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Zero to finals Paediatrics Marina > Zero To Finals > Flashcards

Zero To Finals Flashcards

1
Q

Gram positive cocci

A

Staphylococcus
Streptococcus
Enterococcus

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2
Q

Gram positive rods

A

Corny mike’s list of basic cars

Corneybacteria
Mycobacteria
Listeria 
Bacillus
Nocardia
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3
Q

Gram positive anaerobes

A 
CLAP
Clostridium
Lactobaccilus 
Actinomyces 
Propionibacterium
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4
Q

Abx inhibit cell wall synthesis

A

With beta-lactam ring (penicillin, carbapenem, cephalosporin)

Without beta-lactam ring
(Vancomycin, teicoplanin)

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5
Q

Abx inhibiting folic acid metabolism

A

Sulfamethoxazole and Trimethoprim block formation of folic acid

Co-trimoxazole is a combination of the two

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6
Q

Abx inhibit protein synthesis (target ribosome)

A

Macrolides (erythromycin, clarithromycin, azithromycin)
Clindamycin
Tetracyclines
Chloramphenicol

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7
Q

Unusual chest infection organisms

A 
Moraxella catarrhalis (in immunicompromised with chronic Lung disease)
Pseudomonas auerginosa (CF)
Staphylococcus aureus (CF)
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8
Q

Most common UTI bacteria

A

E. coli

Gram -ve, anaerobic, rod shaped

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9
Q

Chest infection 1st line

A

Amoxicillin

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10
Q

UTI 1st line

A

Trimethoprim

Nitrofurantoin

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11
Q

UTI in pregnancy

A

7d abx
1st Nitrofurantoin (do not give in 3rd trimester - haemolytic anaemia)
2nd amoxicillin

trimethoprim (do not give in 1st or anti-epileptics as has ANTI FOLATE effect)

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12
Q

Cellulitis and golden crust?

A

Staph aureus infection

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13
Q

Cellulitis tx 1st line

A

Flucloxacillin

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14
Q

Centor criteria

A

<3 not bacterial tonsilitis

Fever >38*C
Tonsillar exudates
Absence of cough
Tender lymph nodes

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15
Q

Bacterial tobsilitis 1st line

A

Penicilin V /phenoxymethylpenicillin 10days

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16
Q

Otitis media 1st line

A

Amoxicilin

But (erythronycin, clarithromycin if penicillin Allergy)

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17
Q

Sinusitis management

A

Pencilin V/ phenoxymethylpenicillin 5days

No improvement after 10 days: 2 weeks of high dose steroid nasal spray

No improvement after 10 days + likely bacterial cause: Abx

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18
Q

Septic arthritis tx

A

1st flucloxacillin + rifampicin

2nd vancomycin + rifampicin (joint replacement or penicillin allergy)

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19
Q

Influenza treatment

A

Oral oseltamivir 75mg 2x day for 5 days

Or
Inhaled zanamivir 10mg 2x day for 5 days
(Treatment must start within 48h of symptoms)
Same drugs but 1x day for 10 days in PEP

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20
Q

Gram negative diplococcus

A

Gonorrhoea

Neisseria meningitidis

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21
Q

Bacterial meningitis in adults

A

Neisseria meningitidis, strep pneumoniae

Neonates: group B strep

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22
Q

Lumbar puncture in babies

A

<1 month with fever
1-3 month fever and unwell
<1 year unexplained fever and serious ilness

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23
Q

Kernig’s test

A

Pt on back, flexing hip and straightening knee - meninges stretch and -> resistance or pain

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24
Q

Brudzinski’s test

A

Pt flat on the back, chin to chest -> if meningitis then pt flexes hips

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25
Q

Community meningitis 1st line

A

Benzylpeniclinin IM/IV stat
300mg <1y
600mg 1-9y
1200mg >10y

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26
Q

Meningitis hospital tx

A

<3m cefotaxime + amoxicillin
>3m ceftriaxone

+ Dexamethasone to prevent hearing loss and neuro damage 4x/4 days

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27
Q

Lumbar puncture results

A

Bacterial - cloudy
Viral / normal - clear

Bacteria release proteins and use up glucose
Viruses don’t use glucose and release little protein
Neutrophils released for bacteria and lymphocytes released for viruses
High WBC for both

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28
Q

TB staining

A

Ziehl Neelsen stain turns bacteria bright red and background blue

TB grows acid-fast bacilli (rod shaped)

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29
Q

BCG vaccine

A

Intradermal infection of life attenuated TB

  • works against complicated TB
  • not as effective for pulmonary TB
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30
Q

Mantoux test

A

Injecting tuberculin into intradermal space

Check after 72h, >5mm is positive (previous vaccination, latent, or active TB)

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31
Q

Interferon gamma release assays

A

Confirms latent TB disease

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32
Q

Pts at risk of TB reactivation (w latent TB) tx

A

Isoniazid and rifampicin 3m

Isoniazid 6m

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33
Q

Acute TB tx

A

Rifampicin 6m
Isoniazid 6m
Pyrazinamide 2m
Ethambutol 2m

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34
Q

Isoniazid side effects and tx

A

Peripheral neuropathy

- Pyridoxine (B6)

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35
Q

Rifampicin se

A

Red discolourstion of urnie and tears

Induces p450 so reduces effect of contraceptive pill

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36
Q

Pyrazinamide se

A

Hyperuricaemia (high uric acid and gout)

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37
Q

Ethambutol se

A

Colour blindness and reduced visual acuity

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38
Q

PCP in hiv

A

Co-trimoxazole prophylaxis in CD4 <200

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39
Q

PEP

A

<72h

Truvada (emtricitabine/ tenofovir) and Raltegravir 28days

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40
Q

Uncomplicated malaria treatment

A

Malarone
Quinine sulphate
Doxycycline

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41
Q

IV tx for complicated malaria

A

Artesunate and quinine dihydrochloride

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42
Q

Antimalarials

A

Malarone (2d/during/1week)
Mefloquine (2w/during/4week) - psychotic episodes and seizures
Doxycycline (2w/during/4week) - Abx so thrush, diarrhoea

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43
Q

OA risk factors

A 
Obesity 
Age
Trauma
Female
Family history
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44
Q

OA X-ray

A

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

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45
Q

OA symptoms

A

Pain and stiffness worsened by activity

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46
Q

OA signs

A

Haberdens nodes DIP
Bouchards nodes PIP
Squaring of the thumb

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47
Q

OA management

A

Weight loss, physio
Paracetamol + topical NSAID
Add oral NSAID + PPI
Add codeine / morphine

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48
Q

RA genetics

A

HLA DR4 - RF positive pt

HLA DR1 - often present in RA

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49
Q

Antibodies in RA

A

RF

anti CCP

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50
Q

RA presentation

A 
Symmetrical polyarthritis 
MCP and PIP joints
Atlantoaxial subluxation
Pain, swelling, stiffness
Pain worse after rest, improves with activity
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51
Q

Signs in the hands RA

A 
Boggy feeling
Z shaped thumb
Swan beck deformity
Boutonnières deformity (flexor digitorum superficialis works)
Ulnar deviation
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52
Q

Felty’s syndrome

A

RA, neutropenia, splenomegaly

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53
Q

DAS 28

A

Disease activity score
Swollen joints
Tender joints
ESR/CRP result

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54
Q

RA DMARDs

A

1st mono: methotrexate, leflunomide, sulfasalazine, hydroxychloroquine

2nd: 2 drugs
3rd: methotrexate + biological therapy (TNF inhibitor - adalimumab, infliximab, etanercept)
4rd: methotrexate + rituximab

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55
Q

Methotrexate SEs

A

Pulmonary fibrosis

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56
Q

Leflunomide se

A

Hypertension and peripheral neuropathy

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57
Q

Sulfasalazine se

A

Male infertility (reduced sperm count)

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58
Q

Hydroxychloroquine se

A

Nightmares and reduced visual acuity

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59
Q

Anti TNF se

A

Reactivation of TB and hep B

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60
Q

Rituximab

A

Night sweats and thrombocytopenia

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61
Q

Psoriatic arthritis signs

A 
Nail pitting
Psoriasis plaques on skin
Onycholysis- nail separates from nail bed
Dactylitis 
Conjunctivitis
Pencil in cup appearance
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62
Q

Chlamydia vs

Gonorrhoea ->

A

Chlamydia -> Reactive arthritis

Gonorrhoea -> gonococcal septic arthritis

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63
Q

Reactive arthritis

A

Conjunctivitis, arthritis, balanitis

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64
Q

Seronegative spondyliarthropathy

A

HLA B27 gene
Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis

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65
Q

AS features

A

Sacroiliac and vertebral pain and stiffness
Vertebral fractures
Pain worse at night
Morning stiffness, gets better throughout the day
Stiffness worse with rest and better with movement

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66
Q

AS associations

A 
Anaemia
Anterior uveitis 
Aortitis 
Heart block 
Pulmonary fibrosis
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67
Q

X ray changes in AS

A 
Bamboo spine 
Squaring of vertebral bodies
Subchondral sclerosis
Fusion of joints 
Syndesmophytes
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68
Q

AS treatment

A

Nsaids 2-4weeks then change if no improvement
Steroids
Anti TNF (etanercept)
Monoclonal antibody against TNF (infliximab, adalimumab)

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69
Q

SLE signs

A

Photosensitive malar rash

Worse with sunlight

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70
Q

SLE investigations

A

C3 and C4 decreased in active disease
CRP and ESR raised in active inflammation
Increased PCR in lupus nephritis

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71
Q

SLE antibodies

A

ANA

anti ds DNA (increased with disease activity)

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72
Q

Anti Smith

A

specific to SLE

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73
Q

Sensitivity

A

How many/% ill people had positive result

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74
Q

Specificity

A

What % of healthy people had negative result

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75
Q

Anti centromere

A

Limited cutaneous systemic sclerosis

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76
Q

Anti Ro and Anti La

A

Sjorgen’s syndrome

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77
Q

Anti Scl 70

A

Systemic sclerosis

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78
Q

Anti Jo 1

A

Polymyositis

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79
Q

SLE treatment

A

NSAIDs
Steroids (prednisolone)
Hydroxychloroquine (mild SLE 1st line)
Biological therapies: rituximab, belimumab

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80
Q

Systemic sclerosis

A

Hardening of the skin

Fibrotic connective tissue disease

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81
Q

Limited cutaneous systemic sclerosis antibodies

A

Anti Scl 70

Anti centromere

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82
Q

Limited cutaneous systemic sclerosis features

A 
Calcinosis
Raynuaurd phenomenon
Esophageal dysmotility
Sclerodactyly
Telangectasia
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83
Q

Diffuse cutaneous systemic sclerosis antibodies

A

Anti Scl 70

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84
Q

Diffuse cutaneous systemic sclerosis symptoms

A

CREST
+ CV problems
+ lung problems
+ kidney problems

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85
Q

Polymyalgia rheumatica

A 
2 weeks of
Bilateral shoulder pain, pelvic girdle pain
Worse with movement
Wakes up from sleep
At least 45min stiffness in the morning
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86
Q

Polymyalgia rheumatica tx

A 
15mg prednisolone /day
Until symptoms settle (3-4 weeks)
Then 12.5mg for 3 weeks
10mg for 4-6 weeks
Reduce by 1mg every 4-8 weeks
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87
Q

Giant cell arteritis risk

A

Vision loss

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88
Q

Temporal artery biopsy findings in giant cell arteritis

A

Multinucleated giant cells

Also investigations: raised ESR, CRP, hypoechoic halo on duplex ultrasound

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89
Q

Giant cell arteritis tx

A

40-60mg prednisolone/day

also 75mg aspirin daily

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90
Q

Polymyositis and /dermatomyositis
+ diagnosis
+tx

A

Chronic muscle inflammation /+ skin involvement
Raised CK
Corticosteroids

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91
Q

DermatoMyositis signs

A

Gottron lesions (knuckle hardening)
Photosensitive rash on the back and neck
Calcium deposits in subcut tissue

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92
Q

Polymyositis antibodies

A

Anti Jo 1

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93
Q

Dermatomyositis antibodies

A

Anti Mi 2

ANA

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94
Q

Antiphospholipid syndrome antibodies

A

Lupus anticoagulant
Anticardioliptin antibodies
Anti beta 2 glycoprotein I antibodies

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95
Q

Libmann-Sacks endocarditis

A

Non bacterial endocarditis with vegetations on mitral valve,
SLE and antiphospholipid association

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96
Q

Livedo reticularis

A

Purple lace like rash with mottled appearance to the skin

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97
Q

Sjorgen’s Syndrome

A

Autoimmune condition affecting exocrine glands

-dry mucous membranes, dry mouth, eyes, vagina

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98
Q

Secondary Sjorgen’s

A

When condition is related to SLE or rheumatoid arthritis

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99
Q

Sjorgen’s antibodies

A

Anti Ro

Anti La

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100
Q

Schirmer test

A

Tears should travel 15mm in healthy adult

10mm is significant

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101
Q

Sjorgen’s syndrome tx

A

Artificial saliva, tears
Vaginal lubricants
Hydroxychloroquine stops disease progression

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102
Q

Vasculitis markers

A

ESR and CRP raised

Anti neutrophil cytoplasmic antibody ANCA

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103
Q

pANCA

A

peri Nuclear anti-neutrophil cytoplasmic
Anti-PR3
Microscopic polyangitis, churg-Strauss

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104
Q

cANCA

A

Wegener’s granulomatosis

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105
Q

Vasculitis treatment

A

Steroids,

Immunosuppressants (cyclophosphamide, methrotrexate, azathioprine)

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106
Q

Henoch Schonlein Purpura

A 
IgA Vasculitis 
Purpuric rash in lower limbs and buttocks
- purpura
- joint pain
- abdominal pain
- renal involvement
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107
Q

Wegener’s polyangitis

A

Respiratory track and kidney involvement
Epistaxis
Hearing loss and sinusitis
Saddle shaped nose due to perforated septum

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108
Q

Kawasaki disease (medium vessel Vasculitis)

A 
CRASH AND BURN
Conjunctivitis
Rash
Adenopathy /Lymphadenopathy
Strawberry tongue
Hands and feet skin peeling

Fever >5d

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109
Q

Kawasaki disease complication

A

Coronary artery aneurysm

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110
Q

Behcet disease gene

A

HLA B51 (prognostic of severe disease)

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111
Q

Behcet disease features

A

Oral and genital ulcers
+ skin inflammation, uveitis, muscle stiffness, GI ulceration, veins - Budd chiari syndrome, DVT, pulmonary artery aneurysm)

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112
Q

Pathergy test

A

For Behcet disease
Tests for skin hypersensitivity
Skin subcut abrasion, reviewed 24-48h later, >5mm weal is positive

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113
Q

Behçet’s disease tx

A

Colchicine for inflammation
Immunosuppressant azathioprine
Topical (bethamethasone) and systemic (prednisolone) steroids

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114
Q

Gout aspirate features

A

No bacteria
Needle shaped crystals
Negative birefringent
Monosodium urate

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115
Q

Gout X ray

A

Sclerotic boarders with overhanging edges

Punched out erosions

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116
Q

Gouty throphi

A

Subcut deposits of uric acid

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117
Q

Gout mx

A

Acute: NSAID, colchicine, steroid

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118
Q

Colchicine se

A

Diarrhoea

-given in pts who can’t use NSAID

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119
Q

Gout prophylaxis

A

Allopurinol, reduces uric acid levels

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120
Q

Pseudogout

A

Calcium pyrophosphate crystals / chondrocalcinosis

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121
Q

Pseudogout joint aspirate

A

No bacteria
Calcium pyrophospahte crystals
Rhomboid shaped
Positive birefringent

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122
Q

Pseudogout on X ray

A

Chondrocalcinosis

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123
Q

Pseudogout tx

A

NSAID, colchicine, steroids

+- joint washout

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124
Q

Risk factors for osteoporosis

A 
Old age
Female
Low BMI
Low activity/ mobility
Alcohol and smoking
Rheumatoid arthritis
Long term corticosteroid use
Post menopause (oestrogen is protective)
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125
Q

FRAX tool

A

Prediction of fragility fracture in 10years

Age, BMI, smoking, alcohol, co-morbidities, family history

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126
Q

Osteoporosis tx

A

Bisphosphonates (upright, empty stomach, 30 min before eating)

  • alendronate 75mg/week
  • risedronate 35mg/week
  • zolendronic acid 5mg/ year IV
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127
Q

Osteomalacia

A

Defect in bone mineralisation due to insufficient vit D

If in children before growth plate close - rickets

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128
Q

Osteomalacia pathology

A

Low vit D
causes low Ca and PO4
2* hyperparathyroidism
Reabsorption of Ca from bones (causing soft bones)

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129
Q

Investigation for vit D

A

<25 - vit D deficiency
25-50 insufficient
>75 optimal

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130
Q

Osteomalacia tx

A

Vit D

  1. 000 1x weekly (6w)
  2. 000 2x weekly (7w)
  3. 000 daily (10w)

Maintenance 800 daily

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131
Q

Paget’s disease

A

Excessive bone turnover (formation and reabsorption due to increased osteoblast and osteoclast activity)
Forms high density sclerotic and low density lytic patches.

