w/c 6/02 Flashcards
what is infection with nisseria meningitides associated with adrenal haemorrhage and septic shock known as?
waterhouse friedrichson syndrome
what is seen on abdo x ray in NEC?
dilated bowel loops
pneumatosis intestinalis (gas in bowel)
pneumoperitoneum
what ix are done for suspected rickets?
bloods: calcium, phosphate, ALP, vitamin d
imaging: of joints eg wrists/knees
what might you see on x ray in a child with rickets?
cupping
fraying
widened epiphyseal plates
what is the first line ix for diagnosing duchennes muscular dystrophy?
genetic testing
what electrolyte abnormality is pyloric stenosis most associated with?
hypokalemia
what is the most common extra renal complication of polycystic kidney disease?
liver cysts
what organisms cause impetigo?
staph aureus
strep pyogenes
when should you check serum bilirubin levels after commencing phototherapy?
4-6 hrs
what is the most important side effect to monitor for when a child is on methylphenidate?
reduced growth
due to reduced appetite
how does congenital rubella syndrome present?
cataracts
deafness
patent ductus arteriosus
brain damage
what is seen on US when a child has intussusception?
target sign
what are sx of intussusception?
colicky pain after eating (child writhes or draws knees to chest)
redcurrant jelly stool
whats the first line ix for intussusception?
ultrasound
what imaging modality is used when DDH is suspected?
hip ultrasound
what are the 4 layers to think about when classifying obstetric tears?
perineal skin
perineal muscles
external/internal anal sphincters
anal mucosa
define 1st, 2nd, 3a/3b/3c and 4th degree tear
1= limited to perianal skin or vaginal mucosa
2= limited to perianal mucosa
3a= involves less than 50% of external anal sphincter
3b= involves more than 50% of external anal sphincter
3c= involves internal anal sphincter
4= involves anal mucosa
what are the cut off values for GDM? how do you remember this?
fasting glucose: >5.6mmol/L
2 hour plasma glucose: >7.8mmol/L
rule= 5678
what is given when someone has PPROM?
abx: erythromycin or clarithromycin
what is the biggest complication with breech presentation?
umbilical cord prolapse
when is surgical management in an ectopic not necessary? what is done instead?
bHCG <5000 IU/I
adnexal mass <35mm
no free fluid in abdomen
no intrauterine pregnancy
clinically stable
give methotrexate
what is the cut off for beta HCG in expectant management of a miscarriage?
<1500 IU/I
what are signs of rhesus d haemolytic disease in the newborn?
anaemia: pale or jaundiced
yellow amniotic fluid
hydrops fetalis
hepatosplenomegaly
what is hydrops fetalis? describe why it arises
subcutaneous/ serous cavity fluid collection as the heart has to pump more blood to deliver the same amount of oxygen
what is the triad for amniotic fluid embolism? what are some other sx
hypotension
coagulopathy
hypoxia
other sx: chills, sweating, coughing, cyanosis, hypertension, tachycardia
when is surgery required for an ectopic?
if there is an embryo heartbeat present
if beta HCG is more than 5000 IU/I
what are first line ix for infertility after a couple has been trying for one year in primary care?
semen analysis
mid luteal phase progesterone
what is Asherman’s syndrome? what can it lead to
when there are intrauterine adhesions due to previous surgeries, can lead to secondary amenorrhea due to obstruction of the menstrual outflow track
what can improve fertility in endometriosis?
laparoscopic diathermy and adhesiolysis
what is seen on TVUS in endometriosis?
nothing, its usually normal
what is the biggest risk factor for suicide attempt?
previous suicide attempts
what is the first line pharmacological management for GAD?
sertraline
what vaccines are given to children at 8 weeks?
rotavirus
6 in 1
men B
what does the 6 in 1 vaccine cover?
HIB
diptheria
tetanus
pertussis
polio
hep B
how long do you have to monitor a child with a head injury if they don’t need an urgent CT head?
4 hours
what organism commonly causes roseola infantolum?
human herpes virus 6
whats the formula for calculating dehydration deficit fluids in children?
% dehydration x 10 x body weight
note: leave % dehydration as it is- no need to make it into a decimal eg 4% stays as 4
what is given for acute hypoglycaemia?
