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Year 5/6 > Yr5 PACES > Flashcards

Yr5 PACES Flashcards

1
Q

Key Points in Obs Hx

A

Screen: PV bleeding/discharge, pain, fetal movements, rhesus status, ROM, PET, urinary/bowel, FLAWS, PSHx

Current + Past

ICE + Social Hx

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2
Q

Key Points in Gynae Hx

A

Screen: PV bleeding/discharge, pain, any chance preg, urinary/bowel, FLAWS, PSHx

MOSS: menstrual, obstetric, sexual, smear

ICE + Social Hx

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3
Q

Key Points in Paeds Hx

A 
PC
SVR
Birth
Feeding
Growth
Development
Allergies
Immunisations
School Life
Social Worker
Siblings
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4
Q

Key Points in Psych Hx

A 
Affective
Psychotic
Organic
Flaws
Tremor
Risk
ICE
PMHx
PPHx
DHx
SHx
Forensic
Premorbid
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5
Q

What are classic ix you don’t want to miss for each speciality?

A

Hx: ICE/SHx/Collateral, Exam, Obvs, Bloods, Imaging

Obs: bimanual, speculum, CTG

Gynae: preg test, speculum, TVUS

Paeds: red book, pews score, urine dipstick, involve parents/school, safetynet/FU

Psych: questionnaires eg PHQ-9 and GAD-7, rule out organics eg urine tox screen, ECG

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6
Q

Where can you signpost the pt if they’re having difficulty w employment/landlord?

A

Citizens Advice

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7
Q

What do you always forget to do whilst counselling?

A

Check to see their prior knowledge on the dx

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8
Q

How do you categorise any mx plan?

A 
Conservative
Medical
Surgical
Educate
Senior/MDT
Safetynet/FU
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9
Q

O+G: What is the general structure to obs mx?

A

Preconception eg counselling, antenatal, delivery, postnatal eg F/U and any long term risks

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10
Q

O+G: How are the trimesters divided?

A

T1: 0-12

T2: 12-26

T3: 26-37

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11
Q

O+G: What is included in the booking bloods?

A 
BP
GDM
FBC
ABO
RhD
IDA
HIV
Hep B
Syphilis
Sickle Cell
Thalassemia
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12
Q

O+G: What is used to date the preg during scans in 1st/2nd trimester?

A

CRL 10-14wks + HC 14-20wks

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13
Q

O+G: When is CVS and amniocentesis performed?

A

CVS 11-14wks

Amniocentesis 15-20wks

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14
Q

O+G: How do you interpret a CTG?

A

DR C BRAVADO

Define Risk
Contractions
Baseline Rate: 110-160 bpm
Variability: b/w 5-25 bpm
Accelerations: >15bpm >15s ✅
Decelerations: >15bpm >15s ❌
Overall Impression

Variable Dec - Cord Compression

Late Dec - Fetal Distress

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15
Q

O+G: How to examine the pregnant abdomen?

A

Inspect: general, hands, face, closer

Palpate: nine segments, uterus border, fetal lie, presentation, engagement, SFH

Complete: fetal heartbeat w Pinard/Doppler over ant shoulder, BP, urinalysis, speculum, TAUS

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16
Q

O+G: Which medications are teratogenic?

A 
Triptans
Epileptics
Retinoid
ACEi/ARB
Third Element
OCP
Warfarin
Alcohol
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17
Q

O+G: What do you need to give mum if delivery is <34wks?

A

At least 24hrs before delivery steroids + MgSO4

Steroids: lung maturation - 12mg IM bethamethasone x2 w 12-24hrs apart

MgSO4: neuroprotection - 4g IV loading followed by 1g/hr IV maintenance and maternal obs/reflexes monitoring

Temp: optimise metabolic rate - ensure baby stays warm

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18
Q

O+G: What is the mechanism of labour?

A 
Engagement OT
Descent + Flexion
Internal Rotation OA
Delivery of Head
Restitution of Shoulders
External Rotation OT
Expulsion
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19
Q

O+G: What is the order of manoeuvres for shoulder dystocia + breech px?

A

SD: senior help, McRobert’s and suprapubic pressure, consider episiotomy, Rubins/Woods, turn pt to all fours, consider symphysiotomy/cleidotomy

Breech: ECV, consider ELCS, if SVD hands off approach, Pinard, Lovesets, Mauriceau-Smellie-Veit, forceps

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20
Q

O+G: Shoulder Dystocia RFs

A

Big Mum, Big Baby, Prolonged Labour

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21
Q

O+G: Breech Px RFs

A

Maternal: grand multiparity, placental/uterine abnormalities, obstrc lower segement eg fibroids or pelvic abnormalities

Foetal: multiple pregnancy, oligo/polyhydramnios, prematurity

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22
Q

O+G: How would you explain ECV?

A

Bloods: FBC, U+Es, G+S, XM, clotting

Procedure: 1/2 are successful, before/after CTG, offer tocolysis, positioned slight head down, experienced clinician applies pressure

Benefits: avoid c/s and it’s comps

Risks: placental abruption, PROM, EMCS

CIs: c/s required, abnormal CTG, APH within 7d, ruptured membranes, multiple pregnancy, major uterine anomaly

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23
Q

O+G: How do you explain a colposcopy?

A

After an abnormal smear result colposcopy is performed to follow it up which usually takes 10-15mins

We use the speculum first to have a closer look at the neck of the womb which will involve you lying on your back with your legs up and a chaperone will be available if you wish

The most you will feel is a bit of cold with the solution and a small pinch with the biopsy

It can be done at any point in the menstrual cycle but you should reschedule if you have heavy bleeding on the day and we need to know if you could be pregnant

If solution was used you may have a couple days of brown discharge and following a biopsy do not use cream/tampons/have sex for 48hrs

If heavy bleeding, lasts >7d, foul smelling discharge, pelvic pain that does not improve w ibuprofen, temp >38° come back to us

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24
Q

O+G: SGA vs IUGR

A

We screen using SFH +/- 2cm and perform growth scans: skip to scan if multiple preg, polyhydramnios, fibroids, BMI >35

SGA: constitutionally small where AC <=10th centile for GA eg if have small parents

IUGR: subset which is abnormal where there is red growth rate

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25
Q

O+G: RFs for IUGR

A

Qs: booking, fever, UPSI, PET screen, BP, diabetes, kidneys

Symmetrical: multiple preg, intrauterine infections, chromosomal abnormalities

Asymmetrical: maternal smoking, PET, HTN, diabetes, chronic disease + placental abruption

‘The placenta is becoming tired and not being able to feed the baby as well as it did before’

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26
Q

O+G: Workup for SGA

A

5% of Pregnancies

SFH + AC/EFW

Ix: serial USS and umbilical artery doppler every 2wks from 26-28wks + screen for TORCH and urine tox

Mx: smoking cessation, control maternal disease, inc monitoring to USS wkly and doppler biwkly if PI or RI >2SDs on doppler, seniors consider immediate delivery if AREDV or abnormal CTG, otherwise deliver by 37wks w steroids if <36wks

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27
Q

O+G: RFs for LGA

A

Mod: high BMI, prev DM, GDM

NM: advanced maternal age, multiparity, molar pregnancy, eponymous syndromes eg Sotos

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28
Q

O+G: Workup for LGA

A

10% of Pregnancies

SFH + AC/EFW

Ix: OGTT, serum bHCG, genetic testing

Mx: plan delivery and discuss risk of prolonged labour, shoulder dystocia, nerve injuries -> offer c/s

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29
Q

O+G: Def of PET

A

HTN px >20wks gestation w significant proteinuria ie >0.3g/24hr that can progress to seizures due to impaired trophoblastic invasion of spiral arteries and endothelial cell damage

If px <20wks: chronic HTN

If no proteinuria: gestational HTN

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30
Q

O+G: Mx of PET

A

If at high risk: prev HTN during preg, chronic HTN, CKD, DM, AI disease then 75mg OD aspirin from 12wks

If dx confirmed: 1. Labetalol unless asthmatic 2. Nifedipine unless at term 3. Methyldopa + BP/dip/USS/doppler/CTG every 2wks

Always admit >160/110, measure every 15-30mins until under then x4/day, if sev bloods x3/wk vs mod bloods x2/wk

Intrapartum: continuous CTG, continue antihypertensives and monitor BP, consider epidural and MgSO4, avoid ergometrine

Postpartum: discharge when asx, BP <150/100, stable bloods + F/U until <130/80

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31
Q

O+G: Def of GDM

A

New onset >24wks w comps similar to DM in pregnancy but to a lesser degree

Dx if ‘5678’ fasting plasma glucose >5.6mmol/L or 2hr OGTT >7.8mmol/L

Review at joint diabetes and antenatal clinic within 1wk

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32
Q

O+G: Mx of GDM

A
  1. If fasting <7 then 2wk trial of change in diet and exercise
  2. If unsuccessful + <7 add metformin
  3. If unsuccessful OR >7 add insulin
  4. If can’t tolerate metformin or dec insulin consider glibenclamide
  5. Offer IOL/ELCS b/w 37-39wks w capillary glucose checked every hr to maintain 4-7mmol/L
  6. Check fasting again at 6w postnatal check to assess risk of developing T2DM
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33
Q

O+G: What are the main two CIs for a bimanual examination?

A

Placental Praevia + PROM

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34
Q

O+G: Ddx for Bleeding in Late Pregnancy

A 
Placental Praevia
Vasa Praevia
Placental Abruption
Uterine Abruption
Vaginal/Cervical
Haematuria/Rectal
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35
Q

O+G: How would you F/U a low lying placenta at 20wks?