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132
Q

Paget’s disease biochemistry

A

Raised ALP
Normal Ca
Normal PO4

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133
Q

Paget’s X ray

A

Cotton wool skull

V shaped defect in long bones

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134
Q

Paget’s disease treatment

A

Bisphosphonates
+ vit D and Ca supplementation on bisphosphonates

NSAIDs for pain

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135
Q

ABCD2 score

A 
48h risk of stroke post TIA
Age >60 (1)
BP >140/90 (1)
Clinical features - dysphasia (1), +weakness (2)
Durstion >60min (2), 10-60min (1)
Diabetes (1)
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136
Q

Stroke management

A

Aspirin 300mg/ day for 2 weeks

Thrombolysis with alteplase within 4.5h (after CT)

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137
Q

TIA mx

A

Aspirin 300mg
+ secondsry prevention:
Clopidogrel 75mg 1x or dypiridamole 200mg 2x
Atorvastatin 80mg

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138
Q

Crescendo TIA follow up

A

Within 24h specialist assessment

ABCD2 >3 24h assessment, otherwise 1 week assessment

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139
Q

GCS

A

Eyes: none, Pain, speech, spont
Verbal: None, sounds, words, confused, orientalned
Motor: none, Extends, abnormal flexion, flexion, localises Pain, obeys commands

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140
Q

Subdural haemorrhage location

A

Bridging veins

Between dura and arachnoid

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141
Q

Subdural haemorrhage on CT

A

crescent shape

Crosses cranial sutures

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142
Q

Subdural haemorrhage risk factors

A

Elderly and alcoholic

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143
Q

Extradural haemorrhage location

A

Middle menigeal artery
Temporal/parietal region
Assoc w fx of temporal bone

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144
Q

Extradural haemorrhage CT

A

Biconvex

Does not cross cranial sutures

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145
Q

Extradural haemorrhage hx

A

Young pt
Ongoing headache
Period of improvement and rapid decline in consciousness

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146
Q

Subarachnoid haemorrhage location

A

Pia matter and arachnoid membrane

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147
Q

Subarachnoid haemorrhage vessel

A

Cerebral aneurysm rupture

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148
Q

Subarachnoid haemorrhage hx

A 
Occipital headache (strenous activity)
Thunderclap headache
Neck stiffness
Photophobia
Hit on the back of head
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149
Q

Subarachnoid headache associations

A 
Cocaine use
Sickle cell anaemia
Alcohol
Smoking
HTN
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150
Q

Ix in subarachnoid haemorrhage

A

CT hyperattenuation

CSF red cell count and xantochromia

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151
Q

Subarachnoid haemorrhage mx

A

Coiling or clipping of the aneurysm
Nimodipine for vasospasm
Lumbar puncture and shunt to treat hydrocephalus

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152
Q

CN VI palsy in MS

A

Internuclear ophthalmoplegia

Conjugate lateral gaze disorder

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153
Q

MS lumbar puncture

A

Oligoclonal bands

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154
Q

Optic neuritis features

A

Central scotoma
Pain
Reduced colour vision
RAPD

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155
Q

MS relapse treatment

A

Methylprednisolone 500mg PO 1x for 5 days

Or 1g IV daily 3-5d

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156
Q

Lower motor neurone disease

A

Muscle wasting
Reduced tone
Fasciculations
Reduced reflexes

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157
Q

Upper motor neurone disease

A

Increased tone
Brisk reflexes
Upgoing plantars

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158
Q

Management of motor neurone disease

A

Riluzole

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159
Q

Parkinson’s triad

A

Resting tremor
Rigidity
Bradykinesia

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160
Q

Parkinson’s features

A 
Ansomnia 
Shuffling gait 
Hypomimia 
Asymmetrical tremor 4-6hz
Worse at rest
Improves with movement
No change with alcohol
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161
Q

Levodopa

A

Synthetic dopamine

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162
Q

Peripheral decarboxylase inhibitors

A

Benserazide

Carbidopa

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163
Q

Too high dopamine se

A

Dskinesia (excessive motor activity)

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164
Q

Dystonia

A

Abnormal postures and exaggerated movements

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165
Q

Chorea

A

Abnormal involuntary movements (jerking and random)

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166
Q

Athetosis

A

Involuntary twisting in hands feet fingers

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167
Q

COMT inhibitor

A

Inhibits levodopa metabolism in body and brain

Slows levodopa breakdown

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168
Q

Dopamine agonists

A

SE pulmonary fibrosis
Bromocryptine
Pergolide
Carbergoline

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169
Q

MAO B Inhibitors

A

Block enzyme breaking down dopamine neurotransmitter

Selegiline
Rasagiline

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170
Q

Benign essential tremor tx

A

Propanolol (non selective beta blocker)

Primidone (anti epileptic)

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171
Q

Tonic clinic seizure

A 
Prolonged post ictal
Loss of consciousness 
Confused
Drowsy
Incontinence
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172
Q

Focal seizures characteristics

A

Hearing speech memory
Deja vu
Autopilot (strange things, don’t remember)
Hallucinations

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173
Q

Focal seizure location

A

Temporal

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174
Q

Infantile spasms

A

West syndrome
full body spasms
Tx prednisolone and vigabatrin

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175
Q

Seizure treatment

A

(Everything but focal)
Sodium valproate
Lamotrigine/carbamazepine

Focal
Lamotrigine/carbamazepine
Sodium valproate/levetiracetam

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176
Q

Absence Seizure tx

A

Sodium valproate or Ethosuximide

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177
Q

Carbamazepine se

A 
Agranulocytosis
P450 inducer (eg cocp)
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178
Q

Phenytoin se

A

Folate and vit D deficiency
Osteomalacia
Megaloblastic anaemia

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179
Q

Status epileptic is mx in community

A

Buccal midazolam

Rectal diazepam

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180
Q

Status epilepticus mx in hospital

A 
O2
Check blood glucose 
IV access
IV lorazepam 4mg (repeat after 10min)
IV phenobarbital or phenytoin
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181
Q

Trigeminal neuralgia tx

A

Carbamazepine

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182
Q

Neuropathic pain tx

A 
(1 at a time, if doesn’t work switch, try all 4)
Amitryptyline
Duloxetine
Gabapentin
Pregabalin
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183
Q

Bell’s palsy tx

A

Prednisolone (start within 72h)
50mg for 10days
60mg for 5 days and 5days reducing regime (10a day)

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184
Q

Ramsay Hunt Syndrome

A

Herpes zoster virus

72h prednisolone, acyclovir

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185
Q

Bilateral acoustic neuromas association

A

Neurofibromatosis type 2

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186
Q

Acoustic neuroma symptoms

A

Hearing loss
Tinnitus
Balance problems

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187
Q

Bromocriptine

A

Block prolactin secreting tumours

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188
Q

Somatostatin analogue (ocreotide)

A

Block growth hormone secreting tumours

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189
Q

Huntingtons genetics

A 
AD
On chromosome 4
Trinuckeotide repeat disorder 
mutation in HTT gene
Anticipation
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190
Q

What is anticipation

A

Successive generation have more repeats of the gene

  • earlier onset age
  • increased severity of disease
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191
Q

Drugs to manage huntingtons symptoms

A

Antipsychotic (olanzapine)
Benzodiazepines (diazepam)
Dopamine depleting (tetrabenazine)

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192
Q

Myasthenia gravis antibodies

A

Acetylcholine receptor antibodies 85%
Muscle specific kinase antibodies 10% (make up the receptor)
LRP4 abs (5%)

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193
Q

Edrophonium test

A

IV 10mg of endrophonium chloride / neostigmine
Stops breakdown of acetylcholine and relieves weakness
Atropine 0.6mg IV to reverse

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194
Q

Myasthenia gravis treatment

A

Acetylcholinedterase inhibitors (neostigmine, pyridostigmine)
Or monoclonal:
Rituximab, eculizumab

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195
Q

Myasthenic crisis tx

A

IVIG

Plasma exchange

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196
Q

Lambert Eaton associations

A

Small cell lung cancer
Proximal muscles affected
Diplopia, ptosis, dysphagia

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197
Q

Lambert Eaton treatment

A

Amifampridine - allows more Ach to be released in junction synapses

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198
Q

Charcot Marie tooth genetics

A

AD

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199
Q

Charcot Marie tooth characteristics

A 
High foot arch/ pes cavus
Inverted champagne bottle legs
Loss of ankle dorsiflexion
Weak hands
Reduced muscle tone 
Peripheral neuropathy
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200
Q

Gillian barre triggers

A

-affects PNS
Clampylobacter jejuni
CMV
EBV

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201
Q

Gullain barre ix

A

CSF raised protein

Nerve conduction reduced

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202
Q

NF1 genetics

A

AD

chromosome 17

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203
Q

NF1 diagnostic criteria

A 
Cafe au lait (6 spots >15mm)
Relative with NF1
Axillary/inguinal freckles
Bony dysplasia, bowing of bones
Iris hamartomas
Neurofibromatomas
Glioma of optic nerve
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204
Q

NF2

A

Chromosome 22
AD
—> leads to development of Schwannomas and acoustic neuromas

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205
Q

NF 2 associations

A

Bilateral acoustic neuromas

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206
Q

Tuberous sclerosis genetics

A

TSC1 gene chromosome 9 - hamartin
TSC2 gene chromosome 16 - tuberin

Hamartin and tuberin control cell growth

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207
Q

Skin signs of tuberous sclerosis

A 
Ash leaf spots
Shagreen patches 
Angiofibromas
Cafe au lait
Poliosis
\+ epilepsy and developmental delay
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208
Q

Migraine acute and long term management

A

Acute: paracetamol, sumatriptan 50mg, nsaid, metoclopramide for vomiting
Long: propanolol, topiramate (teratogenic, cleft lip and palate), amitriptyline

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209
Q

Migraine around menstruation tx

A

NSAIDs
Or
Frovatriptan
Zolmitriptan

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210
Q

Cluster headache acute and long term mx

A

Acute: high flow O2, sumatriptan 6mg subcut

Long term: veramapil, lithium, prednisolone

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211
Q

Glaucoma

A

Optic nerve damage due to rise in intraocular pressure

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212
Q

IOP

A

10-21mmHg

Start treatment in >24mmHg

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213
Q

Risk factor for glaucoma

A

Black ethnic
Age
Myopia/ near sight

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214
Q

Glaucoma tx

A

Latanoprost
Timolol
Dorzolamide
Brimonidine

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215
Q

Latanoprost

A

Prostaglandin analogue eye drops
Increase uveoscleral outflow
Eyelash growth
Eyelid and iris pigmentation

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216
Q

Timolol

A

B blocker

Reduce aqueous humour production

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217
Q

Dorzolamide

A

carbonic anhydrase inhibitor

Reduce aqueous humour production

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218
Q

Brimonidine

A

Sympathomimetic

Reduce aqueous fluid production and increase uveoscleral flow

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219
Q

Medications precipitating close/acute angle glaucoma

A

Noradrenalin
Oxybutynin
Solifenacin
Amitryptyline

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220
Q

Close angle glaucoma immediate management

A

Lie on the back
Pilocarpine eye drop (pupil contatriction)
Acetazolamide PO 500mg (carbonic anhydrase, reduces aqueous humour production)

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221
Q

Close angle glaucoma 2* care

A 
Pilocarpine
Acetazolamide 
Hyperosmotics (mannitol, glycerol)
Timolol 
Dorzolamide
Brimonidine
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222
Q

Age Related Macular Degeneration presentation

A 
Reduced visual acuity 
Wavy appearance of straight lines
Worsening of central vision 
-drusen 
-scotoma
-amsler grid
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223
Q

Dry AMD tx

A

Lifestyle
Stop smoking
Control BP

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224
Q

Wet AMD

A

anti VEGF injected into vitreous chamber (ranibizumab, bevacizumab, pegaptanib)

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225
Q

Diabetic retinopathy pathophysiology

A

Blot haemorrhage
Hard exudates
Cotton wool spots

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226
Q

Micro aneurysm

A

Small bulges in blood vessels due to weakness

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227
Q

Venous beading

A

Walls of vessels no longer straight, string of beads or sausages

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228
Q

Cotton wool spots

A

Nerve fibre damage - white fluffy patches

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229
Q

Retinopathy management

A

Laser photocoagulation

Anti VEGF ranibizumab, bevacizumab

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230
Q

Silver wiring/ copper wiring

A

Walls of arterioles are thickened and sclerosed

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231
Q

Av Nicking

A

Arterioles compress veins when they cross over

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232
Q

Cataract

A

Lens of the eye becomes cloudy and opaque

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233
Q

Cataracts presentation

A

Worsening vision
Change in colour vision (colours more brown/yellow)
Starburts around lights
Loss of red reflex

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234
Q

Dilated pupil

A

Horner adie
Raised icp
3rd nerve palsy
Anticholinergics

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235
Q

Constricted pupil

A

Horner syndrome
Argyll Robertson pupil
Opiate
Nicotine

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236
Q

3rd CN palsy (oculomotor)

A

Ptosis
Dilated pupil
Down and out

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237
Q

Horner syndrome

A

Ptosis
Miosis
Anhidrosis
+ enophthalmos/ sunken eye

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238
Q

Anhidrosis - pre ganglionic

A
  • Face anhidrosis
    Cervical rib
    Pancoast tumour
    Trauma
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239
Q

Anhidrosis central

A 
- Face arm trunk
Syringomyelia
Stroke
MS
Swelling (tumour)
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240
Q

Post ganglionic Anhidrosis

A

No Anhidrosis
Carotid aneurysm
Carotid artery dissection
Cavernous sinus thrombosis

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241
Q

Holmes Aldie pupil

A

dilated pupil, slow to react to light, slow dilatation

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242
Q

Holmes aldie syndrome

A

Holmes aldie pupil

Ankle and knee reflexes absent

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243
Q

Test for Horner syndrome

A

Cocaine (stops noradrenaline reuptake) - normal dilates, affected no reaction

Adrenaline eye drop - will dilate affected pupil but no reaction in normal

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244
Q

Hordeolum externum

A

stye

Gland of zeis/ moll infection at base of eyelashes

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245
Q

Hordeolum internum

A

Meibomian glands infection, pointing inwards towards the eyeball

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246
Q

Chalazion

A

Mebomian gland blockage and swelling
Hot compress and analgesia
Chloramphenicol if acutely inflamed

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247
Q

Trichiasis

A

Inward growth of eyelashes

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248
Q

Preorbital cellulitis

A

Infection of eyelid and skin in front of the ortbital septum

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249
Q

Orbital cellulitis

A

Infection around the eyeball involving tissues behind the orbital septum

  • pain on movememt
  • proptosis
  • reduced vision
  • abnormal pupil reactions
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250
Q

Episcleritis vs scleritis

A

Episcleritis painless

Scleritis painful

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251
Q

Conjunctivitis mx

A

Cool water eye cleaning

Chloramphenicol and fusidic acid drops

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252
Q

Neonatal conjunctivitis

A

Gonococcal infection

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253
Q

Anterior uveitis genetics

A

HLA B27
Ankylosing spondylitis
IBD
reactive arthritis

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254
Q

Anterior uveitis mx

A

Steroid (oral topical Iv)
Immunosuppressants (dmard and TNF inhibitor)
Cycloplegic-mydriatic - dilate pupil to reduce pain (cyclopentolate, atropine)

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255
Q

Corneal abrasion in contact lenses

A

Pseudomonas infection

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256
Q

Corneal abrasion complication

A

Herpes keratitis (antiviral treatment)

