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specialties - go over this > things i forgot > Flashcards

things i forgot Flashcards

1
Q

when does cooarctation of aorta present

A

most common at 48 hours when the ductus arteriosus closes

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2
Q

secondum ASD pathophysiology

A

patent foramen ovale

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3
Q

coaarctation tx

A

PGE1 infusion
surgical repair

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4
Q

placenta praevia delivery

A

asx 36-37 weeks

34-36+6 for those with hx of vaginal bleeding and other RF associated with preterm delivery

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5
Q

streptococci infective endocarditis

A

benzylpenicillin

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6
Q

staph infective endocarditis

A

flucloxacillin

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7
Q

PDA increases risk of

A

bacterial endocarditis

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8
Q

PDA tx

A

indomethacin
surgical ligation

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9
Q

pulmonary stenosis tx

A

transcatheter balloon dilatation

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10
Q

differentiating pulmonary stenosis vs aortic stenosis

A

aortic stenosis has carotid thrill

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11
Q

which antibiotic for acute epiglottitis

A

cefotaxime
rifampicin for household

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12
Q

allergic rhinitis ladder of tx

A

intranasal antihistamines > intranasal corticosteroids > intranasal decongestants e.g. epherdrine >. consider subcut immunotherapy for house dust mite allergen, etc

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13
Q

difference in asthma mx between <5 and 5-16yo

A

<5 = if LTRA doesnt work - stop LTRA and refer
5-16 = if LTRA doesnt work - stop LTRA and add LABA

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14
Q

moderate asthma severity

A

use metered dose inhaler

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15
Q

you admit moderate asthma patients - true or false

A

depends - have a lower threshold if young. also if admitted before

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16
Q

bronchiolitis tx

A

if necessary -
humidified oxygen
CPAP
fluids

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17
Q

new notifiable disease

A

covid

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18
Q

croup admit if

A

stridor at rest

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19
Q

cystic fibrosis prophylactic abx

A

flucloxacillin
azithromycin

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20
Q

cystic fibrosis mucoactive tx

A

rhdnase
hypertonic sodium chloride +/- rhdnase
mannitol dry powder for inhalation

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21
Q

cystic fibrosis causes which GI cx and how to tx

A

distal intestinal obstruction syndrome

tx with gastrografin and laxatives

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22
Q

inhaled foreign body tx

A

conscious -
1 encourage cough,
2 5x back blows,
3 5x abdominal thrusts (chest thrusts in under 1)
4 rigid or flexible bronchoscopy
usually rigid

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23
Q

lactose intolerance tx

A

refer to dietician

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24
Q

ix you can do in lactose intolerance

A

usually clinical
but can do breath hydrogen test

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25
Q

hyperemesis ladder of tx

A

antihistamines > antiemetics > steroid

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26
Q

laryngomalacia tx

A

endoscopic supraglottoplasty
GORD tx

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27
Q

otitis externa tx

A

ciprofloxacin ear drops

oral fucloxacillin if immunocompromised or severe

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28
Q

pneumonia in child tx

A

amox 5 days

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29
Q

sinusitis tx

A

sx<10d nothing
>10d consider high dose nasal corticosteroids

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30
Q

sleep disordered breathing

A

adenotonsillectomy

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31
Q

fever pain

A

need 4-5 for likely GAS
Fever over 38°C.
Purulence (pharyngeal/tonsillar exudate).
Attend rapidly (3 days or less)
Severely Inflamed tonsils
No cough or coryza

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32
Q

centor score

A

3-4 needs abx

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33
Q

urticaria

A

cetirizine

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34
Q

viral episodic wheeze

A

burst therapy
review in 48 hours

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35
Q

asthma follow up

A

if not admitted - review in 48hours
if admitted - review in 2 days

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36
Q

admit whooping cough if

A

under 6m or acutely unwell
significant breathing difficulties

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37
Q

whooping cough school exclusion

A

48 hours post abx or 21d since cough onset

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38
Q

anal fissure tx

A

stool softeners
increase fluid intake
glyceryl trinitrate intra-anally

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39
Q

1st line investigations in appendicitis

A

USS (rare<3yo)

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40
Q

clinical shock

A

weight loss>10%
cold extremities
pale or mottled skin
consciousness altered
hypotension
weak pulses
prolonged cap refill
NOT REDUCED SKIN TURGOR

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41
Q

moderate vs mild dehydration tx

A

ORS 100ml/kg for MODERATE
ORS 50ml/kg for MILD (<5%)

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42
Q

alginate therapy trialed for ..

