QM/BM Flashcards
Which metabolic and endocrine markers are elevated in anorexia?
Cortisol, GH, cholesterol, carotinaemia
What is Benign Rolandic Epilepsy (BRE)?
The most common form of epilepsy in childhood, and children usually outgrow it.
How does BRE present?
Typically presents in children <12 years of age with brief, focal episodes of seizure activity. The child maintains awareness throughout the episodes, which commonly occurs at night
What is West syndrome?
Infantile spasms or salaam attacks, is characterised by head, neck and trunk contractions and occurs at around 6 months of age.
What is the characteristic finding in West syndrome?
Hypsarrhythmia describes a chaotic and disorganised pattern on EEG, which is made up of multiple asynchronous spikes
What is the most common cause of obstructive jaundice in the neonate?
Biliary atresia, typically occurring around 3 weeks of age
Why are neonatal livers less able to conjugate bilirubin as efficiently?
Reduced activity of UDP-glucuronosyltransferase (UGT)
When would you hear an S2 sound?
A split S2 describes when the aortic and pulmonary valves close at different times. Inspiration decreases the intrathoracic pressure, which increases venous return. More blood is then pumped through the pulmonary valve, delaying closure relative to the aortic valve.
What is a paradoxical embolus?
Occurs when a thrombus crosses an intracardiac defect into the systemic circulation
How do we treat cluster headaches long term?
Verapamil is a calcium channel blocker. Verapamil 80mg orally TDS is highly effective as long-term prophylaxis and is titrated according to the response. Once the patient has been headache free for at least 2 weeks this is gradually tapered off.
Which bacteria does amoxicillin target in meningitis treatment of those under 3 months old?
Listeria monocytogenes
Why do we use hyperventilation in deteriorating patients with subdural haematoma?
Can reduce pCO2 which causes cerebral vasodilatation and increased cerebral perfusion
What are the symptoms of encephalitis?
Confusion, fever, headache, seizure
Most common cause of encephalitis?
HSV, confirmed with CSF PCR
What is the most common ECG change after antipsychotic commencement?
QT prolongation
What dose of atorvastatin do we give to pts after stroke or TIA?
80mg, in order to reduce non-HDL cholesterol levels by at least 40% within 3 months
What is the characteristic neck XR sign of epiglottitis?
Thumb sign
How do we treat chronic lung disease in children under 9m.o.?
Palivizumab
Define chronic lung disease of the preterm
Preterm and requiring oxygen for at least 28 days from birth
What is a salpingoopherectomy?
A surgical procedure, which involves removing a woman’s ovaries and fallopian tubes
What is the classical finding on chest/neck XR in croup?
Normally clinical diagnosis, but steeple sign (tracheal narrowing) seen on XR
What is the test of cure for women treated for cervical intraepithelial neoplasia (CIN)?
Repeat cytology 6m after tx
What are the symptoms of whooping cough?
Episodic high pitched coughing followed by post tussive vomiting. Maybe also low-grade pyrexia or coryzal symptoms.
If a psych pt has an established diagnosis, do we use section 2 or 3?
3 for treatment as already has diagnosis.
What are the two key side effects of the progesterone depot injection (e.g. Depo-Provera)?
Weight gain and reduced bone mineral density (osteoporosis)
How does PID present?
Lower abdominal pain, usually bilateral, dyspareunia, vaginal discharge, cervical motion tenderness
What most commonly causes PID?
Chlamydia trachomatis
How does fronto-temporal dementia present?
Parkinsonism, visual hallucinations, REM sleep disorder. Cognitive symptoms precede motor symptoms.
What are the cardinal symptoms of parkinsonism?
Bradykinesia, rest tremor and rigidity
How do we treat fronto-temporal dementia?
There are medications to help manage symptoms such as anti-depressants or anti-psychotics, but the mainstay is supportive measures such as relaxation techniques and social interaction[1].
Which tests do you do for a 39y.o. lady with ? ovarian ca?
CA125 + AFP + hCG if under 40 to screen for ovarian germ cell tumour
Only CA125 if over 40
What is rhinorrhoea?
The free discharge of a thin nasal mucus fluid. Commonly known as a runny nose
What is mydriasis?
An unusual dilation or widening of the pupils
Which allele increases the likelihood of developing Alzheimer’s disease?
Apolipoprotein E4, associated with young-onset disease
A pregnant lady with painless bright red vaginal bleeding typically has…
Placenta previa
How does B12 deficiency affect the spinal cord?
Subacute combined degeneration of the spinal cord affects the dorsal column and corticospinal tracts, hence the impairment of proprioception and upper motor neuron signs.
What is the most common cause of cervical cancer?
HPV
Which blood tests do you perform to diagnose Coeliac disease?
Anti-TTG and anti-EMA antibodies areIgA. Some patients have anIgA deficiency. When you test for these antibodies, it is important to test for total Immunoglobulin A levels because if total IgA is low because they have an IgA deficiency then the coeliac test will be negative even when they have coeliacs. In this circumstance, you can test for theIgG versionof anti-TTG or anti-EMA antibodies or simply do an endoscopy with biopsies.
What is Uhthoff’s phenomenon?
When the symptoms of MS (or other demyelinating diseases) worsen following a rise in temperature
How do we treat whooping cough?
If within 21 days of symptom onset, give macrolide abx (azithromycin/clarithromycin)
What environmental factors affect lithium levels?
Increase if dehydrated
Give symptoms of lithium toxicity
Coarse tremor, ataxia, dysarthria, nystagmus, convulsions
How do we distinguish between mania and hypomania?
Hypomania if less than seven days and no grandiosity
Why do we use co-beneldopa in PD?
