Things I need to Learn pt. 2 Flashcards
How can you manage NEC?
Stop oral feeds, give cefotaxime and vancomycin.
Do laparotomy if rapid distension and signs of perforation
Mx of intussusception?
Pneumatic reduction (air insufflation) under fluroscopoic guidance. Failing this surgery
True or false breastcancer is a contraindication to all oral hormonal contraceptives?
FALSE
It is a contraindication to ALL hormonal contraceptives (inlcuding patch, mirenal coil etc.
Mx acute confusional state?
Treat the underlying cause, then try environmental modifications then try oral haloperidol
What is the most likely cause of post coital bleeding in a 24 year old woman on the COCP?
Young woman, post-coital bleed and COCP = ?cervical ectropian
For how long can a urinary pregnancy test remain positive for following TOP?
4 weeks
Which drugs can be used in tocolysis?
MgSO4, indomethacin and nifedipine
Sx of cavernous sinsu syndrome?
Opthalmoplegia, proptosis, sensory loss in V1/V2 distribution, loss of the corneal reflex, horners syndrome (ptosis, miosis and anhydrosis)
Affects CN III/IV/V(1)/V(2)/CNVI
Sx of a parietal brain lesion?
Sensory inattention, astereognosis, apraxia, inferior homomymous quadrantopia
Sx of a occipital brain lesion?
Homonymous hemianoia (with maccula sparring), cortical blindness and visual agnosia
Sx of a temporal brain lesion?
Wernicke’s aphasia, superior homonymous quadrantopia, auditory agnosia and prospagnosia
Sx of a frontal brain lesion?
Broca’s aphasia, disinhibition, perservation, anosmia and inability to generate a list
Sx of a cerebellar brain lesion?
Midline = gait and truncal ataxia Hemisphere = intention tremor, past pointing, dysdiadokinesis and nystagmus
What diagnosis should you suspect in patient presenting with sensorineural hearing loss, vertigo and tinnitus who has cafe au lait spots?
Neurofibromatosis type II (due to the formation of bilateral acoustic neuromas/vestibular schwannomas)
In which condition are lisch nodules (irish haematomas) found?
NF1
Mx of Perthes disease?
If <6 years = observation
If >6 years = surgery
What characteristics are seen in innocent murmurs?
In children! Soft, systolic, short, symptomless and vary with position
In which conditions is cervial excitation seen?
Ectopic pregnancy or PID
AKA cervical motion tenderness
When should in-toeing resolve by?
8-10 years
Tx of Alzheimer’s?
1st line = acetylcholinesterase inhibitors = Donepezil, Galantamine or Rivastigmine 2nd line (or use 1st line in severe disease) = NMDA receptor antagonist - memantine
What can Rotigotine treat?
PD and restless leg syndrome
How pregnant does a woman have to be before pre-eclampsia or gestational HTN can be diagnosed?
20 weeks!
What is cyclothymia?
Chronic shifts in mood seen less severley than in bipolar disorder
What is the 1st line drug Tx for ADHD?
Methylphenidate
Define Bipolar 1 and Bipolar 2?
Bipolar 1 = mania and depression
Bipolar 2 = hypomania and depression
RFs for ectopic pregnancy?
PID, surgery to the tubes, previous ectopic, endometriosis, IUCD, POP and IVF
What is the most common cause of stridor in infants?
laryngomalacia
What is the risk of developing schizophrenia is your identicle twin (monozytoic) develops the condition? What is the risk if your parent has it? What is the risk if your sibling has it?
Monozygotic = 50% Parent = 10-15% Sibiling = 10%
A lady has a history of coagulopathy. How should you manage her miscarriage if she does not want surgery?
Medical = misoprostol vaginal perssary
Where does eczema typically affect in infants, younger children and older children?
Infants = trunk and face
Younger children = extensor surfaces
Older children = flexor surfaces and creases of the face/neck
What are the autonomic and neuroglycopaenic symptoms of neonatal hypoglycaemia?
Autonomic = jitteriness, irritability, tachypnoea, pallor Neuroglycopaenic = poor feeding, weak cry, drowsiness, hypotonia and seizures
What is delusional parasitosis?
