w/c 26/05 Flashcards
what does giving vit K to babies prevent
haemorrhagic disease of the newborn
whats foetal hyantoin syndrome
syndrome due to maternal anti epileptic use (ones which are teratogenic)
manifests as IUGR, microcephaly, cleft lip/palate, intellectual disability, hypoplastic fingernails and distal limb deformity
how many principles in the mca
5
adjustment disorder definition
clear stress
presents within 3 months of stress
sx last <6 months
what type of neonatal jaundice does hypothyroidism cause
unconjugated
NSAIDs in breastfeeding
yes
roseola infantum rash
appears after fever/coryza
starts on trunk and spreads to limbs
what do krukenberg tumors contain histologically
signet ring cells
when does vomitting in pyloric stenosis usually start
3/4th week of life
duodenal atresia is associated with
downs syndrome
describe the respiratory physiological changes in pregnancy
increased tidal volume
increased minute ventilation
this causes breathlessness
how long after vaginal PGE2 is the cervix reassessed
what is done if theres no improvement
6 hrs
if bishop score is still under 6 give PEG2 again
meckels diverticulum rule of 2s
2% of population
2cm from ileocaecal valve
2 inches long
2 types of hypertrophic mucosa (gastric or pancreatic)
how might meckels diverticula present
usually asymptomatic
may mimic appendicitis
what methods of contraception increase risk of ectopic pregnancy
POP
IUD
when is interpersonal therapy used
when there is one clear trigger that can be the focus of therapy
atypical antipsychotic starting dose
10mg
what antihypertensives can contribute to/exacerbate depression
beta blockers
what class of medication is venlaflaxine
SNRI
what class of medication is paroxetine
SSRI
what class of medication is dosulepin
tricyclic
in a second episode of depression how long should you continue antidepressants after remission
2 years
multiple episodes of mania are considered to be a diagnosis of
bipolar affective disorder
NOT recurrent mania
whats the likelihood of someone with a manic episode experiencing depression
90%
3 main effects of lithium use
hypothyroidism
nephrotoxcity
hyperparathyroidism
psychological therapy in mania
is not offered in acute phase, not really effective for mania
effective for concordance with medication and future depressive episodes
max time period of benzo use in anxiety
2-4 weeks
how should someone be weaned off benzos after long term use
reduce 1/8th dose every fortnight
what benzo has the shortest half life
lorazepam
which benzo will give the worst withdrawal sx and why
lorazepam because it has the shortest half life- switch to diazepam (longer half life) then wean off
do all adult patients who self harm need to be seen by a psychiatrist or mental health nurse before discharge?
no
use of what psychiatric medication in the first trimester is associated with cleft lip
benzodiazipines
how should women be routinely screened for depression postpartum
ask about anhedonia and low mood
if they say yes to either, use the edinburgh postnatal depression scale
knights move thinking synonym
loosening of associations
what is the treatment plan for early psychosis
start low, go slow
ie low dose antipsychotics
what are the rules around testing for huntingtons
can only be done after genetic counselling, so not by gp
huntingtons chance of passing down?
50%
environmental risk factors for alzheimers
smoking
head injury
in those with dementia how many have alzheimers
60-70%
memantine class of drug
NMDA (glutamate) receptor partial agonist
acetylcholinesterase inhibitors
donepazil
rivastigmine
galantamine
how many people recover from anorexia nervosa in 20 years
50%
main difference between anorexia nervosa and bullimia
anorexia= weight low
bullimia= wight normal
what is section 48
for transfer of an unsentenced prisoner to hospital for detention there
what is section 49
a restriction order
who can apply a section 49
ministry of justice
IQ for mild, moderate, severe and profound disability
mild= 50-69
moderate= 35-49
severe= 20-34
profound= under 20
how long does a section 5(4) last
6 hrs
what is diagnostic overshadowing
when a persons symptoms are assumed to be relating to their learning disability
why are atypical antipsychotics preferred over typical
less extra pyramidal side effects
atypical antipsychotics cause more x side effects than typicals
metabolic
antipsychotics main moa
dopamine antagonists
what things do you check before starting lithium
patient mental state
pulse/BP
FBC
TFTs
UEs
calcium
what is required before a patient can be detained under section 2?
