Problematic conditions Flashcards
1
Q
What is the cause of infectious mononucleiosis and what are common features?
A
- EBV
- Sore throat, Lymphadenopathy, splenomegaly (splenic rupture)
- RASH AFTER TAKING AMOXICILLIN
2
Q
Mx regarding infectious mononucleiosis
A
- usually self limiting. The acute illness lasts around 2 – 3 weeks, however it can leave the patient with fatigue for several months once the infection is cleared.
- avoid alcohol, as EBV impacts the ability of the liver to process the alcohol.
- avoid contact sports due to the risk of splenic rupture. Emergency surgery is usually required if splenic rupture occurs.
3
Q
What is the vaccination schedule?
A
2mth: 6 in 1 (diphtheria, hep B, Hib, polio, tetanus, whooping cough) Men B, Rotavirus.
3mth: 6 in 1, PCV, Rotavirus.
4mth: 6 in 1, Men B.
1y: Hib/Men C, PCV booster, MMR, Men B booster.
- 3y = 4in1 (dip/tet/whooping/polio), MMR.
- 12-13y = HPV.
- 14y = Tetanus, diphtheria, polio. Men ACWY.
- Influenza vaccine is also offered to all children of primary school age and those in Y7. It is also
offered from 6m to those at high risk.
4
Q
What is ITP and mx
A
- autoimmune destruction of platelets (thrombocytopenia)
Often preceded by viral illness - Bleeding, for example from the gums, epistaxis or menorrhagia
- Bruising
- Petechial or purpuric rash, caused by bleeding under the skin
- Mx: usually resolves by itself. If very low:
-> oral/IV corticosteroid
-> IV immunoglobulins
-> platelet transfusions can be used in an emergency (e.g. active bleeding) but are only a temporary measure as they are soon destroyed by the circulating antibodies
5
Q
Features of haemophilia
A
- Spontaneous bleeding into joints (haemoathrosis) and muscles - painful, swelling
- Haematoma’s/described as extensive bruising
- Can present as intracranial haemorrhages, cord
6
Q
Risk factors for DDH
A
- female sex: 6 times greater risk
- breech presentation
- positive family history
- firstborn children
- oligohydramnios
- birth weight > 5 kg
- congenital calcaneovalgus foot deformity
(Fat, Female, Fanny first, FH, Firstborn, Fluid low, Foot deformity)
7
Q
Ex drugs + S/E:
SSRI
SNRI
Tricyclics
MOA
Tetracyclics
A
- SSRI: Sertaline, Fluoxetine, Citalopram (Stomac,sexual,serot, sleep depr, sodium low)
- SNRI: Duloxetine, Venlafaxine
- Tricy: Amitryptiline, Imipramine (Anticholinergic)
- MOA: IproniaZID, Phenelazine, Trancyclpromine (cheese)
- Tetracy: Mirtazapine
8
Q
Mood stabilising drugs
A
Lithium or Valproate
9
Q
Lithium adverse effects and toxicity
A
- S/E: (lithium + sodium same in periodic table - similar structure and effects) LITHIUM
Lethargy, Insipidus (diabetes) - thirst/urination, Tremor (fine), Hypothyroidism, Impaired memory + cognition, Upset stomach, Muscle weakness - TOXICCC (lithium>1.5mmol/L):
Tremor (coarse), tachycardia/arrhy
Oliguric renal failure
ataXia
Increased reflexes
Convulsions, Coma, Consciousness reduced - Mx: 1. Stop lithium immediately
2. High fluid + IV NACl
3. If severe - renal dialysis
10
Q
Lithium monitoring
A
- when checking lithium levels, the sample should be taken 12 hours post-dose
- after starting lithium levels should be performed WEEKLY and after each dose change until concentrations are stable
- once established, lithium blood level should ‘normally’ be checked every 3 MONTHS
- THYROID and RENAL (from diabetes insipidus) function should be checked every 6 MONTHS
11
Q
Criteria for delirium
A
ICD-10 criteria for delirium:
1.) Impairment of consciousness and attention
2.) Global disturbance in cognition
3.) Psychomotor disturbance
4.) Disturbance of sleep-wake cycle
5.) Emotional disturbances
12
Q
Etiology of delirium
A
D - Drugs and Alcohol
E - Eyes, ears and emotional
L - Low Output state (MI, ARDS, PE, CHF, COPD)
I - Infection
R - Retention (of urine or stool)
I - Ictal
U - Under-hydration/Under-nutrition
M - Metabolic (Electrolyte imbalance, thyroid, wernickes
(S) - Subdural, Sleep deprivation
13
Q
Medical problems associated with Down’s syndrome
A
CHILDHASPROBLEM
Congenital heart disease (VSD,ASD,Fallot)/ Cataracts.
