passmed Flashcards
SHORT STATURE AND AMEONNORHEA”?
TURNERS
FSH AND LH levels in amenorrhea
both will be raised
Menorrhagia, anaemia, bulk-related symptoms e.g. bloating/urinary frequency?
uterine fibroids
cocp are ci with ?
migraines with aura
how to differentiate between endometriosis and fibroids
endo pain is cyclical - ie before and during period
fibroids can be all the time and more likely to feel a palpable mass
typical history of ectopic pregnancy patient
female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding
Shoulder tip pain and cervical excitation may be seen
typical history of UTI patient
Dysuria and frequency are common but women may experience suprapubic burning secondary to cystitis
typical history of PID patient
Pelvic pain, fever, deep dyspareunia, vaginal discharge, dysuria and menstrual irregularities may occur
Cervical excitation may be found on examination
typical history of ovarian torsion patient
Usually sudden onset unilateral lower abdominal pain. Onset may coincide with exercise.
Nausea and vomiting are common
Unilateral, tender adnexal mass on examination
typical history of patient with miscarriage
vaginal bleeding and crampy lower abdominal pain following a period of amenorrhoe
Chronic pelvic pain
Dysmenorrhoea - pain often starts days before bleeding
Deep dyspareunia
Subfertility
?
endometriosis
typical history of patient with ovarian cyst
Unilateral dull ache which may be intermittent or only occur during intercourse. Torsion or rupture may lead to severe abdominal pain
Large cysts may cause abdominal swelling or pressure effects on the bladder
most common side effect of progesterone only pill
irregular vaginal bleeding
why is the cocp CI in post natal women
in women whoa re breastfeeding increased DVT risk in 6-8 weeks
Stereotypical PCOS results
raised LH:FSH ratio
testosterone may be normal or mildly elevated
SHBG is normal to low
what happens with mirena coil
initially irregular bleeding followed by light menses or amenorrhea
what is first line drug for infertility in PCOS
clomifine
what is a common cause of recurrent first trimester miscarriage
anti phospholipid syndrome
PCOS should be diagnosed if 2/3 of the following criteria are present:
-infrequent or no ovulation (thus oligomenorrhoea is the correct answer in this scenario)
-Clinical or biochemical signs of hyperandrogenism or elevated levels of total or free testosterone (no mention of ‘low levels of oestrogen’)
-Polycystic ovaries on ultrasonography or increased ovarian volume
what is androgen insensitivity
genetically XY but are phenotypically female due to reduced/absent testosterone receptors in target tissues.
features of androgen insensitivity
‘primary amenorrhoea’
undescended testes causing groin swellings
breast development may occur as a result of conversion of testosterone to oestradiol
management of androgen insensitivity
counselling - raise child as female
bilateral orchidectomy (increased risk of testicular cancer due to undescended testes)
oestrogen therapy
how to diagnose androgen insensitivity
buccal smear or chromosomal analysis to reveal 46XY genotype
effects of the COCP on cancer
increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer
two differentiating factors of levy body dementia
fluctuating cognition
hallucinations
Urinary incontinence + gait abnormality + dementia
normal pressure hydrocephalus
motor neuron disease is associated with that type of dementia
front-temporal
how would progressive supra nuclear palsy present
postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction
what group of medications to avoid in Lewy body dementia and why
neuroleptics
such as haloperidol as it may cause irreversible Parkinsonism
secondary stroke management for pt with af?
aspirin for 2 weeks then life long anti coagulant
SE of mirtazipine
increased appetite
Obese, young female with headaches / blurred vision?
idiopathic intracranial htn
what virus is croup
parainfluenza
Ipsilateral oculomotor palsy and contralateral weakness of the upper and lower extremity
left posterior cerebral artery
Headaches, amenorrhoea, visual field defects
prolactinoma
Posterior inferior cerebellar artery stroke would present as?
