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w/c 6/02 Flashcards

1
Q

what is infection with nisseria meningitides associated with adrenal haemorrhage and septic shock known as?

A

waterhouse friedrichson syndrome

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2
Q

what is seen on abdo x ray in NEC?

A

dilated bowel loops
pneumatosis intestinalis (gas in bowel)
pneumoperitoneum

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3
Q

what ix are done for suspected rickets?

A

bloods: calcium, phosphate, ALP, vitamin d
imaging: of joints eg wrists/knees

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4
Q

what might you see on x ray in a child with rickets?

A

cupping
fraying
widened epiphyseal plates

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5
Q

what is the first line ix for diagnosing duchennes muscular dystrophy?

A

genetic testing

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6
Q

what electrolyte abnormality is pyloric stenosis most associated with?

A

hypokalemia

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7
Q

what is the most common extra renal complication of polycystic kidney disease?

A

liver cysts

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8
Q

what organisms cause impetigo?

A

staph aureus
strep pyogenes

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9
Q

when should you check serum bilirubin levels after commencing phototherapy?

A

4-6 hrs

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10
Q

what is the most important side effect to monitor for when a child is on methylphenidate?

A

reduced growth
due to reduced appetite

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11
Q

how does congenital rubella syndrome present?

A

cataracts
deafness
patent ductus arteriosus
brain damage

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12
Q

what is seen on US when a child has intussusception?

A

target sign

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13
Q

what are sx of intussusception?

A

colicky pain after eating (child writhes or draws knees to chest)
redcurrant jelly stool

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14
Q

whats the first line ix for intussusception?

A

ultrasound

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15
Q

what imaging modality is used when DDH is suspected?

A

hip ultrasound

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16
Q

what are the 4 layers to think about when classifying obstetric tears?

A

perineal skin
perineal muscles
external/internal anal sphincters
anal mucosa

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17
Q

define 1st, 2nd, 3a/3b/3c and 4th degree tear

A

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

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18
Q

what are the cut off values for GDM? how do you remember this?

A

fasting glucose: >5.6mmol/L
2 hour plasma glucose: >7.8mmol/L
rule= 5678

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19
Q

what is given when someone has PPROM?

A

abx: erythromycin or clarithromycin

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20
Q

what is the biggest complication with breech presentation?

A

umbilical cord prolapse

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21
Q

when is surgical management in an ectopic not necessary? what is done instead?

A

bHCG <5000 IU/I
adnexal mass <35mm
no free fluid in abdomen
no intrauterine pregnancy
clinically stable

give methotrexate

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22
Q

what is the cut off for beta HCG in expectant management of a miscarriage?

A

<1500 IU/I

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23
Q

what are signs of rhesus d haemolytic disease in the newborn?

A

anaemia: pale or jaundiced
yellow amniotic fluid
hydrops fetalis
hepatosplenomegaly

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24
Q

what is hydrops fetalis? describe why it arises

A

subcutaneous/ serous cavity fluid collection as the heart has to pump more blood to deliver the same amount of oxygen

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25
Q

what is the triad for amniotic fluid embolism? what are some other sx

A

hypotension
coagulopathy
hypoxia

other sx: chills, sweating, coughing, cyanosis, hypertension, tachycardia

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26
Q

when is surgery required for an ectopic?

A

if there is an embryo heartbeat present
if beta HCG is more than 5000 IU/I

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27
Q

what are first line ix for infertility after a couple has been trying for one year in primary care?

A

semen analysis
mid luteal phase progesterone

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28
Q

what is Asherman’s syndrome? what can it lead to

A

when there are intrauterine adhesions due to previous surgeries, can lead to secondary amenorrhea due to obstruction of the menstrual outflow track

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29
Q

what can improve fertility in endometriosis?

A

laparoscopic diathermy and adhesiolysis

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30
Q

what is seen on TVUS in endometriosis?

A

nothing, its usually normal

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31
Q

what is the biggest risk factor for suicide attempt?

A

previous suicide attempts

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32
Q

what is the first line pharmacological management for GAD?

A

sertraline

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33
Q

what vaccines are given to children at 8 weeks?

A

rotavirus
6 in 1
men B

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34
Q

what does the 6 in 1 vaccine cover?

A

HIB
diptheria
tetanus
pertussis
polio
hep B

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35
Q

how long do you have to monitor a child with a head injury if they don’t need an urgent CT head?

A

4 hours

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36
Q

what organism commonly causes roseola infantolum?

A

human herpes virus 6

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37
Q

whats the formula for calculating dehydration deficit fluids in children?

A

% 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

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38
Q

what is given for acute hypoglycaemia?

A

2ml/kg IV dextrose

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39
Q

what are sx of GORD in babies?

