w/c 1/04 Flashcards
describe bHCG levels at 24 and 48hrs in someone with a intrauterine pregnancy vs ectopic
intrauterine= double or more increase
ectopic= increase but slowly
what is mum given before ECV?
anti D if rhesus positive
tocolytics
analgesia
what are ENT manifestations of downs syndrome?
flattened nasal bridge
small and low set ears
hearing issues
ear infections
what type of bilirubin is raised in physiological jaundince and why?
unconjugated
1. there is high red cell turnover
2. the immature liver can’t conjugate bilirubin quick enough
how is parity calculated?
delivery of a viable or non viable foetus
twins are counted as 1
+1= miscarriage or TOP
what cancer does tamoxifen increase risk of?
endometrial
within what time do category 1 and 2 c sections need to be performed?
1= 30 mins
2= 75 mins
what are indications for category 1 c section?
placental abruption
cord prolapse
uterine rupture
persistent foetal bradycardia
foetal hypoxia
what are rf for surfactant lung disease?
maternal diabetes
male sex
c section
second born of premature twins
what cardiac pathology is most associated with duchennes muscular dystrophy?
dilated cardiomyopathy
whats nexplanon?
contraceptive progesterone implant
whats the main adverse effect of the progesterone implant?
irregular bleeding
what is done when developmental dysplasia of the hip is suspected?
barlow/ortolani normal= hip US within 4-6 weeks
barlow ortolani abnormal= hip US within 2 weeks
describe how barlow and ortolani tests are performed?
barlow= adduct hip and place downward pressure to see if the hip will dislocate (you can feel the femoral head)
ortolani= abduct hip to see if it relocates (clunk will be heard if positive)
what is the most important treatment for viral encephalitis?
IV aciclovir
how does viral encephalitis present?
confusion
seizures
altered behaviour
all preceded with viral sx
what organisms might cause viral encephalitis?
HSV1
HSV2
japanese encephalitis
CMV
EBV
how is vulval cancer mx?
vulvectomy and inguinal node resection
if invasion <1mm or stage 1a and no lymph nodes involved, lymph node resection can be avoided
whats the most common hallucination in schizpophrenia?
auditory
how do you differentiate tracheooesophageal fistula and pyloric stenosis
in pyloric stenosis the vomited milk will be curdled as it will have passed through the stomach, in tracheoesophageal fistula it wont be
what makes a UTI in a child atypical?
seriously ill
problems with urine flow
septicaemia
high creatinine
mass on bladder
infection with non -coli organisms
failure to respond to treatment within 48 hrs
what are ix are done in children with a UTI and at what age/ times?
if under 6 months
USS during active infection
4-6 months after DMSA and MCUG
how is cellulitis for c section scars mx?
oral flucloxacillin first line
oral erythromycin if allergic
what male/female cells secrete androgens?
leydig
how do you differentiate turners syndrome and androgen insensitivity syndrome? what are their karyotypes
androgen insensitivity= 46 XY, breast development, normal height, primary amenorrhoea, no uterus
turners syndrome= 45 XO, primary amenorrhoea, lack of secondary sexual characteristics
what therapies are used to mx OCD?
exposure response therapy
cognitive behavioural therapy
when is OGTT done if a women has had previous gestational diabetes?
asap
eg after booking visit
what rf for gestational diabetes will warrant an OGTT?
BMI >30
previous macrosomic baby
1st degree relative with diabetes
ethnicity
what are the red flags in the paediatric traffic light system regarding colour, activity, respiratory, circulation and other
colour= pale/mottled/ashen
activity= doesn’t wake or can’t stay awake, weak/high pitched cry
respiratory= resp rate over 60
circulation= reduced skin turgor
other= under 3 months and temp >38, neurological deficit, meningism signs (non blanching rash/neck stiffness), status epilepticus/focal seizures, bulging fontanelle
what does apgar stand for?
appearance
pulse
grimace
activity
resp rate
what is 0/1/2 for appearance on apgar?
0= blue all over
1= peripheral cyanosis
2= pink
what is 0/1/2 for pulse on apgar?
0= absent
1= <100 bpm
2= >100 bpm
what is 0/1/2 for grimace on apgar?
0= absent
1= grimace
2= cries on stimulation/ sneezes/coughs
what is 0/1/2 for activity on apgar?