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257
Q

Corneal abrasion /herpes keratitis diagnosis

A

Fluorescein stain - ulcer /abrasion

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258
Q

Keratitis

A

Inflammation of the cornea

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259
Q

Bacterial keratitis causes

A

Pseudomonas or staphylococcus

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260
Q

Viral keratitis

A

Herpes simplex keratitis

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261
Q

Herpes keratitis fluorescein

A

Dendritic corneal ulcer

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262
Q

Herpes keratitis tx

A

Acyclovir (topical or oral)

Ganciclovir eye gel

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263
Q

Sensorineural hearing loss caused by drugs

A 
Loop diuretics (furosemide)
Aminoglucoside antibiotics (gentamicin)
Chemotherapy drugs (cisplatin)
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264
Q

Causes of prebyscusis

A 
(Sensorineural hearing loss)
Loss of hair cells in cochlea
Loss of neurons in cochlea
Reduced endolymph
Atrophy of stria
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265
Q

Sensorineural hearing loss tx

A

Cochlear implants

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266
Q

Sudden sensorineural hearing loss

A

Over 72h

Loss of 30 decibels in 3 consecutive frequencies

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267
Q

Sudden sensorineural hearing loss tx

A

Steroids (oral, intratympanic)

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268
Q

Eustachian tube dysfunction mx

A

Valsava manouvre (blow closed nose)
Decongestant nasal spray
Surgery (grommet, ballon dilatation)

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269
Q

Otosclerosis

A

Remodelling of small bones of middle ear - bone hardening
AD pattern
Onset <40yo
Conductive hearing loss

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270
Q

Hearing loss at low frequencies

A

Otosclerosis

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271
Q

Conductive hearing loss mx in otosclerosis

A

Hearing aids

Surgery - stapedectomy or stapedotomy

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272
Q

Bacterial cause of otitis media

A

Step pneumoniae

Other:
Hem influenza
Moraxella catarrhalis
Staphylococcus aureus

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273
Q

Otitis media tx

A

Amoxicillin 5-7d
Clarithromycin (in penicillin allergic)
Erythromycin (in pregnant and allergic to penicillin)

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274
Q

Otitis externa bacterial causes

A

Pseudomonas auerginosa

Staph aureus

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275
Q

Otitis externa hearing loss

A

Conductive

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276
Q

Pseudomonas auerginosa

A

Gram -ve aerobic rod shaped bacteria
Colonises in lungs in CF
Tx with aminoglycosides (gentamicin), quinolones (ciprofloxacin)

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277
Q

Otitis externa tx

A 
Mild: acetic acid 2%
Moderate: topical abx + steroid 
- neomycin, dexamethasone, acetic acid
-neomycin and bethamethasone
- gentamicin and hydrocortisone
- ciprofloxacin and dexamethasone
Severe: oral abx flucloxacillin or clarithromycin
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278
Q

Ototoxic drugs

A

Aminoglycosides (gentamicin and neomycin)
Toxic if get past tympanic membrane
Must exclude perforated tympanic membrane

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279
Q

Fungal otitis externa tx

A

Clotrimazole ear drops

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280
Q

Malignant otitis externa findings

A

Granulation tissue

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281
Q

Malignant otitis externa tx

A

Admission
Imaging
IV abx

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282
Q

Methods of removing ear wax

A

Ear drops (olive oil, sodium bicarbonate 5%)
Ear irrigation
Microsuction

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283
Q

Primary tinnitus

A

Occurs with sensorineural hearing loss

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284
Q

BPPV

A

Calcium carbonate crystals displaced into aemicircular canals

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285
Q

Labirynthitis vs vestibular neuronitis

A

Labirynthitis causes hearing loss

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286
Q

Posterior circulation infarction symptoms

A

Vertigo
Ataxia
Diplopia
CN or limb symptoms

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287
Q

Cerebellar examination

A 
Dysdiadochokinesia
Ataxic gait
Nystagmus 
Intention tremor 
Speech
Heel to shin
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288
Q

Head impulse test

A

Shaking head left or right
Asking pt to keep looking at doctors nose
If saccades, PERIPHERAL vertigo

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289
Q

Nystagmus test

A

Quick look right to left (repeat)
Unilateral horizontal: PERIPHERAL cause
Bilateral vertical: CENTRAL cause

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290
Q

Central vertigo treatment

A

Referral, CT MRI

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291
Q

Peripheral vertigo tx

A

Prochlorperazine

Antihistamine

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292
Q

Meniere disease Tx

A

Betahistine

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293
Q

Vestibular migraine tx

A

Triptans

Propanolol/ topiramate/ amitryptyline long term

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294
Q

BPPV symptoms

A

Vertigo attacks 20-60 sec
asymptomatic in between
Over several weeks
No tinnitus or hearing loss

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295
Q

Vestibular neuronitis

A

Vestibular nerve inflammation

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296
Q

Inner ear parts

A

Semicircular canals
Vestibule
Cochlea

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297
Q

Semicircular canals role

A

Detect head rotation

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298
Q

Otolith organs role

A

Detect gravity and linear acceleration

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299
Q

Labirynthitis LOSS of hearing

Neuronitis NO loss of hearing

A

Tinnitus and hearing loss - Labirynthitis or Menieres disease

Nausea and balance - vestibular neuronitis

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300
Q

Vestibular neuritis and Labirynthitis treatment

A

Prochlorperazine

Antihistamines (cyclizine, promethazine)

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301
Q

Meningitis complication

A

Hearing loss

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302
Q

Meniere disease triad

A 
Hearing loss
Vertigo
Tinnitus
- unilateral
- symptoms 20min-couple hours
- low frequency sensorineural hearing loss
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303
Q

Cholesteatoma

A

Squamous epithelial cells abnormal collection in middle ear

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304
Q

Choelsteatoma presentstion

A

Foul discharge

Unilateral conductive hearing loss

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305
Q

Nosebleed management

A

Nasal packing (tampons or inflatable packs)
Nasal cautery with silver nitrate
Then 4x day for 10 days - naseptin nasal cream (chlorhexidine, neomycin)

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306
Q

Naseptin components and contraindication

A

Chlorhexidine and neomycin

Cd: peanut or soya allergy

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307
Q

Acute sinusitis

A

If symptoms not impoving after 10d
High dose nasal spray 14d (momethasone 200mcg 2x daily)
Delayed abx prescription if not improved after 7d (phenoxymethylpenicilline)

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308
Q

Nasal polyps unilateral

A

Concern for malignancy, specialist referral

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309
Q

Samter’S triad

A

Nasal polyps, asthma, aspirin intolerance/allergy

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310
Q

Nasal polyps apperance

A

Pale grey/yellow growth on mucosal wall

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311
Q

Apnoea assessment

A

Epworth sleepiness scale

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312
Q

Tonsilits bacterial cause and tx

A

Group A step (streptococcus pyogenes)
- penicillin V / phenoxymethylpenicillin

Or strep pneumonia
Other causes: 
Haemophilius ibfluenza 
Moraxella catarhhalis 
Staphylococcus aureus
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313
Q

Centor criteria - probability of bacterial tonsilitis

A 
3 or more (40-60%) 
Fever 38*C
Tonsilar exudates
Absence of cough
Lymphadenopathy
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314
Q

FeverPAIN score

A

4-5 score (62-65%)

  • Fever in previous 24h
  • Pus on tonsilitis
  • Attend within 3 days of symptoms
  • Inflamed tobsils (severely inflamed)
  • No cough or coryza
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315
Q

When to prescirbe abx?

A

Centor >= 3

FeverPAIN >= 4

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316
Q

Tonsilitis tx

A

Penicillin V 10 day Course
Or
Clarithromycin for penicillin allergy

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317
Q

Peritonsillar abscess cause

A

Strep pyogenes (group A Strep)
Staph aureus
Haemophilius influenzae

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318
Q

Quinsy treatment

A

Co amoxiclav

Incision and drainage

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319
Q

Tonsilectomy indications

A

7 tonsilitis in 1y
5 tonsilitis in 2y
3 tonsilitis in 3y

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320
Q

Post tonsilectomy bleeding management

A

Hydrogen peroxide gargle
Adrenalin soaked swab
Re - surgery

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321
Q

Thyroid lump

A

Moves with swallowing

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322
Q

Thyroglossal cyst

A

Movement when sticking tongue out

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323
Q

Bronchial cyst

A

Transluminates with light

Anterior triangle

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324
Q

EBV and abx

A

Maculopapular rash in response to amoxicilin and cefalosporin

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325
Q

Hodgkin lymphoma node biopsy

A

Reed Sternberg cell

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326
Q

Thyroglossal cyst

A

Mobile
Non tender
Soft
Fluctuant

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327
Q

Lipoma

A

Mobile
Soft
Painless
No skin change

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328
Q

Branchial cyst

A 
Round
Soft
Cystic swelling
Transluminate with light
Anterior to SCM
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329
Q

Glossitis causes

A

Iron deficiency
B12, folate deficiency
Coeliac disease

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330
Q

Oral candidiasis treatment

A

Miconazole gel
Nystatin suspension
Fluconazole tablets

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331
Q

Leuko and erythroplakia

A

Leuko - white patches
Erythro - red lesions
Precancerous changes, increasing risk of squamous cell carcinoma

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332
Q

Aphthous ulcers treatment

A

Topical:
Choline salicylate
Benzydamine
Lidocaine

Topical corticosteroids - severe:
Hydrocortisone buccal tablets
Bethamethasone soluble tablets
Beclomethasone inhaler spray

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333
Q

VTE prophylaxis in hip/knee

A

LMWH 28d post hip, 14d post knee replacement

Or aspirin, rivaroxaban, stockings

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334
Q

Prostethic joint infection organizm

A

Staphylococcus aureus

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335
Q

Children fracture types

A

Salter Harris ONLY in children
Greenstick
Buckle fracture

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336
Q

Cancers that metastasise to the bone

A 
PoRTaBLe
Prostate
Renal
Thyroid
Breast
Lung
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337
Q

FRAX tool

A

Measures pt’s risk of fragility fracture over 10 years

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338
Q

Tx for preventing fragility fractures

A

Calcium and vit D

Bisphosphonates (alendronic Acid) - alternstive with monoclonal ab Denosumab-

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339
Q

Bisphosphonates side effects

A

Osteonecrosis of jaw or external auditory canal
Reflux and oesophageal erosion
Atypical fractures

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340
Q

Non displaced intra capsular fx tx

A

Internal fixation

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341
Q

Displaced intra capsular fx tx

A

Hemiarthroplasty - elderly, co morbidities, mobility issues

Total hip replacement - young, walk independently

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342
Q

Extra capsular fx

A

Intertrochanteric fx

Subtrochanteric fx

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343
Q

Intertrochanteric fx tx

A

Dynamic hip screw

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344
Q

Subtrochanteric fx tx

A

Intramedullary nail

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345
Q

Hip fx presentation

A

Shortened, abducted, externally rotated leg

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346
Q

Disruption of Shenton line

A

NOF fx

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347
Q

Acute limb ischaemia

A

PULSELESS limb

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348
Q

Acute compartment syndrome

A 
Pain - disproportionate, worsened by passive movememt 
Paraesthesia
Pale
High pressure
Paralysis
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349
Q

Osteomyelitis

A

Inflammation of bone and bone marrow due to bacterial infection

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350
Q

Most common cause of osteomyelitis

A

Staph aureus

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351
Q

Acute osteomyelitis treatment

A

6 weeks of flucloxacillin
with rifampicin/fusidic acid added for first 2 weeks

Clindamycin if penicillin allergy
Vancomycin or teicoplanin if MRSA

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352
Q

Most common bone cancer

A

Osteosarcoma

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353
Q

Kaposi sarcoma cause

A

HHV 8

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354
Q

Most common sarcoma metastasis

A

Lungs

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355
Q

Sciatic nerve roots

A

L4 - S3

Exits pelvis through greater sciatic foramen
Then divided into tibial and common peroneal nerve

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356
Q

Thomas test

A

Flexibility of hip flexors (eg iliopsoas muscle group)

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357
Q

Long term back ache tx

A

Duloxetine

Amitryptyline

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358
Q

Cauda equina

A

Compression of cauda equina nerve roots L3-S5

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359
Q

Cervical cancer Red flag

A

IMB

PCB

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360
Q

Primary amenorrhoea

A

Not starting period by 13yo when no other pubertal development

Not starting period by 15yo when there are other signs of puberty

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361
Q

Normal puberty dates/events

A

Girls 8-14 with Breast buds then pubic hair

Boys 9-15

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362
Q

Hypogonadotrophic hypogonadism

A

LH and FSH deficiency so no stimulation for ovaries to produce sex hormones

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363
Q

Causes of hypogonadotrophic hypogonadism

A 
Hypopituitarism
CF
Delay in growth and development
Growth hormone deficiency
Hypothyroidism
Cushing 
Hyperprolactinemia
Kallman syndrome
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364
Q

Kallman syndrome

A

Hypogonadotrophic hypogonadism

Ansomnia

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365
Q

Hypergonadotrophic hypogonadism

A

Gonads fail to respond to gonadotropins (LH FSH)

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366
Q

Hypergonadotrophic hypogonadism

A

Previous gonads damage (torsion, cancer, mumps)
Congenital absence of ovaries
Turner syndrome XO

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367
Q

Congenital adrenal hyperplasia symptoms

A 
FEMALE with:
Tall
Facial hair
Primary ammenorhoea
Deep voice
Early puberty
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368
Q

Androgen insensitivity syndrome

A

Males
Male sexual characteristics do not develop
Results in female phenotype, female external genitalia, absent uterus/vagina/fallopian tubes/ovaries

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369
Q

GH deficiency screening

A

ILGF low = low GH

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370
Q

Hypogonadotrophic hypogonadism tx

A

(Eg hypopituitarism or Kallman syndrome)
Treat with pulsatile GnRH (induce menstruation and ovulation)
Replacement sex hormones (cocp - induce menstruation)

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371
Q

Secondary amenorrhoea

A

No menstruation >3m if previous regular periods

No menstruation 6-12m if previous irregular

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372
Q

Pituitary causes of secondary amenorrhoea

A 
Pituitary tumour (prolactinoma)
Pituitary failure (Sheehan syndrome)
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373
Q

Drugs to reduce prolactin production

A

Bromocriptine

Cabergoline

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374
Q

Dopamine agonists (cabergoline bromocriptine)

A

Treat hyperprolactinemja
Parkinson’s
Acromegaly

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375
Q

Primary ovarian failure bloods

A

High FSH

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376
Q

PCOS bloods

A

High LH

High LH:FSH ratio

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377
Q

Raised testosterone conditions

A

PCOS
Androgen insensitivity syndrome
Congenital adrenal hyperplasia

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378
Q

Reducing osteoporosis risk in pts with amenorrhoea

A

Vit D and Calcium

Hormone replacement therapy

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379
Q

PMS

A

Symptoms during luteal phase

These are progesterone induced

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380
Q

PMS mx

A

Healthy lifestyle
COCP (drospirenone)
SSRI
CBT

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381
Q

Physical symptoms of PMS tx

A

Brest swelling
Water retention
Bloating
- spironolactone

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382
Q

Cyclical breast pain tx

A

Danazole, tamoxifen

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383
Q

Menorrhagia

A

Heavy menstrual bleeding (>80ml)

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384
Q

Menorrhagia mx (no contraception)

A

Tranexamic acid - if no pain (antifibrynolytic reduced bleed)

Mefenamic acid - pain (NSAID reduce bleed and pain)

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385
Q

Menirrhagia mx contraception

A

Mirena coil IUS
COCP
Cyclical oral progestogens (norethistone 5mg 3x daily days 5-26)

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386
Q

Fibroid

A

Benign tumour of uterus smooth muscle

They grow in response to oestrogen

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387
Q

Fibroid types

A

Intramural
Submucosal
Subserosal
Pedunculated

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388
Q

Fibroids <3cm mx

A

IUS mirena
NSAID/ tranexamic acid
COCP
Cyclical legal progestogens

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389
Q

Surgical options for fibroids <3cm

A

Endometrial ablation
Resection during hysteroscopy
Hysterectomy

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390
Q

Fibroids >3cm mx

A 
Referral to Gynae
NSAID/ tranexamic acid
Mirena coil IUS
COCP
cyclical progestagen

Uterine artery embolisation
Myomectomy
Hysterectomy

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391
Q

How to reduce fibroid size?

