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Qbanks > w/c 25/03 > Flashcards

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
Q

what are rules on breastfeeding on anticonvulsants?

A

you can breastfeed normally

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26
Q

what abx should be avoided in chorioamnionitis and why?

A

co amoxiclav
increases risk of necrotising enterocolitis

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27
Q

describe the analgesic ladder in pregnancy

A

conservative measures: exercise, heat therapy, massage
entonox (nitrous oxide)
simple analgesia: paracetamol
opiate analgesia: codeine phosphate/ diamorphone
epidural
pudendal nerve block

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28
Q

how do you differentiate parkinsons disease dementia from dementia with lewy bodies

A

parkinsons disease dementia= cognitive impairment first then parkinsons sx

dementia with lewy bodies= cognitive impairment and parkinsons sx together

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29
Q

what is henloch schonlein purpura?

A

an autoimmune mediated vasculitis (IgA)

its the most common vasculitis in children

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30
Q

what are the main methods of emergency contraception and what are their rules?

A

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

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31
Q

which contraceptive coil is better for heavy periods?

A

IUS- avoid the IUD in menorrhagia

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32
Q

what vaccines are contraindicated in pregnancy?

A

live eg MMR

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33
Q

what are the rules regarding air travel in pregnancy?

A

single pregnancy= not after 36 weeks
multiple pregnancy= not after 32 weeks or if complicated

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34
Q

what is streptococcus agalactiae?

A

group B strep

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35
Q

how is pre existing hypertension managed in pregnancy?

A

stop ACEi or ARB
start labetalol (first line)
second line is nifedipine eg is asthmatic

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36
Q

how do you differentiate between circumstantiality, flight of ideas and tangentiality

A

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

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37
Q

what medications are used for medical mx of TOP vs ectopic?

A

TOP= oral mifepristone and vaginal misoprostol

ectopic= IM methotrexate

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38
Q

after medical mx of a miscarriage when is a repeat pregnancy test done?

A

3 weeks

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39
Q

what skin change might you see in someone with antiphospholipid syndrome? what does it look like

A

livedo reticularis- purple, mottled rash

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40
Q

what will be in the question stem for necrotising enterocolitis

A

premature baby (almost exclusively)
bile streaked vomits
fresh rectal bleeding
feed intolerance

41
Q

how does parity affect risk of placenta praevia?

A

as parity increases risk increases

42
Q

when should the moro reflex disappear by?

A

6 months

43
Q

how do you differentiate lichen sclerosus and planus?

A

sclerosus= white patches, increased risk of vulval cancer
planus= violaceous discolouration, no increased risk of cancer

44
Q

for surgical mx of PPH, what is done stepwise

A
  1. balloon tamponade
  2. b lynch suture
  3. stepwise uterine devascularisation
  4. uterine artery embolisation
  5. hysterectomy
45
Q

what are protective factors for endometrial cancer?

A

smoking
COCP

46
Q

how do you manage a child with suspected transient synovitis?

A

referral for same day assessment as septic arthritis must be ruled out before you can make a definitive decision about management

47
Q

what are clinical features of a PDA

A

continuous machinery murmur
heaving apex beat
wide pulse pressure
left subclavicular thrill

48
Q

what are differentials for diarrhoea in a toddler?

A

gastroenteritis
lactose intolerance
coeliac disease
toddlers diarrhoea

49
Q

what is retinopathy of prematurity?

A

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
Q

when are abx given for otitis media?

A

eardrum is perforated
<2 yrs and bilateral infection
present for 4 or more days
under 3 months of age

51
Q

what is double bubble sign seen in?

A

duodenal atresia

52
Q

what condition is duodenal atresia associated with?

A

down syndrome (25% of cases)

53
Q

when is n acetylcysteine given in paracetamol overdose?

A

if the overdose is staggered
single intake: measure blood level for 4hrs, plot on nomogram and then decide

54
Q

when is benzodiazepine sedation contraindicated? why?

A

in parkinsons or lewy body dementia patients

due to extra pyramidal side effects of antipsychotics eg haloperidol

55
Q

when do you not give IM haloperidol for sedation?

A

parkinsons patients
dementia with lewy body patients

56
Q

what are some indications for c section

A

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
Q

what form of contraception is most associated with weight gain?

A

injectable contraceptive

58
Q

how do you differentiate osgood schlatter and osteochondritis dissecans?

A

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
Q

what drug is used for paeds bed wetting when pharmacological mx is needed?

A

desmopressin

60
Q

how is DVT/PE ix and mx in pregnancy?