A

vomiting after being laid flat
drawing knees up to chest
no signs of dehydration or being systemically unwell

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40
Q

how does hirchsprung disease present in a newborn?

A

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

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41
Q

how is hirchsprung disease diagnosed?

A

rectal suction biopsy

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42
Q

how is hirchsprung disease managed?

A

removal of the aganglionic segment of the colon

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43
Q

what intervention is done for intussusception in a stable patient?

A

air or contrast enema

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44
Q

how are preterm babies vaccinated?

A

according to normal scheduele

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45
Q

what is given first line in active management of labour?

A

10 units oxytocin

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46
Q

what are the 3 types of ovarian cancers and which is most common?

A

epithelial cell- most common
stromal cell
germ cell

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47
Q

what is the difference between gestational hypertension and pre eclampsia? when are they diagnosed?

A

both cannot be diagnosed before 20 weeks GA
gestational hypertension= only hypertension
pre eclampsia= hypertension plus proteinuria

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48
Q

what is the most common cause of PPH?

A

uterine atony

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49
Q

how is PPH managed?

A

10 IU oxytocin or 500 ug ergometrine
if this doesnt work bakri balloon

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50
Q

what do you need to do when someone who is rhesus negative has management for an ectopic?

A

anti d immunoglobulin

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51
Q

what are indications for surgical management of an ectopic?

A

women in lots of pain
foetal heartbeat detected
embryo >35mm
beta HCG >5000 IU

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52
Q

whats the triad for vasa praevia?

A

foetal bradycardia <100bpm
painless PV bleeding
membrane rupture

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53
Q

what does the hormonal IUS release?

A

levonorgestrel

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54
Q

whats the best form of contraception for someone with menorrhagia with no clear cause and desire for pregnancy?

A

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

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55
Q

what are some common causes of cervical ectropion?

A

COCP
pregnancy

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56
Q

in pregnancy what does trace glycosuria mean?

A

physiological change in pregnancy
there is increased glomerular filtration and reduced tubular reabsorption

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57
Q

what is a trachelectomy?

A

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

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58
Q

what is the gold standard diagnostic test for endometriosis?

A

laparoscopy

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59
Q

what are surgical management options for fibroids?

A

myomectomy
uterine artery embolisation
ablation
hysterectomy

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60
Q

when does the first stage of labour start?

A

4cm cervical dilation

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61
Q

what GA can you do the combined screening test?

A

10-13 weeks

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62
Q

what test is done to screen for downs syndrome when someone presents late to their booking appointment? what GA can it be done

A

quadruple test
done for week 15-22 GA

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63
Q

how can you differentiate GAD and PAD?

A

GAD= constant anxiety
PAD= panic attacks and then feel well inbetween
note: they can often overlap

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64
Q

what is akithisia?

A

inner restlessness and needing to constantly move
associated with low mood, suicidal ideation, agression

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65
Q

what generation antipsychotic is haloperidol?

A

first

66
Q

what generation antipsychotic is olanzapine?

A

second

67
Q

how does neuroleptic malignant syndrome present?

A

diaphoresis, high bp, muscle rigidity, confusion, pyrexia, tachycardia, tachypnoea

68
Q

what is neuroleptic malignant syndrome associated with?

A

use of atypical antipsychoticsw

69
Q

what test is done to diagnose neuroleptic malignant syndrome?

A

CK

70
Q

how can you identify frontotemporal dementia from other types based on patient factors?

A

earlier age of onset

71
Q

what is semantic dementia?

A

a type of frontotemporal dementia where there are issues regarding associating use of objects presented visually or auditory

72
Q

what are features of lithium toxicity?

A

slurred speech
coarse tremor
seizure
confusion
AKI
vomitting

73
Q

what depression medications are contraindicated in those on anticoagulants?

A

SSRI

74
Q

whats the most common side effect of clozapine?

A

constipation

75
Q

what triad indicates dementia with lewy bodies?

A

parkinsonism
visual hallucinations
fluctuating cognition

76
Q

what medication increases lithium levels?

A

ACEi

77
Q

how is lithium toxicity managed?

A

first line IV fluids and monitoring
haemodialysis if: lithium >4mmol/L or >2.5 mmol/L with renal symptoms

78
Q

what is mx for ITP?

A

reassure that its usually self limiting so should resolve in 3-6 months

79
Q

what is first line abx for bacterial tonsilitis?

A

phenoxymethylpenicillin

80
Q

what are signs on examination
of inhaled foreign body?

A

monophonic wheeze and reduced sounds in the right lower lobe of lung

81
Q

what do you add to asthma mx in a child over 5 if ICS and SABA are not sufficient

A

an LTRA

82
Q

what are features of cerebral palsy?