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
basilar artery stroke?
locked in syndrome
amaurosis fugal stroke ?
retinal / ophthalmic artery
ipsilateral - same side
curtain coming down
similarities and differences between PICA and AICA
Ataxia, nystagmus
Pain and temperature loss: ipsilateral for face (trochlear nerve), contralateral for limbs (spinothalamic tract)
BOTH HAVE^^
AICA ONLY –Deafness
Facial paralysis (branches can compress the facial nerve)
FIRST LINE TX for croup
oral dexamethasone
coco increases risk of what cancer
cervical
breast
webers presentation ?
down and out
ipsilateral
Fluctuating consciencousness, behaving out of character, confusion would indicate what type of haemorrhage
subdural
long term side effect od levodopa
at peak dose it can cause chorea, dystonia after pt has been taking it for a few years
Middle-aged, personality changes, involuntary movements?
huntingtons
a headache linked to valsalva manouverus would indicate ?
raised ICP so a lumbar puncture would be CI
what class of medication can lead to medication overuse headache
opioids such as co cocodamol
what class of medications are mostly linked to behaviour changes for patients with Parkinson’s
dopamine receptor agonists such as ropinorole
what medication for bipolar can cause , diminished tendon reflexes excess thirst, feeling cold, and weight loss
lithium
when are seri’s contraindicated for patient with depression
if patient is on warfarin
manic episodes
ischaemic heart disease
what ssris are safe to use during breastfeeding
sertraline
paroxetine
first rank symptoms of schizophrenia
auditory hallucinations
delusional disorder
thought disorders, broadcasting insertion
passivity phenomena
how can we differentiate between posterior circulation stroke and vestibular neuronotis
HinTS exam
is hearing loss in Menderes unilateral or bilateral
unilateral
will also causie tinnitus
at what bmi does the use of coco outweighs the benefits
bmi over 35
what medication is used in Menieres to prevent attacks
betahistine
viral labrynthitis typical history ?
recently developed an upper respiratory tract infection presents with vertigo and vomiting. Hearing is also affected. The symptoms came on suddenly
horizontal nystagmus
a patient has a feeling of ‘fullness’ and ‘pressure’ in ears what does this indicate
menieres disease
low calcium low phosphate and bone pain and raised alp think ??
OSTEOMALACIA
what biochemistry would pagets show
raised alp
normal ca and phosphate
what symptom of croup would make you want to admit a child to hospital ?
stridor at rest
why should you not examine the throat in croup
if stridor is found it can cause further airway obstruction
most common cause of stridor in children
laryngomalacia
if mycoplasma pneumonia is found what abx would you give to a child ?
erythromycin
what is a common side effect of saba
tremor
what would constitute life threatening asthma
bradycardia
dysrhythmia
hypotension
92% or lower
silent chest
what would constitute severe asthma
can’t complete sentences
rr>25/min
PEFR 33-50
non resp related features of cystic fibrosis
short stature
dm
delayed puberty
rectal prolapse
nasal polyps
male infertility
drug contraindications for asthma
beta blockers
adenosine
what is the target o2 sat in acute asthma
94-98
acute epiglottis is caused by what /
Haemophillis influenzai b
next steps for adult suspected asthma after presenting at gp
fractional exhaled nitric oxide + spirometry/bronchodilator reversibility test
strongest risk factor for developing a bells palsy?
pregnancy
who should be given ipratropium bromide
patients with severe or life threatening asthma , or in patients who have not responded to beta agonist and corticosteroid treatment
a normal pco2 of a patient with an asthma attack would indicate ?
life threatening as it is a sign of tiring respiratory effort as the high rr driven by hypoxia should result in a low pco2
what is the adult criteria to be met for asthma
- exhaled Reno of 40 parts per billion
-post bronchodilator improvement of more than 200ml
-post - bronchodilator improvement in FEV1 of 12 % or more
-
what monoclonal antibody is used to prevent babies from getting rsv
palivizumab
what is eczema herpeticum described as
monomorphic punched out erosions usually 1-3cm in diameter
difference of distribution of eczema rash of infants and older children
infants- extensor surfaces knees and elbows
older- elbow crease, knee crease , face and neck creases
how does seborrhoea dermatitis present in infants
greasy, yellow rash with flaky scales most common on scalp
Oral ulcers + genital ulcers + anterior uveitis
Behcets
first line medication for mild urticaria w sleep sx
chlorophenamine
severe or resistant urticaria you would give ?
oral prednisolone
how would erytheme multiforme present
giant non itchy target lesions
target lesions- dark centre with a blister, a ring around this that is pale pinkand raised with bright red outermost ring
what drugs commonly cause urticria
aspirin
penicllin
nsaids
opiates
how would lichen sclerosus present
itchy white patches on genitals
intense itching
thinning of vulvar skin
first line tx for mild urticaria
non sedating anti histamine like loratadine
what is nikolsly sign positive
blisters and erosions on gently rubbing the skin
what is pompholyx eczema characterised by
acute eruptions of deep seated vesicles in the palms and fingers
what is the main side effect of using topical decongestants for prolonger periods
tachyophylaxis
patients feel that their eyes are gritty and sometimes stick in the morning, what is this?
