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.