Carbidopa is added to levodopa to prevent levodopa from being converted into dopamine in the bloodstream
When do we admit paed pts with bronchiolitis based on SpO2?
If SpO2 is less than 90% in children 6 weeks and over. In children under 6 weeks, they should be admitted if SpO2 is less than 92%.
What is pernicious anaemia?
Autoimmune condition where there is a deficiency of IF, meaning B12 can’t be absorbed in the ileum. Most common cause of B12 deficiency in the UK.
What is the first line treatment for PID?
IM ceftriaxone (single dose) followed by oral doxycycline and metronidazole for 14 days
How do we diagnose delirium?
Confusion assessment method
Describe the presentation of placental abruption
Continuous abdo pain, antepartum haemorrhage, abnormalities on the CTG indicating fetal distress,
characteristic “woody” abdomen on palpation (suggesting a large haemorrhage)
If the CTG is normal, how do we manage placental abruption?
Corticosteroids should be given to promote lung maturity if under 37 weeks and both the mother and foetus must be monitored
What increases the risk of epilepsy after febrile seizure?
If seizure was complex e.g. focal features (one side of body), >15min, recurrence within 24hrs, incomplete recovery within 1 hour
What medication do we use as prophylaxis in migraines?
Propanolol
How do we manage placenta praevia at 31+1?
If stable, the position of the placenta should be rechecked at 32 weeks gestation by TVUS, if persistently low-lying another TVUS should be performed at 36 weeks gestation. This will be used to confirm the diagnosis of placenta praevia and guide delivery
How do we diagnose SAH if CT was inconclusive?
LP to see xanthochromia (12 hours post bleed)
How do we treat asthma in children where it affects their sleep?
She should be started on a beta-agonist as a result. As per NICE guidelines, patients who have symptoms ≥3 times a weekornight-time waking should be started on an inhaled corticosteroid (ICS) as well[1].
What is transient global amnesia?
Anterograde amnesia with no other alteration in consciousness
Describe the pathophysiology behind Hirschprung’s Disease.
Proteins that assist neural crest migration through the developing digestive tract (e.g. RET) are mutated in this disease. Therefore, these cells do not migrate and fail to differentiate into the ganglion cells that form the plexuses in the colon.
How do we diagnose Hirschprung’s disease?
Suction renal biopsy
Where would you find no Auerbach or Meissner plexuses?
Hirschprung’s disease
Define placenta praevia
The placenta is < 20mm from the internal cervical os but does not cover it[1].
Describe the constituents of a mature teratoma
An ovarian cyst with features suggesting the presence of fat and teeth. Common in younger women.
How long are whooping cough pts advised to stay at home?
Until 48 hours after the completion of antibiotic therapy or 21 days after the onset of symptoms if they did not receive antibiotic therapy
What usually precedes SAH?
Rupture Berry aneurysm
What is the eye opening response scale in GCS?
4 Spontaneously, to speech, to pain, 1 no response
What is the verbal response in the GCS scale?
5 oriented to time, person and place; confused; inappropriate words; incomprehensible sounds; no response
What is the motor response in GCS scale?
6 Obeys command, moves to localised pain, flex to withdraw from pain, abnormal flexion, abnormal extension, 1 no response
Name a vestibulotoxic drug
Gentamycin - will affect balance not hearing
What is a first line for migraine prophylaxis which isn’t propanolol?
Topiramate
How does oesophageal atresia present?
Oesophageal atresia often presents as polyhydraminos. As the oesophagus is blind-ending, fluid cannot pass through the baby to be absorbed. This results in an accumulation of fluid outside the baby – hence the polyhydramnios.
Postnatally the baby has problems with swallowing. The baby will have difficulty feeding and has overflow saliva. There may also be a trachea-oesophageal fistula
Which cancer do untreated coeliacs pts have a higher risk of?
Lymphoma
A pt at 12+3 asks for amniocentesis due to a family history of Down’s syndrome. What are you going to advise?
Before 15 weeks, chorionic villus sampling is the procedure of choice for obtaining a sample of foetal DNA
How does parvovirus B19 present in children?
Slapped cheek syndrome: fever, coryza and diarrhoea. Following this, a diffuse ‘lace-like’ rash develops across the body with a characteristic bright red rash on the cheeks
How do we diagnose Meckel’s diverticulum?
A technetium scan, using radioactive metastable technetium-99, will highlight ectopic gastric mucosa
A pt refuses refeeding treatment for her anorexia. What are the next steps?
Re-feeding is permitted under the MHA as her physical problem is a result of her mental disorder.
What is splitting?
Where individuals are considered wholly good or bad
Which anti-psychotics have mood stabilising effects?
Olanzapine, haloperidol, risperidone, quetiapine
Name the main side effect of ropinirole (dopamine agonist)
Used in PD
Impulsivity, which can lead to pathological gambling and hypersexuality
A pt with Parkinson’s disease needs rapid tranquillisation. Which drug do we use?
Lorazepam, as haloperidol is contraindicated due to the fact it promotes the dopamine blockade, resulting in psychosis and a deterioration in motor function
How are opiates cleared? Are there any exceptions?
Renally, other than tramadol
Name a common cause of microcytic anaemia
Thalassaemia trait
What is pseudo-dementia?
Also known as depressive dementia, this is an important differential in the elderly, severe depression can lead to psycho-motor slowing, memory impairment and difficulties in concentration similar to dementia in appearance.
A pt who has just recovered from a UTI has a decreased GFR. What are you going to do?
Trimethoprim can reduce creatinine excretion from the kidneys, but doesn’t affect the actual GFR
Name a common SE of amitryptiline
Constipation, as it has anticholinergic properties
What are the three core features of Lewy Body dementia?
