w/c 25/03 Flashcards
what pathogens cause croup and acute epiglottitis?
croup= parainfluenza
acute epiglottitis= HIB
what ix are important to do in henloch scholein purpura?
urine dip- assess kidney function for proteinuria and haematuria
BP- check for hypertension due to kidney involvement
how are 2nd vs 3rd vs 4th degree tears repaired?
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
how many degrees of tears are there?
4
how do you differentiate septic arthritis and transient synovitis?
joint aspirate
presence of white cells or positive culture= septic arthritis
how do you always deal with an antepartum haemorrhage?
admit them
how is maternal and congential varicella zoster infection mx?
maternal (during pregnancy)- if non immune give IG as prophylaxis, if infection develops give aciclovir within 24 hrs of rash onset
congenital= give aciclovir
whats least invasive treatment for prolapse?
pelvic floor exercise
what are rf for placental abruption
anything that stretches the uterus: multiple gestation, polyhydramnios, trauma
pre eclampsia
IVF
what will be in the question stem when someone has symptomatic placenta praevia?
painless bleeding in the second or third trimester
what drugs are used to treat urge vs stress incontinence?
urge= oxybutynin
stress= duloxetine
whats the moa of duloxetine?
noradrenaline and serotonin reuptake inhibitor
increases strength of sphincter
whats the moa of oxybutynin
relaxes the detrusor
what are some absolute contraindications for the COCP
<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
how long might lochia continue after childbirth?
6 weeks
what time frame does amniotic fluid embolism occur?
during or within 30 mins of birth
what medication should be avoided in someone taking SSRIs
triptans
what drugs cannot be taken while breastfeeding?
abx: cipro, tetra, chloramphenicol, sulfonamides
methotrexate
amiodarone
lithium
benzos
aspirin
sulphonylureas
what are the rules regarding methotrexate and conception?
both mum and dad need to stop medication and then dont concieve for 6 months
what are the time frames for alcohol withdrawal symptoms, seizures and delirium tremens?
sx= 6-12 hrs
seizures= 36 hrs
tremens= 72 hrs
how does the COCP affect cancer risk?
increases risk of breast and cervical cancer
protective for endometrial and ovarian cancer
what are the laws regarding FGM?
all cases must be reported
what are missed pill rules for the POP?
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
what is potters sequence, what pathophysiology causes it and what is this most commonly associated with?
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
what are rules on breastfeeding on anticonvulsants?
you can breastfeed normally
what abx should be avoided in chorioamnionitis and why?
co amoxiclav
increases risk of necrotising enterocolitis
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
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
what is henloch schonlein purpura?
an autoimmune mediated vasculitis (IgA)
its the most common vasculitis in children
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
which contraceptive coil is better for heavy periods?
IUS- avoid the IUD in menorrhagia
what vaccines are contraindicated in pregnancy?
live eg MMR
what are the rules regarding air travel in pregnancy?
single pregnancy= not after 36 weeks
multiple pregnancy= not after 32 weeks or if complicated
what is streptococcus agalactiae?
group B strep
how is pre existing hypertension managed in pregnancy?
stop ACEi or ARB
start labetalol (first line)
second line is nifedipine eg is asthmatic
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
what medications are used for medical mx of TOP vs ectopic?
TOP= oral mifepristone and vaginal misoprostol
ectopic= IM methotrexate
after medical mx of a miscarriage when is a repeat pregnancy test done?
3 weeks
what skin change might you see in someone with antiphospholipid syndrome? what does it look like
livedo reticularis- purple, mottled rash
what will be in the question stem for necrotising enterocolitis
premature baby (almost exclusively)
bile streaked vomits
fresh rectal bleeding
feed intolerance
how does parity affect risk of placenta praevia?
as parity increases risk increases
when should the moro reflex disappear by?
6 months
how do you differentiate lichen sclerosus and planus?
sclerosus= white patches, increased risk of vulval cancer
planus= violaceous discolouration, no increased risk of cancer
for surgical mx of PPH, what is done stepwise
- balloon tamponade
- b lynch suture
- stepwise uterine devascularisation
- uterine artery embolisation
- hysterectomy
what are protective factors for endometrial cancer?
smoking
COCP
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
what are clinical features of a PDA
continuous machinery murmur
heaving apex beat
wide pulse pressure
left subclavicular thrill
what are differentials for diarrhoea in a toddler?
gastroenteritis
lactose intolerance
coeliac disease
toddlers diarrhoea
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
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
what is double bubble sign seen in?
duodenal atresia
what condition is duodenal atresia associated with?
down syndrome (25% of cases)
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
when is benzodiazepine sedation contraindicated? why?
in parkinsons or lewy body dementia patients
due to extra pyramidal side effects of antipsychotics eg haloperidol
when do you not give IM haloperidol for sedation?
parkinsons patients
dementia with lewy body patients
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
what form of contraception is most associated with weight gain?
injectable contraceptive
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
what drug is used for paeds bed wetting when pharmacological mx is needed?
desmopressin
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
what is benign rolandic epilepsy?
partial seizures at night in children
what abx is scarlet fever mx with?
10 days penicillin V
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
how is cryptorchidism in a child managed?
unilateral= review in 3 months, if not resolved see surgeon within 6 months
bilateral= see surgeon immediately
what imaging is used to confirm a diagnosis of developmental dysplasia of the hip?
ultrasound
what part of the fallopian tube is a ruptured ectopic likely to be in and when?
isthmus= earlier rupture
ampulla= later rupture
whats the moa of antipsychotics?
dopamine receptor antagonists
what thyroid imbalance causes heavy menstrual bleeding?
hypothyroidism
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
define miscarriage
expulsion of an embryo up to 24 weeks
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
what facial anomalies are seen in foetal alcohol syndrome?
short palpable fissures
smooth philtrum
thin upper lip
whats clomiphene moa and when is it given?
its an antioestrogen so increases FSH
given on day 2 and 6 of the cycle
what electrolyte imbalances occur in refeeding syndrome?
low phosphate, magnesium and potassium
what ecg change is seen in refeeding syndrome and why?
prominent u waves due to hypophosphataemia
what opioid replacements can be given to patients?
methadone
buprenorphrine
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
what hormone are fibroids dependant on?
oestrogen
whats the latent vs active first stage of labour?
latent=0-4cm
active=4-10cm
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)
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)
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
when are low o2 sats after birth normal until?
10 mins
whats the most effective antipsychotic for negative sx of schizophrenia?
clozapine
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
what abx is used for whooping cough?
azith/clarith if onset in past 21 days
whats the most common cause of primary headache in children? describe mx
migraine
mx:
ibuprofen
nasal sumatriptans if >12
what antiemetic should be avoided in hyperemesis gravidarum and why?
metclopramide
causes extrapyramidal side effects- dont use for more than 5 days
what deficiency does phenytoin cause?
folate
what is genetic imprinting?
when the phenotype depends on wether the maternal or paternal gene is deleted
define pre eclampsia
new onset htn >140/90 mmHg
GA >20 weeks
>1 of proteinuria or organ dysfunction
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
what do progestogens in HRT increase risk of?
breast cancer
VTE
cardiovascular disease
whats the most common heart defect in turners syndrome?
bicuspid aortic valve
what is proteinuria in pregnancy defined as?
persistent >300mg protein/24 hrs
what are rf for placenta accreta?
previous c sections
ashermans syndrome
PID
what does polydipsia/polyuria in someone on lithium indicate?
diabetes insipidus
how do u diagnose diabetes insipidus?
low urine osmolarity
high serum osmolarity
