Year 4 Passmed Incorrect Qs 3 Flashcards
What is LIghts Criteria?
- exudates have a protein level of >30 g/L
- transudates have a protein level of <30 g/L
if the protein level is between 25-35 g/L, Light’s criteria should be applied.
An exudate is likely if at least one of the following criteria are met:
- pleural fluid protein divided by serum protein >0.5
- pleural fluid LDH divided by serum LDH >0.6
- pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
Paediatrics- what is gonadotrophin independent precocious puberty (GIPP) and gonadotrophin dependent precocious puberty (GDPP)?
GIPP:
increased levels of sex hormones (testosterone) WITHOUT the increase of GnRH
- leading to the suppression of LH and FSH
Due to: sex hormone secretion may be due to ovarian, testicular or adrenal causes like congenital adrenal hyperplasia. In boys, the testicular volume will tend to be normal or small.
GDPP: Aka ‘central’ precocious puberty
- levels of the gonadotrophins LH and FSH would be high and testes would be large for age.
- Caused by: premature activation of the hypothalamic-pituitary-gonadal axis
FSH & LH raised
Risk factors for Surfactant deficient lung disease (SDLD) (1 major and 4 others)
- The risk of SDLD decreases with gestation
50% of infants born at 26-28 weeks
25% of infants born at 30-31 weeks - male sex
- diabetic mothers
- Caesarean section
- second born of premature twins
Stage 1 of labour:
Start and end
Length of time
latent phase dilatation + time
active phase dilatation + rate
Stage 1 - from the onset of true labour (strong reg contraction lasting 30-70 s and 5-10 mins apart) to when the cervix is fully dilated. In a primigravida lasts typical 10-16 hours
latent phase = 0-3 cm dilation, normally takes 6 hours
active phase = 3-10 cm dilation, normally 1cm/hr
Neaonates: Differences and similarities between Caput succedaneum and Cephalohaematoma- no managment needed for either! (3 for each!)
Caput succedaneum
- Present at birth
- Crosses suture lines and forms over vertex
- Resolves within days
Cephalohaematoma
- Develops several hours after birth
- DOESN’T cross suture lines in parietal region
- may take several months to resolve
Similarities
- Sweling on head of newborn
- more common in prolonged/ difficult deliveries
- managed conservatively
Criteria for discharge following acute asthma attack: 3
- individuals must have a PEFR >75% of expected
- have had their inhaler technique checked and recorded
- be stable on discharge medications (i.e. no longer requiring acute asthma treatment) for at least 12-24 hours.
WHat would you see on a ABG in an acute panic attack?
- Resp alkalosis
- No compensation from bicarb
- LOW Co2
- NORMAL o2
How long should you gradually reduce SSRI for when stopping (not for fluoxetine)
When stopping a SSRI the dose should be gradually reduced over a 4 week period (this is not necessary with fluoxetine). Paroxetine has a higher incidence of discontinuation symptoms.
Out of these fibrosis pathologies, what zones do they usually affected?
Radiation pneumonitis
Asbestosis
Idiopathic pulmonary fibrosis
Radiation pneumonitis- upper zones (complication of radiotherapy is pneumonitis which typically occurs 1-6 months later).
Asbestosis- lower zones. Ship yard worker
Idiopathic pulmonary fibrosis most common form of interstitial lung disease however it typically affects the lower zones.
Side effects of zopiclone and one in particular to be mindful in the elderly? (7)
Zopiclone binds acts GABAA-containing receptors, causing an enhancement of the actions of GABA to produce the therapeutic and adverse effects of zopiclone. It has a similar mode of action to benzodiazepines.
Given for insomnia in short course.
Its side effects include:
- agitation
- bitter taste in mouth
- constipation
- decreased muscle tone
- dizziness
- dry mouth
- * increased risk of falls (especially in the elderly).
Resp- What is Samter’s triad and what medication should be avoided in asthma?
Samter’s triad = asthma + aspirin sensitivity + nasal polyposis
aspirin and other NSAIDs should be avoided as these may precipitate an asthma exacerbation. The combination of asthma, aspirin sensitivity and nasal polyps is known as Samter’s triad.
What is the rule for missing clozapine meds > 48 hours?