Fluctuating attention and concentration, recurrent well-formed visual hallucinations, spontaneous Parkinsonism
What is Charles Bonnet syndrome?
Associated with visual loss, these patients often describe smaller versions of real life objects commonly of faces or cartoons. Importantly, they realise that the hallucinations are not real.
Why can’t you prescribe nitrates and PDE5 inhibitors together?
Leads to vasodilation of the peripheral vasculature leading to a drop in the blood pressure in a similar way to how nitrates work. When taken together the effect is compounded and has led to several deaths in the 1990s.
How do we treat postural hypotension?
Fludrocortisone. A type of corticosteroid, it is mainly used for its mineralocorticoid properties leading to sodium retention and effective blood volume and therefore pressure. Indications include orthostatic intolerance and adrenal insufficiencies.
Define uterine hyper-stimulation
Greater than 5 contractions within 10 minutes
Why does foetal HR decrease in uterine hyper-stimulation?
Due to increased freq of contractions and thus increased compression on the foetal head
How do we treat uterine hyper-stimulation?
Tocolytic agents
What is choriocarcinoma?
A rare tumour which is present after evacuation of a hydatidiform mole, where b-hCG levels fail to drop.
What is external cephalic version?
usually offered at 36 weeks and involves applying pressure to the maternal abdomen in an attempt to “turn” the baby.
What is cyclizine used for?
Reduce N&V
What is placenta percreta?
the most severe form of abnormal placental villous adherence. Here the placental villi extend past the normal confines of the uterine myometrium and can even adhere to other abdominal structures such as the bladder.
How do we diagnose placenta previa?
TVS
How do we treat rhesus-negative pts?
One anti-D dose at 28 weeks of 1500IU
How do we terminate pregnancies between 10+1-23+6 weeks?
200mg oral mifepristone followed by 800mcg misoprostol
What is the action of mifepristone
a progesterone receptor antagonist and functions to inhibit the action of circulating progesterone, causing endometrial degeneration, cervical softening and increases the uterine sensitivity to prostaglandins.
What is the action of misoprostol?
A prostaglandin analogue which causes smooth muscle contractions of the myometrium, resulting in expulsion of uterine contents.
When must a gestational diabetes pt deliver by?
40+6 weeks, due to increased risk of stillbirth.
What is the triad of congenital toxoplasmosis?
Hydrocephalus, chorioretinitis
Usually acquired through exposure to cat faeces.
What does a boggy uterus suggest?
Non-contracted, the uterus has failed to contract sufficiently to stem blood from the uterine vessels sheared during delivery.
What is the Bishop score used for?
Used to predict whether spontaneous labour will occur. A score of 5 or less suggests labour is unlikely to occur w/o induction.
How do prostaglandin pessaries work?
Cause cervical ripening and labour induction.
Why does PID increase ectopic pregnancy risk?
Slows the ovum’s passage through the fallopian tube to the uterus.
What is cervical ectropion?
Happens when cells that line the inside of your cervix grow on the outside. These cells are redder and are more sensitive than the cells typically on the outside, which is why they may cause symptoms, like bleeding and discharge, for some women.
How does ectopic pregnancy usually present?
Unilateral cramping pain, amenorrhea for 6 weeks, scant vaginal bleeding of dark brown colour
Why can’t you do a digital vaginal examination on a woman with placenta praevia?
Performing a digital examination in a woman with placenta praevia can provoke serious haemorrhage.
Why do we avoid amiodarone in breastfeeding?
Present in breastmilk in significant amounts and can lead to neonatal hypothyroidism from release of iodine.
What is acute fatty liver of pregnancy?
a rare complication of pregnancy. Commonly occurs in the third trimester of immediately following delivery, and is thought to be mroe common in nulliparous women. Presents with general malaise, anorexia, vomiting and jaundice. Tx w/ immediate delivery.
Why do we give folic acid?
Folic acid is converted to tetrahydrofolate (THF), which is involved in the synthesis of DNA and RNA. Deficiency in folic acid can cause neural tube defects (NTD).
When do we give folic acid?
Until the 12th week of pregnancy.
What must you be careful of when there’s intractable vomiting in pregnancy?
Thiamine deficiency, leading to Wernicke’s
A 36+1 lady presents with elevated liver enzymes and low platelets. What is the primary differential?
elevated liver enzymes and low platelets should make you think of HELLP syndrome
How do we treat placenta increta?
Hysterectomy
How do we use Naegele’s rule?
Determine the first day of your last menstrual period, add 9 months and 7 days
How does congenital CMV present?
Hearing loss, visual impairment and LD
How does placenta accreta present?
Either through US or failure of delivering the placenta, leading to PPH
What is amniotic fluid embolism?
severe condition where the amniotic fluid passes into the mother’s blood, usually around delivery. Presents similarly to sepsis.
What is congenital toxoplasmosis?
A severe condition typically presenting with hydrocephalus, seizures, visual and hearing impairment. Caused by the parasite toxoplasma gondii, found in cat faeces or contaminated food products
Why don’t we perform CVS sampling before 11 weeks gestation?
Risk of foetal limb abnomalities
What is the first line anti-emetic for hyperemesis gravidarum?
Promethazine
Why is classic caesarean section scar an absolute contraindication to VBAC?
Due to a high risk of uterine rupture
Where do you find listeria monocytogenes?
Unpasteurized dairy products and soft cheeses
How do we treat endometrial hyperplasia and why?
COCP, prevents hyperplasia and can improve acne seen in PCOS
A F pt presents with oligomenorrhoea and clinical signs of hyperandrogenism (acne, hirtuism). What is the primary differential?