A

GnRH agonist before surgery
Goserelin (Zoladex)
Leuprorelin (Prostap)

Induce ovulation-like state

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392
Q

Uterine artery embolisation

A

Blockage of arterial supply to fibroids causes them to shrink

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393
Q

Malignant change of fibroid

A

Leiomyosarcoma

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394
Q

Red degeneration

A

Ischaemia and necrosis if fibroid due to disrupted blood supply (occurs in larger fibroids >5cm)

Fibroid enlarges quickly in 2nd and 3rd trimester and outgrows it’s blood supply so it dies

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395
Q

Red degeneration hx

A 
Severe abdominal pain
Low grade fever 
Tachycardia 
Vomiting 
\+history of fibroids
Tx: test fluid analgesia
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396
Q

Endometriosis

A

Ectopic endometrial tissue outside the uterus

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397
Q

Endometrioma

A

Lump of endometrial tissue outside uterus

  • in ovaries these are called chocolate cysts
  • within the myometrium: adenomyosis
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398
Q

Risk factors for adenomyosis

A

Multiparous

Later reproductive years

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399
Q

Adenomyosis symptoms

A

Dysmenorrhea
Menorhhoagia
Dyspareunia

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400
Q

Gold standard ix for endometriosis and adenomyosis

A

Endometriosis - laparoscopy

Adenomyosis - hysterectomy with histological examination

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401
Q

Adenomyosis tx

A

Same as endometriosis and heavy menstrual bleeding

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402
Q

Premature menopause

A

Before age of 40
Result of premature ovarian insufficiency - lack of ovarian follicular function
- Low oestrogen and progesterone
- LH and FSH High

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403
Q

Lack of oestrogen risks

A 
Osteoporosis 
Pelvic organ prolapse
Urinary incontinence
CVD
Stroke
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404
Q

Symptoms of lack of oestrogen

A 
Hot flashes
Low mood
PMS
irregular and heavy/light period
Low libido
Joint pains
Vaginal dryness
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405
Q

When can menopause be diagnosed?

A

12 months with no periods in women >45yo

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406
Q

When to do FSH blood tests?

A

<40 yo with suspected menopause

40-45yo with symptoms or change in menstruation

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407
Q

Contraception and menopause

A

For 2 years after LMP of <50yo

For 1 year after LMP >50yo

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408
Q

Depo - Provera (progesterone depot injection) SE

A

Weight gain
Reduced bone density / osteoporosis

UNSUITABLE in >45yo

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409
Q

Progesterone with low risk of DVT

A

Norethisterone

Levonorgestrel

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410
Q

Primenopausal symptoms management

A

HRT
Tibolone (steroid hormone, continuous combined HRT)
Clonidine (agonist of alpha-adrenergic and imidazoline receptors)
Testosterone for low libido
Vaginal oestrogen or moisturiser

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411
Q

Premature ovarian insufficiency

A

Menopause <40yo

Hypergonadotrophic hypogonadism

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412
Q

Diagnosis of premature ovarian insufficiency

A

FSH raised >25/30 on 2 samples with 4 weeks apart

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413
Q

HRT under 50yo

A

Does not increase risk of breast cancer

Increased risk of VTE, but this is reduced by transdermal patch

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414
Q

Why progesterone must be added to contraception?

A

Must be given to women with uterus as it prevents endometrial hyperplasia secondary to unopposed oestrogen

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415
Q

Continuous or cyclical HRT

A

if still have periods must go on cyclical HRT with cyclical progesterone and regular breakthrough bleeds

If no periods for >12months go on continuous combined HRT

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416
Q

Non hormonal menopause tx

A 
Lifestyle changes
CBT 
SSRI 
Clonidine (agonist of alpha adrenergic) 
Venlafaxine (SNRI) 
Gabapentin
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417
Q

Clonidine

A

Lowers BP and HR
Alpha 2 adrenergic receptor agonists
Used to prevent vasomotor symptoms
SE dry mouth, headaches, dizziness, fatigue

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418
Q

Alternative remedies for menopause

A 
Black cohosh - cause liver damage
Dong quai - causes bleeding disorders
Red clover - oestrogenic side effects
Primrose oil - clotting disorders and seizures
Ginseng- mood and sleep benefit
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419
Q

HRT risks (worse in older women and longer use)

A

Breast cancer
VTE
Stroke
Coronary artery disease

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420
Q

HRT risks that do not apply

A

To women <50yo
No risk of endometrial cancer if no uterus
No risk of breast cancer and CVD if oestrogen-only HRT

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421
Q

Choosing HRT formulation

A

1) local or systemic symptoms (topical or systemic tx)
2) uterus - combined HRT, no uterus - continuous oestrogen only HRT
3) perimenopausal - cyclical HRT, postmenopausal- continuous HRT

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422
Q

Cyclical progesterone use

A

10-14 days per month

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423
Q

Continuous progesterone HRT

A

When no period in 24months <50yo or 12 months >50yo

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424
Q

Progestogens definition

A

Chemicals that target progesterone receptors

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425
Q

Progesterone

A

Hormone naturally produced in the body

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426
Q

Progestin

A

Synthetic progesterone

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427
Q

Progestogen classes

A

C19 peogestogen derived from testosterone (norethisterone, levonorgestrel, desogestrel) - help with reduced libido

C21 progestogen derived from progesterone (dydrogesterone, medroxyprogesterone) - help with mood and acne

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428
Q

Best way of delivering oestrogen in HRT?

A

Patches, reduced VTE risk

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429
Q

Best way of providing progesterone in HRT?

A

Intrauterine device
Added benefit of contraception and treating heavy period
No progestogenic side effects or risk of breast cancer or CVD

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430
Q

Tibolone

A

Synthetic steroid
Oestrogen and progesterone receptors
Continuous combined HRT
Help with reduced libido

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431
Q

HRT and surgery

A

Stop 4 weeks before major surgery

HRT and oestrogen contraceptive

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432
Q

Oestrogen SE

A

Bloating
Breast swelling
Headache
Leg cramps

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433
Q

Progesterone se

A 
Mood swings 
Bloating
Fluid retention
Acne
Weight gain
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434
Q

Rotterdam criteria for PCOS

A

Anovulation
Hyperandrogenism (hirsuitisn or acne)
PCOS

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435
Q

Drugs causing hirsuitism

A 
Phenytoin
Cyclosporin
Corticosteroids
Testosterone
Anabolic steroids
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436
Q

Pelvic ultrasound in PCOS

A

String of pearls - 12 or more follicles in the ovary

Ovary >10cm3

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437
Q

Impaired fasting glucose

A

6.1-6.9

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438
Q

Impaired glucose tolerance (at OGGT 2h)

A

7.8-11.1

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439
Q

Diabetes OGTY 2h

A

> 11.1

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440
Q

Drugs to induce fertility/ovulation

A

Clomifene

Metformin/letrozole

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441
Q

Hirsuitism mx

A

COCP Co-Cyprindol (treats hirsuitism and acne)

Topical eflornithine

442
Q

Acne mx

A 
Topical adapalene (retinoid)
Topical abs (Clindamycin with benzoyl peroxide)
Tetracycline Abx oral
443
Q

Reducing risk of ovarian cancer (factors)

A

Late menarche
Early menopause
Pregnancy
COCP

444
Q

Risk of malignancy index (whether ovarian mass is malignant)

A

Menopausal status
US
CA125

445
Q

Ovarian cyst Simple 5-7cm

A

Routine gynaecology referral and annual screen

446
Q

Meig syndrome

A

Women (older) with pleural effusion and ovarian mass

Ovarian fibromyalgia
Pleural effusion
Ascites

447
Q

When is ovarian torsion more likely to occur?

A

Pregnancy

Benign tumour

448
Q

Ovarian torsion imaging

A

Whirlpool sign

449
Q

Asherman syndrome

A

Adhesions formed in the uterus due to damage

  • post dilatation and curettage
  • uterine surgery
  • endometritis
450
Q

Asherman syndrome presentation

A

Secondary amenorrhoea
Light periods
Dysmenorrhoea

451
Q

Gold standard ix for Asherman syndrome

A

Hysteroscopy and dissection of adhesions

452
Q

Cervical ectropion

A

Columnar epithelium of endocervix extends to the ectocervix

453
Q

Ectroption presentstion

A

Due to high oestrogen / COCP
increased vaginal discharge
Vaginal bleeding
Dyspareunia

(Boarder between columnar epithelium and squamous epithelium)

454
Q

Ectropion tx

A

Cauterisation with silver nitrate

Cold coagulation during colposcopy

455
Q

Rectocele

A

Defect in posterior vaginal wall, rectum prolapses into the vagina

456
Q

Cystocele

A

Defect in anterior vaginal wall, bladder prolapses backwards into the vagina

If urethra prolapses as well: cystourethrocele

457
Q

Uterine prolapse grades POP-Q

A

Grade 0: normal

1: lowest part >1cm above introitus
2: lowest part within 1cm of introitus
3: lowest part >1cm below introitus
4: full descent with eversion of vagina

458
Q

most common cervical cancer

A

squamous cell carcinoma

Adenocarcinoma

459
Q

hpv cancer strains

A

type 16, 18

HPV inhibits tumour supressor genes

460
Q

risk factors for cervical cancer

A 
smoking
HIV
COCP
increased number of pregnancies
early sexual activity
not using condoms 
increased number of sexual partners
461
Q

CIN - grading for level of dysplasia

A

diagnosed at colposcopy
CIN I: mild dysplasia, affecting 1/3 the thickness of the epithelial layer,
CIN II: moderate dysplasia, affecting 2/3 the thickness of the epithelial layer, ]
CIN III: severe dysplasia, progress to cancer

462
Q

cervical screening programme

A

Every three years aged 25 – 49

Every five years aged 50 – 64

463
Q

exceptions from screening programme

A
  • HIV are screened annually
  • > 65 may request a smear if they have not had one since aged 50
  • previous CIN
  • immunocompromised
  • Pregnant women due a routine smear should wait until 12 weeks post-partum
464
Q

IUD device and smear result

A

Actinomyces-like organisms are often discovered in women with an intrauterine device (coil)

465
Q

inadequate sample

A

repeat the smear after at least three months

466
Q

HPV negative

A

continue routine screening

467
Q

HPV positive with normal cytology –

A

repeat the HPV test after 12 months

468
Q

HPV positive with abnormal cytology –

A

refer for colposcopy

469
Q

acetic acid in colposcopy

A

appear white / acetowhite - CIN and cervical cancer

470
Q

Schiller’s iodine test

A

healthy cells brown, abrnoaml areas do not stain

471
Q

cervical cancer staging

A

Stage 1: Confined to the cervix
Stage 2: Invades the uterus or upper 2/3 of the vagina
Stage 3: Invades the pelvic wall or lower 1/3 of the vagina
Stage 4: Invades the bladder, rectum or beyond the pelvis

472
Q

cervical cancer management

A

1A: LLETZ or cone biopsy
Stage 1B – 2A: Radical hysterectomy and removal of local lymph nodes with chemotherapy and radiotherapy
Stage 2B – 4A: Chemotherapy and radiotherapy
Stage 4B: surgery, radiotherapy, chemotherapy and palliative care

473
Q

Pelvic exenteration

A

removing most or all of the pelvic organs, including the vagina, cervix, uterus, fallopian tubes, ovaries, bladder and rectum.

(for cervical cancer)

474
Q

HPV vaccine

A

Gardasil
strains 6, 11- genital warts
strains 16, 18- cervical cancer

475
Q

most common endometrial cancer and risk factors

A

Adenocarcinoma (oestrogent dependent cancer)

  • obesity
  • diabetes
476
Q

endometrial hyperplsia treatment

A

IUS

continuous oral progestogen (medroxyprogesterone or levonorgestrel)

477
Q

Risk facotrs for endometrial cancer

A 
(unopposed estrogen)Increased age
Earlier onset of menstruation
Late menopause
Oestrogen only hormone replacement 
No pregnancies
Obesity
Polycystic ovarian syndrome
Tamoxifen
478
Q

tamoxifen

A

Tamoxifen has an anti-oestrogenic effect on breast tissue, but an oestrogenic effect on the endometrium

479
Q

protective factors for endometrial cancer

A

Combined contraceptive pill
Mirena coil
Increased pregnancies
Cigarette smoking

480
Q

tx for endometrial cancer

A

radical hysterectomy
radio/chemo
progesterone to slow progression of cancer

481
Q

most common ovarian cancer

A

Epithelial cell tumours (serous tumour most common)

482
Q

germ cell tumours blood results

A

alpha fetoprotein and hCG raised

483
Q

krukenberg tumour

A

metastatis from GI to ovary,

signet ring on histology

484
Q

risk factors for ovarian cancer

A 
BRCA 1 2
obesity
smoking
increased number of ovulation
recurrent use of clomifene
early periods
late menopause
no pregnancies
485
Q

protective facotrs for ovarian cancer

A

COCP
breastfeeding
pregnancy

486
Q

ovarian mass on obturator nerve

A

reffered hip or groin pain

487
Q

ovarian cancer symptromes

A

ascites
pelvic mass
abdominal mass

488
Q

Ix for ovarian cancer

A

CA125 (>35IU/ml is significant)

pelvic ultrasound

489
Q

risk of malignancy index

A

menopausal status
US findigs
CA125

490
Q

germ cell tumour markers

A

raised:
alfa fetoprotein
hCG

491
Q

ovarnian cancer staging

A

Stage 1: Confined to the ovary
Stage 2: Spread past the ovary but inside the pelvis
Stage 3: Spread past the pelvis but inside the abdomen
Stage 4: Spread outside the abdomen (distant metastasis)

492
Q

vulval cancer most common

A

squamous cell carcinoma

493
Q

risk factors for vulval cancer

A

> 75yo
immunosurpression
HPV
lichen sclerosus

494
Q

frequent location of vulval cancer

A

labia majora

ulceration, bleeding, irregular mass

495
Q

Mx in vulval cancer

A

wide local excision
groin lymph node dissection
chemo
radio

496
Q

BV bacteria

A 
anaerobic bacteria 
due to loss of lactobacilli
- Gardnerella vaginalis (most common)
- Mycoplasma hominis
- Prevotella species
497
Q

BV 4

A

clue cells on microscopy
pH >4.5
fishy smell
grey-white discharge

498
Q

mx of BV

A

Metronidazole PO - DO NOT DRINK alcohol, causes N&V, flushing, shock, angiodema
Clindamycin

499
Q

Candidiasis

A

candida albicans
thick white discharge
vulval and vaginal itching, irritation, discomfort
+- erythrema, dyspareunia, dysuria

500
Q

Risk factors for candidasis

A

oestrogen increase (pregnancy)
poorly controlled diabetes
immunosuppression
borad-spectrrum abx

501
Q

pH bacterial vaginosis and trichomonas

A

pH >4.5

502
Q

pH candidiasis

A

pH <4.5

503
Q

candidiasis diagnosis

A

charcoal swab with microscopy

504
Q

candidiasis mx

A 
clotrimazole cream intravaginal (5g 10%)
clotrimazole pessary (500mg)
3 doses of clotrimazole pessaries 200mg 3 nights
oral antifungal tablets: fluconazole (150mg)
505
Q

sex vs candidiasis medication

A

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

506
Q

Chalmydia trichomatis

A

gram -ve bacteria
intracellylar organism
MOST COMMON STI IN UK

507
Q

Chlamydia diagnosis

A

NAAT - nucleic acid amplification tests

508
Q

chlamydia tx

A

doxycycline 100mg 2x daily for 7 days

-contraindicated in pregnancy/brestfeeding
Azithromycin 1g stat then 500mg 1x for 2d
Erythromycin 500mg 4x day for 7d
Erythromycin 500mg 2x dayfor 14 days
Amoxicillin 500mg 3x daily for 7 days

509
Q

LGV

A

painless ulcer and painful lymphadenopathy

Doxycycline 100mg 2x daily for 21 days

510
Q

Gonnorhoea

A

gram -ve dipoloccus

infects mucous membranes with columnar epithelium (endocervix, urethra, rectum, conjunctiva, pharynx)

511
Q

gonorrhoea symptoms

A

discharge odourless
dysuria
pelvic pain
or epidydimo-orchitis

512
Q

Gonorrhoea diagnossi

A

NAAT

513
Q

gonorrhoea tx

A

A single dose of intramuscular ceftriaxone 1g if the sensitivities are NOT known

A single dose of oral ciprofloxacin 500mg if the sensitivities ARE known

514
Q

complication of gonococcal conjunctivitis in neonate

A

Neonatal conjunctivitis is called ophthalmia neonatorum (sepsis, blindness)

515
Q

disseminated gonoccoal infection

A 
complication of untreated gonoccoal infection, bacteria spreads to skin and joints
non-specific skin lesions
joint aches and pains
arthritis that moves between joints
Tenosynovitis
Systemic symptoms
516
Q

Mycoplasma genitalium and dx

A

non gonococcal urethritis
First urine sample in the morning for men
Vaginal swabs (can be self-taken) for women

517
Q

mycoplasma genitalium tx

A

Doxycycline 100mg 2x day for 7d
then
Azithromycin 1g stat then 500mg OD for 2 days (unless it is known to be resistant to macrolides)

If pregnant/breastfeeding: NO Doycycline

518
Q

PID causes

A

Neisseria gonorrhoeae (severe PID)
Chlamydia trachomatis
Mycoplasma genitalium

519
Q

PID symptoms

A 
Pelvic tenderness
cervical excitiation
cervicitis
purulent discharge
fever
dysuria, dyspareunia
520
Q

PID tx

A

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

521
Q

complications of PID

A

Fitz-Hugh-Curtis syndrome

nflammation and infection of the liver capsule, leading to adhesions between the liver and peritoneum.