The fixed false belief that the pt. is infested by bugs
What are the componenets of a confusion screen?
FBC (e.g. infection, anaemia, malignancy)
U&Es (e.g. hyponatraemia, hypernatraemia)
LFTs (e.g. liver failure with secondary encephalopathy)
Coagulation/INR (e.g. intracranial bleeding)
TFTs (e.g. hypothyroidism)
Calcium (e.g. hypercalcaemia)
B12 + folate/haematinics (e.g. B12/folate deficiency)
Glucose (e.g. hypoglycaemia/hyperglycaemia)
Blood cultures (e.g. sepsis)
Urinalysis (UTI)
Also consider CXR and CT Head
How can you tell between a complete and incomplete hydatic mole?
Complete = no foetal parts seen and has a snowstorm appearance Incomplete = some foetal parts seen, does not have a snowstorm appearance
Which hormonal HRT does not increase risk of VTE?
Transdermal patch!
Above which BMI should high dose folic acid be given?
> 30
What is the most common cause of GI malformation?
Oesophageal atresia and distal tracheooesophageal fistula
Which medications can be used to treat ADHD in children?
First line = methyphenidate (Ritalin)
2nd line = dexamfetamine/lisdexamfetamine/atomoxetine
Which mediations can be used to treat ADHD in adults?
1st line =Lisdexamfetamine or methyphenidate
2nd line = dexafetamine or atomoxetine
What is the first line treatment of viral induced wheeze?
Salbutamol inhaler with a spacer
What heart condition is associated with william’s syndrome?
Supravavular aortic stenosis
Which congential heart defects are associated with maternal rubella infection?
Pulmonary artery stenosis and patent ductus arteriosus
Which cardiac probles are associated with Marfan’s?
Mitral valve prolapse/regurgitation, aortic root dilation and cardiomyopathy
What is the inital management of a severe asthma attack?
High flow oxygen (if SpO2 <94%), corticosteroids, nebulised ipratropium and nebulised salbutamol.
If the attack is severe (SpO2 <92%) you can add nebulised magnesium
What are the classical features of the rash in meningococcal septicaemia?
Non-blanching, flat, purpuric rash which can start anywhere on the body and spreads rapidly. The lesions in the rash may vary in size.
The rash occurs as a result of meningococcus in the blood!
When should you offer oral antibiotics in impetigo? Which Abx would you give?
If there are any bullae or if the child is unwell/at risk of complications.
Abx = flucloxacillin or clarithromycin
How can you classify cryptorchidism?
Retractile = the testis is not present in the scrotum but can be minipulated into the scrotum before retracting again. Palpable = the testis can be palpated in the groin but is not retractile. Impalpable = no testis are felt (may lie in the inguinal canal, intraabdominally or may be absent)
By which age are most testes fully descended?
3 - 6 months
If not descended by 6 months reffer for treatment
Describe anaphalaxis?
A life-threatening type 1 hypersensitivity reaction where IgE antibodies on mast cells are stimulated. This causes release of preformed mediators e.g. histamine and tryptase. This can only happen after sensitisation (which is clinically silent)
Mx of anaphylaxis?
IM adrenaline 0.5ml (1 in 1000) - this stabalises mast cells.
IV corticosteroids and antihistamines can also be given
How does volvulous present?
Occurs most commonly in the first few days of life
Severe abdominal pain, billious vomiting and not passing stools
What is the most common cause of intestinal obstruction in infants after the newborn period?
Intussusception
Where is the msot common site of invagination in intussussception - how does it appear?
How should you manage it?
The ileum telescoping into the caecum. THis will cause distended small bowel which may be seen on x-ray.
Rectal air insufflation and IV fluids (to prevent shock as fluid pools in the abdomen)
What is the best management of infective gastroenteritis?
Oral rehydration fluids
Which medications can be used to treat bipolar?
Lithium, , sodium valporate, lamotrigine, carbamazepine, quetiapine, asenapine, aripiprazole or olanzipine
What is the name of the medication which causes negative symptoms on drinking alcohol?
Disulfiram (aka Antabuse)
Which pharmacological options can be offered to manage alcohol dependance?