PCOS
What is Cervical intraepithelial neoplasia?
a grading system for the level of dysplasia (premalignant change) in the cells of the cervix. CIN is diagnosed at colposcopy (not with cervical screening). The grades are:
CIN I: mild dysplasia, affecting 1/3 the thickness of the epithelial layer, likely to return to normal without treatment
CIN II: moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, likely to progress to cancer if untreated
CIN III: severe dysplasia, very likely to progress to cancer if untreated
When is contraception required after delivery?
3 weeks after
How do we treat maternal chickenpox?
Aciclovir
How does herpes simplex virus present in pregnant women?
Flu-like illness and painful vesicular lesions around vagina
What is the difference between the combined and the quadruple test?
Both screening tests. Quadruple after 13 weeks, combined up to 11
What does the turtle neck sign indicate?
Macrosomia
What is HELLP syndrome?
a variation of severe pre-eclampsia and requires immediate treatment including delivery of the foetus.
HELLP syndrome is managed via urgent delivery of the baby and supportive treatment of organ failure.
What three abnormalities do you see in HELLP syndrome?
The three abnormalities found in HELLP syndrome arehaemolysis (H),elevated liverenzymes(EL), andlow platelets (LP).
What is the Kleihauer test?
Used to quantify the dose of Rh-D antigen in maternal circulation. In significant sensitising events (events during which Rh-D antigen enters the maternal Rh-negative circulation), a Kleihauer test can guide the amount of anti-D IG needed to prevent maternal sensitisation
How do we reduce psychotic symptoms medically?
Dopamine receptor antagonism, e.g. by olanzapine or risperidone
What electrolyte imbalances do you see in refeeding syndrome?
Rapidly increasing insulin levels lead to shifts of potassium, magnesium and phosphate from extracellular to intracellular spaces.
Which type of vaccines are contraindicated in immunocompromised pts?
Live attenuated vaccines, such as the MMR vaccine
A ground glass appearance is seen on CXR. Diagnosis?
Neonatal respiratory distress syndrome.
What causes retinopathy of prematurity?
ROP is caused by free radical damage to the retina from high oxygen levels.
What is chorioamnionitis?
Infection of the membranes in the uterus.
How do we treat recurrent miscarriages due to anti-phospholipid syndromes?
Anti-platelets and anticoagulants
How do we treat group B strep in pregnant women?
Penicillin, or vancomycin if contraindicated
What does the Coomb test show?
Antiglobulin testing, also known as the Coombs test, is an immunology laboratory procedure used to detect the presence of antibodies against circulating red blood cells (RBCs) in the body, which then induce hemolysis
Why do we stop methotrexate use in pregnancy?
It is a folic acid antagonist which can result in anencephaly, hydrocephalus, cleft lip/palate and skull defects
How do we manage euthymic pts with diagnoses of hypothyroidism in pregnancy?
NICE recommends increasing levothyroxine by 25 mcg as soon as pregnancy is confirmed despite a euthyroid state. The explanation for this is that in pregnancy there is a physiological increase in serum free thyroxine until the 12th week of pregnancy as the foetus is dependent on mother’s circulating thyroxine until the 12th week of development when the foetal thyroid develops. Untreated hypothyroidism can lead to neurodevelopmental delay of the foetus. This surge is not seen in hypothyroid patients. Therefore, levothyroxine should be increased to mimic this surge.
What does green tinged liqour during birth show?
Meconium is present. If inhaled by baby, meconium aspiration syndrome can occur.
Why is breast feeding preferred in women with epilepsy?
Anticonvulsant medication is present in breast milk in smaller quantities and allows the baby to withdraw slowly
What is fetal renal agenesis?
a cause of oligohydramnios because such abnormalities lead to reduced fetal urine production and thus reduced amniotic fluid.
What is diabetic amyotrophy?
Asymmetric wasting of the thighs in diabetes
What is LEMS?
LEMS is a neuromuscular junction disorder that usually presents with an ascending pattern of weakness that improves upon repetition/usage.
What is gastroparesis?
Partial paralysis of the stomach
What organism causes Lyme disease?
Borrelia Spp.
What is the first line tx for impetigo
Fusidic acid
What is the other name for varicella virus?
Human herpes virus 3
What effect do macrolides have on the heart?
Lengthen the QT interval
What antenatal liver condition can cause CP?
Hepatic ischaemic encephalopathy
What does bilious green vomiting a few days after birth suggest?
Malrotation. Perform upper GI contrast study.
Describe fibrocystic disease presentation.
bilateral nodularity in a younger patient which worsens in relation to their menstrual cycle.
What is the first line tx of infective mastitis
Flucloxacillin
What is the difference between tamoxifen and trastuzumab?
Tamoxifen is a selective oestrogen-receptor modulator used in the treatment of oestrogen receptor positive breast cancer.
Trastuzumab (trade name Herceptin) is a monoclonal antibody used in the treatment of HER2 receptor positive breast cancer
What is Todd’s paresis?
Weakness following a seizure
Name SEs of topiramate.
Weight loss, renal stones, cognitive/behavioural changes
What is Stevens-Johnson syndrome?
A very severe reaction to medications that causes skin tissue to die and detach
What is ovarian hyperstimulation syndrome?
A complication of ovarian stimulation during IVF fertility treatment. It is associated with the use of hCG to mature the follicles during the final steps of of ovarian stimulation.
Describe the pathophysiology leading to OHSS
hCG causes an increase in vascular endothelial growth factor (VEGF) released by granulosa cells leads to an increase in vascular permeability, leading to oedema, ascites and hypovolaemia.
How do we determine the severity of OHSS
By how raised the renin level is
How does haematocrit vary with intravascular fluid volume?