Side effects you get? (3)
If clozapine doses are missed for more than 48 hours the dose will need to be restarted again slowly (like when they first started on it)
This is because when you start Clozapine after a break of >48 hours, it can make side effects worse, such as blood pressure changes, drowsiness and dizziness. If there is a gap in treatment of 3 days (72 hours) then you may also require more frequent blood tests for a short period.
When is the most appropriate time to measure serum progesterone levels for sub-fertility?
To confirm ovulation: Take the serum progesterone level 7 days prior to the expected next period
The features of acute severe asthma (4)
- PEFR 33-50% best or predicted
- inability to complete full sentences
- RR >25/min
- pulse >110 bpm
Definitions:
- Chronic high pressure urinary retention and presentation
- Chronic Low pressure chronic urinary retention and presentation
What happens when you catheterize and what is the management?
High pressure- If urinary retention and renal function is impaired (increase in creatinine) or if there is hydronephrosis. Painless distended bladder.
Low pressure- presents with a painless distended bladder, but no associated hydronephrosis or renal impairment.
Decompression haematuria occurs commonly after catheterisation for chronic retention due to the rapid decrease in the pressure in the bladder.
It usually does not require further treatment.
Management of postpartum haemorrhage
- If life threatening call senior
- ABC approach… (4)
- Then (2)
- Medical (4) 2 CI!!
- Surgical (4)
- first line
- 2 more
- final last resort and life-saving
- If life threatening call senior
- ABC approach:
- 2 peripheral cannulae, 14 gauge
- lie the woman flat
- bloods including group and save
- commence warmed crystalloid infusion - Then mechanical
- palpate the uterine fundus and rub it to stimulate contractions (‘rubbing up the fundus’)
- catheterisation to prevent bladder distension and monitor urine output - Medical:
- IV oxytocin: slow IV injection followed by an IV infusion
- ergometrine slow IV or IM (unless there is a history of HYPERTENSION)
- carboprost IM (unless there is a history of ASTHMA)
- misoprostol sublingual
there is also interest in the role tranexamic acid may play in PPH
5 Surgical: if medical options fail to control the bleeding then surgical options will need to be urgently considered
the RCOG state that
- the intrauterine balloon tamponade is an appropriate first-line ‘surgical’ intervention for most women where uterine atony is the only or main cause of haemorrhage
other options include:
B-Lynch suture
ligation of the uterine arteries or internal iliac arteries
if severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure
What is
Extrinsic allergic alveolitis (EAA, also known as hypersensitivity pneumonitis)
Type of hypersensitivity?
4 STEM causes
a condition caused by hypersensitivity induced lung damage due to a variety of inhaled organic particles. It is thought to be largely caused by immune-complex mediated tissue damage (type III hypersensitivity) although delayed hypersensitivity (type IV) is also thought to play a role in EAA, especially in the chronic phase.
Examples
- bird fanciers’ lung: avian proteins from bird droppings
- farmers lung: spores of Saccharopolyspora rectivirgula from wet hay (formerly Micropolyspora faeni)
- malt workers’ lung Aspergillus clavatus
- mushroom workers’ lung: thermophilic actinomycetes*
Which antibody is associated with Churg-Strauss syndrome
positive pANCA serology
It is an ANCA associated small-medium vessel vasculitis
Fill out the following for Cardiogenic shock (eg. 2), Hypovolaemic shock (eg. 4) and Septic shock (Explain)
- SVR- Systemic vascular resisitance
- HR
- Cardiac output
- Blood Pressure
Cardiogenic shock eg. MI, Valve abnormality
- Inc. SVR (vasoconstriction in response to low BP)
- Inc. HR (sympathetic response)
- Decreased cardiac output
- Decreased blood pressure
Hypovolaemic shock:
blood volume depletion
e.g. haemorrhage, vomiting, diarrhoea, dehydration, third-space losses during major operations
- Increased SVR
- Increased HR
- Decreased cardiac output
- Decreased blood pressure
Septic shock:
occurs when the peripheral vascular dilatation causes a fall in SVR
similar response may occur in anaphylactic shock, neurogenic shock
- Reduced SVR
- Increased HR
- Normal/increased cardiac output
- Decreased blood pressure
How does Crohns increase the risk of gallstone formation?
Bile stone formation consists of a distrubance in what 3 substances?