A

Rescan @ 32wks as only 1/10 will still be low lying at bitth

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36
Q

O+G: Mx of Placenta Praevia

A

Confirm dx >32wks then repeat USS at 36wks

Minor Degree: type 1 lateral + type 2 marginal

Major Degree: type 3 partial + type 4 complete

If bleed/pain/contractions attend, if major w prev bleed admit from 34wks, consider booking in an ELCS

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37
Q

O+G: Mx of PROM

A

Ix: speculum for pooling/os, if no pooling IGFBP-1/PAMG-1, if os closed and >30w TVUS cervical length <15mm likely to be PTL, CTG

Mx: PPROM admission and expectant mx until 37wk if no comps and appropriate safety netting w QDS erythromycin 10d/until established labour vs PROM induce if meconium or >24hrs, do NOT use tocolytics

Prevention: vaginal progesterone, cervical cerclage, future preg under obstetrician

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38
Q

O+G: Mx of PPH

A

Classify: SVD minor 0.5-1L and major or C/S >1L plus 1° <24hrs or 2° 24h-12w

The 4T’s: tone, trauma, tissue, thrombin

Mx: A-E, 2222, bimanual compression, IM/IV syntocinon, IM ergometrine, IM carboprost, ballon tamponade, B-lynch suture, hysterectomy, debrief, document, datix

Comps: death, renal failure, VTE, DIC, Sheehan’s syndrome

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39
Q

O+G: Bishop’s Score

A

To assess likelihood of labour: cervical position, consistency, effacement, dilation + fetal station

If <=5 unlikely to start w/o induction therefore use PV prostaglandin gel, 6-8 consider 1. membrane sweep 2. AROM w amnihook 3. oxytocin, >=9 likely to start spontaneously

Indics: prolonged preg, FGR, PROM, GDM, PET

Contras: major placental/vasa praevia, cord prolapse, prev uterine rupture, vertical c/s scar, transverse lie, active genital herpes

Comps: failed IOL, hyperstimulation, fetal distress, uterine rupture, c/s

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40
Q

O+G: How do you counsel for a VBAC?

A

VBAC > ERCS III+IV > EMCA I+II

Indics: singleton, cephalic, >37w, only one prev c/s, if more consultant decision

Contras: major placental/vasa praevia, cord prolapse, prev uterine rupture, vertical c/s scar, transverse lie, active genital herpes

Risks of VBAC: uterine rupture, instruments, EMCS

Risks of ERCS: usual c/s risks eg infection bleed hysterectomy ureteric/bladder injury fetal lacerations + impact on future preg

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41
Q

O+G: What are the comps of PTB?

A

The Big 4: RDS, NEC, IVH, PVL

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42
Q

O+G: What are the maternal sepsis RFs?

A

Fever
PROM
PTB
GBS

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43
Q

O+G: TOP

A

Hx: ask about partner and whether they’ve told anyone, ‘if you didn’t have this abortion how would it affect you’, explain the options

Indics: The Abortion Act 1967 - risk of continuation greater, to prevent grave permanent injury, usually class C ie above and <24wks, existing children, child born would suffer abnormalities, to save life of preg woman

Mx: confirm preg, STI screen, future contraception and compliance, requires two docs to sign, medical <9w home vs >9w in clinic mifepristone -[48h]-> misoprostol, surgical <14w ERPC vs >14w D+C, if >20w feticide, consider anti-D, preg test a mnth after

Comps: infection, bleed, cervical trauma, uterine perforation, RPOC

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44
Q

O+G: MOA of Mifepristone and Misoprostol

A

Mifepristone: anti progesterone - fetus termination

Misoprostol: synthetic prostaglandin - fetus expulsion

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45
Q

What are the normal obs for a child <1?

A

RR 30-40
HR 110-160
SBP 80-90

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46
Q

What are the normal obs for a child 1-2?

A

RR 25-35
HR 100-150
SBP 85-95

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47
Q

What are the normal obs for a child 2-5?

A

RR 25-30
HR 95-140
SBP 85-100

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48
Q

What are the normal obs for a child 5-12?

A

RR 20-25
HR 80-120
SBP 90-110

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49
Q

What are the normal obs for a child >12?

A

RR 15-20
HR 60-100
SBP 100-120

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50
Q

Paeds: What does the traffic light system look at?

A 
Colour
Activity
Respiratory
Circulation
Other
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51
Q

Paeds: What are the domains of development?

A

Gross Motor

Fine Motor + Vision

Hearing + Language

Social Behaviour

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52
Q

Paeds: What is the developmental screen for children <5yrs?

A

By 6wks: Smiling

By 6ms: Turns to Sound

By 9ms: Sitting

By 18ms: Words + Walking

By 3yrs: 3 Word Sentence

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53
Q

Paeds: What does the guthrie test at 7d screen for?

A

Congenital hypothyroid, SCD, CF plus six inherited metabolic disease

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54
Q

Paeds: What are the definitions of neonate, infant, toddler?

A

<1m, 1m-1y, 1-3yrs

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55
Q

Paeds: Immunisation Schedule

A

2/3/4m: 6in1 + rotavirus@2/3 + pneumococcal/MenB@2/4/1yr

1yr: Hib/MenC + MMR
3yrs: 4in1 + MMR
14yrs: 3in1 + MenACWY

The 3in1 is diphtheria, tetanus, pertussis + inactivated polio in the 4in1 + Hib and Hep B in the 6in1

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56
Q

Paeds: Viva on MMR

A

It’s a liver attenuated vaccine like BCG and typhoid

Therefore CI in pregnancy, immunocomp pts, another live vaccine <4w, Ig therapy <3m, neomycin allergy

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57
Q

Paeds: How do you counsel for worry surrounding the MMR vaccine?

A

The link w autism was disproven and Andrew Wakefield is no longer able to practice medicine

They are all high risk viruses that usually px w temp, tiredness, loss of appetite, sore eyes, rash but may cause serious complications: measles (chest infection + progressive brain damage), mumps (deafness + infertility), rubella (easy bruising + bleeding)

Explain herd immunity, recent outbreaks, provide leaflets

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58
Q

Paeds: Kawasaki’s Disease vs Scarlet Fever

A

KD: vasculitis, >5d fever w four of CRASH ie conjunctivitis rash adenopathy strawberry tongue swollen hands/feet, admit for IVIG and high dose aspirin

SF: group A strep, fever rash adenopathy strawberry tongue, penicillin/erythromycin for 10d

Therefore if febrile make sure you check for rash glands tongue

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59
Q

Paeds: What is the scoring system for croup?

A

Westley: chest wall retractions, stridor, cyanosis, consciousness, air entry

If >3 admit and >8 give neb adrenaline

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60
Q

Paeds: Croup vs Bronchiolitis

A

Both px w coryzal sx first

Auscultate: harsh stridor and barking cough in croup + fine bi-basal end insp crackles and high pitch exp wheeze in bronchiolitis

Croup: upper airway, 6m-6y, autumn, parainfluenza, supportive, single dose dexamethasone

Bronchiolitis: lower airway, <1yo, winter, RSV, supportive, palivizumab every m for 6m

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61
Q

Paeds: Croup vs Epiglottitis vs Bacterial Tracheitis

A

All <6yrs

Croup: viral, harsh stridor and barking cough, normally clinically well, onset over days, dexamethasone +/- adrenaline

Epiglottitis: Hib, soft stridor, toxic and drooling, onset over hrs, ceftriaxone + fluid resus as life threatening

Tracheitis: staph/strep/Hib, barking cough, toxic not drooling, longer hx, ceftriaxone +/- intubation

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62
Q

Paeds: What should you NOT do in children w epiglottitis?

A

Lie them down or examine their throat

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63
Q

Paeds: Ddx of Wheeze

A 
Bronchiolitis
Viral Induced
Asthma
GORD
CF
FB
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64
Q

Paeds: Mx of Asthma

A

Hx of bronchiolitis <1yo + viral induced wheeze 1-5yo

Ix: vital signs + PEFR if 50-75% mod, 33-50% sev (SpO2>92), <33% LT (SpO2<92)

Acute Tx: mod salbutamol 4hrly, oral pred 3d, F/U in 48hrs VS sev/LT admit for (1) burst therapy 10x SABA via MDI and spacer OR 3x salbutamol neb 2x ipratropium neb, 1x oral pred (2) IV bolus MgSO4 (3) IV infusion salbutamol/aminophylline (4) PICU

Chronic Tx: 1.SABA 2.Becotide 3.LTRA 4.Flixotide 5.Prednisolone + trigger avoidance, technique, personalised action plan, Asthma UK, itchywheezysneezy.com, safety net

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65
Q

Paeds: When can you discharge a pt following an acute asthma attack?

A

Stable on 4hrly tx, peak flow at 75%+, SpO2>94

Make sure you F/U within 48hrs and educate pt on what when how

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66
Q

Paeds: Which medications are CI in asthma?

A 
B-B
ACEi
Adenosine
Aspirin
NSAIDs
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67
Q

Paeds: What should you ask in an asthma history?

A

Decipher level of control, triggers and current tx: cough, chest tightness, SOB, exercise, cold weather, nighttime, interfere w activities, prev admissions

Screen for allergies: hx of eczema, hay fever, PESTO

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68
Q

Paeds: Viva on Cystic Fibrosis

A

Sx: recurring chest infections, difficulty putting on wt, diarrhoea/constipation

Signs: clubbing, jaundice, easy bruising

Ix: antenatal guthrie testing, sweat test >60mmol/L, CXR

Mx: MDT w regular reviews and specific mx for 1. Resp 2. Infection 3. Nutrition 4. Psych

Comps: diabetes, liver cirrhosis, sterility

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69
Q

Paeds: Mx of GORD

A

GOR: inappropriate relaxation of LOC where most resolve by 12m

Same day referral: dysphagia, haematemesis, melaena

If breast-fed: assessment, alginate therapy, 4wk PPI/H2 antagonist

If formula-fed: review feeding hx, smaller more freq feeds, thicker formula, alginate therapy, 4wk PPI/H2 antagonist

Still sleep on back there’s NO positional mx

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70
Q

Paeds: Ddx of Pyloric Stenosis

A

GOR, Gastroenteritis, UTI

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71
Q

Paeds: Ddx of Intussusception

A

Incarcerated Hernia, Gastroenteritis, UTI

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72
Q

Paeds: Pyloric Stenosis vs Intussusception

A

PS: hypertrophied pyloric muscle results in projectile vomit in 2-8wk w palpable olive mass in RUQ, visible peristalsis, hypoCl hypoK met alkalosis

Mx of PS: test feed, target lesion on US, slow IV fluid resus and correct electrolytes, def lap Ramstedt pyloromyotomy

IN: invagination of ileum->caecum results in bile stained vomit in 3m-2yo w sausage shaped mass in RUQ, emptiness in RLQ ie Dance sign, red currant jelly stool

Mx of IN: target mass on US, analgesia, drip and suck, rectal air insufflation, if perforated surgical reduction, broad spec abx

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73
Q

Paeds: Ddx for Neonatal Jaundice

A

Always abnormal if <24hrs: infection, haemolysis, metabolic

Can be normal if >24hrs: 1d-2w above, physiological, breastfeeding + >2wks uBR above, pyloric stenosis, congenital hypothyroidism vs cBR biliary atresia, ascending cholangitis, CF

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74
Q

Paeds: Mx of Jaundice

A

Ix: <24hrs serum BR, 1d-2w transcutaneous BR, >2w split BR + identify cause w MC+S, FBC, blood film, DAT, G6PD, ABO, TFTs, LFTs

Mx: if uBR use tx threshold chart for phototherapy vs exchange transfusion + if cBR tx cause

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75
Q

Paeds: What inc the risk of developing kernicterus? (3)

A

Serum BR >340 in babies >37wks, rapidly rising BR >8.5/hr, clinical features eg poor feeding, extreme lethargy, hypotonia

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76
Q

Paeds: How do you counsel for neonatal jaundice tx?

