Things I Got Wrong Flashcards
What are the risk factors for gastroschisis?
IUGR, prematurity, tobacco use, nulliparity
What is seen on the examination of someone with a SUFE?
Hip held in flexion and external rotation, with reduced internal rotation
What blood results are seen in in rickets
Low vitamin D, low calcium, high ALP (ALP is a marker of bone formation - if ALP is raised without GGT, it’s a bone issue)
What is the management of axillary node involvement in breast cancer?
It can either be ANC, or radiotherapy. ANC is required if a SNB has shown that >3 nodes have cancer, if cervical lymphadenopathy is palpable, if the cancer has spread beyond the nodes
What are the risk factors for an amniotic fluid embolism?
Advanced maternal age, vacuum assisted delivery, placental abruption, abdominal trauma
What is gravidity?
The number of times a woman has been pregnant, regardless of outcome
What is parity?
The number of times the woman has given birth to a fetus beyond 24 weeks, regardless of outcome
What diabetes medication should be offered to someone with severe CKD?
SGLT2 inhibitors - metformin is not advised in people with severe CKD as it is renally excreted, meaning it can build up in patients with CKD and cause lactic acidosis
Which medication decreases pleasure when drinking alcohol?
Disulphiram, as it causes unpleasant side effects like facial flushing, nausea and vomiting, sweating and headache when even small amounts are consumed
What medication reduces cravings for alcohol?
Acamprosate, by increasing GABA
What medication makes alcohol and opioids less pleasurable by reducing their effects?
Naltrexone, by blocking opioid receptors
What number on the AUDIT score indicates harmful drinking?
8
What number on the CAGE score indicates harmful drinking?
2 or higher
What is an illness behaviour?
A person’s actions and reactions to physical symptoms and sensations for the purpose of obtaining relief, and how they define their health status - how they monitor and interpret their symptoms, how they use healthcare resources, how they describe their symptoms to HCPs
How should you manage the referral of undescended testes?
- If there is a suspected disorder of sexual development, urgently refer to a paediatrician within 24 hours for urgent endocrine and genetic investigation
- If one teste has not descended, watch-and-wait can be used, should have descended by 3m ⇒ may descend spontaneously if left
- If it hasn’t descended by 3m, routinely refer to a specialist
- Surgery is required if they have not descended by 6 months (orchidopexy), and it should be done by the age of 1
How can omeprazole cause hyponatraemia?
SIADH
How does deltaparin cause hyperkalaemia?
By reducing aldosterone production in the adrenal glands.
What is the greatest risk factor for a fall?
A previous fall
Does amitriptyline have anticholinergic properties?
Yes - can’t pee, can’t see, can’t spit, can’t shit
What is another important side effect of amitriptyline in the elderly?
Postural hypotension
Why do bisphosphonates cause atypical fractures?
They can oversuppress bone turnover and formation (by inhibition of osteoclasts)
What is the most common type of brain tumour in adults?
Metastases
What is the first line hypertensive in a diabetic?
ACEi
What should be avoided during metronidazole treatment?
Alcohol, during the treatment and up to 48 hours later, as it can cause a disulphiram reaction (sickness, stomach pain, hot flushes, palpitations)
What enzyme abnormality is seen in pyloric stenosis?
Hypochloraemic hypokalemic alkalosis
Give 2 examples of medications that should be stopped during an AKI
Ramipril and ibuprofen
What are the stages of the Stages of Change / Transtheoretical Model?
Precontemplation
Contemplation
Preparation
Action
Maintenance
What is an example of a risperidone depo regime?
Risperidone 75mg every 4 weeks
What type of memory loss does ECT cause?
Retrograde amnesia
What mode of inheritance is CMT?
Autosomal dominant
What mechanism of action is tamsulosin?
Alpha blocker
What is the gold standard investigation for coeliac disease?
Endoscopy and Intestinal biopsy
What are the contraindications to LP?
Raised ICP, meningococcal septicaemia (coning), coagulation disorder, focal neurology, if it will delay prompt treatment of meningitis, haemodynamic instability etc
What are infants at risk of if they drink cows milk?
Iron deficiency anaemia. Iron deficiency anaemia can present as irritability, fatigue, developmental delay and poor cognition. Conjunctival pallor and glossitis are also clinical features of iron deficiency anaemia
A baby cries upon stimulation. What is their score for G on an APGAR?
