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w/c 25/03 Flashcards

1
Q

what pathogens cause croup and acute epiglottitis?

A

croup= parainfluenza
acute epiglottitis= HIB

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2
Q

what ix are important to do in henloch scholein purpura?

A

urine dip- assess kidney function for proteinuria and haematuria
BP- check for hypertension due to kidney involvement

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3
Q

how are 2nd vs 3rd vs 4th degree tears repaired?

A

all by sutures
2nd degree= can be done on ward by clinician or experienced midwife
3rd and 4th degree= suture in theatre by experienced clinician

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4
Q

how many degrees of tears are there?

A

4

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5
Q

how do you differentiate septic arthritis and transient synovitis?

A

joint aspirate

presence of white cells or positive culture= septic arthritis

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6
Q

how do you always deal with an antepartum haemorrhage?

A

admit them

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7
Q

how is maternal and congential varicella zoster infection mx?

A

maternal (during pregnancy)- if non immune give IG as prophylaxis, if infection develops give aciclovir within 24 hrs of rash onset

congenital= give aciclovir

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8
Q

whats least invasive treatment for prolapse?

A

pelvic floor exercise

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9
Q

what are rf for placental abruption

A

anything that stretches the uterus: multiple gestation, polyhydramnios, trauma
pre eclampsia
IVF

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10
Q

what will be in the question stem when someone has symptomatic placenta praevia?

A

painless bleeding in the second or third trimester

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11
Q

what drugs are used to treat urge vs stress incontinence?

A

urge= oxybutynin
stress= duloxetine

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12
Q

whats the moa of duloxetine?

A

noradrenaline and serotonin reuptake inhibitor
increases strength of sphincter

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13
Q

whats the moa of oxybutynin

A

relaxes the detrusor

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14
Q

what are some absolute contraindications for the COCP

A

<6 weeks post partum breast feeding
current breast cancer
immobility
anything previous hx of clots- stroke, DVT, IHD
migraine with aura
uncontrolled htn
over 35 smoking >15/day

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15
Q

how long might lochia continue after childbirth?

A

6 weeks

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16
Q

what time frame does amniotic fluid embolism occur?

A

during or within 30 mins of birth

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17
Q

what medication should be avoided in someone taking SSRIs

A

triptans

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18
Q

what drugs cannot be taken while breastfeeding?

A

abx: cipro, tetra, chloramphenicol, sulfonamides
methotrexate
amiodarone
lithium
benzos
aspirin
sulphonylureas

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19
Q

what are the rules regarding methotrexate and conception?

A

both mum and dad need to stop medication and then dont concieve for 6 months

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20
Q

what are the time frames for alcohol withdrawal symptoms, seizures and delirium tremens?

A

sx= 6-12 hrs
seizures= 36 hrs
tremens= 72 hrs

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21
Q

how does the COCP affect cancer risk?

A

increases risk of breast and cervical cancer
protective for endometrial and ovarian cancer

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22
Q

what are the laws regarding FGM?

A

all cases must be reported

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23
Q

what are missed pill rules for the POP?

A

normal POPs if under <3hrs take missed pill and no action, if >3hrs take missed pill and use condoms for 48hrs and go back to taking pill regularly

devogestrel= same but 12 hrs instead of 3

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24
Q

what is potters sequence, what pathophysiology causes it and what is this most commonly associated with?

A

it is a presentation of flattened nose, chin recession, low set ears, resp distress due to pulmonary hyperplasia