A

We need to give X light therapy to prevent the chemical in their blood that is causing them to be yellow from getting too high and damaging the brain/hearing

It’s like a tanning bed where we will ensure they are wearing eye protection and you will be able to be w them the whole time ideally breastfeeding them

Afterwards they will need to stay a bit longer so we can ensure the chemical levels don’t rise again

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77
Q

Paeds: How do you score the GCS verbal component in children <5yo?

A

No response, moans, cries, less than usual ability, alert

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78
Q

Paeds: Ddx for a Fitting Child

A

Ddx: epilepsy, febrile convulsion, reflex anoxic seizure, breath holding attack, infantile spasm, hypoglycaemia, hyperNa

You must rule out: meningitis/encephalitis, sepsis, head trauma

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79
Q

Paeds: Work up for a Fitting Child

A

Hx: duration, tongue biting, incontinence, post-ictal, recent illness, rash, head injury, video of event

Bedside: obs, temp, urine dip, fingerprick glucose, ECG, LP

Bloods: FBC, U+E, CRP

Imaging: MRI +/- EEG

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80
Q

Paeds: How would you classify epilepsy?

A

Classify seizures: focal aware/impaired motor/non-motor vs generalised motor/absence/atonic vs unknown

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81
Q

Paeds: What is a Jacksonian March?

A

Focal clonic seizures initiated in the primary motor cortex spreads from distal limb towards ipsilateral face

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82
Q

Paeds: What is benign rolandic epilepsy?

A

Focal myoclonic seizures initiated around the central sulcus are the most common form in childhood and usually outgrown: hemifacial sensorimotor, speech arrest, hypersalivation

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83
Q

Paeds: What are potential underlying causes of epilepsy?

A

Sickle cell disease + genetic disorders eg Down’s syndrome and tuberous sclerosis

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84
Q

Paeds: Mx of Epilepsy

A

Take an MDT approach w paediatrician, specialist nurse, psychologist, school nurse, GP + refer to neuro first fit clinic if appropriate

Consrv: how to recognise seizure and get help, video record, avoid dangerous activities

Medical: generalised valproate->lamotrigine, myoclonic valproate->levetirecetam, absence ethosuximide->valproate, partial carbamezapine/lamotrigine->valproate

Intractable: ketogenic diet, vagal nerve stimulation, surgery

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85
Q

Paeds: Mx of Status Epilepticus

A

A-E: high flow oxygen if required, IV access, blood glucose

5mins: if vasc access lorazepam OR buccal midazolam/PR diazepam
15mins: IV/IO lorazepam again AND call for senior help
25mins: IV/IO phenytoin over 20mins AND call for anaesthetist
45mins: rapid sequence induction of anaesthesia w thiopental

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86
Q

Paeds: What are the SEs of the common AEDs?

A

Valproate: wt gain, hair loss, liver failure

Carbamazepine: N+V, ataxia, SIADH, neutropenia, drug interactions

Lamotrigine: SJS

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87
Q

Paeds: Dx of DKA

A

Confirm: clinical hx, signs, urine dip/biochemistry (D: >11.1, K: >3, A: <7.3)

Call senior + assess severity: mild <7.3 ie 5% fluid deficit, mod <7.2 ie 7% fluid deficit, sev <7.1 ie 10% fluid deficit

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88
Q

Paeds: Mx of DKA

A

A-E: Kussmaul breathing, shock and dehydration, GCS

Fluids, Potassium, Insulin: if shocked 20ml/kg, if not 10ml/kg over 1hr, correct deficit over 48hrs using 0.9% NaCl w 20mmol KCl in every 500ml minus first 1hr plus maintenance, start 0.05-0.1U/kg/hr insulin infusion 1-2hrs after starting IV fluids

Repeat obs: signs of comps (neuro+hyperK), fluid balance (no improvement consider resus and sepsis), glucose (<14 add 5-10% glucose), ketones, weight

Resolution: clinically well, drinking and eating, blood ketones <1 or normal pH, urine ketones may still be +, start S/C insulin and stop IV @ 1hr, pt education, MDT, FU, OOH number

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89
Q

Paeds: What are the three main comps of DKA and it’s tx?

A

Cerebral oedema: assess hrly for headache, irritability, Cushing’s triad, raised ICP - exclude hypoglycaemia - tx w hypertonic saline or mannitol, restrict fluids, involve paediatric critical care specialist

HypoK: if <3 temporarily stop insulin and use a continuous ECG

Aspiration pneumonia: consrv mx +/- abx

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90
Q

Paeds: How do you counsel for DKA?

A

It’s the first manifestation of type 1 diabetes where the body is unable to make enough insulin to control the blood sugar levels

At the moment they are so high they have caused the drowsiness, tummy pain and dehydration which is why we need to admit to give fluids and insulin

It’s a very well known condition with established tx, we’re going to do everything we care to support you and care for your child, there’s good leaflets on diabetes.org and F/U

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91
Q

Paeds: Mx of T1DM

A

Take an MDT approach w paediatrician, specialist nurse, psychologist, school nurse, GP

Consrv: balanced diet w CHO counting, regular exercise, monitor glucose/ketones/comps

Medical: three types of insulin therapy

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92
Q

Paeds: How do you counsel for a febrile convulsion?

A

Reasonably common in toddlers, although quite dramatic short simple seizures have no long term consequence and do not recur past 5yrs, not the same as epilepsy

They occur early on in a viral infection when their temp starts to rise so we’d like to arrange a hosp assessment by paediatrics and keep him here for observation as 1/3 will have another

In the future maintaining adequate fluid intake helps and paracetamol improves sx but ultimately if you’re ever worried always come back to see us

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93
Q

Paeds: What is the most common cause of febrile convulsions?

A

HHV-6 Roseola Infantum

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94
Q

Paeds: How would you classify febrile convulsions?

A

Classify seizures: simple, complex, febrile status epilepticus >30mins

Simple - <15mins, generalised, no recurrence within 24hrs, recovery <1hr

Complex - 15-30mins, focal, may repeat within 24hrs, recovery >1hr

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95
Q

Paeds: Mx of Febrile Convulsion

A

Protect from injury and do not restrain during and if >5mins give buccal midazolam or PR diazepam

Ambulance: first seizure, serious illness, breathing difficulties, no drugs available at 5mins, not responding to drugs at 10mins

Admission: first or complex seizure, diagnostic uncertainty about cause or currently on abx, <18mnths

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96
Q

Paeds: What is the pathogenesis of SCD?

A

Autosomal recessive point mutation at codon 6 on Chr 11, glutamine -> valine, defective beta globin

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97
Q

Paeds: Mx of Infantile Spasm

A

Dx w hypsarrhythmia on EEG + tx w vigabatrin

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98
Q

Paeds: Mx of Sickle Cell Disease

A

Ix: family origins questionnaire, antenatal guthrie testing, FBC, blood film, electrophoresis

Acute: A-E, admit, oxygen, fluids, analgesia, abx, exchange transfusion

Chronic: educate, vaccination vs encapsulated, daily PO penicillin and folic acid, hydroxycarbamide if recurrent crises

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99
Q

Paeds: What is one of the earliest signs of sickle cell disease and it’s ddx?

A

Dactylitis

Ddx: hand and foot syndrome, osteomyelitis, connective tissue disease

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100
Q

Paeds: What are the encapsulated bacteria?

A

NHS: neisseria, Hib, streptococcus

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101
Q

Paeds: How does hydroxycarbamide work?

A

Stimulates HbF production

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102
Q

Paeds: What are the acute and chronic comps of sickle cell disease?

A

Acute: chest syndrome, hoot and foot syndrome, splenic sequestration, painful crisis, priapism, infection

Chronic: anaemia, pain, epilepsy, gallstones, CKD, impaired growth

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103
Q

Paeds: Ddx for Failure to Thrive

A

Constitutional delay: low BW + small parents

Inadequate intake: malnutrition, impaired suck/swallow, eating disorders, neglect, psychosocial deprivation, malabsorption eg CF, coeliac, CMPA/lactose intolerance

Inadequate retention: GORD + vomiting

Increased requirements: recurrent infections, malignancy, hypothyroid

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104
Q

Paeds: Mx of FTT

A

Tx underlying cause, dehydration status, vit defs, developmental assessment, MDT inc SALT, F/U

Mild: feeding or providing eating behaviour recommendations

Mod: above plus refer to specialist

Sev: above plus hospitalisation

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105
Q

Paeds: At what age do you start weaning?

A

6-12m

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106
Q

Paeds: At what age do you start adopting a normal adult bowel habit of 3/d-3/wk?

A

~4yo

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107
Q

Paeds: Hx of Abdo Pain

A 
Socrates
N+V
Urine
Stool
Fever
Rash
Joints
Fluids
Diet
Allergies
Stress
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108
Q

Paeds: Ddx for Acute Abdo Pain

A

Gastroenteritis
Appendicitis
Mesenteric Adenitis
Meckel’s Diverticulum

Plus: ectopic pregnancy, GU, DKA, SCD

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109
Q

Paeds: Ddx for Recurrent Abdo Pain

A

Functional
Constipation
Coeliac Disease
Lactose Intolerance

Plus: Mittelschmerz + GU

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110
Q

Paeds: What is an abdominal migraine?