- affects the terminal ileum which is involved in the metabolism of bile salts
- Excessive bile salts escape into the colon (retinaed in colon) and are reabsorbed and return to the liver, resulting in excessive secretion of bile pigments and the production of black stones. Also increase in cholesterol synthesis which leads to gallstones.
- Bile salts
- Cholesterol
- Bilirubin
Increase in any cause gallstone to harden
Primary sclerosing cholangitis is linked to what autoimmune disease?
ulcerative colitis (UC) and NOT Crohn’s disease.
It increases risk of gallstone formation
Medication which can cause acute pancreatitis
M(y)- Mesalazine (An aminosalicylate used to treat IBD)
F- Furosamide
A- Azathioprine (immunosupressant used in IBD)
T- tetracyine and thiaziazides (bendroflumethiazide)
S- Statins, Steroids, Sodium Valporate
H- Hydrochlorothiazide
E- Ethanol
E- Oestrogens
P- Protease inhibtors and NRTIs (Didanosine- used in HIV)
- Pentamidine is used to try to prevent Pneumocystis carinii pneumonia (PCP)
Jaundice in the first 24 hours is always pathological.
Causes of jaundice in the first 24 hrs
Times when jaudince is normal and then abnormal?
- rhesus haemolytic disease
- ABO haemolytic disease
- hereditary spherocytosis
- glucose-6 phosphodehydrogenase (G6PD Def)
Day 2- day 14 = normal
(more common in breastfed)
> 14 days is abnormal
Redflags for severe croup and must be admitted (5)
Also admit for mild croup if they tick any of these boxes: (3)
- Frequent barking cough
- Marked audible stridor
- Marked sternal wall recessions
- significant distress. lethargy (sign of hypoxaemia)
- Tachy (occurs with more severe obstructive symptoms and hypoxaemia)
Admit:
1. < 6 months old
2. Known upper airway abnormality- Downs syn, laryngomalacia
3. Diagnosis is not clear- could it be acute epiglottitis?
When can a child return to school with scarlet fever?
A child with scarlet fever can return to school 24 hours after commencing antibiotics
ENT- chronic pus-like ear discharge, which part of ear anatomy must you look at in otoscopy and why?
In patients with chronic or recurrent ear discharge, ensure the attic is visualised to exclude cholesteatoma
In chronic pancreatitis, Which is the best imaging modality to confirm this diagnosis?
CT pancreas (with intravenous contrast) to look for pancreatic calcification.
MRI And USS are poor at picking up calcifications as it relies on the tissues to have fluid in them.
Acute sinusitis
Most common pathogens (3)
Stepwise management
1.
- Potentially use…
- Med
- Med
First line-
Severe-
Streptococcus pneumoniae
Haemophilus influenzae
rhinoviruses.
- analgesia
- intranasal decongestants or nasal saline may be considered but the evidence supporting these is limited - intranasal corticosteroids- if symptoms have been present for more than 10 days
- oral antibiotics are not normally required but may be given for severe presentations.
eg.
- first-line phenoxymethylpenicillin
- if ‘systemically very unwell co-amoxiclav. signs and symptoms of a more serious illness, or at high-risk of complications’
‘double-sickening’ may sometimes be seen, where an initial viral sinusitis worsens due to secondary bacterial infection
When can POP be restarted after preg?
Additional barrier for how long?
When can COCP be started after preg? (2)
Additional barrier for how long?
POP- Immediately/ anytime
2 days barrier if past day 21
COCP
- Cannot be given < 21 days (Increase of DVT)
- If breast feeding can start after 6 weeks (between 6 weeks and 6 months)
- Need barrier additional for 7 days when starting
Audograms
Anything above the… line is marked normal
What would you see in:
- sensorineural hearing loss
-conductive hearing loss
- mixed hearing loss both
- 20dB line
sensorineural hearing loss both air and bone conduction are impaired
conductive hearing loss only air conduction is impaired
mixed hearing loss both air and bone conduction are impaired, with air conduction often being ‘worse’ than bone
Paeds
Nephroblastoma aka…. tumour
What is it?
Presents what age?
2 Presentations
Mets where?
Treatment?
Wilm’s tumour
What is it?
Rare kidney cancer that primarily affects children
Presents what age?
first 4 years of life
2 Presentations
- Haematuria
- 50% have fevers
Mets where?
- Lungs
Treatment?
- Nephrectomy
