Things I need to Learn Flashcards
What are stages 1 and 2 of CKD?
Stage 1 = normal eGFR (>90ml/min) but tests detect signs of abnormal kidney function
Stage 2 = eGFR 60-89ml/min
What are stages 3a and 3b of CKD?
Stage 3a = eGFR 45-59ml/min
Stage 3b = eGFR 30-44ml/min
What are stages 4 and 5 of CKD?
Stage 4 = eGFR 15-29ml/min
Stage 5 = eGFR <15ml/min
What are the 3 stages of AKI (in terms of urine output)?
Stage 1 = <0.5ml/kg/hr for 6-12 hours
Stage 2 = <0.5ml/kg/hr for >=12 hours
Stage 3 = <0.3ml/kg/hr for >=24 hours or anuria for >=12 hours
What are the 3 stages for AKI (in terms of serum creatinine)?
Stage 1 = 1.5-1.9 times baseline or increase >=0.3mg/dl
Stage 2 = 2.0-2.9 times baseline
Stage 3 = 3.0 times baseline or increase >=4.0mg/dl
Define polyhydramnios?
AFI >24cm (or 2000ml+)
Define oligohydramnios?
AFI <5cm (under 200ml)
Name 6 long term complications of PCOS?
Subfertility, DM, Stroke/TIA, Coronary Artery Disease, Endometrial Cancer and Obstructive Sleep Apnoea
What is the first line investigation for Narcolepsy?
Multiple Sleep Latency
What is seen on blood tests in Biliary Atresia?
High levels of conjugated bilirubin and raised LFTs
Name the different extrapyramidal side effects of antipsychotics?
Parkinsonism, Acute Dystonia (e.g. torticollis or oculogyric crisis), Akathesia, Tardive Dyskinesia
How does a Cholesteatoma present?
Foul smelling ear discharge and facial nerve weakness
How does Alzheimer’s Dementia typically present?
Difficulty with learning new things. Then disorientation, changes in mood/behvaiour, suspicion of family/friends/carers
How does Vascular Dementia typically present?
Impaired planning and judgement, uncontrolled laughing/crying, issues with speech (forming or understanding).
Symptoms worsen in a stepwise fashion!
How does Lewy Body Dementia present?
Impaired attention, fluctuating cognition, parkinsonism, visual hallucinations and sleep disturbances
How does Frontotemporal Dementia present?
Clasically presents in younger patients (45-65). Personality and behaviour changes (including impulsive or inappropriate behaviour), language problems, difficulty planning and organising
How does Noonan syndrome present? How is it inherited?
Autosomal Dominant
Presents with a webbed neck, pectus excavatum, short stature and pulmonary stenosis
How does Fragile X syndrome present? How is it inherited?
X-linked
Presents with learning difficulties, long and narrow face, large ears, flexible fingers, large testicles, hypotonia, high arched palate and mitral valve prolapse
What are the risks of HRT?
Oestrogen only = endometrial cancer
Oestrogen and Progesterone = breast cancer and VTE
All HRT = stroke and ischaemic heart disease (if taken for 10 years)
What is seen on a nerve conduction study in Gullain-Barre Syndrome?
Decreased motor nerve conduction velocity
What is Multi System Atrophy?
Autonomic disturbance (erectile dysfunction, postural hypotension and atonic bladder) with either parkinsonism or cerebellar signs
How will a CNV palsy present?
Ipsilateral facial sensation loss and ipsilateral deviation of the jaw towards the weaker/paralyzed side on opening. Loss of the corneal reflex
How will a CNVII palsy present?
Ipsilateral fiacial drooping and loss of the corneal reflex.q
Which direction is diplopia in Trochlear and Abducens nerve palsy?
CNIV = verticle diplopia - issues walking down stairs CNVI = horizontal diplopia
What can be used as secondary prevention of stroke if Clopidogrel is contraindicated?
Aspirin and modified release dypyramidole
Name the 2 main drugs used to induce ovulation?
Clomifene or Letrozole
What PEP should be given to pregnant women exposed to chickenpox who are certain they have not had the illness before?
<20 weeks = VZV Immunoglobulin
>20 weeks = Aciclovir (from 7-10 days after exposure) or VZIG
If they are 20 weeks plus and develop symptoms give aciclovir within 24hrs of rash development
Under what circumstances is Lactational Amenorrhoea and affective method of contraception?
Pt must be amenorrhoeic, breast feeding exclusivley and the baby must be <6 months old,
How does Ovarian Hyperstimulation present and how is it treated?
Abdo pain, bloating and if severe respiratory distress/thrombotic events
Tx = Cabergoline
Tx for Croup?
Single dose dexamethasone (0.15mg/kg)
When should you consider admitting a bronchiolitits patient to hospital?
RR >= 60, Clinical dehydration or inadequate oral intake (50-75% of normal)
What is the definintion of stage 1 and stage 2 COPD?