Hypothyroidism / Hypotonia.
Increased gap between 1st and 2nd toe.
Leukemia risk x2 (AML+ALL) / Lung problem.
Duodenal atresia / Delayed development.
Hirschsprung disease / Hearing loss.
Alzheimer disease
Short neck / Squint.
Palmar crease / Protruding tongue.
Round face / Rolling eye (nystagmus).
Occiput flat / Oblique eye fissure.
Brushfield spots / Brachycephaly.
Low nasal bridge / Language problems.
Epicanthic fold / Ears folded.
Mental retardation / Myoclonus.
Brushfield spots = white/grey spots in iris
14
Q
Heart defects associated with different genetic conditions
A
- Down’s: ASD, VSD, Tetralogy of Fallot, AVSD
- Turner’s: Bicuspid aortic valve, Aortic coarctation
- Fragile X: Mitral valve prolapse
- Edwards: VSD
- William’s: Aortic stenosis
- Noonan’s: pulmonary stenosis (opposite to Turner’s)
15
Q
Barbituate vs Benzo’s mechanism of action
A
GABAA drugs:
- benzodiazipines increase the frequency of chloride channels
- barbiturates increase the duration of chloride channel opening
(Barbidurates increase duration & Frendodiazepines increase frequency)
16
Q
Indications for benzodiazapines
A
Alcohol withdrawal, Seizures, Severe Anxiety, Severe insomnia
17
Q
RF’s for ovarian, endometrial, cervical, vulval cancer
A
- Ovarian: Age>60, clomifene, early menarche, nulliparity, BRCA1/2
- Endometrial: obesity, nulliparity, early menarche, late menopause, diabetes mellitus, tamoxifen, PCOS, HNPCC
- Cervical: HPV 16,18,
smoking, HIV, early first intercourse, many sexual partners, high parity, lower socioeconomic status, COCP - Vulval: - 65 years+, HPV, infection, VIN, Immunosuppression, Lichen sclerosus
18
Q
Common antibacterials contraindicated in pregnancy
A
iM FAST of these drugs
- Metronidazole
- Fluoroquinolones
- Aminoglycoside
- Sulfonamides
- Tetracyclines
19
Q
Ix for a pregnancy of unknown location + bleeding but less than 6wk
A
- Serial serum B-hCGs 48 hours apart can help give an indication of the location and prognosis of the pregnancy:
- If the levels fall then it is suggested that the foetus will not develop or there has been a miscarriage
- If there is only a slight increase or a plateau in B-hCG levels then this may indicate an ectopic pregnancy
- A normal increase in B-hCG suggests the foetus is growing normally, but does not exclude an ectopic pregnancy
A transvaginal ultrasound may help to identify the location of the pregnancy, but in the early days of gestation the foetus may be too small to be accurately identified by ultrasound. In this instance it may be best to repeat the scan at a later date.