2 - a grimace would be 1, and no response would be 0.
A baby has flexed arms that resist extension. What is their score for A on an APGAR?
2 - flexion without resistance would be 1, and no response/floppy would be 0.
What are the cut offs for normal, abnormal and very abnormal in an APGAR?
Scores of 7 or greater indicate the neonate is in good health and is reassuring. A score of 4-6 is considered moderately abnormal. A score of 3 or less is low
What is the pathophysiology of Hirschprung’s disease?
Absence of parasympathetic ganglion cells in the myenteric plexus
What conditions are associated with Hirschprung’s?
MEN type 2, Down’s syndrome
How do you calculate a resus bolus in children?
20ml/kg over <10minutes, 0.9% NaCl (I think 20 is normal, 10 in DKA to prevent cerebral oedema)
What maintenance fluids do children receive?
100ml/kg for first 10kg = 1L
50ml/kg for second 10kg = 500ml
20ml/kg for remaining kgs
0.9% NaCl + 5% glucose
What monitoring is required for a patient on clozapine?
FBC, blood level, lipids, weight, fasting glucose
What’s the difference between tardive dyskinesia and acute dystonia
Acute dystonia is a movement disorder that involves involuntary muscle contractions such as abnormal postures, slow, repetitive movements, cramping, painful contractions, anxiety
Tardive dyskinesia is similar, causing mild to severe twitching, shaking, or jerking in the hands, feet, face, or torso
What are the stages of the menstrual cycle?
Follicular and Luteal
Describe the hormonal changes in the menstrual cycle.
The menstrual cycle consists of 2 stages the luteal stage and the follicular stage. FSH stimulates development of secondary follicles, as these grow the granulosa cells around them secrete oestrogen. One follicle will develop further than the others becoming the dominant follicle. A spike in LH just before ovulation causes the dominant follicle to release the ovum from the ovary. In the luteal phase, the collapsed follicle becomes the corpus luteum. This secretes progesterone which maintains the uterine lining, and oestrogen. If fertilized the embryo secretes hCG then the corupus luteum is maintained, without this the corpus luteum degenerates leading to a fall in progesterone and oestrogen levels. The drop in these hormone levels causes the endometrium to break down and menstruation to occur.
What are some UKMEC 4 restrictions for the COCP?
Breastfeeding <6w post-partum, aged >35 smoking >15 daily, BMI>40, Uncontrolled hypertension (>160/ >100), Migraine with aura, History of VTE, Major surgery (prolonged immobility), cardiac or vascular disease, liver cirrhosis or tumours, Current hormone sensitive breast cancer
What are some contraindications to ulipristal acetate?
Diseases of malabsorption (eg. Crohn’s), Allergy, Severe hepatic dysfunction, patient taking rifampicin, Breast feeding, Asthma, drugs increasing gastric pH (omeprazole, ranitidine)
What are some of the physiological change sin pregnancy?
Increased blood volume, increased cardiac output, increased stroke volume, increased heart rate, increased tidal volume, decreased vascular resistance, increased intra-gastric pressure, decreased gut motility, increased fibrinogen and clotting factors, increased total T3 T4 levels, increased uterine size
Define preterm pre-labour rupture of membranes?
The rupture of foetal membranes prior to 37 weeks of gestation
What are the risk factors for PPROM?
Smoking, Previous PPROM / previous premature delivery, vaginal bleeding during pregnancy, lower genital tract infection, invasive procedures (i.e. Amniocentesis), Polyhydramnios, Multiple pregnancy, Cervical insufficiency
What are some long term complications of levadopa use?
On-off fluctuations, dyskinesias, hallucinations, weaning off phenomenon
What drug is commonly given with levadopa?
Dopa decarboxylase inhibitor (carbidopa, benserezide)
Describe the age ranges and symptoms requiring referral via the suspected cancer pathway (2 week wait) for breast cancer?
Aged over 30 with a unexplained breast lump with or without pain, Aged over 50 with the following symptoms in one nipple; discharge, retraction, changes of concern, consider referral if aged over 30 with unexplained lump in the axilla, consider referral for skin changes indicative of cancer
What is the definition of sensitivity?
Sensitivity is the proportion of people with the disease who are correctly identified by the screening test.
What is specificity?
Specificity is the proportion of people without the disease who are correctly excluded by the screening test
What are the Wilson and Jungner criteria?