blepharitis
what are the first rank symptoms of schizophrenia
passivity phenomena
thought disorders
delusional perceptions
3rd person auditory hallucinations
how to differentiate acute stress disorder vs PTSD
Acute stress - first 4 weeks sx
ptsd- after 4 weeks
what should patients be warned about before taking pregablin
increased risk of suicidal thinking and self harm
weekly follow up is recommended for the first month
define obsession
intrusive, unpleasant and unwanted thought
body dysmorphia ocd medication
fluoxetine
define compulsion
senseless action taken to reduce the anxiety caused by the obsession
if first line SSRI is ineffttive in GAD what is second line
duloxetine or
If patient w ocd feels better with sertraline and wants to stop what is the guideline
to continue for 12 months
what part of the brain is involved in the flight or fight response
amygdala
what is the system to assess pressure sores
Waterlow score
when can orthostatic htn be diagnosed
after lying standing bp if the systolic drops below 20mmhg or more
a drop to below 90 even if less than 20
first line management for alzheimers
donepzil
acetylcholinesterase inhibitor
what medication/s are CI in patients with parkinsins
haloperidol
what is commonly prescribed when patients are in an acute confusional state and become aggressive
haloperidol
if Parkinson’s then lorazepam
typical history of a myasthenia graves patient
40yr old woman with muscle weakness, affecting her legs , double vision but better with rest
management of myasthenic crisis?
iv immunoglobulin + plasmapharesis
what is polymyositis
inflammatory disorder causing symmetrical proximal muscle weakness
associated with malignancy
features of polymyositis
-proximal muscle weakness +/- tenderness
-raynauds
- rest weakness (COPD hx)
what would investigations show
increased CK
AST AND ALT may also be raised
what is Lambert eaton syndrome
in association with small cell lung cancer
limb girdle weakness
What are the features of anorexia
Reduced bmi
Bradycardia
Hypotension
Enlarged salivary glands
Physiological abnormalities of anorexia ?
Hypokalaemia
Low fsh lh oestrogens testosterone
Raised cortisol and growth hormone
Impaired glucose tolerance
Low t3
bullimia vs binge eating disorder ?
bullimia = binge eating followed by compensatory mechanisms , vomitting, laxatives
binge eating = binge but no compensation
first line tx for anorexia?
anorexia focused family therapy
what are the indications for surgical management of ectopic pregnancy
- ruptured ectopic
-signs of infection ie fever - fatal heartbeat on uss
-significant pain
>35mm mass
-hcg above 5000
expectant management of ectopic is used if ?
-unruptured embryo
- <35mm in size
- no heartbeat
- asymptomatic
- hcg <1000
first line medical management of ectopic
methotrexate
when should salpingostomy be used instead of salpingectomy in ectopic ?
when woman has risk factors for tube damage such as PID
How will a threatened miscarriage present
painless vaginal bleeding and closed cervical os
management for incomplete miscarriage
single dose misoprostol
If bishop score is above 8 what is the management
Cervix is ripe or favourable , high chance of spontaneous labour
If bishop score is above 8 what is the management
Cervix is ripe or favourable , high chance of spontaneous labour
Management if bishop score is below 6
Vaginal prostaglandin or oral misoprostol
First line investigation for PROM
Sterile speculum examination
Main complication of induction of Labour ?
Uterine hyper stimulation
is respiratory depression occurs in pregnancy with mag sulph what would you give
calcium gluconate
what position would woman be in for mcroberts manouvere
supine with both hips fully flexed and abducted
correct position for women who have cord prolapse?
all four
knees and elbows
how long should magsulphate be given for eclampsia
24 hours after delivery/ last seizure
first line medication for eclampsia
labetalol
main features of encephalitis
fever headache psychiatric symptoms seizures vomitting aphasia
where does encephalitis typically affect
temporal and inferior frontal lobes
what are the contraindications of a lumbar puncture
focal neurological signs
papilloedema
significant bulging of the fontanelle
disseminated intravascular coagulation
signs of cerebral herniation
what is the most common complication of meningitis
sensorineural hearing loss
how would you differentiate between meningitis rash and meninigoccal septicaemia rash
meningitis- non blanching rash
meningococcal- purpuric rash - more purple and black
what do you give close contacts of someone infected with meningitis
oral ciprofloxacin
what is a life threatening effects of clozapine
agranulocytosis need to monitor FBC
drug used for patients with alcohol withdrawal ?