Acamprostate or naltrexone
True or false oxybutynin can cause diarrhoea?
False it can cause constipation
Name the long term adverse effects of lithium?
Hypothyroidism, hyperparathyroidism, nephrotoxicity, renal tumours and rhabdomyolysis
What should you monitor in long term lithium treatment and how often should you monitor them?
Lithium levels every week until stable at treatment dose (0.6-0.8). Then every 3 months for the first year and every 6 months there after
Monitor U&Es, eGFR, TFTs and BMI every 6 months
You should not prescribe benzos for more than…
2-4 weeks as they are addictive and can cause drowsiness
What tests should you do to rule out organic causes of anxiety (rather than diagnosing GAD)?
FBC and iron studies (exclude anaemia), ECG and TFTs (to exclude causes of arrhythmia), 24-hour urinary metanephrines (exclude phaeochromocytoma)
What is the name of the hallucinations classically seen in Delirium Tremens?
Liliputian hallucinations (seeing lots of small people)
What drug class is Phenelzine? Which foods should you avoid with it?
MAOI
Avoid thymine rich producs e.g. cheese and cured meats as it can cause a hyeprtensive crisis
What heart condition is turner’s syndrome associated with?
Bicuspid aortic valve
Which nerve roots are damaged in Erb’s palsy?
C5-C6
What is Klumpke’s palsy? which nerve roots are affected?
C8-T1
Claw hand, the forearm is supinated and the wrist and fingers are hyperextended with flexion at the IPJ and MPJ joins
What can you give to help prevent preterm labour if the cervix is <25mm?
Vaginal progesterone (it prevents the cervix from remodelling)
Name the risk factors for placenta praevia?
Previous c-section, previous placenta praevia, older maternal age, maternal smoking, structural abnormalities (e.g. fibroids) and assisted repoduciton/IVF
What are normal LH and FSH levels at the mid cycle peak?
FSH = 4-25 LH = 10-75
What are normal LH and FSH levels at the follicular stage?
FSH = 3-10 LH = 2-8
Mx for mastitis?
Simple analgesia and warm compress
Encourage woman to continue breasfeeding or express breast milk by hand/pump (this will prevent nipple damage)
Abx are only given if there is an infected nipple fissure or if symptoms do not improve/worsen over 12-24hrs. Abx = Flucloxacillin
Name the possible presenting features of ovarian neoplasms?
Hirsutism, acute abdomen (due to torsion, rupture or haemorrhage), thyrotxicosis (struma ovarii) or amenorrhoea
What should you do in any new mother with possible Sx of psychosis?
Urgently admit for psychiatric evaluation
What are the X-ray findings in heart failure?
Alveolar oedema (bat wing opacities), kerly B lines, Cardiomegaly, Dilated upper lobe veins and pleural Effusions
In what condition is bilateral hilar lymphadenopathy seen on CXR?
Sarcoidosis
In what condition is bilateral calcified pleural plaques seen on CXR?
Asbestosis
How can you investiagate heart failure in the community? What do the results indicate?
Serum netriretic peptide measurements (pro-BNP)
>2000 = urgent echo (within 2 weeks)
400-2000 = echo within 6 weeks
<400 = normal, consider alternative diagnosis
What is the first step you should take if a patient presents with a hisotory of low mood and fatigue?
Ask them to fill out a PHQ-9 questionnaire
What should you do to assess a patient who you think may be having acute alcohol withdrawal?
Asses the AUDIT score. This will help you determine if the patient has been abusing alcohol and wether he wil be able to be managed in the community
Sx of normal pressure hydrocephalus?
Gait apraxia (levodopa unresponsive), cognitive/memory impairment, urinary frequency/urgency/incontinence and in severe disease faecal incontinence
What is the difference between myoclonic and clonic seizures?
Myoclonic = brief and short jerking in parts of the body Clonic = periods of shaking and jerking in parts of the body - will be regularly repeating (usually 2-3 per second)
What is the path of the CSF?
Lateral ventricles -> foramina of monro -> third ventricle -> cerebral aqueduce -> fourth ventrile -> foramina of luschka and magendie -> subarachnoid space
Sx of Primary Biliary Cholangitis? What may be seen on autoantibodies blood screen?
