Passmed 2 Flashcards
Side effects of ECT
Immediate side effects
-Drowsiness
-Confusion
-Headache
-Nausea
-Aching muscles
-Loss of appetite
Long term side effects
-Apathy
-Anhedonia
-Difficulty concentrating
-Loss of emotional responses
-Difficulty learning new information
Retrograde amnesia is
difficulty remembering events prior to injury
Anterograde amnesia is
loss of ability to form new memories after the insult
Anaesthetic drug that can cause rise in intraocular pressure
Suxamethonium, Oxybutinin
Orbital swellings are classified based on what classification system
Chandler classification
I. Pre-septal cellulitis
II. Orbital cellulitis without abscess
III. Orbital cellulitis with subperiosteal abscess
IV. Intra-orbital abscess
V. Cavernous sinus thrombosis
Offer urgent direct access upper gastrointestinal endoscopy (to be performed within 2 weeks) to assess for oesophageal cancer in people with dysphagia, or aged 55 and over with weight loss and any of the following:
Upper abdominal pain
Reflux
Dyspepsia
Marfans syndrome
- mode of inheritance
- caused by
autosomal dominant
caused by defect in the FBN1 gene on chromosome 15
- codes for protein fibrillin-1
Referral criteria for nausea and vomiting in pregnancy
Admission if:
1. Continued N+V and unable to keep down fluids or oral antiemetics
- Continued N+V w/ ketonuria and/or weight loss (greater than 5% of body weight) despite tx with oral Abx
- Confirmed or suspected comorbidity (for example unable to tolerate oral abx for UTI)
Treatment = IV Saline with added potassium
3 day old male admitted with bilious vomiting and reduced feeding.
Born 30 weeks gestation via uncomplicated delivery.
Abdo X-ray is requested that shows intramural gas.
Oral feeding stopped and started on broad spec Abx.
likely diagnosis:
Necrotising enterocolitis
- pneumatosis intestinalis is a hallmark feature
Causes of euvolaemic hyponatraemia
- SIADH (retention of pure water dilutes sodium further)
- Hypothyroidism
Categorising asthma into moderate, severe and life-threatening
Moderate
- 50-75% best or predicted
- Speech normal
- RR < 25 / min
- Pulse < 110 bpm
Severe
- 33-50% best or predicted
- can’t complete sentences
- RR > 25/min
- Pulse > 110 bpm
Life-threatening
- < 33% best or predicted
- oxygen sats < 92%
- silent chest, cyanosis or feeble respiratory effort
- bradycardia, dysrhythmia or hypotension
- exhaustion, confusion or coma
Development of rash (erythema marginatum) combined with arthritis and pan systolic murmur following recent sore throat is indicative of what condition
Rheumatic fever
first line treatment for rheumatic fever
one of dose of IM BENZYLPENICILLIN
oral pen v can be given too
1st line tx for lichen planus
topical betamethasone
what ECG changes are associated with Wolff-Parkinson White syndrome?
Short PR interval
W: Waves -> delta waves;
P: PR interval shortened;
W: Wide QRS
4 Ts of PPH
Tone - uterine atony
Trauma (perineal tear)
Tissue (Retained placenta)
Thrombin (e.g. clotting / bleeding disorder)
Management of PPH
ABCDE
- two peripheral large bore 14 gauge cannula
- lie woman flat
- bloods –> group and save
- commence warmed crystalloid infusion
Mechanical
- palpate uterine fundus to stimulate contractions
- catheterisation to prevent bladder distention and monitor urine output
Medical
- IV oxytocin: slow IV injection followed by an IV infusion
- Ergometrine slow IV or IM (unless HTN pmh)
- Carboprost IM (unless asthma)
- misoprostol sublingual
- tranexamic acid
Surgical
-1st line intrauterine balloon tamponade
- B lynch suture
- ligation of uterine arteries or internal iliac arteries
Investigation of choice for vesicouteric reflux
Normally diagnosed following a micturating cystourethrogram
DMSA scan may also be performed to look for renal scarring
How might you diagnose primary ovarian insufficency
Raished FSH, LH levels
FSH > 40
Elevated FSH should be shown on two blood samples taken 4-6 weeks apart
Acute epiglottitis pathogen
Haemophilus influenza type B
This is a condition in which scar tissue adhesions form within the uterus (often following uterine surgeries), causing amenorrhoea.
ashermans syndrome
32 F
pc: sudden onset dizziness, describes it as the room spinning.
No hearing loss or tinnitus.
Can occur at rest + during activity
No specific movements exacerbate the symptoms, apart from feeling slightly run down a week prior.
Likely diagnosis
Vestibular neuritis
Notes
- not positional, unlikely to be BPPV
- no signs of infection: unlikely to be otitis media
- no hearing loss: labyrinthitis associated with hearing loss which she denies
What test is performed on symptomatic patients to differentiate between peripheral and central causes of vertigo?
Head impulse test
infective conjunctivitis management
- normally self limiting 1-2 weeks
- topical abx therapy often given
- chloramphenicol drops or ointment
- Fusidic acid if pregnant women BD
If contact lens wearer
- identify any corneal staining with topical fluoresceins
- treat as above
Don’t share towels
No school exlcusion
1st line for spasticity in multiple sclerosis
Baclofen and gabapentin
contraception contraindicated post partum
COCP
- absolute contraindication less than 6 weeks post partum
- combined hormonal contraceptives reduce breast milk volume
Mirena and IUD can be used 4 weeks post partum,
POP can be started 21 days post partum.
Progestogen implant can be inserted at any tine.
Sign associated with shingles
Hutchinson’s sign
- vesicles extending to the tip of the nose
- strongly associated with ocular involvement in shingles