Haematocrit is the concentration of red blood cells in the blood. When the haematocrit goes up, this indicates less fluid in the intravascular space, as the blood is becoming more concentrated. Raised haematocrit can indicate dehydration.
What is infectious mononucleosis
Glandular fever, caused by EBV. It is known as the kissing disease as it is found in the saliva of infected individuals.
Describe the typical glandular fever presentation.
An adolescent with a sore throat, who develops an itchy rash after taking amoxicillin. Mononucleosis causes an intensely itchy maculopapular rash in response to amoxicillin or cefalosporins
What are heterophile antibodies?
In infectious mononucleosis, the body produces something called heterophile antibodies, which are antibodies that are more multipurpose and not specific to the EBV antigens. It takes up to 6 weeks for these antibodies to be produced.
How do we test for heterophile antibodies?
Monospot test: this introduces the patient’s blood to red blood cells from horses. Heterophile antibodies (if present) will react to the horse red blood cells and give a positive result.
Paul-Bunnell test: this is similar to the monospot test but uses red blood cells from sheep.
How do we manage glandular fever?
Patients are advised to avoid alcohol, as EBV impacts the ability of the liver to process the alcohol. Patients are advised to avoid contact sports due to the risk of splenic rupture.
What is Prader-Willi Syndrome?
a genetic condition caused by the loss of functional genes on the proximal arm of the chromosome 15 inherited from the father. This can be due to a deletion of this portion of the chromosome, or when both copies of chromosome 15 are inherited from the mother.
What is the main feature of Prader-Willi syndrome?
The key feature everyone remembers for Prader-Willi syndrome is the the insatiable hunger. Feeding can often be a challenge initially due to hypotonia and it is only later that the food seeking and excessive eating occur. It is worth remembering some other key facts about the condition, such as the treatment with growth hormone and the poor muscle tone, so that you know more than just the link with appetite.
What is Mittelschmerz?
mid-cycle ovulatory pain and it is common. The pain is due to rupture of the Graafian (dominant) follicle, each month, which results in the release of an ovum into the fallopian tube. The pain can vary from being right-sided to left-sided depending on which ovary is ovulating that month.
How do we treat Mittelschmerz?
Duration of pain can vary from minutes up to a few days and it can be controlled using simple analgesics such as paracetamol and NSAIDs.
What is the diagnosis criteria for endometrial cancer on TVS?
Endometrial thickness less than 5mm uniformly
What is the link between rifampicin and COCP?
Rifampicin decreases the efficacy of the COCP as it is a liver enzyme inducer.
Where do 75% of ectopic pregnancies occur?
In the ampulla of the fallopian tube
What is mefenamic acid?
A NSAID that is used in the management of menorrhagia, but it can reduce fertility unlike TXA
How does BMI relate to endometriosis risk?
Low BMI = higher risk
What is the most common cause of postmenopausal bleeding?
Atrophic vaginitis
How do we treat endometrial hyperplasia with cellular atypia?
If atypia is present, a total hysterectomy and bilateral salpingo-oophorectomy isindicated inpostmenopausalwomen. Inpremenopausalwomen, a total hysterectomy alone is possible.
How do we treat endometrial hyperplasia without atypia?
Surveillance +/- progestogens
What are ovarian thecomas?
A rare type of ovarian cancer that secrete oestrogen
Why do we advise against using the COCP during the first trimester?
Associated with miscarriage
What are schistocytes?
fragments of red blood cells seen on blood film
What is the red degeneration of a fibroid?
A history of a pregnant patient with abdominal pain, low-grade fever and background of multiple uterine fibroids is classical for “red degeneration” of a fibroid. This describes the rapid growth of a fibroid, leading to outgrowth of its blood supply causing ischaemia and bleeding, due to the surge of sex hormones, particularly during pregnancy
What does a large uterus for dates suggest?
? hydatidiform mole
How do we manage choriocarcinoma?
Women with low-risk disease are treated with methotrexate. If there is evidence of metastases or high-risk disease, then further agents are added.
What is dermatitis herpetiformis?
an itchy, blistering, autoimmune skin condition associated with coeliac disease. It is causedby IgA deposition in the skin, leading to vesicle formation
Why do we offer the pneumococcal vaccine to coeliac pts?
Patients with coeliac disease often develop splenic dysfunction, known as functional hyposplenism. This leaves patients susceptible to infection by encapsulated bacteria
What type of bacteria is Haemophilus influenzae type B?
Gram -ve, coccobacillary facultative anaerobe
How does dehydration affect lactate levels?
Raises
What does raised serum tryptase suggest?
Anaphylaxis
What type of hypersensitivity reaction is anaphylaxis?
Type I hypersensitivity mediated by IgE
What is acanthosis nigricans, and what is it related to?
The hyper-pigmentation and thickening (hyperkeratosis) in these locations is typically of acanthosis nigricans, which is related to insulin resistance.
What is the triad for vasa previa?
painless vaginal bleeding, rupture of membranes and fetal bradycardia (fetal heart rate <100bpm)
What does a holo-systolic murmur at the lower left sternal edge indicate?
VSD
Describe the rash seen in measles
erythematous, blanching maculopapular rash all over, with grey spots on his buccal mucosa
What is the most common cause of proteinuria in children?
Transient proteinuria. It is benign and tends to recede as the precipitant is removed. Precipitants include seizures, strong infections, pregnancy and heavy exercise.
What does retinal haemorrhage suggest in children?
can be suggestive of non-accidental injury (commonly known as ‘shaken baby syndrome’, but seen in older children as well who may have sustained traumatic brain injuries as a result of physical abuse
What is the third line treatment for fibroids?
Oral norethisterone
What is the Frank breech position?
When the baby’s legs are folded flat up against his head and his bottom is closest to the birth canal.