Fatigue, jaundice, puritus, associated Sjogren’s syndrome, sleep disturbances, postural dizziness and hepatomegaly
Anti-mitochondrial antibodies
Complications of nephrotic syndrome?
Hypovolaemia, thrombosis (DVT or PE), infection, pleural effusions
What is seen under the miscroscope in syphillis?
Spirochaete bacterium - Treponema Pallidum
What is seen under the miscroscope in Trichomoniasis?
Flagellated protozoan - Trichomonas Vaginalis
What is seen under microscope in thrush?
Pseudohyphae - candida
Sx of UC? How do yu treat?
Diarrhoea with blood/pus, abdo pain/cramping, weight loss, fever, pallor and distended abdomen
Tx = IV hydrocortisone in acute flare ups. Mesalazine for maintining remission of mild disease, prednisolone for moderate disease
What is the gold standard investigation for acromegaly?
Oral glucose tolerance test - growth hormone should normally be suppresed by glucose (>1ug/l = acromegaly)
What should you do if you have a febrile illnes in primary adrenal insufficiency?
Double the dose of hydrocortisone (keep fludrocortisone at standard dose)
What are the types of placenta accreta?
Accreta = chorionic villi are attached to the myometrium Increta = villi invade the myometrium Percreta = villi invade through the myometrium
When should you deliver in placenta accreta?
35-36+6 weeks via c-section
Tx for ruptured ectopic?
Emergency laparotomy with salpingectomy or salpingotomy
S/Es of depo provera?
Irregular bleeding, weight gain (only contraceptive proven to cause this), increased risk of osteoporosis and 1 year to return to fertility
When can the pertussis vaccine be given to pregnant women?
16 - 32 weeks
True or false, broad-spectrum antibiotics can affect the efficacy of the POP?
False.
Only rifampicin can affect its efficacy
How is haemophillia A inherited?
X-linked
What is the most common cause of menorrhagia?
Dysfunctional uterine bleeding (no pathology)
Can the rotavirus vaccine be given late? What form does it take?
Live attenuated virus, no becuase it can lead to intussusception
What should you do in a woman presenting with mastitis symptoms that have lasted more than 24 hours?
Oral flucloxacillin (erythromycin if penicillin allergic)
How can you acutley treat MS? How can you reduce the risk of relapse?
Acute = methylprednisolone Relapse = Beta-interferon
What is Meig’s syndrome?
Seen in fibromas (ovarian tumours), there is also ascites and pleural effusion
What is the most common ovarian tumour in under 25s?
Dermoid cysts
What is the most common ovarian tumour in women of reproductive age?
Follicular cyst
Which SSRI should be avoided in post-natal depression?
Fluoxetine
When can you use medical treatment of a uterine fibroid? What can you treat it with?
If it is <3cm and not distorting the uterine cavity
Treat with tranexamic acid, IUS or COCP
How does ondansetron work? What is its main use? What are its main SEs?
5-HT3 antagonist
Treats chemotherapy nausea
SEs = constipation and prolonged QT
Name 3 possible SEs of phenytoin?
Peripheral neuropathy, hirsutism and teratogenicity
What is the best way of giving rescue breaths?
from a 250ml bag via face mask
What is the definition of TIA? What is the most common underlying cause?
TIA = a transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia without acute infarction
Most common cause = AF
What is the wheeze like in bronchiolitis?
FIne inspiratory crackles
True or false, diplopia is not typically seen in PD?
True, it may indicate an alternative diagnosis (a parkinson plus syndrome)
What is required to diagnose dementia?
Neuroimagine (head MRI or CT)
What is seen in imaging in alzheimer’s?
Hippocampal volume loss, atrophy of the medial temporal lobe and posterior cortical atrophy
What drugs can be used to treat menstrual migraine?
Frovatriptan or Zolmitriptan
Who can metoclopromide cause acute dystonic reactions in?
Young patients
Which gene sequence is affected in fragile X?
CGG
Which gene sequence is affected in Huntingtons?