2ml/kg IV dextrose
what are sx of GORD in babies?
vomiting after being laid flat
drawing knees up to chest
no signs of dehydration or being systemically unwell
how does hirchsprung disease present in a newborn?
failure to pass meconium
failure to pass stool unless a finger is inserted into the anus
dilated but non tender abdomen
no vomitting or other signs
how is hirchsprung disease diagnosed?
rectal suction biopsy
how is hirchsprung disease managed?
removal of the aganglionic segment of the colon
what intervention is done for intussusception in a stable patient?
air or contrast enema
how are preterm babies vaccinated?
according to normal scheduele
what is given first line in active management of labour?
10 units oxytocin
what are the 3 types of ovarian cancers and which is most common?
epithelial cell- most common
stromal cell
germ cell
what is the difference between gestational hypertension and pre eclampsia? when are they diagnosed?
both cannot be diagnosed before 20 weeks GA
gestational hypertension= only hypertension
pre eclampsia= hypertension plus proteinuria
what is the most common cause of PPH?
uterine atony
how is PPH managed?
10 IU oxytocin or 500 ug ergometrine
if this doesnt work bakri balloon
what do you need to do when someone who is rhesus negative has management for an ectopic?
anti d immunoglobulin
what are indications for surgical management of an ectopic?
women in lots of pain
foetal heartbeat detected
embryo >35mm
beta HCG >5000 IU
whats the triad for vasa praevia?
foetal bradycardia <100bpm
painless PV bleeding
membrane rupture
what does the hormonal IUS release?
levonorgestrel
whats the best form of contraception for someone with menorrhagia with no clear cause and desire for pregnancy?
IUS (mirena coil)
hormonal contraception to reduce bleeding, IUS over pill as dont need to take it everyday and local effects instead of systemic so less
what are some common causes of cervical ectropion?
COCP
pregnancy
in pregnancy what does trace glycosuria mean?
physiological change in pregnancy
there is increased glomerular filtration and reduced tubular reabsorption
what is a trachelectomy?
a procedure for early stage cervical cancer where the cervix is removed but it is fertility sparing as the womb isn’t removed so the woman can have children in the future
what is the gold standard diagnostic test for endometriosis?
laparoscopy
what are surgical management options for fibroids?
myomectomy
uterine artery embolisation
ablation
hysterectomy
when does the first stage of labour start?
4cm cervical dilation
what GA can you do the combined screening test?
10-13 weeks
what test is done to screen for downs syndrome when someone presents late to their booking appointment? what GA can it be done
quadruple test
done for week 15-22 GA
how can you differentiate GAD and PAD?
GAD= constant anxiety
PAD= panic attacks and then feel well inbetween
note: they can often overlap
what is akithisia?
inner restlessness and needing to constantly move
associated with low mood, suicidal ideation, agression
what generation antipsychotic is haloperidol?
first
what generation antipsychotic is olanzapine?
second
how does neuroleptic malignant syndrome present?
diaphoresis, high bp, muscle rigidity, confusion, pyrexia, tachycardia, tachypnoea
what is neuroleptic malignant syndrome associated with?
use of atypical antipsychoticsw
what test is done to diagnose neuroleptic malignant syndrome?
CK
how can you identify frontotemporal dementia from other types based on patient factors?
earlier age of onset
what is semantic dementia?
a type of frontotemporal dementia where there are issues regarding associating use of objects presented visually or auditory
what are features of lithium toxicity?
slurred speech
coarse tremor
seizure
confusion
AKI
vomitting
what depression medications are contraindicated in those on anticoagulants?
SSRI
whats the most common side effect of clozapine?
constipation
what triad indicates dementia with lewy bodies?
parkinsonism
visual hallucinations
fluctuating cognition
what medication increases lithium levels?
ACEi
how is lithium toxicity managed?
first line IV fluids and monitoring
haemodialysis if: lithium >4mmol/L or >2.5 mmol/L with renal symptoms
what is mx for ITP?
reassure that its usually self limiting so should resolve in 3-6 months
what is first line abx for bacterial tonsilitis?
phenoxymethylpenicillin
what are signs on examination
of inhaled foreign body?
monophonic wheeze and reduced sounds in the right lower lobe of lung
what do you add to asthma mx in a child over 5 if ICS and SABA are not sufficient
an LTRA
what are features of cerebral palsy?
spasticity
increased deep tendon reflexes
persistent primitive reflexes
delayed motor development
impaired fine motor skills
problems balancing/ coordination
delayed speech/language
what age do you give abx if someone has otitis media?
under 2 yrs
what is given to an actively vomitting patient in hyperemesis gravidarum?