A

Poorly localised pain interfering w daily activities >1hr >=2/yr a/w N+V, pallor, anorexia, complete resolution b/w attacks, nil sx of other GI disease

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111
Q

Paeds: Viva on Functional Abdo Pain

A

Sx: at least x4/mnth for >=2mnths, ICE and social hx are key, ask about FHx of IBS and migraines

Ix: FBC, ESR, urinalysis, stool microscopy, avoid unnecessary tests

Mx: explain sx, ascertain causes of stress, encourage not to miss school, probiotics, FODMAPs, antispasmodic/antidiarrhoeal agents, safety net if fever/PR bleed

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112
Q

Paeds: Ddx for Constipation

A

Acute: fluid depletion, metabolic, bowel obstruction, neurological, sexual abuse

Chronic: functional, IBD, coeliac disease, Hirschsprung’s disease, hypothyroidism

Mx: pt education, involve dietician/psychologist, adequate fluid/fibre intake, encourage toileting after mealtimes, star charts, analgesia, movicol stool softener, senna stimulant laxative

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113
Q

Paeds: What are the red flag sx for a constipated child? (6)

A
  1. Failure to pass meconium in first 24hrs: Hirschsprung’s + cystic fibrosis
  2. FTT: coeliac + hypothyroid
  3. Gross abdo distension: Hirschsprung’s + other GI dysmotility
  4. Abnormal LL neuro: lumbosacral pathology
  5. Sacral dimple above gluteal cleft: spina bifida occulta
  6. Perianal fistulae, abscess, fissure: crohn’s
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114
Q

Paeds: Viva on Coeliac Disease

A

Sx: bloating, irritable, not dropping down growth centiles

Signs: wasted buttocks, distended abdomen, dermatitis herpetiformis

Ix: FBC, blood film, anti-tTG, HLA DQ2/8, if older biopsy for villous atrophy and crypt hyperplasia

Mx: MDT paediatrician, specialist nurse, psychologist, school nurse, GP + dietician annual review inc BMI and diet adherence

Comps: FFT, IDA, vit B12/D deficiencies, oestoporosis, EATL

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115
Q

Paeds: When should you suspect NAI?

A

High index of suspicion for: non-contact area bruising, high energy fractures, drowsiness, neglect, delay in reporting, recurring, keep prying if inconsistent hx

“When children have similar injuries sometimes they don’t happen by accident and are caused by others”

“It’s a routine requirement to admit, keep them safe and run more tests”

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116
Q

Paeds: Mx of NAI

A

Ix: full body +/- skeletal survey, draw/photo, attachment, growth, hygiene, bloods and bone profile, fundoscopy, CT head, check child protection register

Mx: must admit, involve 1. seniors 2. named doc for child protection 3. social services, formulate a plan, consider if siblings need protection, F/U

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117
Q

Paeds: What is the classical triad of shaken baby syndrome?

A
  1. Encephalopathy
  2. Retinal Haemorrhages
  3. Subdural Haematoma
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118
Q

Paeds: Ddx of NAI Drowsy Baby

A

Sepsis
Hypoglycaemia
Poor Feeding Technique

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119
Q

Paeds: Ddx of Floppy Neonate

A

Congenital hypothyroidism, rickets, sepsis, chromosomal disorder eg Downs, metabolic disorder eg Prader Willi, muscular dystrophy, cerebral palsy

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120
Q

Paeds: Workup for Floppy Child

A

O/E: truncal hypotonia and head lag, dysmorphic features, limb movements

Urine: amino and organic acids, reducing substances, mucopolysaccharides and oligosaccharide screen

Bloods: antenatal guthrie screen, FBC, U+Es, LFTs, TFTs, Vit D, culture, karyotype

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121
Q

Paeds: Viva on Obesity

A
  1. Plot findings on growth chart
  2. Organic causes: insulin resistance, leptin deficiency, PWS, hypothyroidism, cushings
  3. Risk factors: modifiable inc diet, lack of exercise, psychosocial + non-modifiable inc FHx and birth wt
  4. MDT approach: paediatrician, specialist nurse, psychologist, school nurse, GP, dietician, family therapy
  5. Population approach: public health advertising + education
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122
Q

Paeds: What is the usual age toilet trained children become dry by day and by night?

A

Day <4yrs + Night <5yrs

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123
Q

Paeds: RFs for Enuresis

A

Male
FHx
Obesity
Psych

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124
Q

Paeds: How do you classify bedwetting?

A

Must ascertain whether daytime sx and if prev continence

1°: never achieved sustained continence at night + daytime sx think overactive bladder/ectopic ureter - daytime sx think sleep arousal diff

2°: after achieving six mnths dry at night think diabetes, UTI and constipation

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125
Q

Paeds: Mx of Enuresis

A

Rule out: diabetes, uti, constipation

Ix: urine 1. diary 2. dipstick 3. MC+S, renal USS, MCUG

Consrv: reassure if <5yrs, watch and wait if 5-7yrs <2/wk, alarm and praise success if 5-7yrs >2/wk, optimise weight, avoid caffeine and use toilet before bed, use bed pads

Medical: straight to desmopressin if >7yrs or require short term control

Referral: 1° w daytime sx OR not responded to two courses of tx

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126
Q

Paeds: Ddx for Neonatal Breathing Difficulty

A

More common: transient tachypnoea of the newborn, sepsis, pneumonia

Less common: meconium aspiration, pneumothorax, congenital anomaly eg fistula or diaphragmatic hernia

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127
Q

Paeds: Ddx for Jittery Baby

A

Hypoglycaemia
Drug Withdrawal
Polycythaemia

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128
Q

Paeds: Ddx for Postnatal Collapse

A

Sepsis
Congenital Heart Disease
Congenital Adrenal Hyperplasia

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129
Q

Paeds: Ddx for Neonatal Vomiting

A

Meconium Ileus
Duodenal Atresia
Necrotising Enterocolitis

130
Q

Paeds: When are the different hearing exams done?

A

Newborn: 1. EOAE 2. AABR

7-9m: Distraction Testing

10-18m: Visual Reinforcement Audiometry

18m-4y: Performance + Speech Discrimination Testing

> 4yrs: Pure Tone Audiometry

131
Q

O+G: Workup for Miscarriage

A

Bleed: when, quantity, colour, clots, discharge, haematuria/PR, prev eps

SVR: abdo pain, N+V, fever, dizzy, sob, falls - think infection, anaemia, trauma

Hx: ICE, PGHx inc sexual and smears, POHx, PMHx, PSHx, DHx, FHx, SHx

Ix: o/e, obs chart, bloods, preg test, speculum, TVUS, must exc ectopic

Mx: admit if ectopic or hemo unstable, <6wk expectant w 1wk preg test or 2wk FU, >6wk 1. expectant 7-14d 2. PO/PV misoprostol 3. MVA under LA or ERPC under GA all w 3wk preg test or 4wk FU and anti-D if surg mx or >12w, MDT w psychologist if appropriate

Couns: anyone you’d like to be here w you, it’s not your fault, they’re common 1/5, won’t affect future chances, the tablet helps the womb to push, leaflets

132
Q

O+G: Miscarriage vs PUV

A

Miscarriage: either no FH and CRL >7mm or GS >25mm and no foetus confirmed by two clinicians

PUV: either no FH and CRL <7mm or GS <25mm and no foetus therefore TVUS again in 7d

133
Q

O+G: Classification of Miscarriages

A

Early/Late: <13wks + 13-24wks

Os Open: inevitable + incomplete

Os Closed: threatened, complete, missed

134
Q

O+G: What are the risks a/w surgical mx of miscarriage?

A

I: cervical trauma, uterine perforation, retained POC

E: haemorrhage + infection

L: adhesions + psych

135
Q

O+G: HIV in Pregnancy

A

RFs: vertical risk if high viral load/low CD4 count, prolonged ROM, breastfeeding

Monitoring: test at booking, viral load every 2-4wks and at 36wks, CD4 at baseline and delivery

Mx of Mother: continual ART, at 36wks if <50 copies/mL SVD but if >50 copies/mL or hep C coinfection ELCS at 38w, avoid foetal blood sampling and breastfeeding, consider giving mother cabergoline to red lactation, offer guidance about contraception

Mx of Infant: clamp cord asap and bath baby, if low/med risk 2-4w PO zidovudine monotherapy vs high risk 4w PEP combination, PCR @ 6+12 wks

136
Q

O+G: Workup for Headache

A

Screen for PET, Comps, VIVID

PET: vision, vomiting, swelling

Comps: epigastric/RUQ pain, sob, fatigue, nosebleeds, fits

VIVID: onset, speech, consciousness, head injury, worse lying down, fever, wt loss

137
Q

O+G: Ix for HELLP Syndrome

A

O/e: tenderness in epigastrium/RUQ

Bloods: FBC for low pl, LFTs for inc br, film for schistocytes

138
Q

O+G: Ddx of Itch

A

Obs Cholestasis

Plus: eczema, hepatitis, PBC, GS, pancreatic cancer, CMV

Therefore ask about jaundice, rash, dark urine, pale stools, wt loss

139
Q

O+G: Obs Cholestasis

A

No Rash - itch w excoriations +/- jaundice

RFs: prev OC, FHx, ethnicity, multiple preg, pruritis on COCP

Ix: Raised BR + Bile Acids

Tx: symptoms w loose cotton clothes, topical emollient, ursodeoxycholic acid, sedating antihistamines, monitoring w wkly LFTs and biwkly doppler/CTG, IOL @ 37wks, FU w GP, do NOT use COCP b/w pregnancies

Comps: sev liver impairment, prematurity, stillbirth

140
Q

O+G: Acute Fatty Liver

A

No Pruritis - abdo pain, N+V, jaundice

RFs: nulliparity, male foetus, multiple preg, obesity, PET

Ix: Raised ALT + Uric Acid

Tx: supportive through third trimester then deliver once stable

Comps: haemorrhage 2° to DIC, renal failure, stillbirth

141
Q

Paeds: Difference b/w Osteochondritidies

A

Osgood-Schlatter Disease: patellar tendon inflammation

Chondromalacia Patellae: patella posterior surface cartilage degeneration

Osteochondritis Dissecans: AVN causing bone/cartilage fragmentation

142
Q

Paeds: Ddx for Blue Baby

A

Cardiac: R-L shunt thus dec pulmonary blood flow ie TOF ‘boot shaped heart’, TGA ‘egg on a string’, tricuspid atresia

Resp: surfactant def, meconium aspiration, pulmonary hypoplasia all of which could lead to PPHN

143
Q

Paeds: TOF

A

VSD
RVH
Pulm Stenosis
Overriding Aorta

144
Q

Paeds: What are the limit ages for gross motor development?

A

4m - Head Control

9m - Sits Unsupported

12m - Stands Independently

18m - Walks Independently

145
Q

Paeds: What are the limit ages for vision and fine motor development?

A

3m - Fixes + Follows

6m - Reaches for Objects

9m - Transfers

12m - Pincer Grip

146
Q

Paeds: What are the limit ages for hearing, speech and language development?