- If the pregnancy is < 6 weeks gestation and women have bleeding, but NO pain or risk factors for ectopic pregnancy, then they can be managed expectantly. These women should be advised:
to return if bleeding continues or pain develops
to repeat a urine pregnancy test after 7–10 days and to return if it is positive
a negative pregnancy test means that the pregnancy has miscarried
20
Q
Causes of placental abruption
A
Abruption prev., Blood pressure, Ruptured membranes, Uterine trauma, Polyhydramnios, Twins, Infection, Older age, Narcotics
21
Q
RF for gestational diabetes + Mx
A
Prev macrosomic baby, prev gestational diabetes, BMI >30, ethnic origin, FH Diabetes
Mx: if the fasting plasma glucose level is < 7 mmol/l a trial of diet and exercise should be offered
if glucose targets are not met within 1-2 weeks of altering diet/exercise metformin should be started
if glucose targets are still not met insulin should be added to diet/exercise/metformin
gestational diabetes is treated with SHORT ACTING ONLY
if at the time of diagnosis the fasting glucose level is >= 7 mmol/l insulin should be started
22
Q
High and mod risks for pre-eclampsia
A
- High risk: pre-exis HTN, prev. HTN in preg, AI, T1/2DM, CKD
- Mod risk: 40+ age, BMI >35, 10+ years since last pregnancy, 1st preg, FH
23
Q
Investigations for gestational HTN vs Pre-eclampsia
A
Gestational (>20wk):
- BP -> weekly measurement (until 135/85mmHg)
- Urine dipstick -> weekly
- PIGF -> once
(If >160/110 then admit, BP every 15 mins, urine dipstick daily)
Pre-eclampsia:
- BP -> Every 48 hrs
- Urine dipstick -> only if new sx
- CTG/US fetus -> 2 weeks
24
Q
Mx for gestational HTN
A
- Stop ACEi, ARB, Thiazides
- Change to labetalol (CI if asthmatic)/nifedipine/methyldopa, alpha-blockers
25
Mx for pre-eclampsia
- Prophylaxis: Aspirin from 12 weeks gestation until birth
- Labetalol (CI in asthma)/nifedipine/methyldopa
- IV hydralazine (if severe)
- If severe pre-eclampsia bp or sx (vomiting, blurred vision, papilloedema) then give IV magnesium (if concern may develop eclampsia) and plan immediate delivery, within 24-48hrs, if after 37 weeks gestation. MAGNESIUM SULPHATE FOR 24 HOURS AFTER DELIVERY OR AFTER LAST SEIZURE
- If before 37 weeks, then consider surveillance and early delivery.
26
RF for ectopic pregnancy
smoking, multiple sexual partners/PID,
use of IUD, prior fallopian tube surgery, infertility and using in vitro fertilisation, age <18 at first sexual
intercourse, black race, and age >35 at presentation.
27
What is Mx following preterm premature rupture of membranes
- Following RCOG guidelines, antibiotics (erythromycin) should be given for 10 DAYS following premature preterm rupture
of membranes, or until the woman is in established labour, whichever is sooner. - The presence of a pool of
fluid in the vagina at sterile speculum examination is highly suggestive of membrane rupture, and when
this is clearly observed no further diagnostic tests are required
- antenatal corticosteroids
- delivery considered at 34 weeks of gestation -> trade-off between increased risk of maternal chorioamnionitis with a decreased risk of respiratory distress syndrome as the pregnanct continues
28
Dx of chlamydia
- Vaginal swab - microscopy, culture, sensitivities
- First catch urine sample for NAAT
29
What are the complications of gp B strep, chlamydia, syphillis, VZV during pregnancy
- ALL: chorioamnionitis, PROM, Preterm labour, miscarriage, stillbirth
- Chlamydia: neonate conjunctivitis, pneumonia
- Gp B strep: Meningitis, Encephalitis, Sepsis, Pneumonia (B=Brain, blood, breathing)
- Syphillis: (face) Keratitis, Deafness, Blunted teeth/palate defect, Saddle shaped nose, frontal bossing. (2 L's): Lower extremity problems, bleeding into lungs
- VZV: SMELL - Skin scarring, Microcephaly, Eye problems, Limb hypoplasia, Learning difficulties
30
Tx of Chlamydia + GpB strep in pregnancy
CHLAMYDIA: Erythromycin or amoxicillin
GBS: intrapartum BENZYLPENICILLIN or ampicillin
31
Mx of bacterial meningitis
- Community: benzylpenicillin
- Hospital: Under 3 months = cefotaxime plus amoxicillin (the amoxicillin is to cover listeria contracted during pregnancy), above 3 months = ceftriaxone
- Prophylaxis within 7 days exposure = Ciprofloxacin
32
Non-epileptic attack disorder
- arms flexing/extending or pelvic thrusting
- eyes are usually closed, which may also be the case in syncope; eyes are typically open in epilepsy
- prolonged seizures (often >30 minutes) are common in NEAs; epileptic seizures and syncope typically
do not last >5 minutes
- symptoms wax and wane in NEAs, as opposed to epilepsy, which typically follow set patterns (e.g.
tonic-clonic)
33
Causes of pyschosis
- schizophrenia, depression, bipolar disorder, puerperal psychosis, brief psychotic disorder (sx less than a month), neurological conditions e.g. Parkinson's disease, Huntington's disease, prescribed drugs e.g. CORTICOSTEROIDS, illicit drugs e.g. cannabis, phencyclidine
34
Important pregnancy dates
8 - 12 weeks: Booking visit - general information, BP, urine dipstick, check BMI.