What is complete breech?
when both of the baby’s knees are bent and his feet and bottom are closest to the birth canal
What in incomplete breech?
when one of the baby’s knees is bent and his foot and bottom are closest to the birth canal
What is Bishop scoring used for?
Determining the chance of spontaneous induction of labour without assistance. 6 or above, 5 or below
What causes HIE?
Hypoxic ischaemic encephalopathy (HIE) occurs in neonates as a result of hypoxia during birth
Give RFs for HIE.
Events that could lead to hypoxia during the perinatal or intrapartum period,
acidosis (pH < 7) on the umbilical artery blood gas,
poor Apgar scores,
features of mild, moderate or severe HIE (see below)
or evidence of multi organ failure
What is Sarnat staging?
HIE grades
What is therapeutic hypothermia?
Therapeutic hypothermia involves actively cooling the core temperature of the baby according to a strict protocol. The baby is transferred to neonatal ICU and actively cooled using cooling blankets and a cooling hat. The temperature is carefully monitored with a target of between 33 and 34°C, measured using a rectal probe. This is continued for 72 hours, after which the baby is gradually warmed to a normal temperature over 6 hours.
The intention of therapeutic hypothermia is to reduce the inflammation and neurone loss after the acute hypoxic injury. It reduces the risk of cerebral palsy, developmental delay, learning disability, blindness and death.
What is transient tachypnoea of the newborn?
A parenchymal lung disorder characterised by pulmonary oedema resulting from delayed resorption and clearance of foetal alveolar fluid. Commonly occurs after c-section.
How do we treat transient tachypnoea of the newborn?
Treatment is with oxygen. TTN should resolve in a couple of days with resorption of lung fluid.
What is tuberous sclerosis?
An autosomal-dominant, neurocutaneous, multi-system disorder characterised by cellular hyperplasia, tissue dysplasia, and multiple organ hamartomas.
Give features of tuberous sclerosis
Infantile spasms, ash leaf spots, LD/ASD, epilepsy
What is Friedreich’s ataxia?
a hereditary neurodegenerative disorder affecting the corticospinal tracts, spinocerebellar tracts, dorsal columns, and peripheral nerves
How does Friedreich’s ataxia present?
Teenage years with lower limb weakness, gait abnormalities, or falls
On physical examination there may be cerebellar signs (due to involvement of the spinocerebellar tracts) or mixed upper and lower motor neuron signs
Involvement of the dorsal columns can lead to impaired joint/vibration sense. Other clues on physical examination include a high-arched palate, pes cavus, and kyphoscoliosis
What is Klumpke’s palsy?
Involves the C8-T1 nerve roots with corresponding dermatomal sensory loss, and weakness of the intrinsic muscles of the hand. Uncommonly, T1 involvement may also result in an ipsilateral Horner’s syndrome.
What is Erb’s palsy?
Involves the C5-6 nerve roots with corresponding dermatomal sensory loss, and the so-called “waiter’s tip” sign with shoulder adduction, elbow extension, forearm pronation and wrist flexion. It is most typically associated with shoulder dystocia and traumatic childbirth.
What is ulipristal acetate also known as?
EllaOne
How does ulipristal acetate work?
selective progesterone receptor modulator (SPRM). It is used as the ‘morning after pill’ by preventing/delaying ovulation.
How does leuprorelin acetate work?
An example of a gonadotropin-releasing hormone (GnRH). These agonists (e.g. leuprorelin acetate) prevent FSH/LH release, used in endometriosis. They shut down the ovaries temporarily and can be useful in treating pain in many women.
What is Lynch syndrome?
Also known as hereditary non-polyposis colorectal cancer (HNPCC), is the most common cause of hereditary colorectal (colon) cancer.
What is Lynch syndrome associated with?
MLH1 gene defect. Lynch syndrome is associated with a significantly increased risk of endometrial cancer (as well as many other cancers such as colon, breastand ovarian)
What is Haemolytic uraemic syndrome?
occurs when there is thrombosis within small blood vessels throughout the body. This is usually triggered by a bacterial toxin called shiga toxin (e-coli 0157).
What is the triad in HUS?
Haemolytic anaemia: anaemia caused by red blood cells being destroyed
Acute kidney injury: failure of the kidneys to excrete waste products such as urea
Thrombocytopenia: low platelet count
How do we manage HUS?
Medical emergency and has a 10% mortality. Urgent referral to paediatrics. Supportive management.
How does orbital cellulitis present?
erythema and oedema around one eye, fever, reduced visual acuity, and painful eye movements
Name a common trigger for orbital cellulitis
Bacterial sinusitis (frontal headache, fever, excessive mucous) is a common trigger.
What is the classic XR finding for necrotising enterocolitis?
grossly distended bowel loops with air within the bowel wall (pneumointestinalis)
Name the triad seen in nephrotic syndrome
Oedema (usually periorbital), proteinuria, hypoalbuminaemia
What is the most common cause of nephrotic syndrome in children
Minimal change disease
Where do you refer ? osteosarcomas to, and how quickly?
Very urgent (48-hour) referral for an X-ray to assess for bone sarcomas. Osteosarcomas are the most common non-haematological primary malignant neoplasm of the bone in children
What is the procalcitonin blood test used for?
Inflammatory markers that could detet bacterial sepsis
What is caput succedaneum?
a collection of fluid that collects due to pressure on the head during vaginal delivery. (C)aput (s)uccedaneum (c)rosses (s)uture lines. This will usually spontaneously resolve within days.
How do we rule out vesicoureteric reflux?
MCUG: micturating cystourethrogram (MCUG) is a scan that shows how well your child’s bladder works
What is vesicoureteric reflux?
s a condition in which urine backwashes back up in the ureters/kidneys from the bladder
How does roseola infantum present, and what is it caused by?