The condition should be an important health problem, the natural history of the condition should be understood, there should be a recognisable latent or early symptomatic stage, there should be a test that is easy to perform and interpret, acceptable, accurate, reliable, sensitive and specific, there should be an accepted treatment for the disease, treatment should be more effective if started early, there should be a policy on who to treat, diagnosis and treatment should be cost effective.
What are the monitoring requirements of lithium?
BMI, U&E, eGFR, Calcium and Thyroid levels measured every 6 months
What vaccines should a baby receive at 8 weeks?
6-in-1 vaccine (diphtheria, hepatitis B, Hib, polio, tetanus, whooping cough), rotavirus vaccine, men-b vaccine
What are some examples of live attenuated vaccines?
MMR (measles, mumps, rubella), BCG, Chickenpox, Nasal influenza vaccine,
Give 3 of the 9 conditions screened for on the newborn blood spot test?
cystic fibrosis (CF), sickle cell disease (SCD), congenital hypothyroidism (CHT), phenylketonuria (PKU), medium-chain acyl-CoA dehydrogenase deficiency (MCADD), maple syrup urine disease (MSUD), isovaleric acidaemia (IVA), glutaric aciduria type 1 (GA1), homocystinuria (HCU)
What is the newborn test for CF?
Blood spot - immunoreactive trypsinogen
How old should the child be when they have the newborn bloodspot test?
5 days old
Give 2 advantages and 2 disadvantages of cohort studies?
Advantages: can follow up group with a rare exposure, good for common and multiple outcomes, establish disease risk and cofounders, less risk of selection and recall bias
Disadvantages: takes a long time, people drop out, needs a large sample size, expensive and time consuming
Give 4 beliefs that a patient must hold in the health belief model?
Belief they are susceptible to the condition, belief in serious consequences, belief that taking action reduces susceptibility, belief that the benefits of action outweigh the costs
What is the name of the formula used to calculate maintenance fluids?
Holliday Segar
What sign would you seen on an Xray of a patient with COPD
Flattened hemi-diaphragms and hyperinflated lungs
Which organism is commonly found in diabetic foot ulcers?
P. aeruginosa
What is the most common cause of conjunctivitis?
Adenovirus (viral more common than bacterial)
How should the vaccination schedule be adjusted for premature babies?
It does not need to be adjusted, they get their vaccinations according to their chronological age
How long should children with measles be excluded from school?
4 days after the rash begins
What causes genital warts?
HPV 6 and 11
What sort of bacteria are chlamydia and gonorrhoea?
Chlamydia - GN, intracellular, coccus (not diplococci)
Gonorrhoea - GN, intracellular, diplococci
What is second line in gonorrhoea treatment?
Azithromycin and gentamicin
How is chancroid treated?
Ceftriaxone
What are the 4 criteria to diagnose chancroid?
- Must have a painful ulcer
- Must clinically look like chancroid
- Must not be herpes
- must not be syphilis
What are the Amsel criteria for, and what are they?
For diagnosing BV
1. Thin, grey, watery discharge
2. pH >4.5
3. Positive whiff test
4. Clue cells on microscopy
Where does genital herpes lie dormant?
Sensory nerve ganglion - sacral ganglion
How can you describe the lesions seen in genital warts?
Verrucous fleshy papules that may coalesce into plaques. Can be white, red or flesh coloured.
What investigations are required in erectile dysfunction?
HbA1c, lipid profile, morning sample of free testosterone (if testosterone is abnormal, do FSH, LH and prolactin too)
How often should HbA1c be measured?
Every 3-6 months
What is the difference between vestibular schwannoma and Meniere’s disease?
VS doesn’t present with aural fullness, just vertigo, tinnitus and sensorineural hearing loss. VS does present with facial palsy and loss of corneal reflex, which Meniere’s doesn’t. VS is also progressive, not episodic.
How is Turner’s diagnosed?
Karyotyping
What tests can be used for delirium?
Abbreviated mental test score, 4 A’s Test (attention, awareness, AMT, acute fluctuating course)
How should a physiological murmur be followed up?
A check up in one month
A 2 year old girl attends the Emergency Department with her mother. She has been unwell for five days with presumed chicken pox. She is miserable. She is febrile with a temperature of 38.6˚C. Her heart rate is 182 bpm and her respiratory rate is 34 breaths per minute. Her capillary refill time centrally is 4 seconds. She has multiple vesicular lesions over her body, some of which are crusting over. Areas of erythema are present around some of the lesions on her back, arms and legs.