A

spasticity
increased deep tendon reflexes
persistent primitive reflexes
delayed motor development
impaired fine motor skills
problems balancing/ coordination
delayed speech/language

83
Q

what age do you give abx if someone has otitis media?

A

under 2 yrs

84
Q

what is given to an actively vomitting patient in hyperemesis gravidarum?

A

IM anitemetic eg ploclorperazine

85
Q

what does ‘term’ in pregnancy end (ie when is post term)

A

42+0 weeks and above

86
Q

how can labour be induced? describe how each method induces labour

A

membrane sweep- seperate chorionic membranes from os
vaginal prostaglandins- ripen and dilate os
artificial rupture of membranes
balloon catheter- open os

87
Q

what are hormone levels in PCOS?

A

high LH:FSh ratio

88
Q

what does dyskaryosis on a smear mean?

A

abnormal nucleus ie pre cancerous cells, the patient should be referred to colposcopy

89
Q

whats a normal foetal HR?

A

110-160 bpm

90
Q

how is refeeding syndrome managed?

A

phosphate replacement

91
Q

what do you find on bloods in anorexia nervosa?

A

raised cholesterol (LDL specifically)

92
Q

what is tardive dyskinesia?

A

repeated movements, usually involving the face or jaw but can be limbs

93
Q

what causes tardive dyskinesia in psych?

A

typical/1st gen antipsychotics- risk increases with length of use
metaclopramide

94
Q

what section do police use to bring people from public to a safe place

A

section 136

95
Q

what is the condition where patients believe insects/parasites are crawling over them?

A

ekbom syndrome

96
Q

whats the difference between ekbom syndrome and delusional parasitosis?

A

ekbom= insects
delusional parasitosis= parasites

97
Q

whats the pathology of alzheimers?

A

misfilling of beta amyloid so plaques accumulate in the brain causing neuronal loss and reduced cortex

98
Q

how can you differentiate serotonin syndrome and NMS?

A

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

99
Q

when does normal grief become prolonged grief disorder?

A

past 6 months

100
Q

what is transposition of the great arteries and how does it present?

A

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

101
Q

what infection does a rash that is rose-pink macules with surrounding pale halos indicate?

A

roseola/ human herpes virus 6

102
Q

how does tuberous sclerosis present?

A

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

103
Q

what is tuberous sclerosis? include inheritance pattern and genes mutated

A

autosomal dominant
TSC1/TSC2 genes
a rare neurological condition where benign tumors develop over the body

104
Q

what are shagreen patches? what condition are they pathognomic for?

A

leathery patches of skin over the lumbar spine
seen in tuberous sclerosis

105
Q

whats the formula for corrected gestational age in premature babies

A

age - ( 40- GA)
all in weeks

106
Q

outline the neonatal resus protocol

A

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

107
Q

how does paediatric volvulus present?

A

intense pain/discomfort
significant bilious vomiting
note: all exams and xray may be normal

108
Q

how is volvulus managed?

A

ladds procedure (surgery-laparotomy)

109
Q

what are features of life threatening asthma?

A

PEFR <33%
silent chest
02 sats below 92%

110
Q

what typically causes reyes syndrome in children?

A

aspirin use during viral infections

111
Q

what is reyes syndrome/how does it present?

A

acute encephalopathy with fatty liver degradation
neurological defect (slurred speech, lethargy, coma), vomiting, abnormal LFTs

112
Q

what ix are done for acute liver failure and what is seen?

A

LFTs- transaminases high
albumin- low
PT- prolonged

113
Q

outline paediatric BLS

A
  1. ensure it is safe to approach child
  2. call for help
  3. observe for chest movements and listen for breathing
  4. open airway in neutral position
  5. give 5 breaths
  6. start chest compressions and continue in a 2 rescue breaths: 15 compressions ratio
114
Q

how is orbital/preseptal cellulitis managed?

A

IV abx

115
Q

how does hydrocele present?

A

pain starts after trauma to the testes
swelling on testes
testes can’t be palpated separately from swelling

116
Q

whats the most common complication of measles?

A

otitis media

117
Q

what is mx for gestational diabetes? include BG levels

A

first line lifestyle modifications (provided fasting glucose is <7mmol/L)
reassess in 2 weeks, if BG not controlled start metformin

118
Q

whats the most common site for an ectopic pregnancy?

A

ampulla (fallopian tube)

119
Q

what are risks of polyhydramnios?

A

preterm labour
PPH
increased perinatal mortality
congenital malformations
malpresentation

120
Q

what type of prolapse is associated with the anterior vaginal wall collapsed downwards on speculum examination?