0=floppy
1= flexion of limbs
2= normal movement
what is 0/1/2 for respiration on apgar?
0=no cry
1= weak irregular cry
2= strong cry
what does adding progestogens to HRT increase risk of?
breast cancer
what are rf for transient tachypnoea of the newborn?
c section
male
birth asphyxia
gestational diabetes
what is high foetal fibronectin indicative of?
potential early labour
levels can indicate if its within 1/2 weeks but not definitive
what do you need to do in mums with gestational diabetes when steroids are given?
monitor blood glucose closely as steroids can cause hyperglycaemia
what are rules regarding IUS/IUD insertion after birth?
insert within 48hrs of birth or wait 4 weeks
how is postpartum thyrotoxicosis mx?
propanolol alone
thyroxine later when they enter hypothyroid phase
what is cyclical oral progestogen?
a form of HRT NOT contraception (contraception is continuous progestogen)
what abx are used for whooping cough
macrolide (azithromycin/clarithromycin)
when there is prolonged rom what infections might mum have?
choriamnionitis
intrauterine infection
what vitamin do you need to replace in hyperemesis gravidarum when mum is dehydrated?
thiamine
what ix confirms PID?
endocervical swab
how does transposition of the great arteries present?
cyanosis at birth or within 24hrs of birth
loud S2
how can you differentiate placenta praevia and vasa praevia in a pregnancy woman with PV bleeding?
placenta= placenta on US <2cm from os
vasa= placenta on US >2cm from os
what is chandelier sign?
severe pain on palpation of the anterior cervix while applying pressure to the fundus of the uterus
associated with PID
what does of adrenaline is given to children in anaphylaxis?
<6yrs old= 150 ug 1:1000
6-12 yrs= 300 ug 1:1000
whats the difference between early onset and late onset GBS infection
early= within 48 hrs of delivery
late= after one week, usually presents as meningitis and has a better mortality
in sheehans syndrome where does necrosis occur?
anterior pituitary
if a women is still hypertensive after delivery how is she monitored?
every other day in the community until targets are met
where is foreign body aspiration likely to cause a blockage?
right main bronchus
what skin change is associated with PCOS?
acanthosis nigricans- hyperpigmentation and skin thickening
what can cause cord prolapse during labour?
polyhydramnios
what is used to calculate expected delivery date and how does it work?
naegeles rule
add 9 months to LMP plus 7 days
when can you give an epidural in labour?
once active labour starts
what do nabothian cysts look like and where are they found?
amber/yellow mucous containing cysts
found on the cervical os where the epithelium transitions
how are nabothian cysts mx?
can leave them as they are normal but they should be swabbed
how is proteinuria quantified in pre eclampsia? what is considered significant
urine protein:creatinine
>30 mg/mmol
when should membrane sweep be offered for IOL?
40 weeks nullip
41 weeks parous
how does the pearl index for contraception work?
tells you how many women per 100 would get pregnant on the contraception in one year
what cardiac issue does VSD increase the risk of?
endocarditis
what will be in the question stem for meckels diverticulum?
GI bleed- rectal bleeding
patient is haemodynamically unstable
between 1-2 yrs old
right lower quadrant pain (similar to appendicitis)
how is meckels diverticulum ix and mx?
ix= 99 technetium scan
mx= surgical removal if symptomtatic
what is a diverticula?
a small bulging pouch in the small intestine
why are NSAIDs contraindicated in chickenpox?
they increase the risk of necrotising fascitis
what rate are chest compressions performed in paediatric bls?
100-120 bpm
what abx are given in pprom?
10 days erythromycin
what are early signs of hyperemesis gravidarum?
ketonuria
weight loss >5%
what are some causes of second trimester miscarriage?
SLE
antiphospholipid syndrome
bicornuate or septate uterus
whats type of rash is nappy rash?
irritant dermatitis
what is done when semen analysis is abnormal?
repeat in 3 months
explain ebsteins anomaly
when due to maternal lithium use during pregnancy, there is a heart defect in the baby wherein the tricuspid valve is low set, meaning the right atrium is big and the ventricle is small= atrialisation of the right ventricle
how can you recognise growing pains?
bilateral
affects legs and shins mainly
never present at start of the day
no limitation on activity
systemically well
no findings on examination
how is SUFE mx?
internal fixation
what blood test is done for POI and why?
FSH
2 high FSH 4-6 weeks apart are diagnostic