A

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
Q

what is benign rolandic epilepsy?

A

partial seizures at night in children

62
Q

what abx is scarlet fever mx with?

A

10 days penicillin V

63
Q

what is goserelin, how does it work and when is it used?

A

GnRH agonist
it reduces the size of fibroids but is only used short term eg before surgery

64
Q

how is cryptorchidism in a child managed?

A

unilateral= review in 3 months, if not resolved see surgeon within 6 months
bilateral= see surgeon immediately

65
Q

what imaging is used to confirm a diagnosis of developmental dysplasia of the hip?

A

ultrasound

66
Q

what part of the fallopian tube is a ruptured ectopic likely to be in and when?

A

isthmus= earlier rupture
ampulla= later rupture

67
Q

whats the moa of antipsychotics?

A

dopamine receptor antagonists

68
Q

what thyroid imbalance causes heavy menstrual bleeding?

A

hypothyroidism

69
Q

what is a missed miscarriage and how will it present?

A

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
Q

define miscarriage

A

expulsion of an embryo up to 24 weeks

71
Q

how can you differentiate inevitable vs threatened miscarriage?

A

inevitable= os open, bleeding and pain
threatened= usually 6-8 weeks, maybe light bleeding, os is closed, foetal heartbeat present

72
Q

what facial anomalies are seen in foetal alcohol syndrome?

A

short palpable fissures
smooth philtrum
thin upper lip

73
Q

whats clomiphene moa and when is it given?

A

its an antioestrogen so increases FSH
given on day 2 and 6 of the cycle

74
Q

what electrolyte imbalances occur in refeeding syndrome?

A

low phosphate, magnesium and potassium

75
Q

what ecg change is seen in refeeding syndrome and why?

A

prominent u waves due to hypophosphataemia

76
Q

what opioid replacements can be given to patients?

A

methadone
buprenorphrine

77
Q

when do fibroids cause issues during pregnancy and why?

A

second and third trimester- red degeneration when fibroids enlarge and outgrow their blood supply leading to necrosis/ischaemia

78
Q

what hormone are fibroids dependant on?

A

oestrogen

79
Q

whats the latent vs active first stage of labour?

A

latent=0-4cm
active=4-10cm

80
Q

what are the laws regarding children and refusing treatment?

A

if they are under 18 they cannot refuse treatment unless one parent consents (even if the other disagrees)

81
Q

in terms of placenta accreta/increta/percreta what is invasion into the perimetrium?

A

percreta because the perimetrium is past the myopetrium (its the serosal layer)

82
Q

in someone with chickenpox what organism are they at risk of infection with and what does it cause?

A

beta haemolytic group A streptococcus

causes necrotising fasciitis

83
Q

when are low o2 sats after birth normal until?

A

10 mins

84
Q

whats the most effective antipsychotic for negative sx of schizophrenia?

A

clozapine

85
Q

how does the COCP affect risk of breast, cervical, endometrial and ovariancancer?

A

breast and cervical= increased risk
endometrial and ovarian= reduced risk

remember like b and c early in alphabet= increased risk

86
Q

what abx is used for whooping cough?

A

azith/clarith if onset in past 21 days

87
Q

whats the most common cause of primary headache in children? describe mx

A

migraine

mx:
ibuprofen
nasal sumatriptans if >12

88
Q

what antiemetic should be avoided in hyperemesis gravidarum and why?

A

metclopramide
causes extrapyramidal side effects- dont use for more than 5 days

89
Q

what deficiency does phenytoin cause?

A

folate

90
Q

what is genetic imprinting?

A

when the phenotype depends on wether the maternal or paternal gene is deleted

91
Q

define pre eclampsia

A

new onset htn >140/90 mmHg
GA >20 weeks
>1 of proteinuria or organ dysfunction

92
Q

how is vit K given to babies after birth and why is it important?

A

one IM injection
important for preventing haemorrhagic disease of the newborn

can also be given orally but IM preferred

93
Q

what do progestogens in HRT increase risk of?

A

breast cancer
VTE
cardiovascular disease

94
Q

whats the most common heart defect in turners syndrome?

A

bicuspid aortic valve

95
Q

what is proteinuria in pregnancy defined as?

A

persistent >300mg protein/24 hrs

96
Q

what are rf for placenta accreta?

A

previous c sections
ashermans syndrome
PID

97
Q

what does polydipsia/polyuria in someone on lithium indicate?

A

diabetes insipidus

98
Q

how do u diagnose diabetes insipidus?

A

low urine osmolarity
high serum osmolarity

99
Q
A

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