it is due to oligohydramnios creating high pressure in the womb

most commonly associated with bilateral renal agenesis

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25
what are rules on breastfeeding on anticonvulsants?
you can breastfeed normally
26
what abx should be avoided in chorioamnionitis and why?
co amoxiclav increases risk of necrotising enterocolitis
27
describe the analgesic ladder in pregnancy
conservative measures: exercise, heat therapy, massage entonox (nitrous oxide) simple analgesia: paracetamol opiate analgesia: codeine phosphate/ diamorphone epidural pudendal nerve block
28
how do you differentiate parkinsons disease dementia from dementia with lewy bodies
parkinsons disease dementia= cognitive impairment first then parkinsons sx dementia with lewy bodies= cognitive impairment and parkinsons sx together
29
what is henloch schonlein purpura?
an autoimmune mediated vasculitis (IgA) its the most common vasculitis in children
30
what are the main methods of emergency contraception and what are their rules?
levonorgesterel: use up to 72hrs after UPSI, doesnt affect hormonal contraception, double dose if BMI >26 or >70kg, can be taken multiple times in a cycle if needed, retake if vomitting ulipristal: use up to 120 hrs after UPSI, not for asthmatics, use barrier contraception for 5 days after as it affects hormonal contraception IUD: first line, offer to everyone, insert within 5 days of UPSI or up to 5 days after predicted ovulation date
31
which contraceptive coil is better for heavy periods?
IUS- avoid the IUD in menorrhagia
32
what vaccines are contraindicated in pregnancy?
live eg MMR
33
what are the rules regarding air travel in pregnancy?
single pregnancy= not after 36 weeks multiple pregnancy= not after 32 weeks or if complicated
34
what is streptococcus agalactiae?
group B strep
35
how is pre existing hypertension managed in pregnancy?
stop ACEi or ARB start labetalol (first line) second line is nifedipine eg is asthmatic
36
how do you differentiate between circumstantiality, flight of ideas and tangentiality
circumstantiality= the patient ends up answering the question (circum= circumference= full circle) tangentiality and flight of ideas= the patient does not end up answering the question
37
what medications are used for medical mx of TOP vs ectopic?
TOP= oral mifepristone and vaginal misoprostol ectopic= IM methotrexate
38
after medical mx of a miscarriage when is a repeat pregnancy test done?
3 weeks
39
what skin change might you see in someone with antiphospholipid syndrome? what does it look like
livedo reticularis- purple, mottled rash
40
what will be in the question stem for necrotising enterocolitis
premature baby (almost exclusively) bile streaked vomits fresh rectal bleeding feed intolerance
41
how does parity affect risk of placenta praevia?
as parity increases risk increases
42
when should the moro reflex disappear by?
6 months
43
how do you differentiate lichen sclerosus and planus?
sclerosus= white patches, increased risk of vulval cancer planus= violaceous discolouration, no increased risk of cancer
44
for surgical mx of PPH, what is done stepwise
1. balloon tamponade 2. b lynch suture 3. stepwise uterine devascularisation 4. uterine artery embolisation 5. hysterectomy
45
what are protective factors for endometrial cancer?
smoking COCP
46
how do you manage a child with suspected transient synovitis?
referral for same day assessment as septic arthritis must be ruled out before you can make a definitive decision about management
47
what are clinical features of a PDA
continuous machinery murmur heaving apex beat wide pulse pressure left subclavicular thrill
48
what are differentials for diarrhoea in a toddler?
gastroenteritis lactose intolerance coeliac disease toddlers diarrhoea
49
what is retinopathy of prematurity?
seen in premature babies who require high levels of oxygen and have a LBW there is uncontrolled/abnormal development of blood vessels in the retina due to free radical damage from high oxygen levels
50
when are abx given for otitis media?
eardrum is perforated <2 yrs and bilateral infection present for 4 or more days under 3 months of age
51
what is double bubble sign seen in?
duodenal atresia
52
what condition is duodenal atresia associated with?
down syndrome (25% of cases)
53
when is n acetylcysteine given in paracetamol overdose?
if the overdose is staggered single intake: measure blood level for 4hrs, plot on nomogram and then decide
54
when is benzodiazepine sedation contraindicated? why?
in parkinsons or lewy body dementia patients due to extra pyramidal side effects of antipsychotics eg haloperidol
55
when do you not give IM haloperidol for sedation?
parkinsons patients dementia with lewy body patients
56
what are some indications for c section
malpresentation eg breech/transverse lie placenta praevia twin pregnancy if first twin is not cephalic maternal HIV primary genital herpes in the third trimester
57
what form of contraception is most associated with weight gain?