A 3-5 day fever followed by a maculopapular rash is characteristic of roseola infantum, a condition caused by human herpes virus 6.
What is the main complication to be aware of with roseola infantum?
Febrile seizures
What is pavilizumab used for?
A monoclonal antibody that minimises the risk of infection by RSV. It is given subcutaneously once a month during bronchiolitis season.
What peak flow is indicative of a life-threatening episode of acute asthma?
33%
How does fronto-temporal dementia present?
This condition is characterised by a change in personality. Often recognised by the patient’s friends and family, this can include changes in food preference or picking up new, often problematic hobbies like gambling. Memory remains intact until the later stages of the disease. This patient is not exhibiting any of the classical symptoms of Fronto-temporal lobe dementia.
What is the triad seen in Lewy Body dementia?
Triad of REM sleep disorder, a history of falls (secondary to motor problems), and hallucinations.
What is Munchausen’s syndrome?
Where a pt intentionally faking signs and symptoms (i.e. adding blood to urine and complaining of pain) in order to gain attention and play “the patient role”.
What is the peak age of onset for FTD?
55-65 years
How do we treat the symptoms of menopause?
Monthly, cyclical (sequential) HRT is recommended for women with menopausal symptoms who continue to have regular periods. It consists of taking oestrogen throughout the menstrual cycle, with progesterone taken only in the last 14 days. This combination maintains normal monthly periods which is useful because it is then possible to determine when periods naturally stop. When this occurs, it is an indicator of progression to the last stage of the menopause.
How does ovarian torsion present on ultrasound or CT?
Whirlpool sign
What causes hand foot and mouth disease?
Coxsackie A virus
How does transposition of the great vessels present on CXR?
egg-on-a-string’ appearance
What will you see on abd US in intussusception?
Target/doughnut sign
When do we start worrying about squints?
After 8 weeks
What is a common cause of resp tract infections in pts with cystic fibrosis?
Pseudomonas
What is the key differential for a child with a barking cough that doesn’t resolve with treatment?
Bacterial tracheitis
Define aplastic crisis
Reticulocytes <1%
How does aplastic crisis in Sickle Cell Disease present?
Tachypnoea, tachycardia in the absence of splenomegaly
What is a morbilliform eruption?
A generalised maculopapular rash. Morbilliform reactions are extremely common in patients with infectious mononucleosis taking Amoxicillin.
What is the dose of benzylpenicillin in teenage meningitis?
1.2g
How does CF present in childhood?
meconium ileus as a neonate, failure to thrive and loose stool as a toddler, short stature and chronic respiratory disease in older childhood
What does the heel prick test show for a pt with cystic fibrosis?
High immunoreactive trypsinogen
Why can coarctation of the aorta lead to aneurysm formation?
Reduced perfusion pressures distal to stenosis trigger the renin-angiotensin-aldosterone system with limited effect as this won’t overcome the stenosis. It however will increase perfusion pressures before the stenosis, including the carotids, resulting in higher cerebral perfusion pressures which can cause aneurysms to form.
What causes inguinal hernias in children?
caused by failure of the processus vaginalis to obliterate
What is formication, and where is it seen?
Sensation of insects on the skin, seen in delirium tremens
What is the main SE of memantine?
Constipation
What are neuroleptics?
Neuroleptics, also known as antipsychotic medications, are medications that block dopamine receptors in the nervous system.
How does neuroleptic use impact pts with Lewy Body Dementia?
Causes a deterioration in parkinsonism
What is neologism?
Coining new words together
What is monomania?
The preoccupation with a single subject to a pathological degree
What is logoclonia?
Where a pt repeats the last syllable of a word or phrase.
What is Lichen sclerosus?
a chronic inflammatory skin condition which affects the anogenital area (specifically the glans penis and prepuce in men). The lesions are white thickened papules and/or plaques. Itch can occur, and there may be pain if there are fissures or erosions.
What is Sheehan’s syndrome?
post-partum pituitary gland ischemic necrosis due to blood loss and resultant hypovolemic shock in the immediate post-partum period. Presents with hypothyroidism symptoms.
What is the cut-off for surgical fibroid treatment?
Symptomatic and 3cm or larger. Treated with myomectomy - removes the fibroids from the uterus
What is a cystocele?
A cystocele is the herniation of the bladder into the vagina. There may also be a concurrent urethrocele which is the prolapse of the urethra into the vagina.
What is HSP?
Henoch-Schonlein Purpura (HSP). HSP is the most common small vessel vasculitis in children
How does HSP present?
a purpuric rash over the legs and buttocks, abdominal pain, arthralgia and haematuria
What is the other name for slapped cheek syndrome?
Erythema infectiosum
How does foetal alcohol syndrome present?
Microcephaly, short palpebral fissures, hypoplastic upper lip, absent philtrum, reduced IQ, and cardiac abnormalities.
What is the most common complication associated with measles infection?
Acute otitis media
What is the first line treatment for impetigo?
Hydrogen peroxide 1% cream
A child presents with vomiting after being laid flat and crying with arching of the back and drawing up the knees to the chest. Diagnosis?
Reflux
What is eczema herpeticum?
A serious infection and a dermatological emergency. Urgent anti-viral therapy with acyclovir is required
How does eczema herpeticum present?
Blistering rash over face and high fever. Appears unwell.
How do Kwashiorkor and marasmus differ?
Kwashiorkor no protein but good calories, meramus protein and energy malnutrition
If clomifene and metformin fail in infertility treatment secondary to PCOS, what is the second line treatment?
Laparoscopic drilling
What are the criteria for use of lactational amenorrhoea as an effective contraceptive?