- Blood test -> FBC, blood group, rhesus status, red cell alloantibodies,
haemoglobinopathies,
- Screened for hepatitis B, syphilis, HIV
10 - 13+6 weeks: Dating scan, exclude multiple pregnancy
11 - 13+6 weeks: Combined test (US - Nuchel translucency + Blood test - PAPPA, BHCG) for Downs, Edwards and Patau's syndrome.
14 - 20 weeks: Down syndrome quadruple test (if passed triple date)
18 - 20+6 weeks Anomaly scan
28 weeks: Routine care: BP, urine dipstick, SFH
Second screen for anaemia and atypical red cell alloantibodies
First dose of anti-D prophylaxis to rhesus negative women
34 weeks: Routine care as above
Second dose of anti-D prophylaxis to rhesus negative women*
36 weeks: Routine care as above
Check presentation - offer external cephalic version if indicated
35
Further screening for Down's syndrome if increased risk from combined/quadruple test
When the risk of Down’s is greater than 1 in 150 (occurs in around 5% of tested women), the woman is offered further screening
- Chorionic villus sampling (CVS) involves an ultrasound-guided biopsy of the placental tissue - Done if before 14+6 weeks.
- Amniocentesis involves ultrasound-guided aspiration of amniotic fluid using a needle and syringe. - Done if later in pregnancy
- Non-invasive prenatal testing (NIPT) new test with a simple blood test from the mother. Now preferred as less invasive.
36
Contraception following birth
- After giving birth, women require contraception after day 21
- Lactational amenorrhoea is a reliable method of contraception as long as patient is amenorrhoeic, <6 months post-partum, and breastfeeding exclusively
- COCP: ACI if breastfeeding <6 wk post partum
Not used in first 21 days (+ addit. for 7
days)
- POP: Can start any time postpartum, but use
addit. for 2 days after day 21
e.g. DESOGESTREL
- IUD/IUS: inserted within 48 hours or after 4
weeks.
37
Depression vs dementia
Factors suggesting diagnosis of depression over dementia:
short history, rapid onset
biological symptoms e.g. weight loss, sleep disturbance
patient worried about poor memory
reluctant to take tests, disappointed with results
mini-mental test score: variable
global memory loss (dementia characteristically causes recent memory loss)
37
Depression vs dementia
Factors suggesting diagnosis of depression over dementia:
short history, rapid onset
biological symptoms e.g. weight loss, sleep disturbance
patient worried about poor memory
reluctant to take tests, disappointed with results
mini-mental test score: variable
global memory loss (dementia characteristically causes recent memory loss)
38
Depression vs dementia
Factors suggesting diagnosis of depression over dementia:
short history, rapid onset
biological symptoms e.g. weight loss, sleep disturbance
patient worried about poor memory
reluctant to take tests, disappointed with results
mini-mental test score: variable
global memory loss (dementia characteristically causes recent memory loss)
39
When is the prick heel test done in neonates
5 letters in Prick
4 letters in Heel
Between 5 and 9 days.
40
Termination of pregnancy: legalities and mx
- legal up to 24 weeks if:
Continuing pregnancy involves greater risk to physical or mental health of the woman, existing children of the family.
2 registered medical practitioners must sign to agree abortion is indicated. Must be carried out by a registered medical practitioner in an NHS hospital or approved premise.