CAG
Which gene sequence is affected in myotonic dystrophy?
CTG
Which gene sequence is affected in Fredrich’s ataxia?
GAA
What is syringomyelia and syringobulbia? What is it assocaited with?
Syringomyelia = collection of CSF within the spinal cord
Syringobulbia = fluid-filled cavity in the medulla of the brainstem
Strong association with chiari malformaiton!
Sx of syringomyelia?
Cape like (over the medial hands, arms and the neck) loss of sensation to temperature and pain but preserved light touch, proprioception and vibration
When should you stop methotrexate when intending to concieve?
6 months before concieving in both men and women
When should you give aspirin from to prevent pre-eclampsia?
12 weeks until birth
What is seborrhoeic dermatitis? How do you treat?
Seen in children on the scalp, nappy area, face and limb flexures it is a erythematous rash with course yellow scales (known as cradle cap)
Mild-moderate = baby shampoo and baby oils
Severe = mild topical steroids
Should resolve in 8 months
Tx of trigeminal neuralgia, when should you reffer to neuro?
Carbamazepine
If unusual Sxs or if <50
Is there a C8 vertebrae?
NO this means C8 is the only cervical spine root that exits below the vertebrae (will exit at C7-T1)
> = which values would get a diagnosis of gestational diabetes?
fasting = 5.6 2hr = 7.8
What should you do if a semen sample is abnormal?
Repete test in 3 months
Describe an ataxic gait?
Wide-based with loss of heel to toe walking
How might tardive dyskinesia present?
Chewing, jaw protruding or excessive blinking
What is mittelschmerz?
scarp pain experienced mid cycle, there is little systemic disturbance
What is Fitz Hugh Curtis syndrome?
Peri-hepatic inflammation secondary to chlamydia infection in PID
How should you use the contraceptive patch?
Wear for 1 week, wear 3 weeks in a row and then take a 1 week break
Which antidepressants are most likely to have been used if a patient has new onset intracranial HTN?
TCAs
How do scarlet fever and kawasaki disease differ clinically?
SF = responds to antipyretics and has painful lymphadenopathy, rash is rough KD = does not respond to antipyretics, painless lymphadenopathy and non-specific rash
When should the moro reflex dissapear by?
4 months
When should the moro grasp dissapear by?
5 months
When should the rooting reflex dissapear by?
4 months
When should the stepping reflex dissapear by?
2 months
What are women with PCOS at very high risk of when undergoing IVF?
ovarian hyperstimualtion
How should you manage GAD after trying 2 SSRIs?
Give an SNRI e.g. Venlafaxine
How may epiglotttis present early on?
Acute onset of fever with a normalish RR, sitting forward and stridor
When should you check lithium levels (how many hours after dose)?
12 hours post-dose
What is in the combine DS screen? What indicates a positive test?
nuchal translucency, beta-hCG and PAPP-A
Increased nuchal transulcency and BhCG, decreased PAPP-A
What is in the triple DS screen? What is a positive result?
Beta-hCG, unconjugated oestrodiol and alpha-fetoprotein
High B-hCG and low AFT and oestrodiol
What is in the quadruple DS screen? What is a positive result?
Beta-hCG, unconjugated oestrodiol, alpha-fetoprotein and inhibin A
High B-hCG and inhibin A. Low AFT and oestrodiol
When do the majority of cord prolapses occur?
After artifical amniotomy (AROM)
What type of bleed should you suspect in signs of raised ICP within 72 hours of birth in a premature baby?
Intraventricular haemorrhage
How can you reduce the risk of hypoxic ischaemia in a hypoxic infant?
Neonate therapeutic colling
How can you differentiate between a pituitary tumour and a craniopharyngioma?
Pituitary tumour = superior bitemporal hemianopia
Craniopharyngioma = inferior bitemporal hemianopia
What is the first line non-horomonal Tx for menorrhagia?
Tranexamic acid
What is the most common (benign) epithelial cell tumour?
Serous cystadenoma
Which type of tumour may cause pseudomyxoma peritonei if it ruptures?
Mucinous cystadenoma
What are the key fine motor milestones reached at 3 months, 6 months and 1 year?
