w/c 08/04 Flashcards
what is pco2 in a life threatening asthma attack? why?
normal
this indicates poor respiratory effort
how is whooping cough mx?
admit if under 6 months
macrolide abx if within 21 days of onset
when are patients reviewed after starting an SSRI?
in one week if under 25
in 2 weeks if over 25
how is haemophilia a inherited?
x linked recessive
what vaccines are routinely given to pregnant women? when are they given
pertussis- 16 to 32 weeks, note this is given again in pregnancy even if they have had it previously
influenza- anytime
what does paediatric diarrhoea after gastroenteritis indicate?
lactose intolerance
transient intolerance is common in children after viral gastroenteritis, exclude lactose from diet and reintroduce gradually to mx
whats in the quadruple test for downs and what suggests high likelihood
bHCG and inhibin A high
oestriol and AFP low
what is given first line in alcohol withdrawal?
chlordiazepoxide
whats done if there are late decelerations on CTG?
foetal blood sampling- if acidosis emergency c section
what indicates septic arthritis on kochers criteria?
high temp
raised WCC
raised CRP
non weight bearing joint
what exactly are diagnostic criteria for pre eclampsia
- > 20 weeks GA
- hypertension:
2 readings taken 4-6 hrs apart with systolic >140 or diastolic >90 OR over increase of 30 SBP or 20 DPB from booking - proteinuria (dip at least +1)
what ix do you do when you suspect henloch schonlein purpura and why?
urine dip
to assess kidney involvement
whats the triad for henloch schonlein purpura?
purpura over legs/buttocks
arthralgia
abdo pain
what scale can you use to assess stage of puberty?
tanner
what organism causes scarlet fever?
streptococcus
in babies, what is done to reduce secondary reperfusion injury?
cooling to 33-34 degrees
what is a classical c section
c section with vertical scar
whats the triad for shaken baby syndrome?
retinal haemorrhage
subdural haematoma
encephalopathy
what is avoidant personality disorder?
avoiding relationships (friends/romantic), social inhibition, interpersonal inhibitions due to fear of rejection and negative evaluation
what are caput succedaneum and cephalohaematoma?
caput succedaneum= present at birth, at vertex and crosses suture lines, resolves in days
cephalohaematoma= develops after birth, in parietal region, doesnt cross suture lines, resolves in months
both are mx conservatively
interpret the bishop score
<5= IOL needed, spontaneous labour unlikely
8 or greater= spontaneous labour likely
what are the ESPEs and how are they mx?
acute dystonia= sustained muscle contractions, mx with procyclidine
tardive dyskinesia= abnormal repetitive movements, mx with tetrabenazine
parkinsonism
akathisia= severe restlessness
what GA is lack of fetal movements concerning?
24
when can you put the progesteron implant in after birth?
immediately
whats the most common risk of TOP
infection
what are rules for going to school in hand foot mouth disease?
no exclusion needed
when can you do cone biopsy for mx of cervical cancer?
stage 1a
whats the difference between stage 1a and 1b cervical cancer?
1a= less than 7mm visible by micrsocpy
1b= more than 7mm visible by eye
both confined to cervix cos stage 1
what is the neonatal period?
0-28 days of life
first 7 days= early
7-28= late
when do you do kleihauer test?
any sensitising event after 20 weeks
how long after starting ellaone can you start long term hormonal contraception?
5 days
when is indomethacin given for PDA?
in the neonatal period
can do echo before giving it
whats the first step in PPH?
resus:
2 wide bore cannula
group and save, cross match, FBC, clotting studies
start IV fluids
lay flat
high flow oxygen
what happens when during controlled cord traction a women starts to bleed and the uterus is not palpable in the abdomen?
uterine inversion
how is uterine inversion managed?
push fundus of uterus back into the abdomen
what are some contraindications for lumbar puncture?
meningococcal septicaemia- risk of coning
raised ICP
focal neurological deficit
coagulation disorder
cardiovascular instability
what are the sx of hereditary haemochromatosis?
liver fibrosis
diaebetes
joint pains
secondary amenorrhoea
how can you differentiate ovarian torsion from ovarian cyst rupture and haemorrhage?
torsion will have whirlpool sign on US
what is a high vaginal swab culture used for?
gonorrhoea (it can be cultures, chlamydia cannot)
what is a NAAT vulvovaginal swab used for?
chlamydia or gonorrhoea
what does a NAAT vulvovaginal swab look for?
bacterial DNA
what is cervical motion tenderness and cervical excitation suggestive of?