What might this indicate and how might you treat it?
It indicates a superimposed infection on top of the chicken pox, due to the erythema surrounding her lesions. It might also present as a sudden new fever following initial improvement. This should be treated with IV fluids and antibiotics.
How often should the contraceptive patch be changed?
Every week
How often is the contraceptive depo given?
Every 12 weeks
How long can the implant, the IUS and IUD stay in for?
Implant - 3 years
IUS - 3 years (5 if being used to control dysmenorrhea)
IUD - 5-10 years
What drugs should be given for IUGR?
MgSO4 for neuroprotection
Maternal steroids to mature the fetal lungs
What is a raised ALP without a raised GGT a sign of?
Bone problems
What histological findings would you see in PD?
Loss of dopaminergic neurons (1 mark), in the substantia nigra The presence of Lewy Bodies/ eosinophilic cytoplasmic inclusions
What would you see on a brain CT of PD?
Nothing, normal, no pathology
What is the DOLS acid test?
Are they subject to continuous supervision? Are they free to leave? If botha snwers are positive, a DOLS is needed.
What are the 2 stages of a mental capacity test?
Stage 1
Is the person unable to make a specific decision? This is known as the functional test.
Stage 2
If the answer to stage 1 is yes, is the inability to make the decision caused by an impairment or disturbance in the person’s mind or brain? This is known as the diagnostic test.
The assessment should begin with stage 1 and only proceed to stage 2 if the first stage is met.
The diagnostic test can include: medical examinations and psychological evaluations.
What are the causes of IUGR?
Any three of: ethnicity (specified), booking BMI, pre-existing medical conditions such as hypertension, past obstetric history of hypertension or pre-eclampsia, social history including smoking or taking other drugs
Accept “multiple pregnancy, previous IUGR
Plus many others
At what age do kids get febrile seizures?
6m-5y
Define cerebral palsy:
A chronic disorder o f m ovem ent and posture (1) due to non progressive brain abnormalities (1) occurring before the brain is
fully developed.
What characterises first degree heart block?
Prolongation of the PR interval
What is the mutation in CF and where is it?
Chromosome 7
Delta F508
What condition is associated with hypospadias?
Cryptorchidism
How should you swap from fluoxetine to another SSRI?
Withdraw fluoxetine, wait 4-7 days, start low does of the next antidepressant (fluoxetine has a long half life)
How long do alcohol withdrawal seizures take to start?
36 hours
How often should women who have survived breast cancer be monitored?
Surveillance mammogram every 5 years
How are BRCA positive women monitored?
MRI every year from 25-39
40-50=MRI and mammogram
50+=mammogram
https://www.gov.uk/government/publications/breast-screening-higher-risk-women-surveillance-protocols/tests-and-frequency-of-testing-for-women-at-very-high-risk–2
How does NICE now classify depression?
Less severe and more severe, cut off is 16 on the PHQ9
What are the treatments for less severe depression?
- Guided self help
- Group CBT
- Group behavioural activation
- Individual CBT
- Individual behavioural activation
SSRI is way down the list unless it is patient preference
What are the treatments for more severe depression?
- High intensity individual CBT and SSRI
- High intensity CNT alone
- High intensity individual BA alone
- Antidepressant alone
How is PTSD investigated?
Trauma screening questionnaire
What psychological and medical treatments are available for PTSD?
Trauma focused CBT
Eye movement desensitisation and reprocessing (EMDR)
SSRI or venlafaxine
How is an acute stress reaction managed?
Trauma focused CBT (it’s often too soon for EMDR to work if they have just experienced the traumatic event)
What are the 2 subtypes of schizoaffective disorder?
Schizoaffective disorder is further classified as bipolar type (when manic symptoms are prominent; however major depressive episodes may also occur) or depressive type (when only schizophrenia and major depressive symptoms are present without mania).
Describe the management of a pregnancy of unknown location:
- Pregnancy of >1500 HCG should be visible on US, so if it isn’t then consider ectopic
- Repeat bHCG in 48 hours - bHCG should rise by 63% in an intrauterine pregnancy
- In this case she should return for an US 7-14 days later
- If it was a miscarriage/ectopic it would halve - she should take a urine pregnancy test in 7-14 days to confirm that the pregnancy is gone
When should babies be delivered in pregnancies complicated by intrahepatic cholestasis of pregnancy, and why?