chlorodiazepoxide
what test results would you expect t o find in downs syndrome
increase in bHCG
decrease in PaPPA
Thick nuchal translucency
what are the clinical features of downs ?
face: upslanting palpebral fissures, epicanthic folds, Brushfield spots in iris, protruding tongue, small low-set ears, round/flat face
flat occiput
single palmar crease, pronounced ‘sandal gap’ between big and first toe
hypotonia
congenital heart defects (40-50%, see below)
duodenal atresia
Hirschsprung’s disease
weak femoral pulses on a baby in a 6 week check would make you think ?
coarctation of the aorta
use of indomethacin and prostaglinds post birth for neonates is used for what purpose ?
indomethacin- inhibits prostaglandins so will shut things
prostalgandins- to keep things open until corrective surgery can be performed
left subclavicular thrill, a heaving apex beat, and a continuous ‘machinery like’ murmur?
patent ductus arteriosus
what murmur do you hear in tetralogy of fallout?
ejection systolic murmur
lack of milk production and amenorrhea post birth would indicate ?
Sheehans syndrome
ischaemic necrosis of the pititutary gland
first line surgical management for pph
intrauterine balloon tamponade
alternative to oxybutinin in frail old women with dementia ?
meragabnon
what medication is used to treat alcohol addiction that causes them to violently vomit
disulfiram
what drug is used for anti craving in alcohol
acamprostate
what medication commonly caused serotonin syndrome
tramadol
what can cause necrotising fasciitis in pt with chicken pox
beta- haemolytic group a streptococcus
what is an indication for high dose aspirin in childrn
Kawasaki disease
elderly patient with unilateral rash that is macular then vesicular and also painful ?
shingles
where can shingles be reactivated
dorsal root ganglion
cranial nerve ganglion
what form of contraception is completely CI in breastfeeding women
COcP
UKMEC4 for cocp
-more than 35 years old and -smoking more than 15 cigarettes/day
-migraine with aura
-history of thromboembolic -disease or thrombogenic -mutation
-history of stroke or –ischaemic heart disease
-breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
contraceptives and their time until effectiveness ?
IUD- instant
POP- 2 days
COC, IUS,Injection, implant - 7 days
what contraception is safe in breastfeeding women
progesterone only pill
which form of contraception has a proven link to weight gain
depo injection
what is the guideline regarding going back to school with Scarlett fever
can return 24 hrs after the first dose of ABX which is oral penicillin
most common complaint in crohns, adult vs child
adult = bloody diarhhoea
child= abdominal pain
first Line medication for spasticity in multiple sclerosis
gabapentin
baclofen
typical MS history
30-40 YO woman with visual issues, tingling, relapsing and remitting
typical history of child w intusuccesption
inconsolable crying child, currant / red stools/ knees to chest , billions vomitting
first line management of hirschprungs
bowel irrigation/ wash out
A 6-week-old baby boy presents with ‘projectle’ vomiting 30 minutes after feeding. On examination he is mildy dehydrated and has a small palpable mass in the upper abdomen is a stereotypical history of
pyloric stenosis
necrotising enterocolitis typical history ?
1 week old with feeding intolerance , dark urine and pale stools
x ray shows gas cysts/ bubbles
a patient comes into the ER with acute chest pain, fever, dyspnoea and cough with px admission of joint pains what are you thinking
sickle cell crisis
long term management of sickle cell
hydroxyurea - increases hbf levels
Isolated rise in GGT in the context of a macrocytic anaemia should suggest
alcohol excess
blood film for megaloblastic anaemia would show ?
hyper - segmented neutrophil polymorphs
psych patient believes they are dead what is this phenomenon
cotard syndrome
psych patient repeating questions back to you
echolalia
capgras syndrome
irrational delusion of misidentification where patients believe that a relative has been replaced by an identical imposter
Charles bonnet syndrome?