1. Mifepristone - halts pregnancy/relaxes cervix (anti-progestegon)
2. Misoprostol - 1-2 days later softens cervix and stimulates uterine contractions
3. Rh-ve women 10wk+ having abortion should have anti-D prophylaxis
41
Differentiating between flight of ideas and knights move
Knight's move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas
42
Features of chorioamnionitis in pregnancy and differentials
- preterm-PROM with a triad of maternal pyrexia, maternal tachycardia, and FETAL tachycardia ('urinary incontinence w/ discharge' may be actually ROM)
- UTI
- PID
43
Ruptured ovarian cyst vs torsion
- Ruptured ovarian cyst presents as sharp unilateral pain immediately following intercourse or strenuous exercise. Bimanual examination in non-severe cases is generally UNREMARKABLE but the lower abdomen is tender. Ultrasound shows free fluid in the pelvic cavity.
- Ovarian or adnexal torsion can present similarly with sharp unilateral pain often associated with N+V. There is a tender PALPABLE adnexal mass on BIMANUAL exam. Ultrasound shows an ENLARGED, oedematous ovary with impaired blood flow. WHIRLPOOL SIGN/free fluid
44
Mx of LUTI and UUTI in paediatrics
- infants less than 3 months old should be REFERRED immediately to a paediatrician
- children aged more than 3 months old with an UPPER UTI should be considered for ADMISSION to hospital. If not admitted oral antibiotics such as CEPHALOSPORIN or CO-AMOXICLAV should be given for 7-10 DAYS
- children aged more than 3 months old with a lower UTI should be treated with oral antibiotics for 3 DAYS according to local guidelines, usually trimethoprim, nitrofurantoin, cephalosporin or amoxicillin. Parents should be asked to bring the children back if they remain unwell after 24-48 hours.
- antibiotic prophylaxis is not given after the first UTI but should be considered with recurrent UTIs
45
Medical mx of ectopic vs miscarriage vs abortion
- Ectopic = Methotrexate (if <1500hCG, <35mm, no FHR, no pain)
- Miscarriage = Misoprostol (if >6wk or <6wk w/pain = cant do expectant) (if any sign of haemodynamic instability then D+C). Or if 14+ days and expectant not complete
- Abortion = Mifepristone and Misoprostol
46
Risk factors for umbilical cord prolapse
- Fetus TRAMPles on cord
- Twin pregnancy
- artificial ROM (MOST COMMON)
- abnormal fetal position
- multiparity
- prematurity, polyhydramnios
47
COCP contraindications
AH, NO BABIES!
A - Abnormal clotting (DVT/STROKE/MI personal history = 4) or Family History (3)
H - Hypertension (Uncontrolled - 4) or Controlled (3)
N - Nocked Up (Pregnant)
O - Obesity - BMI >35 (3)
B - Breast Feeding <6w PP (4)
A - Aura Migranes (4)
B - Breast cancer (4)
I - Immobility (Prolongued e.g. major surgery - 4) or Reduced (E.g. wheelchair - 3)
E - slE - positve phospholiipid antibodies (4)
S - Smoking >15 + >35 years (4)
48
RF for neonatal sepsis
- Mother who has had a previous baby with GBS infection, who has current GBS colonisation from prenatal screening, current bacteruria, intrapartum temperature ≥38ºC, membrane rupture ≥18 hours, or current infection throughout pregnancy
- Premature (<37 weeks): approximately 85% of neonatal sepsis cases are in premature neonates
- Low birth weight (<2.5kg): approximately 80% are low birth weight
- Evidence of maternal chorioamnionitis
49
What is the management of parkinsons and which drug is most likely to cause impulse control problems (gambling, sexual behaviour, shopping)
Motor Sx affecting QOL: levodopa
Not affecting QOL: dopamine agonist or MAO-B inhibitor
Dopamine receptor agonists most likely to cause impulse problems
50
What is fetal fibronectin
- A protein released from the gestational sac. High level is related with early labour - but not definite.