Stage 1 = FEV1 >80% of predicted
Stage 2 = FEV1 50-79% of predicted
What is the definintion of stage 3 and stage 4 COPD?
Stage 3 = FEV1 30-49% of predicted
Stage 4 = FEV1 <30% of predicted
Which fluids should you give in a child with DKA who has nausea/vomiting or reduced consiousness (and over how long)?
0.9% NaCl 10ml/kg bolus and S/C insulin (0.1 units/kg/hr).
Give maintenance/corrective fluids over 48 hours to prevent cerebral oedema. Start insulin 1 hour after fluids have been started. Monitor K+ as levels may drop when you give insuling!
What will you see on blood tests in DKA?
hyperglycaemia, ketonaemia, acidosis, mildly raised creatinine, raised K+ and low HCO3-
Sx of Turner’s syndrome?
Congenital heart defects (coarctation of the aorta most commonly), short stature, primary amenorrhoea, hypothyroidism, webbed neck, widley spaced nipples and LDs
What are the complications of JIA?
Leg length discrepency, joint erosion, anterior uveitis (most common) and macrophage activation syndrome
What is Stephen-Johnson Syndrome?
Begins with flu-like Sxs followed by a red/purple target like rash which spreads and forms blisters. The affected skin eventually peels and dies. Rash will start on the trunk and extend abruptly to the face and limbs
Which medications can cause Stephen-Johnson Syndrome?
Allopurinol, anticonvulsants, antipsychotics, sulfsalazine, penicillin, simple pain relief
What is the primary treatment of JME and what is the most significant trigger?
Treat with sodium valporate (lamotrigine in women of child bearing age). Sleep deprevation (associated with alcohol consumption) is the most significant trigger
What are the complications of chicken pox?
Bacterial skin infections, DIC, encephalitis/cerebellitis, sepsis, dehydration, disseminated disease
How does the CSF appear in bacterial vs viral meningititis?
Bacterial = turbid, raised polymorphs, raised proteins and reduced glucose Viral = clear, raised lymphocytes, normal/raised protein, normal/low glucose
How does the CSF appear in TB?
Turbid/clear, raised lymphocytes, raised protein and low glucose
What are the 1st rank symptoms of schizophrenia?
3rd person auditory hallucinations, delusional perceptions, somatic passivity, thought alienation (insertion, withdrawal or broadcast)
What is the treatement for delirium tremens?
Oral lorazepam or failing that IV lorazepam (or haloperiodol)
What should you do if 12 weeks of SSRI and exposure response prevention CBT are ineffective in treating OCD?
Switch to a different SSRI or commence Clomipramine
What does your result on the PHQ-9 score indicate?
0-4 = no depression 5-9 = mild depression 10-14 = moderate depression 15-19 = moderatley severe depression 20-27 = severe depression Treat mild depression with 2 weeks watch and wait!
What are the withdrawal symptoms from SSRIs?
Restlessness, trouble sleeping, unsteadiness, anxiety, irritability and sweating
Name a cognitive function test commonly used in primary care?
6CIT (6 item Cognitive Impairment Test)
How often should you monitor bloods when starting a patient on Clozapine?
Weekly for the 1st 18 weeks, fortnightly until the end of the 1st year, monthly after this
What is akathasia?
A subjective feeling of motor restlessness manifested by a compelling need to me in constant motion/movement
What should you do in a ?miscarriage with a crown rump length of <7mm?
Rescan in 1 week, at this size you can not tell if the pregnancy is still viable
What should you do if you find CNI/CNII/CNIII/CGIN on colposcopy?
CNI = repeate cervical smear in 12 months CNII/CNIII/CGIN = remove cells e.g. with LLETZ then screen in 6 months to test for cure
What do late decelerations indicate?
Foetal distress
What are the features of a missed miscarriage?
Light vaginal bleeding and decreased pregnancy symptoms, closed cervic and a non-viable foetus seen in the uterus.
Pt is often unaware!
What are the features of an inevitable miscarriage?
Vaginal bleeding (lots clots and tissues may be passed) and uterine cramps, open cervix and a foetus (with possible heart beat) seen in uterus
What are the features of an incomplete miscarriage?
Vaginal bleeding (lots clots and tissues are passed), uterine cramps, open cervix and products of conception seen in the uterus
What are the features of a threatened miscarriage?
Variable vaginal bleeding (painless), closed cervix and a viable foetus seen in the uterus
What are the features of a septic miscarriage?
Fever, malaise and sepsis Sxs. Foul smelling vaginal discharge, cervical motion and uterine tenderness. Cervix is usually open and products of conception are usually retained
What is the most common type of vaginal cancer?
Secondary from the cervix or endometrium. Primary is rare but most commonly squamous cell.
How does vasa praevia present?
Painless vaginal bleeding occuring after rupture of membranes, foetal compromise and no hisotry of antenatal bleeding
How should you manage vasa praevia?
Corticosteroids from 32 weeks, C-section at 34-36 weeks and AVOID digital vaginal examinations
What are the stages the foetus goes through during birth?