A

7m - Polysyllabic Babble

10m - Consonant Babble

18m - 6 Words w Meaning

2y - Joins Words Together

2.5y - 3 Words Sentences

147
Q

Paeds: What are the limit ages for social, emotional and behavioural development?

A

8w - Smiles

10m - Fear of Strangers

18m - Can Self Feed

  1. 5y - Symbolic Play
  2. 5y - Interactive Play
148
Q

O+G: What are the RFs for an ectopic pregnancy?

A 
Inc Age
Smoker
Chlamydia
IUD
IVF
Prev Ectopic
Prev Abdo/Pelvic Surgery
149
Q

O+G: What are the key points to a contraception hx?

A

Screen for any UKMEC health problems in PMHx

Explain the pros and cons of each form of contraception

Refer for sexual health screening if appropriate

Safetynet eg if period >7d late or lower abdo pain

150
Q

O&G: Placental Praevia vs Abruption

A

Extent of abdo pain + if any signs of shock

151
Q

O&G: Ddx for PV Bleeding

A

Non-Preg: menstrual, PCB (cervical polyp/ectropion/malignancy), PMB (atrophic vaginitis and endometrial polyp/hyperplasia/malignancy)

Early Preg: above plus miscarriage (pain precedes bleeding), ectopic (bleeding precedes pain), molar preg

Late Preg: vasa previa, placenta previa/accreta, placental abruption, uterine rupture, bloody show, PPH

Kleihauer Test, Hb Electrophoresis, Anti-D

152
Q

O&G: Ddx for PV Discharge

A

High Vaginal Swab:
Candidiasis
Bacterial Vaginosis
Trichomonas Vaginitis

Endocervical Swab:
Chlamydia
Gonorrhoea
Physiological

153
Q

O&G: Ddx for Abdo Pain

A

Non-Preg: GI, UTI, tubo-ovarian pathology, PID, fibroids, endometriosis

Early Preg: above plus miscarriage (pain precedes bleeding), ectopic (bleeding precedes pain), molar preg

Late Preg: labour, placental abruption, uterine rupture, HELLP, AFLP

154
Q

O&G: Ddx for Red Fetal Movements

A

TORCH, IUGR, Miscarriage/SB

155
Q

O&G: Rashes

A

Infectious: MMR, VZV, syphilis

Non Inf: linea nigra, striae gravidarum, acne flares, atopic eczema, psoriasis, pruritis folliculitis, pemphigoid gestations, prurigo, PUPPP

156
Q

Paeds: ASD vs VSD

A

ASD
O/e: raised JVP, thrill, ESM
A/w: pulm HTN, CCF, Downs

VSD
O/e: SOB, thrill, PSM
A/w: TOF, coarctation, PDA

157
Q

Paeds: SRV

A 
Fever
Rash
Fits
Cough
SOB
Vomit
Blood
Bile
Pain
Urine
Stool
Blood
Mucus
Lumps
Joints
Injury
Colour
Activity

Plus: bulging fontanelle, feeding, nappies in infants

158
Q

Paeds: Ddx for Fever

A

Make sure you do SRV + FLAWS

Infection: work through the systems - sepsis, meningitis, ENT, croup, bronchiolitis, pneumonia, bronchiectasis, gastroenteritis, UTI, transient synovitis, scarlet fever, HIV

Inflammation: kawasaki disease, JIA, SLE

Malignancy: ALL, lymphoma, ewing’s sarcoma

159
Q

Paeds: Ddx for Rash

A

Make sure you ask about itch + SRV

Infection: bacterial/viral/fungal/parasitic - impetigo, meningitis, lyme disease, HHV, MMR, poxvirus, parvovirus, enterovirus, tinea, scabies

Inflammation: kawasaki disease, JIA, HSP

Dermatological: dermatitis, CMPA, eczema +/- herpeticum, psoriasis, acne

Haematological: vascular birthmarks, ITP/DIC, NAI/trauma

Systemic: urticaria, jaundice, erythema nodosum/multiforme

160
Q

Paeds: Ddx for Vomiting

A

Emergencies: sepsis, meningitis, DKA

Gastro Medical: gastroenteritis, GORD, CMPA

Gastro Surgical: pyloric stenosis, intussusception, malrotation, volvulus, appendicitis

Misc: raised ICP, torsion, bulimia

161
Q

Paeds: Ddx for Abdo Mass

A 
Constipation
Hepatomegaly
Splenomegaly
Pyloric Stenosis
Intussusception
Neuroblastoma
Wilm Tumour
162
Q

Paeds: Ddx for Headache

A

Sinister: infection, raised ICP, haematoma, trauma

Non-Sinister: tension, migraine, sinusitis, dehydration

163
Q

Paeds: Ddx for Diarrhoea

A

Infection, Inflammation, Food Intolerance, Overflow, Anxiety

164
Q

Paeds: Ddx for Encoporesis

A

Chronic Constipation + Anxiety

Plus: Hirschsprungs, imperforate anus, anal trauma

165
Q

Paeds: Ddx for Developmental Delay

A

Specific: LD + impairments

Global: cerebral palsy, ASD, ADHD, genetic syndromes, neglect

166
Q

Paeds: Ix for DD

A

Bedside: developmental history, RFs, MH screen, bloods for genetic testing, vision/hearing

Referral: developmental paediatrician + CAMHS

167
Q

Paeds: Cardiac Arrest Algorithm

A

Five initial breaths then 15:2

168
Q

Paeds: List the Autistic Spectrum Disorders

A
  1. PDD-NOS
  2. Autism
  3. Asperger’s
  4. Rett Syndrome
  5. Childhood Disintegrative Disorder
169
Q

Paeds: Autistic Spectrum Disorder Triad + Mx

A

Triad of: impaired social interaction, speech and language disorder, routine w ritualistic and repetitive behaviours

Ix: physical exam to exclude Down syndrome and establish baseline, autism diagnostic interview, autism diagnostic observation schedule, WPSSI/WISC

Tx: MDT approach inc SALT, education health and care plan, applied behavioural analysis

170
Q

Paeds: ADHD Triad + Mx

A

Triad of: hyperactivity, impulsivity, inattention

Ix: conners rating scale, classroom observation, educational psychological assessment

Tx: refer, parent training, behavioural and educational interventions, 6w methylphenidate, 6w lisdexamphetamine, atomoxetine

171
Q

Paeds: WAGR Syndrome

A

Wilms Tumour
Aniridia
GU Malformations
Retardation

172
Q

Paeds: Ix for Recurrent UTIs

A

US: structural abnormalities

MCUG: VUR + PUV

DMSA: renal scarring

173
Q

Paeds: Sepsis 6

A
  1. Oxygen
  2. Bloods
  3. IV/IO Abx
  4. Fluids
  5. Senior
  6. Inotropes
174
Q

Paeds: Red Flags of Sepsis

A 
Hypotension
Lactate >2
Inc HR/RR
SpO2 <90
AVPU P/U
Immunocomp
Rash/Mottled
175
Q

Paeds: Mx of OSD

A

Reassure + Consrv: analgesia, intermittent ice packs, protective knee pads, red sporting activity until sx dec, encourage stretching

176
Q

Paeds: Mx of TGA

A

Set up a prostaglandin infusion, call seniors and paediatric surgery, hyperoxia test, CXR, echo

177
Q

Paeds: Up to what age would hand dominance be considered pathological?

A

12m

178
Q

Paeds: Primitive Reflexes

A

If absent at birth = abnormal

2m - StePPing

4m - Root + Moro

5m - Palmar/Plantar Grasp

179
Q

Paeds: What is a devastating long term consequence of a VSD that may present in early adulthood?

A

Eisenmenger Syndrome: L-R Shunt -> R-L Shunt

180
Q

Paeds: Precocious Puberty Ages

A

Girls <8y
Boys <9y

True - GnRH dependent: idiopathic, CNS tumour/injury, congenital anomaly

Pseudo - GnRH independent: congenital adrenal hyperplasia, Leydig cell/ovarian tumours, McCune-Albright syndrome

181
Q

Paeds: Pubertal Delay Ages

A

Girls >13.5y
Boys >14y

Central - hypogonadotrophic hypogonadism: Kallmann syndrome, chronic illness, anorexia nervosa

Peripheral - hypergonadotrophic hypogonadism: Klinefelter’s/Turner’s, gonadotropin resistance, acquired

182
Q

Paeds: Down Syndrome

A

Facies: upslanting palpebral fissures, epicanthal folds, brushfield spots in iris, flattened nasal bridge, low set small folded ears, small mouth, macroglossia, short neck, flat occiput

Associations: heart defects, resp infections, Hirschprung, coeliac, duodenal atresia, obstructive sleep apnoea, dental problems, short stature, developmental delay, epilepsy, ALL/germ cell tumour, early onset Alzheimer’s

183
Q

O+G: Fetal Screening

A

Combined @ 10-14w: Nuchal Transluceny + b-hCG/PAPP-A

Quadruple Test @ 14-20w: b-hCG, AFP, unconjugated oestriol, inhibin A

184
Q

O+G: Which vaccinations are offered in pregnancy?

A

Influenza + Pertussis

185
Q

O+G: When should you induce labour in multiple pregnancies?

A

MCMA: 32-34w
MCDA: 36-37w
DCDA: 37-38w

186
Q

O+G: What are the criteria for IVF on the NHS?