IM anitemetic eg ploclorperazine
what does ‘term’ in pregnancy end (ie when is post term)
42+0 weeks and above
how can labour be induced? describe how each method induces labour
membrane sweep- seperate chorionic membranes from os
vaginal prostaglandins- ripen and dilate os
artificial rupture of membranes
balloon catheter- open os
what are hormone levels in PCOS?
high LH:FSh ratio
what does dyskaryosis on a smear mean?
abnormal nucleus ie pre cancerous cells, the patient should be referred to colposcopy
whats a normal foetal HR?
110-160 bpm
how is refeeding syndrome managed?
phosphate replacement
what do you find on bloods in anorexia nervosa?
raised cholesterol (LDL specifically)
what is tardive dyskinesia?
repeated movements, usually involving the face or jaw but can be limbs
what causes tardive dyskinesia in psych?
typical/1st gen antipsychotics- risk increases with length of use
metaclopramide
what section do police use to bring people from public to a safe place
section 136
what is the condition where patients believe insects/parasites are crawling over them?
ekbom syndrome
whats the difference between ekbom syndrome and delusional parasitosis?
ekbom= insects
delusional parasitosis= parasites
whats the pathology of alzheimers?
misfilling of beta amyloid so plaques accumulate in the brain causing neuronal loss and reduced cortex
how can you differentiate serotonin syndrome and NMS?
NMS= slower onset over days/weeks, hyporeflexia and normal pupils, associated with antipsycotics
Serotonin syndrome= acute onset, clonus, hyperreflexia, dilated pupils, associated with SSRIs and amphetamines
when does normal grief become prolonged grief disorder?
past 6 months
what is transposition of the great arteries and how does it present?
when the insertion of the pulmonary artery and aorta is swapped, babies may be cyanotic at birth or have sudden onset cyanosis/low o2 sats when the patent ductus arteriosus closes after a few days of being born
what infection does a rash that is rose-pink macules with surrounding pale halos indicate?
roseola/ human herpes virus 6
how does tuberous sclerosis present?
cutaneous: ash leaf shaped patches, leathery patch over base of spine,
neurological= seizures, developmental delay, infantile spasms, intellectual disability
other= cysts in lungs and kidneys
what is tuberous sclerosis? include inheritance pattern and genes mutated
autosomal dominant
TSC1/TSC2 genes
a rare neurological condition where benign tumors develop over the body
what are shagreen patches? what condition are they pathognomic for?
leathery patches of skin over the lumbar spine
seen in tuberous sclerosis
whats the formula for corrected gestational age in premature babies
age - ( 40- GA)
all in weeks
outline the neonatal resus protocol
check baby for tone, HR and breathing
if not breathing spontaneously / gasping provide tactile stimulation
reassess, if still not breathing give 5 rescue breaths and consider o2/ECG monitoring
reassess, if not breathing repeat 5 rescue breaths and start 02/ECG monitoring if not started
when chest starts moving, if HR <60bpm then ventilate for 30secs and reassess
continue assessing every 30 secs, if HR <60bpm consider venous/interosseous access and drugs
time and inform parents throughout
how does paediatric volvulus present?
intense pain/discomfort
significant bilious vomiting
note: all exams and xray may be normal
how is volvulus managed?
ladds procedure (surgery-laparotomy)
what are features of life threatening asthma?
PEFR <33%
silent chest
02 sats below 92%
what typically causes reyes syndrome in children?
aspirin use during viral infections
what is reyes syndrome/how does it present?
acute encephalopathy with fatty liver degradation
neurological defect (slurred speech, lethargy, coma), vomiting, abnormal LFTs
what ix are done for acute liver failure and what is seen?
LFTs- transaminases high
albumin- low
PT- prolonged
outline paediatric BLS
- ensure it is safe to approach child
- call for help
- observe for chest movements and listen for breathing
- open airway in neutral position
- give 5 breaths
- start chest compressions and continue in a 2 rescue breaths: 15 compressions ratio
how is orbital/preseptal cellulitis managed?