patients with significant vision loss have vivid, often recurrent visual hallucinations
endocrine disorder linked to chronic lithium toxicity
hypothyroidism
what SSRI is most likely to lead to qt prolongation
citalopram
how long should antidepressants be taken once patients wants to stop
6 months
what examinations must you do before starting lithium
ecg- prolongeg QT syndrome
U and E
TFT
what are some effects of lithium toxicity
seizures
coma
tremor
convulsions
mechanism of tamsulosin
a-antagonist
mechanism of finasteride
5 alpha reductase inhibitor
mediation for UTi in non pregnant women and men
non pregnant women - nitrofurantoin or trimethoroim for 3 days
men- same but for 7 days
for what reason would you send a urine culture in suspected UTI
-OVER 65 female
-pregnany
-visible or non visible haematuria
-men
common side effect of tamsulosin
dizziness and postural hypotension
uti treatment for pregnant woman
nitrofurantoin for 7 days
what would a blood film show in myeloma
rouleax formation
burrkits lymphoma is associated with what mutation
translocation of c myc gene
characteristic blood film finding of CLL
SMEAR/ SMUDGE CELLS
Where would you find auer rods
acute myeloid leukaemia
common causative organism for Haemolytic uraemic syndrome and its sx
E coli 0157
bloody diarrhoea preceding gastroenteritis
what is hypospadias
ventral urethral meatus
a hooded prepuce
chordee (ventral curvature of the penis) in more severe forms
nephrotic syndrome is associated with a hyper coagulable state due to ?
loss of antithrombin 3 and plasminogen via the kidneys
Membranous glomerulonephritis histology:
basement membrane thickening on light microscopy
subepithelial spikes on sliver stain
positive immunohistochemistry for PLA2
causes of acute interstitial nephritis
penicillin
rifampicin
NSAIDs
allopurinol
furosemide
systemic disease: SLE, sarcoidosis, and Sjogren’s syndrome
infection: Hanta virus , staphylococci
features of acute interstitial nephritis
-fever,
-rash,
-arthralgia
-eosinophilia
-mild renal impairment
-hypertension
psgn vs iga nephropathy timeframe
psgn- 1-2 weeks after strep infection
iga- 1-2 days after iga ifection
tetracyclines for acne management should be avoided in what patient population
breastfeeding
under 12
pregnant
what is first line for moderate acne
tetracycline + retinoid/ benzyl peroxide
doxycycline
safe medication for acne in pregnancy
oral erythromycin
what medication needs a dermatologist referral and what warrants it
topical isotretinoin
scarring , pitting severe acne
first line mx for non bullous impetigo
1% hydrogen peroxide cream
second line mx for impetigo
topical fusidic acid
what syndrome must you look out for with olanzapine/clozapine
acute dystonic reaction
how long does a section 2 last
28 dasy
how long Is a section 3
6 months
how long is a section 136
24hrs so the police can take someoen from a public place to a place of safety
what murmur would you expect in turners
ejection systolic murmur due to bicupsid aortic valvw
potential complication of fragile x
mitral valve prolapse
long term cardiac complication of turners
aortic dissection and dilatation n
common cardiac pathology with Duchenne muscular dystrophy
dilated cardiomyopathy
diet advice for cystic fibrosus
high fat high calorie with pancreatic enzymes with every meal
presenting features of cystic fibrosis
neonatal period (around 20%): meconium ileus, less commonly prolonged jaundice
recurrent chest infections (40%)
malabsorption (30%): steatorrhoea, failure to thrive
other features (10%): liver disease
what is used for peri and pre menopausal woman in breast cancer
tamoxifen
what is used for post menopausal women in breast cancer
anastrozole
side effects of tamoxifen
vte
endometrial cancer
when is excision of fibroadenoma indicated
more than 3cm
hormone levels and management for patient with subclinical hypothyroidsim
normal t4 but low raised tsh
give thyroxine
what is tangentiality
Tangentiality refers to wandering from a topic without returning to it.
what is circumstantiality
Circumstantiality is the inability to answer a question without giving excessive, unnecessary detail. However, this differs from tangentiality in that the person does eventually return to the original point.
young obese boy with groin pain and limp?
management?
slipped capital femoral epiphysis
in situ fixation with cannulated screw
blood test results for osteogenesis imperfecta
normal path, calcium, calcitril, calcidiol
most common benign ovarian tumour in women under 25
dermoid cyst - teratoma
Most common type of ovarian pathology associated with Meigs’ syndrome
fibroma
ovarian torsion would show what on ultrasound?
whirlpool sign
why should metaclopramide not be used for more than 5 days in hyperemesis gravid arum
risk of extra pyramidical effects such as tremor
how would you confirm ovulation
take progesterone levels 7 days before next period
most common cause of post coital bleeding
cervical ectropion
first line menorrhagia tx?
