WCF Flashcards
gravidity
Number of pregnancies
parity
number of births after 24 weeks (still births and live births)
nulliparous
has not delivered a baby
multip
previous delivery of at least 1 baby
grand multip
number of previous births >4
what are grandmultips at risk of
post partum haemorrhage
EDD
estimated date of delivery
SFH
symphysis fundal height (measure from fundus of uterus to pubic symphysis
booking appointment
10 weeks
dating scan
12 weeks
screening bloods
16 weeks
anomaly scan
18-20
what rhesus combo is bad
Rh -ve mum Rh +ve baby
how soon must anti-d be given
within 7 days of the incident
neonate
<4 weeks
infant
<1yr
toddler
1-2yrs
preschool/young child
2-5yrs
school age/older child
5-11yrs
adolescent
12-18yrs
what trimester is warfarin teratogenic in?
1st trimester - increased risk of intracranial bleed in foetus
how long can retinoids remain in the body
2yrs - conception should be avoided in this period
effect of teratogens in the pre-embryonic period
either no effect or prevents implantation
effect of teratogens in the 1st trimester
organogenesis (2-8wks), major anatomical defects, irreparable tissue damage
effect of teratogens in the foetal period to term
fetal growth, continued brain renal differentiation, neonatal problems etc.
teratogenic effect of sodium valproate
spina bifida and neural tube defects
dose related IQ effects
teratogenic effect of phenytoin
fetal anticonvulsant syndrome
teratogenic effect of carbamazepine
NTDs and fetal anticonvulsant syndrome
teratogenic effect of Lamotrigine
cleft lip
what drug should be given to pregnant women on anticonvulsants and from when
vitamin K from 36 weeks
antiphospholipid syndrome has increased risk of…
miscarriage
does heparin cross the placenta?
no
effect of prostaglandins in a pregnant woman
induce labour
effect of oxytocin in labour
brings on contractions
effect of tocolytics
=competitive inhibitor of oxytocin, stops labour (e.g. nifedipine)
what are ergot derivatives
given postpartum, stops blood supply to the placenta
what 3 serious bacterial infections must be proactively ruled out in a sick child?
- sepsis
- meningitis
- penumonia
Signs of compensated shock
- Tachycardia
- Poor perfusion (cap refill >3sec)
- Decreased tone (floppy - decreased blood to brain)
- Petechial rash
What does a petechial rash indicate
Meningococcal infection
signs of meningitis
- Neck stiffness
- Bulging fontanelle (<18months)
- Irritability
Under what age should ALL children receive a septic screen?
<3months
Signs of respiratory distress
- tachypnoea
- recession
- use of accessory muscles (sternocleidomastoid - tracheal tug)
- expiratory grunt
2 causes of recession
- obstructive disease (e.g. asthma, croup, epiglottis, bronchiolitis)
- stiff lungs (e.g. pneumonia, pulmonary oedema)
cause of epiglottits
Haemophilis influenza type B
cause of croup
parainfluenza virus
description of lobar pneumonia
focal infection in the alveolar space in 1 lobe of the lung
leading cause of lobar pneumonia
streptococcal pneuminiae
3 less common causes of lobar pneumonia
- haemophilis influenza type B
- staph. aureus
- group A strep
does lobar pneumonia cause recession?
NO - no obstruction and no stiff lungs
definition of broncho/interstitial pneumonia
infection in all the peri-vascular scaffolds of the lung (everywhere!)
cause of broncho/interstitial pneumonia
- adults + children <10yrs = mycoplasma pneumonia (treat with erythromycin)
- children = VIRAL
signs of broncho/interstitial pneumonia in children
recession and significant hypoxia
stiff lungs
what type of breath sounds do you get with lobar pneumonia?