Descent -> engagement -> flexion -> internal rotation of the head (will face the spine) -> crowning -> extension of the presenting part -> external rotation of the head (back to the spine) -> delivery
What are the causes of polyhydramnios?
Idiopathic (most common), macrosomia, maternal DM, structural abnormalities of the foetus, viral infections
True or False, personality changes may be seen in middle cerebral artery stroke
FALSE
They can be seen in anterior cerebral artery stroke!
What is polypharmacy?
A single patient taking >= 5 medications daily
How does Horner’s syndrome present?
What type of tumour commonly causes it?
Miosis, ptosis, unilateral anhydrosis, enopthalmos. Pancoast tumour (apical lung cancer)
What is the only medication liscenced to treat MND?
Riluzole
What is the 1st line Tx for trigeminal neuralgia?
Carbamazepine
What is the Rotterdam criteria for PCOS?
Polycystic ovaries (>= 12 follicles or ovarian volume >10cm3), oligoovulation or anovulation, clinical and/or biochemical signs of hyperandrogenism.
What are the hormones like in PCOS?
Raised testosterone and LH, low SHBG (due to insulin resistance) and progesterone, normal FSH
What can metformin do to help PCOS patients?
Reduce the appetitie, decrease androgen production, decrease LH secretion from the anterior pituitary, increase sex-hormone binding globulin (SHBG) in the liver
If you see dark urine, right sided abdo pain, low platelets and raised LFTs in pregnancy what should you do?
DELIVER!
This is HELLP syndrome. It occurs most commonly after delivery but if it occurs before delivery the baby must be delivered
What should you do in a mother with gestational diabetes who has a FPG >7mmol/l?
Begin insuin +/- metformin with diet and lifestyle advice
Which type of lung cancer is associated with cushing’s syndrome and which is associated with hypercalcaemia?
Cushings = small cell carcinoma Hypercalcaemia = squamous cell
What causes Conn’s syndrome most commonly, what will blood tests show and how is it treated?
Primary hyperaldosteronism (due to adrenal adenoma), raised aldosterone but low renin, there will be HTN, low potassium and alkalosis. Treat with spironolactone and surgical excision
How may pain help us to differentiate between a gastric and duodenal ulcer?
Pain immediatley after eating = gastric
Pain a short while after eating = duodenal
Which drugs can cause PD?
How can drug induced PD differ from idiopathic?
Prochlorperazine, Metoclopromide, Neuroleptic drugs and Antipsychotic drugs
Idiopathic is normally asymmetrical, drug induced is normally symmetrical
How should you manage steroid responsive COPD?
SABA or SAMA
SABA + LABA + ICS
SABA + LABA + ICS + LAMA
How should you manage steroid non-responsive COPD?
SABA or SAMA,
SABA + LABA + LAMA
How can you differentiate between steroid responsive and steroid non-responsive COPD?
Steroid responsive = asthmatic features, atopic illness and variation in FEV1
Steroid non-responsive = non of the above features
What are the high risk factors for pre-eclampsia?
- hypertensive disease in a previous pregnancy
- chronic kidney disease
- autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome
- type 1 or type 2 diabetes
- chronic hypertension
What are the moderate risk factors for pre-eclampsia?
- first pregnancy
- age 40 years or older
- pregnancy interval of more than 10 years
- body mass index (BMI) of 35 kg/m² or more at first visit
- family history of pre-eclampsia
- multiple pregnancy
What are the degrees of peroneal tear?
- first degree: superficial damage with no muscle involvement
- second degree: injury to the perineal muscle, but not involving the anal sphincter
- third degree: injury to perineum involving the anal sphincter complex
- fourth degree: injury to perineum involving the anal sphincter complex and rectal mucosa
How is placenta praevia graded?
- I - placenta reaches lower segment but not the internal os
- II - placenta reaches internal os but doesn’t cover it
- III - placenta covers the internal os before dilation but not when dilated
- IV (‘major’) - placenta completely covers the internal os
What must BHCG be for the different types of ectopic pregnancy management?
Expectant = <1500 and adnexal mass <35mm and no visible heartbeat Medical = <5000 (if able to return to follow up), if not able to return <1500 Surgical = >5000 or adnexal mass >35mm or visible heart beat
What is seen in blood tests in obstetric cholestatsis?
Raised bile salts and derranged LFTs (mainly ALT, AST and GGT)
When can you prescribe anti-epileptic drugs without input from a specialist?
- Seizure activity is confirmed on EEG
- There is neurological deficit
- There is structural brain abnormalities
- Pt, parent or carer considers the risk of another seizure unacceptable
What are the 5 causes of cyanotic heart disease?
Tetralogy of Fallot, Transposition of the great arteries, Tricuspid atresia, Total anaomalous pulmonary venous return, Truncus arteriosus
What is agonal breathing?
Irregular gasping which occurs in the first few mins of cardiac arrest - commence CPR!