A

1-2 weeks

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43
Q

more common side of inguinal hernia

A

right

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44
Q

umbilical hernia tx for

small and asx

large and sx

A

observation until 4-5 years of age

elective repair at 2-3 years of age

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45
Q

intussuception abx

A

clindamycin and gentamicin

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46
Q

IBS mx

A

diarrhoea - loperamide
antispasmodic - pain

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47
Q

pyloric stenosis fluids

A

1.5x fluid maintenance

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48
Q

UC induction

A

topical ASA > oral ASA > steroids

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49
Q

meningitis child tx

A

<3m = cefotaxime + amoxicillin
>3m = ceftriaxone

can give dex if >3m

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50
Q

second line kawasaki

A

steroids and infliximab

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51
Q

measles cx

A

otitis media
pneumonia
encephalitis
subacute sclerosing panencephalitis
keratoconjunctivitis

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52
Q

eczema severe itch

A

non-sedating antihistamine

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53
Q

erysipelas tx

A

penicillin V

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54
Q

head lice tx

A

wet comb and or malathion

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55
Q

HSP tx

A

supportive
joint pain - NSAIDs
scrotal involvement of SEVERE oedema or pain - oral prednisolone
in renal failure - iv corticosteroids

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56
Q

paraphimosis - definition and tx

A

urological emergency - foreskin becomes trapped in the retracted position

tx with analgesia and attempt to reduce gently with warm saline

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57
Q

retinoblastoma tx

A

vitreous seeding present (floaters) - enucleation

minimal or none - systemic chemo

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58
Q

Still’s dx

A

NSAIDs
DMARDs
high dose steroids

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59
Q

absence seizure tx

A

ethosuximide + valproate

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60
Q

ondansetron problem

A

increased risk of cleft lip

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61
Q

focal seizure tx

A

carbamazepine

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62
Q

which ectopic women cant have IUD

A

those tx with salpinectomy

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63
Q

do not use gestational age from the LMP alone to determine whether a fetal HB should be visible - true of false

A

true

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64
Q

ectopic follow up

A

if had methotrexate - day 4 and day7 bhcg, then 1 per week

if had surgery - bhcg on day 7 post op and then once a week until negative

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65
Q

patch missed change

A

<48 hours is fine

week1+2 >48 hours
change immediately, barrier for 7 days, emergency contraception if <5d since UPSI

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66
Q

“other” ukmec 4

A

HTN >160 syst or >100 dias
cirrhosis
CURRENT BC
PAST VTE
liver tumour
diabetes w complications

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67
Q

vomiting and contraception

A

< within last 2 hours - COCP and levonorg
within last 3 hours - ellaone

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68
Q

cocp and pop confer immediate protection if

A

started on day1-5 of cycle

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69
Q

rotterdam criteria requires anovulation for how long

A

> 2y

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70
Q

pcos oligomenorrhoea tx

A

REFER FOR TVUSS
weight loss
cocp or cyclical progesteron

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71
Q

pcos hyperandrogenism tx

A

co-cyprindiol +- eflornithine cream
metformin

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72
Q

pcos fertility tx if medical doesnt wrok

A

laparoscopic ovarian drilling

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73
Q

PCOS ovaries

A

12+ follicles (measuring 2-9mm in diameter) or volume increase by 10cm^3

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74
Q

PCOS long term cx

A

diabetes
CVD
OSA
endometrial cancer

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75
Q

pcos lady becomes pregnant - what do u offer

A

OGTT at 24-28weeks

76
Q

poi definition

A

menopause sx PLUS 2x FSH >30 4-6 weeks apart

77
Q

HRT no uterus

A

oestrogen only

78
Q

menopause in under 50 mx

A

offer HRT or COCP

79
Q

menopause urogenital sx

A

vaginal oestrogen

80
Q

HRT and breast cancr

A

NEVER AFFECTS THE RISK OF DYING FROM BREAST CANCER
O+P INCREASES RISK OF GETTING BREAST CANCER (P COMPONENT)

