Psych, obs and gynae, stats Flashcards
Dementia vs depression
rapid onset
weight loss/sleep disturbance
global memory loss
Variable MMSE
Thought disorders
circumstantiality: excessive detail but eventually answers q
tangentiality: off topic
neologisms: new word formations
clang associations: rhyme
word salad: incoherent speech
knights move thinking: unexpected leaps of ideas (schizophrenia)
flight ideas: links between leaps
echolalia: repetition
Symptoms mania
IDIGFASTER
Irritable
Distracted/disinhibited
Insight impaired
Grandiose delusions
Flight ideas
Activity increased
Sleep decreased
Talkative
Elevated mood
Reduced concentration
Mx OCD
via YBOCs scale
mild: ERP CBT +/- sertraline 12 weeks and review in 1 week
sev: clomipramine + secondary mental health referral
Mx acute stress disorder
CBT
benzos
Symptoms of depression
core: low energy, anhedonia, low mood
cognitive: poor conc, suicidal
biological: worse morning, early morning wakening, appetite
psychotic: poverty/guilt/nihilism delusions, hallucinations
PHQ9 + mx
<16 = less severe: self help, cbt, ssris
16 or more = severe: cbt + ssri
Mx post mental health admission
Referral for CPN (comm psychiatric nurse)
Referral for outpatient psych clinic
Referral to crisis for initial discharge support
CBT
Support groups
Lifestyle advice on sleep, alc, mindfulness etc
Strongest risk factor for schizophrenia
fx
First line mx for alc withdrawal
chlordiazepoxide
lorazepam if liver cirrhosis
Symptoms of PTSD
- reliving - flashbacks/hall
- avoidance
- hyperarousal
- emotional numbing
Unexplained symptoms
somatisation: multiple physical symptoms
hypochondriasis: belief of serious disease
conversion/functional: motor/sensory loss
dissociative: seperates off certain memories
factitious: intentional
malignering: exaggeration of symptoms for financial gain
Medication to treat tardive dyskinesia
tetrabenazine
Mx PTSD
If <3 months CBT
If >3 months CBT/ EMDR +/- venafalaxine
Symptoms GAD
WATCHERS
worry
autonomic hyperactivity
tension muscles
conc dec
headache
energy loss
restless
sleep disturbance
Organic causes of psychosis
drugs
meds: steroids, levodopa
delirium/dementia
b12 deficiency
Schneiders first rank symptoms
passivity phenomenon
thought interference
3rd person auditory hallucinations
delusional perception
Definition BPAD
1 episode mania/hypomania and another mania/depression
Ix to do before starting methylphenidate
hr/bp
height/weight
fbc
lfts
ecg
SSRI for child
fluoxetine
Triad for acute dystonia
torticolis
trismus
oculogyric crisis
What are principles of MHA
- existing MH condition
- risk to self/others
- relapsing/remitting
- hospital only option
Sections
5(4): detain inpatient 6 hours nurse
5(2): detain inpatient 72 hours consultant
2: 28 days for suspected MH condition via 2 doctors + RMN
3: 6 months if already diagnosed
Indications for ECT
depression
mania
catatonia
Interactions with sertraline
nsaids (give ppi), warfarin/heparin (switch to mirtazapine), aspirin, triptans, maois
Neuroleptic malig syndrome vs serotonin syndrome
both n+v, confusion, headaches, autonomic hyperactivity, muscle rigidity
neuroleptic: hyporeflexia, aki/rhabdomyolysis
serotonin: hyperreflexia, myoclonus, dilated pupils
SSRI which causes discontinuation syndrome
paroxetine
Features of bulimia
normal weight
depression
irregular periods
dehydrated
hypokalaemia
Russells sign
parotid swelling
dental erosion
COCP contraindications
UKMEC4:
- >35years + >15 cigs day
- migraine with aura
- vte/stroke/ihd/uncontrolled htn
- breast cancer
- breast feeding <6 weeks
UKMEC3:
BMI>35
1st degree fx vte <45
Emergency levonorgestrel rules
if >70kg or bmi >26 double dose