What is the most common cause of gastroenteritis in children and why might diarrhoea still be seen after the gastroenteritis is treated?
Rotavirus
Lactose intolerance is sometimes seen after the infection is treated
What is atypicla hyperplasia of the endometrium and what causes it?
A pre-malignant condition occuring due to overstimulation of the endometrium by oestrogen. Can be caused by granulosa cell tumours
What is the first line Tx for respiratory distress caused by MgSO4?
Calcium gluconate
What is Cushing’s triad?
Seen in raised ICP it is:
Bradycardia (but HTN)
Wide pulse pressure
Irregular breathing
Sx of Acustic neuroma (aka vestibular schwannoma)?
Vertigo, tinnitus, unilateral sensorineural hearing loss and absent corneal reflex (if invasion of the trigeminal nerve)
What will be seen in Rinne’s and Webber’s test in conductive hearing loss?
Rinne's = Bone conduction > air conduction Webber's = Heard loudest in bad ear
What will be seen in Rinne’s and Webber’s test in sensorineural hearing loss?
Rinne's = Air conduction > bone conduction Webber's = Heard loudest in good ear
What should you do if you miss 2 pills in week 3 of a packet?
Finish week 3 and immediatley start the new pack (omit pill free week)
Which women with placenta praevia should be offered an elective C-section at 37-38 weeks?
Grade III and Grade IV
What is a key side effect of SNRIs e.g. Venlafaxine?
Raised blood pressure! Blood pressure should be monitored when starting or changing dose!
WHat is a key side effect of Citalopram or Escitalopram?
Prolonged QT and/or ventricular arrythmias
What is a key side effect of SSRIs in the elderly?
Hyponatraemia
Sx of Tuberous Sclerosis?
Epilepsy, developmental delay, roughened patches on the lumbar spine, ash leaf spots (hypopigmented macules) and cafe au lait spots
Why should you avoid typical antipsychotics and Risperidone in Lewy Body Dementia?
They ay cause rigidity, immoblity, postural falls, confusion and irreversible parkinsonism
Which medications are commonly used to treat Lewy Body Dementia?
Donepezil = 1st line for cognitive impairment and behavioural issues Carbidopa/Levodopa = treat motor Sxs Clonazepam = treat REM sleep Sertraline = treat depression
What is the first line investigation for intusseception?
Abdo US
When should Levonorgestrel be given in double dose?
BMI >26kg/m2 or who weigh >70kg
Who should you avoid Ulipristal in?
Severe asthmatics and those breastfeeding (breast feeding must be stopped for 1 week after)
Use barrier contraception for 1 week as it reduces efficacy of hormonal birth control!
Within what time frame must you give another dose of Levonorgestrel if vomiting occurs?
3 hours
What is the first line treatmetn of OCD?
ERP. Add SSRI if pt is unable to engage
True/False Aspirin is contraindicated in beastfeeding?
True - risk of reyes syndrome
Briefly describe Myasthenia Gravis
Autoimmune.
Causes diplopia, ptosis, dysphagia, facial weakness and slurred speech. FATIGUEABLE!!
Ix = serum AChR antibodies, CT for thyomas
Tx = Pyridostigmine, prednisolone/azathioprine and thymectomy
IV Immunoglobulins and plasma exhange in myesthenic crisis
What is the likely cause of ovarian cyst in early pregnancy?
Physiological cysts due to the corpus luteum
What are the best contraceptives in medicated epilepsy?
Depo, IUD or IUS. If she takes lamotrigine POP and the implant are also acceptable.
Consistent use of condoms is reccomended also
Which antibiotics are safe in breastfeeding?
Cephalosporins, Trimethoprim and Penicillins
How can you differentiate between acute and chronic haematoas on CT?
Acute = hyperdense (bright) Chronic = hypodense (dark)
What are the Sx and management for idiopathic intracranial hypertension?
Sx = headache, blurred vision, papilloedema, blind spot and 6th nerve palsy Mx = weigth loss, diuretics (acatazolamide), topiramate, repeated LP and surgery
When should rhesus negative women recieive anti-D?
At sensitizing events, as standard at 28 and 34 weeks
What are the 1st and 2nd line Tx for dysmenorrhoea?
1st line = ibuprofen or mefenamic acid
2nd line = cocp
What is hypothalamic hypogonadism?
A cause of secondary amenorrhoea in very athletic women with a low BMI
What is Sheehan’s syndrone?
Hypopituitarism caused by blood loss/shock
Sx = agalactorrhoea, secondary amenorrhoea, hypothyroidism, hypoadrenalism
Mx = corticosteroids, levothyroxine and oestrogen
What is Asherman’s syndrome?
Intrauterine adhesions which can cause secondary amenorrhoea. Occurs after surgey to the uterus e.g. surgical management of miscarriage
How can you prevent acute dystonia in a PD patient who is NBM?
Dopamine agonsit patch
What should you do in women on COCP who are going to have surgery?