A

If <40yo offered three cycles if: unable to get pregnant through regular UPSI for 2yrs OR after 12 cycles of artificial insemination

If 40-42yo offered one cycle if: above AND first time, no evidence of low ovarian reserve, informed of comps w pregnancy at this age

187
Q

O+G: Ddx for Subfertility

A

Anovulation: ovarian failure, PCOS, AN, Kallmann, Sheehan’s, hyperprolactinaemia

Plus: tubal pathology, endometriosis, male infertility, unexplained

188
Q

O+G: Menorrhagia Qs

A

Anaemia + Bleeding Disorders

189
Q

O+G: Mx of Menorrhagia

A

Ddx: physiological, cervical pathology, fibroids (TVUS), endometriosis (diagnostic lap), adenomyosis (MRI)

Ix: hx, abdo exam, preg test, bloods for FBC TFTs G+S clotting, bimanual/speculum/special tests if suspect ddx

Tx: establish if they’re trying to conceive, mirena/COCP vs MFA/TXA, ferrous sulphate, endometrial ablation/hysterectomy

190
Q

O+G: Naegele’s Rule

A

EDD = LMP - 3m + 1w

191
Q

O+G: Ddx for Hyperemesis

A

O+G:
Morning Sickness
Gravidarum
Molar Preg

GI/GU:
Gastroenteritis
Bowel Obstrc
UTI

192
Q

O+G: Morning Sickness vs Hyperemesis Gravidarum

A

MS: common, tends to improve after first trimester, none of below

HG: >5% wt loss, dehydration, electrolyte imbalances

RFs: modifiable smoker/high BMI + NM nulliparous, prev hx, multiple preg, molar preg

PUQE: assess severity if >13 admit vs <13 but cannot tolerate oral mx ambulatory day case

Ix: obs/assess dehydration, body wt, urine dipstick infection/DKA, bloods for FBC U+Es LFTs TFTs VBG +/- US exclude other causes

Tx: antihistamine eg promethazine/cyclizine, antiemetic eg metoclopramide/ondansetron, steroids, IV fluids w KCL and thiamine, LMWH

193
Q

O+G: GTD

A

Complete: empty egg fertilised by two sperm/one which duplicates ie 46XY/XX - snowstorm

Partial: normal egg fertilised by two sperm/one which duplicates ie 69XXX/XXY - fetal parts

Malignancy: invasive moles, choriocarcinoma, placental site trophoblastic tumour

RFs: extremes of reproductive age, ethnicity, prev GTD, low beta carotene/saturated fat diet

Px: usually painless irregular PV bleeding, hyperemesis, XS uterine enlargement

Mx: serum b-hCG/TFTs, pelvic US/histology, cancer screen, ERPC +/- methotrexate, avoid pregnancy until 6m of normal b-hCG

194
Q

O+G: Amsel Criteria

A

To dx BV require >=3 of: discharge, whiff test, vaginal pH >4.5, clue cells on microscopy

195
Q

O+G: Rotterdam Criteria

A

To dx PCOS require >=2 of: 2y oligo/anovulation, clinical/biochem features of hyperandrogenism eg hirsutism/LH>FSH, polycystic ovaries on TVUS ie >12 in >=1 ovary OR volume >=10cm^3

Ix: above plus monitoring for DM and CVD

Tx: optimise wt, oligo/anovulation and hyperandrogenism w COCP, infertility w endogenous clomiphene +/- metformin, exogenous gonadotrophins/IVF, lap ovarian drilling

196
Q

O+G: Tx/Comps of Chlamydia/Gonorrhoea

A

Chlamydia: 7d doxycyline/3d azithromycin - PID, fitz-hugh-curtis, Reiter’s syndrome

Gonorrhoea: single dose of IM ceftriaxone/PO ciprofloxacin - PID, Skene/Bartholin abscess, disseminated gonorrhoea

197
Q

O+G: Def of Labour

A

Painful uterine contractions + cervical dilatation and effacement +/- rom

NB: Braxton-Hicks contractions are painless and there’s no cervical change

198
Q

O+G: Mx of Cord Prolapse

A
  1. Help
  2. Prevent further cord compression: avoid handling, elevate the presenting part/fill maternal bladder, tocolytics
  3. Place mother in either: all fours, left lateral position, knees to chest
  4. Deliver
199
Q

O+G: Menopause

A

If <45 take FSH twice a mnth apart to see if elevated vs >45 clinical retrospective diagnosis

  1. Lifestyle: regular exercise, red stress, sleep hygiene
  2. HRT: establish whether they still have a uterus, Elleste Solo if no, Elleste Duet if yes, both carry risk of breast cancer and VTE, FU @ 3m then annually for effectiveness/SEs/BP
  3. Alternatives: CBT/SSRI, lubricants, bisphosphonates
200
Q

O+G: Amenorrhoea

A

1°: no menstruation by >16y in those w secondary sexual characteristics or >14y in those w/o

2°: cessation of regular menses for >3m or if irregular menses for >6m

201
Q

O+G: DVT

A

RFs + Wells <=1 DD vs >=2 US

Tx: start s/c LMWH and continue until >6w postnatally or >3m of tx whichever is greater, do NOT use DOAC/warfarin in pregnancy, discontinue LMWH 24hrs before delivery, if VTE at term use IV unfractionated heparin which can be reversed w protamine sulphate

202
Q

O+G: The FIGO Stages

A

Ovarian: confined, pelvis, abdomen, beyond

Endometrial: confined, cervix, local, bladder/bowel/distant mets

Cervical: confined, upper vagina, lower vagina, bladder/bowel/distant mets

203
Q

O+G: Incontinence

A

Types: stress, urge, mixed, overflow, functional

Both: exclude DM/UTI, bladder diaries, urodynamic testing, encourage reduction of caffeine/fizzy drinks, optimise wt

Stress RFs: age, obesity, children, traumatic delivery, pelvic surgery

Stress Mx: 1. 3m pelvic floor exercises 2. SNRI eg duloxetine OR surgical eg burch colposuspension

Urge RFs: age, obesity, smoking, DM, FHx

Urge Mx: 1. 6w bladder training 2. antimuscarinic eg oxybutynin 3. beta-3 agonist eg mirabegron 4. surgical eg botox injection

204
Q

O+G: Threatened Miscarriage vs APH

A

> 20wks

205
Q

O+G: RFs for Placental Abruption

A

Prev, C/S, PET, smoking, cocaine

206
Q

O+G: What US finding is suggestive of a MCDA pregnancy?

A

T-sign

207
Q

O+G: Cervical Cancer Screening

A

25 -[3]- 49 -[5]- 64

208
Q

O+G: Mx of Ectopic

A

It depends on pt sx, stable, adnexal size, fetal heartbeat, serum hCG

Expectant: serial hCG

Medical: IM methotrexate

Surgical: salpingectomy 3w FU vs salpingotomy wkly FU both +/- anti-D

If accidental discuss contraception and STI screen

209
Q

O+G: Breast Cancer Screening

A

50 -[3]- 71

210
Q

O+G: RFs for PPROM

A

Maternal: smoker, prev PROM/PTL, APH, trauma, cervical incompetence

Fetal: multiple preg + polyhydramnios

211
Q

O+G: Levator Ani

A

Puborectalis
Pubococcygeus
Iliococcygeus

212
Q

O+G: What are the four categories of uterine prolapse?

A
  1. Cervix is in the upper half of the vagina

2. Introitus 3. Protrudes 4. Procidentia

213
Q

O+G: Tx of PID

A

Tx Comps + Remove IUD

IM Ceftriaxone x1
PO Doxycycline 14d
PO Metronidazole 14d

If sys unwell, tubo-ovarian abscess, signs of peritonitis, unable to rule out other surgical causes, unable to tolerate oral abx - inpatient

214
Q

O+G: Gardasil

A

6
11
16
18

215
Q

O+G: Ddx for Dysmenorrhoea

A 
Primary
Endometriosis
Adenomyosis
Fibroids
PID
216
Q

Psych: Depression Hx

A

How long

Tell me about whats been going on

Would it be okay for me to ask you some more details qs about how you’ve been feeling

How have you been feeling in yourself

What about feeling tearful - things that wouldn’t ordinarily bother you

What about your energy levels

How have you been managing at work

With all this going on how are you sleeping
How long does it take you to fall asleep
Are you waking up much in the night
And able to get back to sleep

Appetite
Concentration
Memory

Are there still things in your life that you still enjoy

How old are your children
Looking after children takes up a lot of time, how are you coping with that feeling as low as you do
What about looking after yourself

When pple feel down it can have an impact on their relationship w close ones …

It can also affect everything in the relationship including their sex life, have you noticed any changes there

Every had episodes in the past where you feel like this

217
Q

Psych: Mania Hx

A

Has long has this been going on for

Am I right in thinking you normally do a different job

Can I take you back a step you said God tells you, can you tell me a bit more about that

Does the voice come through the ears or from inside your head

Who have you shown it to

Sorry to interrupt, it sounds like this has been keeping you really busy, have you been sleeping much at all

How are your thoughts

How do you feel about yourself and you self esteem

Have you ever had anything like this before in your life where you feel full of energy
…
And any times where it’s been the opposite, where you’ve feel low and lacked energy

Anyone in the family w things like this

How have you been feeling phsyically

Taking any prescribed medication, over the counter, recreational drugs

It sounded like your friend/family didn’t think you were very well atm, what do you think about that

218
Q

Psych: ‘Can we talk about this now you seem to be going off on one’ - Mania

A

I would like to hear about it but before we get back into that

What I’m wondering is this might be a sign that you’re not very well atm

219
Q

Psych: Anxiety Hx

A

Take your time

How long has this been going on for

Before this had you had anything similar

Can you remember what happened to start it all off
What did you think was going on

Are you finding yourself avoiding situations

How is it affecting your relationship w pple close to you

Have you had a heart trace done - what were you told about the results

Even though you’ve been told nothings wrong w the heart, do you still worry there might be

220
Q

Psych: ‘What do you think it is’ - Anxiety

A

I’d agree that there doesn’t seem to be anything wrong w the heart

I say this because of the ECG and no RFs

Justify: normal ECG + no RFs

What I’m wondering is if it’s the anxiety giving you a lot of these symptoms

Have you ever thought this might be the case

Has anyone ever explained anxiety and panic attacks to you - talk about adrenaline, fight or flight, hypervigilance, our heart rate goes up and down throughout the day but most of us don’t notice us but because you’ve had a prev panic attack it makes you more aware of it

221
Q

Psych: Psychosis Hx

A

How long has it been going on for

How did you first notice this was happening

I’ve noticed while we’ve been talking you’ve been looking around the room as if you’re checking for something, could I ask you whats happening at those times

Who is it you can hear/recognise
How many voices
Can you hear what they’re saying
Do they talk to each other
Why do you think they’re doing that

Has there been any other changes, perhaps to the way you’re thinking, sometimes pple tell us they’re getting thoughts put into their head that aren’t their own
Do you have any idea how that’s happening

What about the experience that somehow other pple are able to know what you’re thinking even though you haven’t told them

And that your thoughts stop all together

Any problems w the rest of your body, changes in sensation

Has it had any other affect on your life

Any problems watching the tv or listening to the radio

222
Q

Psych: ‘Do you believe me?’ - Psychosis

A

I certainly believe that you’re having a really difficult time atm and this is all very real for you I guess what I’m not so sure about is what’s causing this

223
Q

Psych: Def of Depression

A

> 2wks

Low mood, Anhedonia, Anergia

224
Q

Psych: Beck’s Negative Triad

A

All w/o Reason:

Worthless - how is your self esteem?

