WCF Flashcards
What medications can be given to a preterm baby promote PDA closure?
Ibuprofen or indomethacin
PDA management
Ibuprofen or indomethacin if preterm to close the PDA. If asymptomatic watch and wait until 1 year. Surgical closure (open or endovascular) if symptomatic or not closed at 1 year.
Biliary atresia management
Kasai procedure at 45-60 days (uses some small bowel to join to liver)
Most children then need transplant
Necrotising enterocolitis symptoms
bilious vomiting, intolerance to feeds, a distended tender abdomen with absent bowel sound and blood in the stools
Necrotising enterocolitis management
Initial management is to stop oral feeds and give IV fluids, nutrition and antibiotics. An NG tube can drain gas from the abdomen. Often emergency surgery is needed to remove necrotic bowel.
Necrotising enterocolitis complications
Complications include perforation, peritonitis, strictures, sepsis or abscesses. Complications of surgery include stomas and short bowel syndrome
Congenital varicella syndrome symptoms
growth restriction, scars, microcephaly, learning difficulty, eye problems or limb defect
Congenital CMV symtpoms
growth restriction, vision and hearing loss, learning difficulty or microcephaly
Congenital rubella symptoms
cataracts, heart disease, hearing problems and learning disability
Congenital toxoplasmosis symptoms
hydrocephalus, intracranial calcification, and chorioretinitis
Congenital Zika symptoms
growth restriction and microcephaly
What is caput succedaneum?
fluid collects on the scalp due to prolonged pressure
What is cephalohaematoma?
blood between the skull and periosteum due to blood vessel damage
What causes Erb’s palsy?
Brachial plexus injury
Risk factor for facial nerve paralysis birth injury
Forceps
Risk factor for Erb’s palsy birth injury
Shoulder dystocia
Fractured clavicle birth injury investigation
X-ray or USS
Cephalohematoma prognosis
Usually heals within a few months
Cephalohematoma complications
Anaemia and jaundice (as blood is broken down)
facial nerve paralysis birth injury prognosis
Resolves in a few months
Erb’s palsy birth injury prognosis
Resolves in a few months
Mild croup treatment
Single dose oral dexamethasone then supportive care
Severe croup treatment
Nebulised adrenaline and supportive care
Epiglottitis causative organism
HiB
Whooping cough management
Abx if presenting in first 3 weeks
Off school until 5 days abx and good hygiene
Supportive care
Glandular fever complications
splenic damage (may cause hypochondriac pain and usually resolves in a few weeks), hepatic inflammation (may cause jaundice but usually resolves in a few weeks), post-viral fatigue and depression
Glandular fever patient advice
Rest
Avoid alcohol
Avoid contact sports
Avoid kissing / sharing cups etc
Who should have acyclovir with chicken pox?
children presenting within 24 hours, neonates, adolescents, pregnant women, immunocompromised individuals and adults or children with a chronic health condition
Immunocompromised contacts
Roseola infantum symptoms
sudden onset high fever for 3-5 days with flu-like symptoms. This usually settles as a non-itchy rash develops on the chest or abdomen and spreads to the arms, face and neck
Roseola infantum treatment
Supportive
Age of Kawasaki disease
Under 5
De Quervain’s tenosynovitis symptoms
pain on the radial side of the wrist
tenderness over the radial styloid process
abduction of the thumb against resistance is painful
De Quervain’s tenosynovitis management
analgesia
steroid injection
immobilisation with a thumb splint (spica) may be effective
surgical treatment is sometimes required
Impetigo management
Topical abx first line
Oral abx if severe
Stay off school until lesions crusted or 48hrs abx
ITP advice
avoiding contact sports, injections and NSAIDs and advice on management of nosebleeds and seeking help after injuries that may cause internal bleeding.
Severe ITP treatment
with steroids, IVIG, or blood or platelet transfusion (short term cure)
Wilms tumour management
Management is nephrectomy surgery. Adjuvant chemotherapy or radiotherapy may be indicated
What is minor APH?
<50mls
What is major APH?
50-1000mls
What is severe APH?
> 1000mls or shock
What is minor PPH?
500-1000mls
What is major PPH?
1000-2000mls
What is severe PPH?