A

cystocele

121
Q

what are RF for pelvic organ prolapse?

A

multiple pregnancy
instrumental delivery
increasing age

122
Q

what drug is given before external cephalic version?

A

terbutaline

123
Q

what is the moa of terbutaline

A

tocolytic with beta mimetic effect
causes relaxation of uterine muscles

124
Q

what are some RF for uterine atony?

A

multiple pregnancy
polyhydramnios
foetal macrosomia
uterine fibroids

125
Q

how is PROM at term managed?

A

IOL due to risk of infection

126
Q

what is given for medical management in termination of pregnancy?

A

mifepristone
followed by misoprostol 2 days later

127
Q

what is the moa of mifepristone?

A

blocks the action of progesterone (and relaxes cervix)

128
Q

what is the moa of misoprostol?

A

prostaglandin analogue
softens the cervix and stimulates contraction

129
Q

what are features of congenital varicella syndrome?

A

limb hypoplasia
microcephaly
skin scarring
low birth weight

130
Q

what is given to a pregnant woman who gets chickenpox in the first trimester and why?

A

aciclovir
to prevent congenital varicella syndrome

131
Q

whats the triad for wernickes encephalopathy?

A

opthalmoplegia
ataxia
confusion

132
Q

what causes wernickes encephalopathy?

A

thiamine deficiency
classic in alcoholism

133
Q

how do you remember side effects of carbamazepine

A

CARBA MEAN
confusion
ataxia
rashes
blurred vision
aplastic anaemia
marrow suppression
eosinophilia
ADH release
neutropenia

134
Q

what is derailment?

A

when a patient says sentences that are completely unrelated, commonly seen in schizophrenia

135
Q

what is first line medical mx for panic disorder?

A

SSRI or venlaflaxine

136
Q

what antidepressant is often used in anorexia nervosa? why?

A

mirtazipine
it promotes weight gain and helps with depressive sx

137
Q

when can personality disorders be diagnosed?

A

18yrs or older

138
Q

what blood tests need to be done before starting lithium?

A

TFTs
kidney function- creatinine, GFR, U+Es

138
Q

what are class c personality disorders and what do they include?

A

anxious and fearful:
dependant
obsessive compulsive
avoidant

138
Q

whats the time frame for post partum depression?

A

4 weeks to one year after birth

138
Q

whats the triad for normal pressure hydrocephalus?

A

gait disturbance
urinary incontinence
dementia

138
Q

whats russels sign and what condition is it seen in?

A

knuckle scarring due to forced vomitting
seen in bullimia nervosa

139
Q

what section under the MHA lasts up to 6 months?

A

3

140
Q

how does mesenteric adenitis present?

A

acute diffuse abdo pain
follows an URTI
no loss of appetite

141
Q

what is mesenteric adenitis?

A

swelling/enlargement of mesenteric lymph nodes

142
Q

what ix are done for mesenteric adenitis and what would you see?

A

FBC- all normal, normal WCC rules out appendicitis
abdominal ultrasound- shows enlarged lymph nodes

143
Q

what is jaundice, pale stool and dark urine with reduction in growth in a 2 week old baby indicative of?

A

biliary atresia

144
Q

what ix is done to confirm biliary atresia?

A

cholangiography

145
Q

how is biliary atresia managed?

A

kasai procedure at 2-3 months of age

146
Q

what rash is associated with coeliacs disease?

A

dermatitis herpretiformis

147
Q

what pathogen causes hand foot and mouth disease?

A

coxsackie A

148
Q

what is the most common congenital heart defect in babies with diabetic mothers?

A

transposition of the great arteries
note: this is true of mothers with T1 and T2 diabetes NOT gestational diabetes

149
Q

what is displaced in SUFE?

A

the capital femoral ephiphysis

150
Q

what 3 abnormalities are seen in HELLP syndrome?

A

haemolysis
elevated liver enzymes
low platelets

151
Q

how is HELLP syndrome managed?

A

expedite delivery
supportive management of organ failure

152
Q

whats the most common type of epithelial ovarian cancer?

A

serous cystadenoma

153
Q

what does psamomma bodies on pathology indicate?

A

epithelial ovarian cancer- serous cystadenoma

154
Q

how do you remember how to differentiate placenta accreta/increta/percreta on scans?

A

accreta= attaches to myometrium
increta= invades myometrium
percreta= penetrates past myometrium

155
Q

what age are ix done for menopause and what is done?

A

over 45= ix not needed
under 45= first line serum FSH can be done and will be raised in menopausal women

156
Q

what is given to manage bleeding prior to surgery to women with fibroids? whats the moa

A

goserelin
GnRH analogue

157
Q
A

Qbanks (19 decks)

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