injectable contraceptive
58
how do you differentiate osgood schlatter and osteochondritis dissecans?
osteochondritis dissecans= pain, swelling, locking, does sport, bone fragment in knee joint detaches due to lack of blood supply, discomfort/pain on rest too osgood schlatter= localised tenderness/ enlargement as apposed to swelling, inflammation where patellar tendon attaches to the tibia, discomfort on activity
59
what drug is used for paeds bed wetting when pharmacological mx is needed?
desmopressin
60
how is DVT/PE ix and mx in pregnancy?
DVT: compression duplex US PE: chest x ray or ECG V/Q scan and CTPA after discussion mx= start LMWH if suspicion without delay/ need to confirm diagnosis
61
what is benign rolandic epilepsy?
partial seizures at night in children
62
what abx is scarlet fever mx with?
10 days penicillin V
63
what is goserelin, how does it work and when is it used?
GnRH agonist it reduces the size of fibroids but is only used short term eg before surgery
64
how is cryptorchidism in a child managed?
unilateral= review in 3 months, if not resolved see surgeon within 6 months bilateral= see surgeon immediately
65
what imaging is used to confirm a diagnosis of developmental dysplasia of the hip?
ultrasound
66
what part of the fallopian tube is a ruptured ectopic likely to be in and when?
isthmus= earlier rupture ampulla= later rupture
67
whats the moa of antipsychotics?
dopamine receptor antagonists
68
what thyroid imbalance causes heavy menstrual bleeding?
hypothyroidism
69
what is a missed miscarriage and how will it present?
when the foetus dies but has not yet been expelled presents with painless bleeding, closed os, foetus in gestational sac but no foetal heartbeat
70
define miscarriage
expulsion of an embryo up to 24 weeks
71
how can you differentiate inevitable vs threatened miscarriage?
inevitable= os open, bleeding and pain threatened= usually 6-8 weeks, maybe light bleeding, os is closed, foetal heartbeat present
72
what facial anomalies are seen in foetal alcohol syndrome?
short palpable fissures smooth philtrum thin upper lip
73
whats clomiphene moa and when is it given?
its an antioestrogen so increases FSH given on day 2 and 6 of the cycle
74
what electrolyte imbalances occur in refeeding syndrome?
low phosphate, magnesium and potassium
75
what ecg change is seen in refeeding syndrome and why?
prominent u waves due to hypophosphataemia
76
what opioid replacements can be given to patients?
methadone buprenorphrine
77
when do fibroids cause issues during pregnancy and why?
second and third trimester- red degeneration when fibroids enlarge and outgrow their blood supply leading to necrosis/ischaemia
78
what hormone are fibroids dependant on?
oestrogen
79
whats the latent vs active first stage of labour?
latent=0-4cm active=4-10cm
80
what are the laws regarding children and refusing treatment?
if they are under 18 they cannot refuse treatment unless one parent consents (even if the other disagrees)
81
in terms of placenta accreta/increta/percreta what is invasion into the perimetrium?
percreta because the perimetrium is past the myopetrium (its the serosal layer)
82
in someone with chickenpox what organism are they at risk of infection with and what does it cause?
beta haemolytic group A streptococcus causes necrotising fasciitis
83
when are low o2 sats after birth normal until?
10 mins
84
whats the most effective antipsychotic for negative sx of schizophrenia?
clozapine
85
how does the COCP affect risk of breast, cervical, endometrial and ovariancancer?
breast and cervical= increased risk endometrial and ovarian= reduced risk remember like b and c early in alphabet= increased risk
86
what abx is used for whooping cough?
azith/clarith if onset in past 21 days
87
whats the most common cause of primary headache in children? describe mx
migraine mx: ibuprofen nasal sumatriptans if >12
88
what antiemetic should be avoided in hyperemesis gravidarum and why?
metclopramide causes extrapyramidal side effects- dont use for more than 5 days
89
what deficiency does phenytoin cause?
folate
90
what is genetic imprinting?
when the phenotype depends on wether the maternal or paternal gene is deleted
91
define pre eclampsia
new onset htn >140/90 mmHg GA >20 weeks >1 of proteinuria or organ dysfunction
92
how is vit K given to babies after birth and why is it important?
one IM injection important for preventing haemorrhagic disease of the newborn can also be given orally but IM preferred
93
what do progestogens in HRT increase risk of?
breast cancer VTE cardiovascular disease
94
whats the most common heart defect in turners syndrome?
bicuspid aortic valve
95
what is proteinuria in pregnancy defined as?
persistent >300mg protein/24 hrs
96
what are rf for placenta accreta?
previous c sections ashermans syndrome PID
97
what does polydipsia/polyuria in someone on lithium indicate?
diabetes insipidus
98
how do u diagnose diabetes insipidus?
low urine osmolarity high serum osmolarity
99

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