Pulsenotes finals Flashcards
Management of ruptured ectopic
Emergency surgery
Management of ectopic pregnancy with severe symptoms
Surgery
Management of ectopic with very high bHCG
Surgery
Management of ectopic with low hCG
Expectant management
Management of ectopic with intermediate hCG
Medical management
Management of ectopic with high hCG (not very high)
Medical or surgical
Definition of missed miscarriage
Non viable pregnancy but no miscarriage symptoms
Definition of threatened miscarriage
Viable pregnancy with PV bleeding
Definition of inevitable miscarriage
Non viable pregnancy with PV bleeding and open os
Definition of incomplete miscarriage
Os is open but foetus not fully expelled
Definition of complete misscarriage
Os is closed and foetus expelled
Follow-up after expectant misscarriage
Pregnancy test after 3 weeks
Follow-up after medical misscarriage
Pregnancy test after 3 weeks
Options for surgical miscarriage
Local or general anaesthetic
Manual vacuum aspiration or open surgery (general anaesthetic)
Risk factors for ovarian torsion
Young female
Enlarged ovaries e.g. PCOS or cysts
What does a ruptured endometrioma look like?
Chocolate coloured fluid seen
Complications of endometriosis
Adhesions
Endometrioma
Reduced fertility
Cysts
Gold standard for endometriosis diagnosis
laparoscopy
Investigation of endometriosis
USS
MRI
Laparotomy
Medical management of endometriosis
Analgesia
GnRH agonists
Indications for surgery in endometriosis
Failed medical management
Surgery indicated for fertility
High-risk factors for pre-eclampsia
Previous pre-eclampsia Current HTN Autoimmune disease Diabetes CKD
Medication given for pre-eclampsia prophylaxis
Aspirin
Signs and symptoms of pre-eclampsia
Proteinuria HTN Persistent headache Vision changes Confusion Abdo pain Oedema
Management of pre-eclampsia if over 37 weeks
Induction of labour
When to admit patients with pre-eclampsia
BP over 160\110
First line medication in pre-eclampsia
Labetolol
Second line medication in per-eclampsia
Nifedipine or methyl-dopa
Investigations in pre-eclampsia
BP Urinalysis Bloods Foetal heart beat USS CTG monitoring of foetus
What is vasa praevia?
Vessels cover the cervical os
What meds should be given prior to anticipated pre-term labour?
Steroids or magnesium sulfate (helps with foetal lung maturation)
Management of minor antepartum haemorrhage
Admit and observe for 24 hours
Causes of post-partum haemorrhage
Uterine atony (most common cause of bleeding in the 12 hours after birth Retention of tissue (most common cause of delayed post-partum haemorrhage) Trauma
Management of post partum haemorrhage where uterus isn’t contracted (feels soft)
Massage
Synthetic oxytocin
If ongoing, balloon / packing
If still ongoing, surgery
Causative organism of bacterial vaginosis
Gardnerella vaginalis
Diagnosis of bacterial vaginosis
3 out of: Typical discharge (thin grey) Clue cells Positive whiff test Low vaginal pH
Microscopic finding in bacterial vagonosis
Clue cells
Treatment of bacterial vagonosis
Abx (metronidazole)
Advice on reducing risk
Risk factors for bacterial vaginosis
Young females
Change sexual partner
Excessive hygiene
Common symptoms in secondary syphylis
General e.g. fever/ headache
Dermatological (dense red-brown rash on trunk, palms and soles)
GI symptoms e.g. hepatitis
Neurological symptoms
Most common form of tertiary syphilis
Cardiovascular (often affects aorta e.g. aortitis)
Treatment of syphilis
Single dose of IM penicillin
What is the Jarisch-Herxheimer reaction?
Acute febrile illness within a day of syphilis treatment. Usually self-resolves within a day
Treatment of chlamydia
Single dose azithromycin or seven days doxycycline
Who should be followed-up after chlamydia treatment?
Under 25s should have re-testing in 3-6 months due to high rate or reinfection
Treatment of gonorrhoea
Single dose of IM ceftriaxone
Age affected by bronchiolitis
Under 2 (usually under 1)
Symptoms of bronchiolitis
Cough
Cold-like symptoms
Signs of resp distress
Reduced feeding and wet nappies
How to differentiate croup and bronchiolitis
Croup tends to have barking cough
Symptoms of croup
Barking cough
Cold-like symptoms
Signs of resp distress
Reduced feeding and wet nappies
What is biliary atresia?