mirena ius
first line tx for gonorrhoea
1g im ceftriaxone
first line tx for bv and tv
ORAL METRONIDAZOLE
how to diagnose premature ovarian insufficiency and tx
raised fish on two account
HRT till 51 or combined oral contraceptive till 51
how to diagnose complete miscarriage on us
-The crown-rump length is greater than 7mm OR
-The gestational sack is greater than 25mm
thrush first line mx
oral fluconazole - not pregnant
pregnant - clomitrazole pessary
most common se of ivf
ovarian hyperstimulation syndrome
what does adding progesterone to HRT do
increase risk of breast cancer
most common cause of post menopausal bleeding
vaginal atrophy
prophylaxis for infantile spasms
buccal midazolam
rectal diazepam
most common cause of horners
pan coast tumir
pregnant woman with jaundice and itchy skin would indicate ?
obstetric cholestasis
presentation of molar pregnancy
painless vaginal bleeding
excessive morning sickness
SOB
BY what week should mother feel feral movements at the latest ?
24 weeks if not then refer to FMU
Immediate management if pregnant women has confirmed DVT
LMWH
first line management for reduced fetal movements ?
handheld doppler to confirm heartbeat
how does blood pressure change throughout pregnancy
blood pressure falls in the first trimester
till 24 weeks then begins to increase till term
define pregnancy induced htn
hypertension post 20 weeks gestation
no proteinuria or oedema
140/90 +
most common cause of fever/ infection of post partum woman
endometriosis with c section
biggest risk factor for PPH
placenta accreta
guidance on folic acid during pregnancy
women should take 4mg before conception
women with raised BMI, epilepsy , fh of neural tube defect to take 5
management for acute pulmonary oedema
iv furosemide
what vaccine should all heart failure have
annual influenza
what combination therapy is not recommended in heart failure patients
ace inhibitor and arb
use spironolactone instead
women collapses after PROM? what is the most likely diagnosis
Amniotic fluid embolism
first line management for mastitis
oral flucoxacillin for 10-14 days
continue breastfeeding and expressing
what drugs should be avoided in breastfeeding ?
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
medication of choice to suppress breast feeding
cabergoline
how would you assess SGA
Symphysis fundal height should correlate to gestation by 1-2cm
what is HELPP syndrome and how does it present
severe pre eclampsia
presents as malaise, headaches, vomiting
most important prognostic factor in paracetamol overdose
arterial blood gas ph
main point for liver transplant in paracetamol overdose
ph less than 7.3
typical MS patient history
young person with relapsing remitting sx
balance issues, increased tone and clonus
pupillary defect
what is the alternative to clopidogrel in stroke treatment if it is CI
ASPIRIN AND DIPYRIDAMOLE
mechanism of ondansetron
5 HT3 ANTAGONIST
vision worse going down stairs ?
4th nerve palsy
MANAGEMENT Of brain abscess
cephalosporin + metronidazole
what blood test will differentiate between true seizure and pseudoseizue
prolactin
what obstetric condition would cause painless vaginal bleeding
placenta previa-
placenta completely or partially covers the cervix
chorionic villi invade the myometrium but not the perimetrium
placenta accrete
timeframe for cat 1 c section
30 mins
presentation of chorioamnionitis
uterine tenderness and foul smelling discharge
scale for post natal depression
Edinburgh scale
what would variable decelerations indicate
cord compression
what would early decelerations indicate
head compression
what would late declarations indicate
placental insufficiency
adrenaline doses for anaphylaxis
under 6 months - 100-150mcg
6m-6yrs- 150mcg
6-12- 300mcg
12+ -500mcg
most useful test to establish anaphylaxis
serum tryptase
define threatened miscarriage
painless vaginal bleeding , cervical os is closed
define missed miscarriage
gestational sac contains a dead foetus but remaining utero
define inevitable miscarriage
cervix is dilated, heavy bleeding , clots and pain
define incomplete miscarriage
not all products have been expelled , pain and vaginal bleeding
ectopic pregnancy RF
damage to tubes- pID
previous ectopic
IUCD
progesterone pill
IVF
wha measurement would make you consider hydratiform mole
excess bhcg 300,000
typical px of hand foot and mouth
fever then ulcers in mouth
red spots on hands and feet
what is hand foot and mouth caused by
coxsackie a16
more rare enterovirus 71
biggest risk factor for toxic shock syndrome
use of tampons
hormone findings in kallman syndrome
low fhs/lh
low testoerone
key unique finding of pt with kallman syndrome
taller than average
anosmia - no smell
post MI drugs
Ace inhibitor
Beta blocker
statin
aspirin
ticagrelor
reasons for PCI with NSTEMI/ UNSTABLE ANGINA
IMMEDIATE- patient is hypotensive or clinically unstable
within 72 hrs- if GRACE score is above 3%
a patient develops acute HF 5 days post MI ? what is this and what is heard
Ventricular septal defect
new pan systolic murmur
raised JVP
bi basal crackles
characteristics of acute epiglottis and its cause
tripod position - neck extended
haemophillus influenzae
main points about polymyalgia rheumatica
ESR is raised
shoulder and neck pain
difficulty getting out of chair
morning stiffness
ORAL PREDNOSOLONE
management of stroke if pt presents within 4.5hrs and no evidence of haemorrhagic stroke
aspirin 300mg
thrombolysis with alteplase within 4.5h and thrombectomy within 6h
does amaurosis fugax cause ipsilateral or contralateral vision problems
ipsilateral
After what period of time would continued lochia warrant further investigation with ultrasound?