PID
what is a seizure after a child has been crying inconsolably indicative of?
breath holding spell
they can be reassured and discharged
how does hydrocephalus present?
enlarged head circumference
sunsetting eyes
bulging anterior fontanelle
what are RF for hydrocephalus?
prematurity
spina bifida
meningitis
how can you differentiate inhaled foreign body from asthma?
asthma ALWAYS has a wheeze
how does the progesterone implant work?
inhibits ovulation
how do you differentiate somatisation vs hypochondriasis?
somatisation= symptoms are present
hypochondriasis= symptoms not present
whats first line abx for UTI while breastfeeding?
thrimethorpim
what is the test done if newborn otoacoustic emission test is abnormal?
auditory brainstem response test
what can someone with migraines on an SSRI not take
triptans
what do you need to monitor in someone on SNRI?
BP
name an SNRI
venlaflaxine
how is new onset confusion in someone starting an SSRI/ increasing their SSRI dose indicative of?
hyponatraemia
check their UEs
what ovarian pathology is associated with meigs syndrome?
fibroma
whats the most common benign ovarian tumor in women under 25?
dermoid cyst
how long after birth is contraception not needed in a women who isnt breastfeeding?
21 days
what are rocker bottom feet associated with?
edwards syndrome
where does gestational trophobastic disease metastasise to?
lungs
what vol of amniotic fluid is considered plyhydramnios?
2-3 l
what medication switch can be done if someone on antipsychotics has espes?
put them on olanzapine- lowest risk of espes
whats chlorpromazine?
a typical antipsychotic
what medication can you not give to someone with lewy body dementia?
first gen antipsychotics
why does downs syndrome increase risk of alzheimers?
amyloid protein gene is on chr 21 and downs is trisomy 21
what are rules regarding breast cancer and HRT?
past or active breast cancer is a contraindication
even if they are in remission, HRT can accelerate recurrence
whats the risk of transmission of HIV to baby if there is optimal treatment? outline what this treatment is
undetectable viral load
on ART
neonatal zidovudine
avoiding breastfeeding
risk of transmission is 2%
how can you differentiate viral hepatitis in pregnancy from acute fatty liver?
viral hep= LFTs severely raised (>500)
acute fatty liver= LFTs raised but not severely
whats the moa of tranexamic acid?
antifibrinolytic
describe acetic acid and iodine staining in colposcopy
acetic acid= abnormal cells take it up and appear white, normal cells stay pink
iodine= stains normal cells so white cells from acetic acid appear more prominent
note acetic acid is applied first then iodine
whats a missed miscarriage?
os closed
gestational sac in uterus
no symptoms
no heartbeat
whats the hyperemesis gravidarum diagnosis triad?
5% weight loss
dehydration
electrolyte imbalance
what is abx regime for PID?
IM ceftriaxone 1g
for 14 days
metronidazole 400mg orally twice daily
doxycycline 100mg orally twice daily
how long does section 3 last?
6 months
describe the renewal rules for section 3
initial 6 months
first renewal: 6 months
second renewals and thereafter: 1 year at a time
what fluid is commonly given in hyperemesis gravidarum?
IV saline with potassium
what BP are pregnant women admitted?
> 160/110
what class of drugs is phenelzine?
MAOI
what abx is given in children to cover for listeria?
IV amoxicillin
what abx is given to all children for meningitis?
IV cefotaxime
