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MBBS Y5 > Y4 zero to finals mix 2 > Flashcards

Y4 zero to finals mix 2 Flashcards

1
Q

pH bacterial vaginosis and trichomonas

A

pH >4.5

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2
Q

pH candidiasis

A

pH <4.5

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3
Q

candidiasis diagnosis

A

charcoal swab with microscopy

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4
Q

candidiasis mx

A 
clotrimazole cream intravaginal (5g 10%)clotrimazole pessary (500mg)3 doses of clotrimazole pessaries 200mg 3 nightsoral antifungal tablets: fluconazole (150mg)
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5
Q

sex vs candidiasis medication

A

antifungals can damage latex condoms and impair spermicides: so ALTERNATIVE contraceptive for 5 days after use

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6
Q

Chalmydia trichomatis

A

gram -ve bacteriaintracellylar organismMOST COMMON STI IN UK

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7
Q

Chlamydia diagnosis

A

NAAT - nucleic acid amplification tests

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8
Q

chlamydia tx

A

doxycycline 100mg 2x daily for 7 days-contraindicated in pregnancy/brestfeedingAzithromycin 1g stat then 500mg 1x for 2dErythromycin 500mg 4x day for 7dErythromycin 500mg 2x dayfor 14 daysAmoxicillin 500mg 3x daily for 7 days

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9
Q

LGV

A

painless ulcer and painful lymphadenopathy Doxycycline 100mg 2x daily for 21 days

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10
Q

Gonnorhoea

A

gram -ve dipoloccus| infects mucous membranes with columnar epithelium (endocervix, urethra, rectum, conjunctiva, pharynx)

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11
Q

gonorrhoea symptoms

A

discharge odourlessdysuriapelvic painor epidydimo-orchitis

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12
Q

Gonorrhoea diagnossi

A

NAAT

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13
Q

gonorrhoea tx

A

A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT knownA single dose of oral ciprofloxacin 500mg if the sensitivities ARE known

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14
Q

complication of gonococcal conjunctivitis in neonate

A

Neonatal conjunctivitis is called ophthalmia neonatorum (sepsis, blindness)

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15
Q

disseminated gonoccoal infection

A 
complication of untreated gonoccoal infection, bacteria spreads to skin and jointsnon-specific skin lesionsjoint aches and painsarthritis that moves between jointsTenosynovitisSystemic symptoms
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16
Q

Mycoplasma genitalium and dx

A

non gonococcal urethritisFirst urine sample in the morning for menVaginal swabs (can be self-taken) for women

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17
Q

mycoplasma genitalium tx

A

Doxycycline 100mg 2x day for 7dthenAzithromycin 1g stat then 500mg OD for 2 days (unless it is known to be resistant to macrolides)If pregnant/breastfeeding: NO Doycycline

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18
Q

PID causes

A

Neisseria gonorrhoeae (severe PID)Chlamydia trachomatisMycoplasma genitalium

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19
Q

PID symptoms

A 
Pelvic tendernesscervical excitiationcervicitispurulent dischargefeverdysuria, dyspareunia
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20
Q

PID tx

A

A single dose of intramuscular ceftriaxone 1g (to cover gonorrhoea)Doxycycline 100mg 2xday for 14 days (chlamydia and Mycoplasma genitalium)Metronidazole 400mg 2x day for 14 days ( anaerobes such as Gardnerella vaginalis)

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21
Q

complications of PID

A

Fitz-Hugh-Curtis syndrome| nflammation and infection of the liver capsule, leading to adhesions between the liver and peritoneum.

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22
Q

trichomonas

A 
protozoan flagellaswab from posterior fornix of vaginapH >4.5forthy yellow-greenfishy smellstrawberry cervix (colpitis macularis)tx Metronidazole
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23
Q

HSV

A

cold sores (hepres labialis) and genital herpesHSV 1 and HSV 2multiple painful ulcersviral PCR

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24
Q

HSV tx

A

aciclovir1* genital herpes treat with acyclovir (if contracted before 28weeks gestation) - acyclovir at infection and prophylactic aciclovir from 36w. if asymptomatic -> vaginal delivery1*genital herpes after 28 weeks treat with acyclovir until delivery, C section

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25
Q

HIV most common type

A

HIV -1| virus enters and destroys CD4 T=helper cells

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26
Q

AIDS defining ilness

A 
Kaposi’s sarcomaPneumocystis jirovecii pneumonia (PCP)Cytomegalovirus infectionCandidiasis (oesophageal or bronchial)LymphomasTuberculosis
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27
Q

when to test for HIV

A

can be negative up to 3 months post exposureAntibody testing for HIVPCR testing for viral load

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28
Q

CD4 in HIV

A

500-1200 cells/mm3 is the normal range| Under 200 cells/mm3 is considered end-stage HIV (AIDS) and puts the patient at high risk of opportunistic infections

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29
Q

PCP prophylaxis

A

co-trimoxazole (septrin)

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30
Q

HIV and birth

A

vaginal delivery if <50 copies/mlC section if >50 copiesIV zidovudine given to mother >10 000Bebo:if mother <50: zidovudine 4wif mother >50: zidovudine, lamivudine, nevirapine for 4w

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31
Q

PEP

A

ART therapy| Truvada (emitricitabine and tenofovir) and raltegravir, for 28d

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32
Q

Syphilisi

A

teponema pallidumspirochetespiral-shaped bacteriaincubation period 21d

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33
Q

stages of syphilis

A

1: painless ulcer, chancre, local painless lymphadenopathy2 systemic symptoms, condylomata lata resolves after 3-12 weeks3* gummas/gummatous lesions and cardiovascular and neurological complicationsneurosyphilis - in CNS (ocular syphilis, tabes dorsalis)

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34
Q

syphilis dx

A

antibody testing| samples for dark field microscopy or PCR

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35
Q

syphilis tx

A

deep IM benzathine benzylpenicillin alternative: ceftriaxone, amoxicillin, docycyline

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36
Q

UKMEC

A

UKMEC 1: No restriction in use (minimal risk)UKMEC 2: Benefits generally outweigh the risksUKMEC 3: Risks generally outweigh the benefitsUKMEC 4: Unacceptable risk (typically this means the method is contraindicated)

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37
Q

What contraception to avoid in breast cacncer?

A

avoid any hormonal contraception and go for the copper coil or barrier methods

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38
Q

What contraception to avoid in cervical/endometrial cancer?

A

avoid the intrauterine system (i.e. Mirena coil)

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39
Q

what contraception to avoid in Wilson’s disease?

A

avoid copper coil

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40
Q

RF to avoid COCP

A

Uncontrolled hypertension (particularly ≥160 / ≥100)Migraine with auraHistory of VTE>35yo smoking >15 cigarettes/dayMajor surgery with prolonged immobilityVascular disease or strokeIschaemic heart disease, cardiomyopathy or atrial fibrillationLiver cirrhosis and liver tumoursSystemic lupus erythematosus and antiphospholipid syndrome

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41
Q

when should progestogen injection (Depo provera) be stopped?

A

before 50yo due to risk of osteoporosis

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42
Q

lactational amenorrhoea

A

effective as contraception for up to 6 months after birth. Women must be fully breastfeeding and amenorrhoeic (no periods)

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43
Q

IUS/IUD in breastfeeding?

A

can be inserted either within 48 hours of birth or more than 4 weeks after birth

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44
Q

COCP and rbreastfeeding

A

should be avoided in breastfeeding and can’t be started <6w after childbrith

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45
Q

COCP MOA

A

prevents ovulation progesterone thickens mucusprogesterons recued endometrial proliferation

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46
Q

2 types of COCP

A

monophasic (same amount of hormone in each pill)| multiphasic (varying amounts of hormone to match normal cyclical changes)

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47
Q

COCP with lower risk of VTE

A

progesterone as levonorgester or norethisterone

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48
Q

1st line COCP for PMS

A

Yasmin - the ones with drospirenone (help with water retention, bloating, modd changes)

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49
Q

COCP in treatemtn of acne/hirsutism

A

Dianette - with cuproterone acetate, but high risk of VTE

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50
Q

COCP benefits

A

improves PMS, menorrhagia, dysmenorrhoea, reduced risk of endometrial , ovarian, colon cancer

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51
Q

starting COCP

A

no additional contraception if starting in 1st 5 days of cycleif after 5 days, requres extra contraception for 7 days

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52
Q

how to switch COCPs?