37-38 weeks, induction of labour required, risk of still birth
When is labour induced in preterm rupture of membranes?
IOL from 34 weeks to reduce risk of chorioamnionitis
What are the school exclusion criteria for the common paediatric infections?
- Chicken pox –> Off school until lesions have crusted (typically ~5 days)
- Diarrhoea and Vomiting –> 2 things so can only come back to school 2 days symptom free
- Mumps –> 5 letters in mumps so 5 days after swelling onset (If part of MMR so now can remember these are all ~ around 5 days after a sx onset)
- Rubella –> Part of MMR so can remember 5 days after rash onset
- Measles –> Part of MMR so can remember ~5 days after rash onset (it’s actually specifically 4 lmao)
- Whooping cough (Pertussis) –> ‘whoop whoop, sound of the alarm’, 2 whoops so can return to school 2 days after antibiotics
- Hand foot and mouth can just chill! Think about how it’s not the whole body so it’s probs not that deep
- Roseola also doesn’t need time off
- Scarlet fever - 24 hours after starting antibiotics
- Impetigo - 48 hours after starting antibiotics
What is the triad of Meig syndrome?
The three features of Meig’s syndrome are:
a benign ovarian tumour
ascites
pleural effusion
How is placenta praevia managed?
- Scans
- 20 week scan is used to asses the location of the placenta
- If placenta praecia is diagnosed, a further transvaginal ultrasound is required at 32 weeks
- If it is still present, a scan is done at 36 weeks
- If it is still present, then decisions need to be made about delivery. Planned CS is considered between 36-37 weeks to reduce the risk of spontaneous labour
What are the criteria for LMWH in pregnancy?
- 4+ RFs = LMWH until 6 weeks post partum
- 3 RFs = LMWH from 28 weeks until 6 weeks post partum
- some women need to take it for 7-10 days after delivery, even if they didn’t take it during their pregnancy
How is DVT diagnosed in pregnancy?
- Compression duplex ultrasound (DVT)
- If this is negative and there is low clinical suspicion, heparin can be discontinued
- If ultrasound is negative and a high level of clinical suspicion exists, anticoagulant
treatment should be discontinued but the ultrasound should be repeated on days 3 and 7 - If positive, treat for DVT - no further investigation needed
NO DDIMER
How is PE diagnosed in pregnancy?
- ECG and CXR and CTPA (PE)
- Perform ECG and CXR
- When the chest X-ray is abnormal and there is a clinical suspicion of PE, CTPA should be performed
- In women with suspected PE who also have symptoms and signs of DVT, compression duplex ultrasound should be performed
NO DDMIER
What surgeries are available for vaginal prolapse?
- Vaginal hysterectomy
- Vaginal sacrospinous hysteropexy
- Manchester repair
What BP is defined as hypertension in pregnancy?
> 140 systolic
What are the indications for 5mg of folic acid?
Obesity >30 BMI, epilepsy, previous history of NTD
How long should magnesium sulphate continue to be given following a seizure in eclampsia?
- 24 hours
What tocolytic is given during EVC?
Terbutaline
How long should couples have unprotected intercourse before being offered IVF in cases of unexplained infertility?
2 years
How does gestational diabetes lead to macrosomia?
An increase in foetal blood glucose causes hyperinsulinaemia in the foetus, leading to increased fat deposition.
What is the risk of post partum psychosis occurring in future pregnancies following a first episode?
25-50%
How do mifepristone and misoprostol work?
Mifepristone - progesterone blocker
Misoprostol - prostaglandin, causes uterine contractions
When should IOL be offered in PPROm?
34 weeks
What are the risk factors for VTE in pregnancy?
- Before pregnancy
- 35+
- 3+ babies
- Previous VTE
- 1st degree relative with VTE
- Thrombophilia - factor V leiden, antiphospholipid syndrome
- Existing medical conditions - heart disease, lung disease, arthritis
- Severe varicose veins - painful, above the knee, red, swollen
- Wheelchair user
- Lifestyle
- BMI >30
- Smoker
- IVDU
- During pregnacy
- Hospital admission
- Multiple pregnancy
- Dehydration/reduced mobility in pregnancy, due to hyperemesis, severe infection, ovarian hyperstimulation syndrome etc
- Long periods of immobility - operation, long travel 4h+
- Pre-eclampsia
When is VTE risk in pregnancy assessed?