522
Q

trichomonas

A 
protozoan flagella
swab from posterior fornix of vagina
pH >4.5
forthy yellow-green
fishy smell
strawberry cervix (colpitis macularis)
tx Metronidazole
523
Q

HSV

A

cold sores (hepres labialis) and genital herpes
HSV 1 and HSV 2
multiple painful ulcers
viral PCR

524
Q

HSV tx

A

aciclovir
1* genital herpes treat with acyclovir (if contracted before 28weeks gestation) - acyclovir at infection and prophylactic aciclovir from 36w. if asymptomatic -> vaginal delivery

1*genital herpes after 28 weeks treat with acyclovir until delivery, C section

525
Q

HIV most common type

A

HIV -1

virus enters and destroys CD4 T=helper cells

526
Q

AIDS defining ilness

A 
Kaposi’s sarcoma
Pneumocystis jirovecii pneumonia (PCP)
Cytomegalovirus infection
Candidiasis (oesophageal or bronchial)
Lymphomas
Tuberculosis
527
Q

when to test for HIV

A

can be negative up to 3 months post exposure

Antibody testing for HIV
PCR testing for viral load

528
Q

CD4 in HIV

A

500-1200 cells/mm3 is the normal range

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

529
Q

PCP prophylaxis

A

co-trimoxazole (septrin)

530
Q

HIV and birth

A

vaginal delivery if <50 copies/ml
C section if >50 copies
IV zidovudine given to mother >10 000

Bebo:
if mother <50: zidovudine 4w
if mother >50: zidovudine, lamivudine, nevirapine for 4w

531
Q

PEP

A

ART therapy

Truvada (emitricitabine and tenofovir) and raltegravir, for 28d

532
Q

Syphilisi

A

teponema pallidum
spirochete
spiral-shaped bacteria

incubation period 21d

533
Q

stages of syphilis

A

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

534
Q

syphilis dx

A

antibody testing

samples for dark field microscopy or PCR

535
Q

syphilis tx

A

deep IM benzathine benzylpenicillin

alternative: ceftriaxone, amoxicillin, docycyline

536
Q

UKMEC

A

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

537
Q

What contraception to avoid in breast cacncer?

A

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

538
Q

What contraception to avoid in cervical/endometrial cancer?

A

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

539
Q

what contraception to avoid in Wilson’s disease?

A

avoid copper coil

540
Q

RF to avoid COCP

A

Uncontrolled hypertension (particularly ≥160 / ≥100)
Migraine with aura
History of VTE
>35yo smoking >15 cigarettes/day
Major surgery with prolonged immobility
Vascular disease or stroke
Ischaemic heart disease, cardiomyopathy or atrial fibrillation
Liver cirrhosis and liver tumours
Systemic lupus erythematosus and antiphospholipid syndrome

541
Q

when should progestogen injection (Depo provera) be stopped?

A

before 50yo due to risk of osteoporosis

542
Q

lactational amenorrhoea

A

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

543
Q

IUS/IUD in breastfeeding?

A

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

544
Q

COCP and rbreastfeeding

A

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

545
Q

COCP MOA

A

prevents ovulation
progesterone thickens mucus
progesterons recued endometrial proliferation

546
Q

2 types of COCP

A

monophasic (same amount of hormone in each pill)

multiphasic (varying amounts of hormone to match normal cyclical changes)

547
Q

COCP with lower risk of VTE

A

progesterone as levonorgester or norethisterone

548
Q

1st line COCP for PMS

A

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

549
Q

COCP in treatemtn of acne/hirsutism

A

Dianette - with cuproterone acetate, but high risk of VTE

550
Q

COCP benefits

A

improves PMS, menorrhagia, dysmenorrhoea,

reduced risk of endometrial , ovarian, colon cancer

551
Q

starting COCP

A

no additional contraception if starting in 1st 5 days of cycle

if after 5 days, requres extra contraception for 7 days

552
Q

how to switch COCPs?

A

take one pack after the other with no pill free interval

553
Q

swithing from POP to COCP

A

switch at any time but 7days extra contracception

unless switching from desogestrel which inhibits ovulation, then no extras

554
Q

when to stop COCP

A

4 weeks before major operation

555
Q

the only POP UKMEC 4

A

active breast cancer

556
Q

POP MOA

A

Thickening the cervical mucus
Altering the endometrium and making it less accepting of implantation
Reducing ciliary action in the fallopian tubes

557
Q

starting POP

A

if starting on days 1-5 no extras
if after day 5, additional contraception is required for 48h.

if switching from POP - extra contraception for 48h (best to switch during hormone free period)

558
Q

progesterone only injection (DMPA)

A

IM or SC every 12-13 weeks, medroxyrpogesterone acetate

depo provera: IM
sayana press: SC self injection

noristerat - norethisterone for 8 weeks, altrnative

559
Q

progesterone only injection (DMPA)

A

IM or SC every 12-13 weeks, medroxyrpogesterone acetate

depo provera: IM
sayana press: SC self injection

noristerat - norethisterone for 8 weeks, altrnative

560
Q

progesterone only injection (DMPA)

A

IM or SC every 12-13 weeks, medroxyrpogesterone acetate

depo provera: IM
sayana press: SC self injection

noristerat - norethisterone for 8 weeks, altrnative

561
Q

Progesterone injection MOA

A

inhibits ovulation
thickens mucus
alters endometrium

562
Q

when to do progesterone injection

A

day 1-5 of cycle

if after that, 7 days extra contraception

563
Q

SE of progesterone injection

A

1) weight gain
2) osteoporosis
alopecia
reduced libido
delays return to fertility
mood changes

benefits: recued sickle cell crisis severity, improved endometriosis or dysmenorrhoea

564
Q

progesterogen only implant +MOA

A

lasts 3 years
nexplanon (etonogestrel)

inhibits ovulation
thickens mucus
alterns endometrium

565
Q

age of sexual consent

A

13 yo

566
Q

IUD and smear - organism

A

actinomyces like organisms

567
Q

UPSI

A

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

568
Q

levonorgestrel Emergency contraception

A

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

569
Q

Levonorgestrel doses

A

1.5mg as a single dose

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

570
Q

Ullipristal (EllaOne) emergency contraception

A 
single dose (30mg)
wait 5 days until starting the combined pill or progestogen-only pill after taking ulipristal
cndoms 7days cocp, 2days pop
571
Q

Ulipristal restriction

A

Breastfeeding - avoid 7d post ulipristal

Avoid in pts with asthma (Severe)

572
Q

female hormone testing in intertility

A

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

573
Q

how to stimulate ovulation

A 
clomifene 
letrozole (aromatase inhibitor)
gonadotropins 
ovarian drilling
metformin
574
Q

Azoospermia

A

absence of sperm in the semen.

575
Q

Cryptozoospermia

A

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

576
Q

Polyspermia (or polyzoospermia)

A

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

577
Q

Normospermia (or normozoospermia)

A

normal characteristics of the sperm in the semen sample.

578
Q

Oligospermia

A 
reduced number of sperm in semen sample
Mild oligospermia (10 to 15 million / ml)
Moderate oligospermia (5 to 10 million / ml)
Severe oligospermia (less than 5 million / ml)
579
Q

IVF steps

A 
Suppressing the natural menstrual cycle
Ovarian stimulation
Oocyte collection
Insemination / intracytoplasmic sperm injection (ICSI)
Embryo culture
Embryo transfer
580
Q

Ovarian hyperstimulation syndrome

A

complication of ovarian stimulation during IVF infertility treatment

  • increase in VEGR increased vascular permeability
  • oedema, ascites, hypovolaemia
  • raised renin level
  • Haematocrist indicates dehydration
581
Q

Prevention of gout

A

Allopurinol (inhibits xanthine oxidase)

100mg OD titrated to serum uric acid of 300umol/L

582
Q

Allopurinol interactions

A

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

583
Q

Alpha blockers use

A

HTN
BPH

SE: postural hypotension
Drowsiness
Confusion

584
Q

Alpha blockers examples

A

Postural hypotension
Drowsiness
Dyspnoea

585
Q

Sildenafil contraindications

A

Nitrates and nicorandil

586
Q

Oculogyric crisis in overdose. Drug

A

Antipsychotics
Metoclopramide
(Extrapyramidal Side effect)

587
Q

Lithium toxicity precipitants

A 
Thiazides
Bendroflumethazide
ACE inhibitors and Angiogensin II
NSAID
Metronidazole
588
Q

Digoxin antibody

A

Digibind

589
Q

Lactic acidosis risk?

A

Suspend Metformin in illness like diarrhoea and vomiting

590
Q

Serotonin syndrome drugs (causative)

A

SSRI
Ecstasy
Amphetamine
MAO inhibitors

591
Q

Heroin overdose

A

Respiratory depression

CNS depression

592
Q

Cocaine overdose

A

Chest pain
Mood changes
Cardiac symptoms

593
Q

Aminoglycoside antibiotics

A

Ototoxicity + nephrotoxicity

594
Q

Severe renal impairment VTE prophylaxis

A

LMWH - allowed in <30 creatinine but high bleeding risk

-> Unfractioned heparin 1st line

595
Q

Anion gap normal and formula

A

10-18

Na+ + K+) - (Cl- + HCO3-

596
Q

Ethylene glycol toxicity

A

Metabolic acidosis with high anion gap

597
Q

Cyclosporin se

A 
Everything high
HTN
high fluid
High K+
Hair, gums, glucose

(It is immunosuppressant)

598
Q

Which diuretics should not be combined?

A

Amiloride + Spironolactone

Both potassium sparing

599
Q

Drugs causing urinary retention

A 
TCA (Amitryptyline)
Antipsychotics
Antihistamine
Opioids
NSAID
600
Q

TCA overdose

A

Amitryptyline or dothiepin, dusolepin

Dry mouth 
Dilated pupils
Agitation 
Sinus tachy 
Blurred vision 
QT prolongation
Coma
Metabolic acidosis
Seizures 
Arrhythmias
601
Q

Tuberculosis drugs SE

A

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

602
Q

P450 inducers

A 
CRAP GPSSS
Carbamazepine
Rifampicin
Alcohol (chronic) 
Phenytoin 
Griseofluvin
Phenobarbital
Sulphonylurea
Smoking
St John wort
603
Q

Inhibitors of p450 (will cause toxicity)

A

Sick faces . Com (+ grapefruit)

Sodium valproate
Isoniazid 
Chloramphenicol
Ketoconazole
Fluconazole
Alcohol Acute, Amiodarone, Allopurinol 
Cimetidine
Erythromycin
Sulfonamides, Sertraline/Fluoxetine 
.
Ciprofloxacin
Omeprazole
Metronidazole
604
Q

Heparin mechanism of action

A

Activates: antithrombin III
Inhibits: thrombin, factors Xa, IXa, XIa, XIIa

605
Q

LMWH mechanism of action

A

Activates: antithrombin III
inhibits: factor Xa

606
Q

Salicylate overdose

A

Respiratory alkalosis followed by metabolic acidosis

Tinnitus
Anxiety
Seizures
Sweating
Lethargy
Hypervention
607
Q

Serotonin syndrome

A 
SSRI/ MAOI/ ecstasy
Onset hours 
Hyperreflexia, Clonus, dilated pupils 
Tachycardia, HTN
pyrexia, rigidity
IV fluids, benzodiazepines
Mx cyproheptadine, chlorpromazine
608
Q

Neuroleptic malignant syndrome

A 
caused by antipsychotics 
Slow onset hours-days
Hyporeflexes, rigidity (lead-pipe) normal pupils
Tachycardia, HTN
pyrexia, rigidity
IV fluids, benzodiazepines
Mx: dantrolene
609
Q

Organophopshate insecticide poisoning

A

Salivation
Lacrimation
Urination
Diarrhoea

+ Small pupils

Mx: atropine

610
Q

Galactorrhoea treatment

A

Dopamine agonist (eg ropinirole)

611
Q

Paracetamol overdose biochemistry

A

ALP and AST in 10,000

612
Q

Ecstasy/ MDMA overdose

A 
Agitation, confusion, anxiety, ataxia
Tachycardia, HTN
fever 
Hyponatremia 
Rhabdomyolysis

Mx: dandrolene

613
Q

Aminoglycosides examples

A

Gentamycin
Neomycin
Tobramycin

614
Q

ectopic pregnancy location

A

fallpian tube

615
Q

ectopic pregnancy risk factors

A 
Previous ectopic pregnancy
Previous pelvic inflammatory disease
Previous surgery to the fallopian tubes
Intrauterine devices (coils)
Older age
Smoking
616
Q

US mass with empty gestational sac

A

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

617
Q

tubal ectopic pregnancy vs corpus luteum

A

corpus luteum moves WITH the ovary

the tubal ectopic moves SEPARATELY to ovary

618
Q

When should bHCG double?

A

Every 48h

619
Q

when should pregnancy be visible on US?

A

hCG >1500 IU/L

620
Q

Ectopic expectant management criteria

A 
The ectopic needs to be unruptured
Adnexal mass < 35mm
No visible heartbeat
No significant pain
HCG level < 1500 IU / l
621
Q

Ectopic medical management criteria

A 
HCG level must be < 5000 IU / l
Confirmed absence of intrauterine pregnancy on ultrasound
The ectopic needs to be unruptured
Adnexal mass < 35mm
No visible heartbeat
No significant pain
622
Q

Ectopic surgical management

A

The ectopic needs to be unruptured
Adnexal mass < 35mm
No visible heartbeat
No significant pain

-Laparoscopic salpingectomy
Laparoscopic salpingotomy

623
Q

surgical management of ectopic - prophylaxis

A

Anti D to Rh negative women

624
Q

Miscarriage dates criteria

A

Early <12 weeks gestation

Late >12 weeks gestation

625
Q

Missed miscarriage

A

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

626
Q

Threatened miscarriage

A

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

627
Q

Inevitable miscarriage

A

– vaginal bleeding with an open cervix

628
Q

Incomplete miscarriage

A

retained products of conception remain in the uterus after the miscarriage

629
Q

Complete miscarriage

A

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

630
Q

Anembryonic pregnancy

A

– a gestational sac is present but contains no embryo

631
Q

fetal heartbeat

A

when crown-rump length >7mm

632
Q

<7mm, no heartbeat

A

repeat US after >7d

then if >7mm and no heartbeat: Non-Viable Pregnancy

633
Q

Mean gestational sac diameter >25mm without a fetal pole

A

Repeat after 1 week and confirm Anembryonic pregnancy

634
Q

Miscarriage medical management

A

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

635
Q

Misoprostol side effects

A

Heavier bleeding
Pain
Vomiting
Diarrhoea

636
Q

Surgical management of miscarriage

A

Manual vacuum aspiration under local anaesthetic as an outpatient OR
Electric vacuum aspiration under general anaesthetic

Prostaglandins (misoprostol) given before surgical management

637
Q

ERPC - evacuation of retained products of conception

A

under GA
cervix dilated, retained products removed though vaccum aspiration and curettage

Key complication: endometritis

638
Q

Recurrent miscarriage definition

A

3 or more consecutive miscarriages

investigations after: 3 1st trimester, 1 2nd trimester miscarriage

639
Q

hereditary thrombophilias (miscarriage)

A 
Factor V Leiden (most common)
Factor II (prothrombin) gene mutation
Protein S deficiency
640
Q

uterine abnormalities (miscarriage)

A

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

641
Q

Chronic Histiocytic Intervillositis (miscarriage)

A

2nd trimester miscarriage
causes IUGR and IUD death
infiltrated of mononuclear cells in intervillous space

642
Q

Ix in recurrent miscarriage

A 
Antiphospholipid antibodies
Testing for hereditary thrombophilias
Pelvic ultrasound
Genetic testing of the products of conception from the third or future miscarriages
Genetic testing on parents
643
Q

latest legal abortion

A

24w

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

644
Q

Medical abortion

A

Mifepristone (anti-progestogen) - stops the pregnancy and relaxes cervix
Misoprostol (24-48h later) - prostaglandin analogue, softens cervix and stimulates contractions

> 10w gestation, misoprostol every 3h dose until expulsion

645
Q

Surgical abortion

A

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

646
Q

hyperemesis gravidarum

A

More than 5 % weight loss compared with before pregnancy
Dehydration
Electrolyte imbalance

647
Q

PUQE score

A

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

648
Q

Antiemetics in pregnancy (in order of safety)

A

Prochlorperazine (stemetil)
Cyclizine
Ondansetron
Metoclopramide

+ginger and acupressure

649
Q

Acid reflux treatment in pregnancy

A

Ranitidine or Omeprazole

650
Q

When to admit in hyperemesis gravidarum?