3 months = reaches for objects
6 months = palmar grasp
12 months = pincer grip
Before when is hand preference considered a sign of cerebral palsy?
Before 12 months
What shapes can children draw at 2, 3, 4 and 5 years?
2 = line 3 = circle 4 = cross 5 = square
When can a child turn pasges of a book individually?
2 years
What is the name of the questionairre used to assess frailty?
PRISMA-7
RFs for breech presentation?
Uterine malformations, poly/oligo-hydramnios, multiple pregnancy, multiparity, prematurity, placenta praevia and foetal abnormality
What should you do in a woman who becomes pregnant whilst taking a DOAC?
SWITCH to LMWH (DOACs are contraindicated in pregnancy)
Above what reading should maternal insulin be given in gestational diabetes?
Fasting plasma glucose >=7
How much weight loss in the first week of life would prompt a refferal to midwife-led breastfeeding services?
> 10%
What is the first and second line investigation for Pre-PROM?
1st line = speculum examination - looking for pooling of fluid in the posterior vaginal vault
2nd line = US - looking for oligohydramnios
When should you consider delivery from in Pre-PROM? What medications should you give?
34 weeks
up 10 days maternal oral erythromycin (or until in established labour begins - whichever is sooner)
What can be used to treat NMS?
Bromocriptine
What is the most common complication of TOP?
Infection
What medications are used in medical TOP?
Mifepristone then after 48 hours misoprostol
What is conductive aphasia?
Speech is fluent but repetition is poor. Comprehension is relativley in tact
1st line Tx for generalised seziures? What is a commonly recorded SE?
Sodium Valporate - weight gain
What is the disagnostic criteria for chronic insomnia?
A person has trouble sleeping (staying asleep OR falling asleep) for at least 3 nights a week for at least 3 months
What scale can be used to measure severity of OCD, what does the results indicate?
Yale brown Obsessive Compulsive Scale
>= 24 is severe or extremley severe - medicate
8-23 = mild-moderate - CBT
How long post-partum is contraception not required?
21 days
At what age is the peak incidence of croup?
6 months - 3 years
What is the diagnosis if you have precocious puberty and small testes?
Adrenal issues - commonly adrenal hyperplasia
What is the diagnosis if you have precocious puberty and one large testicle?
Sex-cord gonadal stromal tumour
What is the diagnosis if you have precocious puberty , large testicles and a history of sexual aggression in childhood?
Testotoxicosis
What is the diagnosis if you have precocious puberty and large testicles?
Brain tumour
Above which age is bed wetting considered abnormal?
> = 5 years
If you are going to offer GBS swabs when should you offer them?
3-5 weeks prior to anticipated delivery date
Which women should recieve intrapartum benzylpenicillin?
Had a previous child with GBS disease, are having pre-term labour, GBS colonisation in current pregnancy, prolonged rupture of membranes, have a fever of >38 degrees
Name some risk factors for MS?
Being female, being aged 20-40 and being vitamin D deficient
Below what score is dementia implied on MMSE?
<= 24
Which type of antidepressants should be stopped after diagnosing dementia and why?
TCA - risk of worsening cognitive impairment
Which type of cancer are you at higher risk of if progesterone is added to HRT? Which are you at higher risk of if there is unopposed oestrogen HRT?
Progesterone added = breast cancer
Unopposed oestrogen = endometrial cancer - do not give to women with a uterus
What are the requirements for an instrumental delivery?
FORCEPS
Fully dilated cervix, OA/OP position, Ruptured membranes, Cephalic presentation, Engaged presenting part, Pain relief, Sphincter (empty bladder)
What are the precautions that must be taken if >=2 pills are missed?
Take the last pill and today’s pill!
Week 1 = emergency contraception if UPSI in the pill free week
Week 2 = no need for emergency contraception
Week 3 = finish this pack and continue the next without a break
What are the Sx of Osgood-Schlatter Disease?
Seen in sporty teenager
Gradual onset unialteral knee pain which is initally mild and intermittment (but may progress and become severe/continuous)
Relieved by rest and worsened by kneeling and doing activity
Where is the inflammation in Osgood-Schlatter Disease?