The woman has complete amenorrhoea. The woman is fully, or nearly fully (>85% of feeds are breast milk) breastfeeding. It has been six months or less since the birth of the baby.
How does vasa praevia present?
Rupture of membranes followed immediately by vaginal bleeding
What is Asherman’s syndrome?
Characterised by intrauterine adhesions commonly as a result of previous uterine surgery such as dilation and curettage. It can lead to obstruction to the menstrual outflow tract which presents as secondary amenorrhoea
How do we diagnose Asherman’s syndrome?
HSG or hysteroscopy might be needed for confirmation.
What are reflex anoxic seizures?
Paroxysmal self limited periods of asystole that aretriggeredby pain, fear or anxiety
What is alprostadil?
Prostaglandin E1 - prevent ductus arteriosus from closing
How does slapped cheek syndrome effect pregnant women?
asymptomatic in pregnant women but can cause cross the placenta and cause severe anaemia in the fetus due to viral suppression of fetal erythropoiesis. This causes hydrops fetalis and carries a high risk of intrauterine death.
How does Prader-Willi syndrome present?
learning difficulties, hyperphagia (insatiable appetite) and obesity with a background of hypotonia, poor feeding and developmental delay
What causes congenital adrenal hyperplasia?
90% is caused by 21-hydroxylase deficiency
How does CAH present?
There is virilisation of the female external genitalia due to overproduction of ACTH and subsequently adrenal androgens, and a salt wasting crisis caused by deficiency of aldosterone.
What is phenylketonuria?
An autosomal recessive disorder from an enzyme mutation that leads to high levels of the amino acid phenylalanine in the blood. Avoid diet pepsi.
What is tabes dorsalis?
The progressive degeneration of the dorsal columns seen in late-stage syphilis (tertiary syphilis). Treponemal antibodies will be positive
What is the action of triptans?
Selective serotonin receptoragonistswith high affinity for the 5HT 1B/D receptors.
What do we combine IM haloperidol with for de-escalation?
IM promethazine
What would be monitor with lithium use?
Renal/thyroid disfunction
How do we treat multiple viral-induced wheeze admissions?
Inhaled corticosteroid or montelukast
What is the action of leukotrienes?
Inflammatory mediators which cause bronchoconstriction, inflammation, microvascular permeability and mucus secretion
What is the difference between diffuse and focal crackles on paediatric resp examination?
With pneumonia, localising signs on chest examination would be expected, such as focal rather than diffuse crackles
How do we rehydrate children first-line?
Nasogastric or orogastric fluids
What is a tet spell?
cyanosis following exertion (e.g. feeds or crying). Seen in tetralogy of fallot
What are the five features of tetralogy of fallot?
Pulmonary stenosis Right ventricular hypertrophy Overriding aorta Ventricular septal defect (VSD) Ejection systolic murmur (pulmonary stenosis)
Where would you see the “Coeur-en-sabot” finding?
In ToF, which is a characteristic boot-like appearance associated with RVH. Not a common finding.
What is a Blalock-Taussig shunt?
A surgical shunt between the subclavian and pulmonary artery. The pulmonary circulation does not receive enough blood from the right ventricle due to outflowobstruction. The shunt allows for perfusion of the pulmonary circuit, thereby improving oxygenation.It is used only as a temporary holding measure until surgery
How do we treat severe croup with impending airway obstruction that hasn’t responded to steroids?
Nebulised adrenaline can provide temporary relief of airway obstruction
What is the Westley score?
Used to quantify croup severity
What imaging must all myasthenia gravis pts have?
Thymus imaging, usually through a CT chest. 10% will have a thymoma, whilst 70% have thymic hyperplasia
What is pyridostigmine used for?
Acetylcholinesterase inhibitor. Inhibition of acetylcholinesterase causes a reduced breakdown of acetylcholine and an increased concentration of acetylcholine in the synaptic cleft, resulting in symptomatic relief of weakness
Which abx are avoided in myasthenia gravis?
Aminoglycosides, polymyxins, macrolides, quinolones, and tetracyclines should be avoided if possible[6]. Aminoglycosides and polymyxins areparticularlythought to interfere with neuromuscular junction transmission and exacerbate weakness.
How does scarlet fever present?
initially presents with non-specific features such as headache, fever, sore throat. The characteristic rash is described as ‘sandpaper’ texture and children can develop ‘strawberry tongue’, named as the tongue appears bright red
How do we treat scarlet fever?
Abx
What is the most common finding at paediatric cardiac arrests?
Asystole
What is scissor walking, and where is it found?
Periventricular damage (due to a hypoxic ischaemic event during a prolonged delivery due to the baby getting stuck) is the aetiology behind spastic diplegia.
How do we treat persistent ductus arteriosis?
If symptomatic, this can be managed medically with a prostaglandin synthesis inhibitor (NSAID) like indomethacin, causing vasoconstriction to close the duct.
What murmur is found in PDA?
Continuous machine-like murmur
What are Koplik’s spots?
Koplik’s spots (grey) on his buccal mucosa which supports the diagnosis of measles.
This child has presented with fever, chest pain and shortness of breath on a background of sickle cell disease which makes the most likely diagnosis…
acute chest syndrome
How do we treat uterine inversion?
Immediate replacement of the uterus is the best first step as the greater the delay in attempting this, the greater the likelihood the manoeuvre will fail. General resuscitation measures should also be taken and tocolytic drugs can be used to aid replacement of the uterus if a first attempt fails.
What is polymorphic eruption of pregnancy?
also known as pruritic urticarial papules and plaques of pregnancy (PUPPP) typically present in the third trimester. It occurs as itchy red patches and often first appears on the abdomen, particularly over striae.