Stop the pill 4 weeks before surgery, resume again 2 weeks after surgery
Sx of patau’s syndrome (T13)
microcephaly, small eyes, low set ears, cleft lip and polydactly
What might you see in vulval carcinoma vs vulval intraepithelial neoplasia?
Vulval carcinoma = ulcerated
Intraepithelial neoplasia = white or plaque like
You see a patient with reduced GCS. Which is more likely, delirium or dementia?
Delirium - impairment of consious level implies delirium
How do you diagnose pertussis? Who should you always admit?
Per nasal swab culture.
Admit all infants under 6 months!
What is Hoover’s sign?
Pressure felt under the paretic leg when lifting the non-paretic leg against pressure (due to involuntary contralateral hip extension) - this is a good way of identifying non-orgnaic paresis
What is the first line ivestigation for post-menopausal bleeding?
TVUS
How does mirtazipine work?
Noradrenergic and specific serotonergic antidepressant. Increases neurotransmitters by blocking alpha 2 receptors
What are the symptoms of rubella?
Pink maculopapular rash (initally found on the face) but spreading to the whole body. Suboccipital and post-auricular lymphadenopathy are found
What type of rash is Scarlet fever?
Rough, punctate rash which sparres the area around the mouth
How should you treat mild, moderate and severe PMS?
Mild = life style advice (e.g. frequent and carb rich meals) Moderate = COCP Severe = SSRIs (continuous or during luteal phase, typically days 15-28)
When is the booking visit? What is done here?
8-10 weeks
FBC, blood grouping, Rh status, RBC autoantibodies and haemoglobinopathies
Hep B, HIV (not routine) and Syphillis screen
Urine culture
When is the dating scan and the anomoly scan?
Dating = 10-13+6 weeks Anomoly = 18-20+6 weeks
When is the Down’s syndrome screen, if it is positive what further investiagions can be done?
DS Screen = 11-13+6 weeks
Quadruple DS screen = 14+2-20+0 weeks
Chorionic Villous Sampling = 11+0-14+6 weeks
Amniocentisis = 15+0-20+6
When is the second screen for anaemia and atypical red cell autoantibodies done?
28 weeks
When can ECV and IOL be offered?
ECV = 36 weeks (nulliparous), 37 weeks (multiparous) IOL = 41 weeks
Tx of Menorrhagia?
Contaception = mirena coil
No contraception = Mefenamic or Tranexamic acid (start on 1st day of period)
From when should symphysis fundal height closely match gestational age?
20 weeks
Which things score you a 2 on APGAR score?
Pulse >100, Strong resp effort (crying), Pink colour, Active movement, Reflex irritability = Cries on stimulation (sneezes/coughs)
Which things score you a 1 on APGAR score?
Pulse <100, weak irregular resp effort, body pink but extremities blue, limb flexion, reflex irritability = grimace
Which things score you a 0 on APGAR score?
Absent pulses, nil resp effort, blue colour, flaccid muscle tone and nil reflex irritability
What is Phimosis, when should you treat?
Non-retractability of the foreskin and/or ballooning during urination
If <2years manage expectantly as this will likely self resolve
Tx = topical steroids or circumsision
Sx of foetal alcohol syndrome?
IUGR, microcephaly, midfacial hypoplasia, micrognathia, smooth philtrum, short palpable fissues, epicanthic folds, thin upper lip, irritability and ADHD
How long does it take for contraceptive methods to be effective if not started on first day of period?
IUD = immediate
POP = 2 days
COCP, injection, IUS and implant = 7 days
Describe the newborn resuscitation pathway?
1) dry baby and maintain temperature
2) assess tone, rep rate and heart rate
3) if gasping/not breathing give 5 inflation breaths
4) reassess
5) if HR is <60 and not improving commence CPR (3:1)
What type of drug is Duloextine?
SNRI
True or False, lithium, naproxen, aspirin and codeine should ALL be avoided in breastfeeding?
True
What should you monitor for in a baby when their mother is breastfeeding them and on anti-epilleptics?
Monitor for apnoea, lethargy and poor weight gain
What should you give to the mother in the last month of pregnancy if she takes phenytoin?
Vit K - prevents clotting issues in the baby
What should you do when taking Rifampicin and oral contraceptives?
Use barrier protection for 4 weeks after stopping treatment (it reduces the efficacy of oral contraceptives)
How should you screen for the main complication of Kawasaki’s disease?
Echo - for coronary artery aneurysms
What findings will you see O/E in: Endometriosis Uterine Leiomyoma (Fibroid)
Endometriosis = uterosacral nodularity and tenderness on recto-vaginal exam Fibroid = enlarged mobile uterus, may be nodular
Medical Mx of miscarriage vs Medical Mx of TOP?
Miscarriage = Misoprostol TOP = Misoprostol and Mifepristone
What is Ebstein’s abnormality (aka Atrialisation)?