A

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

651
Q

complete mole

A

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

652
Q

Partial mole

A

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

653
Q

symptoms of molar pregnancy

A 
More severe morning sickness
Vaginal bleeding
Increased size of uterus
abnormally high hCG
Thyrotoxicosis
654
Q

Paracetamol overdose mx

A

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

655
Q

Salicylate overdose mx

A

urinary alkalinization with IV bicarbonate

haemodialysis

656
Q

Benzodiazepines overdose mx

A

Flumazenil (risk of seizures tho)

657
Q

TCA overdose mx

A

IV bicarbonate - reduced seizure risk and arrhythmia risk

1st step is correct the acidosis

658
Q

Lithium overdose mx

A

haemodialysis

sodium bicarbonate

659
Q

Warfarin overdose mx

A

Vitamin K, prothrombin complex

660
Q

Heparin overdose mx

A

Protamine sulphate

661
Q

B blockers overdose mx

A

if bradycardic then atropine

in resistant cases glucagon may be used

662
Q

Etylene glycol

A

fomepizole - inhibitor of alcohol dehydrogenase

haemodialysis

663
Q

Methanol poisoning mx

A

fomepizole or ethanol

haemodialysis

664
Q

Organophosphate insecticides overdose/poisoning mx

A

atropine

665
Q

CO2 poisoning mx

A

100% oxygen

hyperbaric oxygen

666
Q

Cyanide poisoning mx

A

Hydroxocobalamin

667
Q

Iron overdose mx

A

Desferrioxamine, a chelating agent

668
Q

Lithium monitoring

A

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

669
Q

Meig’s syndrome

A

Benign ovarian tumour
Ascites
Pleural effusion

670
Q

Caplan syndrome

A

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

671
Q

RA histology

A

Fibrinoid necrosis surrounded by palisading epithelioid cells

672
Q

Cribriform plate fx

A

Panda eyes/ periorbital bruising
Rhinorrhoea - CSF leaking
Do not use nasogastric tube or nasal airway adjunct - can enter the cranium

673
Q

Disulfiram reaction

A

Reaction to medication (or alcohol cessation medication)

Eg metronidazole, disulfiram

674
Q

Homonymous quadrantopias

A

Superior - inferior optic radiation temporal lobe lesion (meyers loop)

Inferior - superior optic radiation in parietal lobe lesion

PITS

675
Q

Bitemporal hemianopia

A

Upper quadrant defect - inferior chiasm compression, pituitary tumour

Lower quadrant - superior chiasm compression, craniopharyngioma

676
Q

Smoking and p450

A

Induces metabolism

677
Q

Tetralogy of fallot

A

VSD
Pulmonary stenosis
Overriding aorta
Right ventricular hypertrophy

Ejection systolic murmur left eternal border

678
Q

Vascular dementia

A

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

679
Q

Lewy body dementia

A

Parkinsonian symptoms
Visual hallucinations
Sleep behaviour disorders

680
Q

Frontotemporal dementia

A 
Personality changes
Loss of insight 
Stereotypes behaviours 
Slowly progressive, onset <70yo
Family history
681
Q

Travellers diarrhoea cause

A

Enterotixigenic escherichia coli

682
Q

POPQ prolapse

A

Stage 1 cervix prolapses more than 1cm above hymen

Stage 2 - prolapse between 1cm above and 1cm below level of hymen

683
Q

Acute Subdural haematoma

A

Elderly on warfarin
No head trauma
Fluctuating confusions and consciousness

684
Q

Yersinia enterocolitica

A

Invasive gastroenteritis
Mesenteric lymphadenitis
Erythrema nodosum

685
Q

Schizoid personality disorder

A 
Alone
Loneliness
Odd behaviour
No socialising
Flat affect
686
Q

Schizotypal personality disorder

A

Magical and weird thinking

687
Q

Schizophrenia and schizoaffective disorder

A

Have Psychotic symptoms

688
Q

Ottawa ankle rules

A

X ray is required if:

1) pain
2) - medial malleolus tenderness
- lateral malleolus tenderness
- inability to bear weight

689
Q

Absent femoral pulses

A

Coarctation of the aorta
Tx balloon angioplasty
Re coarctation can occur, plus HTN and CVD

690
Q

Acute PE and shock - thrombolytic choice

A

Streptokinase

691
Q

Supracondylar humerus fx nerve injury

A

Anterior interosseous nerve injury

Weakness to 2nd finger

692
Q

Musculocutsneous nerve ix

A

Atrophy of biceps brachii

693
Q

Ulnar nerve injury

A

4th and 5th fingers loss of sensation

694
Q

Gonorrhoea symptoms

A

Thick green-yellow discharge from the vagina
Painful urination
Bleeding between periods

695
Q

Chlamydia sx

A

Pain on urination
Vaginal discharge
Bleeding between periods

696
Q

Dyskinesia vs akathisia

A

Tardive dyskinesia - involuntary movement (chorea movement)

Akathisia - restlesness

697
Q

Giant cell arteritis vision loss type

A

Anterior ischaemic optic neuropathy

698
Q

Cataract surgery complications

A

Endophthalmitis

Posterior capsule opacification

699
Q

1st line treatment for prolactinoma

A

Bromocriptine or cabergoline

Dopamine receptor agonist

700
Q

Cat scratch organism and symptoms

A

Bartonella henselae
Brownish red papules
Lymphadenopathy

701
Q

Antistreptolysin O titer

A

Used to determine recent group A strep infection

702
Q

INR 6-8, no bleeding

A

Stop warfarin
Check INR
Recommence warfarin if <5

703
Q

INR >8 minor/no bleeding

A

Stop warfarin
5mg oral vit K, 0.5-1mg IV
Recheck INR and can re give vit K in 24h
Recommence warfarin if INR <5

704
Q

Raised INR with major bleeding

A

Stop warfarin

IV phytomenadione and fresh frozen plasma 15mg/kg

705
Q

Shigella treatment

A

(Severe if bloody diarrhoea - dysentery)

Ciprofloxacin 500mg PO BD 1day
Or
Azithromycin 500mg PO OD for 3 days

Shigella is notifiable disease

706
Q

Pre eclampsia risk factors

A 
Nullparity
Previous pre eclampsia
Family history
Maternal age >40
Pregnancy interval >10
Multiple pregnancy 
HTN
BMI >35
Pre existing vascular/kidney/diabetes
707
Q

Hep B serology

A

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

708
Q

If HBsAg -ve

A

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

709
Q

If HBsAg +

A

IgM a-HBc
+ acute infection
- chronic infection

710
Q

If HBsAg -

a-HBc -

A

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

711
Q

SLE ab

A

Anti-dsDNA
anti-Histone
Anti-Smith
ANA

712
Q

Polymyositis

A

Anti-Jo1

713
Q

Myasthenia gravis

A

Anti-acetylcholine receptor

714
Q

Lambert Eaton ab

A

Anti-VGCC

715
Q

HIV treatment drugs

A

2 nucleotide reverse transcriptase inhibitors

1 NNRTI or integrase inhibitor

716
Q

Anatomical landmarks spine

A

T3 spine of scapula
T7 inferior aspect of scapula
L4 superior aspect of iliac crest
S2 PSIS

717
Q

Scabies treatment

A

Caused by sarcoptes scabiei

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

718
Q

Anterior tongue tie vs posterior tongue tie

A

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

719
Q

Allergic rhinitis in pregnancy

A

Oral loratadine

720
Q

GCS motor

A 
6 obeys commands
5 localises pain
4 withdraws from pain
3 abnormal flexion 
2 abnormal extension
1no response
721
Q

Rubella vaccination antibodies

A

IgM antibody negative

IgG antibody positive

722
Q

Amiodarone se and tx

A

se: hypothyroidism, tx with levothyroxine (amiodarone ctd)

723
Q

when to prescribe cyclical combined HRT

A

LMP <1y ago

724
Q

when to prescribe continyous combined HRT

A
  • taken cyclical combined for 1year
  • at least 1y since LMP
  • at least 2y since LMP in premature menopause (<40y)
725
Q

TCA overdose

A

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

726
Q

Ethylene glycol overdose tx

A

Fomepizole

727
Q

opioid detox drug

A

Methadone

728
Q

lorazepam overdose (benzodiazepine) tx

A

gaba antagonist

FLUMAZENIL

729
Q

adrenaline doses

A

anaphylaxis: 0.5mg - 0.5ml 1:1,000 IM

cardiac arrest: 1mg - 10ml 1:10,000 IV or 1ml of 1:1000 IV

730
Q

salicylate poisoning

A

1) resp alkalosis

2) metabolic acidosis

731
Q

anaphylactoid reactions to IV acetylcysteine

A

stop IV acetylcysteine
give nebulised salbutamol
restart IV infusion at a slower rate

732
Q

ciprofloxacin SE

A

lowers seizure threshold

tendonitis

733
Q

metronidazole se

A

reaction following alcohol ingestion

734
Q

doxycycline se

A

photosensitivity

735
Q

trimethoprim side effects

A

photosensitibty
pruritis
supression of haematopoiesis

736
Q

LSD intoxication tx

A

Lorazepam

737
Q

criteria for paracetamol liver transplant

A

Arterial pH < 7.3, 24 hours after ingestion

or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

738
Q

CURB

A
739
Q

Alcohol addiction drugs

A

benzodiazepines for acute withdrawal

disulfram: promotes abstinence (contraindications: ischaemic heart disease, psychosis)
acamprosate: reduces craving

740
Q

heparin overdose tx

A

protamine sulphate

741
Q

ACE inhibitors se

A

cough

hyperkalaemia

742
Q

bendroflumethiazide se

A

gout
hypokalemia
hyponatremia
impaired glucose tolerance

743
Q

calcium channel blockers se

A

headache
flushing
ankle oedema

744
Q

beta blockers se

A

bronchospasm
fatigue
cold peripheries

745
Q

doxazosin se

A

postural hypotension

746
Q

ethylene glycol toxicity

A

Fomepizole

747
Q

amarurosis fugax tx

A

Aspirin

748
Q

Malignant melanoma margins

A
749
Q

Bishop score

A
750
Q

fever followed by maculopapular rash

A

(Once fever resolved)

Roseola infantum HHV6

751
Q

Itchy red papillae lesions between toes and fingers

A

Scabies - sarcoptes scabiei

752
Q

Bilateral malar erythrema

A

Slapped cheek syndrome / 5th disease

Parvovirus b19

753
Q

Papules and vesicles and pustules

A

Chicken pox VZV

754
Q

Widespread erythrema and tenderness, desquamation

A

Scalded skin syndrome

Staphylococcus

755
Q

Painful vesicular lesions on hands, feet, mouth

A

Hand foot and moths

Coxsackie virus

756
Q

Erythrematous pustules with yellow crust

A

Impetigo

Staph aureus

757
Q

Erythrematous rash in nappy

A 
Irritant dermatitis (spares flexures)
Candida (involves flexures)
Seborrhoeic dermatitis (scalp changes, not itchy)
758
Q

Vesicles surrounded by maculopapular rash (target like)

A

Erythrema multiformae

759
Q

Measles

A 
Spread by droplets
Incubation 7-12d
Cough, conjunctivitis, fever 
Koplik spots 
Rash from behind the ears to face neck and body
Supportive treatment
760
Q

Mumps

A

Supportive treatment
Complication- orchitis, encephalitis
Prodromal fever and malaise
Droplet, 12-21 incubation

761
Q

Rubella

A

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

762
Q

2 month vaccinations

A

DTaP/IPV/Hib, MenB, rotavirus

763
Q

3 month vaccinations

A

DTaP/IPV/Hib, PCV, rotavirus

764
Q

4 months vaccines

A

DTaP/IPV/Hib, PCV, MenB

765
Q

12 month vaccines

A

Hib/MenC, PCV, MMR, MenB

766
Q

3 years vaccines

A

MMR/DTaP/IPV

767
Q

12 years vaccines

A

HPV

768
Q

14 years vaccines

A

MenACWY/DTa/IPV

769
Q

Live attenuated vaccines

A 
TB
OPV (polio vaccine)
MMR
Rotavirus 
Yellow fever
770
Q

Inactivated vaccines (killed antigen)

A

Pertrussis

IPV

771
Q

Inactivated toxins

A

Diptheria

Tetanus

772
Q

Paediatric fluids

A

0.9 NaCl and 5% dextrose

24h Na 2-4mmol/kg
24h K 1-2mmol/kg

773
Q

developmental milestones

A
774
Q

G4 P3

A

A pregnant woman with three previous deliveries at term

775
Q

G1 P1

A

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

776
Q

G1 P0 + 1

A

A non-pregnant woman with a previous miscarriage

777
Q

G1 P1

A

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

778
Q

booking clinics

A

<10w

779
Q

Dating scan

A

Between 10 and 13 + 6

An accurate gestational age is calculated from the crown rump length (CRL), and multiple pregnancies are identified

780
Q

Anomaly scan

A

Between 18 and 20 + 6

An ultrasound to identify any anomalies, such as heart conditions

781
Q

Antenatal appointments

A

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

782
Q

Oral glucose tolerance test in pregnancy

A

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

783
Q

Anti-D injections

A

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

784
Q

placenta praevia on the anomaly scan

A

Ultrasound scan at 32 weeks

785
Q

vaccines in pregnancy

A 
Whooping cough (pertussis) from 16 weeks gestation
Influenza (flu) when available in autumn or winter
786
Q

FAS

A 
Microcephaly 
Thin upper lip
Smooth flat philtrum
Short palpebral fissure 
Learning disability
Behavioural difficulties
Hearing and vision problems
Cerebral palsy
787
Q

Smoking in pregnancy

A 
Fetal growth restriction (FGR)
Miscarriage
Stillbirth
Preterm labour and delivery
Placental abruption
Pre-eclampsia
Cleft lip or palate
Sudden infant death syndrome (SIDS)
788
Q

Combined test

A

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

789
Q

Triple test

A

between 14 and 20 weeks gestation
Beta-HCG – a higher result indicates greater risk
Alpha-fetoprotein (AFP) – a lower result indicates a greater risk
Serum oestriol (female sex hormone) – a lower result indicates a greater risk

790
Q

quadruple test

A

between 14 and 20 weeks gestation
Beta-HCG – a higher result indicates greater risk
Alpha-fetoprotein (AFP) – a lower result indicates a greater risk
Serum oestriol (female sex hormone) – a lower result indicates a greater risk
Inhibin-A - higher inhibin-A indicates a greater risk.