A

take one pack after the other with no pill free interval

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53
Q

swithing from POP to COCP

A

switch at any time but 7days extra contracceptionunless switching from desogestrel which inhibits ovulation, then no extras

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54
Q

when to stop COCP

A

4 weeks before major operation

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55
Q

the only POP UKMEC 4

A

active breast cancer

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56
Q

POP MOA

A

Thickening the cervical mucusAltering the endometrium and making it less accepting of implantationReducing ciliary action in the fallopian tubes

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57
Q

starting POP

A

if starting on days 1-5 no extrasif after day 5, additional contraception is required for 48h.if switching from POP - extra contraception for 48h (best to switch during hormone free period)

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58
Q

progesterone only injection (DMPA)

A

IM or SC every 12-13 weeks, medroxyrpogesterone acetatedepo provera: IM sayana press: SC self injectionnoristerat - norethisterone for 8 weeks, altrnative

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59
Q

progesterone only injection (DMPA)

A

IM or SC every 12-13 weeks, medroxyrpogesterone acetatedepo provera: IM sayana press: SC self injectionnoristerat - norethisterone for 8 weeks, altrnative

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60
Q

progesterone only injection (DMPA)

A

IM or SC every 12-13 weeks, medroxyrpogesterone acetatedepo provera: IM sayana press: SC self injectionnoristerat - norethisterone for 8 weeks, altrnative

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61
Q

Progesterone injection MOA

A

inhibits ovulationthickens mucusalters endometrium

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62
Q

when to do progesterone injection

A

day 1-5 of cycle| if after that, 7 days extra contraception

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63
Q

SE of progesterone injection

A

1) weight gain2) osteoporosisalopeciareduced libidodelays return to fertilitymood changesbenefits: recued sickle cell crisis severity, improved endometriosis or dysmenorrhoea

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64
Q

progesterogen only implant +MOA

A

lasts 3 yearsnexplanon (etonogestrel)inhibits ovulationthickens mucusalterns endometrium

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65
Q

age of sexual consent

A

13 yo

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66
Q

IUD and smear - organism

A

actinomyces like organisms

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67
Q

UPSI

A

Levonorgestrel within 72 hours of UPSIUlipristal within 120 hours of UPSICopper coil within 5 days of UPSI, or within 5 days of the estimated date of ovulation

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68
Q

levonorgestrel Emergency contraception

A

COCP or POP can be started immediately additional 7 days condoms COCPadditional 2 days condoms POP

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69
Q

Levonorgestrel doses

A

1.5mg as a single dose| 3mg as a single dose in women above 70kg or BMI above 26

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70
Q

Ullipristal (EllaOne) emergency contraception

A 
single dose (30mg)wait 5 days until starting the combined pill or progestogen-only pill after taking ulipristalcndoms 7days cocp, 2days pop
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71
Q

Ulipristal restriction

A

Breastfeeding - avoid 7d post ulipristal| Avoid in pts with asthma (Severe)

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72
Q

female hormone testing in intertility

A

serum LH FSH days 2-5 (high LH PCOS, high FSH poor ovarian reserve)serum progesterone on day 21 (or 7 days before period) (rise incidates ovulation)

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73
Q

how to stimulate ovulation

A 
clomifene letrozole (aromatase inhibitor)gonadotropins ovarian drillingmetformin
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74
Q

Azoospermia

A

absence of sperm in the semen.

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75
Q

Cryptozoospermia

A

very few sperm in the semen sample (less than 1 million / ml).

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76
Q

Polyspermia (or polyzoospermia)

A

high number of sperm in the semen sample (more than 250 million per ml).

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77
Q

Normospermia (or normozoospermia)

A

normal characteristics of the sperm in the semen sample.

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78
Q

Oligospermia

A 
reduced number of sperm in semen sampleMild oligospermia (10 to 15 million / ml)Moderate oligospermia (5 to 10 million / ml)Severe oligospermia (less than 5 million / ml)
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79
Q

IVF steps

A 
Suppressing the natural menstrual cycleOvarian stimulationOocyte collectionInsemination / intracytoplasmic sperm injection (ICSI)Embryo cultureEmbryo transfer
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80
Q

Ovarian hyperstimulation syndrome

A

complication of ovarian stimulation during IVF infertility treatment- increase in VEGR increased vascular permeability- oedema, ascites, hypovolaemia- raised renin level- Haematocrist indicates dehydration

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81
Q

Prevention of gout

A

Allopurinol (inhibits xanthine oxidase)| 100mg OD titrated to serum uric acid of 300umol/L

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82
Q

Allopurinol interactions

A

Azathioprine (allopurinol increases azathioprine dose so low dose allopurinol 1/4)Cyclophosphamide (allopurinol reduces renal clearance -> marrow toxicity)Theophylline (allopurinol inhibits it’s breakdown)

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83
Q

Alpha blockers use

A

HTNBPHSE: postural hypotensionDrowsinessConfusion

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84
Q

Alpha blockers examples

A

Postural hypotensionDrowsinessDyspnoea

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85
Q

Sildenafil contraindications

A

Nitrates and nicorandil

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86
Q

Oculogyric crisis in overdose. Drug

A

AntipsychoticsMetoclopramide(Extrapyramidal Side effect)

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87
Q

Lithium toxicity precipitants

A 
ThiazidesBendroflumethazideACE inhibitors and Angiogensin IINSAIDMetronidazole
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88
Q

Digoxin antibody

A

Digibind

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89
Q

Lactic acidosis risk?

A

Suspend Metformin in illness like diarrhoea and vomiting

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90
Q

Serotonin syndrome drugs (causative)

A

SSRIEcstasyAmphetamineMAO inhibitors

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91
Q

Heroin overdose

A

Respiratory depression| CNS depression

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92
Q

Cocaine overdose

A

Chest painMood changesCardiac symptoms

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93
Q

Aminoglycoside antibiotics

A

Ototoxicity + nephrotoxicity

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94
Q

Severe renal impairment VTE prophylaxis

A

LMWH - allowed in <30 creatinine but high bleeding risk| -> Unfractioned heparin 1st line

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95
Q

Anion gap normal and formula

A

10-18| Na+ + K+) - (Cl- + HCO3-

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96
Q

Ethylene glycol toxicity

A

Metabolic acidosis with high anion gap

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97
Q

Cyclosporin se

A 
Everything highHTNhigh fluidHigh K+Hair, gums, glucose
(It is immunosuppressant)
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98
Q

Which diuretics should not be combined?

A

Amiloride + Spironolactone| Both potassium sparing

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99
Q

Drugs causing urinary retention

A 
TCA (Amitryptyline)AntipsychoticsAntihistamineOpioidsNSAID
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100
Q

TCA overdose

A

Amitryptyline or dothiepin, dusolepin

Dry mouth Dilated pupilsAgitation Sinus tachy Blurred vision QT prolongationComaMetabolic acidosisSeizures Arrhythmias
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101
Q

Tuberculosis drugs SE

A

Rifampicin (orange secretions, p450 inducer, hepatotoxicity)Isoniazid (hepatitis, agranylocytosis, peripheral neuropathy B6)Pyrazinamide (hyperuricaemia, hepatitis)Ethambutol (optic neuritis, loss of colour vision)

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102
Q

P450 inducers

A 
CRAP GPSSSCarbamazepineRifampicinAlcohol (chronic) Phenytoin
GriseofluvinPhenobarbitalSulphonylureaSmokingSt John wort
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103
Q

Inhibitors of p450 (will cause toxicity)

A

Sick faces . Com (+ grapefruit)

Sodium valproateIsoniazid ChloramphenicolKetoconazoleFluconazoleAlcohol Acute, Amiodarone, Allopurinol CimetidineErythromycinSulfonamides, Sertraline/Fluoxetine .CiprofloxacinOmeprazoleMetronidazole
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104
Q