- maternal steroids
51
During a lower segment Caesarian section, the following lies in between the skin and the fetus:
Superficial fascia
Deep fascia
Anterior rectus sheath
Rectus abdominis muscle (not cut, rather pushed laterally following incision of the linea alba)
Transversalis fascia
Extraperitoneal connective tissue
Peritoneum
Uterus
52
Complications of measles
Myocarditis, meningitis
Encephalitis
Appendicitis
Subacute sclerosing pancephalitis
Laryngitis
Early death
Shits (diarrheoa)
Corneal ulcer
Otitis media
Mesenteric lymphadenitis
Pneumonia
53
How to manage unscheduled bleeding with a implant
- Add a COCP
- Nexplanon/implant = slow release of progeston -> prevents ovulation. Also thickens cervical mucus
54
What is premenstrual syndrome and how to manage
PMS only occurs in the presence of ovulatory menstrual cycles
- Emotional symptoms include:
anxiety
stress
fatigue
mood swings
- Physical symptoms:
bloating
breast pain
Tx: Mild: lifestyle -> regular, frequent, balanced meals rich in complex carbs, sleep, exercise
Mod: new gen COCP
Severe: SSRI
55
You review a 60-year-old man who complains that he is 'tripping over' all the time. Whilst examining him you notice he has a 'high-stepping' gait - he tends to excessively flex his knees to ensure the feet 'clear' the ground when walking. What is the most likely cause for this examination finding?
Peripheral neuropathy
56
What is usual symphysis-fundal height?
Should match the gestational age in weeks to within 2cm, after 20 weeks. e.g. if 24 weeks, then normal SFH = 22-26cm
57
cystic fibrosis management
- regular chest physiotherapy and postural drainage
- high calorie diet, including high fat intake
- vitamin supplements
- pancreatic enzyme supplements
58
Undiagnosed breech birth in early labour requires what management
- Category 2 C-section
- An undiagnosed breech in early labour, without foetal or maternal compromise, is not an obstetric emergency. Examples of obstetric emergencies include undiagnosed breech in uterine rupture, cord prolapse or an abnormal CTG. A crash caesarean section may be appropriate in some cases of obstetric emergencies, where the foetus needs to be delivered within 5 minutes. (crash category 1)
59
Anaemia cut-offs and Ix/Mx
First trimester < 110 g/L
Second/third trimester < 105 g/L
Postpartum < 100 g/L
- no further Ix -> oral ferrous sulfate
60
Types of Cerebal palsy and where the damage is
- spastic (70%)
subtypes include hemiplegia, diplegia or quadriplegia
increased tone resulting from damage to upper motor neurons
- dyskinetic
caused by damage to the basal ganglia and the substantia nigra
athetoid movements (slow writhing movements) and oro-motor problems
- ataxic
caused by damage to the cerebellum with typical cerebellar signs
- mixed
61
Tx for postnatal depression
CBT
SSRI if severe -> sertaline or paroxetine
62
Key points w/ anti-parkinson drugs
- Levodopa:
Always combined with a decarboxylase inhibitor e.g. carbidpoa.
Hard to get a steady dose -> end-of-dose wearing off, on-off phenomenon.
Dyskinesias at peak dose - chorea, athetosis, dystonia.
- Dopamine receptor agonists: ropinirole, cabergoline
Cause impulse control disorders, more likely to cause hallucinations in older patients
- All cant be stopped suddenly -> dopamine agonist patch as rescue medication to prevent acute dystonia. Can also cause psychosis and postural hypotension.
63
Features of different types of tremor
Essential
- bilateral
- postural -> worse if arms outstretched
- improved by alcohol and rest
- Strong family history
- Mx: propanolol
Parkinson's
- Worse at rest, improved with movement
- Asymmetrical
- Slow frequency
64
Lactational mastitis Mx
- Breast pain w/ erythmatous, warm and tender area in breastfeeding woman.
- Mx -> analgesia + encourage milk removal.
IF SX DONT IMPROVE AFTER 12-24 HRS THEN ABX -> FLUCLOX
65
HIV in pregnancy
- all pregnant women offered CART
- vaginal delivery if viral load less than 50 copies/ml at 36 weeks, otherwise C-section
- Zidovudine infusion 4 hours before beginnning c-section + administered to neonate
- advised not to breast feed
66
Headache Red flags
- obvious signs of malignancy/neurological etc.
- triggered by cough, valsalva (trying to breathe out with nose and mouth blocked), sneeze or exercise
- orthostatic headache
- Sx of giant cell arteritis
67
Mx of threadworms
- Mebendazole (worms bend in ass hole)
- hygiene measures for all members of household
68
Complications of Parvovirus B19 + in preg?