bronchial breathing
signs of lobar pneumonia
- bronchial breathing
- decreased expansion
- dull on percussion
signs of pleural effusion
- decreased expansion
- stony dullness on percussion
- decreased breath sounds
signs of pneumothorax
- decreased chest expansion
- hyperesonant percussion
- absent breath sounds
- tracheal deviation (away from pneumothorax)
signs of heart failure in adults
- tachycardia (with gallop rhythm)
- fine late inspiratory crackers (both bases)
- raised JVP
- peripheral oedema
Course of RSV bronchiolitis
- begins as URTI
- worsens for 3 days
- static for 3 days
- slow recovery (w/ tachypnoea + cough) for 1-2wks
clinical presentation of RSV bronchiolitis
- chest cough
- resp. distress
- hypoxia
- vesicular breath sounds
- bilateral fine crackles
- wheeze (sometimes)
duration of a viral fever
5 days - any longer = bacterial cause
reasons for failure to improve after 6 days
- secondary bacterial infection
- heart failure
- immunodeficiency
- TAPVD
Management of RSV bronchiolitis
- supportive
- feeding
- O2
preventative strategies for RSV bronchiolitis
Palivizumab injection (only for at risk individuals)
Importance of O2 sats in croup?
should be normal –> if not = critical airway (emergency)
signs of croup
inspiratory stridor and barking cough
noise of intrathoracic problem
expiratory noise
noise of extrathoracic problem
inspiratory noise
what does stridor indicate in croup
critical airway! do not examine, as could cause obstruction –> keep child calm
signs of epiglottitis
- inspiratory stridor, barking cough
- drooling
management of croup
-corticosteroid (dexamethasone)
-adrenaline nebuliser
(-intubation and ventilation)
3 common causes of sepsis in neonates
Group B streptococcus
E. coli
Listeria monocytogenes
common cause of sepsis in 1st yr of life
staph aureus
classic organisms causing sepsis
N. meningitides
Strep. pneumoniae
Haemophilis influenza type B
when treating meningitis, what do you focus on first?
SHOCK
how much weight should a child gain per week
6 ounces (180g)
3 common malabsorption problems
- coeliac disease (only presents when they’re weaned onto solids)
- CF
- Cows milk protein intolerance
Cause of lactose intolerance
rotavirus –> viral diarrhoea –> destroys microvilli, which contain lactase, so you become temporarily lactose intolerant
how is CF diagnosed?
- sweat test
- genetics
what antenatal USS finding indicates CF?
echogenic bowel (mucus obstructs bowel)
3 things required for linear growth
-genetics
-nutrition
-hormones
(+nuturing environment)
onset of puberty in males
12-12.5yrs males
what indicates onset of puberty in males?
testicular growth (4ml testis indicates onset of puberty)
aspects of tanner staging…
males = penile length + testicular volume females = breast development, pubic hair and axillary hair
target height calculation
target height = mid-parental centime +/- 8.5cm
Initial investigations for short stature
U+E/creatinine FBC/ESR/CRP bone biochemistry bicarb (abnormal in eg. renal tubular acidosis) anti-TTG/IgA chromosomes TFT IGF-1 bone age - XR of non-dominant hand and wrist
2nd line investigations of short stature
GH provocation tests
Insulin induced hypoglycaemia
Genetics
etc.
syndromic causes of tall stature
- kleinfelters syndrome
- overgrowth syndrome
endocrine causes of tall stature
- precocious puberty
- GH secreting pituitary tumour
- hyperthyroidism
Investigations for tall stature
Karyotyping
T4 + TSH
IGF-1
Bone age
how much more iron do you need in pregnancy?
3x
treatment for women at high risk of VTE in pregnancy
- prophylactic aspirin in 1st trimester
- clexane in 2nd trimester (?)
test for gestational diabetes
oral glucose tolerance test
4 groups of women at increased risk of gestational diabetes
- prev. gestational diabetes
- asian descent
- high BMI
- Macrosomic fetus
hypertension at booking visit or before 20 weeks =
chronic hypertension (nothing to do with pregnancy)
gestational hypertension
hypertension after 20wks, without significant proteinuria
pre-eclampsia
new hypertension after 20wks, with significant proteinuria
severe pre-eclampsia
severe hypertension and/or symptoms and/or biochemical/haematological impairment
eclampsia
convulsive condition associated with pre-eclampsia
at what BMI do women require consultant led care?
> 35
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