Tibial tuberosity
Which medications can be used to treat PPH?
Oxytocin (IV), Ergometrine (IV/IM), Tranexamic acid (IV), Carboprost (IM) and Misoprostol (PO)
Name the causes of jaundice in the first 24 hours of life?
Rhesus haemolytic disease, ABO haemolytic disease, Hereditary spherocytosis, G6PD deficiency
What are the reflexes seen in pre-eclampsia?
Brisk tendon reflexes
What are the Sx of acute fatty liver in pregnancy?
Occurs in the 3rd trimester or immediatley after delivery.
Abdo pain, nausea, vomiting, headache, jaundice, hypoglycaemia, pre-eclampsia if severe.
What are the investigations and management for acute fatty liver in pregnancy?
Ix = Increased ALT Mx = supportive care and delivery
What is the most effective form of contraception? What are the most significant side effects?
Contraceptive implant
Irregular or heavy menstrual bleeding
What score will ‘decorticate motor response’ achieve on motor score for GCS?
3
What shoudl you do with a GCS <8?
intubate with an endotacheal tube
How does the development of dementia enable us to differentiate between LB dementia and PD?
LB = dementia occurs before the symptoms PD = dementia occurs after motor symptoms
What are the SSRIs of choice in breastfeeding women?
Sertraline and Paroxetine
What should you do with a patient who presents to GP within 7 days of ?TIA
300mg aspirin
Sx of luncar strokes?
Unilateral motor disturbance affecting the face, arm, leg or all 3
Complete one sided sensory loss
Ataxia hemiparaesis
How do you correct for prematurity?
40 - (however many weeks they were born at) add this to any expected age for milestones or minus their current age depending on the context
What are the key speech milestones (3 months, 6 months, 9 months, 12 months)
3 months = turns to sound
6 months = double syylables
9 months = “mamma, dadda”, understands no
12 months = responds to name
What are the key speech milestones (2 yrs, 3 yrs, 4 yrs)
2 years = combines 2 words, points to body parts
3 years = short sentences
4 years = asks when, how and why questions
What is the most common presenting feature of MS?
Optic neuritis
What is infantile colic?
Seen in children <3 monhts, bouts of excessive crying and pulling up of the legs - the child will become distressed DURING the ‘spasms’. Symptoms are often worse in the evening
What is infantile spasms?
Arms and legs go stiff and the babys head bends forwards, often associated with slowed development. Child settles during spasms and becomes distressed again AFTER
Do an EEG
What should you do in a woman with signs of severe pre-eclampsia at >37 weeks?
Give MgSO4 and deliver
Continuous dribbling incontinence after prolonged labour suggests what?
Vesicovaginal fistula
When should you measure APGAR scores?
1, 5 and 10 mins of age
What should you do if there is grunting in bronchiolitis?
Immediate hospital refferal
Treatment for threadworms?
Mebendazole
Describe hCG?
Prevents the disintegration of the corpus luteum. It doubles every 48 hours in the first few week of pregnancy and levels peak at 8-10 weeks. It can be detected from 8 days after conception. It is secreted by syncytiotrophoblasts
Above what is the concerning blood pressure in pregnancy (with significant proteinuria you will admit urgently)?
> 160/100
What should you always suspect as the inital diagnosis in bilateral optic disc blurring and inability to abduct the eye in a woman?
Papilloedema and CNVI palsy
Idopathic Intracranial Hypertension
When should you be concerned if children have not begun to walk by?
18 months
What should you suspect in a patient with blurring of the vision and ptosis worse at night with facial flushing and distension of the veins in the neck?
Myaesthenia Gravis
Thyoma is a common cause of MG and is the reason for the facial flusing and distension of neck veins
How may a brain abscess appear on CT ?
A central cavity which is surrounded by oedema. Raised ICP will be commonly seen
Mx of brain abscess?
Craniotomy and abscess drainage. Cephalosporin and metronidazole. Dexamethasone for raised ICP
1st and 2nd line Tx for Generalised tonic clonic seizures?
1st = sodium valporate 2nd = lamotrigine and carbamazepine
1st line Tx for absence seizures?