assessment by 2 doctors
how do atypical antipsychotics cause weight gain?
increased appetite
venlaflaxine class of drug
SNRI
driving and dementia
patient should be asked to inform the DVLA (even if they can still drive)
explore accidents etc with them and the family
screening for before someone is put on an acetylcholiensterase inhibitor
peptic ulcer disease/dyspepsia
LFTs
ECG
cardiac hx
asthma
activated charcoal is given when
when a patient presents within an hour of taking an overdose
when should bloods be done in paracetamol overdose
4 hours after ingestion as this is when levels peak
when do paracetamol levels peak after overdose
4 hours
whats used in the acute treatment of mania
atypical antipsychotic
consider adding lithium or valproate
what should you not prescribe in bipolar affective disorder
antidepressant
which is the only antidepressant licensed for use in bipolar affective disorder
fluoxetine
one unit of alcohol is
the amount of alcohol an adult can metabolise in an hr, 10ml or 8g of pure ethanol
what neurotransmitter does alcohol enhance and what effect does this produce
GABA-A
causes reduced anxiety
what neurotransmitter does alcohol inhibit and what effect does this produce
NMDA
causes amnesia
harmful drinking vs dependant drinking
dependant= has withdrawal sx
harmful= non dependant drinking that continues despite harm
alchohol withdrawal time
4-12 hrs after last drink
whats the most common infection in IVDU
hep C
benzo OD reversal
flumazenil
opiate OD reversal
naloxone
when can you start buprenorphrine
when withdrawal symptoms start (dont give before this)
does opiate analgesia need to be avoided in IVDU
no
what is given acutely in delirium tremens
benzodiazepine
what medications reduce seizure threshold when giving ECT
antipsychotics
antidepressants
first rank sx of schizophrenia
auditory hallucinations (3rd person where people are speaking about pt is most common)
passivity
thought interference
delusional perception
learning disability vs difficulty
difficulty= challenges in one aspect of learning
disability= overall intellectual function is impacted
how to differentiate dilutional anaemia of pregnancy from iron deficiency anaemia
dilutional= normal MCV
IDA= microcytic
why are foreign inhaled bodies more likely to be in the right main bronchus than the left
the angle the right bronchus makes with the carina is less severe
indications for CT head within an hour in a child
do CT within an hour if more than 1 of:
- 3 episodes of vomiting
- amnesia for over 5 mins
- LOC over 5 mins
- abnormal drowsiness
- dangerous mechanism of injury
what to do if a child doesn’t qualify for CT head within an hour
observe them for 4 hrs if they have 1 of
- 3 episodes of vomiting
- amnesia for over 5 mins
- LOC over 5 mins
- abnormal drowsiness
- dangerous mechanism of injury
exudative ascites definition
> 30 g/L protein
exudative ascites causes
malignancy
abdominal TB
pancreatitis
transudate ascites definition
protein <30g/L
transudate ascites causes
cardiac failure
hypoalbunaemia
liver cirrhosis
myoexedma
renal failure
what ovarian mass is associated with meigs syndrome
ovarian fibroma
most common histological subtype of ovarian cancer
cystadenocarcinoma
corpus luteum produces what
prgesterone
what cyst is most likely to tort and why
dermoid
heavy in weight due to hair, teeth etc
usually have a long peduncle so twist anticlockwise
most common presentation of chlamydia
asymptomatic
abx for chlamydia in pregnant women
azithromycin
after CIN 1 diagnosis how often is follow up done
yearly
what diagnostic test should you not perform on an ovarian mass and why not
biopsy
it will disseminate the disease, remove the mass as a whole
how is bartholins cyst managed
marsupialisation
what class of medications are tranexamic acid and mefanamic acid
antifibrinolyitcs
in what patient group should you not discuss mirena IUS/IUD
patients who arent sexually active
what class of analgesics should be avoided in pregnancy
NSAIDs
NSAID use in pregnancy affects
renal agenesis
teratogenic in 1st trimester
surgical TOP preferred at what GA
> 14 weeks
missed miscarriage what do you see on TVUS
gestational sac small for dates