Hopeless - how do you feel about the world?

Helpless - what are your feelings towards the future?

225
Q

Psych: Sx of Depression

A

Core: low mood, anhedonia, anergia

Biological: sleep, appetite, libido

Cognitive: concentration + Beck’s Triad of worthlessness, hopelessness, helplessness

Always ask about elevated mood too

226
Q

Psych: Ddx for Depression

A 
Pseudo
Bipolar
Dysthymia
Cyclothymia
Hypothyroid
Substances
Postnatal
Dementia
GAD

Adjustment
Grief Reaction

227
Q

Psych: Mx of Depression

A

U+Es
ECG

PHQ-9

Self referral to CBT - computerised cbt

‘The positive side is you’ve done something about it by coming in today and there’s certainly a range of things we can put in place to support you and treatments available - can we spend a few minutes going through those options’

Mild-Mod: CBT or IPT

Mod-Sev: above + antidepressants +/- augmentation

ECT

Support groups/charities

228
Q

Psych: What should you check before starting antidepressants?

A

Any periods of elevated mood + ECG for long QT syndrome

229
Q

Psych: Ddx of Mania

A

Tbc

230
Q

Psych: PTSD

A

> 1m

  1. Trauma Focused CBT + EMDR
  2. SSRI - Paroxetine
  3. NaSSA - Mirtazapine
231
Q

Psych: Grief Reaction vs ASR vs PTSD

A

GR: can be normal

232
Q

Psych: Monitoring of Lithium

A

Tbc

233
Q

Psych: Def of GAD

A

Tbc

234
Q

Psych: GAD

A

> 6m

‘React more easily’

‘If we start to tackle this as if it’s more anxiety we have talking therapies and tablets - theres pros and cons to both which we’ll need to run through’

235
Q

Psych: What are the two types of bipolar affective disorder?

A

Type I: >=1 Manic Ep >1w

Type II: >=1 Hypomanic Ep >4d AND >=1 Major Depressive Ep >2w

236
Q

Psych: OCD

A

> 2w

Recurrent obsessional thoughts or compulsive repeated acts

  1. Exposure + Response Prevention CBT
  2. SSRI - Fluoxetine
  3. TFA - Clomipramine
237
Q

Psych: Ddx of GAD

A

Tbc

238
Q

Psych: Physical Sx of Anxiety

A 
Dizzy
Sweating
Palpitations
Hyperventilation
Loose Bowels
239
Q

Psych: Def of Schizophrenia

A

Typically starts in 20s for males and 30s for females

> 6m

Make sure you acknowledge the pt ‘I know these are real for you’

>=1sx >=1m
Third person auditory hallucinations
Delusions of thought
Delusions of control
Delusional perception

OR

>=2 
Paranoid
Hebephrenic
Catatonic
Simple
AND
present most time >=1m
AND 
not caused by substance/oganic
240
Q

Psych: Schizo vs OCD

A

Whether the thoughts were put there or originated from their own head

241
Q

Psych: Mx of Schizophrenia

A

Bio-Psycho-Social

U+Es
ECG

CBT
Family Therapy
Art Therapy

Atypical Antipsychotics - queutapine +/- CBT

Do prolactin and CVD rfs inc lipids and HbA1c, measure wt, before starting antipsychotic, optimise cv rfs

Smoking/substance support

Clozapine - neutropenia, NMS - raised CK and AKI, rlly high fever, muscle stiffness - stop offending drug, dantrolene, bromocriptine, benzos

Support groups/charities

242
Q

Psych: How to ask the first rank sx?

A

Auditory Hallucinations: ‘Do you ever hear noises or voices?’ ‘Do you recognise them?’ ‘What do they say?’ ‘Do they tell you to do things and you obey?’

Somatic Hallucinations: ‘Do you ever feel that something is touching you when there’s nobody there?’

Thought Abnormalities: ‘Do you experience your thoughts suddenly stopping?’ ‘Do you ever feel like anyone is taking thoughts out of your head?’ ‘Are your thoughts your own?’ ‘Can other people hear your thoughts?’

Delusional Perception: ‘Do you ever feel that specific events in the world or on TV are related to you in some way?’

Passivity: ‘Do you ever feel as though you are being controlled?’

243
Q

Psych: Ddx for Schizophrenia

A 
Psychosis
Schizophreniform
Schizoaffective
Postnatal
Cluster A
Thyrotoxicosis
Substances
OCD

Delusional Disorder
Hepatic Encephalopathy

244
Q

Psych: What are the SEs of atypical antipsychotics?

A

Typicals - Extra-pyramidal: tardive dyskinesia, acute dystonia, parkinsonism

Atypicals - Metabolic: sedation, wt gain, dyslipidaemia, hyperprolactinaemia

245
Q

Psych: How to px the MSE?

A

ASEPTIC

Appearance + Behaviour: dress, hygiene, eye contact, rapport, concentration

Speech: rate rhythm tone volume quantity, poverty, pressured

Emotion: subj mood/season now + obj affect/weather then

Perception: illusions + hallucinations

Thought: formal thought abnormality, alogia, clanging, neologism, perseveration, derailment, depersonalisation, delusions, possession

Insight: preserved, partial, nil

Cognition: time, place, person - what’s the date, where are we now, who am I

246
Q

Psych: Depression MSE

A

A: signs of neglect, dehydration, miserable, disinterested, anxious movements, poor eye contact, looking down, posture, tearful

S: slow, quiet, mute

E: constricted affect, nihilism

P: severe, nihilistic delusions, persecutory delusions, evil images, guilt ‘feel they have harmed someone/done something bad’

T: Beck’s Triad

I: nil

C: psychomotor retardation mimics cognitive impairment

247
Q

Psych: Mania MSE

A

A: excitable, irritable, distracted, inappropriate clothing

S: pressured

E: inc self esteem, grandiose, labile mood, irritable, insomnia, loss of inhibition, inc appetite, inc libido, exaggerated and euphoric affect

P: grandiose delusions
Feel like they are destined for something special/have special abilities’, paranoia, catatonic stupor

T: flight of ideas, racing thought, suicidal ideas, third person auditory hallucinations

I: minimal

C: nil impact

248
Q

Psych: Schizophrenia MSE

A

A: disheveled, dec eye contact, agitated, suspicious

S: disorganised, word salad

E: blunted and inappropriate affect

P: paranoid ‘sometimes have the feeling that a person/group wants to harm them’

T: procress: block, insertion, broadcasting, derailment + content: delusional?

I: variable

C: deficit

249
Q

Psych: Def of AN

A

BMI <17.5 OR Wt Loss >15%

250
Q

Psych: Personality Disorders

A

Cluster A - odd: paranoid, schizoid, schizotypal

Cluster B - dramatic: histrionic, EUPD, antisocial

Cluster C - anxious: avoidant, anankastic, dependent

251
Q

Psych: SEs of Antipsychotics

A

Typicals - early acute dystonia (procyclidine), late tardive dyskinesia (tetrabenazine), parkinsonism, akathisia

Atypicals - wt gain, dyslipidaemia, hyperprolactinaemia, sedation

Clozapine - agranulocytosis + neuroleptic malignant syndrome

252
Q

Psych: Emergencies

A

SS
NMS
Psychosis
Delirium

253
Q

Psych: Risk Assessment

A

It sounds like a very difficult time for you, can I ask you how you’re coping with all of this

It sounds like you don’t feel very safe have I got that right

Have you felt the need to take steps to protect yourself in any way

Has it got so bad that you’re felt the need to hurt yourself or kill yourself as the only way out

In the past ever had problems w your temper, getting in fights

Can I double check you haven’t been in trouble w the police before

With all of this going on, is their anywhere you feel safe

It’s a difficult q to ask but one we ask everybody in your situation, have things ever been so bad that you not only thought about harming yourself but also to take the children with you

What about the other side of that, things to live for

Are there pple that can be supportive

Do you feel able to keep yourself safe atm from hurting yourself
Do you think if that was to change, you’d be able to let anyone know

254
Q

Psych: Suicide Risk Assessment

A

Before-During-After

Before: careful planning, writing a note, sorting will/finances, isolation, mental illness, prev act

During: method (drugs, alcohol, violent) + purpose (intent to die)

After: route to hospital, any regret, future risk

Assess capacity and admit if high risk, at the greatest risk during first wk of admission, formulate 1. crisis plan 2. coping strategies 3. F/U <1wk

255
Q

Psych: Suicide RFs

A

SAD PERSONS

Sex Male
Age Extremities <25/>45
Depression + Others

Prev Act
Excessive Alcohol/Drugs
Rational Thinking Loss
Social Support Lacking
Organised Plan
No Partner
Sickness
256
Q

Psych: Mx of EUPD

A

Bio-Psycho-Social

Refer for dialectical behavioural therapy first line and consider mentalisation-based therapy, art therapy, SSRIs

Formulate short/long term goals and a crisis plan inc providing contact numbers for local crisis resolution team, community mental health nurse, OOH social worker

Educate pt on dx and identify triggers, seek senior and MDT input, F/U

257
Q

Psych: How would you explain EUPD?

A

It’s often undiagnosed and characterised by an inc sensitivity to emotions and is likely linked to stressful life circumstances

258
Q

Psych: What does the total score on the PHQ-9, GAD-7, HADS reflect?

A

PHQ-9: 0-4 none, 5-9 mild, 10-14 mod, 15-19 mod/sev, 20-27 sev

GAD-7: 0-4 none, 5-9 mild, 10-14 mod, 15-21 sev

HADS: 7Qs for Depression + 7Qs for Anxiety each scores 0-7 norm, 8-10 borderline, 11-21 abnormal

259
Q

Psych: Mx of Alcohol Withdrawal

A

Tx if CIWA-Ar >8: oral lorazepam/chlordiazepoxide + parenteral thiamine

Bio-Psycho-Social: detox and then acamprosate/disulfiram, motivational interviewing, alcoholics anonymous

260
Q

Postnatal Depression

A

Bio-Psycho-Social: sertraline/paroxetine, CBT, involve home tx team or if severe admit to MBU

Screen for neglect by ascertaining feelings towards baby

It usually takes <1m to recover, explain it’s normal to feel low after giving birth but do not expect to continue past 2wks, likely due to hormonal changes

261
Q

Puerperal Psychosis

A

Admit to MBU and depending on px: antipsychotics/antidepressants/lithium, if agitated benzos, if severe ECT

Screen for neglect by ascertaining feelings towards baby

It usually takes 6-12wks to recover and you must F/U as 1/3 recur

262
Q

Psych: Tx of Paracetamol OD

A

Admit and establish exact time taken:

If <1hr give activated charcoal

If 4-8hrs measure serum paracetamol, plot on nomogram and if over tx line commence NAC infusion

If >8hrs/OD was staggered commence NAC infusion, measure serum paracetamol and ALT, if over tx line or raised ALT continue

263
Q

Psych: How would you explain dialectical behavioural therapy?