81
Q

peri-menopause HRT

A

cyclical - monthly for regular periods, 3monthly for irregular

82
Q

abx prophylaxis for surgical mx of TOP

A

doxy 7d or stat azithro

83
Q

ultrasound and TOP

A

required after to confirm evacuation

84
Q

HRT contraindications

A

breast cancer - past or present

85
Q

alternative to standard PID regimen

A

ofloxacin + metronidazole for 14d

86
Q

swabs for PID

A

triple - 2x endo and 1 HVS

87
Q

what to consider adding to prescription for medical mx of urge incontinence

A

if old - consider topical vaginal oestrogen

88
Q

surgical mx of urge incontinence

A

botulinum toxin type A
percutaneous sacral nerve stimulation

89
Q

uterine prolapse srugcial tx for women who wants to retain fertility

A

vaginal sacrospinous hysteropexy

90
Q

pessary types

A

ring - sex is fine
shelf - cant have sex
gelhorn - cant have sex
cube - advanced prolapse

91
Q

GnRH should not be used for more than 6m due to risk of…

A

osteoporosis

92
Q

endometriosis - does tx have to wait for imaging dx

A

no medical mx can start with clinical suspision even with normal TVUSS

93
Q

endometriosis surgery in women A who wants baby but not NOW versus B who wants baby ASAP

A

both laparoscopic excision or ablation of endometriosis
A should receive hormone therapy post op
B should receive adhesiolysis with NO HORMONES POST OP

women with endometriomas should be oiffered excision of the cyst wall

94
Q

benefit of UAE for fibroids

A

women who dont care about fertility but do not want surgery

95
Q

how do injectsble GnRH work for fibroids pre surgery

A

induce menopausal state

96
Q

lichen sclerosus tx

A

betamethasone valerate or mometasone
if doesnt work - tacrolimus

97
Q

dx of PMS

A

> 2 cycle sx diaries

98
Q

CC IA2-IB2

A

radical hysterectomy and BSO

smaller (<4) can be tx with radical trachelectomy

IB3 = chemoradiation

99
Q

cc stage 2 vs 3

A

2 = upper 2/3 vag
3 = lower 1/3 vag

100
Q

ovarian cancer tx

A

midline laparatopy - TAH + BSO
grade 1 low risk do not require chemo
figo stage 1 doesnt require retrograde lymphadenopathy

above this - adjunct chemo - cisplatin

101
Q

vaginal cancer tx

A

figo 1 - WL excision +- neoadjuvant chemo = radical surgical excision with 10-15mm clear margin
above figo 1 = radical vulvectomy + bilateral inguinal lymphadenectomy

102
Q

vulval cancer sx

A

vulval swelling
vulval ulcer
pruritus, pain, bleeding, discharge

103
Q

biggest RF for ashermans

A

d&c after miscarriage

104
Q

asherman ix

A

saline hysterosalpingogram

105
Q

fluclox for mastitis if

A

nipple fissure present
sx not improve since 24-48hr of effective breast removal

106
Q

tx for breast abscess

A

immediate referral to general surgeon for:
1. confirmation by ultrasound
2. incision and drainage

107
Q

duration of LNG-IUS tx for EH w/out atypia

A

at least 6m
require 6monthly surveillance

108
Q

EH w/out atypia with BMI>35 or taking only oral progesterones require what extra

A

6monthly biopsies

109
Q

EH w/atypia but declines surgery - what now

A

LNG-IUS
3monthly surveillance

110
Q

turners associated to which ovarian tumour

A

dysgerminoma

111
Q

5mg folic acid

A

diabetic
BMI>30
epileptics
SCA

112
Q

vaccine in preg

A

flu and covid straight away / anytime
pertussis from 16wk

113
Q

iron <___ at ___week scan - give iron tablets

A

11
16

114
Q

major RF for IUGR (not inc ones you always remember)

A

PAPPA<0.4
cocaine use
previous still birth
mum>40yo
chronic HTN

115
Q

Women with a single SFH which plots below the 10th centile or serial measurements which demonstrate
slow or static growth by crossing centiles should be referred for ultrasound measurement of fetal size.