Heparin mechanism of action

A

Activates: antithrombin IIIInhibits: thrombin, factors Xa, IXa, XIa, XIIa

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105
Q

LMWH mechanism of action

A

Activates: antithrombin IIIinhibits: factor Xa

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106
Q

Salicylate overdose

A

Respiratory alkalosis followed by metabolic acidosis

TinnitusAnxietySeizuresSweatingLethargyHypervention
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107
Q

Serotonin syndrome

A 
SSRI/ MAOI/ ecstasyOnset hours Hyperreflexia, Clonus, dilated pupils Tachycardia, HTNpyrexia, rigidityIV fluids, benzodiazepinesMx cyproheptadine, chlorpromazine
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108
Q

Neuroleptic malignant syndrome

A 
caused by antipsychotics Slow onset hours-daysHyporeflexes, rigidity (lead-pipe) normal pupilsTachycardia, HTNpyrexia, rigidityIV fluids, benzodiazepinesMx: dantrolene
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109
Q

Organophopshate insecticide poisoning

A

SalivationLacrimationUrinationDiarrhoea+ Small pupilsMx: atropine

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110
Q

Galactorrhoea treatment

A

Dopamine agonist (eg ropinirole)

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111
Q

Paracetamol overdose biochemistry

A

ALP and AST in 10,000

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112
Q

Ecstasy/ MDMA overdose

A 
Agitation, confusion, anxiety, ataxiaTachycardia, HTNfever Hyponatremia Rhabdomyolysis
Mx: dandrolene
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113
Q

Aminoglycosides examples

A

Gentamycin Neomycin Tobramycin

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114
Q

ectopic pregnancy location

A

fallpian tube

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115
Q

ectopic pregnancy risk factors

A 
Previous ectopic pregnancyPrevious pelvic inflammatory diseasePrevious surgery to the fallopian tubesIntrauterine devices (coils)Older ageSmoking
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116
Q

US mass with empty gestational sac

A

“blob sign”, “bagel sign” or “tubal ring sign’’

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117
Q

tubal ectopic pregnancy vs corpus luteum

A

corpus luteum moves WITH the ovary| the tubal ectopic moves SEPARATELY to ovary

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118
Q

When should bHCG double?

A

Every 48h

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119
Q

when should pregnancy be visible on US?

A

hCG >1500 IU/L

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120
Q

Ectopic expectant management criteria

A 
The ectopic needs to be unrupturedAdnexal mass < 35mmNo visible heartbeatNo significant painHCG level < 1500 IU / l
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121
Q

Ectopic medical management criteria

A 
HCG level must be < 5000 IU / lConfirmed absence of intrauterine pregnancy on ultrasoundThe ectopic needs to be unrupturedAdnexal mass < 35mmNo visible heartbeatNo significant pain
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122
Q

Ectopic surgical management

A

The ectopic needs to be unrupturedAdnexal mass < 35mmNo visible heartbeatNo significant pain-Laparoscopic salpingectomyLaparoscopic salpingotomy

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123
Q

surgical management of ectopic - prophylaxis

A

Anti D to Rh negative women

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124
Q

Miscarriage dates criteria

A

Early <12 weeks gestation| Late >12 weeks gestation

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125
Q

Missed miscarriage

A

the fetus is no longer alive, but no symptoms have occurred

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126
Q

Threatened miscarriage

A

– vaginal bleeding with a closed cervix and a fetus that is alive

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127
Q

Inevitable miscarriage

A

– vaginal bleeding with an open cervix

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128
Q

Incomplete miscarriage

A

retained products of conception remain in the uterus after the miscarriage

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129
Q

Complete miscarriage

A

– a full miscarriage has occurred, and there are no products of conception left in the uterus

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130
Q

Anembryonic pregnancy

A

– a gestational sac is present but contains no embryo

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131
Q

fetal heartbeat

A

when crown-rump length >7mm

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132
Q

<7mm, no heartbeat

A

repeat US after >7d then if >7mm and no heartbeat: Non-Viable Pregnancy

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133
Q

Mean gestational sac diameter >25mm without a fetal pole

A

Repeat after 1 week and confirm Anembryonic pregnancy

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134
Q

Miscarriage medical management

A

Misoprostol (vaginal suppository or oral dose) - prostaglandin analogue, binds to prostaglandin receptions and softens the cervix, stimulates contractions.

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135
Q

Misoprostol side effects

A

Heavier bleedingPainVomitingDiarrhoea

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136
Q

Surgical management of miscarriage

A

Manual vacuum aspiration under local anaesthetic as an outpatient ORElectric vacuum aspiration under general anaestheticProstaglandins (misoprostol) given before surgical management

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137
Q

ERPC - evacuation of retained products of conception

A

under GAcervix dilated, retained products removed though vaccum aspiration and curettage Key complication: endometritis

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138
Q

Recurrent miscarriage definition

A

3 or more consecutive miscarriagesinvestigations after: 3 1st trimester, 1 2nd trimester miscarriage

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139
Q

hereditary thrombophilias (miscarriage)

A 
Factor V Leiden (most common)Factor II (prothrombin) gene mutationProtein S deficiency
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140
Q

uterine abnormalities (miscarriage)

A

Uterine septum (a partition through the uterus)Unicornuate uterus (single-horned uterus)Bicornuate uterus (heart-shaped uterus)Didelphic uterus (double uterus)Cervical insufficiencyFibroids

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141
Q

Chronic Histiocytic Intervillositis (miscarriage)

A

2nd trimester miscarriagecauses IUGR and IUD deathinfiltrated of mononuclear cells in intervillous space

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142
Q

Ix in recurrent miscarriage

A 
Antiphospholipid antibodiesTesting for hereditary thrombophiliasPelvic ultrasoundGenetic testing of the products of conception from the third or future miscarriagesGenetic testing on parents
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143
Q

latest legal abortion

A

24w| 1990 Human Fertilisation and Embryology Act (switched from 28w)

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144
Q

Medical abortion

A

Mifepristone (anti-progestogen) - stops the pregnancy and relaxes cervixMisoprostol (24-48h later) - prostaglandin analogue, softens cervix and stimulates contractions>10w gestation, misoprostol every 3h dose until expulsion

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145
Q

Surgical abortion

A

Cervical dilatation and suction of the contents of the uterus (usually up to 14 weeks)Cervical dilatation and evacuation using forceps (between 14 and 24 weeks)Cervical priming before the procedure to dilate the cervix with Mife, Miso, Osmotic dilators

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146
Q

hyperemesis gravidarum

A

More than 5 % weight loss compared with before pregnancyDehydrationElectrolyte imbalance

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147
Q

PUQE score

A

Pregnancy-Unique Quantification of Emesis< 7: Mild7 – 12: Moderate> 12: Severe

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148
Q

Antiemetics in pregnancy (in order of safety)

A

Prochlorperazine (stemetil)CyclizineOndansetronMetoclopramide+ginger and acupressure

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149
Q

Acid reflux treatment in pregnancy

A

Ranitidine or Omeprazole

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150
Q

When to admit in hyperemesis gravidarum?

A

Unable to tolerate antiemetics or keep down fluids>5% weight lossKetones (2+) on urine dipstick

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151
Q

complete mole

A

2 sperms fertilise empty ovum (no genetic material) = no foetal material forms

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152
Q

Partial mole

A

2 sperms fertilise normal ovum = triple chromosome set, haploid cell

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153
Q

symptoms of molar pregnancy

A 
More severe morning sicknessVaginal bleedingIncreased size of uterusabnormally high hCGThyrotoxicosis
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154
Q

Paracetamol overdose mx

A

activated charcoal if ingested < 1 hour agoN-acetylcysteine (NAC)liver transplantation

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155
Q

Salicylate overdose mx

A

urinary alkalinization with IV bicarbonate| haemodialysis

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156
Q

Benzodiazepines overdose mx

A

Flumazenil (risk of seizures tho)

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157
Q

TCA overdose mx

A

IV bicarbonate - reduced seizure risk and arrhythmia risk| 1st step is correct the acidosis