791
Q

If risk of Down syndrome 1:150

A

Chorionic vilious sampling >15weeks

Amniocentesis later in pregnancy

792
Q

Hypothyroid in pregnancy

A

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

793
Q

anti-epileptics safe in pregnancy

A

Levetiracetam, lamotrigine and carbamazepine

794
Q

anti-epileptics safe in pregnancy

A

Levetiracetam, lamotrigine and carbamazepine

795
Q

Anti epileptics to avoid in pregnancy

A

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

796
Q

Telogen effluvium

A

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

797
Q

Anagen effluvium

A

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

798
Q

Trichotillomania

A

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

799
Q

Insulinoma

A

Rise in insulin
Rise in C-peptide
Presents with hypoglycaemia

800
Q

Factitious hypoglycaemia (eg exogenous insulin injection)

A

Elevated insulin
Low C-peptide
Presents with hypoglycaemia

801
Q

5th disease risk

A

Fetal death if pregnant women infected

- parvovirus b19

802
Q

Measles complications

A

acute demyelinating encephalitis

hearing loss

803
Q

Rubella complications

A

congenital deafness (most common cause of congenital deafness)

804
Q

Scarlet fever (group A haemolytic strep) complications

A

Rheumatic fever

805
Q

Normal CSF results

A 
WCC (5x 10^6) all lymphocytes, no neutrophils
RBC: 10
protein 0.2-0.4 (<1% from serum)
glucose: 3.3-4.4 (>60% from serum)
pH: 7.31
opening pressure: 70-180 mmH2O
806
Q

Right homonymous hemianopia with macular sparing

A

left occipital visual cortex

807
Q

Gamophobia

A

phobia of getting marries

808
Q

Acrophobia

A

fear of heights

809
Q

Algophobia

A

fear of pain

810
Q

Kawasaki disease mnemonic and complication

A

CRASH and burn

coronary artery aneurysm

811
Q

DMD treatment

A

steroids

812
Q

Most common cause of genital ulcerative disease

A

HSV - 2

813
Q

Tropicamide

A

mydriatic, pupil dilator

814
Q

Pilocarpine

A

miotic eye drops

815
Q

cyclopenolate

A

mydriatric, long acting eye drop

816
Q

HSV microscopy/ also CMV and VZV

A

multinucleated giant cells

817
Q

Reduced CSF glucose:plasma ratio <60% on LP

A

bacterial meningitis

818
Q

Erythrema nodosum most common causes

A

tuberculosis and sarcoidosis

819
Q

cavernous sinus thrombosis

A

visual disturbance
CNs III, IV, VI
ophthalmoplegia and diplopia

820
Q

Aims of antiretroviral therapy

A

<50 copies of viral load
CD4 >350
reduce transmission
increase quality of life without drug side effects

821
Q

Akathisia vs tardive dyskinesia

A

tardive dyskinesia - oral-facial movements, excessive blinking, lip smacking, grimacing, tongue movements

akathisia - restlessness, can’t sit still

822
Q

Hep C treatment

A

ledipasvir/sofosbuvir

823
Q

Craniopharyngioma vs Pituitary adenoma

A

craniopharyngioma in young/adolescent

824
Q

Non communicating hydrocephalus

A

pinealoma/ pineal gland tumour

825
Q

Lichen sclerosus treatment

A

topical tacrolimus

826
Q

Staph aureus valve infection findings

A

gram positive coccus
catalase +ve
coagulase -ve

827
Q

Lacrimal gland nerve supply

A

Intermediate nerve (facial nerve portion)

828
Q

Tx of hypersalivation in clozapine treatment

A

Hyoscine
Pirenzipine
Benzhexol

829
Q

Gastroschisis

A

no sac
c section
immediate (<4h) surgery

830
Q

Omphalocele

A

related to other conditions (trisomy 13, 18, 21, turner syndrome)
sac
vaginal delivery
staged surgical repair

831
Q

Carbuncle

A

subcutaneous pus collection discharging via multiple sinuses

Staphylococcal infection

832
Q

Furuncle

A

Perifollicular (around hair root) abscess caused by Staphylococcus aureus

833
Q

Beta blockers SE in pregnancy

A

Fetal growth restriction
Hypoglycaemia in the neonate
Bradycardia in the neonate

834
Q

ACE inhibitors and ARBs SEs in pregnancy

A

Oligohydroamnios

Hypocalvaria

835
Q

Opiates SE in pregnancy

A

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

836
Q

Lithium SE in pregnancy

A

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

837
Q

SSRI

A

paroxetine - strong link with congenital malformation
1st trimester - congenital heart defects
3rd trimester - PPH

838
Q

Rubella in pregnancy

A

congenital rubella - infection before <20weeks gestation

  • Congenital deafness, cataracts
  • PDA and pulmonary stenosis
  • Learning disability
839
Q

Chickenpox in pregnancy

A

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

840
Q

Listeria in pregnancy

A

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

841
Q

CMV in pregnancy

A

congenital CMV:

  • growth restriction
  • vision and hearing loss
  • microcephaly
  • learning disability
  • seizures
842
Q

Congenital toxoplasmosis

A

intracranial calcification
hydrocephalus
chorioretinitis

843
Q

Parvovirus infection in pregnancy complications

A

5th disease/slapped cheek/ erythrema infectiosum

  • fetal anaemia
  • hydrops fetalis (foetal heart failure)
  • miscarriage or foetal death
844
Q

Zika virus in pregnancy

A

spread by Aedes mosquitos
congenital zika syndrome: microcephaly, foetal growth restriction, ventriculomegaly and cerebellar atrophy
test with PCR and antibodies

845
Q

Anti D injections (when)

A

28 and 34 (or 28 and birth)

+ sensitisation: antepartum haemorrhage, amniocentesis, abdo trauma

846
Q

When is Anti D given in sensitisation event

A

72h post event

Kleinhauer test determines if further doses are required

847
Q

Small for gestational age

A

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

848
Q

Severe small for gestational age

A

<3rd centile for gestational age

849
Q

Low birth weight

A

<2500g

850
Q

Complications of foetal growth restriction

A

Fetal death
Birth asphyxia
neonatal hypothermia/ hypoglycaemia

851
Q

SGA risk factors

A 
Old mother <35yo
Multiple pregnancy
low PAPPA
Obesity
Smoking
Diabetes
HTN
pre-exlampsia
852
Q

Tx for SGA?

A

Early delivery +corticosteroids

853
Q

Large for gestational age

A

=macrosomia
>4.5kg
estimated fetal weight >90th centile

854
Q

Causes of macrosomia

A 
Maternal diabetes (Gestational diabetes)
maternal obesity
overdue
male bebo
previous macrosomia
855
Q

LGA risks

A 
Shoulder dystocia !!!
peineal tears
neonatal hypoglycaemia
clavicular facture/erb palsy/ birth injury
PPH, uterine rupture
856
Q

PID treatment

A

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

857
Q

Dichorionic diamniotic

A

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

858
Q

Monochorionic diamniotic

A

membrane between the twins, with a T sign

859
Q

Monochorionic monoamniotic

A

no membrane separating the twins

860
Q

Lambda sign

A
  • twin peak sign

membrane between twins meets the placents (dichorionic pregnancy)

861
Q

T sign

A

membrane between twins abruptly meets chorion (monochorionic pregnancy)

862
Q

twin to twin transfusion syndrome

A
  • laser treatment to destroy connection between blood supplies
    receipient foetus receives majority of blood, donor foetus is starved of blood.
    Receipient: HF, polyhydramnios
    Donor: anaemia, growth restriction, oligohydromnios
863
Q

Prengnacy checks for anaemia

A

FBC at
Booking clinic
20 weeks gestation
28 weeks gestation

864
Q

Additional US in multiple pregnancy

A

2 weekly scans from 16 weeks for monochorionic twins

4 weekly scans from 20 weeks for dichorionic twins

865
Q

Monoamniotic twins birth

A

elective caesarean section at between 32 and 33 + 6 weeks

866
Q

Diamniotic twins birth

A

37 and 37 + 6 weeks
Vaginal delivery if 1st bebo is cephalic
C section
Elective c section when 1st bebo not cephalic

867
Q

urine dipstick nitrites and leukocytes

A

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

868
Q

UTI causing organisms

A

E Coli (gram-ve, anaerobic, rod-shaped), found in faeces
Klebsiella pneumoniae (gram-ve anaerobic rod)
Candida albicans
Staph saprophyticus
Pseudomonas auerginosa
Enterococcus

869
Q

Physiological changes in pregnancy

A

Plasma volume increases (reduced Hb concentration)

870
Q

Low MCV

A

iron deficiency

871
Q

Raised MCV

A

B12, Folate deficiency

872
Q

HB screening in pregnancy

A

Thalassaemia - all women tested

Sickle cell disease - women at high risk

873
Q

Tx options for B12

A

Intramuscular hydroxocobalamin injections

Oral cyanocobalamin tablets

874
Q

VTE risk factors in pregnancy

A 
Smoking
Parity ≥ 3
Age > 35 years
BMI > 30
Reduced mobility
Multiple pregnancy
Pre-eclampsia
Gross varicose veins
Immobility
Family history of VTE
Thrombophilia
IVF pregnancy
875
Q

VTE prophylaxis in pregnancy

A

28 weeks if there are three risk factors

First trimester if there are four or more of these risk factors

876
Q

LMWH examples

A

enoxaparin
dalteparin
tinzaparin

877
Q

PE ix

A

chest X ray
ECG
CTPA in abnormal xray or VQ
CTPA-breast cancer risk, VQ childhood cancer

878
Q

DVT ix

A

doppler ultrasound

879
Q

Massive PE treatment

A

UnfrActioned heparin

surgical embolectomy

880
Q

Pre-eclampsiatriad

A

Hypertension
Proteinuria
Oedema

881
Q

RF for preeclampsia and tx

A

Tx, aspirin from 12 weeks until birth

Pre-existing hypertension
Previous hypertension in pregnancy
Diabetes
Chronic kidney disease
Older than 40
BMI > 35
More than 10 years since previous pregnancy
Multiple pregnancy
First pregnancy
Family history of pre-eclampsia
882
Q

pre eclampsia diagnosis

A

SBP above 140 mmHg
DBP above 90 mmHg
PLUS any of:

Proteinuria
Organ dysfunction
Placental dysfunction

883
Q

proteinuria quantification

A

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

884
Q

HELLP

A

Heamolysis
Eleveated Liver enzymes
Low Platelets

885
Q

Pre eclampsia tx

A

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

886
Q

Gestational diabetes treatment

A

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

887
Q

Alternative for metformin in pregnancy

A

Glibenclamide (sylfonylurea)

888
Q

target sugar levels in pregnancy

A

Fasting: 5.3 mmol/l
1 hour post-meal: 7.8 mmol/l
2 hours post-meal: 6.4 mmol/l

889
Q

Sliding scale insulin

A

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

890
Q

Pre existing diabetes delivery

A

Planned beterrn 37 and 38+6

891
Q

Babies of mothers with diabetes rf

A 
Neonatal hypoglycaemia
Polycythaemia (raised haemoglobin)
Jaundice (raised bilirubin)
Congenital heart disease
Cardiomyopathy
892
Q

Neonatal hypoglycaemia

A

aim for sugar >2mmol/L,

if below: IV dextrose or nasogastric feeding

893
Q

Obstetric cholestasis

A 
Itching (palms and soles)
Fatigue
Dark urine
Pale, greasy stools
Jaundice
894
Q

Rashes in pregnancy

A

Pemphigoid getationis - includes bellybutton

Polymorphic erupion - tam gdzie majtki / stretch marks

895
Q

Obstetric cholestasis bloods

A

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

896
Q

Tx for obstetric cholestasis

A

Ursodeoxycholic acid,
Emollients/calamine lotion
Antihistamine (chlorphenamine)

897
Q

Acute fatty liver of pregnancy symptoms

A 
General malaise and fatigue
Nausea and vomiting
Jaundice
Abdominal pain
(lack of appetite)
Ascites !!!
898
Q

Acute fatty liver of pregnancy bloods and tx

A

Raised bilirubin
Raised WBC count
Deranged clotting (raised prothrombin time and INR)
Low platelets

tx delivery of bebo

899
Q

Polymorphic eruoption of pregnancy

A

Also / pruritic and utricarial papules and plaques of pregnancy

tx emollients, steroids, antihistamines

900
Q

Placenta praevia

A

placenta over the internal cervical os

- risk of antepartum haemorrhage

901
Q

Low lying placenta

A

20mm from internal cervical os

902
Q

foetal vessels

A

umbilical arteries x2

umbilical vein x1

903
Q

placenta praevia vs vasa praevia risk

A

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

904
Q

vasa previa

A

Foetal vessels exposed outside the umbilical cord or placenta

905
Q

vasa praevia types

A
906
Q

Superficial placenta accreta

A

Placenta implants in surface of myometrium

907
Q

Placenta increta

A

Placenta attaches deeply into myometrium

908
Q

Placenta percreta

A

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

909
Q

How to assess depth/width of placental invasion?

A

MRI scans

910
Q

Delivery in placenta accreta

A

Delivery 35-36+6
Hysterectomy
Uterus preserving surgery

911
Q

breech types

A
912
Q

ECV

A

50% successful
nulliparous: ECV if breech >36w
multiparous: ECV if breech >37w
Tocolysis with SC terbutaline (beta agonist) + anti D

913
Q

Major causes of cardiac arrest in pregnancy

A

Obstetric haemorrhage
PE
Sepsis (metabolic acidosis and septic shock)

914
Q

signs of labour

A

Show (mucus plug from the cervix)
Rupture of membranes
Regular, painful contractions
Dilating cervix on examination

915
Q

phases of birth

A

latent: 0-3cm, 0.5cm/h
active: 3-7cm, 1cm/h
transition: 7-10cm 1cm/h

916
Q

Preterm prelabour rupture of membranes (P‑PROM)

A

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

917
Q

Prolonged rupture of membranes (also PROM)

A

amniotic sac ruptures more than 18 hours before delivery

918
Q

Prematurity and classes

A

Birth before 37w

Under 28 weeks: extreme preterm
28 – 32 weeks: very preterm
32 – 37 weeks: moderate to late preterm

919
Q

Diagnosis of PPROM

A

ILGFBP-1: high concentrations in amniotic fluid

PAMG-1: alternative

920
Q

Mx of PPROM

A

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

921
Q

Preterm labour with intact membranes

A

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

922
Q

Antenatal steroids regime

A

2 doses of IM bethametasone 24h apart

923
Q

Main complication of induction of labour

A

due to vaginal prostaglanding

  • -> uterine hyperstimulation
  • Individual uterine contractions lasting more than 2 minutes in duration
  • More than five uterine contractions every 10 minutes

It leads to: foetal hypoxia, uterine rupture, emergency C section

924
Q

Mx of uterine hyperstimulation

A

Stopping oxytocin
vaginal prostaglandins
Tocolysis with terbutaline

925
Q

IOL options

A

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

926
Q

Baseline rate of CTG

A

110-160 normal

abnormal <100, >180

927
Q

Variability in CTG

A

5-25 Normal

<5 for 50 min or >25 for 25min

928
Q

Prolonged decelerations

A

2-10 min
drop of >15bpm from baseline
means: foetal hypoxia

929
Q

Oxytocin in labour

A

syntocinon - oxytocin

atosiban - oxytocin receptor antagonist (- used for tocolysis

930
Q

Ergometrine

A

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

931
Q

Pain relief in labour

A 
Paracetamol and codeine
Gas and air (entonox)
IM pethidine/Diamorphine 
Pt controlled analgesia: Remifentanil
Epidural (levobupivacaine or bupivacaine mixed with fentanyl)
932
Q

Maternal infection in instrumental delivery mx

A

Single dose of co-amoxiclav

933
Q

Instrumental delivery risks for baby

A

Cephalohematoma (ventouse)

facial nerve palsy (forceps)

934
Q

Instrumental delivery risks for mother

A 
femoral nerve (anterior thigh weakness, knee extension weakness, patella reflex loss)
obturator nerve (hip adduction and rotation loss, numbness of medial thigh)
935
Q

Lateral cutenous nerve injury

A

numbness of anterolateral thigh

936
Q

lumbosacral plexus injury

A

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

937
Q

common peroneal nerve injury

A

foot drop

938
Q

Classification of perineal tears

A

1st – injury limited to the frenulum of the labia minora
2nd – perineal muscles, but not the anal sphincter
3rd – the anal sphincter, but not the rectal mucosa
4th– the rectal mucosa

939
Q

3rd degree tear subcategories

A

3A - <50% external anal sphincter
3B - >50% external anal spincter
3C - external and internal anal sphincters affected

940
Q

Antibiotics in sepsis 6

A

piperacillin and tazobactam (tazocin), gentamicin,

amoxicillin, clindamycin and gentamicin.

