Year 4 Final stuff Flashcards
Bishop’s score categories?
Cervical position - posterior; middle; anterior
Cervical consistency - firm; medium; soft
Cervical effacement - 0-30%; 40-50%; 60-70%; 80%+
Cervical dilatation - closed; 1-2cm; 3-4 cm; 5cm
Fetal station - -3; -2; -1/0; +1/+2
Bishop’s score relevance?
Score > 8 vaginal delivery likely
Score < 8 vaginal delivery unlikely without cervical ripening, eg vaginal prostaglandins.
Antibodies in mother to fetus or mother to baby?
IgG mother to fetus, only Ig to cross placenta
IgA mother to baby in breastmilk
Well’ score categories?
Active cancer (in last 6 months)
Bed ridden >3 days (or major surgery 4 weeks)
Calf swelling >3cm comparatively
Collateral superficial veins
Entire leg swelling
Localised tenderness over deep veins
Unilateral pitting oedema
Paralysis, or immobilisation of lower leg
Previous DVT
ALL ABOVE ARE +1
Alternative diagnosis more likely MINUS 2
What to do with Well’s score?
Score of 0-2: do D-dimer, if positive, USS leg
If negative, DVT very unlikely
Score >2: USS leg without D-dimer
What point to extrinsic and intrinsic pathways converge in coagulation cascade?
Factor Xa
What are protein c and s in coagulation cascade?
Protein C (and thrombomodulin) is activated by protein S Activated protein C inhibits activation of Factors V and VIII i.e. it is a natural anticoagulant
What is Factor V Leiden?
Mutation in gene for Factor V
Activated protein C cannot degrade Factor V as normal, thus leading to a hypercoagulable state
Most commonly inherited hypercoagulability
Treatment of iron-deficiency anaemia?
200mcg ferrous sulfate PO BD/TDS
Should continue for 3 months after deficiency is corrected to replenish stores
Who to refer in iron-deficiency anaemia?
USC:
if > 60 years
if < 50 years with rectal bleeding (consider USC)
Refer to gastro:
All men and postmenopausal women
All those > 50
Premenopausal <50 with colonic symptoms; FHx of GI cancer, or not responding to treatment
When to offer platelet transfusion?
Clinically significant bleeding and PLT < 30
If severe bleeding, or CNS bleed, consider transfusion if PLT < 100
Offer prophylactic transfusions if PLT < 10
What is acute haemolytic transfusion reaction?
Transfusion of incompatible ABO red cells
Immediate destruction by anti-A or anti-B antibodies
Shock, renal failure, DIC
Main differences between TRALI and TACO (and similarities)?
TRALI: Hypotension and fever TACO Hypertension without fever Peripheral oedema Leukopenia Raised JVP
Both will have acute dyspnoea and bilateral diffuse infiltrates on CXR
How to treat non-haemolytic transfusion reaction
Stop transfusion and rule out other causes, eg haemolytic transfusion reaction
Treat pyrexia with anti-pyretic
Recommence transfusion at slow rate
Treatment of bipolar disorder - acute episodes?
Mania, one of: Olanzapine Haloperidol Quetiapine Risperidone Mixed episodes also treated with above
Depressive episode, one of: Quetiapine Fluoxetine with olanzapine Olanzapine Lamotrigine
Long term management of bipolar disorder?
4 weeks after episode has resolved
Consider continuing treatment as for acute episode
OR
Lithium
Or Lithium + valproate
Or valproate alone (if lithium poorly tolerated)
or olanzapine (if lithium poorly tolerated)
Acne treatment?
Mild-moderate
Topical retinoid alone or with benzoyl peroxide
Topical antibiotic (clindamycin 1%) always with top. benzoyl peroxide
Mod-severe Oral antibiotic (lymecycline or doxycycline) WITH top retionoid or benzoyl peroxide
Treatment of acne in pregnancy?
Topical retinoids are contraindicated
Topical benzoyl peroxide and topical erythromycin are safe
Efficacy vs effectiveness?
Performance of an intervention
Efficacy - performance in ideal circumstances, highly selected, homogenous population, strict exclusion criteria
Effectiveness - “real life” performance, heterogenous population, few exclusion criteria
Four principles in medical ethics?
Autonomy - acknowledge one’s right to make their own decisions
Justice - treat others equally, distribute benefits/burdens fairly
Beneficence (do good) - provide benefits to persons and contribute to their welfare
Non-maleficence (do no harm) - obligation to not inflict harm intentionally
Antipsychotics main MOA?
Reduce dopaminergic transmission specifically D2 receptors
Second generation also have:
5-HT2a ANTagonism
5-HT1a AGonism