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158
Q

Lithium overdose mx

A

haemodialysis| sodium bicarbonate

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159
Q

Warfarin overdose mx

A

Vitamin K, prothrombin complex

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160
Q

Heparin overdose mx

A

Protamine sulphate

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161
Q

B blockers overdose mx

A

if bradycardic then atropine| in resistant cases glucagon may be used

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162
Q

Etylene glycol

A

fomepizole - inhibitor of alcohol dehydrogenase| haemodialysis

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163
Q

Methanol poisoning mx

A

fomepizole or ethanol| haemodialysis

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164
Q

Organophosphate insecticides overdose/poisoning mx

A

atropine

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165
Q

CO2 poisoning mx

A

100% oxygen| hyperbaric oxygen

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166
Q

Cyanide poisoning mx

A

Hydroxocobalamin

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167
Q

Iron overdose mx

A

Desferrioxamine, a chelating agent

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168
Q

Lithium monitoring

A

TFT, U&E prior to treatmentLithium levels weekly until stabilised then every 3 monthsTFT, U&E every 6 months

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169
Q

Meig’s syndrome

A

Benign ovarian tumour AscitesPleural effusion

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170
Q

Caplan syndrome

A

Swelling and scarring of lungs in RA (in people who breathed in dust, coal, silica)

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171
Q

RA histology

A

Fibrinoid necrosis surrounded by palisading epithelioid cells

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172
Q

Cribriform plate fx

A

Panda eyes/ periorbital bruisingRhinorrhoea - CSF leakingDo not use nasogastric tube or nasal airway adjunct - can enter the cranium

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173
Q

Disulfiram reaction

A

Reaction to medication (or alcohol cessation medication)| Eg metronidazole, disulfiram

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174
Q

Homonymous quadrantopias

A

Superior - inferior optic radiation temporal lobe lesion (meyers loop)Inferior - superior optic radiation in parietal lobe lesion PITS

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175
Q

Bitemporal hemianopia

A

Upper quadrant defect - inferior chiasm compression, pituitary tumour Lower quadrant - superior chiasm compression, craniopharyngioma

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176
Q

Smoking and p450

A

Induces metabolism

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177
Q

Tetralogy of fallot

A

VSDPulmonary stenosisOverriding aortaRight ventricular hypertrophyEjection systolic murmur left eternal border

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178
Q

Vascular dementia

A

Sudden stepwise deterioration of cognition Risk factors for vascular diseaseGait disturbance and urinary symptoms Change in mood and concentration

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179
Q

Lewy body dementia

A

Parkinsonian symptoms Visual hallucinationsSleep behaviour disorders

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180
Q

Frontotemporal dementia

A 
Personality changesLoss of insight Stereotypes behaviours Slowly progressive, onset <70yoFamily history
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181
Q

Travellers diarrhoea cause

A

Enterotixigenic escherichia coli

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182
Q

POPQ prolapse

A

Stage 1 cervix prolapses more than 1cm above hymen| Stage 2 - prolapse between 1cm above and 1cm below level of hymen

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183
Q

Acute Subdural haematoma

A

Elderly on warfarin No head trauma Fluctuating confusions and consciousness

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184
Q

Yersinia enterocolitica

A

Invasive gastroenteritisMesenteric lymphadenitisErythrema nodosum

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185
Q

Schizoid personality disorder

A 
AloneLonelinessOdd behaviourNo socialisingFlat affect
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186
Q

Schizotypal personality disorder

A

Magical and weird thinking

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187
Q

Schizophrenia and schizoaffective disorder

A

Have Psychotic symptoms

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188
Q

Ottawa ankle rules

A

X ray is required if: 1) pain 2) - medial malleolus tenderness- lateral malleolus tenderness- inability to bear weight

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189
Q

Absent femoral pulses

A

Coarctation of the aortaTx balloon angioplastyRe coarctation can occur, plus HTN and CVD

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190
Q

Acute PE and shock - thrombolytic choice

A

Streptokinase

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191
Q

Supracondylar humerus fx nerve injury

A

Anterior interosseous nerve injury| Weakness to 2nd finger

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192
Q

Musculocutsneous nerve ix

A

Atrophy of biceps brachii

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193
Q

Ulnar nerve injury

A

4th and 5th fingers loss of sensation

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194
Q

Gonorrhoea symptoms

A

Thick green-yellow discharge from the vaginaPainful urinationBleeding between periods

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195
Q

Chlamydia sx

A

Pain on urination Vaginal dischargeBleeding between periods

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196
Q

Dyskinesia vs akathisia

A

Tardive dyskinesia - involuntary movement (chorea movement)| Akathisia - restlesness

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197
Q

Giant cell arteritis vision loss type

A

Anterior ischaemic optic neuropathy

198
Q

Cataract surgery complications

A

Endophthalmitis| Posterior capsule opacification

199
Q

1st line treatment for prolactinoma

A

Bromocriptine or cabergoline| Dopamine receptor agonist

200
Q

Cat scratch organism and symptoms

A

Bartonella henselaeBrownish red papulesLymphadenopathy

201
Q

Antistreptolysin O titer

A

Used to determine recent group A strep infection

202
Q

INR 6-8, no bleeding

A

Stop warfarin Check INRRecommence warfarin if <5

203
Q

INR >8 minor/no bleeding

A

Stop warfarin5mg oral vit K, 0.5-1mg IVRecheck INR and can re give vit K in 24hRecommence warfarin if INR <5

204
Q

Raised INR with major bleeding

A

Stop warfarin| IV phytomenadione and fresh frozen plasma 15mg/kg

205
Q

Shigella treatment

A

(Severe if bloody diarrhoea - dysentery) Ciprofloxacin 500mg PO BD 1dayOr Azithromycin 500mg PO OD for 3 daysShigella is notifiable disease

206
Q

Pre eclampsia risk factors

A 
NullparityPrevious pre eclampsiaFamily historyMaternal age >40Pregnancy interval >10Multiple pregnancy HTNBMI >35Pre existing vascular/kidney/diabetes
207
Q

Hep B serology

A

HBsAg (positive- currently infected, negative - not currently infected)

208
Q

If HBsAg -ve

A

Look at a-HBc+ natural infection, naturally immune- no natural infection

209
Q

If HBsAg +

A

IgM a-HBc + acute infection- chronic infection

210
Q

If HBsAg -| a-HBc -

A

a-HBs+ immune from Hep B vaccine - never had vaccine or infection

211
Q

SLE ab

A

Anti-dsDNAanti-HistoneAnti-SmithANA

212
Q

Polymyositis

A

Anti-Jo1

213
Q

Myasthenia gravis

A

Anti-acetylcholine receptor

214
Q

Lambert Eaton ab

A

Anti-VGCC

215
Q

HIV treatment drugs

A

2 nucleotide reverse transcriptase inhibitors| 1 NNRTI or integrase inhibitor

216
Q

Anatomical landmarks spine

A

T3 spine of scapulaT7 inferior aspect of scapulaL4 superior aspect of iliac crestS2 PSIS

217
Q

Scabies treatment

A

Caused by sarcoptes scabiei1) permethrin 5% (whole body and wash after 8-12h, repeat after 1w)2) malathion

218
Q

Anterior tongue tie vs posterior tongue tie

A

Anterior: prominent restrictive frelunum seen in front of the tongue Posterior: frelunum back underneath the tongue

219
Q

Allergic rhinitis in pregnancy

A

Oral loratadine

220
Q

GCS motor

A 
6 obeys commands5 localises pain4 withdraws from pain3 abnormal flexion 2 abnormal extension1no response
221
Q

Rubella vaccination antibodies

A

IgM antibody negative| IgG antibody positive

222
Q

Amiodarone se and tx

A

se: hypothyroidism, tx with levothyroxine (amiodarone ctd)

223
Q

when to prescribe cyclical combined HRT

A

LMP <1y ago

224
Q

when to prescribe continyous combined HRT

A
  • taken cyclical combined for 1year- at least 1y since LMP- at least 2y since LMP in premature menopause (<40y)
225
Q

TCA overdose

A

widened QRS (>160ms)arrhythmia (eg amiodarone and dusoleptin) tx. IV sodium bicarbonate

226
Q

Ethylene glycol overdose tx

A

Fomepizole

227
Q

opioid detox drug

A

Methadone

228
Q

lorazepam overdose (benzodiazepine) tx

A

gaba antagonist| FLUMAZENIL

229
Q

adrenaline doses

A

anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM| cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV

230
Q

salicylate poisoning

A

1) resp alkalosis| 2) metabolic acidosis

231
Q

anaphylactoid reactions to IV acetylcysteine

A

stop IV acetylcysteinegive nebulised salbutamolrestart IV infusion at a slower rate

232
Q

ciprofloxacin SE

A

lowers seizure threshold| tendonitis

233
Q

metronidazole se

A

reaction following alcohol ingestion

234
Q

doxycycline se

A

photosensitivity

235
Q

trimethoprim side effects

A

photosensitibtypruritissupression of haematopoiesis

236
Q

LSD intoxication tx

A

Lorazepam

237
Q

criteria for paracetamol liver transplant

A

Arterial pH < 7.3, 24 hours after ingestionor all of the following:prothrombin time > 100 secondscreatinine > 300 µmol/lgrade III or IV encephalopathy

238
Q

Alcohol addiction drugs

A

benzodiazepines for acute withdrawaldisulfram: promotes abstinence (contraindications: ischaemic heart disease, psychosis)acamprosate: reduces craving

239
Q

heparin overdose tx

A

protamine sulphate

240
Q

ACE inhibitors se

A

cough| hyperkalaemia

241
Q

bendroflumethiazide se

A

gouthypokalemiahyponatremiaimpaired glucose tolerance

242
Q

calcium channel blockers se

A

headacheflushingankle oedema

243
Q

beta blockers se

A

bronchospasmfatiguecold peripheries

244
Q

doxazosin se

A

postural hypotension

245
Q

ethylene glycol toxicity

A

Fomepizole

246
Q

amarurosis fugax tx

A

Aspirin

247
Q

fever followed by maculopapular rash

A

(Once fever resolved)| Roseola infantum HHV6

248
Q

Itchy red papillae lesions between toes and fingers

A

Scabies - sarcoptes scabiei

249
Q

Bilateral malar erythrema

A

Slapped cheek syndrome / 5th disease| Parvovirus b19

250
Q

Papules and vesicles and pustules

A

Chicken pox VZV

251
Q

Widespread erythrema and tenderness, desquamation

A

Scalded skin syndrome| Staphylococcus

252
Q

Painful vesicular lesions on hands, feet, mouth

A

Hand foot and moths| Coxsackie virus

253
Q

Erythrematous pustules with yellow crust

A

Impetigo| Staph aureus

254
Q

Erythrematous rash in nappy

A 
Irritant dermatitis (spares flexures)Candida (involves flexures)Seborrhoeic dermatitis (scalp changes, not itchy)
255
Q

Vesicles surrounded by maculopapular rash (target like)

A

Erythrema multiformae

256
Q

Measles

A 
Spread by dropletsIncubation 7-12dCough, conjunctivitis, fever Koplik spots Rash from behind the ears to face neck and bodySupportive treatment
257
Q

Mumps

A

Supportive treatment Complication- orchitis, encephalitisProdromal fever and malaiseDroplet, 12-21 incubation

258
Q

Rubella

A

Respiratory spread Incubation 15-20Fever and maculopapular rash (from face to body)Concern: congenital infection

259
Q

2 month vaccinations

A

DTaP/IPV/Hib, MenB, rotavirus

260
Q

3 month vaccinations

A

DTaP/IPV/Hib, PCV, rotavirus

261
Q

4 months vaccines

A

DTaP/IPV/Hib, PCV, MenB

262
Q

12 month vaccines

A

Hib/MenC, PCV, MMR, MenB

263
Q

3 years vaccines

A

MMR/DTaP/IPV

264
Q

12 years vaccines

A

HPV

265
Q

14 years vaccines

A

MenACWY/DTa/IPV

266
Q

Live attenuated vaccines

A 
TBOPV (polio vaccine)MMRRotavirus Yellow fever
267
Q

Inactivated vaccines (killed antigen)

A

Pertrussis| IPV

268
Q

Inactivated toxins

A

Diptheria| Tetanus

269
Q

Paediatric fluids

A

0.9 NaCl and 5% dextrose 24h Na 2-4mmol/kg24h K 1-2mmol/kg

270
Q

G4 P3

A

A pregnant woman with three previous deliveries at term

271
Q

G1 P1

A

A non-pregnant woman with a previous birth of healthy twins:

272
Q

G1 P0 + 1

A

A non-pregnant woman with a previous miscarriage

273
Q

G1 P1

A

A non-pregnant woman with a previous stillbirth (after 24 weeks gestation

274
Q

booking clinics

A

<10w

275
Q

Dating scan

A

Between 10 and 13 + 6| An accurate gestational age is calculated from the crown rump length (CRL), and multiple pregnancies are identified

276
Q

Anomaly scan

A

Between 18 and 20 + 6| An ultrasound to identify any anomalies, such as heart conditions

277
Q

Antenatal appointments

A

16, 25, 28, 31, 34, 36, 38, 40, 41 and 42 weeks

278
Q

Oral glucose tolerance test in pregnancy

A

Women at risk of gestational diabetes (between 24 – 28 weeks)

279
Q

Anti-D injections

A

Anti-D injections in rhesus negative women (at 28 and 34 weeks)

280
Q

placenta praevia on the anomaly scan

A

Ultrasound scan at 32 weeks

281
Q

vaccines in pregnancy

A 
Whooping cough (pertussis) from 16 weeks gestationInfluenza (flu) when available in autumn or winter
282
Q

FAS

A 
Microcephaly Thin upper lipSmooth flat philtrumShort palpebral fissure Learning disabilityBehavioural difficultiesHearing and vision problemsCerebral palsy
283
Q

Smoking in pregnancy

A 
Fetal growth restriction (FGR)MiscarriageStillbirthPreterm labour and deliveryPlacental abruptionPre-eclampsiaCleft lip or palateSudden infant death syndrome (SIDS)
284
Q

Combined test

A

between 11 and 14 weeks gestation nuchal translucency >6mmBeta‑human chorionic gonadotrophin (beta-HCG) – a higher result indicates a greater riskPregnancy‑associated plasma protein‑A (PAPPA) – a lower result indicates a greater risk

285
Q

Triple test

A

between 14 and 20 weeks gestationBeta-HCG – a higher result indicates greater riskAlpha-fetoprotein (AFP) – a lower result indicates a greater riskSerum oestriol (female sex hormone) – a lower result indicates a greater risk

286
Q

quadruple test

A

between 14 and 20 weeks gestationBeta-HCG – a higher result indicates greater riskAlpha-fetoprotein (AFP) – a lower result indicates a greater riskSerum oestriol (female sex hormone) – a lower result indicates a greater riskInhibin-A - higher inhibin-A indicates a greater risk.

287
Q

If risk of Down syndrome 1:150

A

Chorionic vilious sampling >15weeks| Amniocentesis later in pregnancy

288
Q

Hypothyroid in pregnancy

A

levothyroxine dose needs to be increased during pregnancy, usually by at least 25 – 50 mcg

289
Q

anti-epileptics safe in pregnancy

A

Levetiracetam, lamotrigine and carbamazepine

290
Q

anti-epileptics safe in pregnancy

A

Levetiracetam, lamotrigine and carbamazepine

291
Q

Anti epileptics to avoid in pregnancy

A

Sodium valproate -neural tube defects and developmental delayPhenytoin is avoided - cleft lip and palate

292
Q

Telogen effluvium

A

Increased hair shedding, hair shift from anagen/growing phase to telogen/shedding phase. Due to childbirth. trauma, ilness, bereavement

293
Q

Anagen effluvium

A

Generalised hair loss associated with medications (Chemotherapy, TCA, allopurinol, beta blockers, retinoids)

294
Q

Trichotillomania

A

people pull their own hair, patchy hair loss in assymetrical distribution

295
Q

Insulinoma

A

Rise in insulin Rise in C-peptidePresents with hypoglycaemia

296
Q

Factitious hypoglycaemia (eg exogenous insulin injection)

A

Elevated insulinLow C-peptidePresents with hypoglycaemia

297
Q

5th disease risk

A

Fetal death if pregnant women infected| - parvovirus b19

298
Q

Measles complications

A

acute demyelinating encephalitis| hearing loss

299
Q

Rubella complications

A

congenital deafness (most common cause of congenital deafness)