IV abx
how does hydrocele present?
pain starts after trauma to the testes
swelling on testes
testes can’t be palpated separately from swelling
whats the most common complication of measles?
otitis media
what is mx for gestational diabetes? include BG levels
first line lifestyle modifications (provided fasting glucose is <7mmol/L)
reassess in 2 weeks, if BG not controlled start metformin
whats the most common site for an ectopic pregnancy?
ampulla (fallopian tube)
what are risks of polyhydramnios?
preterm labour
PPH
increased perinatal mortality
congenital malformations
malpresentation
what type of prolapse is associated with the anterior vaginal wall collapsed downwards on speculum examination?
cystocele
what are RF for pelvic organ prolapse?
multiple pregnancy
instrumental delivery
increasing age
what drug is given before external cephalic version?
terbutaline
what is the moa of terbutaline
tocolytic with beta mimetic effect
causes relaxation of uterine muscles
what are some RF for uterine atony?
multiple pregnancy
polyhydramnios
foetal macrosomia
uterine fibroids
how is PROM at term managed?
IOL due to risk of infection
what is given for medical management in termination of pregnancy?
mifepristone
followed by misoprostol 2 days later
what is the moa of mifepristone?
blocks the action of progesterone (and relaxes cervix)
what is the moa of misoprostol?
prostaglandin analogue
softens the cervix and stimulates contraction
what are features of congenital varicella syndrome?
limb hypoplasia
microcephaly
skin scarring
low birth weight
what is given to a pregnant woman who gets chickenpox in the first trimester and why?
aciclovir
to prevent congenital varicella syndrome
whats the triad for wernickes encephalopathy?
opthalmoplegia
ataxia
confusion
what causes wernickes encephalopathy?
thiamine deficiency
classic in alcoholism
how do you remember side effects of carbamazepine
CARBA MEAN
confusion
ataxia
rashes
blurred vision
aplastic anaemia
marrow suppression
eosinophilia
ADH release
neutropenia
what is derailment?
when a patient says sentences that are completely unrelated, commonly seen in schizophrenia
what is first line medical mx for panic disorder?
SSRI or venlaflaxine
what antidepressant is often used in anorexia nervosa? why?
mirtazipine
it promotes weight gain and helps with depressive sx
when can personality disorders be diagnosed?
18yrs or older
what blood tests need to be done before starting lithium?
TFTs
kidney function- creatinine, GFR, U+Es
what are class c personality disorders and what do they include?
anxious and fearful:
dependant
obsessive compulsive
avoidant
whats the time frame for post partum depression?
4 weeks to one year after birth
whats the triad for normal pressure hydrocephalus?
gait disturbance
urinary incontinence
dementia
whats russels sign and what condition is it seen in?
knuckle scarring due to forced vomitting
seen in bullimia nervosa
what section under the MHA lasts up to 6 months?
3
how does mesenteric adenitis present?
acute diffuse abdo pain
follows an URTI
no loss of appetite
what is mesenteric adenitis?
swelling/enlargement of mesenteric lymph nodes
what ix are done for mesenteric adenitis and what would you see?
FBC- all normal, normal WCC rules out appendicitis
abdominal ultrasound- shows enlarged lymph nodes
what is jaundice, pale stool and dark urine with reduction in growth in a 2 week old baby indicative of?
biliary atresia
what ix is done to confirm biliary atresia?
cholangiography
how is biliary atresia managed?
kasai procedure at 2-3 months of age
what rash is associated with coeliacs disease?
dermatitis herpretiformis
what pathogen causes hand foot and mouth disease?
coxsackie A
what is the most common congenital heart defect in babies with diabetic mothers?
transposition of the great arteries
note: this is true of mothers with T1 and T2 diabetes NOT gestational diabetes
what is displaced in SUFE?
the capital femoral ephiphysis
what 3 abnormalities are seen in HELLP syndrome?
haemolysis
elevated liver enzymes
low platelets
how is HELLP syndrome managed?
expedite delivery
supportive management of organ failure
whats the most common type of epithelial ovarian cancer?
serous cystadenoma
what does psamomma bodies on pathology indicate?
epithelial ovarian cancer- serous cystadenoma
how do you remember how to differentiate placenta accreta/increta/percreta on scans?
accreta= attaches to myometrium
increta= invades myometrium
percreta= penetrates past myometrium
what age are ix done for menopause and what is done?
over 45= ix not needed
under 45= first line serum FSH can be done and will be raised in menopausal women
what is given to manage bleeding prior to surgery to women with fibroids? whats the moa
goserelin
GnRH analogue