941
Q

Mastitis treatment

A

flucloxacillin

infection with staph aureus

942
Q

Candida of the nipple

A 
topical miconazole (2% after breastfeed)
Treatment for the babcy (miconazole gel or nystatin)
943
Q

Sheehan’s syndrome

A

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

944
Q

posterior pituitary hormones

A

ADH

oxytocin

945
Q

Sheehan’s syndrome presentation

A

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

946
Q

Tx of Sheehan’s syndrome

A

Oestrogen and progesterone
Hydrocortisone for adrenal insufficiency
Levothyroxine
Growth hormone

947
Q

GBS prophylaxis

A

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

Benzylpenicillin

948
Q

Serum progesterone in infertility

A

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

949
Q

EllaOne

A

Ullipristal acetate

950
Q

Urge incontinence

A

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

951
Q

Stress incontinence

A

Pelvic floor training
Tape procedure
Duloxetine (Contraction of urethral sphincter)

952
Q

Ullipristal acetate (EllaOne)

A

120h
Do not give to asthmatics
No breastfeeding for 7days
Return to hormonal contraception after 5d

953
Q

COCP postpartum

A

Contraindicated in <6 weeks post Partum

954
Q

HRT SEs

A

Nausea
Breast tenderness
Fluid retention
Weight gain

955
Q

HRT complications

A

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

956
Q

Diagnostic tests for Downs

A

<13w chorionic villous sampling

>15w amniocentesis

957
Q

Endometriosis tx

A

NSAIDs
COCP
Or GnRH

958
Q

1* PPH

A

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

959
Q

Pregnancy and VTE

A

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

960
Q

Epilepsy in pregnancy drug

A

Lamotrigine

961
Q

Mucinous cystadenoma

A

If ruptured, causes pseudomyoxoma peritonei

962
Q

Meig’s syndrome

A

Benign ovarian tumour
Ascites
Plural effusion
Causes FIBROMA

963
Q

Dermoid cyst

A

Most Common benigh ovarian tumour <25

964
Q

Follicular cyst

A

Most Common cause of ovarian enlargment

965
Q

Ovarian cancer RF

A 
Many ovulations
Early menarche
Late menopause
Nullparity
Increased risk with all HRT
966
Q

Drugs causing folate deficiency

A

Pnenytoin

Methrotrexate

967
Q

Misoprostol mode of action

A

Strong myometrial contractions causing tissue expulsion

968
Q

Mifepristone mode of action

A

Thins uterine lining

969
Q

Endometrial cancer rf

A 
(Frail elderly - progesterone therapy) 
Risk factors: periods increase risk of ovulations
- nullparity
- early menarche
- late menopause
- unopposed oestrogen
- obesity
970
Q

Magnesium sulphate and eclampsia tx

A

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

971
Q

Injectable (progesterone only) contraception

A

Do not give >50 as reduces bone density

972
Q

Congenital rubella syndrome

A 
<16w infection 
Sensorineural deafness
Congenital cataracts
Congenital Heart disease 
Salt and pepper chorioretinitis
973
Q

Semen analysis

A

Min 3 days and Max 5 days abstinence
Sample delivered within 1h

Volume >1,5ml
pH >7.2
15mln/ml concentration

974
Q

Hep B in mother, bebo management:

A

Hep B vaxx <12h, 1mth, 6mth
Hep B IG 0.5ml <12h
No transmission via breastfeeding

975
Q

Breast cancer

A

Increased risk when progesterone added

Also pregnancy increased risk

976
Q

COCP rf

A

Increased: Breast and cervical cancer
Decreased: ovarian and endometrial

977
Q

Implantable contraceptive

A

Nexplanon or implanon

3y

978
Q

Cervical excitation conditions

A

PID

Ectopic pregnancy

979
Q

Unopposed oestrogen risk

A

Endometrial cancer

980
Q

N&V medication in pregnancy

A

Metoclopramide

Do not use >5d

981
Q

Desogestrel

A

POP

12h Window for taking

982
Q

Hyperechogenic bowel

A

CF
Down’s syndrome
CMV

983
Q

HRT adding progesterone

A

Increased Breast cancer risk

984
Q

Increased nuchal translucency

A

Down’s syndrome
Congenital Heart defect
Abdominal wall defect

985
Q

Hyperemesis gravidarum

A

5% weight loss
Dehydration
Electrolyte imbalabce

986
Q

Progesterone rf

A

Increased risk of Breast cancer and VTE

987
Q

Varicella zoster monitoring

A

IgM - chickenpox now

IgG - chickenpox in the past

988
Q

Drugs to avoid in breastfeeding

A 
Abx (ciprofloxacin, tetracycline, chloramphenicol, sulphonamides)
Lithium
Benzodiazepines
Aspirin
Carbimazole
METHOTREXATE
Sulfonylureas
Cytotoxic drugs
Amiodarone
989
Q

BV diagnostic criteria

A

Thin white discharge
Clue cells
pH <4.5
Whiff test +ve

Fishy grey
Oral metronidazole

990
Q

Trichomonas vaginalis

A 
Yellow green
Offensive 
Strawberry cervix
Vulvovaginitis
Frothy discharge

Oral metronidazole

991
Q

Gonorehoea

A

IM ceftriaxone

992
Q

Felty’s syndrome generic

A

HLA DR4

993
Q

Apgar score

A

1,5,10 min

Pulse, resp effort, colour, tone, reflex

994
Q

CF diet

A

High calorie, High fat diet

To reduce streathorrhoea

995
Q

Meckels diverticulum Scan

A

Techtenium scan

996
Q

<1 BLS

A

15:2

Two thumbs

997
Q

> 1 BLS

A

Lower sternum, 1 hand, 15:2

998
Q

Thelarche

A

1st stage of breast development

999
Q

Adrenarche

A

1st stage of pubic hair development

1000
Q

Scarlet fever symptoms

A

Torso sandpaper rash
Spares soles and palms
Back to School 24h post starting Abx

1001
Q

Impetigo School

A

No School until crusted over

1002
Q

Necrotising enterocolitis signs

A

Rigler sign

Football sign

1003
Q

Kawasaki tx

A

Aspirin, IVIG

1004
Q

Viral ilness + purpura

A

Idiopathic thrombocytopenic purpura

1005
Q

Newborn Hearing tests

A

Otoacoustic emission test

Auditory brainstem response tezt

1006
Q

Dehydration fluids

A

Maintenance + 50ml/kg over 4h

1007
Q

Fragile X syndrome

A 
X linked dominant 
Elongated face 
Protruding ears
Otitis media
Macrocephaly
Learning difficulty
1008
Q

Vesicoureteric reflux ix

A

Micturating cystourethrogram

1009
Q

Noonan syndrome

A

Webbed neck

Pectus excavatum

1010
Q

Patau syndrome

A

Small eyes

Polydactyly

1011
Q

Asthma paeds tx

A

SABA
SABA + ICS
SABA + ICS + LTRA
SABA + ICS + LABA

1012
Q

Formuła baby allergy

A

1) Extensive hydrolysyed formuła

2) amino acid formuła (CMPA severe)

1013
Q

Congenital diaphragmatic hernja

A

Displaced apex beat + decreased się entry + scaphoid abdomen

1014
Q

Achondroplasia

A 
Short statuę 
AD
short limbs and fingers 
Large head 
Trident hands
1015
Q

Distended abdo + bilious vomiting

A

Intestinal malrotation

1016
Q

Threadworm tx

A

Mebendazole

1017
Q

William syndrome

A 
Elf face
Friendly
Social
Shirt stature
Elongated philtrum
1018
Q

Pyloric stenosis ABG

A

Hypochloremic hypokalemic metabolic alkalosis

1019
Q

Newborn resuscitation

A 
Dry bebo
Assess tone RR HR
5 Inflantom breaths
Reasses
<60bpm 3:1
1020
Q

Whooping cough tx

A

Clarithromycin/azithromycin/erythromycin

No School for 48h on Abx
Or 21 days - if No treatment

1021
Q

Kocher criteria for septic arthritis

A

> 38.5
Can’t weight bear
WBC >12
ESR >40

1022
Q

ADHD drugs

A

Methylphenidate (stunted growth)

Lisdexamohetamine

1023
Q

Girl with haemophilia

A

Turner syndrome

1024
Q

Bebo laxatives

A

Movicol
Movicol + Senna
Senna + Lactulose/Docusate

1025
Q

Nephrotic syndrome

A

Proteinuria 1g/m3
Hypoalbuminaemia <25g/L
Oedema

1026
Q

Shaken baby syndrome

A

Retinal haemoorhage
Subdural hematoma
Encephalopathy

1027
Q

GORD bebo tx

A

2 week alginate therapy

4 week omeprazole trial

1028
Q

Scarlet fever vs Kawasaki

A

Scarlet: phenoxymethylpenicillin and DOES NOT AFFCT CONJUNCTIVA AND LIPS

1029
Q

Triceps reflex

A

C7

Radial nerve

1030
Q

Stills disease

A

Pink rash
Joint Pain
Fever
Increased Serum Ferritin and Leukocytes

Negative RF, ANA

1031
Q

Hip fx staging

A

I stable
II complete, undisplaced
III displaced (AVN)
IV complete disruption of bone (AVN)

1032
Q

Brown sequard syndrome

A

Ipsilateral paralysis and propioception loss

Contralateral Pain and temp

1033
Q

Osteonyelitis in sickle cell

A

Salmonella

1034
Q

Reactive arthritis skin lesions

A

Circinate balanitis

Keratoderma blenorrhagica

1035
Q

Ehlers Danlos syndrome

A 
AD connective tissue 
Increased skin elasticity
Joint hypermobolity 
Aorthic regurg
Pectum excavatum
1036
Q

Biceps attachments

A

Long tendon: glenoid

Short tendon: coracoid

1037
Q

Anti phospholipid syndrome

A 
VTE
foetal loss
Thrombocytopenia
Raised APTT
livedo reticularis
1038
Q

Simmonds triad

A

Test for Achilles rupture
Palpation
Squeeze
Declination at rest

1039
Q

Osteogenesis imperfecta / brittle bone disease

A 
AD
Type 1 collagen abnormality
Blue sclera
Deafness
Normal bloods!!!
1040
Q

Compartment syndrome pressure

A

20mmHg abnormal

40mmHg diagnostic

1041
Q

Methrotrexate and other drugs

A

Do not give with co-trimoxazole or trimethoprin: causes bone marrow surpression

1042
Q

Osteomalacia

A

Raised ALP

Low Ca, PO

1043
Q

Pott’s fx

A

Bimalleolar fx

Eversion foot

1044
Q

Monteggia fx

A

Ulnar fx
FOOSH
Proximal radioulnar joint dislocation

1045
Q

Galeazzi fx

A

Foosh
Distal radioulnar joint
Radial shaft fx

1046
Q

Drugs that induce lupus

A

Isoniazid
Phenytoin
Hydralazine

1047
Q

Mirtazapine

A

NaSSA

increased sedation and appetite

1048
Q

Smoking cessation drug

A

Bupropion

1049
Q

GAD tx

A

1) SSRI
2) SSRI/SNRI
3) Pregabalin

1050
Q

Panic disorder tx

A

CBT or SSRI

End step: clomipramine/imipramine

1051
Q

Othello syndrome

A

Delusional jealousy that partner is unfaithful

1052
Q

Dystonic reactions and tx

A

Torticollis
Dysarthia
Oculogyric crisis
Tx Procyclidine

1053
Q

Adolescent/children SSRI

A

Fluoxetine

1054
Q

New onset psychosis ix

A

CT head

1055
Q

Torticollis

A

Wry neck
Sustained muscle contraction
Neck hyperextension

1056
Q

Oculogyric crisis

A

Upward eye deviation

Clenched jaw

1057
Q

PTSD symptoms

A

> 4 weeks

<4w is Acute stress reaction

Hyperarousal
Re experiencing
Avoidance of reminders
Emotional numbing

1058
Q

Treatment of PTSD

A

Trauma focused CBT
EMDR
Venlafaxine/SSRI/Risperidone

1059
Q

OCD tx

A

CBT

ERP exposure and response prevention

1060
Q

Conversion dislrder

A

Drop arm test

Psych stress manifested as physical symptoms

1061
Q

Dissociative disorder

A

Erasing certain disorders

1062
Q

Tardive dyskinesia tx

A

Tetrabenazine

1063
Q

Flight of ideas

A

Leaps from one topic to another but with link

1064
Q

Knights move thinking

A

No asdociations between ideas

1065
Q

grief stages

A 
Denial
Anger
Bargaining
Depression
Acceptance
1066
Q

Capgras syndrome

A

Pt believe someone significant in life has been replaced by imposter

1067
Q

Fregoli syndrome

A

Pt believes multiple people are one person changing appearance

1068
Q

Circumstantiality vs tangentiality

A

Wonder off but circumstaniality DOES RETURN TO QS/TOPIC

1069
Q

Clang assoc

A

Topics are related by sounding familiar

1070
Q

Clerambault syndrome

A

Delusions someone famous is in love with them

1071
Q

Wernickes

A

Nystagmus
Ophthalmoplegia
Ataxia

1072
Q

Korsakkofs syndrome

A

Confabulation

Anterograde/retrograde amnesia

1073
Q

Paranoid personality

A

Sensitive
Unforgiving
Questions loyalty

1074
Q

Schizoid prrsonality disorder

A

Lack of interest, indifference

Negative symptoms schuzoprenia

1075
Q

Schizotypal

A

Magical weird thinking

1076
Q

Clozapine se

A 
If >48h missed, must be retitrated
Reduce dose if stopped smoking
Reduce seizure threshold
Hypersalivation
Constipation
Agranulocytosis/neurtropemia
1077
Q

Central Vision loss

A

Age related macular degeneration

1078
Q

Peripheral Vision loss

A

Primary open angle glaucoma

1079
Q

Retinal detachment symptoms

A

Peripheral curtain over Vision
Spider webs
Floaters and Flashing lights
Straight lines appear curved

1080
Q

Flashers and floaters

A

Vitreous detachment

1081
Q

Red saturation Vision

A

Vitreous haemorrhage

1082
Q

Red desaturation

A

Optic neuritis

1083
Q

Retinal detachment

A

Flashers and floaters

1084
Q

Acute angle closure glaucoma tx

A

IV acetazolamide

1085
Q

Global aphasia

A

No speech, no comprehension

1086
Q

Conductive aphasia

A

Fluent speech and comprehension
Aware of errors
Poor repetition

1087
Q

MCA Broca’s aphasia

A

No speech but comprehension (expressive)

1088
Q

MCA Wernicke’s area

A

Speech but no comprehension
Receptive
Word salad, neologisms

1089
Q

Normal pressure hydrocephalus

A

Urinary incontinence + gait + dementia

1090
Q

Cushing triad

A

Raised ICP

raised pulse pressure + bradycardia + irregular breath

1091
Q

Brain abscess

A

IV cephalosporin and metronidazole

1092
Q

Anterior circulation infarct

A

Total 3
Partial 2

Unilateral hemiparesis
Homonymous hemianopia
Dysphagia

1093
Q

Otitis externa in diabetics

A

Ciprofloxacin for pseudomonas

1094
Q

Audio gram

A 
1) anything below 20? 
NO normal, YES step 2
2) is there a gap between air and bone?
YES conductive/mixed, NO sensorineural
3) one or both below 20? 
ONE conductive, BOTH mixed
1095
Q

Burns fluids

A

% surface area x weight x 4

1/2 administered in 8h

1096
Q

Curlings ulcer

A

Stress ulcer causing haematmesis

1097
Q

Guttae psoriasis vs Pityriasis rosacea

A

Guttae (strep throat, tear drop rash, 2-3mth resolve)

Pityrasis (resp/viral infection, Herald patch, 6 weeks resolve)

1098
Q

India ink stain

A

Cryptococcus neoformans

in HIV

1099
Q

CMV treatment

A

Gancyclovir or Valgancyclovir

1100
Q

Toxoplasma gondii tx

A

Sulphadiazine and pyrimethamine

Zero to finals Paediatrics Marina (18 decks)

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