300
Q

Scarlet fever (group A haemolytic strep) complications

A

Rheumatic fever

301
Q

Normal CSF results

A 
WCC (5x 10^6) all lymphocytes, no neutrophilsRBC: 10protein 0.2-0.4 (<1% from serum)glucose: 3.3-4.4 (>60% from serum)pH: 7.31opening pressure: 70-180 mmH2O
302
Q

Right homonymous hemianopia with macular sparing

A

left occipital visual cortex

303
Q

Gamophobia

A

phobia of getting marries

304
Q

Acrophobia

A

fear of heights

305
Q

Algophobia

A

fear of pain

306
Q

Kawasaki disease mnemonic and complication

A

CRASH and burncoronary artery aneurysm

307
Q

DMD treatment

A

steroids

308
Q

Most common cause of genital ulcerative disease

A

HSV - 2

309
Q

Tropicamide

A

mydriatic, pupil dilator

310
Q

Pilocarpine

A

miotic eye drops

311
Q

cyclopenolate

A

mydriatric, long acting eye drop

312
Q

HSV microscopy/ also CMV and VZV

A

multinucleated giant cells

313
Q

Reduced CSF glucose:plasma ratio <60% on LP

A

bacterial meningitis

314
Q

Erythrema nodosum most common causes

A

tuberculosis and sarcoidosis

315
Q

cavernous sinus thrombosis

A

visual disturbanceCNs III, IV, VI ophthalmoplegia and diplopia

316
Q

Aims of antiretroviral therapy

A

<50 copies of viral loadCD4 >350reduce transmissionincrease quality of life without drug side effects

317
Q

Akathisia vs tardive dyskinesia

A

tardive dyskinesia - oral-facial movements, excessive blinking, lip smacking, grimacing, tongue movementsakathisia - restlessness, can’t sit still

318
Q

Hep C treatment

A

ledipasvir/sofosbuvir

319
Q

Craniopharyngioma vs Pituitary adenoma

A

craniopharyngioma in young/adolescent

320
Q

Non communicating hydrocephalus

A

pinealoma/ pineal gland tumour

321
Q

Lichen sclerosus treatment

A

topical tacrolimus

322
Q

Staph aureus valve infection findings

A

gram positive coccuscatalase +vecoagulase -ve

323
Q

Lacrimal gland nerve supply

A

Intermediate nerve (facial nerve portion)

324
Q

Tx of hypersalivation in clozapine treatment

A

HyoscinePirenzipineBenzhexol

325
Q

Gastroschisis

A

no sacc sectionimmediate (<4h) surgery

326
Q

Omphalocele

A

related to other conditions (trisomy 13, 18, 21, turner syndrome)sacvaginal deliverystaged surgical repair

327
Q

Carbuncle

A

subcutaneous pus collection discharging via multiple sinuses| Staphylococcal infection

328
Q

Furuncle

A

Perifollicular (around hair root) abscess caused by Staphylococcus aureus

329
Q

Beta blockers SE in pregnancy

A

Fetal growth restrictionHypoglycaemia in the neonateBradycardia in the neonate

330
Q

ACE inhibitors and ARBs SEs in pregnancy

A

Oligohydroamnios| Hypocalvaria

331
Q

Opiates SE in pregnancy

A

neonatal abstinence syndrome (NAS) 3-72h post birthirritability, tachypnoea, fever, poor feeding

332
Q

Lithium SE in pregnancy

A

Ebstein’s anomaly (tricuspid is set lower in the right side so bigger right atrium and smaller right ventricle)

333
Q

SSRI

A

paroxetine - strong link with congenital malformation1st trimester - congenital heart defects3rd trimester - PPH

334
Q

Rubella in pregnancy

A

congenital rubella - infection before <20weeks gestation- Congenital deafness, cataracts- PDA and pulmonary stenosis- Learning disability

335
Q

Chickenpox in pregnancy

A

mother complication: hepatitis, encephalitis, varicella pneumonitiscongenital varicella syndrome (if <28 weeks gestation): foetal growth restriction, microcephaly, hydrocephalus, scarring, limb hypoplasia, chorioretinitis

336
Q

Listeria in pregnancy

A

Gram positive bacteria due to unpasteurised dairy products (eg blue cheese) miscarriage, severe neonatal infection

337
Q

CMV in pregnancy

A

congenital CMV:- growth restriction- vision and hearing loss- microcephaly- learning disability- seizures

338
Q

Congenital toxoplasmosis

A

intracranial calcificationhydrocephaluschorioretinitis

339
Q

Parvovirus infection in pregnancy complications

A

5th disease/slapped cheek/ erythrema infectiosum - fetal anaemia - hydrops fetalis (foetal heart failure)- miscarriage or foetal death

340
Q

Zika virus in pregnancy

A

spread by Aedes mosquitoscongenital zika syndrome: microcephaly, foetal growth restriction, ventriculomegaly and cerebellar atrophytest with PCR and antibodies

341
Q

Anti D injections (when)

A

28 and 34 (or 28 and birth)| + sensitisation: antepartum haemorrhage, amniocentesis, abdo trauma

342
Q

When is Anti D given in sensitisation event

A

72h post event| Kleinhauer test determines if further doses are required

343
Q

Small for gestational age

A

<10th centile assesed via: - estimated foetal weight- foetal abdominal circumeference

344
Q

Severe small for gestational age

A

<3rd centile for gestational age

345
Q

Low birth weight

A

<2500g

346
Q

Complications of foetal growth restriction

A

Fetal deathBirth asphyxianeonatal hypothermia/ hypoglycaemia

347
Q

SGA risk factors

A 
Old mother <35yoMultiple pregnancylow PAPPAObesitySmokingDiabetesHTNpre-exlampsia
348
Q

Tx for SGA?

A

Early delivery +corticosteroids

349
Q

Large for gestational age

A

=macrosomia>4.5kgestimated fetal weight >90th centile

350
Q

Causes of macrosomia

A 
Maternal diabetes (Gestational diabetes)maternal obesityoverduemale beboprevious macrosomia
351
Q

LGA risks

A 
Shoulder dystocia !!!peineal tearsneonatal hypoglycaemiaclavicular facture/erb palsy/ birth injuryPPH, uterine rupture
352
Q

PID treatment

A

1g ceftriaxone IM (single dose), 400mg metronidazole PO BD, doxycycline 100mg PO BD for 14d

353
Q

Dichorionic diamniotic

A

membrane between the twins, with a lambda sign or twin peak sign

354
Q

Monochorionic diamniotic

A

membrane between the twins, with a T sign

355
Q

Monochorionic monoamniotic

A

no membrane separating the twins

356
Q

Lambda sign

A
  • twin peak sign| membrane between twins meets the placents (dichorionic pregnancy)
357
Q

T sign

A

membrane between twins abruptly meets chorion (monochorionic pregnancy)

358
Q

twin to twin transfusion syndrome

A

NAME?