A

It helps you understand your thought process and shows you things are rarely black and white and skills to cope w difficult emotions

264
Q

Psych: CAGE + FAST

A

CAGE >=2: cut down, annoyed, guilty, eye opener

FAST >=3: predominantly used in A+E

265
Q

Psych: How is psychosis in depression different from psychosis in schizophrenia?

A

It’s mood congruent in depression vs not in schizophrenia due to their blunted affect

266
Q

Psych: Dependence Syndrome Classification

A

> =3 present together within prev yr: compulsion, difficulty controlling, physiological withdrawal or use to relieve/avoid, tolerance, progressive neglect, persistent use despite overt harmful consequences

267
Q

Psych: Wernicke’s + Korsakoff’s

A

W: ataxia, ophthalmoplegia, acute confusion - reversible

K: plus anterograde amnesia w confabulation - irreversible

268
Q

Psych: Ddx for Puerperal Psychosis

A

Schizophrenia
BPAD w Psychosis
Psychotic Depression

269
Q

Psych: Mx of Opiate Withdrawal

A

Tx if COWS >5: naloxone + lofexidine for sx relief

Bio-Psycho-Social: involve crisis assessment team followed by CMHT/primary care plus + harm reduction approaches eg needle exchange and vaccinations

270
Q

Psych: Def of Dementia

A

An acquired progressive degenerative disorder giving global impairment of all mental functions in clear consciousness

271
Q

Psych: What is the def/causes of delirium?

A

State of mental confusion that starts suddenly and is caused by a physical condition ie PInCH ME: pain, infection, constipation, dehydration and urinary retention, medications esp anticholinergics, electrolytes

Mx: admit, MCA, tx underlying cause, safe low stimulation environment, de-escalation techniques, seek advice from elderly care, low dose lorazpem/haloperidol w senior input

272
Q

Psych: What screening tests assess cognitive function?

A 
AMTS
MMSE
ACE-III
MoCA
Rudas
273
Q

Psych: How do you do a quick mental state assessment?

A

This is a shorter MMSE w/o the attention or language

Registration: Apple, Table, Penny

Orientation: What year is this? (1) What month is this? (1) What day of the wk is this? (1)

Recall: What were the three objects? (1)

> 3 high likelihood of dementia

274
Q

Psych: MCA

A

Tbc

275
Q

Psych: MHA

A

Tbc

As an F1 wouldn’t be doing myself

2 (28d) - assessment
3 (6m) - treatment
4 (72h) - emerg tx
5(2) - holding for 72h

276
Q

Psych: Sx of Parkinson’s

A

Tremor
Rigidity
Bradykinesia

Always ask if they’re on antipsychotics

277
Q

Psych: CBT

A

The ABC of CBT: there’s an activating event, that’s mediated by beliefs (thoughts, attitudes, assumptions) and results in consequences (emotions/behaviour)

Aim to understand the link b/w thoughts and emotions

Formulation: rationale for pts problem - origin, current status, maintenance

Map out the links b/w thoughts, emotions, bodily sensations, behaviour

Session: set an agenda, homework from prev session, specific interventions

Depression - activity schedule to link mood and activities - build in activities that bring pleasure
Negotiate behavioural targets

Identify the negative automatic thoughts - thought record, identify cognitive disorders (allow events to fit in with underlying assumptions and beliefs), challenge (thought records, socratic questioning)

Push pt to think about their thoughts/behaviours and design experiments to disprove the negative ones

278
Q

Psych: ECT

A

T

279
Q

Psych: CBT Anxiety Model

A

Anxiety

Adrenaline + Hyperventilation

Physical Sx

Catastrophic Thoughts

Safety Behaviours

Anxiety

280
Q

Psych: CBT Depression Model

A

T

281
Q

Psych: What are the SEs of SSRIs?

A 
The Five S’s:
Suicide
Stomach
Sexual
Sleep
Serotonin
282
Q

O+G: What are the urodynamics of a normal bladder function?

A

Voiding Detrusor Pressure <70 cm H2O

Peak Flow Rate >15 mL/s

283
Q

Depression sx screen

A

Core: low mood, anhedonia, anergia

Biological: appetite/wt change, low libido, sleep disturbance

Cognitive: memory impairment, beck’s triad, suicidal

PLUS hx of hypomania, psychosis, mood incongruence

284
Q

Schizophrenic sx screen

A

ICD-10 states >=1 of Schneider’s first rank sx OR >=2 ABCD

285
Q

Duration of schizophrenia to dx

A

> =1m

286
Q

What are Schneider’s first rank sx?

A

Auditory Hallucinations: thought echo, third person voices, running commentary

Abnormal Thoughts: insertion, withdrawal, broadcasting

Delusion of Control: SIVA

Delusional Perception

287
Q

What does the SIVA in delusion of control stand for?

A

Somatic
Impulse
Volition
Affect

288
Q

What is a hallucination?

A

Perception in the absence of a stimulus

289
Q

What is a delusion?

A

Fixed false belief

290
Q

What is the ABCD part of the schizophrenia screen?

A

Always present hallucinations in any modality every day for a mnth

Breaks in train of thought, incoherent speech, neologisms

Caratonic behaviours: WRENCHES

Defeatist sx: 5A’s

291
Q

What are the WRENCHES of catatonic behaviours?

A 
Waxy Flexibility
Rigidity
Echopraxia
Negativism
Catalepsy
Hyperactive
Echolalia
Stupor
292
Q

What are the five A’s of the negative sx?

A 
Apathy
Anhedonia
Affect Blunted
Asociality
Alogia
293
Q

What are the acute and chronic sx of schizophrenia?

A

Acute, +ve sx, hallucinations, thought interference, delusions

Chronic, -ve sx, 5A’s

294
Q

What is the cause of these acute and chronic sx?

A

Acute: XS dopamine in mesolimbic tracts

Chronic: def dopamine in mesocortical tracts

295
Q

Outline the MSE

A

ASEPTIC

Appearance + Behaviour

Speech: rate, quantity, tone, volume, fluency

Emotion: Mood + Affect

Perceptions: Hallucinations + Illusions

Thoughts: Form, Content, Possession

Insight + Judgement

Cognition: oritentation, attention, memory

296
Q

Outline the capacity assessment

A

Understand
Retain
Weighup
Communicate

297
Q

How is one orientated?

A

Time, place, person

298
Q

What is inc in appearance + behaviour during the MSE?

A

Kempt, eye contact, distracted

299
Q

What is inc in insight + judgement during the MSE?

A

Tbc

300
Q

What is mood + affect?

A

Mood - generally (flat/labile)
Vs
Affect - currently (blunted/elevated)

Ask to rate their mood on a scale of 1-10

301
Q

What is an illusion?

A

Misinterpreted perception

302
Q

What are the different types of depression?

A

Unipolar
Bipolar
Psychotic
Psychosocial

Ddx: dysthymia, pseudo, adjustment disorder, hypothyroidism

303
Q

Which drugs shouldn’t you give to a bipolar entering hypomanic state?

A

Antidepressants w/o mood stabilisers

304
Q

What drugs shouldn’t you give to a Parkinson’s pt?

A

Antipsychotics

305
Q

Depression vs Adjustment Disorder

A

Depression may not necessarily have a preceding event and is likely to be more severe

306
Q

Biological vs Psychosocial

A

If it was: spontaneous, episodic, responded to prev tx, strong fhx etc all point towards a biological cause

307
Q

The sensitivity and specificity of the depression screen

A

Core+Bio - sensitive but not specific

Cognitive - specific but not sensitive

308
Q

What is typical thought broadcasting?

A

They’re in the newspapers/TV

309
Q

Which screening tools are their for alcohol misuse/dependency?

A

CAGE, AUDIT, SADQ

310
Q

What are the four CAGE qs?

A

Have you ever felt you need to cut down on your drinking?

Have people annoyed you by criticising your drinking?

Have you ever felt guilty about drinking?

Have you ever felt you needed a drink first thing in the morning to steady your nerves or to get rid of a hangover?

311
Q

What is considered a positive CAGE?

A

> =2

312
Q

What are the seven DSM-IV criteria for alcohol dependence?

A 
Restricted
Cravings
Primacy
Tolerance
Withdrawal
Relief Drinking
Reinstatement
313
Q

How could you word asking about primacy?

A

Do you find yourself neglecting other aspects of your life because of alcohol

314
Q

What should you briefly ask about after screening for alcohol dependency?

A

Ascertain what exactly they’re drinking

Ask about smoking and drugs

Anything they see the GP for reg

Ask for them to fill in AUDIT whilst you liaise w the rest of the team

315
Q

How could you word asking about tolerance?

A

Do you find you have to drink more to reach the same affect

316
Q

How many of the DSM-IV criteria are required for alcohol dependence?

A

> =3 occurring at any time in the same twelve mnth period

317
Q

How are non-fatal offences sentenced?

A

Offences Against the Person Act 1861:

Assault + Battery - 6m

S47 ABH + S20 GBH - 5y

S18 GBH w Intent - up to life

318
Q

How often should pts in isolation be checked?

A

2hrly by nurse + 4hrly by dr

319
Q

What are T2 (consent form), T3 (certificate of second opinion) and S62 forms?

A

Apply to meds used to alleviate sx of mental disorder and their SEs after the initial 3m w/o consent period

320
Q

When does the T2 become invalid?

A

If the pt loses capacity to consent or withdraws consent -> SOAD

If the tx changes or additional meds are prescribed -> new form

321
Q

SSRI SEs

A

GI disturbance, drowsiness, fatigue, dry mouth, sexual dysfunction

322
Q

What is the Braak staging for Alzheimer’s disease?

A

Stage I+II: transentorhinal - autonomic and olfactory disturbances

Stage III+IV: limbic - sleep and motor disturbances

Stage V+VI: neocortical - emotional and cognitive disturbances

Year 5/6 (20 decks)

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