- Booking appt
- 28w appt
- After any hospital admission
What are the grades of CIN in the cervix?
- 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, affects 3/3 of the thickness of the epithelial layer, very likely to progress to cancer if untreated
What are the grades of CIN in the vulva?
- VIN 1 means that the depth of abnormal cells is less than one-third of the top layer of vulvar skin.
- VIN 2 means that the depth of abnormal cells is less than two-thirds of the top layer of vulvar skin.
- VIN 3 means that the depth of abnormal cells is more than two-thirds of the top layer of vulvar skin.
What is the management of VIN and vulva cancer?
VIN - WLE, imiquimod cream, laser ablation
Cancer - WLE (<2cm in size, 1mm in depth), lymph node dissection (lesions bigger than that)
What type of ovarian cysts grow teeth and why?
Dermoid cysts
Derived from primitive germ cells which can differentiate into anybody tissue, e.g. hair, teeth, sebaceous material, bone, etc.
What is the most common type of ovarian cyst? What’s the most common type of ovarian cancer in younger and older women?
Follicular - represents the developing follicle which fails to rupture and release the egg, causing the cyst to persist - most common and disappear after a few cycles
Cancer - epithelial cell in older women, germ cell in younger women
How are ovarian cysts monitored?
- Less than 5cm cysts will almost always resolve within three cycles. They do not require a follow-up scan.
- 5cm to 7cm: Require routine referral to gynaecology and yearly ultrasound monitoring.
- More than 7cm: Consider an MRI scan or surgical evaluation as they can be difficult to characterise with ultrasound.
When should twins be delivered?
Women with monochorionic monoamniotic twins should be induced 32-34 weeks.
Women with monochorionic diamniotic should be induced at 36 weeks.
Women with dichorionic diamniotic twins should be induced at 37 weeks.
Antenatal steroids should be given.
What is a fibroadenoma made of?
Stromal/epithelial tissue
What is the most common type of cervical cancer?
Squamous cell carcinoma adenocarcinoma also possible)
What is the surgical management of miscarriage?
- Vacuum aspiration
- Dilation and curettage
What is the surgical management of TOP?
- Vacuum aspiration up to 14 weeks
- Dilation and evacuation - 15-24 weeks
What damage might mothers experience during an instrumental delivery?
Femoral or obturator nerve injury
Perianal tears -> incontinence
Episiotomy
PPH
What damage might babies experience during an instrumental delivery?
- Cephalohematoma from forceps (blood between the skull and periosteum that doesn’t cross the sutures)
- Facial nerve palsy from forceps delivery
When should instrumental deliveries be abandoned?
After 3 attempts -> CS
What are the indications for an elective CS?
- Abnormal presentation e.g. breech or transverse.
- Twin pregnancy if first twin is not cephalic.
- Maternal HIV.
- Primary genital herpes in third trimester.
- Placenta praevia, vasa previa
- Anatomical reasons
- Perianal tear symptoms
How are pregnant mothers with HepB managed?
Newborns are given HBV IgG and HBV vaccination within 24 hours of delivery ⇒ prevents vertical transmission
How are pregnant mothers with HSV managed?
If active infection is present from 6 weeks of birth, elective section is recommended with maternal aciclovir. If she declines, IV aciclovir can be given during delivery.
How are UTIs managed in pregnancy?
- Cefalexin 500mg 3 times a day for 7 days.
- Amoxicillin 500mg 3 times a day for 7 days.
- Nitrofurantion 100mg modified-release twice daily for 7 days (avoid in third trimester).
- Trimethoprim 200mg twice daily for 7 days (avoid in first trimester).
How is BV managed in pregnancy?
Metronidazole, same as non-pregnant women
How is thrush managed in pregnant women?
Antifungal pessary(i.e. clotrimazole) - single dose at night, or 3 doses over 3 nights - used for pregnant women as fluconazole causes congenital abnormalities
How are trichomoniasis, gonorrhoea and chlamydia managed in pregnancy?
Chlamydia: azithromycin
Gonorrhoea: ceftriaxone
Trichomoniasis: metronidazole
What does obstetric cholestasis occur? What’s the pathophysiology?