359
Q

Prengnacy checks for anaemia

A

FBC atBooking clinic20 weeks gestation28 weeks gestation

360
Q

Additional US in multiple pregnancy

A

2 weekly scans from 16 weeks for monochorionic twins| 4 weekly scans from 20 weeks for dichorionic twins

361
Q

Monoamniotic twins birth

A

elective caesarean section at between 32 and 33 + 6 weeks

362
Q

Diamniotic twins birth

A

37 and 37 + 6 weeksVaginal delivery if 1st bebo is cephalicC sectionElective c section when 1st bebo not cephalic

363
Q

urine dipstick nitrites and leukocytes

A

gram -ve bacteria E.Coli break down nitrates into nitritesleukocytes - test for leukocyte esteraseNitrites are a MORE ACUTE sign of infection than leukocytes

364
Q

UTI causing organisms

A

E Coli (gram-ve, anaerobic, rod-shaped), found in faecesKlebsiella pneumoniae (gram-ve anaerobic rod)Candida albicansStaph saprophyticusPseudomonas auerginosaEnterococcus

365
Q

Physiological changes in pregnancy

A

Plasma volume increases (reduced Hb concentration)

366
Q

Low MCV

A

iron deficiency

367
Q

Raised MCV

A

B12, Folate deficiency

368
Q

HB screening in pregnancy

A

Thalassaemia - all women tested| Sickle cell disease - women at high risk

369
Q

Tx options for B12

A

Intramuscular hydroxocobalamin injections| Oral cyanocobalamin tablets

370
Q

VTE risk factors in pregnancy

A 
SmokingParity ≥ 3Age > 35 yearsBMI > 30Reduced mobilityMultiple pregnancyPre-eclampsiaGross varicose veinsImmobilityFamily history of VTEThrombophiliaIVF pregnancy
371
Q

VTE prophylaxis in pregnancy

A

28 weeks if there are three risk factors| First trimester if there are four or more of these risk factors

372
Q

LMWH examples

A

enoxaparindalteparintinzaparin

373
Q

PE ix

A

chest X rayECGCTPA in abnormal xray or VQCTPA-breast cancer risk, VQ childhood cancer

374
Q

DVT ix

A

doppler ultrasound

375
Q

Massive PE treatment

A

UnfrActioned heparin| surgical embolectomy

376
Q

Pre-eclampsiatriad

A

HypertensionProteinuriaOedema

377
Q

RF for preeclampsia and tx

A

Tx, aspirin from 12 weeks until birth

Pre-existing hypertensionPrevious hypertension in pregnancyDiabetesChronic kidney diseaseOlder than 40BMI > 35More than 10 years since previous pregnancyMultiple pregnancyFirst pregnancyFamily history of pre-eclampsia
378
Q

pre eclampsia diagnosis

A

SBP above 140 mmHgDBP above 90 mmHgPLUS any of:ProteinuriaOrgan dysfunctionPlacental dysfunction

379
Q

proteinuria quantification

A

Urine protein:creatinine ratio (above 30mg/mmol is significant)Urine albumin:creatinine ratio (above 8mg/mmol is significant)

380
Q

HELLP

A

HeamolysisEleveated Liver enzymesLow Platelets

381
Q

Pre eclampsia tx

A

LabetololNifedipineMethyldopa (3rd line, must be stopped within 48h from birth)IV hydralazine (antihypertensive in severe preeclampsia)IV magnesium sulphate

382
Q

Gestational diabetes treatment

A

Fasting glucose <7 mmol/l: diet and exercise for 1-2w, then metformin, then insulinFasting glucose >7 mmol/l: start insulin ± metforminFasting glucose >6 mmol/l plus macrosomia (or other complications): start insulin ± metformin

383
Q

Alternative for metformin in pregnancy

A

Glibenclamide (sylfonylurea)

384
Q

target sugar levels in pregnancy

A

Fasting: 5.3 mmol/l1 hour post-meal: 7.8 mmol/l2 hours post-meal: 6.4 mmol/l

385
Q

Sliding scale insulin

A

dextrose and insulin infusion is titrated to blood surgar levels during labour in T1D

386
Q

Pre existing diabetes delivery

A

Planned beterrn 37 and 38+6

387
Q

Babies of mothers with diabetes rf

A 
Neonatal hypoglycaemiaPolycythaemia (raised haemoglobin)Jaundice (raised bilirubin)Congenital heart diseaseCardiomyopathy
388
Q

Neonatal hypoglycaemia

A

aim for sugar >2mmol/L,| if below: IV dextrose or nasogastric feeding

389
Q

Obstetric cholestasis

A 
Itching (palms and soles)FatigueDark urinePale, greasy stoolsJaundice
390
Q

Rashes in pregnancy

A

Pemphigoid getationis - includes bellybutton| Polymorphic erupion - tam gdzie majtki / stretch marks

391
Q

Obstetric cholestasis bloods

A

Abnormal liver function tests (LFTs), mainly ALT, AST and GGTRaised bile acids

392
Q

Tx for obstetric cholestasis

A

Ursodeoxycholic acid, Emollients/calamine lotion Antihistamine (chlorphenamine)

393
Q

Acute fatty liver of pregnancy symptoms

A 
General malaise and fatigueNausea and vomitingJaundiceAbdominal pain(lack of appetite)Ascites !!!
394
Q

Acute fatty liver of pregnancy bloods and tx

A

Raised bilirubinRaised WBC countDeranged clotting (raised prothrombin time and INR)Low plateletstx delivery of bebo

395
Q

Polymorphic eruoption of pregnancy

A

Also / pruritic and utricarial papules and plaques of pregnancy tx emollients, steroids, antihistamines

396
Q

Placenta praevia

A

placenta over the internal cervical os| - risk of antepartum haemorrhage

397
Q

Low lying placenta

A

20mm from internal cervical os

398
Q

foetal vessels

A

umbilical arteries x2| umbilical vein x1

399
Q

placenta praevia vs vasa praevia risk

A

Placenta previa: corticosteroids from 34-36w, C section 36-37Vasa praevia: cotricosteroids 32w, C section 34-36

400
Q

vasa previa

A

Foetal vessels exposed outside the umbilical cord or placenta

401
Q

Superficial placenta accreta

A

Placenta implants in surface of myometrium

402
Q

Placenta increta

A

Placenta attaches deeply into myometrium

403
Q

Placenta percreta

A

Placenta invades past myometrium and perimetrium and reaches other organs (eg bladder)

404
Q

How to assess depth/width of placental invasion?

A

MRI scans

405
Q

Delivery in placenta accreta

A

Delivery 35-36+6Hysterectomy Uterus preserving surgery

406
Q

ECV

A

50% successfulnulliparous: ECV if breech >36wmultiparous: ECV if breech >37wTocolysis with SC terbutaline (beta agonist) + anti D

407
Q

Major causes of cardiac arrest in pregnancy

A

Obstetric haemorrhagePESepsis (metabolic acidosis and septic shock)

408
Q

signs of labour

A

Show (mucus plug from the cervix)Rupture of membranesRegular, painful contractionsDilating cervix on examination

409
Q

phases of birth

A

latent: 0-3cm, 0.5cm/hactive: 3-7cm, 1cm/htransition: 7-10cm 1cm/h

410
Q

Preterm prelabour rupture of membranes (P‑PROM)

A

amniotic sac has ruptured before the onset of labour and before 37 weeks gestation

411
Q

Prolonged rupture of membranes (also PROM)

A

amniotic sac ruptures more than 18 hours before delivery

412
Q

Prematurity and classes

A

Birth before 37w Under 28 weeks: extreme preterm28 – 32 weeks: very preterm32 – 37 weeks: moderate to late preterm

413
Q

Diagnosis of PPROM

A

ILGFBP-1: high concentrations in amniotic fluid| PAMG-1: alternative

414
Q

Mx of PPROM

A

Prophylactic Abx (erythromycin 250mg 4x/10d or until labour ir earlier)

415
Q

Preterm labour with intact membranes

A

Foetal fibronectin:if <50ng/ml, negative and preterm labour unlikely

416
Q

Antenatal steroids regime

A

2 doses of IM bethametasone 24h apart

417
Q

Main complication of induction of labour

A

due to vaginal prostaglanding - -> uterine hyperstimulation - Individual uterine contractions lasting more than 2 minutes in duration- More than five uterine contractions every 10 minutesIt leads to: foetal hypoxia, uterine rupture, emergency C section

418
Q

Mx of uterine hyperstimulation

A

Stopping oxytocinvaginal prostaglandinsTocolysis with terbutaline

419
Q

IOL options

A

Membrane sweep (from 40w)Vag Prostaglanding E2 (Dinoprostone)Cervical ripening baloonArtifical rupture of membranes with oxytocin infusion

420
Q

Baseline rate of CTG

A

110-160 normal abnormal <100, >180

421
Q

Variability in CTG

A

5-25 Normal| <5 for 50 min or >25 for 25min

422
Q

Prolonged decelerations

A

2-10 mindrop of >15bpm from baselinemeans: foetal hypoxia

423
Q

Oxytocin in labour

A

syntocinon - oxytocin| atosiban - oxytocin receptor antagonist (- used for tocolysis

424
Q

Ergometrine

A

stimulates smooth muscle contraction in uterus and blood vessels - SE: hypertension, diarrhoea, vomiting, angina

