Tuesday 10th Flashcards
1
Q
High risk of developing pre-eclampsia
A
- hypertensive disease during previous pregnancies
- chronic kidney disease
- autoimmune disorders such as SLE or antiphospholipid syndrome
- type 1 or 2 diabetes mellitus
2
Q
Blood pressure in pregnancy
A
- blood pressure usually falls in the first trimester (particularly the diastolic), and continues to fall until 20-24 weeks
- after this time the blood pressure usually increases to pre-pregnancy levels by term
3
Q
Hypertension in pregnancy
A
- systolic > 140 mmHg or diastolic > 90 mmHg
- an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic
- No proteinuria, no oedema
4
Q
Pseudodementia depression
A
Severe depression can mimic dementia but gives a pattern of global memory loss rather than short-term memory loss
- less than six months
- rapid onset
- biological symptoms e.g. weight loss, sleep disturbance
- patient worried about poor memory
5
Q
Evra patch is the only combined contraceptive patch licensed for use in the UK
A
- The patch cycle lasts 4 weeks
- For the first 3 weeks, the patch is worn everyday and needs to be changed each week.
- During the 4th week, the patch is not worn and during this time there will be a withdrawal bleed.
- Action required if delayed patch change over 48 hours: barrier protection for 7 days and emergency contraception if required
6
Q
High-risk HPV (hrHPV)
A
- If hrHPV positive, cytology is performed; if this shows normal cells then the cervical smear test is repeated in 12 months time.
- If this repeat test is still positive for hrHPV but cytology normal, another repeat test in a further 12 months
7
Q
Sepsis: RED FLAGs
A
- Responds only to voice or pain/ unresponsive
- Acute confusional state
- Systolic B.P <= 90 mmHg (or drop >40 from normal)
- Heart rate > 130 per minute
- Respiratory rate >= 25 per minute
- Needs oxygen to keep SpO2 >=92%
- Non-blanching rash, mottled/ ashen/ cyanotic
- Not passed urine in last 18 h/ UO < 0.5 ml/kg/hr
- Lactate >=2 mmol/l
- Recent chemotherapy
8
Q
Sepsis: fluid resus over 16yr
A
- use crystalloids that contain sodium in the range 130–154 mmol/litre with a bolus of 500 ml over less than 15 minutes
9
Q
qSOFA score: Sepsis
A
- Respiratory rate > 22/min
- Altered mentation
- Systolic blood pressure < 100 mm Hg
10
Q
Sepsis: Amber flags
A
- Relatives concerned about mental status
- Acute deterioration in functional ability
- Immunosuppressed
- Trauma/ surgery/ procedure in last 6 weeks
- Respiratory rate 21-24
- Systolic B.P 91-100 mmHg
- Heart rate 91-130 OR new dysrhythmia
- Not passed urine in last 12-18 hours
- Temperature < 36ºC
- Clinical signs of wound, device or skin infection
11
Q
SEPSIS SIX
A
- Administer oxygen: Aim to keep saturations > 94% (88-92% if at risk of CO2 retention e.g. COPD)
- Take blood cultures
- Give broad spectrum antibiotics
- Give intravenous fluid challenges: NICE recommend a bolus of 500ml crystalloid over less than 15 minutes
- Measure serum lactate
- Measure accurate hourly urine output
12
Q
Sequential (Sepsis-Related) Organ Failure Assessment Score (SOFA)
A
- PaO2 /FI O2 <400
- Platelets x103 microlitres <150
- Bilirubin µmol/L >20
- Cardiovascular: MAP <70mmHg
- GCS <15
- Creatinine µmol/L > 110
- Urine output ml/day <500
13
Q
human papillomavirus (HPV) vaccine
A
all 12- and 13-year-olds in school Year 8
14
Q
Suxamethonium
A
- Depolarising neuromuscular blocker
- Inhibits action of acetylcholine at the neuromuscular junction
- Degraded by plasma cholinesterase and acetylcholinesterase
- Fastest onset and shortest duration of action of all muscle relaxants
- Produces generalised muscular contraction prior to paralysis
- Adverse effects include hyperkalaemia, malignant hyperthermia and lack of acetylcholinesterase
15
Q
Asthma: diagnosis
Patients >= 17 years
A
- patients should be asked if their symptoms are better on days away from work/during holidays. If so, patients should be referred to a specialist as possible occupational asthma
- all patients should have spirometry: FEV1/FVC ratio less than 70%
- bronchodilator reversibility (BDR) test: in adults, a positive test is indicated by an improvement in FEV1 of 12% or more and increase in volume of 200 ml or more- - all patients should have a FeNO test: >= 40 parts per billion (ppb)
16
Q
Acute otitis externa
A
- Boil in external auditory meatus
- Acute pain on moving the pinna
- Conductive hearing loss if lesion is large
- When rupture occurs pus will flow from ear
- Ear packs may be used
- Topical antibiotics
- Operative debridement may be needed in severe cases
