five years aged 50 – 64
92
93
what antobiotics for PROM
erythromucin
penecillin second lie
94
normal feotal blood ph and reassuong sign son a CTG
7.25
no deceleration
HR 110-160
varaibaility of grather thna 5 per min
prescen of accelerations
#
95
which leg is more lickey to ge DVT in pregnacu
left - illiac vien crosses ethe illiac artery causing compressions
96
what to check when givbing mgso4
reflexes
97