Low insertion of the tricuspid valve with large atrium and small ventricle - caused by inutero lithium exposure
Presents with tricuspid regurg (pansystolic murmur worse on inspiration), cyanosis, hepatomeglay and RBBB
What is Rigler sign?
Seen on X-ray in NEC
Air both inside and outside the bowel wall
What is Football sign?
Seen on X-ray in NEC
Air outlining the falciform ligament
How should you manage a child with asthma whos symptoms are not controlled by Salbutamol, Beclamethasone and Montelukast?
Stop the Montelukast (LTRA) Continue Salbutamol (SABA) and Beclamethasone (ICS) and start Salmeterol (LABA)
What are infantile spasms?
Seizure like activity in infants characterised by repeated flexion of the head/arms/trunk followed by extension of the arms
In women >50 when should you definatley perform a CA125?
If they have any of the following on a regular basis?
- Abdo distention or ‘bloating’
- Early satiety or loss of appetite
- Pelvic or abdo pain
- Increased urinary urge or frequency
What should you do if CA-125 is raised?
Perform abdo and pelvis US
What must be rulled out before diagnosing TIA?
Hypoglycaemia
What can you do to diagnose PPROM when there is no fluid in the posterior vaginal vault?
Use US to check for oligohydramnios
What is seen classically in shaken baby syndrome?
Retinal heamorrhage, subdrual haematoma and encephalopathy
Trigeminal neuralgia is treated with carbamazepine unless…
because these are red flag symptoms and so sould be reffered urgently to a specialist
- Sensory changes
- Deafness/ear issues
- Pain bilaterally or only in the opthalmic devision
- Optic neuritis
- Family Hx of MS
- Onset <40 years
- Hx of skin or oral lesions
What should you give all paediatric patients who have had an acute epsiode of asthma exacerbation?
3-5 days of oral steroids
Which nerve is damaged if you lose thumb adduction?
Ulnar nerve
When should folic acid be taken until, when should aspirin be taken from?
Folic acid = to 12 weeks
Aspirin = from 12 weeks until birth
What is the name of the tool which can be used in pts with multiple morbidities to decide weather initiation of a new medication will be benificial?
START tool
What is Diamorphine?
Heroin!!
What is Normative need?
Need that is defined by experts e.g. a need for vaccination
What is Felt need?
Need as percieved by an individual e.g. having a headache
What is Expressed need?
Felt need turned into an action (help seeking) e.g. going to the dentist for a toothache
What is Comparative need?
Needs identified by comparing services recieved by one group of individuals to those recieved by a comparable group (e.g. a rural village identifying a need for a school because a neighbouring village has one)
What is primary syphyillis?
Painless chancre in the genital area, swelling of the lymph nodes near to the chancre. Chancre lasts 3-6 weeks
What is secondary syphyillis?
Reddish borwn rash develops 2-8 weeks after the chancre develops. Rash is usually non-itchy and may affect the mucous membranes (leading to snail track ulcers).
There will be systemic symptoms of disease, patchy alopecia and condylomata lata which are mistaken for genital warts
What Sx may be seen in congenital syphyillis?
Pegshaped incisors, severe anaemia, aseptic meningitis, saddle nose deformity, blurred vision, abnormal sensitivity to light, sensorineural deafness and jaundice
How do you treat Wernicke’s Encephalopathy?
Thiamine (Pabrinex), MgSO4 and multivitamins
Headache and neurological signs after having your hair washed at the salon or after whiplash is a sign of?
Carotid artery dissection
What is Impetigo, how do you treat it?
A crusty golden rash around the mouth and chin. Treat with fusidic acid. Exclude from school until leasions are crusted and healed or until 48 hrs after commencing treatment
Group A strep and Staph Aureus
What is Oppositional Defiant Disorder?
Angry and irritable mood, often argues with/defies adults and authority figures. Is often spiteful or vidicitive and blames others for their mistakes.
Between which gestational ages should steroids be given in premature birth?
Between 24+0 and 33+6
True or false, high dose steroids can cause Psychosis?
TRUE
Which injuries are commonly associated with weakness of the shoulder and difficulty raising the arms above the head?
Axillary nerve injury due to proximal humerous fracture
Which injuries are commonly associated with wrist drop?
Radial nerve injury due to fracture of the shaft of humerous
Which injuries are commonly associated with loss of grip strength?
Ulnar nerve injry due to supracondylar fracture of the humerous or elbow dislocation
Which injuries are commonly associated with foot drop?
Common peroneal nerve injury due to fracture of the fibula or dislocation of the knee
How is Charcot-Marie Tooth Syndrome (aka HSMN) inherited?
Autosomal Dominant
How is disability or dependance in ADLs measured in stroke patients?
Barthel index
How can you shrink fibroids before myomectomy?
GnRH agonists e.g. Triptorelin or Gosorelin
When can the contraceptive pills, patches and intrauterine devices be safley given after birth?
POP = immediatley
COCP/Patch = after 3 weeks if not breastfeeding, after 6 weeks if breastfeeding,
Intrauterine decvices = after 4 weeks
After which age should X-ray be 1st line investigation for DDH?