425
Q

Pain relief in labour

A 
Paracetamol and codeineGas and air (entonox)IM pethidine/Diamorphine Pt controlled analgesia: RemifentanilEpidural (levobupivacaine or bupivacaine mixed with fentanyl)
426
Q

Maternal infection in instrumental delivery mx

A

Single dose of co-amoxiclav

427
Q

Instrumental delivery risks for baby

A

Cephalohematoma (ventouse)| facial nerve palsy (forceps)

428
Q

Instrumental delivery risks for mother

A 
femoral nerve (anterior thigh weakness, knee extension weakness, patella reflex loss)obturator nerve (hip adduction and rotation loss, numbness of medial thigh)
429
Q

Lateral cutenous nerve injury

A

numbness of anterolateral thigh

430
Q

lumbosacral plexus injury

A

foot drop and numbness of anterolateral thigh, lower leg, foot

431
Q

common peroneal nerve injury

A

foot drop

432
Q

Classification of perineal tears

A

1st – injury limited to the frenulum of the labia minora2nd – perineal muscles, but not the anal sphincter3rd – the anal sphincter, but not the rectal mucosa4th– the rectal mucosa

433
Q

3rd degree tear subcategories

A

3A - <50% external anal sphincter3B - >50% external anal spincter3C - external and internal anal sphincters affected

434
Q

Antibiotics in sepsis 6

A

piperacillin and tazobactam (tazocin), gentamicin,amoxicillin, clindamycin and gentamicin.

435
Q

Mastitis treatment

A

flucloxacillin| infection with staph aureus

436
Q

Candida of the nipple

A 
topical miconazole (2% after breastfeed)Treatment for the babcy (miconazole gel or nystatin)
437
Q

Sheehan’s syndrome

A

avascular necrosis of pituitary gland ischaemia due to reduced perfusion.Only affects Anterior pituitary.

438
Q

posterior pituitary hormones

A

ADH| oxytocin

439
Q

Sheehan’s syndrome presentation

A

reduced lactation (lack of prolactin)amenorrhoea (lack of LH FSH)adrenal infufficiency (low cortisol, lack of ACTH)hypothyroidism (low TSH)

440
Q

Tx of Sheehan’s syndrome

A

Oestrogen and progesteroneHydrocortisone for adrenal insufficiencyLevothyroxineGrowth hormone

441
Q

GBS prophylaxis

A

Intrapartum haemorrhage: previous GBS, pyrexia in labour, Swabs at 35-37w or 3-5w before delivery Benzylpenicillin

442
Q

Serum progesterone in infertility

A

Check 7 days before period<16 repeat, treat16-30 repeat>30 ovulation

443
Q

EllaOne

A

Ullipristal acetate

444
Q

Urge incontinence

A

Bladder retrainingAntimuscarinixs (oxybutynin, tolteridone, darifenacin) Mirabegron: for old frail

445
Q

Stress incontinence

A

Pelvic floor trainingTape procedureDuloxetine (Contraction of urethral sphincter)

446
Q

Ullipristal acetate (EllaOne)

A

120h Do not give to asthmaticsNo breastfeeding for 7daysReturn to hormonal contraception after 5d

447
Q

COCP postpartum

A

Contraindicated in <6 weeks post Partum

448
Q

HRT SEs

A

NauseaBreast tendernessFluid retentionWeight gain

449
Q

HRT complications

A

Risk of VTE, stroke, IHDRisk of endometrial cancer Increased risk of Breast cancer (due to addition of oestrogen)

450
Q

Diagnostic tests for Downs

A

<13w chorionic villous sampling| >15w amniocentesis

451
Q

Endometriosis tx

A

NSAIDsCOCPOr GnRH

452
Q

1* PPH

A

IV syntocinon 10u OR IV ergometrine 500mcgIM carboprost Intrauterine balloon tamponade (ligation of uterine arterie or internal iliac artery)

453
Q

Pregnancy and VTE

A

Do not give DOAC and warfarin >4 rf: LMWH until 6 weeks post partum>3 rf: 28w-6w pp LMWHDVT before delivery: until 3 mth pp LMWH

454
Q

Epilepsy in pregnancy drug

A

Lamotrigine

455
Q

Mucinous cystadenoma

A

If ruptured, causes pseudomyoxoma peritonei

456
Q

Meig’s syndrome

A

Benign ovarian tumourAscitesPlural effusionCauses FIBROMA

457
Q

Dermoid cyst

A

Most Common benigh ovarian tumour <25

458
Q

Follicular cyst

A

Most Common cause of ovarian enlargment

459
Q

Ovarian cancer RF

A 
Many ovulationsEarly menarcheLate menopauseNullparityIncreased risk with all HRT
460
Q

Drugs causing folate deficiency

A

Pnenytoin| Methrotrexate

461
Q

Misoprostol mode of action

A

Strong myometrial contractions causing tissue expulsion

462
Q

Mifepristone mode of action

A

Thins uterine lining

463
Q

Endometrial cancer rf

A 
(Frail elderly - progesterone therapy) Risk factors: periods increase risk of ovulations- nullparity- early menarche- late menopause- unopposed oestrogen- obesity
464
Q

Magnesium sulphate and eclampsia tx

A

IV bolus 4g 5-10mIV infusion 1g/h Calcium gluconate for resp depression

465
Q

Injectable (progesterone only) contraception

A

Do not give >50 as reduces bone density

466
Q

Congenital rubella syndrome

A 
<16w infection Sensorineural deafnessCongenital cataractsCongenital Heart disease Salt and pepper chorioretinitis
467
Q

Semen analysis

A

Min 3 days and Max 5 days abstinenceSample delivered within 1hVolume >1,5mlpH >7.215mln/ml concentration

468
Q

Hep B in mother, bebo management:

A

Hep B vaxx <12h, 1mth, 6mthHep B IG 0.5ml <12hNo transmission via breastfeeding

469
Q

Breast cancer

A

Increased risk when progesterone added| Also pregnancy increased risk

470
Q

COCP rf

A

Increased: Breast and cervical cancer Decreased: ovarian and endometrial

471
Q

Implantable contraceptive

A

Nexplanon or implanon| 3y

472
Q

Cervical excitation conditions

A

PID| Ectopic pregnancy

473
Q

Unopposed oestrogen risk

A

Endometrial cancer

474
Q

N&V medication in pregnancy

A

Metoclopramide| Do not use >5d

475
Q

Desogestrel

A

POP| 12h Window for taking

476
Q

Hyperechogenic bowel

A

CFDown’s syndrome CMV

477
Q

HRT adding progesterone

A

Increased Breast cancer risk

478
Q

Increased nuchal translucency

A

Down’s syndrome Congenital Heart defectAbdominal wall defect

479
Q

Hyperemesis gravidarum

A

5% weight lossDehydration Electrolyte imbalabce

480
Q

Progesterone rf

A

Increased risk of Breast cancer and VTE

481
Q

Varicella zoster monitoring

A

IgM - chickenpox now| IgG - chickenpox in the past

482
Q

Drugs to avoid in breastfeeding

A 
Abx (ciprofloxacin, tetracycline, chloramphenicol, sulphonamides)LithiumBenzodiazepinesAspirinCarbimazoleMETHOTREXATESulfonylureasCytotoxic drugsAmiodarone
483
Q

BV diagnostic criteria

A

Thin white discharge Clue cells pH <4.5Whiff test +veFishy greyOral metronidazole

484
Q

Trichomonas vaginalis

A 
Yellow greenOffensive Strawberry cervixVulvovaginitisFrothy discharge
Oral metronidazole
485
Q

Gonorehoea

A

IM ceftriaxone

486
Q

Felty’s syndrome generic

A

HLA DR4

487
Q

Apgar score

A

1,5,10 min| Pulse, resp effort, colour, tone, reflex

488
Q

CF diet

A

High calorie, High fat diet| To reduce streathorrhoea

489
Q

Meckels diverticulum Scan

A

Techtenium scan

490
Q

<1 BLS

A

15:2| Two thumbs

491
Q

> 1 BLS

A

Lower sternum, 1 hand, 15:2

492
Q

Thelarche

A

1st stage of breast development

MBBS Y5 (27 decks)

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