no foetal heartbeat
VSD presentation
6 weeks of age
failure to thrive
systolic murmur at lower left sternal edge
VSD close spontaneously in what age
<1
>2 unlikely to close
patients with VSD at higher risk of what infection
infective endocarditis
medications for neuroleptic malignant syndrome
dantrolene
bromocriptine
how quickly does acute dystonia present
can present in a few hrs
how is imperforate hymen managed
incise the membrane
mid urethreal tape repair is for
stress incontinence
sacrcospinous fixation is done for
vaginal vault prolapse
urethral bulking agent is for
stress incontinence
burch colposuspension is for
stress incontinence
sacrocolpexy is for
prolapse repair
what class of medication is used for urge incontinence
parasympathomimetics
LMWH dose during pregnancy
BD 1mg/kg
stop LMWH injections in pregnancy if
feel like going into labour
24hrs before an elective procedure
spinal/epidural analgesia can only be given how long after last LMWH injection
24hrs
protamine sulfate reverses
unfractionated heparin
continue anticoagulation in pregnancy for
at least 3 months total duration
for 6 weeks postpartum
risks of evacuation of retained products of conception
bleeding
cervical trauma
infection
retained products of conception
uterine perforation
repeat evacuation of retained products needed
pph order of steps
A-E
call for help
vaginal exam and remove placenta if present
uterine massage
administer syntocinon
inset wide bore cannulae
FBC, groupsave, x match
consider catheterisation
what ix is important for pregnant women with suspected diabetes apart from glucose tests
obstetric US
what does an US help with in suspected diabetes?
exclude congenital abnormality
establish foetal growth
assess for polyhydramnios
what genetic condition is pyloric stenosis seen in
turners syndrome
how to differentiate schizoaffective disorder and major depression with psychotic features
in schizoaffective there will be evidence of psychosis even when mood is normal
in depression with psychosis the psychosis will only occur during/around the low mood
what is reaction formation
when a feeling/emotion is repressed by doing the exact opposite eg a homosexual man being outspokenly homophobic
what is dissociation
when someones personality/identity is drastically changed to avoid a stressor eg a child being abused adopting an aggressive personality
what is identification
when someone adopts the personality of someone who is more powerful eg a child who was abused becomes abusive as an adult
what is splitting
when someone sees people/things as either completely good or completely bad
what metabolic condition is associated with premature menopause
addisons disease
surgical procedures of total vault prolapse
sacrocolpopexy and sacrospinous fixation
what nerve may be damaged as a complication of sacrospinous fixation
sciatic
what type of hallucinations do you get with cocaine use
auditory or tactile
o2 sats above what allow salbutamol therapy to be stretched
92%
pregnancy parvovirus b19 infection complication
foetal death
when does most plasma volume expansion occur in pregnancy
2nd trimester
mumps complications
epididymo orchitis
pancreatitis
meningitis
what 2 methods are used for monitoring in uncomplicated labour
CTG
intermittent auscultation
causes of early late and variable decelerations
early= head compression
late= foetal hypoxia
variable= cord compression
normal foetal blood pH
> 7.25
when is progesterone level not an important ix in infertility
when the woman has irregular/absent periods as you cant determine when she has ovulated
FSH above what indicates poor ovarian reserve
15
poor ovarian reserve conceiving options
donor egg IVF
how does premature ovarian insufficiency affect thyroid
causes hypothyroid disease
what route is oestrogen not available
IM
risk of uterine scar rupture in VBAC
0.5%
grade 3a/3b/3c tear
3a= <50% of external anal sphincter
3b=>50% of external anal sphincter
3c=involves internal anal sphincter
what 3 things are women with 3/4th degree tears given on disharge
physiotherapy
laxatives
analgesia
dont give ulipristal on what medication
enzyme inducing drugs
incomplete miscarriage on ultrasound