4.5 months
What is the most important lifestyle modification in idiopathic intracranial hypertension?
Weight loss
Name 5 SEs of Sodium Valporate?
Teratogenic, Cytochrome P450 inhibitor, nausea, weigth gain/increased appetite, alopecia, tremor, hepatotoxicity, pancreatitis, thrombocytopenia, hyponatraemia, encephalopathy
What is the definition of orthostatic hypotension?
Drop in systolic BP >= 20mmHg on standing OR any drop in systolic BP to <90mmHg OR drop in diastolic BP >= 10mmHg with symptoms
Name 5 medications which can cause orthostatic hypotension?
Nitrates, diuretics, anti-depressants, anticholinergics, beta blockers, l-dopa, ACEis
What is the first line Tx in nocturnal enuresis when lifestyle mods/reward charts fail?
<7 years = enuresis alarm
>7 years = desmopressin or enuresis alarm
When is a whirl pool sign seen?
In ovarian torsion or bowel volvulous
Which signs can be seen on X-ray in NEC?
Pneumatosis Intestinalis (intramural gas) Rigler Sign (air inside and outside the bowel wall) Football Sign (air outlining the falciform ligament)
Apart from the eye going down and out what is seen in CNIII palsy?
Ptosis, absent direct and indirect light reflex in the affected eye and pupil dilation.
Intact direct/indirect light refelx in the unaffected eye
After what length of time may a grief reaction be considered abnormal?
After 6 months
RFs for hyperemesis gravidarum?
multiple pregnancy, trophoblastic disease, hyperthyroidism, nulliparity and obesity.
Smoking is protective!
Which nerve roots are affected in Erb-Duchenne Paralysis (aka Erb’s palsy?)
C5/6
Winged scapula or weighter’s tip sign - may be caused by breech position or shoulder dystocia
Which nerve roots are affected in Klumpke’s Paralysis?
T1
loss of intrinsic hand muscles (e.g. finger abduction weakness) - may be caused by traction injury
How can you treat CMPA?
Switch to extensive hydrolysed formula milk. If this is not affective switch to amino acid based formula milk
How is post-natal depression screened for?
With the Edinbrough scale
In hypospadius where is the urethral opening most commonly found?
On the distal ventral surface of the penis. There is often also a hooded foreskin
Which is the most common site for ectopic pregnancy? Which site is highest risk of rupture?
Commonest = ampulla of the fallopian tube
Highest risk of rupture = isthmus of the fallopian tube
How is G6PD defficiency inherited?
X-linked
Can you give sumitriptan to a patient who has cluster headaches and has had a CABG for coronary artery disease?
NO
Triptans are contraindicated in CAD as they can cause coronary vasospasm. Give only humidified oxygen for acute Tx
Give 4 examples of neuropathic pain, how can we treat it?
Diabetic neuropathy, post-herpetic neuralgia, trigeminal neuralgia and prolapsed intervertebral disc.
Give one of amitryptilline, duloxetine, gabapentin and pregabalin. Switch until one works
Name 5 SEs of Levodopa?
Dyskineasia, cardaic arrythmias, sexual inhibition, on-off effect, nausea/vomiting, postural hypotension, psychosis, reddish discolouration of urine on standing
How does degenerative cervical myopathy present and how is it investigated/treated?
Loss of fine motor function in both upper limbs which worsens over time.
Ix = MRI
Mx = surgical decompression
Where are wernicke’s and broca’s areas most commonly located?
Broca’s = L inferior frontal gyrus
Wernicke’s L posterior superior temporal gyrus
How do you investigate ?MS?
brain and spine MRI with contrast
What will an anterior criculation stroke affect?
ACA (motor and sensory Sx in the legs, gait apraxia, may be confusion), MCA (movement and sensation impairment of limbs and face, impaired speech and hemianopia) and opthalmic artery
Which branches of MCA are affected in Wernicke’s and Broca’s aphasia?
Broca aphasia = superior division of the MCA is affected.
Wernicke’s or conduction aphasia = inferior division of the MCA is affected
What is seen during the H test in CNVI palsy?
Abduction is normal but Adduction is limited
How is anaemia defined in the stages of pregnancy?
1st trimester = Hb <110g/L
2nd/3rd trimester = Hb <105g/L
Postpartum = Hb <100g/L
When is an ovarian cyst deemed complicated? What should you do?
Mulit-loculated
Biopsy!
What features are suggestive of a pseudo seizure?
Pelvic thrusting, female patient, family member with epilepsy, crying after seizure, gradual onset and don’t occur when the patient is alone
How long does contraception need to be used for after menopause?
<50 = 2 years of amenorrhoea >50 = 1 year of amenorrhoea
What is the emergency Tx of croup?
high flow oxygen and nebulised adrenaline
Sx of a pontine haemorrhage?
often a complication of chronic HTN.