repeat if vomit within 3 hours
COCP missed rules
if missed 1 continue as normal
if missed 2:
- if within first 7 days emergency contraception + 7 days condoms
- if week 3: omit pill free period
Risks of COCP
cervical cancer/breast cancer
vte
cvs
Contraception age contrsaindications
> 40 cocp
45 injection
Contraindication to ulipristal acetate
asthma
also wait 5 days before starting normal contraception
Time before contraception is effective
(if not first day period):
instant: IUD
2 days: POP
7 days: COCP, injection, implant, IUS
Mx thrush + preg
pessary clotrimazole
Features of non specific urethritis
urethritis without identifiable gonococcal
5+ polymorphonuclear leucocytes only
oral doxy
Mx mycoplasma genitalium
1 week doxy
2 days azithromycin
(or 7 days moxyflucloxacillin if macrolide resistant)
Mx genital warts
topical podophyllium/imiquimod
if preg then cyrotherapy
Symptoms of syphilis
primary: chancre, inguinal lymphadenopathy
secondary: systemic lymphadenopathy, fever, maculopapular rash on palms, condylomata late
tertiary: gummas, aortitis, neurosyphilis (tabis dorsalis, argyll)
Ix and Mx for syphilis
dark ground microscopy = spirochetes
im benzathine benzylpenicillin
Screening criteria
condition should be high freq + severity
test must be simple + safe
intervention leads to better outcome
screen is ethically acceptable
adequate facilities
definition of sensitivity vs specificity
sensitivity: proportion of people who have the disease who test +
specificity: proportion of people who dont have the disease who test -
Incidence vs prevalence
incidence: number new cases of disease arriving in a population in a given time
prevalence: all cases of disease existing in a population at a given time
likelihood ratio
sensitivity / (1-specificity)
number needed to treat
1/ absolute risk reduction
Mx hyperemesis g
promethazine
nacl + kcl
bland food, p6 acupuncture
thiamine
vte prophylaxis
PUQE questionnaire
Definitive mx for adenomyosis
hysterectomy
Risk factors for endometrial hyperplasia
post menopausal
late menopause/ early menarche
tamoxifen
thyroid
pcos
diabetes
Risks of HRT
vte (not transdermal)
breast cancer (cocp)
stroke (oest)
chd (cocp)
Woman aged > 30 years with dysmenorrhoea, menorrhagia, enlarged, boggy uterus
adenomyosis
Drug to take whilst waiting for surgery for fibroid
gnrh agonists
Complications of ovarian hyper stimulation syndrome
hypovolaemic shock
acute renal failure
vte
1st line for dysmenorrhoea
nsaids - mefenamic acid
Infertility + fibroid
myomectomy
Where do ovaries drain
paraaortic
First line ix vs GS for ovarian ca
1st line: uss abdo
GS: laprotomy
Types of ovarian cysts
- follicular: commonest, regresses after several cycles
- corpus luteum
- dermoid: <30yrs
- serous cyst adenoma: resembles ovarian cancer
- mucinous cyst adenoma: can become very large
- fibroma: in meigs syndrome
Meigs syndrome
ovarian mass (fibroma)
ascites
pleural effusion
Risk of malig index RMI
uss
menopausal status
ca125
Mx PID
IM ceft
2 weeks doxy + metronidazole
1st line ix vs GS ix for ovarian torsion
1st line: pelvic uss + doppler (free fluid + whirlpool)
GS: lapro
Features anorexia
hypokal
enlarged saliv glands
arrythmias/ bradycardia
peripheral neuropathy
osteoporosis
hypothermia
lugano hair
Features refeeding syndrome
hypokal
hypophos
hypomag
How long after miscarriage do u take pregnancy test
3 weeks
Causes of miscarriage
uterine abnormalities - fibroids
coagulopathy - antiphospholipid
chromosome abnormalities
diabetes
thyroid
pcos
Features of antiphospholipid syndrome
venous/arterial thrombosis
recurrent miscarriages
anticardiolipin ab
thrombocytopenia