A

.

116
Q

use of middle cerebral artery doppler

A

no use in preterm foetus - use Ductus venosus Doppler instead
use in term fetus to estimate acidosis at birth and hence estimate delivery

117
Q

delivery of iUGR

A

AREDV - csection
otherwise can offer IOL

118
Q

sca mx pregnancy

A

stop hydroxyurea 3m before pregnancy
low dose aspirin from 12 weeks
delivery is IOL at 38 weeks

119
Q

all women should take

A

10 micrograms of vitamin D

120
Q

most common cause of PTL

A

infection

121
Q

how does previous PPROM affect future pregnancies

A

go straight to obstetrician led care

122
Q

when is magnesium sulphate indicated over 30 weeks

A

PTL or PTL in next 24 hours - CONSIDER MGSO4 infusion for 30-33+6 weekers (NOT PPROM)

123
Q

other signs of mgs40 toxicity apart from resp depression

A

oliguria –> renal failure
arrythmias

124
Q

macrosomic babies

A

cannot have induction

diabetic mums with normal sized fetuses are offered early induction of labour as reduces incidence of IOL

125
Q

bilateral shoulder dystocia

A

zavanelli method

126
Q

cord prolapse on CTG

A

variable decelerations is classic sign

127
Q

bishop score <6 but pt has high risk of HS or is attempting VBAC

A

balloon catheter

128
Q

how does membrane sweep work

A

releases physiological prostaglandins

129
Q

contraindication to PPROM IOL

A

<34weeks

130
Q

If a woman has PPROM after 34+0 weeks (but before 37+0 weeks), and has had a positive GBS at any time current pregnancy

A

offer immediate induction of labour or caesarean birth.

131
Q

PGE2 for induction

A

dinoprostone is vaginal tablet
or oral misoprostol

132
Q

why is ARM only indicated if bishop>6

A

baby will likely be high if BS<6
risks cord prolapse

133
Q

epidural effect on 1st and 2nd stage of labour

A

no change on 1st stage length
linked to increased length of 2nd length - and requirement for assisted delivery

134
Q

chronic htn/gestational htn/pre-eclampsia need what scans

A

USS and Umbilical artery doppler:
chronic HTN - week 28, 32 and 34
gestational HTN - every 2-4 weeks
pre-eclampsia - every 2 weeks

135
Q

intrapartum BP measuring

A

hourly
every 15-30 mins if >160/110

136
Q

when to consider mgso4 in pre-ec delivery

A

previous eclampsic fits OR
any signs of severe pre-eclampsia:
- severe headaches
- scotomata
- N&V
- epigastric pain

137
Q

who gets specialist fetal scan at 20ish weeks

A

cardiac disease mums
diabetic mums

138
Q

listeria amoxicillin administration

A

IV

139
Q

hiv and coinfection of hep c

A

ELCS

140
Q

gestational diabetes postnatal fasting BG interpretation

A

<6 = moderate chance of T2DM
6.1-6.9 = good chance
>7.0 = near certain
offer insulin if this is over >7

141
Q

2 things elevated in AFLP

A

ALT
uric acid

142
Q

AFLP mx

A

DELIVER when stablised pt

143
Q

placenta praevia delivery if stable

A

34-36 if hx of bleeding
36-37 if has been asx all pregnancy

144
Q

stable abruption >37 weeks

A

induction of labour

145
Q

stable abruption <37weeks

A

admit, give steroids - discharge after 48 hours/bleeding stopped if stable

146
Q

DCDA delivery

A

37wks

147
Q

MCDA delivery

A

36wks

148
Q

no accelerations

A

f hypoxia

149
Q

pemphigoid gestationis

A

DISCRETE LESIONS starts on abdo(50%)
spares face
potent topical steroids or ral pred