Sx = low GCS, quadraplegia, miosis, absent horizontal eye movements
What is the 1st line long term prophylaxis of cluster headaches?
Verapamil
What is RAPD?
Seen in optic neuritis and CNII damage.
When light is shone into the affected eye both pupils dialte. When light is shone into the unaffected eye both pupils constrict
What happens to the pupillary reflex in CN III damage?
The damaged eye will not constrict at all (loss of direct and indirect pupillary reflex), the good eye will constrict as normal when light is shone in it and also the bad eye (direct and indirect pupillary reflex remain in tact)
What are the complications of Pethes disease, which gender is it most common in?
Osteoarthritis and premature fusion of the growth plates
5x more common in boys
How long should you leave between MMR doses (outside of routine vaccination schedule), when can you reduce this time?
3 months
1 month if >10 years or urgent situation e.g. outbreak in the child’s school
At what age should you refer a baby who is not sitting without support?
12 months
At what age should you refer a baby who is not walking without support?
18 months
Sx of Achondroplasia?
Trident hands, rhizomelia and brachydactyly, midface hypoplasia and flattened nasal bridge, lumbar lordosis and large head
Sx of Edward’s syndrome?
micrognathia, low set ears, cleft lip/palate rockerbottom feet and overlapping fingers
Sx of Patau’s syndrome?
mirocephaly, small eys, cleft lip/palate, scalp lesions, hypotelorism and polydactyly
What is the first line Abx for paediatric pneumonia? What do you give if there is also influenza? What do you giver if it is caused by mycoplasma?
1st line = amoxicillin
+ influenza = co-amoxiclav
Mycoplasma = erythromycin
Name some Sx of SSRI discontinuation syndrome?
Dizziness, electric shock sensations, anxiety, mood swings, fatigue, flu like Sxs, headache and loss of coordination
What is the cuasative oragnism in necrotising fascitits?
Betal haemolytic, group A strep
What is the causative organism in roseola infantum?
Human Herpes Virus 6
What is the causative organism in impetigo?
Group A strep and staph aureus
How can you differentiate between otitis media and otits media with effusion?
Otits media = red, bluging and tender tympaic membrane
With effusion = grey tympaic membrane with loss of the cone of light reflex and a visible fluid level behind the membrane - there may also be tinnitus, hearing loss and vertigo!
Sx of mastoiditis?
Boggy swelling behind the pinna, loss of the post-auricular sulcus and auricular proptosis
Naevus flammeus vs cavernous heamangioma?
Naevus flammeus = port wine stain, present at birth and grows with the child. Treat with laser therapy
Cavernous haemangioma = strawberry naevus, presents in first few months of life. No treatment unless interfering with vision or the airway
What is the Swenson procedure?
Tx for Hirschprungs
What is wedge excision?
Tx for meckles diverticulum (most common congenital GI malformation)
In which condition do you see pectus excavatum at birth?
Noonan syndrome
When and how should you giveacetylcystine in paracetamol OD?
Within 8 hours!
3 infusions - the first is over 1 hour
What is a fibroadenoma?
Small, painless, rubbery and mobile breast lump which moves easily under the skin and increases in size during menstruation
How do you investigate breast lumps?
<35 = USS and aspiration if cystic or biopsy if solid >35 = mammogram
What are the non-immune causes of foetal hydrops?
Severe anaemie (if maternal parovirus B19 infection, alpha thassaemia major or massive matero-foetal haemorrhage), cardiac abnormalities, T13/18/21, Turners sundrome, infection (toxoplasmosis, rubella, CMV and VZV), twin-twin transfusion syndrome (recipient twin) and chorioangioma
When do you need to give anti-D in misscarriage and TOP?
Non-sensitized rhesus negative women
Miscarriage = after 12+0
ToP = after 10+0
1st and 2nd line Tx of Guillaine-barre?
1st = IVIG 2nd = plasma exchange
What is Sandifer Syndrome?
Acid reflux and toticollis
Sudden deviation of the head and neck to one side and the legs to the other after feeding - seizure like, spine arches
Mx = manage GORD
What is heard in VSD?
Pansystolic murmur heard loudest at the lower left sternal edge
What is heard in ASD?
Ejection systolic murmur heard loudest at the upper left sternal edge
What is heard in ToF?
Harsh ejection systolic murmur heard loudest over the upper-left sternal angle
RFs for placenta accreata?
Previous PA, Previous surgical ToP/miscarrigae, previous C-section, multigravida, increasing maternal age, placenta praevia
What can cause an RAPD?
Large retinal detatchment, central retinal artery or vein occlusion, optic nerve ischaemia, optic neuritis, compression and asymmetric glaucoma
Which Abx can be used to treat chlamydia and gonorrhoea?
Azithromycin single dose orally
What is the best way to treat malignant spinal cord compression?
High dose dexamethasone
Which organisms can cause COPD exacerbation most commonly?
H. influenzaem Strep. pneumoniae, Moraxella cararrhalis