From 28 weeks (third trimester)
- Bile acidsare produced in the liver from the breakdown ofcholesterol ⇒ bile acids flow from liver to thehepatic ducts, past thegallbladderand out of thebile ductto the intestines.
- In obstetric cholestasis, the outflow of bile acids is reduced, causing them to build up in the blood, resulting in the classic symptoms of itching (pruritis)
What tests are performed in obstetric cholestasis?
- LFTs - will cause raised ALT/AST/GGT
- Bile acids - will be raised
- Bilirubin
- Liver and biliary tree US to rule out other diagnoses
How is obstetric cholestasis managed?
- Antihistamines - chlorphenamine (H1 antagonist) can help sleeping (sedative) in all cases (PRIMARY CARE)
- UDCA - does not effectively reduce total serum bile acid concentrations or clearly prevent stillbirth but does cause a marginal improvement in maternal itch in moderate to severe cases (only in SECONDARY CARE)
- Vitamin K if at risk of vitamin K deficiency in mild-severe cases
- IOL if severe to reduce risk of stillbirth
When are pregnancies complicated by accreta delivered?
Planned delivery at 35-36+6 weeks to reduce the risk of spontaneous labour
What are the 2 types of vasa praevia?
- Type I vasa praevia– the fetal vessels are exposed as a velamentous umbilical cord
- Type II vasa praevia– the fetal vessels are exposed as they travel to an accessory placental lobe
What is the pathophysiology of duct ectasia?
Milk ducts widen and the walls thicken ⇒ duct becomes blocked ⇒ fluid builds up ⇒ thick, sticky green or yellow discharge with nipple inversion
How is duct ectasia treated?
- Warm compress and waiting
- Antibiotic if infection develops
- Surgical excision of the abnormal duct (microdochectomy)
How is duct ectasia treated?
- Warm compress and waiting
- Antibiotic if infection develops
- Surgical excision of the abnormal duct (microdochectomy)
What is a papilloma?
- develops on milk ducts, arising from the epithelial surface
- Small wart like growth that grows outwards
How is a papilloma managed?
- Excision biopsy
- Vacuum assisted excision biopsy
- Surgical removal of the duct (microdochectomy)
How does duct ectasia present?
May cause nipple discharge that is green/yellow, sticky and thick, with a red and tender nipple. Scar tissue might form a lump, which can present similarly to cancer (but isn’t). The nipple may invert, because the scarred ducts can shorten
Describe a fibroadenoma
- Firm, smooth and non-tender breast lump with a rubbery texture
- Very mobile - described as a breast mouse!!!!!
- Commonly in the upper outer quadrant
- Commonly does not grow bigger than 3cm
Describe a fibroadenoma
- Firm, smooth and non-tender breast lump with a rubbery texture
- Very mobile - described as a breast mouse!!!!!
- Commonly in the upper outer quadrant
- Commonly does not grow bigger than 3cm
How are breast abscesses managed?
- Needle aspiration with local anaesthesia
- Diagnostic and therapeutic at the same time - used to drain the abscess
- If <5cm
- Excision and drainage
- If >5cm
- Antibiotics (IV/oral)
- If not systemically unwell, she can have oral
- If she’s lethargic and systemically unwell she needs IV
- Dicloxacillin
- Cefalexin
- Doxycycline
- Clindamycin
- Flucloxacillin
- Etc etc etc
- Vancomycin if MRSA is confirmed
- Pain relief
- Paracetamol
- Ibuprofen
How is the corpus luteum involved in the maintenance of pregnancy, and when does the placenta take over?
If sperm fertilizes the egg and a pregnancy occurs (conception), the corpus luteum will release progesterone for about 12 weeks. Around week 12 in the first trimester of pregnancy, the placenta will start to produce enough progesterone for the fetus so that the corpus luteum doesn’t need to anymore.
What maintains the CL in the early stages of pregnancy?
bHCG
What is an important side effect of levadopa to consider?
Postural hypotension
What is Naegele’s rule?
Add one year and seven days to the first day of the LMP and subtract three months
How long does death take to occur in Huntington’s disease?
10-20 years after the onset of motor symptoms
What is the management for a benzodiazepine overdose?
Flumazenil
How is rubella investigated in babies <6m and children >6m?
<6m - IgM
>6m - IgM and IgG