- Aplastic anaemia
- Pregnancy -> hydrops fetalis
69
Tx pathway for Endometriosis
ANY WOMEN WITH SECONDARY DYSMENORRHEA SHOULD BE REFFERRED TO GYNAE FOR INVESTIGATION
Initial Mx:
1. NSAIDs + Paracetamol -> Txa (HMB)/Mfa (pain)
2. COCP or POP or other hormonal
If initial doesnt work or infertility:
3. GnRH agonists - adjunct/3m. before surgery
4. Surgical laparoscopic excision or ablation of endometrial adhesions
Complete:
5. Hysterectomy
70
Tx pathway for HMB
Fibroids <3cm/adnomyosis/unknown pathology
1. LNG-IUS
2. COCP/POP Or Txa/NSAIDs
Fibroids >3cm
Consider -> uterine artery embolisation, myomectomy, hysterectomy
71
Px of Adenomyosis vs Endometriosis
Adenomyosis:
- Dysmenorrhea, Menorrhagia, Dyspareunia,
- Enlarged, boggy, tender uterus
Endometriosis:
- Cyclical chronic pelvic pain, dysmenorrhea, infertility, deep dyspareunia, painful urination/bowels
Fibroids:
- Mennorhagia, bladder symptoms, subfertility
- Non-tender, enlarged uterus
72
Types of febrile seizures
Simple
< 15 minutes, Generalised, Typically no recurrence within 24 hours, Should be complete RECOVERY within an HOUR.
Complex
15 - 30 minutes, FOCAL, May have REPEAT seizures within 24 hours. Drowsy FOR OVER AN HOUR.
Febrile status epilepticus
> 30 minutes
Management following a seizure:
- children who have had a first seizure OR any features of a complex seizure should be admitted to paediatrics
- if recurrences, try teaching parents how to use rectal diazepam or buccal midazolam. Parents should be advised to phone for an ambulance if the seizure lasts > 5 minutes
73
Mx of MND (drugs + nutrition)
- Riluzole
- percutaneous gastrostomy tube (PEG) is the preferred way to support nutrition and has been associated with prolonged survival
74
Adverse effects of nexplanon
- Implantable contraceptive - slowly releases progestogen etonogestrel.
- Prevent ovulation. Also thickens cervical mucus
- irregukar/heavy bleeding: can be managed w/ cocp
- progestogen effects: nausea, headache, breast pain
75
Tx pathway for dysmenorrhea
Primary = In primary dysmenorrhoea there is no underlying pelvic pathology. Appears within 1-2 years of the menarche.
- pain typically starts just before or within a few hours of the period starting
- Mx: NSAIDs e.g. Mefenamic acid and ibuprofen. 2nd line = COCP
Secondary = ALL patients with SECONDARY dysmenorrhoea REFER to gynaecology for investigation.
Develops many years after the menarche and is the result of an underlying pathology
- pain usually 3-4 days before onset of period (unlike primary)
76
How does cytomeglovirus infection in pregnancy present
Congenital CMV manifests with hearing loss, low birth weight, petechial rash, microcephaly and seizures
77
Women with gestational diabetes in previous pregnancy should be offered screening when?
Women with gestational diabetes in a previous pregnancy should be offered an OGTT as soon as possible after booking and subsequently at 24-28 weeks
78
Webers px, PICA/Wallenberg/lateral medullary, AICA/lateral pontine, basilar artery
Webers (posterior cerebral artery that supply the midbrain)
- Ipsilateral CN III palsy
- Contralateral weakness of upper and lower extremity
PICA
- Ipsilateral: facial pain and temperature loss
- Contralateral: limb/torso pain and temperature loss
- Ataxia, nystagmus
AICA
- Symptoms are similar to Wallenberg's (see above), but:
- Ipsilateral: facial paralysis and deafness
Basilar artery
- 'Locked-in' syndrome
79
Signs of pontine haemmorhage
- Pontine haemorrhage commonly presents with reduced GCS, paralysis and bilateral pin point pupils
80
Mx of a child having an acute asthma attack
Any child with asthma:
- Bronchodilator therapy
give a beta-2 agonist via a spacer
+ Steroid therapy
should be given to all children with an asthma exacerbation - treatment should be given for 3-5 days
Severe transferred to hospital immediately