loch
what is bhcg secreted by
syncitiotrophoblasts
guidance regarding methotrexate in conception
both men and women should stop for 6 months
classic triad of sx for vasa previa
painless vaginal bleeding
rupture of membranes
bradycardia
normal pregnancy lab findings
Reduced urea, reduced creatinine, increased urinary protein loss
A baby is born with micrognathia, low-set ears, rocker bottom feet and overlapping of fingers is typical for ?
edwards
most common fracture in childhood abuse
humeral fracture
neonatal causes for jaundice
rubella
syhphillis
G6PD def
haematome
possible complication If biliary atresia is not sorted
kernicketerus
treatment for neonatal jaundice
phototherapy
exchange transfusion
signs of cyanotic heart disease
poor feeding, dyspnoea, tachycardia, weak pulse, engorged neck veins, sweating, gallop
risk factors for respiratory distress syndrome in neonates
maternial diabetes
c section
second twins
males
hypothermia
perinatal asphyxia
what cells produce surfactant
type 2 pneumocytes
patient loses conciosunes sbrifefly regains then loses again is what type of stroke
SUBDURAL HAEMATOMA
what medication commonly causes Steven Johnson syndrome
carbamezapine
used in epilepsy, trigeminal neuralgia
DVLA rules on epilepsy
6months no driving with first unprovoked sezure
12 months seizure free for epileptics
nerve root for biceps reflex
c5-c6
cushings triad ?
widening pulse pressure
hypertension
bradycardia
how would a pontine haemorrhage present
reduced GCS
paralysis
pinpoint pupils
medications for neuropathic pain
amitryptyline
duloxetine
gabapentin
pregablin
what is de clerambaults syndrome
erotomania - delusion that someone famous is in love w th them
what is de fregoli syndrome
delusion that identifying a familiar person in various people they encounter
indications for catatonia
treatment resistant severe depression
manic episodes
life threatening catatonia
what is conversion disorder
functional neurological disorder
what is somatosisation disorder
patient feels multiple sx but ni tests can provide any answer
what is a common SE of nexplanon and how can it be treated
irregular menstrual bleeding
three month course of COCP
what are the common extra pyramidal se of typical antipsychotics
Parkinsonism
acute dystonia
tardily dyskinesia
akathisia
what is tardive dyskinesia
repetitive involuntary movement such as pouting mouth
what are the feature of acute dystonia
torticollis
oculogyric crisis
mouth open
pain and distress
what is neologism
making up new words
what is perseveration
repeating the same words/ answers
what is catatonia
Stopping of voluntary movement or staying still in an unusual position
drug related Parkinson would present how?