prolonged APTT
Mx antiphospholipid syndrome
low dose aspirin
if had a thromboembolic event then lifelong warfarin 2-3 INR
if pregnant: low dose aspirin and then add on LMWH when fetal heart beat seen on uss
Features molar pregnancy
severe n+v
thyrotoxicosis (hcg mimics tsh)
enlarged uterus
pelvic uss snowstorm
low tsh, high t4
When do to preg test after abortion
2 weeks via multi level test
MOA mifepristone + misoprostol
mifepristone: progesterone rec antag - weakens attachment to endometrial wall + cervical softening/dilatation
misoprostol: prostaglandin analogue - causes contraction of myometrium to expel
Mx uterine hyperstimulation
remove vaginal prostaglandins
stop oxytocin infusion
consider tocolysis
When to give iv benzylpenicillin during labour
+ gbs swab
previous
preterm labour
pyrexia
Mx PPROM
admit
oral erythromycin 10 days or until in labour
if <35 weeks dexamethasone
if >34 weeks consider delivery
iv mg sulphate if 24-29 weeks
When to do external cephalic
36 weeks 1st baby
37 weeks multip
Contraindications to external cephalic
ruptured membranes
multiple preg
major uterine abnormality
abnormal ctg
<7 days since haemorrhage
Risks of twin pregnancies
mum inc risk of htn, anaemia, pph
twin-twin transfusion syndrome
premature
congenital abnormalities
Mx cord prolapse
push head back in
all 4s
minimal handling + keep moist
fill bladder
Scoring of bishops
if >6 will go into natural Labour so amniotomy + iv oxytocin
if <6 unlikely so dinoprostone
Prevention of preeclampsia
if 1 high or 2 mod risk factors
150mg aspirin 12 weeks -> delivery
When to give 5mg folic acid
bmi >30
fx NTD
epilepsy
diabetes
coeliac
Risk factors for VTE in pregnancy
Age > 35
Body mass index > 30
Parity > 3
Smoker
Gross varicose veins
Current pre-eclampsia
Immobility
Family history of unprovoked VTE
Low risk thrombophilia
Multiple pregnancy
IVF pregnancy
If >3 then LMWH 28 weeks until 6 weeks pp
Categories for c section
- immediate threat to life - within 30 mins
- compromise - within 75 mins
- both stable
- elective
SSRIs to give in post partum depression
paroxetine
sertraline
Risk factors of placenta praevia
previous c section
ivf
smoking
multiparity
>40
multiple pregnancy
Mx polyhydraminos
indomethacin before 32 weeks
amnioreduction
Risk factors for placental abruption
> 35yrs
multiparity
pre-ec/htn
previous
antiphospholipid syndrome
smoking
Mx obstetric cholestasis
ursodeoxycholic acid
emollients
chlorphenamine
water sol vit k
deliver 37 weeks
Disseminated gonococcal infection triad
= tenosynovitis, migratory polyarthritis, dermatitis
How does each component of virchows triad increase risk of DVT in pregnancy
Venous stasis: uterus compresses on pelvic veins
endothelial damage: if obese or multiparous or previous venous damage
hypercoagulable: increase in clotting factors in pregnancy
Mx DVT in pregnancy
treatment dose LMWH - need to monitor factor Xa during bc obesity and pregnancy can affect its bioavailability. Need to check fbc, clotting, u+es before starting.
Mx PPH (>500ml)
- A-E - lie flat, cannulas, g&s
- rub uterine fundus + catheter
- iv oxytocin
- ergometrin (not in htn)
- carboprost IM (not if asthma)
- surgical balloon tamponade
Manoveures for shoulder dystocia
mcroberts
wood screw
zavanelli
episiotomy
Classes perineal tears + mx
1st = minora = no repair
2nd = perineal muscles = ward suture
3rd = anal sphincter = theatre
4th = rectal mucosa
PCOS blood results
raised LH:FSH ratio
testosterone may be normal or mildly elevated
SHBG is normal to low
Complications of pcos
infertility
endometrial cancer - cocp!!
cvs disease
gestational diabetes
biggest risk factor for ddoh
female