there will be retained products of conception
what oral contraceptive is associated with an increased risk of ectopic pregnancy
POP
listeria prgenancy abx
ampicillin
erythromycin
steroids in placenta praevia/low lying placenta given when
34-35+6 weeks
what type of incident is given medication by wrong route vs wrong dose
wrong route= never event
wrong dose= serious incident
complication of listeria
septic abortion or premature labour and severely infected baby
mullerian agenesis is agenesis of
the uterus and top 2/3 of the vagina
klinefelter karyotype
47 XXY
HRT reduces risk of what cancer
colorectal
low libido on HRT what is given
testosterone
what nerve pain might you get in ovarian cyst torsion
medial thigh- obturator nerve
rf for ovarian cyst torsion
dermoid cyst
polycystic kidneys
IVF (ovarian hyperstimulation)
ca125 is useful when
post menopausal
due to low sensitivity its not useful in early cancers
ca125 physiologically raised when
during menstruation, first trimester and post partum
how does BMI affect severity of endometriosis
low BMI= more severe
anaemia in pregnancy screened at
booking
28 weeks
how does c section affect risk of PPH
increases
in psych/paeds ACE stands for
adverse childhood experiences
how is speech affected by autism
less words spoken for the age
no social smile at what age is concerning
3 monthsq
when to give combined HRT progesterone last 14 days of every month vs every 3 months
3 monthly if their periods are irregular
1 monthly if their periods are regular
physiological changes in pregnancy are due to what hormone
progesterone
how does cardiac output change in pregnancy and why
increases
due to increased stroke volume and heart rate
increase in what makes pregnant women hypercoagulable
fibrinogen and factor 8
how does blood pressure change in pregnancy
decreases in first trimester then starts to normalise by term
how does FRC change in pregnancy
decreases so oxygen reserve is less
how does minute ventilation change in pregnancy
increases due to increased oxygen demand and co2 production
if a women is due for a smear during pregnancy it is delayed in
3 months post partum
schizophrenia diagnostic criteria
1 out of: auditory hallucinations, thought interference, passivity, delusional perception
or 2 out of: any other hallucination, negative sx, speech disorder, catatonia
present for 1 month with a decline in function for 6 months
not occuring alongside substance misuse or affective episode
whats the most common site of referred pain from the ovaries
periumbilical
what is ulcer in the ileum associated with
meckels diverticulum
meckels diverticulum presentation
usually asymptomatic
rectal bleeding
inflammation
signs of obstruction
in korsakoffs syndrome what type of anemia do you get
anterograde
what type of cells line the endometrium
columnar
LH and FSH levels in PCOS
LH is high
FSH is normal (might be a bit high)
dose of dexamethasone for croup
single dose 0.15mg/kg
trichomonas vaginalis diagnosis
high vaginal swab
wet mount
urethrocele is what
descent of front part of vagina which is attached to the urethra
urethrocele causes what incontinence symptoms
stress
sacrocolpoplexy is used in what prolapse
vaginal vault
when is a lump on babies head concerning
when it crosses the suture lines
how many hrs after peak LH does ovulation occur
12
dsm v criteria for anorexia nervosa
intense fear of getting fat leading to reduced food intake
height/weight <85th percentile for their age
ortolani test is to see if what has happened to the hip
posterior dislocation
what does nitrofurantoin cause near term
haemolysis
lichen sclerosus treatment after steroids
topical tacrolimus
reviewing after starting ssri
weekly for a month after starting if under 30
what is contraindicated when a women is on tamoxifen therapy
ssris
what hormone do leydig vs sertoli cells respond to
leydig=LH
sertoli=FSH
1st/2nd/3rd/4th degree prolapse
1st= descent of cervix and uterus but doesnt reach introitus
2nd= descent of cervix and uterus but reaches introitus
3rd= descent of cervix and uterus to outside the introitus
4th= cervix, uterus and vaginal wall outside introitus
whats the pathology of henloch schonlein purpura