with a bilateral resting tremor
management for acute dystonia
IM PROCYCLIDINE
management for tardike dyskinesia
tetrabenezine
what is akathisia and management
restlessness
propranolol
what is a section 2
admission for up to 28 days
APHM on the recommendation of two doctors
tx can be given without wishes
what is a section 3
6 months - can be renewed
pt must have been seen within past 24hrs
tx can be given against wishes
what is a section 4
72hr assessment
used as an emergency
often changed to a section 2 once at hospital
what is a section 5(2) and 5(4)
5,2 doctor can detain patient in hispital for up to 72hrs to assess and determine if further tx necessary
5,4 nurse or mhp can detain for 6 hours only id doc cant do so
section 136
24hrs
someone found in public space can be taken to a place of safety by the police
what do you give to a pt who presents with confusion agitation with liver cirrhosis/ without
with liver cirrhosis-lorazepam
without- chlordiazepoxide
most common cause of IE within 2 months of valve replacement and after 2 months
within 2 months - s epidermis
after2 months - s aureus
mc location site of infective endocarditis
IVDU- tricupsid
MITRAL FOR EVERYONE ELSE
treatment for acute relapse, first line tx and preventing relapses of multiple sclerosis
acute relapse = methyl prednisolone
first line - baclofen or gabapentin
relapse prevent- natalizumab , monoclonal AB
first line tx for myasthenia gravis
pryridostigmine
first line for most dementias
donepzil - ach inhibitor
Triad of symptoms for haemolytic uraemic syndrome
AKI
THROMBOCYTOPENIA
normocytic anaemia
Tx for delirium tremens in alcohol withdrawal
Iv pabrinex and high dose benzo
acute treatment and prophylaxis of cluster headaches
acute- high flow oxygen and subcutaneous sumatriptan
prophylaxis - verapamil
How would you manage post partum thyroiditis
propranolol not thyroid medication
can present up to a yr after birth
what is the post partum cut off for iron therapy regards to hb
100
most common cause of post partum pyrexia
endometritis
mx- send to hospital
what would blood film for HELPP syndrome show
shistocytes and polychromasia
causes of oligohydramniosis
premature rupture of membranes
Potter sequence
bilateral renal agenesis + pulmonary hypoplasia
intrauterine growth restriction
post-term gestation
pre-eclampsia
by what week should lack of fetal movements concern you
24 weeks
what would indicate viral meningitis over bacterial
csf would show normal glucose and normal protein
bacterial - reduced glucose and increased protein
most common complication following meningitis
sensorineural hearing loss
first rank sx of schizophrenia
delusional disorder
passivity phenomena
auditory hallucinatiins
thought disorders
typical history for anterior uveitis and the management
pt who has history of chrons or UC or ankylosing spondiltits has sudden onset eye pain with redness and lacrimation and photophobia
steroid eye drops and cycloplegic eye drops
what is the significance of fetal fibronectin in women
protein that is released from gestational sac
can indicate that labour is soon but women can also end up being full term
planned VBAC Is CI in what patients
vertical c section scar
prior uterine rupture
placenta previa
highest morbidity and mortality position for baby to be born
footling position
what is placenta increta
chorionic villi invade into the myometrium but not the perimetrium
blood results for molar pregnancy
hig bhcg
low tsh
high thyroxine
most common treatment plan for termination of pregnancy
mifepristone + misoprostol 48hrs later and multi level pregnancy test 14 days later
how to confirm PROM
sterile speculum
if no pooling of liquid then test placental alpha microglobulin or insulin like growth factor
typical hx of patient with a vesicovaginal fistula
continuous urine dribbling not linked to sneezing or coughing after a prolonged labour
what is a myelopathy and radiculopathy
r- compression of nerve root
m- compression of spinal cord
how may a radiculogpthy present c7
arm pain
sensory loss
motor loss- weakness
diminished or absent reflexes
no tricep reflex
how may a c7 myelopathy present
umm and lmm signs and compression will affect discs below
- arm pain
reduced power - leg pain
- tripping over
-positve Hoffman test
what Is an ataxic gait
can’t walk heel to toe and a wide gait
first line for idiopathic intracranial hypertension
acetozolamide
how would IIH oresent
worse headache on postural movements
intermittent visual loss
young fat female
drugs that increase the risk of idiopathic intracranial hen
COMAAR - ciclosporin, oral contraceptives, mineralocorticoids, amiodarone, antibiotics (tetracyclines, sulphonamides), retinoic acid.
triad of sx for wernickes
confusion, ataxia and nystagmus
give iv pabrinex
normal pressure hydrocephalus imaging findings
ventrucomegaly witout sulcal enlargement
what cranial nerves are affected in vestibular schwannoma
5 7 8
loss of corneal reflex think ?
acoustic neuroma
lateral medullary syndrome or wallenberg syndrome is also known as .
posterior inferior cerebellear artery stroke
lateral pontine syndrome is also known as
anterior inferior cerebellar artery stroke