> 2000mls
Investigation of secondary PPH
High vaginal swab for infection
USS for retained products
Pre-eclampsia investigations
BP Urinalysis and protein: creatinine ratio Bloods (look for HELLP syndrome) USS at diagnosis CTG at diagnosis
Pre-eclampsia monitoring
FBC, U&Es, LFTs twice per week if mild or moderate or three times per week if severe to monitor for organ damage. A USS should be done every other week
Medication given to reduce chance of seizures during birth in pre-eclampsia
Mg sulphate (in labour and 24 hours after birth)
Drug that can be used to reduce contractions in premature labour to delay it and allow time for steroids for the baby’s lungs
Nifedipine
What is given to mothers in labour with preterm baby
Steroids (for lungs) Mg sulphate (for neuroprotection)
Pre-labour rupture of membranes investigation
Often no investigation is needed for diagnosis. If diagnosis is unclear, USS may look for reduced amniotic fluid or vaginal fluid can be tested for insulin-like growth factor binding protein 1 (IGFBP1) or placental alpha-microglobulin-1 (PAMG1). A high vaginal swab for group B strep or other infection should be done
Advice to women after premature rupture of membranes
Avoid sex
Prophylactic erythromycin
Management of premature rupture of membranes under 34 weeks
Aim to increase gestation to 34 weeks
Steroids and Mg sulphate
Management of premature rupture of membranes over 34 weeks
Induction of labour. Steroids if under 36 weeks
Additional monitoring in gestational diabetes
Additional growth scans at 28, 32 and 36 weeks
When should delivery be planned in gestational diabetes?
37-38 weeks if medication controlled. By 41 weeks if diet controlled
Monitoring after delivery in mothers with gestational diabetes
OGTT at 6-12 weeks after birth then yearly
Additional monitoring in multiple pregnancy
Additional growth scans form 20 weeks (2-weekly if one placenta, 4-weekly if 2 placentas) and FBC at 20 and 28 weeks
Management of monoamniotic twins
C-section 32-34 weeks
Management of diamniotic twins
Vaginal / C-section 36-38 weeks
Vulval cancer main investigation
Punch biopsy
Lichen sclerosus main investigation
Punch biopsy
What other conditions are lichen sclerosus associated with?
Autoimmune (may screen for these)
Lichen sclerosus treatment
Education and advice e.g. avoid scratching
Steroids (long course topical or injected)
Second line is other immunosuppressants
Surgery on complications
Lichen sclerosus follow-up
Yearly follow up to assess for malignancy
Menorrhagia treatment
Education and iron if anaemic IUS first line TXA or mefenamic acid second line COCP Long acting progestogens Treat underlying cause
Medication to induce ovulation
Clomifene
First line investigation in endometriosis
TV USS
Endometriosis treatment
NSAIDS / paracetamol first line
Hormonal contraception second line
Laparoscopy and ablation third line
What is rectocele?
when the rectum prolapses into the posterior vagina
What is cystocele?
when the bladder prolapses into the anterior vagina
Chlamydia treatment
single dose of azithromycin or 7 days of doxycycline
Chlamydia repeat testing
Repeat in 3-6 months if under 25
Gonorrhoea repeat testing
Repeat for everyone
Syphilis treatment
Penicillin
Dose depends on stage e.g. if primary 1 dose IM. If tertiary 1 dose IM for 3 weeks. If neuro IV
Treatment prior to penicillin in syphilis
3 days steroids if tertiary as high risk of Jarisch-Herzheimer reaction
BV treatment
None if asymptomatic
Metronidazole (single high dose or 7 days lower dose or topical)
Trichomoniasis symptoms
asymptomatic in up to 50% of patients
smelly frothy green/yellow discharge
Other symptoms in women include vulval itching and soreness and dysuria
Other symptoms in men include urethral discharge and irritation and dysuria
Trichomoniasis treatment
Metronidazole (single IM dose or 7 days oral)
When to abstain from sex in herpes
Prodrome or infection
Genital herpes complications
bacterial superinfection, infection of other body areas, autonomic neuropathy (can lead to urine retention), meningitis, encephalitis, pneumonia, oesophagitis and hepatitis
Genital thrush investigation
None needed for diagnosis
May do whiff tests / pH to exclude differentials
STI screen recommended
HbA1c if recurrent
Genital thrush treatment
Uncomplicated - clotrimazole cream or pessary
Complicated - oral fluclonazole