deposition of IgA complexes
cin 1/2/3 mx
cin1= observation and follow up smear in 12 months
cin2/3=lletz
if a mother contracts parovirus b19 how is foetal monitoring carried out
doppler ultrasound of middle meningeal artery fortnightly
pathological baseline rate on ctg
<100
>180
pathological variability on ctg
<5 for >50 mins
>25 for >25 mins
pregnant women on LMWH for DVT stop when
24 hrs before delivery
then give for 6 more weeks postpartum
what are the 2 different prolapses of the posterior vaginal wall and how do you differentiate them
rectocele= dre finger insertion will affect the prolapse
enterocele= dre finger insertion will not affect the prolapse
what does enterocele involve
loops of the small bowel
hypothyroidism in pregnancy increases risk of
pre eclampsia
what is the ROM plus test used for and what is measured
to check if membranes have ruptured
looks for IGF-1
miscarriages in the first trimester are usually due to
genetic abnormality
miscarriages in antiphospholipid syndrome usually occur when
after first trimester
fever pain score
used to determine risk of bacterial pharyngitis
<2= unlikely to be bacterial so no abx
2-3= maybe bacterial so deayed abx prescription
4-5= likely bacterial so start abx
cxr for meconium aspiration vs RDS
meconium aspiration= patchy opacity
RDS= ground glass opacities and air bronchograms
chondromalacia patellae presentation
pain at the knee
present more when walking up stairs or standing from a seated position
osteogenesis imperfect is a mutation in
type 1 collagen
features of osteogenesis imperfecta
repeated fractures
blue tinge to the eye
gold standard imaging for cerebral palsy diagnosis
MRI head
section 18 is for
forced return of a patient on leave from their section under section 17
section 135 vs 136
135= from home
136= from public
rapid plasma reagin in syphilis
positive
first line mx for catatonia
benzodiazepine
when might you give typical antipsychotics instead of atypical?
if someone has metabolic conditions like diabetes, hyperlipidaemia etc
atypicals have metabolic side effects
haloperidol what type of antipsychotic
typical
tricyclics have what side effects
anticholinergic:
blurred vision
dry mouth
constipation
tachycardia
delirium
urinary retention
antidepressant for someone with a background of heart disease
SSRI- sertraline
definition of antepartum haemorrhage
bleeding after 24 weeks
what organism is most commonly involved in puerperal sepsis
group a streptococcus/streptococcus pyogenes
dont do kleihauer test before what GA
20 weeks
give anti d within
72 hrs of a sensitising event
dose of anti d after a sensitising event before 20 weeks ga vs after
before 20 weeks= 250 IU
after 20 weeks= 500 IU (plus kleihauer test)
nuchal translucency over what is considered elevated
9mm
how is gestational age estimated at the first ultrasound
crown lump length
if its over 84 mm head circumference is used
conclusive tests offered is high risk of downs syndrome
amniocentesis
chorionic villus sampling
SFH low how do you mx
book appt to see midwife in 2 weeks
if still low refer for US to see foetal size
women with previous gestational diabetes are offered what screening and when
OGTT at booking and 24-28 weeks
early self monitoring can also be used
category 3 c sections require delivery within
24 hrs
duchenne vs becker muscular dystrophy presentation/life expectation
duchenne- presents earlier, life expectancy 20 yrs
becker- presents later (5-25) yrs, life expectancy 40, its like a milder duchennes
what rash is seen in children after a viral infection
pityriasis rosea
describe pityriasis rosea
follows a viral infection
large oval macule
followed by widespread rash around torso
what diet may be helpful in crohns
polymeric feeds
tonic clonic seizures first line anti epileptic
sodium valproate
wilms tumor presenation
firm non tender flank mass
haematuria
hypertension
wilms tumor imaging
abdominal ultrasound
shizophreniform disorder is
milder schizophrenia lasting 1-6 months
what is used in a care home/hospital to restrict someone
deprivation of liberty safeguard
what is used outside a care home/hospital to restrict someone
the court of protection