150
Q

prurigo of preg

A

excoriated lesions on extensor limbs, abdo and shoulder

151
Q

pruritis folliculitis tx

A

topical steroids

152
Q

section 35 vs 37

A

35 - 28d assessment of accused - no appeal
37 - 6m treatment stint for convicted - appealable

153
Q

section 47

A

transfer of prisoner to hospital

154
Q

diabetics - best antipsychotic

A

aripip or 1st gen APs

155
Q

atypical which confers highest risk of hyperprolactinaemia

A

risperidone

156
Q

HTN associated with which antipsychotics

A

clozapine MAINLY
aripiprazole
olanzapine
quetiapine
risperidone

157
Q

specific aripiprazole SE

A

diplopia

158
Q

quetiapine specific SE

A

sleep anoea

159
Q

things to monitor on antipsychotics

A

lipids
weight
blood sugar
cardiac risk
blood pressure
FBC

160
Q

RIMA

A

moclobemide

161
Q

5 signs of BZD withdrawal

A

anxiety
slurred speech
insomnia
irritbility
tinnitus

162
Q

BZD OD

A

resp depression
low BP
dilated pupils

163
Q

BSD intoxication

A

slurred speech
ataxia
stupor

164
Q

tx for the following:

ALCOHOL W/DRAW SEIZURE
DELIRIUM TREMENS
OUTPATIENT W/DRAWAL
INPATIENT W/DRAWL

A

IV lorazepam

Oral lorazpam AND thiamine IV/IM

oral chlordiazepoxide + thiamine IV/IM

oral chlordiazepoxide + thiamine iV/IM rapid reducing dose

NO SEIZURES OR NOT DELIRIUM THEN CHLOR>LORAZ

165
Q

features of DT

A

lilliputian hallucinations
anterograde amnesia
fever
CVS collapse
agitation

166
Q

fluox to TCA

A

Stop fluoxetine over 2 weeks, start TCA at a low dose 4–7 days later and increase dose very slowly

167
Q

non-fluoxetine SSRI to another non-fluoxetine SSRI

A

direct switch

168
Q

Rapid-cycling bipolar disorder

A

defined as the experience of at least four depressive, manic, hypomanic, or mixed episodes within a 12-month period.

169
Q

preservation

A

repitition of words in attempt to change the topic

170
Q

social phobia nice recommendation

A

education + self help
CBT
SSRI

171
Q

nicher “low” things in anorexia

A

ESR
platelets, wcc,hb

172
Q

nicher “high” things in anorexia

A

LFTs
salivary glands

173
Q

anorexia pregnancy

A

advised to not
also refrain from progesterone injectable - osteoporosis risk

174
Q

If individual CBT-ED, MANTRA, or SSCM is unacceptable,

A

eating-disorder-focused focal psychodynamic therapy (FPT) may be considered

175
Q

contraindications to anticholinesterases (which can only be prescribed from specialists)

A

NSAIDs
anticholinergics
beta blockers

176
Q

contraindications to anticholinesterases (which can only be prescribed from specialists)

A

NSAIDs
anticholinergics
beta blockers

177
Q

VTE prophylaxis post c section

A

LMWH 10d if emergency
LMWH 10d if elective and mum has RF including smoking, age, mobility, BMII
stockings if multiple RF

178
Q

AD vs VD

A

VD retains most personality

179
Q

VD sx

A

stepwise decline
labile
cognitive deficit
focal neurology

180
Q

methadone - check what

A

ECG for long QTc

181
Q

Foetal Hydantoin Syndrome

A

associated with phenytoin/carbamazepine use

IUGR
hypoplastic finger nails
microcephaly
cleft lip
distal limb deformities

182
Q

RR in pregnancy

A

no change

183
Q

what causes decrease in peripheral resistance in pregnancy

A

progesterone

184
Q

Chloasma gravidarum

A

hyperpigmentation of face

185
Q

dyskinetic cp

A

basal ganglia
causes involuntary movements
fanning fingers
twisted appearance

186
Q

ataxic cp

A

biggest genetic component
hypotonic
balance issues
tremor
delayed motor development

187
Q

TOF feature

A

clubbing

specialties - go over this (1 decks)

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