Biliary tree not fully formed leads to obstructive jaundice in a newborn
Imaging in suspected ovarian cancer (no mass)
Urgent abdo and pelvic USS
Sites of dissemination of gonorrhoea
Joints
Skin
Brain
Heart
Management of pyloric stenosis
NG tube
IV access, bloods, fluids
Surgery
Acute management manic episode
Antipsychotic
Consider a benzodiazepine
Section 2
Patient detained for assessment and treatment for 28 days
Platelet count in Henloch-Schonlein purpura
Normal
Section 5(2)
Doctor detained person for 72 hours for assessment
Management of neuroleptic malignant syndrome
Stop precipitating drug
Cooling and fever control
Symptom relief e.g. manage agitation
Symptom of conjunctivitis
Red eye
Discharge
Vision intact
What suggests viral conjunctivitis?
Bilateral
What symptom suggests allergic conjunctivitis?
Itchy
What symptoms suggest anterior uveitis?
Pain Red eye Gradual loss of vision Irregular pupil Association with inflammatory diseases
Symptoms of angle closure glaucoma
Acute painful red eye unilateral Headache Nausea and vomiting Visual loss Halo around lights
Symptoms of open angle glaucoma
Often asymptomatic and picked up routinely
May have gradual vision loss
Signs in angle closure glaucoma
Fixed mid dilated pupil that isn’t reactive
Hazy pupil
Red eye
What is idiopathic cholestasis of pregnancy?
Liver disease of pregnancy (typically 2nd and 3rd trimester) causing pruritis and bile accumulation
Good standard for diagnosis of angle closure glaucoma
Gonioscopy (looks disentangle closure)
Medication to reduce intraocular pressure
IV acetazolamide
Treatment to cure closed angle glaucoma
Laser iridotomy (creates hole in iris for fluid to drain)
Surgical options in glaucoma
Cataract surgery
Iridectomy
What does a cherry red spot indicate?
Retinal artery occlusion
Symptoms of retinal artery occlusion
Vision loss
Cherry red spot on retina
Pale retina
Retinal vein occlusion on ophthalmoscopy
Retinal haemorrhage and exudate
Retinal vein occlusion symptoms
Acute painless vision loss
Ophthalmoscopy in GCA
Pale and oedematous optic disc
Treatment of GCA with vision loss
IV steroids for 3 days
Then oral steroids as normal in GCA
Management of bronchiolitis
Mostly supportive
If severe, feeding / hydration support or respiratory support
Imaging in suspected ovarian cancer (no mass)
Urgent abdo and pelvic USS
Sites of dissemination of gonorrhoea
Joints
Skin
Brain
Heart
How to differentiate reactive and septic arthritis
Reactive will have sterile joint aspiration
What is Henloch-Schonelein purpura?
Vasculitic rash following viral illness
Main differentials in new onset petichial or purpuric rash in children
Immune thrombocytopenic purpura
Henloch-Schonlein purpura
Infection
Cancer
Platelet count in Henloch-Schonlein purpura
Normal
Symptoms of neuroleptic malignant syndrome
On anti-psychotic Altered mental status and agitation Rigidity Fevers Autonomic dysfunction AKI
Management of neuroleptic malignant syndrome
Stop precipitating drug
Cooling and fever control
Symptom relief e.g. manage agitation
When does neuroleptic malignant syndrome occur?
Any time but usually first 2 weeks of taking drug
Key investigation in neuroleptic malignant syndrome
Raised CK
What is retinitis pigmentosa?
Inherited vision disorders due to loss of photoreceptor function
Symptoms of retinitis pigmentosa
Progressive night vision loss and progressive peripheral vision loss
Ophthalmoscopy in retinitis pigmentosa
Pigmented around edge of retina
Treatment of proliferative diabetic retinopathy
Panretinal photocoagulation
Investigation in patient with thickened endothelium and suspected endometrial cnacer
Papelle biopsy
What is idiopathic cholestasis of pregnancy?
Liver disease of pregnancy (typically 2nd and 3rd trimester) causing pruritis and bile accumulation
What organism causes lymphogranuloma venereum
Chlamydia trachomatis
Symptoms of lymphogranuloma venereum
Painless ulcers
Lymphadenopathy
Proctitis if rectal
Symptoms of antidepressant withdrawal syndrome
Nausea, headache, dizziness, fatigue within a week of stopping SSRI
Prognosis of antidepressant withdrawal syndrome
Typically mild and resolves within 1-2 weeks
