Stations Flashcards
Investigationes and managment for bronchiolitis
Investigatins ==> Usuallly a clinical diagnosis, but can do a NPA to confirm, if the baby is exceptionally distressed then perform CXR to rule out pneumonia
Management ==> Criteeria for hospital admission: Apnoea, grunting, SpO2 < 92%, poor oral FLUID intake, severe respitraotry distress.
Supportive therapies such as nassal O2, NG tube, CPAP if respiraotry failure.
Consider palivizumab in high rist infants
Investigations and management for ALL in girl
Investigations ==> FBC, U+Es for TLS, film, CXR, biopsy
Management ==> Supportive (blood products, abx, managemetn fo tumour lysys synrome)
Systemic chemotherapy (2-3 years of indcution and maintentce)
CNS specififc therapies (intrathecal)
Molecular therpeis (if psoitive for Ph imantinib, even rituxmab)Boen marrow transplantation
Investigations and mangament for Delusional disorder
Investigations ==> Hisotry + MSE, exclude organic casues
Mangmenet ==> biopscyhosocial approach
biological ==> limited evidence for antipsychotic medications
Psychological ==> psychoeducation + individual CBT
Social ==> Social skills, family therapy, psychoeducation
Investigations and managment for elderly depression
Investigatiosn ==> Full hisotry and examination, FBC, TFTs, glucose, rating squales such as PHQ-9, HAD
Management ==> Stepped care approach, 1. wathcful wianign and psychoeducation, 2. Low intensity psychological intervention, 3. high intensity + medications, 4. High intesity + ECT
Investigations and management for preterm labour
Investigations: CTG, urine dip / MC&S if indicated
Management: ruptured ==> treat like PPROM
non-ruptured < 34 weeks ==> tocolysis, steroids
non-ruptured < 30 weeks ==> MgSO4
if extremently premature without complication, emergency cerclage may be performed
vaginal prgesterone and cerlage may be used in at risk women
Investigatiosn and management for Endometrial cancer
Investigations: Pelvic examination ==> bulky uterus, TVUSS ==> >4mm then ==> Hysteroscopy (could show complex hyperlasia with atypia)
Managament: Dependent on FIGO stage
Stage 1 ==> TAH, BSO, peritoneal wahsings
Stage 2+ ==> radical hysterectomy + radiotherpay
Hormones ==> high does oral / intrauterine progestins in women with complex atypical hyperplasisa (not suitble for surgery)
Investigations and manegemetn for Panic disorder
investigations: signs and symptoms of anxiety
Management ==> typical for anxiety
investigations and management for Gestational diabetes
Investigations: urine dip, previous GDM ==> immediated OGTT
Other risk factors ==> OGTT at 24-28 weeks
Managemnet ==> review iwthin one week at daibetes clinic
==> you know the step wise managemnt withing pregnancy
==> IOL or ELCS 37 - 39 weeks, monitor glucose every hour during labout, discontinue medications immediately following labour, GP to perform OGTT at six week check
Non accidental injury workup
MDT ==> senior colleauges, police, delegated child protection doctor, social services, multi agency safeguarding hub
Shaken baby ==> retinal haemorrhages, brain swelling, subdural
Invesitgations ==> skeletal + body survey (important for baseline!!)
==> check child rptection register
==> CT head / fundoscopy + bloods to rule out other differentials
Psychosis workup
investigations ==> collateral hisotry, physical exam, bloods urine drugs screen (i.e.rule out organic causes)
==> breif psychitric rating scale
==> ADL assessment
Managemnt ==> emergency == crisis resolution team, otherwise == EIP
==> Rapid tranq / admission may be considered for obvious reasons
==> antipschotics firs tline for all schizophrenia
==> CBT to be offered with a specific focus on reality
==> social skills training, education, risk assessment
Monitoring ==> cna be done by GP, weight, waist, HR BP
Dementia work up
History ==> look out for four As, Psychiatric presentationa and behavioural
Investigations ==> Screen with AMTS, investigate with MMSE, MoCA, ACE-R
==> exclude orgnaic pathology (TFTs, LFTs, U+Es, glucose, B12)
==> imaging (PET, MRI)
==> Refer to memory assssment clinic
Management ==> biopychosocia approach
Bio ==> anticholinesterases ro aspirrin (dpeend on vareity)
Psycho ==> group cognitive stimulation therapy
Socialogical ==> Minmise comorbidities, occupational therpist, carer support, medication review
AMTS
- Wha ttime is it to the nearest hour
- blah
- blah
- remomber 32 west street
- where are we
- identify two people
- when i syou birthday
- when was WW2
- who is the primemnister
- count backwards from 20
- what was the address
PPROM work up
if membrnaes intact and premature, manage as per premature labour (tocolyiss etc)
PROM ==> expectant mangmeent, most will labour wihtin 24 hours, of there is meconium staining induce immediately
Pre-term PROM ==> admit with expectant manement untill 37 weeks, no tocolyiss, administer seroids, administer eryhtromycin, mag sulf if less than 30 weeks
==> in both carefully monoitor for choriamnionitis (crp, tempertatire, WCC, CTG, clinical assessment)
Complications of preterm birth
Big 4: RDS, NEC, IVH, HIE
Atrophic vaginits
Investigations for AV (clinical, swabs, biposy)
Managemnt ==> Systemic HRT, PV oestrogen, lubrivants