1st = sodium valoprate or ethosuximide
1st and 2nd line Tx for myoclonic seizures?
1st = sodium valporate 2nd = clonazepam and lamotrigine
1st and 2nd line Tx for focal (non absence) seizures?
1st = carbamazepine or lamotrigine 2nd = sodium valporate
Which type of seizures may carbamazepine exacerbate?
Absence and myoclonic
Below which value is capillary blood glucose considered very low in neonates. What is the Mx?
<1mmol/l
admit and start on 10% dextrose even if asymptomatic
In which conditions is it NOT appropritate to give haloperidol to treat an acute confusional state? What should you give instead?
Parkinson’s disease, Parkinsonism, LB Dementia and QT prolongation.
Give lorazepam
Below which centile for height should children be reviewed by a paediatrician
<= 0.4th centile
School exclusion for scarlet fever?
24 hrs after Abx
School exclusion for whooping cough?
2 days after Abx or 21 days after symptom onset
School exclusion for measles?
4 days
School exclusion for rubella?
5 days
School exclusion for chicken pox?
all lesions crusted over
School exclusion for mumps?
5 days from onset of swollen glands
School exclusion for D&V
until symptoms have settled for 48 hrs
School exclusion for impetigo?
until lesions have crusted and healed or 48 hrs after Abx
School exclusion for scabies?
until treated
School exclusion for influenza?
until recovered
How can neonatal sepsis present (vague symptoms)?
Poor feeding, grunting and lethargy
What is galactosaemia?
Disorder where by the body can not process galactose.
Sx = feeding difficulties, lethargy, failure to thrive, jaundice, liver damage and abnormal bleeding
Presents in the first few days of life
What are the signs of compensated (early) vs uncompensated (late) shock?
Compensated = normal BP, raised HR and RR, dereased urine output and pale/mottled skin Uncompensated = low BP, low HR, Kissmaul breathing (due to acidosis), absent urine output and blue skin
What are the characteristics of a simple febrile convulsion?
<15mins, generalised seizure, no recurrence within 24 hrs, complete recovery within 1 hour
What are the characteristics of a complex febrile convulsion?
15-30mins, focal seizure, repeated episodes may occur in 24 hours
What is febrile status epilepticus?
Convulsions lasting for >30mins
Sx of Roseola infantum? What is the most common complication?
High fever followed by maculopapular rash, Nagayama spots in the mouth, diarrhoea and cough
Febrile convulsions = complication
Which is considered worse in a patient with a fever, nasal flaring or moderate-severe intercostal recessions?
Intercostal recessions
Sx of William’s syndrome?
Elfin-like facies, extremley extroverted and friendly, LDs, short stature, transient neonatal hyeprcalcaemia and supravalvular aortic stenosis
Which chromosome is defected in William’s syndrome, how is it diagnosed?
7
FISH studies
What is the main risk factor for transient tachypnoea of the newborn?
C-section
What is the main risk factor for aspiration pneumonia of the newborn?
Meconium staining at birth
What is the characteristic X-ray finding of newborn respiratory distress syndrome, how do you manage it?
Diffuse ground glass lungs
Mx = oxygen, ventilation and exogenous surfactant via endotracheal tube
What is seen on CXR in transient tachypnoea of the newborn?
Interstitial oedema and pleural effusions (is a similar appearance to HF)
In which conditions is a bisferiens pulse notes?
Aortic stenosis and aortic regurg
What are the signs of PDA on examination?
L subclavicular thrill, continuous machinery murmur, large volume bounding collapsing pulse, wide pulse pressure, heaving apex beat
What is the most common childhood malignancy?
ALL
Mx for congenital diaphragmatic hernia? Which is the most common cause?
Left sided posterolateral bochdalek hernia
Mx = intubation and ventilation - survival = 50%
Causes of cleft palate?
Maternal smoking, benzo use, anti-epilleptic use, maternal rubella infection, T18/13/15
What is the cause of a nappy rash with well defined beefy red plaques?
Candida
What is the most common cuase of hypothyroidism in the UK and the developing world?
UK = autoimmune thyroiditis
Developing world = iodine deficinecy
